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Biomedical subjects

W S Howland

Publications and source records attributed to W S Howland.

At least 91 records · Page 5Linked to original sources
PubMedDate not supplied

The therapeutic intervention scoring system. An application to acutely ill cancer patients.

The Therapeutic Intervention Scoring System (TISS) has been introduced (Cullen DJ, Civetta JM, Briggs BA, et al: Therapeutic intervention scoring system: A method for quantitative comparison of patient care. Crit Care Med 2:57-60, 1974) at the Massachusetts General Hospital as a means of quantifying the medical and nursing care required by critically ill patients. The method has been instituted in the Intensive Care Unit of Memorial Cancer Center to evaluate its applicability to patients who develop life-threatening complications of their disease or its treatment. This is a preliminary report of the system's use in 55 consecutive patients who averaged 33.4 intervention points per day. This average compares closely with that of postcardiac surgery patients (31.8 points), the group that required the most care of all patients in the initial study. The results indicate the usefulness of this sytem in evaluating severity of illness, predicting survival, and assessing cost benefits. It has proven to be a simple and accurate method of assessment when simple and accurate method of assessment when applied to this patient population, but certain modifications seem warranted and have been suggested herein.

Acute Disease↗
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Hemodynamic pressure variables and stroke index.

The relationships between right atrial mean, pulmonary artery diastolic, mean, and wedge pressures, and stroke index were studied in 100 patients. The various pressures correlated fairly well with one another, but poorly with stroke index. However, this correlation improved when the values of individual patients were analyzed. Infusion of calcium chloride modified the correlation of the various pressures with the stroke index over a short period of time. During anesthesia, when pulmonary vascular resistances, systemic resistances and myocardial contractility were stable, both pulmonary artery mean and wedge pressure correlated significantly with the stroke index.

Anesthesia↗
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Long-term infusion of sodium thiopental: hemodynamic and respiratory effects.

To establish the possible advantages of ultrashort acting barbiturates administered in continuous infusion as the only sedative agent for mechanically ventilated patients, sodium thiopental was given to 30 subjects for periods ranging from 2--14 days. Plasma levels were maintained at approximately 15 microgram/ml, using both laboratory determinations and clinical judgment. This technique proved effective for patients requiring either controlled ventilation or intermittent mandatory ventilation. None of the hemodynamic and respiratory variables studied was significantly altered during the infusion, with the exception of decreased heart rates. In view of these results, the technique is considered both expedient and safe for prolonged sedation of patients requiring ventilatory support.

Clinical Trials as Topic↗
PubMedDate not supplied

Unusual complications during pulmonary artery catheterization.

Two unusual complications, encountered during pulmonary artery catheterization, are described. In both cases the catheter had been introduced percutaneously with the Seldinger technique. Inadvertent entry of the right pleural space occured in one case in which the catheter had been inserted into the internal jugular vein through a low cervical approach. The second complication was separation of the shaft of the introducer from the hub, with consequent risk of embolization. Possible means of preventing and treating these complications are discussed.

Adolescent↗
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Acute life-threatening ventilation-perfusion inequality: an indication for independent lung ventilation.

Although reports of independent lung ventilation are found in the literature more frequently, firm criteria for its use have not yet been established. It is probable that major ventilation-perfusion inequality, especially in cases in which the blood flow is primarily diverted to the less ventilated lung, could sometimes be corrected by this technique. The present report deals with such a case and describes the angiographic studies which convinced us that differential ventilation was necessary. By this means we were able to provide successful treatment for patients who had developed preterminal hypoxemia.

Adult↗
PubMedDate not supplied

Fibrinogen and albumin deficiencies associated with packed red blood cell transfusions.

Fibrinogen content was determined for each of 50 units of citrate-dextrose-phosphate (CPD)-preserved whole blood, packed red blood cells reconstituted with 250 ml. of saline, and packed red cells reconstituted with 250 ml. of purified plasma protein fraction (PPF). The total protein and albumin were measured, by electrophoresis, on each of 10 units of the three varieties of blood. The fibrinogen content of the two types of reconstituted cells was significantly lower than that of whole blood. Although the total protein/albumin content of whole blood and PPF-reconstituted red cells was similar, saline-reconstituted cells were markedly deficient in both total protein and albumin. Low fibrinogen and platelet levels subsequent to transfusion with reconstituted packed red cells can lead to an erroneous diagnosis of disseminated intravascular coagulation. Administration of large quantities of saline-reconstituted packed cells could be an etiologic factor in postoperative interstitial pulmonary edema.

Adult↗
PubMedDate not supplied

Rapid volume expansion in patients with interstitial lung diseases.

Rapid administration of intravascular volume expanders is often necessary during anesthesia. Significant controversy still exists on the relative values of different volume expanders. Fifteen hypoxemic patients (Pao2 less than 70 torr on room air) were studied preoperatively. They were randomized into three groups. One group received 1.5 ml/kg of 25% salt-poor human albumin, a second group, 7 ml/kg of fresh frozen plasma; a third group, 7 ml/kg of 0.9% NaCl in water (normal saline). The infusions were given intravenously and completed in 20 minutes. Changes in hemodynamic pressures and flows, blood chemistries, and oxygen uptake and transport variables were studied. It was concluded that fresh frozen plasma afforded the greatest increase in cardiac output and oxygen availability with the least increase in left ventricular stroke work. Colloid osmotic pressure was more significantly increased by fresh frozen plasma than by salt-poor human albumin. Normal saline caused both a decrease in oxygen availability and colloid osmotic pressure. Pulmonary venous admixture increased to some extent in all patients receiving fresh frozen plasma or normal saline. In three patients, this increase was very marked and accompanied by severe arterial hypoxemia.

Adult↗