Graziano C. Carlon

Factors influencing postoperative morbidity and mortality in patients treated with bleomycin.

Patients treated with bleomycin are at risk of developing the acute adult respiratory distress syndrome post-operatively. In a prospective study of 12 patients who had received bleomycin preoperatively and were undergoing removal of retroperitoneal lymph nodes or pulmonary metastases several preventive factors were established. These were the use of low concentrations of inspired oxygen during operation and in the immediate postoperative period, careful monitoring of fluid replacement, and restriction of crystalloids in favour of colloids.

Clinical experience with high frequency jet ventilation.

: High frequency jet ventilation (HFJV) has been used in recent years in some forms of respiratory failure, where the presence of barotrauma limited the application of high peak inspiratory pressure. In the present report, the authors describe the clinical experience with 17 patients, who could not be supported with conventional mechanical support and were placed on HFJV. Rates of 100 breath/min, inspiratory/expiratory ratio of 1:2 and cannula size of 1.06--1.62 mm (18--14) gauge were used. Driving pressure required to maintain a PaCO2 of 40--45 torr was 14--45 psig; however, except in 2 patients who developed hemorrhagic tracheitis with subtotal obstruction of both mainstem bronchi, a driving pressure higher than 27 psig was never required, even when PEEP up to 32 cm H2O was used. Of 17 patients treated, 8 survived. In all cases, alveolar ventilation could be maintained within the desired range with high frequency ventilation, even in those patients who eventually died; mechanical support never provided better oxygenation or alveolar ventilation than high frequency ventilation. Hemodynamic function was essentially unchanged with high frequency ventilation; indeed, in three cases, inotropic support with dopamine could be discontinued after initiation of high frequency ventilation.

The seventies evolution in liver surgery for cancer.

During the past decade, one of the major changes in the field of oncology has been in the surgical approach to primary and secondary cancer of the liver. As a result of data and experience gained in liver transplantation programs and with the application of vascular surgical principles, resectability rates have been increased. The present rate of 32% has been achieved with an overall 30‐day operative mortality rate of 9%. More sophisticated intraoperative and postoperative supports have been essential in achieving these results. The median operating time is now 4′3/4 hours in length. Complications are minimal. The median postoperative hospital stay is now 13 days.

Dopamine administration in oliguria and oliguric renal failure.

Oliguric renal failure significantly worsens the prognosis of many critical illnesses, particularly in patients with respiratory failure. In 52 patients, a continuous infusion of dopamine, 1.5–2.5 μg/kgμmin, was administered when creatinine clearance (Cer) fell below 40 ml/ min and urinary output was less than 1 ml/kgμh despite normal intravascular volume. In 18 patients, a continuous infusion of furosemide (3–5 mg/kgμday) was also administered. Daily, two 3-h collections of urine and blood specimens were obtained to determine Ccr, osmolar clearance (Cosm), free water clearance (CHO2) and excreted fraction of filtered sodium (FENa); one collection was made during dopamine infusion and one while the infusion was suspended. Cardiac output and pulmonary venous admixture were also measured. The authors obtained 199 urine collections in 52 patients; considering the aggregate patient population, urinary output increased by 42.3% (30.2 ± 3.45 (SEM) ml/h), on dopamine infusion. Cosm, FENa, and Ccr were also higher on dopamine. CH2O and hemodynamic variables were not altered by dopamine infusion.When patients were stratified on the basis of mechanical veritilatory support, Ccr and furosemide administration, dopamine infusion essentially caused the same changes in the variables studied as described for the aggregate patient population. Diuresis and sodium excretion increased significantly on dopamine even in those patients receiving furosemide infusion.The authors conclude that fluid and osmolar load can be eliminated more effectively in critically ill patients with continuous infusion of 1.5–2.5 μg/kgμmin of dopamine.

The inverse relationship between cost and survival in the critically ill cancer patient.

The enormous cost of intensive multiple organ system support is apparent from patient or third party charges of

High-Frequency Jet Ventilation in Major Airway or Pulmonary Disruption

1500–

Naloxone in septic shock.

2000 per day exclusive of physician fees sampled during a retrospective review of 700 consecutive recent admissions to the Critical Care Facility of Memorial Cancer Center. Mortality rates of 49% for general medical, 54% for lymphoma or leukemia, and 20% for surgery patients suggest the need for a selective admission and discharge policy which concentrates financial and personnel resources on those for whom there remains a reasonable chance of worthwhile palliation, if not cure, of their malignancy.An informal policy of this kind may have contributed to a 10% increase in hospital discharges and a reduction of in-unit mortality from 22–18% when compared to 1035 earlier unselected admissions.A modified version of the classification suggested by the Critical Care Committee of the Massachusetts General Hospital has been adopted for use at this institution. A similar approach by other cancer centers is urged so that predictive indices based on prognosis of the underlying disease as well as physiological status may be developed. Otherwise, cost-benefit analysis by third party payers or government will become an unavoidable, and less satisfactory, alternative.

The toxicity of anticancer drugs

High-frequency jet ventilation is an experimental method of mechanical support, which achieves satisfactory alveolar ventilation and oxygenation at low peak-inspiratory pressures of 5 to 8 cm H2O and low end-expiratory pressures of 3 to 5 cm H2O. This characteristic was used to advantage in 23 patients with cancer, 12 of whom had tracheal or bronchial disruption complicated by pneumonia. Eight patients who could not be supported by conventional means were salvaged. Barotrauma complicated the very high peak airway pressures required to ventilate 8 of 11 patients with respiratory failure associated with diffuse interstitial pneumonia or pulmonary fibrosis. There were only 2 survivors despite temporary normalization of arterial blood gas values in 7 patients. Earlier use of high-frequency jet ventilation in patients with poor compliance may prevent pulmonary disruption in addition to deleterious hemodynamic and systemic effects of conventional high-pressure ventilation. Other applications under study include the role of jet ventilation in resection of the trachea or carina, and in major airway trauma.

Age and utilization of intensive care unit resources of critically ill cancer patients

Abstract Naloxone, 0.3 mg/kg of a 10 mg/ml solution, was administered as a single bolus to patients in septic shock if their systolic blood pressure (BP) was less than 100 mm Hg or MAP less than 70 mm Hg with evidence of renal or cerebral hypoperfusion. Patients with chronic or acute (less than 12 h) administration of narcotics were excluded. Ten patients received naloxone; 5 patients had significant increases in blood pressure; 5 had no response. Maximal response in BP occurred by 15 min, and lasted 45-165 min. Responders could not be separated by nonresponders by analysis of baseline, hemodynamics, or prior steroid therapy; nonresponders were hemodynamically compromised greater than 24 h; responders less than or equal to 8. Two patients in each group were chronically on high-dose steroids and responded to a 2nd smaller dose of naloxone when effects of initial bolus had ended. Naloxone, 0.3 mg/kg, can reverse endorphin-mediated hypotension in acute septic shock in patients who have received chronic steroid therapy.

Evaluation of a closed-tracheal suction system.

A solution to get the problem off, have you found it? Really? What kind of solution do you resolve the problem? From what sources? Well, there are so many questions that we utter every day. No matter how you will get the solution, it will mean better. You can take the reference from some books. And the toxicity of anticancer drugs is one book that we really recommend you to read, to get more solutions in solving this problem.