Infection prevention in patients with severe multiple trauma with the immunomodulator beta 1-3 polyglucose (glucan).

In a effect to prevent nosocomial pneumonia and sepsis, we treated patients with severe multiple trauma with an immunomodulator--beta 1-3 polyglucose (glucan). Forty-one patients with no infection at admission were stratified using Trauma Score and included in a randomized double-blind controlled trial. They were divided into a control group (n = 20) and a glucan group (n = 21). Pneumonia occurred in 11 of 20 patients in the control group and in two of 21 recipients of glucan (p < 0.01). Sepsis occurred in seven of 20 patients in the control group and in two of 21 patients treated with glucan (p < 0.05). Considering patients with pneumonia and sepsis, a decrease was observed in nosocomial infection from 65.0 to 14.4 percent (p < 0.001). The mortality rate related to infection was 30.0 percent in patients in the control group and 4.8 percent in the group treated with glucan (p < 0.05). The general mortality rate, cerebral deaths excluded, was 42.1 percent in the control group and 23.5 percent in the glucan group.

Acute hemodynamic effects of hypertonic (7.5%) saline infusion in patients with cardiogenic shock due to right ventricular infarction.

The hemodynamic effects, after infusion of 4 ml/kg of hypertonic (7.5%) saline solution (HS), were evaluated in six patients (mean age = 56.6 years) with cardiogenic shock (CS) due to right ventricular infarction (RVI). Basal condition data (mean +/- SEM) were as follows: cardiac index (CI) = 1.9 +/- 0.1 1/min/m2, arterial pressure (AP) = 66.5 +/- 0.9 mmHg, and systemic vascular resistance (SVR) = 31.3 +/- 1.0 mmHg/1/min/m2. Five- and 240-minute post-HS infusion data (respectively) revealed: CI = 3.3 +/- 0.1* and 2.9 +/- 0.1* 1/min/m2, AP = 87.7 +/- 1.6* and 80.7 +/- 2.2* mmHg, and SVR = 22.5 +/- 0.6* and 24.5 +/- 1.1* mmHg/1/min/m2 (*P less than 0.05 compared to baseline values). These data suggest that small-volume infusion of HS induced an important acute and sustained hemodynamic improvement in these patients with CS due to RVI.

An inexpensive pulmonary artery catheter for pressure measurements and blood sampling.

Inexpensive 5-Fr, single-lumen polyvinyl catheters are light and flexible enough to be floated into the root of the pulmonary artery. True mixed venous blood samples can be obtained rapidly from these catheters, and pressure waves are insignificantly damped. In 36 (84%) of 43 dogs, after the catheter had been surgically introduced via the external jugular vein, its tip was positioned in the root of the pulmonary artery. Twenty hours later, the overall success rate rose to 91%. In 11 (92%) of 12 critically ill human patients the catheter's tip was rapidly placed in the root of the pulmonary artery after the catheter had been introduced percutaneously via the subclavian vein. Only 2 patients and 2 dogs exhibited ventricular extrasystoles.

Hemodiluiçâo com dextran durante infarto agudo experimental do miocárdio: aumento do fluxo na área isquêmica / Hemodilution with dextran during experimental acute myocardial infarction: increase of the flow in the schemic area

Foram estudados os efeitos hemodinamicos sistemicos e regionais da hemodiluicao com solucao de Dextran-40 durante oclusao coronaria aguda experimental.Observou-se reducao da resistencia vascular sistemica por queda da viscosidade sanguinea e elevacao do debito cardiaco, sem alteracoes significativa da frequencia cardiaca e da pressao arterial. No miocardio isquemico, houve aumento do fluxo pela circulacao colateral, sem modificacao em sua oxigenacao residual. O grau de isquemia permaneceu inalterado,avaliado por mapaeamento eletrocardiografico epicardico. Os autores concluem que hemodiluicao com solucao de Dextran-40 melhora a funcao de bomba do coracao e concomitantemente aumenta a perfusao da area isquemica, sem aumentar o grau de isquemia, no modelo experimental utilizad