Humanizing the intensive care unit experience in a comprehensive cancer center: A patient- and family-centered improvement study.

Objectives: Improving family-centered outcomes is a priority in oncologic critical care. As part of the Intensive Care Unit (ICU) Patient-Centered Outcomes Research Collaborative, we implemented patient- and family-centered initiatives in a comprehensive cancer center.

Methods: A multidisciplinary team was created to implement the initiatives.

Effects of resistance exercise on plasma, erythrocyte, and urine Zn.

Twelve healthy male volunteers performed two resistance exercise sessions: a moderate resistance (MR) exercise session and a heavy resistance (HR) exercise session. Blood was collected before exercise and 5 min, 30 min, and 24 h after exercise. Urine was collected for 24 h before and 24 h after exercise.

Effects of blast exposure on exercise performance in sheep.

Background: The effects of blast on maximal exercise performance were investigated in sheep that were trained to perform maximal exercise.

Methods And Results: Sheep were fully instrumented for determination of pulmonary and systemic hemodynamics. Blast exposure was administered by using a compressed air driven shock tube that was positioned to primarily produce cardiopulmonary injury.

Cardiopulmonary effects of high-impulse noise exposure.

In high-energy impulse noise environments, the biomechanical coupling process between the external forces and the pathophysiology of cardiopulmonary injury is not well understood. A 12-in-diameter compressed air-driven shock tube with reflector plate was used to induce three levels of pulmonary contusion injury in a large animal model. Twenty-one anesthetized sheep were exposed to the various levels of impulse noise generated by the shock tube, with six additional sheep serving as a control group.

Maximal exercise performance-impairing effects of simulated blast overpressure in sheep.

Lung contusion has been identified as a primary blast injury. These experiments addressed a fundamental and overt endpoint of primary blast injury, incapacitation (performance decrement). Respiration, hemodynamics, and blood gases were measured in sheep undergoing incremental exercise challenge before and 1 h after simulated blast exposure of the thorax.

Exogenous surfactant decreases oxygenation in Escherichia coli endotoxin-treated neonatal piglets.

Abnormalities of pulmonary surfactant function have been described in association with the acute respiratory distress syndrome (ARDS). Because gram-negative sepsis is a common cause of ARDS, we treated neonatal piglets with Escherichia coli endotoxin to create a neonatal ARDS model. We hypothesized that under these conditions administration of exogenous surfactant would improve pulmonary function.

Preservation of pulmonary function in the ventilated neonatal piglet with normal lungs.

Little attention has been focused on the progressive pulmonary deterioration which occurs in mechanically ventilated infants with normal or mildly abnormal lungs. We hypothesized that lung function would deteriorate over a 24-hr period in anesthetized neonatal piglets with normal lungs mechanically ventilated at 2 cm H2O PEEP (2PEEP group). We further hypothesized that an intermittent lung inflation procedure consisting of 15 out of 60 min of increasing lung distention (4, 8, 12 cm H2O PEEP), with the remaining 45 min at 2 cm H2O PEEP (Inflation group) would prevent this deterioration in lung function, similar to piglets mechanically ventilated continuously at 6 cm H2O PEEP (6PEEP).

Continuous negative extrathoracic pressure and positive end-expiratory pressure. A comparative study in Escherichia coli endotoxin-treated neonatal piglets.

Recent clinical studies have suggested that improvement in pulmonary gas exchange with the use of continuous negative extrathoracic pressure (CNEP) in conjunction with intermittent mandatory ventilation (IMV) may be due to increased pulmonary blood flow. Accordingly, we investigated the effects of CNEP vs positive end-expiratory pressure (PEEP) in ventilated neonatal piglets after Escherichia coli endotoxin was administered to induce pulmonary hypertension. Two experimental groups of piglets with six in each, were subjected to three 30-min alternating periods--6 cm H2O CNEP with 6 cm H2O PEEP, beginning 2 h after endotoxin infusion.

Effect of baseline lung compliance on the subsequent response to positive end-expiratory pressure in ventilated piglets with normal lungs.

Objective: To determine the pulmonary function and hemodynamic effects of incremental positive end-expiratory pressure in two groups of normal ventilated newborn piglets with different baseline dynamic lung compliance.

Design: Prospective, controlled, intervention study.

Setting: Animal laboratory.

Continuous negative extrathoracic pressure versus positive end-expiratory pressure in piglets after saline lung lavage.

Recent reports have suggested that substituting continuous negative extrathoracic pressure (CNEP) for positive end-expiratory pressure (PEEP) may result in clinical benefits to infants with pulmonary disease. Other studies have suggested potential hemodynamic advantages. We compared the effects of CNEP and PEEP in 13 mechanically ventilated newborn piglets after acute lung injury induced by saline lavage.

The effects of reversing distending pressure sequences in the neonatal piglet.

We studied different sequences of lung inflation in ventilated newborn piglets with normal lungs in order to determine the effects of sequence, magnitude and duration of distending pressure on pulmonary function, and/or hemodynamics. End-expiratory pressure was varied using a continuous negative extrathoracic pressure (CNEP) device. Three groups of ventilated piglets with normal lungs were exposed to 2 cmH2O increments of CNEP from -2 to -12 cmH2O, and to decrements from -12 to -2 cmH2O, or to only -6 cmH2O.

Relationship of functional residual capacity to various body measurements in normal sheep.

Functional residual capacity (FRC) was determined by nitrogen washout in 55 normal sheep. Data on various external body measurements were collected which included body weight, chest circumference, chest width, body length, height, and sternum length. In addition, data on wet lung weight and wet lung weight/body weight ratio were collected on 10 of the sheep.

Methemoglobinemia induced by a benzocaine-based topically administered anesthetic in eight sheep.

Benzocaine-based anesthetic sprays are commonly used in sheep to anesthetize the nasal passages and glottis before intubation. Sprays containing benzocaine have been identified as causing methemoglobinemia in dogs, cats, and human beings. Diagnosis of benzocaine-induced methemoglobinemia was made in 8 Dorset-Finn ewes exposed to a 2-second burst of (approx 56 to 112 mg of benzocaine) anesthetic spray.

Effects of epinephrine, phenoxybenzamine, and propranolol on maximal exercise in sheep.

The mixed adrenergic agonist, epinephrine (10 micrograms/kg, i.v.), the beta-adrenergic receptor antagonist, propranolol (0.

Evaluation of the operational capabilities of a new extrathoracic negative pressure device for use in newborn infants.

We evaluated the operational capabilities of a new negative pressure incubator from Chelmsford, England prior to its use in our Neonatal Intensive Care Unit (NICU). Successful manufacturer's testing had already been completed. Teams of respiratory therapists and a biomedical engineer evaluated two identical units using 22 criteria, and results were scored on a pass/fail basis.

Urinary desmosine excretion as a marker of lung injury in the adult respiratory distress syndrome.

Desmosine, the intermolecular and intramolecular cross link between the chains of elastin polypeptide, may be useful as a marker of a lung injury in adult respiratory distress syndrome (ARDS). A radioimmunoassay for rabbit antibody developed against desmosine, conjugated to bovine serum albumin, can detect as little as 100 pg of desmosine in plasma or urine. Desmosine is not metabolically absorbed, reused, or catabolized by the body, but rather eliminated unchanged in the urine as low molecular weight peptides.

Effects of conditioning and maximal incremental exercise on oxygen consumption in sheep.

To assess the suitability of sheep for exercise studies, the effect of incremental exercise and conditioning on oxygen consumption (VO2) was studied. Six sheep were adapted to a treadmill and subsequently trained 8 weeks. The sheep were then studied, in random order, using 3 incremental exercise protocols (EX-1, EX-2, and EX-3).

Prediction of carbon monoxide diffusing capacity of the lung in splenectomized sheep.

The steady state diffusing capacity of the lung for carbon monoxide (DLCO) was studied in 18 splenectomized adult ewes. Seven animals were anemic when studied. Weight (Wt) and, to a lesser extent, hemoglobin (Hb) level were the key predictive variables of DLCO.

Middle ear injury in animals exposed to complex blast waves inside an armored vehicle.

With greater reliance on armored vehicles of improved survivability, questions have arisen about the likelihood of the wounding of vehicle occupants from blast waves alone. In this study, we placed anesthetized animals (sheep or pigs) inside lightly armored vehicles and exposed them to the blast waves generated by one of three sizes of shaped-charge munitions. Sixty-seven animals were exposed and 15 served as controls.

Computer-controlled large-animal pulmonary function system.

Breath by breath determination of lung volume and specific lung conductance is challenging, yet desirable particularly when rapid changes in lung function accompany abrupt changes in lung volume. We have developed a large-animal pulmonary function data acquisition system using two personal computers with custom-made software which continuously tracks breath by breath changes in pulmonary function and lung volume. Accurate measurement of respiratory flow signals is accomplished by collecting separate pneumotachometer-derived expiratory and inspiratory flow signals, correcting them to standard temperature pressure dry (STPD) and summing them into a single flow data array.

A steady state method of measuring carbon monoxide diffusing capacity of the lung of sheep.

A method for measuring the diffusing capacity of the lung for carbon monoxide (DLCO) in sheep was developed. The test's usefulness and reliability was studied in ten, splenectomized adult ewes. Hemoglobin concentration and weight were found to affect sheep DLCO.

Cloth ballistic vest alters response to blast.

Ballistic wounds have been and will remain the principal cause of casualties in combat. Cloth ballistic vests (CBV) play an important role in limiting critical wounds from fragments and small-arms fire. There is an increased risk of primary blast injury on the modern battlefield.

Effect of exercise in sheep on the absorption of intramuscular atropine sulfate.

In normal female sheep, we investigated effects of exercise on the absorption of atropine sulfate (0.02 mg/kg) given intramuscularly. The exercise regime consisted of treadmill running (20 min at 3-4 mph at 0 degrees grade) starting immediately after intramuscular atropine injection into the biceps femoris.

Etiopathogenic mechanisms of bronchoconstriction in byssinois--a review.

Studies of etiopathogenic mechanisms of bronchoconstriction in byssinosis indicate the possible involvement of histamine, 5-HT, platelet-activating factor, and metabolites of arachidonic acid as mediators of bronchoconstriction. These substances might be released by a variety of lung and/or recruited cells to induce construction of respiratory airways characteristic of the acute byssinotic reaction. It certainly seems possible that cotton dust induces acute bronchoconstriction by more than one mechanism and that a number of factors, both endogenous and exogenous, influence the increased bronchomotor response to cotton dust inhalation in any given textile worker.