Organ donor index: a benchmark for comparing hospital organ donor rates.

Objective: To develop organ donor indices to assess donor rates of individual hospitals.

Design: Data from hospital databases were retrospectively reviewed for patient separation ICD-9-CM codes (i.e.

Continuous renal replacement therapy in critically ill patients: monitoring circuit function.

There is currently no universally accepted method to monitor circuit function or guidelines for circuit replacement during continuous renal replacement therapies (CRRT). The objectives of this study were to diagnose the causes of circuit failure, identify factors responsible for circuit clotting and determine a predictive monitor of circuit function. The CRRT technique used in this study was continuous venovenous haemodialysis (CVVHD).

Intensive care costing methodology: cost benefit analysis of mask continuous positive airway pressure for severe cardiogenic pulmonary oedema.

Costing data for intensive care admissions is important, not only for unit funding, but also for cost outcome analysis of new therapies. This paper presents an intensive care episode costing methodology using the example of a cost-benefit analysis of mask CPAP for severe cardiogenic pulmonary oedema (CPO). This analysis examines the intervention of admitting all patients with severe CPO to the intensive care unit for mask CPAP, compared with the previous practice of admitting only patients failing conventional non-CPAP treatment and requiring mechanical ventilation.

Efficacy of pressure support in compensating for apparatus work.

Breathing through an endotracheal tube, connector, and ventilator demand valve imposes an added load on the respiratory muscles. As respiratory muscle fatigue is thought to be a frequent cause of ventilator dependence, we sought to examine the efficacy of five different ventilators in reducing this imposed work through the application of pressure support ventilation. Using a model of spontaneous breathing, we examined the apparatus work imposed by the Servo 900-C, Puritan Bennett 7200a, Engstrom Erica, Drager EV-A or Hamilton Veolar ventilators, a size 7.

Prospective evaluation of residents and nurses as severity score data collectors.

Objectives: To determine the interobserver reliability of residents and nurses collecting Acute Physiology and Chronic Health Evaluation (APACHE II) data and the subsequent effect of these data collections on individual patient mortality prediction.

Design: In a prospective study, residents and nurses independently collected data to derive APACHE II scores. When their scores differed, a standard score was determined by one of the investigators.

Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask.

Background: Severe cardiogenic pulmonary edema is a frequent cause of respiratory failure, and many patients with this condition require endotracheal intubation and mechanical ventilation. We investigated whether continuous positive airway pressure delivered by means of a face mask had physiologic benefit and would reduce the need for intubation and mechanical ventilation.

Methods: We randomly assigned 39 consecutive patients with respiratory failure due to severe cardiogenic pulmonary edema to receive either oxygen alone or oxygen plus continuous positive airway pressure delivered through a face mask.

Optimizing fresh gas flow and circuit design for the delivery of continuous positive airway pressure.

Objective: To examine the effect of varying circuit design and the fresh gas flow rate on the circuit work imposed by a continuous positive airway pressure (CPAP) circuit.

Design: Circuit work was measured during simulated inspiration (500 mL) with a lung model at inspiratory flow rates (V) of 40, 60, and 80 L/min during the administration of 10 cm H2O CPAP through either a modified Mapleson-A or modified Mapleson-D circuit, both alone and when connected to a face mask (i.e.

Additional work of breathing imposed by endotracheal tubes, breathing circuits, and intensive care ventilators.

A disadvantage of spontaneous breathing through an endotracheal tube (ETT) and connector attached to a breathing circuit and/or ventilator (breathing device) is an increase in the work of breathing. The work of breathing associated with ETT of 6 to 9-mm diameter and eight breathing devices was determined, using a lung simulator to mimic spontaneous inspiration at flow rates of 20 to 100 L/min and a tidal volume of 500 ml, at both zero end-expiratory pressure (ZEEP) and 10 cm H2O continuous positive airway pressure (CPAP). Work associated with the breathing devices alone (WCIR) ranged from -0.

The effect of buprenorphine on the analgesic and respiratory depressant effects of pethidine: a preliminary study.

The effects on respiration and pain perception of giving 0.6 mg buprenorphine alone and of giving the same dose after the administration of pethidine intravenously to achieve a steady-state blood pethidine level (mean blood level 0.29-0.

Relationship of ventilatory depression to steady-state blood pethidine concentrations.

An i.v. infusion regimen was developed to permit rapid attainment of steady-state blood pethidine concentrations (Cpss).

Deaths in intensive care: analysis and prediction.

Analysis of the data relating to the most critically ill (grade IV) patients admitted to the intensive care unit at Flinders Medical Centre in 1977 and 1978 has been carried out. The mortality rate in this group was 37% in 1977, and 32% in 1978. No absolute predictors of outcome were found, indicating the need for early aggressive investigation and management of critically ill patients.

Metabolic and cardiovascular side effects of the beta 2-adrenoceptor agonists salbutamol and rimiterol.

The metabolic and cardiovascular side-effects of intravenous infusions of therapeutic doses of beta 2-adrenoceptor agonists salbutamol and rimiterol have been determined in four healthy male subjects. There were dose-related increases in plasma glucose, renin activity, serum insulin and heart rate, and significant hyperlactataemia and ketonaemia. There were dose-related decreases in plasma potassium, phosphate and corticosteroids and significant hypocalcaemia and hypomagnesaemia.