RESUMEN
The effects of total parenteral nutrition (TPN) were studied in nine of 19 patients with intra-aortic balloon pumping TPN (c. 27 kcal/kg/day) was begun 3 hours after the start of pumping. The non-protein caloric source was composed of hypertonic dextrose and fat emulsion (60% and 40%). The nitrogen intake was 1 g/150-200 kcal/day. The ten control patients received 5% dextrose in corresponding volume/hour. Hemodynamic studies were performed before and 24, 48 and 72 hours after the start of counterpulsation. The predicted and the observed resting energy expenditure were recorded in both patient groups during counter-pulsation. Systemic and pulmonary vascular resistance differed significantly between the groups. Cardiac function improved in both groups. In the TPN group the measured resting energy expenditure increased by 33% more than predicted on day 2 and by 56% on day 3 and in the controls the figures were 31% and 40%--all rises significant. Total parenteral nutrition with low fat content thus alters the hemodynamic equilibrium without clinically significant effects in patients undergoing intra-aortic balloon pumping. These patients are hypermetabolic and should receive artificial nutrition as soon as possible.
Asunto(s)
Alimentos Formulados , Hemodinámica/fisiología , Contrapulsador Intraaórtico , Nutrición Parenteral Total , Puente de Arteria Coronaria , Ingestión de Energía , Metabolismo Energético/fisiología , Humanos , Masculino , Persona de Mediana Edad , Cuidados PosoperatoriosRESUMEN
Cardiac arrest usually carries a bleak prognosis when occurring in patients who have undergone open heart surgery. We report two cases where cardiac arrest was not responsive to routine therapies. Doses of epinephrine 5-10 times higher than recommended were able to provide a resolution, and the patients were discharged in a normal neurological state.
Asunto(s)
Reanimación Cardiopulmonar/métodos , Puente de Arteria Coronaria , Epinefrina/administración & dosificación , Paro Cardíaco/tratamiento farmacológico , Complicaciones Posoperatorias/tratamiento farmacológico , Anciano , Reanimación Cardiopulmonar/normas , Protocolos Clínicos/normas , Epinefrina/uso terapéutico , Humanos , Infusiones Intravenosas , Inyecciones Intravenosas , Masculino , Persona de Mediana EdadRESUMEN
The authors describe a patient affected with Behçet's disease who developed, after cardiac surgery, acute clinical manifestations of the syndrome and died of a generalized infection. They also discuss the clinical aspects, the particular clinical course, and the therapy of the disease.