Summary
The volumes and pH of gastric aspirates obtained from 110 children (aged 1–14 years) who underwent surgery for trauma were related to the duration of pre‐operative starvation and to the ...interval between food and injury. Aspirates were larger in children fasted for 4–6 hours than in those fasted for up to 10 hours, and were larger in children injured within 2 hours of eating than in those in whom this interval was longer (p < 0.05). However, 19 of 39 children (49%) starved for over 8 hours had an aspirate of more than 0.4 ml/kg. as did five of 16 children (31%) injured 3 or more hours after eating. Thus, a ‘safe’ interval between oral intake and induction cannot be predicted. We conclude that securing the airway by prompt tracheal intubation is the safest way to manage any child who presents for emergency anaesthesia after trauma.
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BFBNIB, FZAB, GIS, IJS, KILJ, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
OBJECTIVE:To evaluate an intravenous meropenem dosage regimen in adult intensive care patients with acute renal failure treated by continuous renal replacement therapy.
DESIGN:A prospective, clinical ...study.
SETTING:General intensive care unit of a university hospital.
PATIENTS:Ten critically ill adult patients being treated with meropenem and receiving continuous veno-venous hemofiltration (hemofiltration rates, 1-2 L/hr) (n = 5) or continuous veno-venous hemodiafiltration (hemofiltration rates, 1-1.5 L/hr; dialysis rates, 1-1.5 L/hr) (n = 5) via a polyacrylonitrile hollow fiber 0.9-m filter.
INTERVENTIONS:Patients received a meropenem dose of 1 g iv every 12 hrs as a 5-min bolus.
MEASUREMENTS AND MAIN RESULTS:Meropenem concentrations were measured by high-performance liquid chromatography in serum taken at timed intervals and in ultrafiltrate/dialysate to determine serum concentration-time profiles, derive pharmacokinetic variable estimates, and determine sieving coefficients and filter clearances. The serum concentrations were examined to see whether they were above the minimum inhibitory concentrations (MICs) for pathogens that may be encountered in intensive care patients. Serum concentrations exceeded 4 mg/L (MIC90 for Pseudomonas aeruginosa) during 67% of the dosage period in all patients. Sub-MIC90 concentrations were obtained in three patients immediately before treatment and in one patient 12 hrs after treatment. Mean (SD) (n = 10) pharmacokinetic variable estimates were as followselimination half-life, 5.16 hrs (1.83 hrs); volume of distribution, 0.35 L/kg (0.10 L/kg); and total clearance, 4.30 L/hr (1.38 L/hr). A sieving coefficient of 0.93 (0.06) (n = 9) indicated free flow across the filter. The fraction cleared by the extracorporeal route was 48% (13%) (n = 9), which is clinically important.
CONCLUSIONS:A meropenem dose of 1 g iv every 12 hrs provides adequate serum concentrations in the majority of patients receiving continuous veno-venous hemofiltration or continuous veno-venous hemofiltration with a 0.9-m polyacrylonitrile filter at combined ultrafiltrate/dialysate flow rates of up to 3 L/hr. A lower dose would not be sufficient for the empirical treatment of potentially life-threatening infections in all patients.
To evaluate the safety of liposomal PGE1 (TLC C-53) in patients with acute respiratory distress syndrome (ARDS), and determine its efficacy in improving oxygenation and reducing ventilator ...dependency.
A multi-centre, randomized, double-blind, placebo-controlled clinical study.
Thirty-one hospitals in six European countries.
One hundred two patients with ARDS.
Patients were randomized in a 2:1 ratio to receive infusions of either the study drug TLC C-53 or placebo. Infusions were given over 60 min every 6 h for 7 days. The dose of study drug started at 0.6 microg/kg per h, rising over 24 h to a maximum dose of 1.8 microg/kg per h.
Seventy patients received the study drug and 32 placebo. Sixty-nine patients (47 treatment, 22 placebo) completed the study protocol. Patients were monitored for changes in the PaO2/FIO2 ratio, changes in lung compliance, time to off-ventilator and 28-day mortality, in addition to basic haematological and haemodynamic parameters. There were no significant differences in demographics and baseline characteristics between the two groups. There were no differences in the time to off-ventilation (16 days with treatment, 16.6 days with placebo, p=0.94) or in 28-day mortality (30% with treatment, 28% with placebo, p=0.78). There was a difference in the time to achieve a PaO2/FIO2 ratio above 300 in favour of TLC C-53 (10.3 versus 26.5 days) but this was not statistically significant (p=0.23).
TLC C-53 was generally well-tolerated but failed to reduce mortality or duration of mechanical ventilation.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
This study examines the interactive effect of two management controls, superstar recognition with and without the inclusion of a strategy signal and performance value statements, on an employee’s net ...learning goal orientation. I predict recognizing superstar employees together with a strategy signal of how a superstar achieves outstanding performance increases peer employees’ net learning goal orientation. I also predict performance value statements moderate the effect of the strategy signal by shifting employee focus from learning to output. I expect this moderation effect has contrasting effects on employees’ net learning goal orientation based on whether it occurs directly or indirectly through peer employees’ expectations about the payoffs for learning. Results of an abstract experiment support that the inclusion of a strategy signal increases the likelihood of a peer employee adopting a net learning goal orientation but only when a performance value statement is also present. Results support that a performance value statement moderates the relation between a strategy signal and a peer employee’s net learning goal orientation by increasing the effect of the strategy signal. Importantly, my study’s findings highlight how performance values can bolster management’s recognition of a superstar with a strategy signal when managers seek to motivate employees to learn to increase productivity.
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