摘要:

ObjectiveTo report the clinical, laboratory, and radiologic features of children with severe acute respiratory syndrome (SARS) and to examine the difference between the younger and older age groups.DesignRetrospective descriptive cohort study.SettingA regional hospital in Hong Kong.PatientsChildren younger than 18 yrs with SARS.ResultsTwenty-one children were included, with a mean age of 10.7 ± 5.1 yrs. Children with SARS presented with fever, nonproductive cough, malaise, chills, headache, myalgia, and loss of appetite. Examination of the chest showed minimal auscultatory findings. Common laboratory findings included lymphopenia, thrombocytopenia, and mild elevations of activated partial thromboplastin time, alanine transaminase, lactic dehydrogenase, and creatine phosphokinase. Bacteriologic and virologic studies were all negative for common pathogens. Unilateral focal opacity was the commonest finding in chest radiography. High-resolution computerized tomography of the thorax was an early diagnostic tool if the chest radiograph was negative. The clinical course was less severe in comparison with adult patients. However, adolescents (age, ≥12 yrs) resembled adults in their clinical features. When compared with the younger age group, the adolescents had significantly higher temperatures, more constitutional upset, and a greater need for steroid treatment. Children younger than 12 yrs seemed less ill but had more coughing. On the whole, the outcome was favorable.ConclusionSevere acute respiratory syndrome affects children, but the course is less severe. Nevertheless, the disease could have a significant psychosocial impact on children because of the potential seriousness of the disease in their adult family members.

ISSN:1529-7535    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo describe the incidence, location, and factors associated with the development of pressure ulcers in patients cared for in the pediatric intensive care unit (PICU).DesignMultisite prospective cohort study.SettingThree PICUs contained within freestanding children’s hospitals.PatientsA total of 322 patients, 21 days to 8 yrs of age, on bed rest in the PICU for at least 24 hrs without preexisting pressure ulcers or congenital heart disease.InterventionPatients were observed up to three times a week for 2 wks, then once a week until PICU discharge for a median of two observation periods (interquartile range, 1–4), reflecting 877 skin assessments. Skin assessments were independently rated, and data collectors were blinded to the assessments of the others.Measurements and Main ResultsPressure ulcers were staged according to the American National Pressure Ulcer Advisory Panel Consensus Development Conference recommendations. Eighty-six patients (27%) developed 199 pressure ulcers; 139 (70%) were Stage I, 54 (27%) were Stage II, and 6 (3%) were Stage III. Of the 60 Stage II/III pressure ulcers, 19 (32%) involved the head. Stage III pressure ulcers involved the occiput, ear, chest, and coccyx. An additional 27 pressure-related injuries were caused by medical devices. Statistically significant Stage I pressure ulcer predictor variables include the use of mechanical ventilation, mean arterial pressures ≤50 mm Hg, and lower Braden Q scores.ConclusionsPICU patients at risk include those supported on mechanical ventilation, those with hypotension, and those who have low Braden Q scores. This study provides unique benchmark data for the general PICU population from which pediatric interventional studies can be designed to reduce the incidence of pressure ulcers in this vulnerable patient population.

ISSN:1529-7535    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivesTo describe a single center’s experience with the primary use of venovenous cannulation for supporting pediatric acute respiratory failure patients with extracorporeal membrane oxygenation (ECMO).DesignRetrospective chart review of all patients receiving extracorporeal life support at a single institution.SettingPediatric intensive care unit at a tertiary care children’s hospital.PatientsEighty-two patients between the ages of 2 wks and 18 yrs with severe acute respiratory failure.InterventionsECMO for acute respiratory failure.Measurements and Main ResultsFrom January 1991 until April 2002, 82 pediatric patients with acute respiratory failure were cannulated for ECMO support. Median duration of ventilation before ECMO was 5 days (range, 1–17 days). Sixty-eight of these patients (82%) initially were placed on venovenous ECMO. Fourteen patients were initiated and remained on venoarterial support, including six in whom venovenous cannulae could not be placed. One patient was converted from venovenous to venoarterial support due to inadequate oxygenation. Venoarterial patients had significantly greater alveolar-arterial oxygen gradients and lower Pao2/Fio2ratios than venovenous patients (p< .03). Fifty-five of 81 venovenous patients received additional drainage cannulae (46 of 55 with an internal jugular cephalad catheter). Thirty-five percent of venovenous patients and 36% of venoarterial patients required at least one vasopressor infusion at time of cannulation (p= nonsignificant); vasopressor dependence decreased over the course of ECMO in both groups. Median duration on venovenous ECMO for acute hypoxemic respiratory failure was 218 hrs (range, 24–921). Venovenous ECMO survivors remained cannulated for significantly shorter time than nonsurvivors did (median, 212 vs. 350 hrs;p= .04). Sixty-three of 82 ECMO (77%) patients survived to discharge—56 of 68 venovenous ECMO (81%) and nine of 14 venoarterial ECMO (64%).ConclusionsVenovenous ECMO can effectively provide adequate oxygenation for pediatric patients with severe acute respiratory failure receiving ECMO support. Additional cannulae placed at the initiation of venovenous ECMO could be beneficial in achieving flow rates necessary for adequate oxygenation and lung rest.

ISSN:1529-7535    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo investigate whether generation and liberation of bradykinin and histamine contribute to generalized edema formation in pediatric cardiopulmonary bypass surgery.DesignProspective observational study.SettingPediatric heart surgery of a university hospital.PatientsForty-one neonates, infants, and children undergoing cardiopulmonary bypass to correct congenital cardiac anomalies.InterventionsPlasma concentrations of bradykinin and histamine were determined before, during, and after cardiopulmonary bypass. Fluid balance was evaluated by control of fluid intake and output.Measurements and Main ResultsThe susceptibility to generalized edema formation increased significantly (r = −.457;p< .005) with decreasing age. Approximately three times higher plasma concentrations of bradykinin (p< .001) were found at the onset of anesthesia and during the total observation period in patients with a fluid retention of >6% of body weight compared with patients with a lower retention rate. Plasma bradykinin reached significantly (p< .01) higher peak concentrations of 237.9 ± 58.6 fmol/mL during cardiopulmonary bypass and of 227.5 ± 90.7 fmol/mL during the early postoperative period in patients with severe edema formation in contrast to only 86.6 ± 10.9 and 65.5 ± 26.8 fmol/mL in patients with minor fluid retention. A tendency (p= .06) to slightly increasing histamine concentrations from 2.07 ± 0.13 nmol/L at baseline to 3.32 ± 1.41 nmol/L during 90 mins of cardiopulmonary bypass was only observed in patients with high fluid retention.ConclusionsBradykinin seems to be essentially involved in the enhancement of microvascular permeability in pediatric cardiopulmonary bypass surgery, although a dominant causal role cannot be claimed by this study. Histamine, however, doesn’t appear to play a major role and may only contribute as a cofactor. To what extent an increased expression of bradykinin-1 and bradykinin-2 receptors or a reduced potential of bradykinin-degrading enzymes is involved is the object of a further clinical study.

ISSN:1529-7535    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo study the renal effects (measured by creatininemia) of plasma volume expansion with a medium molecular weight hydroxyethyl starch in the newborn.DesignA prospective, randomized, double-blinded, pilot study.PatientsThe study included 26 neonates weighing 690–4030 g (gestational age, 26–40 wks), without cardiac or renal failure or major hemostasis abnormalities and requiring a peripherally inserted central catheter for parenteral nutrition.SettingPediatric and neonatal intensive care unit of a university-affiliated hospital.InterventionsPlasma volume expansion was performed to facilitate insertion of the central catheter. After parental consent, neonates were randomly allocated to receive intravenous infusions at 10 mL·kg−1of 5% albumin or 6% hydroxyethyl starch 200/0.5. Sample size was calculated to detect an increase in mean creatininemia of >20 &mgr;mol·L−1(with &agr; = 0.05, &bgr; = 0.80).Measurements and Main ResultsNo clinically or statistically significant differences were found between the two groups 6 hrs, 24 hrs, 48 hrs, and 7 days after plasma volume expansion. The study could detect an increase in creatininemia ≥20 &mgr;mol·L−1with a power of 80%.ConclusionsIn 13 healthy neonates, plasma volume expansion with 10 mL·kg−1of 6% hydroxyethyl starch 200/0.5 does not increase creatininemia.

ISSN:1529-7535    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo determine whether heart rate variability metrics provide an accurate method of monitoring depth of anesthesia, assessing the response to painful stimuli, and assessing neuroautonomic regulation of cardiac activity in children receiving propofol anesthesia for short-duration procedures.DesignProspective, case series.SettingSixteen-bed pediatric intensive care unit, oncology unit, and endoscopy suite in a tertiary care children’s hospital and ophthalmology examination rooms in an associated eye institute.PatientsThirty-three pediatric patients undergoing propofol anesthesia for short procedures.InterventionsNone.Measurements and Main ResultsHeart rate variability metrics studied included mean, sd, low- and high-frequency power, detrended fluctuation analysis (represented by correlation coefficient, &agr;), and approximate entropy. Compared with the initial anesthetized state, we found increased heart rate sd (3.17 ± 1.31 vs. 7.05 ± 0.26 bpm,p< .0001), heart rate low-frequency power (3.69 ± 0.36 vs. 4.48 ± 0.41 bpm2/Hz,p< .0001), heart rate low-/high-frequency ratio (1.47 ± 0.26 vs. 1.26 ± 0.24,p= .001), and heart rate &agr; (1.12 ± 0.24 vs. 1.35 ± 0.21,p< .0001) during painful procedure. Mean heart rate (105.8 ± 13.4 vs. 101.5 ± 12.4 bpm,p= .005) and heart rate approximate entropy decreased with painful procedure (0.75 ± 0.19 vs. 0.53 + 0.16,p< .001), whereas there was no significant change in heart rate high-frequency power (3.04 ± 0.63 vs. 3.16 ± 0.71 bpm2/Hz,p= .26).ConclusionsWe conclude that power spectral analysis of heart rate variability may be an accurate and clinically useful measure of depth of propofol anesthesia. We speculate that high-frequency heart rate power during propofol anesthesia correlates with depth of anesthesia, whereas low-frequency power allows for assessment of the patient’s sympathetic response to pain.

ISSN:1529-7535    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo determine whether soluble intercellular adhesion molecule (sICAM)-1, a biological marker of alveolar epithelial and lung endothelial injury and alveolar macrophage activation, is elevated in the plasma of pediatric patients with acute lung injury and to examine whether elevated plasma sICAM-1 levels correlate with two clinically relevant outcomes, mortality and the duration of mechanical ventilation.DesignProspective cohort study.SettingPediatric intensive care units at an urban children’s hospital and a tertiary university medical center.PatientsEighty-three pediatric patients with acute lung injury and five intubated controls.InterventionsPlasma sICAM-1 levels were measured on days 1 and 2 of acute lung injury in pediatric patients and on day 1 of mechanical ventilation in control patients.Measurements and Main ResultsPlasma sICAM-1 levels were significantly higher in patients with acute lung injury compared with controls (966 ± 830 vs. 251 ± 168 ng/mL,p< .05). Levels of sICAM-1 were also significantly higher on days 1 and 2 of acute lung injury in nonsurvivors and in patients requiring prolonged duration of mechanical ventilation. Also, plasma sICAM-1 levels >1000 ng/mL had a high specificity for identifying nonsurvivors of acute lung injury.ConclusionsEarly elevation of sICAM-1 in the plasma of pediatric patients with acute lung injury is associated with increased risk of death or prolonged duration of mechanical ventilation.

ISSN:1529-7535    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveThe objective of this study was to obtain data to further define the extent of traumatic brain injury by using S-100B protein and standard noncontrast magnetic resonance imaging with added fluid-attenuated inversion recovery (FLAIR) and gradient echo sequence in children with normal head computed tomography.DesignPilot, single cohort, prospective, clinical diagnostic study.SettingPediatric intensive care and intermediate care unit in a tertiary care children’s hospital.PatientsChildren ages 5–18 yrs who sustained traumatic brain injury, had a negative computed tomography of the brain, and were admitted to hospital were eligible for enrollment.InterventionsTwo blood samples were drawn for S-100B protein analysis: the first (t-1) as soon as possible or close to 6 hrs of injury and the second (t-2) close to 12 hrs from the time of injury. A magnetic resonance image of the brain was obtained within 96 hrs of injury.Measurements and Main ResultsSeven of 17 patients (41%) had positive magnetic resonance image. Of the seven patients with positive magnetic resonance image, 100% (seven of seven) had a positive magnetic resonance image with FLAIR sequence, 85% (six of seven) with axial T2 sequence and 50% (three of six) with gradient echo sequence. There was no statistically significant difference in S-100B protein concentrations in patients with a positive magnetic resonance image (n = 7) and those with a negative magnetic resonance image (n = 10;p= .40 at t-1 andp= .13 at t-2). The concentration of S-100B protein was statistically significantly higher in patients with head and other bodily injury (n = 9) compared with isolated head injury (n = 6;p= .018 at t-1 andp= .025 at t-2). Patients with a positive magnetic resonance image had a lower Glasgow Coma Scale score and longer duration of hospital stay.ConclusionsMagnetic resonance imaging seems to be a useful modality to better define the spectrum of brain injury in children with mild head trauma. The addition of S-100B protein measurement does not seem to be useful in this setting.

ISSN:1529-7535    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveHypertension in pediatric patients after surgical repair of coarctation of the aorta can be difficult to control and may lead to morbidity. The renin-angiotensin system mediates at least part of this hypertension. Enalaprilat, the only intravenous angiotensin-converting enzyme inhibitor, is used to treat hypertension in pediatric patients in other settings. However, its effect on postoperative hypertension during the early postoperative period in patients undergoing surgical repair of coarctation of the aorta is unknown.DesignProspective, randomized, double-blind study.SettingOperating room and the pediatric intensive care unit.PatientsFourteen consecutive pediatric patients between the ages of 1 and 18 yrs scheduled to undergo surgical repair of coarctation of the aorta.InterventionsPatients were randomized to receive enalaprilat or saline placebo. Infusions were begun intraoperatively within 15 mins of aortic repair and repeated every 6 hrs.Measurements and Main ResultsPlasma renin activity was measured at baseline and on postoperative day 1. Blood pressure was determined at 30 mins and at 2, 4, and 6 hrs after infusion and scored relative to the preoperative blood pressure. The blood pressure in the enalaprilat group was consistently lower at 30 mins, 2 hrs, and 4 hrs after infusion (p< .05), but not at 6 hrs. Plasma renin activity was significantly lower in the placebo group on postoperative day 1. Length of stay in the pediatric intensive care unit trended shorter in the treated group.ConclusionsConclusions are limited by a small cohort. Angiotensin-converting enzyme inhibitor therapy resulted in improved blood pressure control after coarctation repair. Further improvement of blood pressure control may be achievable by use of a larger dose of enalaprilat or a 4-hr enalaprilat-dosing interval.

ISSN:1529-7535    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivesTo determine the current mortality rates for pediatric patients with septic shock and the frequency and outcome of associated multiple organ system failure.DesignRetrospective chart review.SettingMultidisciplinary pediatric intensive care unit.PatientsChildren age 1 month to 21 yrs admitted to the pediatric intensive care unit from January 1, 1998, to December 31, 1999, with a diagnosis of septic shock.InterventionsNone.Measurements and Main ResultsA database of all admissions to the pediatric intensive care unit was queried, and cases with diagnoses of sepsis and septic shock were reviewed. The final study cohort consisted of 96 episodes of septic shock in 80 patients. Septic shock was defined as a clinical suspicion of sepsis manifested by hyperthermia or hypothermia accompanied by hypotension and/or alteration in perfusion. Multiple organ system failure was defined by established criteria. Data were analyzed by using Fisher’s exact test. The overall mortality rate for the study cohort was 13.5%. There were differences in case mortality rates between patients requiring one inotropic agent (0%) and patients requiring multiple inotropic agents (42.9%), between oncology patients who had undergone bone marrow transplantation (38.5%) and oncology patients without bone marrow transplantation (5.5%), and between patients with multiple organ system failure (18.6%) and those without multiple organ system failure (0%);p< .05. There did not appear to be differences in the case mortality rates between oncology and nononcology patients or among patients with varying degrees of neutropenia.ConclusionsThe mortality rate in pediatric septic shock is lower than has been previously reported. Oncologic illness in the absence of bone marrow transplantation does not appear to be associated with an increased mortality rate in children with septic shock. Bone marrow transplantation patients have an increased mortality rate compared with other patients with septic shock. Mortality from septic shock occurs most frequently in the context of multiple organ system failure.

ISSN:1529-7535    

出版商:OVID    

年代:2003

数据来源: OVID