摘要:

ObjectiveTo determine the efficacy of a helium-oxygen mixture in children admitted to the pediatric intensive care unit with acute respiratory syncytial virus (RSV) bronchiolitis.DesignRandomized, double-blind, controlled, crossover study and nonrandomized, prospective study.SettingA pediatric intensive care unit in a university hospital.PatientsNonintubated children with signs of acute lower respiratory tract infection and a positive rapid immunoassay for RSV admitted to the pediatric intensive care unit.InterventionsTreatment with either helium-oxygen or air-oxygen was administered in random order for 20 mins. Nonrandomized patients received helium-oxygen as initial therapy.Measurements and Main Resultsor=to6) were initially given helium-oxygen and scored at 20 mins. Mean Clinical Asthma Score was 3.04 (range 1 to 7.5) in the 13 randomized patients and 4.25 (range 1 to 9) in the 18 patients overall. Clinical Asthma Score decreased in the 13 randomized patients (mean 0.46, p < .05) and in the 18 patients overall (mean 1.23, p < .01) during helium-oxygen delivery. In randomized patients with Clinical Asthma Scores of <6 (n = 12), a positive correlation (rs= .72) was observed between the Clinical Asthma Score at baseline and the change in Clinical Asthma Score during helium-oxygen administration (p = .009). Respiratory rate and heart rate decreased during helium-oxygen treatment but were not statistically significant. No complications occurred during helium-oxygen delivery.ConclusionsInhaled helium-oxygen improves the overall respiratory status of children with acute RSV lower respiratory tract infection. In patients with mild-to-moderate bronchiolitis (Clinical Asthma Scores of <6), the beneficial effects of hellum-oxygen were most pronounced in children with the greatest degree of respiratory compromise. (Crit Care Med 1998; 26:1731-1736)

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectivesTo compare pediatric intensive care unit (ICU) mortality risk using models from two distinct time periods; and to discuss the implications of changing mortality risk for severity systems and quality-of-care assessment.Data Sources and SettingConsecutive admissions (n = 10,833) from 16 pediatric ICUs across the United States that participate in the Pediatric Critical Care Study Group were recorded prospectively. Data collection occurred during a 12-mo period beginning in January 1993.MethodsData collection for the development and validation of the original Pediatric Risk of Mortality (PRISM) score occurred from 1980 to 1985. The original PRISM coefficients were used to calculate mortality probabilities in the current data set. Updated estimates of mortality probabilities were calculated, using coefficients from a logistic regression analysis using the original PRISM variable set. Quality-of-care tests were performed using standardized mortality ratios.ResultsRisk of mortality from pediatric ICU admission improved considerably between the two periods. Overall, the reduction in mortality risk averaged 15% (p < .001). Analysis of mortality risk by age indicated a large improvement for younger infants. The mortality risk for infants <1 mo improved by 39% (p < .001). Mortality risk improved by 28% (p < .001) for infants between 1 and 12 mos. Analysis of mortality risk by principal diagnosis indicated substantial improvement in respiratory diseases, including respiratory diseases developing in the perinatal period. The mortality risk for respiratory diseases improved by 45% (p < .001). The improvement in mortality risk substantially deteriorated the calibration of the original PRISM severity system (p < .001). As a result of changing mortality risk, the standardized mortality ratios across the 16 pediatric ICUs demonstrated substantial disparities, depending on the choice of models.ConclusionsThis study documents differences in pediatric ICU risk of mortality over time that are consistent with a general improvement in the quality of pediatric intensive care. Despite continued widespread use of the original PRISM, recent improvements in pediatric ICU quality of care have negated its usefulness for many intended applications, including quality-of-care assessment. (Crit Care Med 1998; 26:1737-1743)

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objectives0.4 [micro sign]g/kg/min in children with status asthmaticus; to describe the clinical findings associated with such therapy, including creatinine phosphokinase-myocardial band isoenzyme (CPK-MB) concentrations, electrocardiographic alterations, and decreased diastolic blood pressure (DBP) with terbutaline usage; and to assess the requirement for epinephrine to counteract the decrease in diastolic blood pressure.DesignA retrospective review of children admitted with status asthmaticus who failed emergency room therapy and required intravenous terbutaline.SettingSan Diego Children's Hospital Pediatric Intensive Care Unit.PatientsEighteen children with status asthmaticus, based on clinical and laboratory criteria, between September 1994 and July 1996.InterventionsEpinephrine was added for below-normal decreases in diastolic blood pressure.Measurements and Main ResultsContinuous monitoring for arrhythmias, ST-segment changes, and DBP values during variations in the dose of intravenous terbutaline, with or without epinephrine. CPK-MB concentrations were determined in 15 of 18 patients.Conclusions2 [micro sign]g/kg/min. There was no mortality. (Crit Care Med 1998; 26:1744-1748)

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo review current knowledge about the effects of vasoactive agents on gastric intramucosal pH (pHi).Data SourcesAll studies involving pHi and vasoactive agents were retrieved from a computerized MEDLINE search from 1980 to 1997. We also reviewed the reference lists of all available review articles and primary studies to identify references not found in the computerized searches.Study SelectionClinical and experimental studies using dopamine, dopexamine, dobutamine, norepinephrine, epinephrine, nitric oxide, N-acetylcysteine, prostaglandins, or pentoxifylline were considered if splanchnic perfusion and/or pHi measurements were utilized.Data ExtractionFrom the selected studies, information was obtained regarding patient population, dosing regimen, duration of study, and effects on splanchnic blood flow (SBF), splanchnic oxygenation, and pHi.Data SynthesisAlthough dopaminergic effects increase SBF, dopamine does not generally increase pHi. Data on the effects of dopexamine on pHi are scarce and inconsistent. Dobutamine can significantly increase SBF and usually increases pHi. In septic patients, norepinephrine seems to increase pHi. Epinephrine may have detrimental effects on gastric perfusion. Prostacyclin seems to increase pHi but data are limited. Insufficient evidence exists to support the beneficial effects of nitric oxide donors or blockers, pentoxifylline, or N-acetylcysteine on pHi.ConclusionsOverall, the effects of vasoactive agents on pHi are unpredictable. Among the catecholamines, dopamine is the least likely, and dobutamine the most likely, to increase pHi. (Crit Care Med 1998;26:1749-1758)

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID