摘要:

ObjectiveMeasuring outcome in pediatric intensive care is necessary to equate the high cost of treatment with benefits to the patient. Although mortality rates and morbidity are relatively insensitive measures of the benefits of treatment, quality of life measurement gives insight into the long-term outcomes. The aim of this study was to investigate the long-term quality of life outcome of children admitted to a pediatric intensive care unit.DesignProspective survey.SettingA 13-bed pediatric intensive care unit in a university-affiliated, tertiary referral children’s hospital.PatientsPatients were 432 children discharged from the pediatric intensive care unit between May 1992 and April 1994.InterventionsQuality of life was measured by using the Royal Alexandra Hospital for Children Measure of Function. The scale has two components, the first part completed by the clinician after parent interview and the second part completed separately by the parent.Measurements and Main ResultsParents of 432 children were contacted between 3 and 24 months after discharge. Twenty-seven children (6.3%) had died after discharge from the pediatric intensive care unit; 59.3% (256) had scores indicating a normal quality of life, and 32.4% (140) had a fair quality of life with ongoing health, social, or cognitive problems requiring some intervention. Two percent of survivors (nine children) had scores indicating a poor quality of life as they had continued to experience significant or disabling health problems requiring hospitalization or the equivalent. Predictors of poor quality of life included presence of comorbidities, increased length of stay, and a diagnostic category of malignancy. Diagnostic categories of respiratory, trauma, and cardiac dysfunction were associated with a better outcome.ConclusionsOur results indicate that the long-term outcome in terms of quality of life after admission to a pediatric intensive care unit is good or normal for the majority of surviving children. Those children with a poor outcome are likely to have significant comorbidities or a diagnosis of malignancy.

ISSN:1529-7535    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo compare the distribution of an inhaled labeled radioaerosol (diethilenotriaminopenthacetate labeled with technetium-99m) when either oxygen or heliox was used as a gas vehicle of nebulization.DesignRandomized, double-blind, controlled study.SettingNuclear medicine imagining department of tertiary university-affiliated hospital.PatientsTwenty children (5–15 yrs old) with confirmed diagnosis of chronic lower airway obstruction and referred for a ventilatory scintigraphy study.InterventionPatients were randomized to use either the heliox mixture (helium/oxygen, 80:20) or oxygen during the scintigraphy study. The maximal cumulative irradiation absorbed by the lungs and the slope of the curve of the cumulative irradiation incorporated into the lungs over the time were used to compare the groups. Student’st-test, one-way analysis of variance, chi-square test, and Fisher’s exact test were used to compare the groups.Measurements and Main ResultsTen patients were allocated to each group with no differences in demographic data, main diagnosis, and pulmonary function tests. Ninety-five percent of the particles produced by both gases had a diameter <2.4 &mgr;. The heliox group showed a higher slope of the irradiation incorporated curve (p< .05) than the oxygen group. When broken down into groups, these changes were more significant in those patients classified by the pulmonary function tests as having severe lower airway obstruction. They showed higher cumulative lung irradiation (p= .045) and better slope of the irradiation incorporated curve (p= .017) when heliox rather than oxygen was used as a vehicle for the diethilenotriaminopenthacetate labeled with technetium-99m. Nevertheless, in those patients with mild lower airway obstruction, heliox did not show any advantage over oxygen in the distribution the radioaerosol into the lungs.ConclusionRelated to its physical properties, heliox gas seems to have a strong and pronounced effect when used in patients with severe lower airway obstruction. However, in the absence of severe lower airway obstruction, there is no advantage to using heliox instead of oxygen as a vehicle of nebulization.

ISSN:1529-7535    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo evaluate bispectral index technology in critically ill children and compare its performance to standard clinical assessment of sedation level.DesignProspective convenience sample.SettingMultidisciplinary 16-bed pediatric intensive care unit at a large, urban, university-affiliated children’s hospital.PatientsThirty-one pediatric intensive care unit patients requiring mechanical ventilation and sedation.Measurements and Main ResultsIntubated, sedated, pediatric intensive care unit patients were evaluated for their level of sedation by using bispectral index (BIS) and the COMFORT scale twice daily for up to 5 days. The lowest and highest BIS measurements and their corresponding COMFORT scale measurements were selected from each subject. The mean BIS and COMFORT scale measurements were 62.4 ± 2.6 and 18 ± 0.6, respectively; however the individual measurements were only moderately correlated. The BIS values were categorized into very deep (<40), deep (41–60), moderate (61–80), and light (>80) levels of sedation. The corresponding COMFORT scale mean measurements in each category were 15.8 ± 0.6, 16.2 ± 0.6, 18.1 ± 1.3, and 22.3 ± 1.4 (R2= .89).ConclusionsBIS measurements evaluated in clinically relevant ranges compare favorably with a standard assessment of the level of sedation. However, comparisons of BIS and COMFORT scale measurements at isolated moments during a prolonged pediatric intensive care unit course of sedation were less correlated. BIS may be best used to identify and prevent oversedation of patients in the pediatric intensive care unit.

ISSN:1529-7535    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This article describes case studies of five children treated with vasopressin for refractory hypotension. In addition, physiology and pharmacology of vasopressin are reviewed in a comprehensive survey of the literature from 1966 until the present. In all five children, blood pressure increased immediately after vasopressin administration. The preliminary success of vasopressin for hypotension the setting of vasodilatory shock is promising. This limited use of vasopressin in the setting of refractory hypotension in these patients appears to be safe; the appropriate patient population and dose regimen are not yet determined.

ISSN:1529-7535    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectivesThe detection of glucose in tracheal secretions has been used as an indicator of aspiration in mechanically ventilated, tube-fed children. Pepsin detection may be a more specific indicator. We determined the frequency of pepsin and glucose detection in tracheal secretions of mechanically ventilated children and studied the relationships between tracheal secretion pepsin and glucose and clinical evidence of gastroesophageal reflux.DesignProspective observational study.SettingUniversity teaching hospital.PatientsA convenience sample of mechanically ventilated children.InterventionsTracheal secretions were collected at the time of routine endotracheal tube suctioning. Tracheal aspirate glucose concentrations were assessed by using glucose oxidase reagent strips. Tracheal aspirate pepsin was detected by laboratory immunoassay.Measurements and Main ResultsOne hundred tracheal aspirates were collected from 37 children. Pepsin (≥1 &mgr;g/mL) was detected in nine aspirates, and glucose (≥20 mg/dL) was detected in 59 aspirates. Overall, five (13.5%) patients had at least one pepsin-positive aspirate, and 33 (89%) had at least one glucose-positive aspirate. Patients with at least one pepsin-positive aspirate were more likely to have clinical evidence of gastroesophageal reflux than patients with pepsin-negative aspirates (5 of 5 vs. 9 of 32,p< .01, Fisher’s exact test). Tracheal aspirate glucose positivity was unrelated to the administration of tube feedings and gastroesophageal reflux. No relationship between pepsin and glucose positivity was observed.ConclusionsPepsin is detectable in tracheal secretions of mechanically ventilated children at risk for aspiration. Elevated glucose concentrations in tracheal secretions can occur by mechanisms other than aspiration of glucose-rich formula. Pepsin may be a more specific marker for aspiration than glucose.

ISSN:1529-7535    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo investigate whether plasma concentrations of soluble intercellular cell adhesion molecule (ICAM)-1 and L-selectin at 24 hrs of life are related to good or poor response to exogenous surfactant in preterm infants.DesignProspective study of markers of inflammation in circulating blood at 24 hrs of life.SettingLevel III neonatal intensive care unit.PatientsTwenty-nine preterm newborns suffering from severe respiratory distress syndrome (Fio2> 0.4) without signs of infection or fetal acidosis, and 17 healthy preterm newborns of similar gestational age serving as controls.InterventionsInfants with respiratory distress were treated with natural surfactant at 0.3–5 hrs of life. A response to surfactant, defined as a decrease of Fio2>50% within 6 hrs after surfactant, was seen in 21 infants.Measurements and Main ResultsSoluble ICAM-1 and L-selectin concentrations were determined in plasma samples taken at 24 hrs of age. ICAM-1 was elevated (p< .001) in infants who responded poorly to surfactant (median, 392 ng/mL; range, 58.26–4884.24 ng/mL) compared with good responders (20.52 ng/mL, 2.32–138.58 ng/mL) or controls (21.91 ng/mL, 2.61–65.73 ng/mL), without differences between controls and good responders. L-selectin was lower (p= .004) in surfactant-treated infants (4.45 nmol/L, 2.0–10.4 ng/mL) than in controls (6.0/2.35–10.25 nmol/L) without differences between surfactant good and poor responders. However, infants requiring supplemental oxygen at 36 wks of gestational age had reduced L-selectin at 24 hrs of age (3.2/2.0–3.45 vs. 5.0/2.35–10.4 nmol/L,p= .004), whereas there was no difference in ICAM-1.ConclusionsIn preterm infants with respiratory distress, a poor response to surfactant within 6 hrs of administration is associated with elevated circulating ICAM-1 concentrations at 24 hrs of age. Low plasma L-selectin at 24 hrs of age predicts prolonged requirement for supplemental oxygen.

ISSN:1529-7535    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1529-7535    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveSimple, preferably noninvasive measurements of cardiac output are useful in pediatric patients receiving inotropic support. Oxygen saturation in pulmonary artery (Svo2) gives information about oxygen delivery and demand. Many inotropic drugs influence oxygen consumption. When effects on Svo2are studied, after a change in inotropic drug dosage, a change in oxygen consumption needs to be considered to accurately estimate the change in cardiac output. The aim of this investigation was to study whether information on inspired to end-tidal oxygen concentration difference (Fi-eto2) in addition to Svo2would improve estimation of changes in cardiac output.DesignProspective observational study of Fi-eto2, Svo2, and oxygen saturation from central vein (Scvco2) for measurements of circulatory and metabolic effects of changes in dopamine dosage.SettingIntensive care unit in a children’s hospital.PatientsTwenty patients (age 4 days to 98 months) were studied after cardiac surgery.InterventionsDopamine was administered in doses of 5, 10, 0, and 5 &mgr;g·kg−1·min−1, 20 mins on each level.Measurements and Main ResultsCardiac output, measured with thermodilution, oxygen saturation from systemic artery (Sao2), Svo2, and Scvco2were measured at 15 mins on each dopamine dose. Oxygen consumption was calculated by using the Fick equation. Fi-eto2was measured continuously with a paramagnetic oxygen analyzer. Both cardiac output and oxygen consumption were affected by changes in dopamine dosage. Relative changes in cardiac output were poorly correlated to the change in 1/Sa-vo2(r2= .54). Using Fi-eto2improved correlation between changes in cardiac output and changes in Fi-eto2/Sa-vo2(r2= .72). When Svo2was replaced by Scvco2, the correlation between changes in cardiac output and changes in Fi-eto2/Sa-cvco2was only slightly altered (r2= .69).ConclusionsDopamine affects oxygen consumption as well as cardiac output. The accuracy of Svo2-based estimations of changes in cardiac output after dopamine is enhanced if changes in Fi-eto2are also considered. The more easily achievable Scvco2gave equivalent information as Svo2.

ISSN:1529-7535    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveSeveral indexes are used to quantify the severity of hypoxemia, including the arterial to alveolar oxygen ratio (a/APO2), the alveolar-arterial difference P(a−a)o2, the ratio Pao2/Fio2, and the oxygenation index (OI = mean airway pressure × Pao2/Fio2). This study was carried out to test how stable these indexes are when small changes in Fio2are made in ventilated neonates.DesignOpen prospective clinical study.SettingLevel III neonatal intensive care unit of a teaching hospital.PatientsForty studies were performed in 31 clinically stable ventilated neonates (median birth weight, 1450 g; median gestation, 30.6 wks), monitored by transcutaneous Pao2-oxygen saturation (Sao2).InterventionsIf hyper- or hypoxemia without derangements of Paco2or pH were detected in a blood sample taken from an indwelling arterial catheter, Fio2was changed (median change, 0.05; range, −0.3 to 0.25) and another arterial blood sample was obtained 26–83 mins (median, 42) after. The indexes were calculated in the two blood samples, and for each index the changes between baseline and the value after Fio2change were analyzed.Measurements and Main ResultsMedian baseline P(a−a)o2was 211.7 torr, median a/APO2was 0.24, median Pao2/Fio2was 161 torr, and median OI was 6.14. After the Fio2change, the coefficients of variation (sd/mean) were calculated, and they were 27.5%, 23.8%, 24.5%, and 31.6% for P(a−a)o2, a/APO2, Pao2/Fio2, and OI, respectively. Changes in the value of each index were correlated to changes in Fio2, indicating a dependency on Fio2. When data were analyzed as “high Fio2” (approximate Sao295%) vs. “low Fio2” (approximate Sao290%), differences were statistically significant for all indexes except for a/APO2.ConclusionsAll the indexes tested showed a dependency on the value of Fio2: increasing Fio2spuriously made neonates appear less hypoxemic. The a/APO2appeared to perform better than other indexes in this study, with a lower variability and a lower oxygen dependency.

ISSN:1529-7535    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo determine the relationship between cerebrospinal fluid procalcitonin concentration and severe traumatic brain injury in children.DesignProspective, observational clinical study.SettingA multidisciplinary, tertiary-care pediatric intensive care unit.PatientsTwenty-eight patients who required external ventricular drainage for management of severe traumatic brain injury (Glasgow Coma Scale score of <8) and 22 control patients for whom lumbar cerebrospinal fluid evaluation excluded possible meningitis.InterventionsStandard intracranial pressure-directed neurointensive care, including intraventricular catheter placement and continuous cerebrospinal fluid drainage, was used to manage patients with severe traumatic brain injury.Measurements and Main ResultsDemographic data including age, mechanism of injury, time of injury, initial Glasgow Coma Scale score, and outcome were collected. Cerebrospinal fluid procalcitonin concentration was determined by immunoluminometric assay. Initial cerebrospinal fluid procalcitonin concentration (median [range]) in patients with severe traumatic brain injury was increased greater than three-fold vs. controls (0.41 ng/mL [0.15–2.14] vs. 0.12 ng/mL [0.00–0.24],p< .001). Initial cerebrospinal fluid procalcitonin concentration among patients with abusive head trauma (0.31 ng/mL [0.29–0.50]) also was increased vs. controls (p< .05), although this increase was less robust than patients with accidental trauma (0.41 ng/mL [0.15–2.14],p< .001 vs. controls).Additional examination of key demographic and outcome variables with a generalized linear regression model was performed for patients with severe traumatic brain injury. Univariate analysis revealed that both time after injury (p< .01) and abusive head trauma as a mechanism of injury (p< .001) were associated with attenuation of the increased cerebrospinal fluid procalcitonin response after traumatic brain injury.ConclusionCerebrospinal fluid procalcitonin concentration is increased in children after traumatic brain injury. The attenuated increase in cerebrospinal fluid procalcitonin among victims of abusive head trauma warrants further study because it may reflect impairment of endogenous neuroprotective mechanisms or delay in seeking medical attention. The significance of these observations remains to be determined as future studies elucidate the physiologic and mechanistic properties of procalcitonin.

ISSN:1529-7535    

出版商:OVID    

年代:2002

数据来源: OVID