ISSN:1529-7535    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1529-7535    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo present a state-of-the-art review of mechanisms of secondary injury in the evolution of damage after severe traumatic brain injury in infants and children.Data SourcesWe reviewed 152 peer-reviewed publications, 15 abstracts and proceedings, and other material relevant to the study of biochemical, cellular, and molecular mechanisms of damage in traumatic brain injury. Clinical studies of severe traumatic brain injury in infants and children were the focus, but reports in experimental models in immature animals were also considered. Results from both clinical studies in adults and models of traumatic brain injury in adult animals were presented for comparison.Data SynthesisCategories of mechanisms defined were those associated with ischemia, excitotoxicity, energy failure, and resultant cell death cascades; secondary cerebral swelling; axonal injury; and inflammation and regeneration.ConclusionsA constellation of mediators of secondary damage, endogenous neuroprotection, repair, and regeneration are set into motion in the brain after severe traumatic injury. The quantitative contribution of each mediator to outcome, the interplay between these mediators, and the integration of these mechanistic findings with novel imaging methods, bedside physiology, outcome assessment, and therapeutic intervention remain an important target for future research.

ISSN:1529-7535    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Scoring systems and risk prediction rules quantitate the severity of clinical conditions and stratify patients according to a specified outcome. In intensive care medicine, the complexity and number of clinical scoring systems is increasing as their utility in both health services research and clinical medicine broadens. We anticipate that with increasing healthcare costs and competition, the demand for risk adjusted outcomes and institutional benchmarking will increase. As academicians and clinicians, it is vital to be knowledgeable regarding the methodologies and applications of these scoring and risk prediction systems to ensure their quality and appropriate utilization.

ISSN:1529-7535    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveUnsuccessful extubation from mechanical ventilation increases mortality and morbidity. Therefore, the identification of an accurate predictor of successful extubation is desirable. This study was designed to determine whether the results of easily performed respiratory measurements, particularly if reported as “combined extubation” indices, were better predictors of extubation failure in a pediatric population than were readily available clinical data.DesignProspective observational study.SettingTertiary pediatric intensive care unit.PatientsAll children who required mechanical ventilation for ≥24 hrs during a 12-month period and whose parents gave informed written consent.InterventionsRespiratory function measurements were made (on average) 7 hrs (range, 0.2–25.0 hrs) before extubation. Arterial blood gas results were obtained immediately before extubation. The values of each predictor associated with maximum sensitivity and specificity were determined, and the areas under receiver operator characteristic curves were compared to determine the most accurate predictor of successful extubation.Measurements and Main ResultsA total of 47 children (mean age, 3.90 yrs; range, 0.10–17.3 yrs) were studied; extubation failed in 7. A low tidal volume (<7.5 mL/kg) and a low minute volume (<250 mL/kg) had the highest sensitivities (86% and 71%, respectively) and specificities (61% and 71%, respectively) in predicting extubation failure. The a/A ratio performed least well in predicting extubation failure (area under the receiver operating characteristic curve, 0.51).ConclusionsVolume measurements during pediatric mechanical ventilation may facilitate successful extubation.

ISSN:1529-7535    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo describe improved ventilation during high-frequency oscillatory ventilation when a nitrogen-oxygen gas mixture is replaced by a helium-oxygen gas mixture.DesignCase series.SettingA tertiary pediatric intensive care unit.PatientsFive patients with hypoxemic respiratory failure who developed persistent respiratory acidosis during treatment with high-frequency oscillatory ventilation.InterventionsIntroduction of helium-oxygen into a conventional high-frequency oscillatory ventilation circuit.Measurements and Main ResultsBlood gas values (pH, Pco2, and Po2) were compared in these patients during treatment with high-frequency oscillatory ventilation with nitrogen-oxygen gas flow and then for several hours after a change in treatment to helium-oxygen gas flow. An initial 24% decrease in Pco2was documented, and an ultimate 43% decrease in Pco2was observed. The mechanism for this improved ventilation may be related to improved gas flow properties as well as increased CO2diffusion resulting from helium’s low-mass density. Oxygenation was not adversely affected in any way.ConclusionIn patients with hypoxemic respiratory failure and in whom respiratory acidosis develops during high-frequency oscillatory ventilation, the use of helium-oxygen rather than nitrogen-oxygen may improve ventilation and decrease ventilator-related trauma. Further investigation is needed to validate these findings and to elucidate the mechanisms of improved ventilation.

ISSN:1529-7535    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo evaluate the efficacy of hypoxic gas therapy using nitrogen, where the fraction of inspired oxygen (Fio2) was reduced to <0.21 in patients with univentricular parallel circulation.DesignCase report.SettingA pediatric intensive care unit at a university hospital.PatientsTwo neonatal patients with hypoplastic left heart syndrome admitted to the pediatric intensive care unit preoperatively.InterventionsNitrogen insufflation by using continuous-flow respiratory support.Measurements and Main ResultsWe reduced the Fio2in these patients by giving additional nitrogen to relieve pulmonary overcirculation and systemic hypoperfusion suspected by transcutaneous arterial oxygen saturation >90%, systemic arterial hypotension, and low urine output in the preoperative course. The improvement of systemic hemodynamics concomitant with decreases in transcutaneous arterial oxygen saturation <85% was accomplished by controlling Fio2between 0.14 and 0.18. These infants were able to undergo Norwood’s surgery after several days without complications relating to Fio2reduction.ConclusionHypoxic gas therapy with nitrogen was effective clinically in preventing pulmonary overcirculation in neonatal patients with univentricular and parallel circulation.

ISSN:1529-7535    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo evaluate the efficacy of artificial neural networks in categorizing pediatric trauma patients into four distinct acuity of care groups and in determining the length of stay (LOS) within specific areas of the hospital.DesignUsing historical information from >8,000 pediatric trauma patient records, train and evaluate artificial neural networks to predict the injury severity and LOS for each patient in pediatric intensive care units (PICUs), step-down units, and floor units. Each artificial neural network is evaluated for categorization accuracy and mean absolute error difference on the predicted LOS.SubjectsA total of 10,353 patient records from the National Pediatric Trauma registry, representing all pediatric trauma patients treated at affiliated hospitals from April 1994 through December 1996. Records with incomplete information were eliminated from the study, leaving 8,081 usable patient records.MeasurementsA total of 14 variables are selected from the 81 values present in the National Pediatric Trauma Registry as independent variables for the artificial neural networks. Each neural network produces nine output values: five for categorizing the patient’s injury severity, three for the LOS in the PICU, step-down unit, and floor units, and one for the patient’s total LOS.ResultsA fuzzy ARTMAP neural network accurately categorizes 88% of mortality patients and 58.3% of critical PICU patients. A backpropagation neural network succeeded in predicting the total LOS to within 1 day for 51.4% and the ICU LOS to within 1 day for 70.4% of all evaluated patients.ConclusionInformation available in the first 10 mins of a patient’s presentation at the emergency room can be used by an artificial neural network to predict injury severity and LOS. Artificial neural networks enable more effective resource planning and patient management.

ISSN:1529-7535    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectivePrevious studies demonstrated that the use of a custom-made intraoral acrylic appliance, known as a palatal stabilizing device, prevents palatal groove formation and reduces the frequency rate of accidental extubations in premature, intubated babies. In this study, we compared the effectiveness of a prefabricated palatal device with an acrylic custom-made palatal stabilizing device. Specifically, we compared the stability, fit, and retention of these two devices.DesignRandomized comparative study.SettingClincal trial.PatientsA total of 70 medically stable, premature, intubated babies.InterventionsA total of 70 medically stable, premature, intubated babies randomly received Pala-nate (experimental group, n = 34) or palatal stabilizing device (control group, n = 36).Measurements and Main ResultsDifferences among birth weight, gestational age, and period of intubation of the two groups were statistically nonsignificant atp≤ .05. Although both appliances were effective in the prevention of palatal grooves, the Pala-nate was less retentive, thus requiring greater monitoring, and it was associated with a larger number of accidental extubations. The differences between the two groups were statistically significant atp≤ .05.ConclusionsWe concluded that the custom-made, acrylic, palatal stabilizing device was more stable and more effective in the prevention of spontaneous extubations in premature orally intubated infants.

ISSN:1529-7535    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo describe an often-unrecognized clinical picture of multiple organ failure in hemophagocytic lymphohistiocytic syndrome (HLS).DesignRetrospective chart review.SettingA ten-bed pediatric intensive care unit (PICU) in a tertiary children’s university hospital.PatientsA total of 11 children (age, 5 months to 13 yrs) who fulfilled the criteria for the diagnosis of familial- or infectious-associated hemophagocytic lymphohistiocytosis and who required intensive care support for organ failure.InterventionNone.Main ResultsDuring a 10-yr period, 5,439 children were hospitalized in our PICU. A total of 11 children were diagnosed as suffering with HLS. Of these 11 patients, three (27%) had the familial form and eight had the infectious-associated form. After admission to the PICU, seven patients (63%) were diagnosed as suffering with HLS and each had one or more organ failures (patients 3–7, 9, and 10). All presented with fever, hepatomegaly, and splenomegaly; in addition, all had at least two of the following: anemia, neutropenia, or thrombocytopenia. All 11 had lymphohistiocytic accumulation in bone marrow (n = 10), lymph node (n = 2), lung (n = 2), and/or liver (n = 1). Organ failure was noted most often in the respiratory system (n = 7) attributable to severe, acute respiratory distress syndrome and pleural effusion. Of the 11 patients, six had cardiovascular involvement that manifested as shock in three and as capillary leak syndrome in three. Renal failure occurred in four patients. Of these, two required hemodiafiltration and one required peritoneal dialysis. Liver failure occurred in three and central nervous system involvement and coma in three. Most of the patients required massive therapeutic intervention, including assisted ventilation (n = 6), inotropic support (n = 3), and hemofiltration (n = 3). A total of seven patients (63%) died.ConclusionsHemophagocytic lymphohistiocytic syndrome in the pediatric population may have a dramatic clinical picture, with multiple organ failure as a presenting symptom or early in the disease course, mandating intensive support in the PICU.

ISSN:1529-7535    

出版商:OVID    

年代:2000

数据来源: OVID