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  • 1
    Electronic Resource
    Electronic Resource
    Surfactant adjunctive therapy forPneumocystis carinii pneumonitis in an infant with acute lymphoblastic leukaemia (1995)
    Springer
    Intensive care medicine 21 (1995), S. 261-263 
    Details
    ISSN: 1432-1238
    Keywords: Surfactant ; ARDSPneumocystis carinii pneumonitis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report successful treatment of adult respiratory distress syndrome (ARDS) with artificial surfactant (40mg/kg, Colfosceril Palmitate, ‘Exosurf’, Wellcome) in an infant with severePneumocystis carinii pneumonitis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01701485
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  • 2
    Electronic Resource
    Electronic Resource
    Persistent pulmonary hypertension of the term neonate: a strategy for management (1999)
    Springer
    European journal of pediatrics 158 (1999), S. 825-827 
    Details
    ISSN: 1432-1076
    Keywords: Key words Persistent pulmonary hypertension of newborn ; Nitric oxide ; High frequency ventilation ; Extracorporeal membrane oxygenation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The management of 32 consecutive term infants referred with persistent pulmonary hypertension of the newborn were reviewed. Despite indices suggesting severe cardiorespiratory failure with a median alveolar-arterial oxygen gradient of 591 torr (inter-quartile range 432–618) and oxygenation index of 31 (18–44), all but one patient responded to conventional treatment with inhaled nitric oxide and high frequency oscillatory ventilation. Conclusion Patients should be referred early to centres where maximal conventional support can be offered before consideration for extracorporeal membrane oxygenation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310051214
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  • 3
    Electronic Resource
    Electronic Resource
    One hundred courses of high frequency oscillatory ventilation: what have we learned? (2000)
    Springer
    European journal of pediatrics 159 (2000), S. 134-134 
    Details
    ISSN: 1432-1076
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310050033
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Near infrared spectroscopy can detect changes in splanchnic oxygen delivery in neonates during apnoeic episodes (1999)
    Springer
    European journal of pediatrics 158 (1999), S. 173-174 
    Details
    ISSN: 1432-1076
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310051046
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    Protein turnover in critically ill children (1997)
    Springer
    European journal of pediatrics 156 (1997), S. S59 
    Details
    ISSN: 1432-1076
    Keywords: Key words Stable isotope ; Tracer ; Leucine ; Phenylalanine ; Glycine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract There is a paucity of data documenting the metabolic response to catabolic stress in childhood in general and about protein turnover in critically ill children in particular. Despite a high overall morbidity and mortality rate there is little information on which to base decisions to improve the management either by dietary therapy or by use of growth factors. Protein turnover is a key metabolic process that significantly alters during the catabolic state. Protein kinetics are easy to quantify using various stable isotope models, with some having advantages in the critically ill child. The 1-13C leucine technique is the most widely used and best validated model to date, requiring accurate estimation of CO2 production. There is also uncertainty about the bicarbonate kinetics and pool sizes in ventilated children whose respiratory function is severely impaired. The value of the 15N glycine (end product) technique is more limited because the time to achieve isotopic equilibrium is lengthy and considerable concerns about the validity of the model exist. The ring-D5 phenylalanine technique has the advantage of not requiring the measurement of CO2 production or 13C enrichment, but the model has not yet been validated in critically ill children. Despite it is of obvious value to measure protein turnover, few studies in critically ill children have been done.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014273
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  • 6
    Electronic Resource
    Electronic Resource
    Unexpected brainstem compression following routine surgery in a child with oto-palato-digital syndrome (1995)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 50 (1995), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Oto-palato-digital syndrome type 1 is a rare condition with several features of concern to the anaesthetist. We report a patient who developed respiratory depression 5 h after general anaesthesia. This was subsequently found to be due to brainstem compression secondary to congenital deformities of the skull base and cervical vertebrae.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1995.tb15121.x
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  • 7
    Electronic Resource
    Electronic Resource
    Combined lung injury, meningitis and cerebral edema: how permissive can hypercapnia be? (1998)
    Springer
    Intensive care medicine 24 (1998), S. 616-619 
    Details
    ISSN: 1432-1238
    Keywords: Key words Meningococcus ; Meningitis ; ARDS ; Brain edema ; Hypercapnia ; Hyperemia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We describe a patient with combined meningococcal septicemia and meningitis, cerebral edema and acute respiratory distress syndrome, in whom we balanced the conflicting carbon dioxide strategies for optimal pulmonary and neurological management using jugular oxygen saturation (SjvO2) monitoring to identify the upper limit of “tolerable” hypercapnia. Our observations suggest that significant acidosis was not well tolerated; however, cautious induction of pH down to 7.32 and an arterial carbondioxide tension (PaCO2) 〈 5.9 kPa was tolerated acutely without significant cerebral hyperemia. Moreover, with the development of metabolic compensation and normal pH, higher levels of PaCO2 could be permitted. In similar cerebro-pulmonary circumstances we suggest that these findings warrant consideration. Alternatively, invasive monitoring of SjvO2 could be undertaken so that patient-specific criteria for permissive hypercapnia can be determined.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050624
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  • 8
    Electronic Resource
    Electronic Resource
    Acute hypoxemic respiratory failure in children: case mix and the utility of respiratory severity indices (1998)
    Springer
    Intensive care medicine 24 (1998), S. 699-705 
    Details
    ISSN: 1432-1238
    Keywords: Key words Respiratory failure ; Mechanical ventilation ; Lung disease ; Pediatrics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Acute hypoxemic respiratory failure (AHRF) is a common reason for emergency pediatric intensive care. An objective assessment of disease severity from acute physiological parameters would be of value in clinical practice and in the design of clinical trials. We hypothesised that there was a difference in the best early respiratory indices in those who died compared with those who survived. Design: A prospective observational study of 118 consecutive AHRF admissions with data analysis incorporating all blood gases. Setting: A pediatric intensive care unit in a national children's hospital. Interventions: None. Results: Mortality was 26/118, 22 % (95 % confidence interval 18–26 %). There were no significant differences in the best alveolar-arterial oxygen tension gradient (A-aDO2, torr), oxygenation index (OI), ventilation index (VI), or PaO2/FIO2 during the first 2 days of intensive care between the survivors and non-survivors. Only the mean airway pressure (MAP, cm H2O) used for supportive care was significantly different on days 0 and 1 (p K 0.05) with higher pressure being used in non-survivors. Multiple logistic regression analysis did not identify any gas exchange or ventilator parameter independently associated with mortality. Rather, all deaths were associated with coincident pathology or multi-organ system failure, or perceived treatment futility due to pre-existing diagnoses instead of unsupportable respiratory failure. When using previously published predictors of outcome (VI 〉 40 and OI 〉 40; A-aDO2 〉 450 for 24 h; A-aDO2 〉 470 or MAP 〉 23; or A-aDO2 〉 420) the risk of mortality was overestimated significantly in the current population. Conclusion: The original hypothesis was refuted. It appears that the outcome of AHRF in present day pediatric critical care is principally related to the severity of associated pathology and now no longer solely to the severity of respiratory failure. Further studies in larger series are needed to confirm these findings.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050647
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  • 9
    Electronic Resource
    Electronic Resource
    Reply (2000)
    Springer
    Intensive care medicine 26 (2000), S. 149-149 
    Details
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050035
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  • 10
    Electronic Resource
    Electronic Resource
    The cerebral function analysing monitor in paediatric medical intensive care: Applications and limitations (1990)
    Springer
    Intensive care medicine 16 (1990), S. 60-68 
    Details
    ISSN: 1432-1238
    Keywords: CFAM monitoring ; EEG ; Children ; Coma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Practical guidelines for continuous single channel EEG monitoring using the Cerebral Function Analysing Monitor (CFAM) have been outlined based on experience of 54 critically ill comatose and/or paralysed sedated children monitored for up to 9 days during the acute phase of illness. Fall in amplitude and slowing of frequency following either a cerebral insult or barbiturate administration as well as paroxysmal events were readily recognisable in the CFAM traces. Such changes could be used to (1) identify effects of cerebral insults (acute or cumulative), (2) recognise unstable patients exquisitely sensitive to aspects of standard care and (3) evaluate seizure control. Despite these useful contributions to clinical care, significant limitations were apparent. It is recommended that CFAM monitoring should be combined with serial conventional EEG recording in order to check the appropriateness of the cortical areas being monitored, the quality and type of signal being processed as well as the significance of the 1 or 2 channel CFAM findings in relation to global cerebral function.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01706327
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