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Biomedical subjects

A I Fields

Publications and source records attributed to A I Fields.

27 records · Page 2Linked to original sources
PubMed1982

Assessment of pediatric intensive care--application of the Therapeutic Intervention Scoring System.

There are few reports analyzing the results of intensive care for children. We evaluated quantitatively the amount of care required in our multidisciplinary pediatric ICU using the Therapeutic Intervention Scoring System (TISS) and assessed qualitatively the severity of illness using the Clinical Classification System (CCS). Over a 6-month period, there were 323 patients (99 CCS Class II, 83 Class III, 141 Class IV) whose overall mortality at 1-month follow-up was 10% (Class II, 0%; Class III 2%; Class IV, 23%). A strong association was obtained between CCS and TISS admission scores (Class II-TISS, 11 +/- 0.6; Class III-TISS, 20 +/- 0.8; Class IV-TISS, 38 +/- 1.0). Class IV patients had a highly significant difference between survivors (S) and nonsurvivors (NS) for admission TISS (S = 36, NS = 47, p less than 0.001) and highest TISS (S = 38, NS = 54, p less than 0.001), as well as slopes of the regression of TISS points versus days of care (S = -4.2 vs. NS = +2.3). The mortality of our Class IV patients was lower than a comparable adult population with similar TISS scores; however, the TISS regression slopes for Class IV patients were similar. We conclude that CCS and TISS are both useful for describing the pediatric intensive care patient population. TISS is particularly helpful in assessing the amount of care received as well as providing a means of evaluating severity of illness.

Child↗
PubMed1981

Aspiration of activated charcoal and gastric contents.

A case of aspiration of activated charcoal and gastric contents is reported. The patient developed immediate airway obstruction treated by endotracheal intubation and suctioning. Protracted respiratory insufficiency characterized by severe bronchospasm developed after airway obstruction was alleviated.

Airway Obstruction↗
PubMed1980

Adult respiratory distress syndrome in children.

Respiratory distress syndrome is the clinical manifestation of injury to the terminal alveolar-capillary unit, and may result from a variety of nonpulmonary insults including shock, sepsis, and trauma. The clinical characteristics, pathophysiology, and treatment of respiratory distress syndrome in children are reviewed.

Biological Transport↗
PubMed1980

Cardiopulmonary parameters during high PEEP in children.

There are a few reports of the application of high PEEP (PEEP greater than or equal to 15 cm H2O) infants and children. Data concerning cardiac index (CI), pulmonary venous admixture (Qsp/Qt), and arterial mixed venous oxygen content difference (avDO2) during mechanical ventilation with high PEEP have not been reported. Fourteen infants and children were treated with high levels of PEEP; 8 of these patients were monitored with pulmonary artery catheters. Cardiopulmonary data were obtained from these 8 patients and pulmonary barotrauma data were tabulated from all 14 patients. At highest PEEP, CI = 3.6 +/- 0.6 L/min x M2, avDO2 = 4,45 +/- 0.83 ml/dl and Qsp/Qt = 16.7 +/- 2.1%. One patient experienced severe cardiac depression unresponsive to therapy; it resolved when PEEP was lowered. Pulmonary barotrauma was a frequent complication. Pneumothroax occurred in 6 patients. No patient died from pulmonary barotrauma. We conclude that PEEP greater than or equal to 15 cm H2O can be used in infants and children to decrease Qsp/Qt toward normal; CI and avDO2 can usually be maintained in an acceptable range. Patients should be frequently monitored for pulmonary barotrauma.

Adolescent↗
PubMed1980

Cerebellar herniation in infancy.

Cerebellar herniation with frank necrosis of the cerebellum is a rare event in infants with unfused sutures and open fontanelles. We have described this case of cerebellar herniation to emphasize its occurrence in infancy.

Cerebellar Diseases↗
PubMed1979

Pneumothorax and pneumomediastinum during pediatric mechanical ventilation.

The incidence of pulmonary barotrauma during mechanical ventilation in children beyond the neonatal age group was studied in two groups of patients. In the first group, 179 cases of pediatric mechanical ventilation for over 12 hours were retrospectively analyzed for the occurrence of pneumothorax and pneumomediastrinum. Eleven percent (6 of 57) of young infants (0--6 months) without hyaline membrane disease and 3% (4 of 122) of older infants and children (over 6 months) developed these complications. Pulmonary barotrauma in young infants occurred only after cardiothoracic surgery and involved the same site as the intraoperative repair in all cases. Pulmonary barotrauma in older infants and children occurred in patients with severe respiratory disease requiring high peak airway pressures, PEEP, and respiratory rates. In the second group, the incidence of pulmonary barotrauma during ventilation with PEEP greater than or equal to 15 cm H2O was analyzed in 14 patients including 4 patients from the previous group. Overall, 64% (9 of 14) of this group developed pulmonary barotrauma and 43% (6 of 14) developed pneumothorax. Of 9 patients receiving PEEP greater than or equal to 15 cm H2O for longer than 24 hours, 6 developed pulmonary barotrauma after the first 24 hours. The incidence of pneumothorax and pneumomediastinum in ventilated infants without hyaline membrane disease and children is comparable to adult series.

Adolescent↗
PubMedDate not supplied

Changes in cardiac rhythm in children treated with dopamine.

We reviewed the charts of 31 children receiving dopamine to document possible changes in cardiac rhythm associated with dopamine infusion. Six of these developed a dysrhythmia while on dopamine. All six were receiving dosages greater than 10 microgram/kg/min; in five of the six patients the infusion rate varied from 10-20 microgram/kg/min. Of the remaining 25 patients, 14 had preexisting dysrhythmias of nonventricular origin. Two of these 14 patients converted to sinus rhythm while on dopamine. Eleven patients who were in preexisting sinus rhythm had no rhythm changes on dopamine. Based on the results of this study, we recommend that dopamine should be used cautiously in children in the dosage range between 10-20 microgram/kg/min.

Adolescent↗