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Biomedical subjects

F Shann

Publications and source records attributed to F Shann.

At least 73 records · Page 4Linked to original sources
PubMed1992

Experience with extracorporeal membrane oxygenation in children more than one month old.

Extracorporeal membrane oxygenation (ECMO) has been used at the Royal Children's Hospital, Melbourne, in the treatment of children with life-threatening respiratory or cardiac failure since May 1988. The main indications for its use are, first, the disease is thought to be reversible, second, the child will survive with an acceptable quality of life and, third, the child has an 80% chance of dying without ECMO. Seven of eighteen children receiving ECMO have survived to leave hospital, and all are functionally normal: these results are similar to international results. It would appear that ECMO is a useful therapy for some children with otherwise fatal cardiorespiratory failure.

Adolescent↗
PubMed1992

Mortality prediction in infants with congenital diaphragmatic hernia: potential criteria for ECMO.

Over the last ten years the survival of infants born with congenital diaphragmatic hernia who reach the Intensive Care Unit of the Royal Children's Hospital, Melbourne has been constant at 56 +/- 6%. Experimental therapies such as extracorporeal membrane oxygenation, high-frequency oscillation and lung transplantation are now being considered as therapeutic options, and as such the ability to predict survival or death of these infants is increasingly important. The records of all infants with congenital diaphragmatic hernia admitted to the Intensive Care Unit between 1 January 1980 and 30 April 1989 were reviewed; blood gas, ventilatory details, and outcome information was obtained. Receiver operating curve analysis was used to determine the best predictor of death. An oxygenation index (MAP x FiO2/PaO2) > 0.3 or ventilation index (PIP x RR x CO2/1000) > 70 predicted a 94% mortality with a specificity of 96% and a sensitivity of 82%.

Blood Gas Analysis↗
PubMed1991

Clinical signs of pneumonia in children.

Clinical and chest radiographic findings were recorded prospectively in 185 children with cough who attended an outpatient clinic in Papua New Guinea. Children were studied if they were between 8 weeks and 6 years of age; patients with wheeze, stridor, measles, or pertussis were excluded. 56 children (30%) had radiological evidence of pneumonia. The presence of either a respiratory rate greater than or equal to 50/min or chest indrawing, or of both signs, was a good indication of pneumonia, with a predictive power of 46% for a positive test and 83% for a negative test. A more complex definition of tachypnoea, as a respiratory rate greater than or equal to 40/min in children over 12 months old and greater than or equal to 50/min in infants, showed little additional diagnostic benefit.

Child, Preschool↗
PubMed1991

Comparison between prostaglandin E1 and epoprostenol (prostacyclin) in infants after heart surgery.

OBJECTIVE: To study the dose response characteristics of prostaglandin E1 and epoprostenol (prostacyclin) and directly to compare their effectiveness as pulmonary vasodilators in infants with pulmonary hypertension. DESIGN: A crossover design with each patient receiving both drugs in random order. SETTING: Infants were studied in the intensive care unit while they were sedated, paralysed, and ventilated. PATIENTS: Twenty infants who had undergone corrective cardiac surgery and who were in sinus rhythm, had stable haemodynamic function, and had a pulmonary artery catheter in place. All infants were receiving dopamine and phenoxybenzamine. INTERVENTIONS: Baseline haemodynamic measurements were taken and an infusion of the first drug was started at the lowest dose: after 20 minutes the measurements were repeated and the dose increased. This protocol was repeated for all doses of both drugs: 10, 30, and 100 ng/kg/min of prostaglandin E1 and 5, 10, and 25 ng/kg/min of epoprostenol. Cardiac output was measured by the pulsed Doppler ultrasound method. MAIN OUTCOME MEASURES: Pulmonary and systemic vascular resistances were calculated from the cardiac output and compared by the Wilcoxon signed ranks test. RESULTS: Both prostaglandin E1 and epoprostenol were effective vasodilators: 5 ng/kg/min of epoprostenol was equivalent to 30 ng/kg/min of prostaglandin E1. CONCLUSIONS: Neither drug showed pulmonary specificity.

Alprostadil↗
PubMed1991

Core-peripheral temperature gradient does not predict cardiac output or systemic vascular resistance in children.

We prospectively measured toe temperature, rectal temperature, systemic arterial pressure and cardiac output on two occasions one hour apart in 136 children who had had phenoxybenzamine after cardiac surgery while on cardiopulmonary bypass. Repeated measures analysis showed that there was no significant correlation between the change in temperature gradient over one hour in each patient and the change in cardiac index (r = 0.03, P greater than 0.1) or systemic vascular resistance (r = 0.007, P greater than 0.1). Although the peripheral temperature (toe temperature), and the core-peripheral temperature difference are simple, safe and inexpensive to measure in the population studied, they did not provide any guide to either cardiac output or systemic vascular resistance.

Body Temperature↗
PubMed1990

Long-term outcome of children after intensive care.

To determine the long-term outcome of children admitted to a pediatric ICU (PICU), we studied 976 consecutive patients admitted to our PICU in the 12 months ending June 30, 1983, and evaluated their outcome 30 to 36 months after PICU admission. There was no relationship between duration of PICU admission and outcome. Young children were more likely to die than older children, but young children who survived did not have an increased risk of handicap. Of the 974 children available for follow-up, 20% died, 5% had a severe handicap, 2% had a moderate handicap, 12% had a mild handicap, 17% were functionally normal but required medical supervision, and 42% were normal. Thus, 80% of the children survived 30 months or more, and 91% of the survivors will probably lead an independent life.

Adolescent↗
PubMed1990

Predictors of mortality in children with respiratory failure: possible indications for ECMO.

There are many unproven methods of ventilation and oxygenation that have been used in children dying from respiratory failure, including extracorporeal devices and high frequency ventilation. However, no objective predictors of death have been developed that enable clinicians to decide when it is reasonable to use these therapies in children over one month of age with acute respiratory failure. To determine predictors of death, we evaluated the charts of all 42 children aged one month to eighteen years admitted to the intensive care unit who were ventilated for more than twelve hours, received greater than 90% oxygen, received a peak inspiratory pressure greater than 25 cmH2O and had no pre-existing neurodevelopmental handicap. A combination of a variable reflecting ventilation and a variable reflecting oxygenation reliably predicted death: a combination of ventilation index greater than 40 and oxygenation index greater than 0.4 was associated with a 77% chance of mortality (sensitivity 65% and specificity 74%); a combination of peak inspiratory pressure greater than 40 cmH2O and A-aDO2 greater than 580 was associated with an 81% chance of mortality (sensitivity 74% and specificity 79%). These criteria may be useful in predicting death from respiratory failure in children.

Adolescent↗
PubMed1989

Clinical signs of dehydration in children.

102 children with acute gastroenteritis were thought by the admitting junior doctors to be 5% or more dehydrated. As judged by subsequent weight recovery in hospital, the main indicators of mild to moderate dehydration were decreased peripheral perfusion, deep breathing, decreased skin turgor, high urea, low pH, and a large base deficit; a history of increased thirst was just short of statistical significance. Dehydration was not indicated by a history of oliguria, by the presence of restlessness or lethargy, sunken eyes, dry mouth, or a sunken fontanelle or by the absence of tears. Clinical signs of dehydration became apparent at 3-4% rather than 5% dehydration. The degree of dehydration was overestimated by a mean of 3.2%; this caused unnecessary hospital admissions and overtreatment with intravenous fluid.

Acute Disease↗
PubMed1989

Clinical signs that predict death in children with severe pneumonia.

It is important to define clinical signs that can be used to identify children who have a high risk of dying from pneumonia so that these children can be given more intensive therapy. We prospectively studied 748 children in Papua New Guinea who had severe pneumonia, as defined by the World Health Organization. There was a very high mortality in children with a prolonged illness, severe roentgenogram changes, cyanosis, leukocytosis, hepatomegaly or inability to feed, and there was a trend toward a higher mortality in children with grunting or severe chest indrawing. Afebrile malnourished children had a particularly high mortality, but afebrile children had an increased mortality only if they were malnourished, and malnourished children had an increased mortality only if they were afebrile. Mortality was not increased in very young children or in children with tachypnea or tachycardia. The World Health Organization has suggested that most children with pneumonia in developing countries can be treated with penicillin but has recommended that children who are cyanotic or too sick to feed be treated with chloramphenicol because of their high risk of dying; our findings confirm that children who are cyanotic or too sick to feed have a very high risk of dying from pneumonia.

Age Factors↗
PubMed1988

Nasopharyngeal oxygen in children.

Hypoxia caused by pneumonia or bronchiolitis is a common cause of death in children in developing countries. Oxygen is very expensive in developing countries, and it is important that the limited supplies available be used as efficiently as possible. This study evaluated the administration of oxygen through an 8 FG catheter inserted into the nose to a depth equal to the distance from the side of the nose to the front of the ear, so that the tip of the catheter was just visible in the pharynx below the soft palate. A flow rate of 150 ml/kg/min gave an inspired oxygen concentration of about 50% in children less than 2 years old. Thus, newborn infants with pneumonia can usually be treated with 0.5 l/min and infants up to 12 months old with 1.0 l/min of nasopharyngeal oxygen.

Blood Gas Monitoring, Transcutaneous↗