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Biomedical subjects

H M Grubbauer

Publications and source records attributed to H M Grubbauer.

At least 37 records · Page 2Linked to original sources
PubMed1991

Nitrogen and amino acid balance during total parenteral nutrition and continuous arteriovenous hemofiltration in critically ill anuric children.

Amino acid balance and nitrogen balance during total parenteral nutrition (TPN) and continuous arteriovenous hemofiltration (CAVH) were investigated in 11 critically ill anuric patients during the first 7 days after onset of anuria. Nitrogen intake ranged from 0.115 +/- 0.013 (SEM) g/kg/day on day 1 to 0.291 +/- 0.029 (SEM) g/kg/day on day 7. After 7 days of TPN, 9 patients had a positive cumulative protein-N balance of 287.52 +/- 68.52 (SEM) mg/kg, 2 patients had a negative balance of 781.8 and 1,103.2 mg/kg, respectively. Mean amino acid loss in ultrafiltrate was 0.159 +/- 0.008 (SEM) g/kg/day. Four patients died without recovery of renal function.

Acute Kidney Injury↗
PubMed1991

[A clinical score system for children with ARDS].

In a retrospective study we developed a simple acute respiratory distress syndrome (ARDS) scoring system in order to analyze the severity of ARDS as precisely as possible. From March 1983 to May 1990, 17 children with ARDS were admitted and treated at the pediatric intensive care unit of the University Hospital of Graz. The ARDS score was evaluated as a predictor of outcome. The score is based on four variables: mean airway pressure, oxygenation index, additional number of organ system failure and a radiological score, each of which was assigned a score between 0 and 3 (Table 3). The score was recorded on admission or immediately after respiratory failure and after 24, 48 and 72 h. The patients were divided into survivors and non-survivors. After 24 h of mechanical ventilation the ARDS score was 7.16 +/- 0.79 in survivors and 10.4 +/- 0.4 points in non-survivors (P less than 0.0006). Similar differences were found after 48 and 72 h of therapy. In addition, the predictive power of the ARDS score after 24 h was tested at a level of 8 points. The sensitivity and the positive predictive value were 90%, while specificity and negative predictive value were 85.7%. The correct prediction was 88.2%. We conclude that this simple ARDS score can be an useful prognostic factor in patients with ARDS.

Carbon Dioxide↗
PubMed1990

Ceftriaxone monotherapy for bacterial meningitis in children.

A total of 33 patients with bacterial meningitis were treated with single daily doses of ceftriaxone (CTR 100 mg/kg/day i.v.) for a median duration of 13 days. Pathogens isolated by culture and/or determined by latex agglutination were 15 Haemophilus influenzae b, 7 Neisseria meningitidis, 2 Streptococcus pneumoniae, 1 group B streptococcus, 2 Streptococcus viridans and 2 Staphylococcus epidermidis. In 4 cases a diagnosis of purulent meningitis could only be made by means of the inflammatory liquor parameters. All cerebrospinal fluid (CSF) drug levels even at the end of the dosing interval were at least 10-fold higher than the MICs of the respective bacterial isolates. The average penetration of CTR into the CSF was 6.6%. Within 12-46 h after the first dose, control spinal taps were performed. Cultures were sterile in all cases. Side effects encountered were diarrhea, exanthema, neutropenia and transient elevation of glutamic oxaloacetic transaminase, but none caused a change of therapy. One patient developed a biliary concrement. No patient died; 5 patients had prolonged fever (greater than 5 days), and 2 were left with persistent hearing deficiencies. CTR can be recommended as a safe and effective antibiotic agent for once daily treatment of bacterial meningitis in children.

Adolescent↗
PubMed1990

Evaluation of clinical scoring systems in critically ill infants and children.

Four scoring systems, the Acute Physiologic Score for Children (APSC), the Physiologic Stability Index (PSI), the Paediatric Risk of Mortality (PRISM) and the Therapeutic Intervention Scoring System (TISS), were evaluated for 103 critically ill infants and children according to the Clinical Classification System (CCS) class IV. The admission scores were higher for children who died than those who lived (APSC, PSI, PRISM p less than 0.001, TISS p <0.025). In addition, the mean APSC and PSI showed significant differences (p less than 0.01) between survivors (S) and nonsurvivors (NS) in all patients, mean PRISM showed significant differences (p less than 0.01) between S and NS in all but renal failure patients and the mean TISS showed only significant differences (p less than 0.01) between S and NS with primary cardiovascular and respiratory diseases. The mortality rate was 30%. Using the 0.5 predicted risk rate, total correct prediction of admission APSC, PSI, and PRISM was 80%, 80.5% and 80% respectively. Receiver Operating Characteristic (ROC) curves drawn for each severity index were in a discriminating position. There were no significant differences between the areas under the ROC curves of the physiological scores. However, there was a significant difference between the physiologic scores and TISS (p less than 0.001). Admission APSC, PSI and PRISM excellently describe severity of illness and give prognostic information in critically ill paediatric patients. In addition, TISS gives information about the therapeutic support needed.

Child, Preschool↗
PubMed1990

Clinical scoring systems in children with continuous extracorporeal renal support.

Three physiologic scoring systems, the Physiologic Stability Index (PSI), the Pediatric Risk of Mortality (PRISM), the Acute Physiologic Score for Children (APSC), and the Therapeutic Intervention Scoring System (TISS) were applied to 32 critically ill infants and children with acute renal failure or multiple organ system failure undergoing continuous extracorporeal renal support. APSC was developed from the Apache II score. It describes 6 organ systems with 14 variables. PSI describes 7 organ systems with 34 variables, PRISM 5 organ systems with 14 variables. Simultaneously, the TISS was recorded at admission, 24, 48, 96 and 144 h later. All physiologic scores showed significant differences between survivors (S) (n = 18) and nonsurvivors (NS) (n = 14) from admission on. The highest significance was obtained with the APSC (admission score: S: 17.8 +/- 7.4 vs. 27.1 +/- 11.4 NS; p = 0.01; day 4: S: 10.3 +/- 6.1 vs. 26.1 +/- 10.8 NS; p = 0.0001). No significant differences in TISS and in the number of organ system failure were observed during the first 4 days of intensive care.

Acute Kidney Injury↗
PubMed1989

[Respiratory insufficiency in acute bronchiolitis in infancy].

Forty-one infants with acute viral bronchiolitis were hospitalized in our paediatric intensive care unit during the seven year period from 1980 to 1987. In 14 out of 27 evaluated patients, Respiratory Syncitial Virus (RSV) was detected in the nasal secretions. Twenty-three children required only supportive care and monitoring. Eighteen infants had to be ventilated because of respiratory failure. The major indication for mechanical ventilation was an arterial or capillary pCO2 of more than 64 mmHg; other criteria were repeated apnoea, respiratory acidosis, and clinical deterioration. In all cases the type of the mechanical ventilation was an intermittent mandatory ventilation (IMV) with flow and time cycled respirators; muscle relaxation was not required in any case. The average duration of mechanical ventilation was 40 hours. All the children recovered uneventfully. These data suggest that even the most severe cases of acute bronchiolotis can be treated successfully, and that the mortality rate of this disease entity can be reduced to zero.

Bronchiolitis, Viral↗
PubMed1988

[Tasks and organization of a pediatric intensive care unit].

Paediatric intensive care medicine mainly involves infants during the neonatal period and, in particular, premature babies. 70% of the children on assisted ventilation at the paediatric hospital of Graz University in 1985 and 1986 were neonates. Older children needing mechanical ventilation comprised only 1.6% of the total number of patients at our paediatric hospital. Paediatric intensive care units are therefore almost exclusively neonatal care units. Otherwise when serving the needs of children beyond the neonatal period these units are mostly required by paediatric subspecialities (i.e. cardiology, burns unit etc.). In view of the small number of patients in this group a high-standard paediatric intensive care unit should be multidisciplinary and preferentially attached to a university hospital rather than a regional hospital so as to maximise experience in the management of these children and ensure optimal care.

Austria↗
PubMed1988

Suction-supported continuous arteriovenous hemofiltration in children.

Spontaneous continuous arteriovenous hemofiltration (CAVH) may fail to control azotemia in small patients with renal failure due to poor blood flow. To produce adequate ultrafiltrate a continuous negative pressure was added to the ultrafiltrate line. Two hemofilter systems of different membrane and surface area were used. Suction support approximately doubled ultrafiltration rate in both hemofilters. No side effects such as severe hypotonia or early hemofilter clotting occurred. Added suction can serve as a useful support of spontaneous CAVH in children with renal failure and too poor a blood flow to control azotemia.

Acute Kidney Injury↗
PubMed1988

[Assessment of a commonly available latex particle agglutination test in rapid, bacteriologic cerebrospinal fluid diagnosis].

36 cerebrospinal fluid specimens (CSF) from patients with bacterial meningitis were tested for the presence of bacterial antigens with the "Slidex Meningite Kit" (Bio Merieux). This kit has latex particles coated with antibodies against hemophilus influenzae type B (Hib) streptococcus pneumoniae (SP) and neisseria meningitidis (NM) group A and C. With the LAT we could detect the bacterial antigens in 84% of bacterial meningitis cases, 23 of the 27 of Hib meningitis (85.2%), all of the 6 cases of SP meningitis (100%) and two of the three NM meningitis cases. The test is handicapped by the fact, that there is no antiserum against NM sero-group B, the main cause of NM meningitis in Austria. There were no false positive results with the LAT. False negative results were obtained in 19.2% of Hib and in one case of NM. Even under sufficient antibiotic therapy and with negative culture we could detect 9 Hib- and 1 NM-cases during the first 12-48 hours of therapy with this method. The LAT-Kit is a useful addition to standard methods of CSF examinations in bacterial meningitis. With the LAT a rapid bacteriological diagnosis is possible within 15 minutes. The Kit is also able to identify bacterial antigens even with negative culture and after initiation of antibiotic treatment.

Antigens, Bacterial↗
PubMed1987

Continuous arteriovenous hemofiltration in critically ill children with acute renal failure.

Last year, five critically ill children with acute renal failure were treated by continuous arteriovenous hemofiltration. Mean treatment duration was 326 +/- 89 (SD)h, for a total of 1632 h. Mean ultrafiltration rates of 5.4 +/- 1.7 ml/min X m2 achieved mean serum urea levels of 150 +/- 25 mg/dl and a decline of mean prehemofiltration serum creatinine level of 3.5 +/- 3.6 to 2.9 +/- 2.0 mg/dl posthemofiltration. Continuous arteriovenous hemofiltration allowed adequate parenteral nutrition with a mean caloric intake of 79.6 +/- 9.2 kcal/kg X day. In the four surviving patients, urinary output started between 12 and 42 days after the onset of acute renal failure. Continuous arteriovenous hemofiltration is a very effective extracorporeal therapeutic system to control azotemia, fluid, and electrolyte balance in critically ill children with acute renal failure and hemodynamic instability.

Acute Kidney Injury↗
PubMed1987

[Continuous arteriovenous hemofiltration in childhood. Indications and technics].

CAVH is an extracorporal treatment modality by which fluid and solutes can be removed from the body by convective transport. Without using a blood pump the blood passes through the hemofilter driven only by the arteriovenous pressure gradient. From May 1985 to October 1986 18 critically ill children with a mean age of 5.1 years (range 10 days to 18 years) and a mean body weight of 20.8 kg (range 3 to 80 kg) were treated by CAVH. Indications for CAVH were: acute renal failure, multiple organ system failure, diuretic-resistant hypervolemia, interstitial pulmonary edema, electrolyte disorders, and metabolic crisis in maple syrup urine disease. Five different hemofilter systems with a membrane surface of 0.015 m2 to 0.6 m2 and an extracorporal filling volume of 9 to 70 ml were used. Mean duration of CAVH was 132 h (range 10 to 432 h), for a total time of 2344 h. Mean ultrafiltration rates ranged from 0.34 +/- 0.1 (SD) ml/min (Amicon Minifilter 0.015 m2) to 9.1 +/- 1.47 (SD) ml/min (Gambro FH55 0.6 m2). The application of a continuous negative pressure of 200 mmHg onto the ultrafiltrate line the ultrafiltrate increased from 3.96 +/- 0.62 (SD) ml/min to 13.4 +/- 1.63 (SD) ml/min. CAVH allowed good compensation of azotemia in critically ill children with acute renal failure, rapid correction of severe hypervolemia, interstitial pulmonary edema, electrolyte disorders, and metabolic crisis in maple syrup urine disease. It was well tolerated by all children. The only complication due to hemofiltration was a femoral artery thrombosis which needed surgical revision.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗
PubMed1987

Arteriovenous hemofiltration in children with multiple organ system failure.

In the last year nine critically ill children with multiple organ system failure (MOSF) were treated by continuous arteriovenous hemofiltration (CAVH). The mean number of organ systems involved was five per patient (range 4 to 7). Mean duration of hemofiltration was 136 hours (range 10 to 432 h.). Mean ultrafiltration rates of 6.4 +/- 3.0 ml/m2 b.s./min achieved mean serum creatinine levels of 2.39 +/- 1.49 mg/dl. Hypervolemia and pulmonary edema were corrected rapidly by CAVH. Total parenteral nutrition with a mean caloric intake of 62 +/- 15 kcal/kg b.w./day was provided throughout the hemofiltration period. In addition high ultrafiltration rates allowed delivery of large amounts of i.v. medications. CAVH is an ideal extracorporeal renal replacement system to control azotemia, fluid, electrolyte, and acid-base status in critically ill children. It carries the potential to improve survival rate in children with MOSF.

Adolescent↗
PubMed1986

Arteriovenous haemofiltration in hypervolaemia.

Arteriovenous haemofiltration was used for removal of fluid overload in a 9 month old burned infant with diuretic resistant hypervolaemia. After 60 hours of arteriovenous haemofiltration hypervolaemia had disappeared. Arteriovenous haemofiltration proved to be a safe and simple extracorporal method of managing severe fluid overload.

Blood↗
PubMed1986

[Follow-up of children after toxoplasmosis infection in pregnancy].

A vival toxoplasmosis infection was diagnosed in 188 cases (3,8%) out, of 49,582 pregnant women routinely screened. 4 children live with congenital toxoplasmosis. Follow-up studies showed that 33 children have specific antibodies, 5 are with suspect clinical findings. Therefore is the conclusion that more late signs of connatal toxoplasmosis are to be detected by follow-up investigations.

Antibodies↗
PubMed1985

[Combined propyphenazone and codeine poisoning in childhood (analysis of 6 patients with Spasmoplus poisoning)].

The case histories are presented of 6 patients with accidental poisoning by Spasmoplus suppositories. The main toxic constituents are codeine and the pyrazolone derivative, propyphenazone. All patients had symptoms of codeine intoxication with somnolence, miosis and oedema, 2 patients had also symptoms of prophyphenazone intoxication with hypotension, coma and convulsions. 1 patient died during the acute stage in a state of shock, with arrhythmia, and asystole.

Aminopyrine↗
PubMed1985

[Clonidine poisoning].

Accidental clonidine poisoning of infants has been more frequently observed during the last years. The early onset of sedation together with miosis, hypotension, bradycardia and sometimes respiratory depression should draw our attention to clonidine poisoning. Treatment of cardiac and circulatory symptoms with atropine sulfate, epinephrine chloride, dopamine hydrochloride and intravenous fluids should start early. Ventilatory support must be available for children in case of apnoe. We report our experience with the treatment of five infants.

Apnea↗