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Biomedical subjects

I D Todres

Publications and source records attributed to I D Todres.

64 records · Page 4Linked to original sources
PubMed1975

Prevention of apnea and bradycardia in low-birthweight infants.

The efficacy of theophylline in preventing severe apnea was evaluated in 17 low-birthweight infants (mean weight, 1,400 gm). Apnea was detected and accurately quantified by 13-hour pneumogram recordings and correlated with serum theophylline levels. Nursing observations coupled with on-line alarm systems detected only 39% of severe apneic episodes as compared to the pneumogram recording technique. Theophylline in six hourly oral doses(1.5 to 4.0 mg/kg) yielded two-hour serum concentrations of 6.6 to 11.0 mug/ml which completely controlled apneic spells exceeding 20 seconds in duration and markedly reduced 10- 19-second apneic episodes and any resultant bradycardia. At these serum levels, toxicity was not observed. Therapy with theophylline should be instituted at a dose of 2 to 3 mg/kg every six hours and the optimum therapeutic dose should be individualized as determined by objective quantitation of apnea and serum theophylline concentration.

Apnea↗
PubMed1975

Edema of the pulmonary interstitium in infants and children.

Ten infants and children with respiratory failure, receiving standard maintenance water requirements, were treated on 13 occasions with intravenously given furosemide (1 to 2 mg/kg) because of continued impairment of oxygenation despite conventional therapy. Pulmonary auscultation and radiographs were normal or typical of the primary diagnosis. After a five-fold increase in urine output the mean Po2 rose from 61 mm Hg at a mean FiO2 of 0.7 to 140 mm Hg at an FiO2 of 0.65. The Pco2 decreased from 46 to 38 mm Hg. Interstitial pulmonary edema in these patients can be related to both their lung disease and impaired water tolerance during ventilatory therapy.

Adolescent↗
PubMedDate not supplied

High risk pediatric emergency air transport.

INTRODUCTION: Pediatric Emergency Air Transports (PEATs) at Massachusetts General Hospital, Boston, Massachusetts, were reviewed between November 1986 and December 1987. Severity of illness, complications, and outcome of PEATs were compared with ground transports. Factors associated with PEAT survival were identified. METHODS: Severity of illness was measured using a modified Denver Patient Status Category (DPSC) method and the Therapeutic Intervention Scoring System (TISS). There were 35 PEATs (30 helicopter, five fixed-wing) and 96 ground transports. RESULTS: Mean severity of illness for patients was greater in PEAT than for the ground transport (PEAT DPSC score=4.23+/-1.06 versus ground DPSC=3.57+/-0.89 [SD], p=.0005). The PEAT mortality was associated with a greater mean severity of illness (TISS survivors=19.1+/-11.4 versus non-survivors=44.3+/-9.5, p=.0001), but not with: the presence of an on-flight physician; transport delay; transport duration; age; sex; history of chronic illness; or intra-transport medical complications. CONCLUSIONS: Compared to ground transports, PEATs were used for higher risk patients.

Adolescent↗
PubMedDate not supplied

Moral and ethical dilemmas in critically ill newborns: a 20-year follow-up survey of Massachusetts pediatricians.

OBJECTIVE: To replicate the 1987 survey, referring to the original 1977 study, regarding opinions about treatment for critically ill neonates. STUDY DESIGN: A long-term follow-up survey of American Academy of Pediatrics Massachusetts membership, maintaining the 1987 instrument, was initiated. RESULTS: A notable demographic shift in respondents from a majority of male practitioners in 1977 (89.6%), to 73% in 1987, to more equal numbers of men and women in 1997 (55% and 45%, respectively; p < 0.001; 1987 vs 1997) was apparent. Pediatricians' attitude changes over the 20-year period were relatively modest and were statistically associated with active medical intervention. In 1997, 75% of respondents rejected review committees as mediators, a marked change from 1987. Regardless of healthcare maintenance organization affiliations, 95% indicated that restrictive fiscal policies would not affect decision-making. CONCLUSION: This study indicates stability and consensus in pediatricians' attitudes toward active intervention for critically ill neonates compared with 1977 and 1987 surveys and reveals several claims to professional autonomy.

Adult↗
PubMedDate not supplied

The relationship of bronchopulmonary dysplasia to the occurrence of alveolar rupture during positive pressure ventilation.

The effect of altered mechanical ventilation on the incidence of alveolar rupture and bronchopulmonary dysplasia (BPD) was reviewed in infants who had neonatal respiratory distress syndrome (RDS) (N = 99). From 1971 to 1974 we attempted to minimize pulmonary oxygen exposure. Accordingly, during the resolution of respiratory distress syndrome, the ventilator pressures were not reduced until the FIO2 had been lowered to 0.4 (n = 61). In 1974 to 1975 earlier reduction of pressure was instituted as the FIO2 was lowered to 0.6 or less (N = 38). Birth weight and gestational age were comparable in the two groups. With earlier reduction of ventilator pressures, there was a significant decrease in the duration of exposure to peak inspiratory pressures greater than or equal to 40 cm H2O (p is less than 0.004) and greater than or equal to 50 cm H2O (p is less than 0.002). The incidence of alveolar rupture during postive pressure ventilation fell from 51 to 24% (p is less than 0.015) and bronchopulmonary dysplasia from 41 to 13% (p is less than 0.003). In addition, there was a decrease in the duration of mechanical ventilation (p is less than 0.02) and exposure to an FIO2 is greater than or equal to 0.6 (p = 0.07). The results confirm the intimate relationship of pulmonary barotrauma, as reflected by the occurrence of alveolar rupture during positive pressure inflation of the lungs, to the subsequent development of bronchopulmonary dysplasia and that prevention of the former is associated with a concomitant fall in incidence of the latter.

Follow-Up Studies↗