Biomedical subjects

J M Dean

Publications and source records attributed to J M Dean.

98 records · Page 6Linked to original sources

PubMedDate not supplied

The epidemiology of pediatric air medical transports in Utah.

OBJECTIVE: To describe the air-transported patients treated at Primary Children's Medical Center (PCMC), the sole pediatric tertiary care center in Utah and a referral center in the intermountain region. This study describes the patients who utilized the air medical transport system, the medical services provided in the prehospital setting, and the corresponding charges for transport and treatment. METHODS: Participants were air-transported patients aged 17 years and less who were treated at PCMC during the calendar years 1991-1992. The study population excluded patients who were transported to other medical facilities, and newborns. Data were abstracted retrospectively from the patients' medical and transport records. Data collected included demographic information, patient diagnoses, and treatments performed during transport. Financial data were supplied by the hospital. RESULTS: During the study period, 874 pediatric patients met the participant criteria. Helicopter and fixed-wing transports comprised 561 and 313, respectively, from nine states in the mountain and western regions. The majority (313, 56%) of the patients transported by helicopter were trauma patients, while the majority (195, 62%) of fixed-wing transports were for illness-related conditions. Scene transports accounted for 120 (21%) of helicopter transports. Children with special health care needs accounted for 171 (20%) of all transports. CONCLUSIONS: Injury severity scores indicate that, overall, air-transported patients were more severely injured than comparable ground-transported patients. However, it is apparent that some patients who were air-transported could have been transported by ground ambulance without detriment. medical services.

Adolescent↗

PubMedDate not supplied

Effect of lidoflazine on cerebral blood flow following twelve minutes total cerebral ischemia.

Lidoflazine, a calcium channel blocker, was administered to dogs following twelve minutes of cerebral ischemia, induced by aortic cross-clamping. The effects of lidoflazine (1 mg/kg i.v.) on cerebral blood flow following ischemia was studied in 15 anesthetized, mechanically ventilated dogs. Cerebral blood flow was measured with the radiolabelled microsphere technique before and 10, 30, 60, 90 and 150 minutes following ischemia. Cerebral blood flow increased in all brain regions following ischemia, but by 60 minutes had decreased to control values. Lidoflazine had no effect on this reperfusion phenomenon, or on the distribution of blood flow within the brain. Regional cerebral blood flow was also not altered by lidoflazine therapy. Our data demonstrate that this dose of lidoflazine has no effect on regional or total cerebral blood flow following 12 minutes of cerebral ischemia in dogs. These data do not support perfusion preservation as a mechanism of amelioration of neurologic injury after ischemia by this calcium channel blocker.

Animals↗

PubMedDate not supplied

Comparison of thermal clearance measurement of regional cerebral blood flow with radiolabelled microspheres.

A thermal clearance technique for measuring cerebral blood flow is described and compared with the radiolabelled microsphere technique. The thermal technique involves measurement of the rewarming curve generated after bolus infusion of 4-5 ml of ice-cold saline into the common carotid artery with a subdural thermistor placed on the parietal cortex. Evaluation of the biexponential decay curves obtained with this technique demonstrated a close correlation with total hemispheric, parietal, and parietal gray blood flow determined by simultaneous microsphere measurement. Despite significant correlations (p less than 0.001), scatter in the data produced a broad 95% confidence interval, thus making interpretation of blood flow with the thermal clearance technique impossible. Furthermore, instrumentation with the thermal probe, which required opening of the dura, blunted the cerebral blood flow response to hypercapnia. We conclude that the major limitations of the thermal clearance technique include: nonhomogeneous clearance function, significant variability, and depression of CO2 reactivity. These limitations must be addressed before this technique can be used reliably in the laboratory.

Animals↗

PubMedDate not supplied

Early enteral feeding in the pediatric intensive care unit.

BACKGROUND: The purpose of this study was to evaluate the feasibility and safety of early enteral feedings of critically ill pediatric patients. METHODS: The subject population of 42 critically ill patients ranged in age from 5 days to 18 years (mean 5.8 years), mean weight 17 kg. Transpyloric nasoenteric tubes were placed in all patients by a nonfluoroscopic bedside technique. All subjects were mechanically ventilated; 32 (76%) were on one or more vasoactive medications. Six (15%) patients were fed for more than 13 days while on vasoactive support and pharmacological paralysis. RESULTS: There were no documented complications of early enteral feeding, including aspiration. All patients were able to achieve caloric goals within 48 hours of beginning enteral feedings. All patients developed regular stool patterns despite periodic absence of bowel sounds. Enteral feedings replaced 256 days of total parenteral nutrition. Estimated patient charge savings averaged $425 for each day of enteral feedings. CONCLUSIONS: Early enteral feedings are feasible, well tolerated, and cost effective in critically ill pediatric patients.

Adolescent↗

PubMedDate not supplied

Bedside transpyloric tube placement in the pediatric intensive care unit.

BACKGROUND: The purpose of this study was to demonstrate the feasibility of placing transpyloric feeding tubes at the bedside without fluoroscopy in critically ill pediatric patients. METHODS: The patient population consisted of 90 patients (ages 1 week to 15 years, median age 9 months) admitted to a 26-bed pediatric intensive care unit in a university-affiliated pediatric hospital. Patient weights ranged from 2.4 to 100 kg with a median weight of 7.5 kg. Seventy-six patients were endotracheally intubated and mechanically ventilated; one patient had a tracheotomy. A total of 24 patients were pharmacologically paralyzed; 38 patients were receiving catecholamine infusions, and 17 patients had intracranial monitoring devices in place. All had concurrent nasogastric suctioning. Nonweighted Silicone Rubber 6F or 8F nasoenteric tubes were inserted at the bedside using metoclopramide, air insufflation and positioning to achieve transpyloric passage. Blue-dyed water was instilled in 58 patients to test for reflux and confirm transpyloric position. RESULTS: Successful nonfluoroscopic bedside transpyloric (duodenal or jejunal) tube placement was verified radiographically in 84 (93%) patients; seven of these patients were less than 4 weeks of age. One patient had blue dye in the nasogastric fluids, consistent with duodenogastric reflux or failure of transpyloric passage. The abdominal radiographs confirmed the results of the blue dye test in all 58 patients. There were six (6.7%) unsuccessful attempts at transpyloric bedside tube placement: four were a result of hemodynamic instability, one was a result of oropharyngeal trauma, and one was due to intestinal malrotation. The average time for placement was 15 minutes with a range of 5 to 45 minutes. No complications from tube placement were observed. CONCLUSIONS: Bedside placement of transpyloric feeding tubes is a safe and effective method to institute enteral feedings in critically ill pediatric patients.

Adolescent↗

PubMedDate not supplied

GasMan.

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Anesthesiology↗

PubMedDate not supplied

HeartLab.

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Computer-Assisted Instruction↗

PubMedDate not supplied

Albuterol in acute bronchiolitis--continued therapy despite poor response?

To determine whether clinicians continue to treat acute bronchiolitis with nebulized albuterol despite lack of clinical improvement after such treatment, we reviewed the medical records of 90 randomly selected infants and children with the primary diagnosis of that disorder who were treated in this 232-bed tertiary care children's hospital. Clinical improvement and no clinical improvement were defined as improvement and lack of improvement, respectively, in air movement, wheezing, retractions, oxygen saturation, work of breathing, and respiratory rate after administration of nebulized albuterol. Response to nebulized albuterol was determined from explicit written documentation in the medical records. Of 68 children who received nebulized albuterol in the emergency department, 52% had written documentation indicating no clinical improvement; however, 94% had admission orders to continue the therapy. Within 12 hours after admission, 61% were again noted to have no clinical improvement with nebulized albuterol. Eighty-seven percent of nonresponders continued to receive albuterol throughout hospitalization, and 54% continued to receive it after discharge. Continuing therapy despite lack of response resulted in unnecessary medical expenses.

Albuterol↗