Search PubMed⌕ Search

Biomedical subjects

J Tibballs

Publications and source records attributed to J Tibballs.

At least 91 records · Page 5Linked to original sources
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↗
PubMed1989

Ventilator-dependent children.

The issue of the ventilator-dependent child is a relatively-new one in Australia. Ventilator-dependent children pose complex and unique ethical, medical, economic and psychological problems. The experience of two Australian centres that are involved with the care of ventilator-dependent children is reported. Most of these children now are being cared for at home. Aspects of home care are outlined. After the initial period, the technical aspects are not a problem for most parents for whom the major issues are the provision and funding of nursing support. The complex ethical issues that are involved are discussed. It is concluded that undergoing ventilation at home rather than in a hospital appears to make the best of an otherwise almost-intolerable situation for ventilator-dependent children, but that much more information is required about the outcome for these children and the long-term psychosocial impact of this treatment.

Adolescent↗
PubMed1989

A comparative study of cardiac output in neonates supported by mechanical ventilation: measurement with thoracic electrical bioimpedance and pulsed Doppler ultrasound.

In newborn infants supported by mechanical ventilation, cardiac output was measured simultaneously with thoracic electrical bioimpedance and pulsed Doppler ultrasound to determine whether the impedance technique is reliable and accurate in this age group. The mean difference between paired measurements with the two techniques in 26 subjects was negligible (less than 1 ml/kg/min), with 95% confidence limits being approximately 11% of the mean Doppler-derived cardiac output. In addition, the two techniques related well (correlation coefficient r = 0.94) over a wide range of Doppler-derived cardiac output measurements (120 to 530 ml/kg/min). In 8 of the 26 subjects, cardiac output was observed for 7 to 12 hours. The mean difference between the Doppler and impedance techniques was 6.1% to -0.7% of the Doppler value. Thoracic electrical bioimpedance is applicable to newborn infants and offers a continuous noninvasive method of cardiac output measurement.

Cardiac Output↗
PubMed1989

Studies on Australian snake venoms. Part 1: The haemodynamic effects of brown snake (Pseudonaja) species in the dog.

The haemodynamic effects of Brown Snake (Pseudonaja) species (textilis, nuchalis, affinis) were investigated in anaesthetised, mechanically ventilated dogs. Blood pressure decreased to minimal levels five minutes after intravenous envenomation. Hypotension was accompanied by significant decrements in cardiac output and stroke volume and a rise in peripheral vascular resistance. Heart rate increased transiently during 0.5-2.0 minutes after envenomation but had declined below resting levels five minutes after envenomation. No statistically significant change was recorded in central venous pressure. Depression of myocardial contractility is postulated as the mechanism of venom induced hypotension.

Animals↗
PubMed1988

Optimization of oxygen transport in mechanically ventilated newborns using oximetry and pulsed Doppler-derived cardiac output.

In respiratory distress syndrome (RDS), PEEP improves arterial oxygenation but may impair cardiac output. The effects of PEEP on gas exchange and hemodynamics were studied in 12 mechanically ventilated newborns in the acute phase of RDS. Stepwise increase in PEEP resulted in both a) a progressive increase in PaO2 and transcutaneous oxyhemoglobin saturation, and b) a depression of pulsed Doppler-measured cardiac output that was statistically significant at 9 cm H2O PEEP. Thus, averaged systemic oxygen delivery (DO2) was maintained with improved arterial oxygenation up to 6 cm H2O PEEP. Further increase in PEEP induced a significant fall in DO2. No variation was observed in heart rate and mean arterial pressure. The combined use of oximetry and pulsed Doppler echocardiography enables noninvasive optimization of mechanical ventilation and PEEP during the clinical course.

Acute Disease↗
PubMed1988

Practical aspects of advanced paediatric cardiopulmonary resuscitation.

Successful cardiopulmonary resuscitation in the paediatric age group necessitates the acquisition of technical skills for rapid tracheal intubation, external cardiac compression and access to the circulation. Skills and equipment must be adapted to each age group. For optimal mechanical ventilation and the avoidance of complications, correct selection of endotracheal tube diameter and length is necessary. New techniques in resuscitation incorporate an understanding of the mechanism of blood flow during cardiac compression, the use of the intratracheal route for drug administration, and a revision of the use of catecholamines, sodium bicarbonate and calcium solutions in the treatment of asystole-bradycardia, electromechanical dissociation, ventricular fibrillation and tachycardia. Early intubation, adequate ventilation with oxygen, well performed external cardiac compression, prompt defibrillation and administration of adrenaline remain the cornerstones of advanced cardiopulmonary resuscitation.

Adolescent↗
PubMed1988

Cardiovascular responses to induction of anaesthesia with thiopentone and suxamethonium in infants and children.

Cardiac output, systolic blood pressure and heart rate were measured with non-invasive techniques before, during and after induction of anaesthesia with thiopentone (7.5-8.5 mg/kg) and suxamethonium (1.4-1.7 mg/kg), and after intubation in unpremedicated infants and diazepam-atropine premedicated children. Cardiac output was measured with a combination of M-mode and pulsed doppler echocardiography. Significant decreases in systolic blood pressure, cardiac index and stroke volume index were observed during induction in both infants and children. Intubation caused increases above pre-induction levels of heart rate, blood pressure and cardiac index in both infants and children. Stroke volume index increased marginally in infants but remained depressed in children after intubation. Left ventricular shortening fraction decreased significantly in five other children during induction. It is concluded that thiopentone causes significant reduction in cardiac output by depression of myocardial contractility manifested by depression of blood pressure and stroke volume. Premedication with atropine may ameliorate reduction in cardiac output by permitting an increase in heart rate during induction. Induction of anaesthesia with thiopentone and premedication with diazepam does not prevent hypertension and tachycardia occurring with intubation.

Anesthesia, Intravenous↗
PubMed1988

Cardiovascular changes during deep halothane anaesthesia in infants and children.

Cardiac output, blood pressure and heart rate were measured with noninvasive techniques before, during and after induction of anaesthesia with halothane and after intubation in unpremedicated infants and in diazepam-atropine premedicated children presenting for elective surgery. Cardiac output was measured with pulsed doppler echocardiography. Left ventricular shortening fraction was estimated with M-mode echocardiography during induction. Induction with halothane in infants caused significant decrements in blood pressure, cardiac index, stroke volume index and significant depression of left ventricular shortening fraction. Induction with halothane in diazepam-atropine premedicated children caused a significant increase in heart rate but significant decreases in blood pressure, stroke volume index and left ventricular shortening fraction while cardiac index decreased slightly. Intubation in infants caused a mild increase in heart rate compared with pre-induction values but blood pressure, cardiac index and stroke volume index remained below pre-induction values. Intubation in diazepam-atropine premedicated children caused significant increases in heart rate and cardiac index, and a non-significant increase in blood pressure but stroke volume index remained significantly below pre-induction values. Healthy infants and children tolerate induction of anaesthesia with halothane to a depth to permit intubation but large reductions in cardiac output and myocardial contractility are expected with subsequent reductions in blood pressure.

Anesthesia, Inhalation↗
PubMed1987

Efficacy and safety of continuous morphine infusion for postoperative analgesia in the paediatric surgical ward.

This study determines the efficacy and safety of continuous infusion of morphine following major surgery in non-ventilated children being nursed in general paediatric surgical wards. Pain and analgesia were assessed by a linear analogue scale. Assessment of pain by nursing staff was similar to that made by the patient and parent. Continuous infusions were easy to institute, well accepted by staff and patients alike and resulted in few side effects. The safety and efficacy of morphine infusions allow for wider adoption as a routine method of analgesia for children following major surgery.

Adolescent↗
PubMed1986

Paralysis with Ixodes cornuatus envenomation.

Ixodes cornuatus is a tick that is widely distributed in Victoria, Tasmania and southern New South Wales. Serious human envenomation has not been reported previously. The clinical syndrome that results from envenomation by Ixodes cornuatus in a three-year-old boy is presented. Bulbar palsy and respiratory failure necessitated endotracheal intubation and mechanical ventilation for five days. Canine tick antivenom was administered.

Animals↗
PubMed1985

Drug overdose in children.

This paper reviews epidemiological factors, drugs taken, management and outcome of 478 children admitted to the Royal Children's Hospital with drug poisoning during the 5 years 1978-82. Accidental ingestion in young children is still common whilst self poisoning is increasing in the age group 8-17 years. Suicide attempts and self destructive ingestion accounted for 11.5% of all cases with two deaths. A significant number in this group were less than 10 years of age. Iatrogenic poisoning accounted for 11% of all cases with metoclopramide or prochlorperazine frequently involved. Benzodiazepines, major tranquillizers and antihistamines were the most commonly taken groups of drugs whilst the greatest number of admissions to Intensive Care Unit were due to tricyclic poisoning. Principles of management are discussed.

Accidents↗