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Biomedical subjects

M M Pollack

Publications and source records attributed to M M Pollack.

At least 91 records · Page 5Linked to original sources
PubMed1987

Long-stay pediatric intensive care unit patients: outcome and resource utilization.

Outcome, resource utilization, and health care characteristics of patients staying in a multidisciplinary pediatric intensive care unit (PICU) for more than 13 days (long-stay patients) were analyzed. Of 647 children admitted consecutively, 46 were long-stay patients. Compared with short-stay patients, long-stay patients were significantly younger and sicker and had a higher incidence of chronic disease. Most important, long-stay patients had significantly higher PICU mortality rates (17.4% v 7.3%, P less than .05) and hospital mortality rates (23.9% v 8.7%, P less than .01) than short-stay PICU patients. Although only 7.1% of the patient sample, long-stay patients consumed approximately 50% of all PICU resources. One-year follow-up on those long-stay patients surviving their hospitalization revealed that 58% had died or were severely disabled. Long-stay patients had relatively poor prognoses and consumed health care resources in excess of their numeric proportions.

Age Factors↗
PubMed1986

Shock following generalized hypoxic-ischemic injury in previously healthy infants and children.

Eighteen previously healthy patients with hypoxic-ischemic shock were observed longitudinally by means of data measured or derived from systemic arterial and pulmonary artery catheters. Shock was characterized by low cardiac index, elevated right and left heart filling pressures, elevated systemic and pulmonary vascular resistances, decreased oxygen consumption, and elevated oxygen extraction indices. Oxygen consumption was significantly correlated with oxygen delivery (r = 0.74, P less than 0.0001). This pattern fits that of cardiogenic shock. Cardiopulmonary data were not significantly different in survivors (n = 10) and nonsurvivors (n = 8). Outcome was determined by neurologic injury.

Blood Pressure↗
PubMed1986

Effectiveness of continuous positive airway pressure in the treatment of bronchomalacia in infants: a bronchoscopic documentation.

Continuous positive airway pressure (CPAP) was used to treat severe respiratory distress in four infants with bronchomalacia. Fiberoptic bronchoscopy diagnosed the area of bronchomalacia, documented the effects of CPAP on the airway, and helped determine an effective level of CPAP. CPAP immediately decreased respiratory distress, and was correlated with improved airway patency in the formerly collapsed airways. All four infants, including three who had required prolonged mechanical ventilation, maintained spontaneous ventilation on CPAP.

Bronchial Diseases↗
PubMed1986

Dynamic assessment of severity of illness in pediatric intensive care.

Severity of illness in 293 pediatric ICU patients was assessed by a daily estimate of ICU survival. The probability of nonsurvival was obtained by logistic regression analysis, using physiologic stability index (PSI) values from previous days as time-dependent covariates. Only PSI values from the previous 2 days gave statistically significant predictions of short-term (less than 24 h) outcome. When the prediction model derived from these data was tested prospectively on a separate set of 345 pediatric patients, there was excellent agreement between observed and predicted short-term mortality. Receiver operating characteristic curves for the 345 patients were statistically equivalent to those originally derived for the 293 patients, and this prediction model had significantly (p less than .025) more accuracy than prediction based on admission PSI. These results indicate that this model for daily risk assessment is statistically reliable and objective, as verified against eventual outcome. In the 345 patients, ICU mortality was predicted with 89% sensitivity and 91% specificity. This prediction model may be used to stratify patient groups for clinical studies, or identify very low-risk patients for potential early ICU discharge.

Child↗
PubMed1986

Outcome of pediatric patients with multiple organ system failure.

The association of multiple organ system failure (MOSF) with mortality was investigated in 831 consecutive admissions to a pediatric ICU. The incidence of MOSF (at least two organ system failures, OSF) was 27%. Of the 62 nonsurvivors, 60 (97%) had MOSF. The mortality for patients with MOSF was 54%, compared to a mortality of 0.3% for patients without MOSF. Mortality increased directly with increasing number of OSF (p less than .0001). The mortality was 1% for one OSF, 11% for two OSF, 50% for three OSF, and 75% for four OSF. Comparison of these results with data from adult ICU patients indicates that the mortality and clinical course of MOSF in children is distinct from adults. MOSF is significantly associated with mortality in pediatric patients; however, it is not sufficiently discriminating to determine continuation or withdrawal of ICU support.

Adolescent↗
PubMed1985

Distributions of cardiopulmonary variables in pediatric survivors and nonsurvivors of septic shock.

The association of cardiopulmonary variables with outcome was investigated in 42 pediatric patients (18 survivors) with septic shock. All cardiopulmonary variables were obtained during active BP support. The variable distributions were separated into ranges by two empiric cutoff methods: normal ranges and the survivor median values. The proportion of survivors with normal values of wedge pressure and cardiac index was significantly (p less than .05) higher than the proportion of survivors outside the normal range. The percentage of survival also significantly (p less than .05) increased with above-normal values of oxygen consumption, arteriovenous O2 content difference, O2 extraction, pH, and core temperature. There were significantly (p less than .05) more nonsurvivors with wedge pressure, pulmonary shunt, and pH values below the survivor medians. Therapeutic goals based on the distributions of these eight variables isolated patient groups with survival rates of 59% to 75%, compared to the overall survival rate of 43%.

Adolescent↗
PubMed1985

Monitoring patients in pediatric intensive care.

All admissions to a 16-bed multidisciplinary pediatric intensive care unit (PICU) were evaluated during two time periods totaling 13.5 months. Daily evaluations of therapeutic and monitoring care modalities were accomplished with the Therapeutic Intervention Scoring System (TISS) and daily assessments of severity of illness were done by using the Physiologic Stability Index. Of the 822 patients included in this study, 226 (27.5%) never received a therapy that could only be given in the PICU. These patients were known as the monitoring group and used 7.5% (297/3,969) of the bed days. The percentage of Therapeutic Intervention Scoring System points used by the monitoring patients was 3.6% (3,575/100,109). All patients who were monitored survived; 213 (94.2%) were classified as low mortality risk based on their level of physiologic stability. These data indicate that a significant percentage of PICU patients never receive a therapy that requires the PICU but only receive monitoring and routine care techniques. Significant reductions in PICU use could occur with more efficient usage.

Child↗
PubMed1984

Evaluation of pediatric intensive care.

A total of 294 Clinical Classification System (CCS) Classes III and IV patients in a pediatric ICU (PICU) were evaluated in terms of severity of illness and quantity of care. The group was comprised of patients from 3 services: medicine, cardiovascular surgery, and other surgery. Severity of illness was measured by the Physiologic Stability Index (PSI) and quantity of care was measured by the Therapeutic Intervention Scoring System (TISS). Comparisons were made between survivors and nonsurvivors and among the 3 services. Nonsurvivors had significantly higher (p less than .01) PSI and TISS scores than survivors. Medical patients had the highest PSI scores while cardiovascular surgery patients had the highest TISS scores. Analysis of 7-day regression slopes for all survivor groups and medicine and other surgery nonsurvivor groups demonstrated slopes consistent with the expected clinical course. Cardiovascular surgery nonsurvivor slopes were unique and demonstrated increasing stability with stable amounts of care. The PSI/TISS ratio was used to relate levels of physiologic instability to the amount of therapy. Medical patients had the highest ratios and cardiovascular surgery patients had the lowest ratios. Comparisons of survivors and nonsurvivors for the PSI/TISS ratios and regression slopes demonstrated differences that were not evident through comparison of PSI and TISS scores alone.

Child↗
PubMed1984

Sequential cardiopulmonary variables of infants and children in septic shock.

Sequential cardiopulmonary variables were analyzed in 32 infants and children with septic shock. Variables were staged by a system based on therapeutic efforts to control blood pressure. There were 14 survivors and 18 nonsurvivors. Systemic circulation variables (MAP, cardiac index [CI], systemic vascular resistance index [SVRI], wedge pressure [WP], left cardiac work index [LCWI]) and pulmonary circulation variables (mean pulmonary artery pressure [MPAP], pulmonary vascular resistance index [PVRI], CVP, right cardiac work index [RCWI]) were similar in survivors and nonsurvivors. Pulmonary variables (intrapulmonary shunt [Qsp/Qt], fraction of inspired oxygen [FIO2], Pao2, PaCO2) revealed significantly more dysfunction in nonsurvivors than survivors during the postresuscitation (PR) and middle (M) shock stages. Even though oxygen delivery was equivalent in survivors and nonsurvivors, nonsurvivors demonstrated decreased oxygen utilization variables (oxygen consumption [Vo2], arteriovenous oxygen content difference [C(a-v)O2], O2 extraction index, core temperature) during the resuscitation (RS) and PR stages.

Blood Circulation↗
PubMed1984

Validation of a physiologic stability index for use in critically ill infants and children.

We developed a physiology-based scoring system, the Physiologic Stability Index (PSI) to assess severity of acute illness in the total population of pediatric Intensive Care Unit (ICU) patients. Thirty-four variables from seven physiologic systems were chosen, and the degree of abnormality of each variable was assigned a score reflecting the clinical importance of the derangements. Validity was demonstrated by comparing PSI to hospital mortality and to two other methods that reflect severity of illness, the Clinical Classification System (CCS) and the Therapeutic Intervention Scoring System ( TISS ). Four hundred and twenty-three consecutive admissions to a multidisciplinary ICU were followed daily. Patients classified into higher CCS classes had significantly higher PSI scores (P less than 0.001), and there was a highly significant correlation (P less than 0.001) between PSI and TISS scores. The linear-logistic regression of observed mortality versus PSI was highly significant (P less than 0.0001) and provided an excellent fit. Highly significant differences between survivors and nonsurvivors were observed for PSI scores (P less than 0.001), as well as for composite slopes of the regression of PSI scores versus days of care (P less than 0.001). These data demonstrate validity of the PSI scoring system.

Acute Disease↗
PubMed1983

Pulmonary artery catheterization in pediatric intensive care.

Pulmonary artery catheterization has become a routine part of pediatric intensive care even for small infants. Measured and derived variables provide clinicians with better understanding of the patient's cardiovascular and pulmonary systems and provide the means by which the results and complications of therapy may be monitored. While significant complications from pulmonary artery catheterization do occur, the risks are acceptable and warranted. Proper patient selection, strict attention to detail in all aspects of catheter use, and prompt removal will help to minimize complications.

Blood Pressure↗
PubMed1982

Assessment of pediatric intensive care--application of the Therapeutic Intervention Scoring System.

There are few reports analyzing the results of intensive care for children. We evaluated quantitatively the amount of care required in our multidisciplinary pediatric ICU using the Therapeutic Intervention Scoring System (TISS) and assessed qualitatively the severity of illness using the Clinical Classification System (CCS). Over a 6-month period, there were 323 patients (99 CCS Class II, 83 Class III, 141 Class IV) whose overall mortality at 1-month follow-up was 10% (Class II, 0%; Class III 2%; Class IV, 23%). A strong association was obtained between CCS and TISS admission scores (Class II-TISS, 11 +/- 0.6; Class III-TISS, 20 +/- 0.8; Class IV-TISS, 38 +/- 1.0). Class IV patients had a highly significant difference between survivors (S) and nonsurvivors (NS) for admission TISS (S = 36, NS = 47, p less than 0.001) and highest TISS (S = 38, NS = 54, p less than 0.001), as well as slopes of the regression of TISS points versus days of care (S = -4.2 vs. NS = +2.3). The mortality of our Class IV patients was lower than a comparable adult population with similar TISS scores; however, the TISS regression slopes for Class IV patients were similar. We conclude that CCS and TISS are both useful for describing the pediatric intensive care patient population. TISS is particularly helpful in assessing the amount of care received as well as providing a means of evaluating severity of illness.

Child↗
PubMed1981

Aspiration of activated charcoal and gastric contents.

A case of aspiration of activated charcoal and gastric contents is reported. The patient developed immediate airway obstruction treated by endotracheal intubation and suctioning. Protracted respiratory insufficiency characterized by severe bronchospasm developed after airway obstruction was alleviated.

Airway Obstruction↗
PubMed1981

Early nutritional depletion in critically ill children.

Nutritional status was evaluated in 50 medical admissions to a pediatric ICU. All patients were evaluated within 48 h of admission; none had chronic organ failure or malignancies. Nutritional assessment included weight/50th percentile weight for length, length/50th percentile length for age, triceps skinfold thickness, and midarm muscle circumference. Acute protein-energy malnutrition (PEM) occurred in 16% of all children. Chronic PEM also occurred in 16%. The nutrient stores of fat and somatic protein were deficient in 18 and 20% of all children. Acute PEM and deficient somatic protein stores were more frequent in children less than 2 years (p less than 0.05). These findings indicate that malnutrition and nutrient store deficiencies are common early in the course of critical illnesses in children, especially in those less than 2 years of age. However, the findings do not indicate if the severity of illness was the cause or effect of poor nutritional status.

Acute Disease↗