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At least 199 records · Page 11Linked to original sources
PubMed1993

Electroencephalographic and neuroimaging findings in neonates undergoing extracorporeal membrane oxygenation.

Electroencephalograms (EEGs) were recorded on 36 infants who were treated with arteriovenous extracorporeal membrane oxygenation (ECMO) between 1986 and 1989. Twelve of 36 infants had EEGs prior to and during ECMO. Twenty-one infants who met ECMO criteria but were treated with mechanical ventilation only served as a comparison (COMP) group. Electrographic seizures occurred in 7 of the 36 (19%) ECMO patients and in 3 of the 21 (14%) COMP patients. Five of 7 ECMO infants had electrographic status epilepticus. Three infants developed electrographic seizures during ECMO in association with an acute cerebral injury. These patients did not have significant hemispheric predominance in the origin of electrographic seizures (2 right, 3 left and 2 bilateral). Repetitive or periodic discharges (RPD) with frequencies between 0.5 and 5 Hz were seen after starting therapy in 23 of the 36 (64%) ECMO patients and 15 of the 21 (71%) of the COMP group. Only in the ECMO patients did RPD arise significantly more frequently from the right hemisphere (13 right, 4 left and 6 bilateral; p = 0.015). Neuroimaging studies showed evidence of ischemic lesion in 8 of the 36 (22%) ECMO patients with significantly right-sided predominance (5 right, 1 left and 2 bilateral; p = .05). Cerebellar hemorrhages occurred in 3 ECMO patients. Ischemic lesions occurred in 3 of the 21 (14%) COMP patients, all occurring on the left side. In the ECMO group, severe outcome or death was significantly associated with the presence of electrographic seizures, status epilepticus, and suppression-burst pattern (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Brain Injuries↗
PubMed2003

Long-term follow-up of home mechanical ventilation in young children with spinal cord injury and neuromuscular conditions.

OBJECTIVES: To provide outcomes of two decades of experience in home ventilation of children with spinal cord injury and neuromuscular conditions. STUDY DESIGN: Data were collected through chart review and interviews on 39 children who had become ventilator-dependent before their 6th birthday; 23 children had neuromuscular diseases and 16 had spinal cord injuries. RESULTS: Patients required an average of 0.7 rehospitalizations per year. There were 8 deaths. Survival rates were 97% at 1 year, 97% at 3 years, 84% at 5 years, and 71% at 10 years. Thirty children attended school, 13 were in regular school (1 at university level), 5 were home-schooled, 5 were in special education schools, and 5 were in regular school with some special education classes. One graduated high school, and another graduated university and received a graduate degree. Three children had progressive weakness. Two gained significant muscle strength. CONCLUSIONS: Our experience showed that these patients can be discharged to home with low morbidity and mortality rates and successful reintegration into the community.

Child↗
PubMed1999

Incidence, ultrasonic patterns and resolution of nephrocalcinosis in very low birthweight infants.

This longitudinal study was undertaken in order to elucidate the incidence and natural course of nephrocalcinosis in preterm infants and to evaluate whether the ultrasonic classification for nephrocalcinosis used here is suitable for predicting subsequent resolution of the condition. A total of 129 very low birthweight infants were screened for nephrocalcinosis by renal ultrasonography at 2 wk, 6 wk and 3 mo. The pyramidal changes were classified as peripheral, scattered or extensive. Follow-up renal ultrasonography was performed on the infants with nephrocalcinosis at 6, 12, 18 and 24 mo, and thereafter annually up to 6 y of age, or until ultrasonic resolution. The overall incidence of nephrocalcinosis was 20% (26/129). Nephrocalcinotic changes were peripheral in 14 out of the 26 infants (54%), scattered in 7 (27%) and extensive in 5 (19%). Ultrasonic resolution had taken place in all the cases with peripheral nephrocalcinosis by 12 mo, but 3 of the 7 infants with the scattered pattern and 3 of the 4 with the extensive pattern (1 died) were still affected at 24 mo. In two cases with extensive nephrocalcinosis the condition still persisted at 5-6 y of age. We conclude that about 20% of very low birthweight infants develop nephrocalcinosis during the first 3 mo of life. In about half of the affected infants renal changes are restricted and transient, but more extensive forms may last several years. The classification of nephrocalcinosis used here is appropriate for predicting later ultrasonic resolution.

Anti-Inflammatory Agents↗
PubMed2004

Automated detection of obstructive sleep apnoea at different time scales using the electrocardiogram.

An automated classification algorithm is presented which processes short-duration epochs of surface electrocardiogram data derived from polysomnography studies, and determines whether an epoch is from a period of sleep disordered respiration (SDR) or normal respiration (NR). The epoch lengths considered were 15, 30, 45, 60, 75, and 90 s. Epochs were labeled as 'NR' or 'SDR' by a human expert, based on standard polysomnography interpretation rules. The automated classification algorithm was trained and tested on a database of 70 overnight ECG recordings from subjects with and without obstructive sleep apnoea syndrome (35 used for training, 35 for independent validation). Depending on the epoch length, the classifier correctly labeled between 87% (15 s epochs) and 91% (60 s epochs) of the epochs in the test set. Accuracy was lowest for the shortest (15 s) and longest (90 s) epoch lengths, but the analysis was relatively insensitive to choice of epoch length. The classifications from these epochs were combined to form an overall summary measure of minutes-of-SDR, allowing per-subject classification.

Adult↗
PubMed1998

Respiratory complications associated with tracheal intubation and extubation.

We conducted a prospective survey on the incidence of respiratory complications associated with tracheal intubation and extubation in 1005 patients who underwent elective general anaesthesia over a 4-month period. During induction of anaesthesia, respiratory complications occurred in 46 patients (4.6%; 95% confidence limits (CL): 3.3, 5.9%). The common complications were coughing (1.5%) and difficult ventilation through a facemask (1.4%). Tracheal intubation was difficult in eight patients (0.8%). Complications occurred immediately after tracheal extubation in 127 patients (12.6%; 95% CL: 10.6, 14.7) and in the recovery room in 95 patients (9.5%; 95% CL: 7.6, 11.3%). The common complications immediately after extubation were coughing (6.6%) and oxygen desaturation (SaO2 < 90%) (2.4%), and in the recovery room, airway obstruction (3.8%) and coughing (3.1%). The incidence of complications was significantly higher immediately after tracheal extubation than during induction of anaesthesia (P << 0.001). Even when all incidents of coughing that occurred after tracheal extubation were disregarded as a complication, the overall incidence was still higher immediately after extubation (7.4%) than during induction of anaesthesia (P < 0.01). We conclude that the incidence of respiratory complications associated with tracheal extubation may be higher than that during tracheal intubation.

Adolescent↗
PubMed1991

Myocardial perfusion as assessed by thallium-201 scintigraphy during the discontinuation of mechanical ventilation in ventilator-dependent patients.

Patients who cannot be separated from mechanical ventilation (MV) after an episode of acute respiratory failure often have coexisting coronary artery disease. The authors hypothesized that increased left ventricular (LV) wall stress during periods of spontaneous ventilation (SV) could alter myocardial perfusion in these patients. Using thallium-201 (201TI) myocardial scintigraphy, the authors studied the occurrence of myocardial perfusion abnormalities during periods of SV in 15 MV-dependent patients (nine women, six men; aged 71 +/- 7 yr, mean +/- SD). Fourteen of these patients were studied once with 201TI myocardial scintigraphy during intermittent mechanical ventilation (IMV) and again on another day, after at least 10 min of SV through a T-piece. One patient was studied during SV only. Thirteen of 14 of the patients (93%) studied during MV had abnormal patterns of initial myocardial 201TI uptake, but only 1 patient demonstrated redistribution of 201TI on delayed images. The remainder of the abnormalities observed during MV were fixed defects. SV produced significant alterations of myocardial 201TI distribution or transient LV dilation, or both, in 7 of the 15 patients (47%). Four patients demonstrated new regional decreases of LV myocardial thallium concentration with redistribution of the isotope on delayed images. The patient studied only during SV also had myocardial 201TI defects with redistribution. Five patients (3 also having areas of 201TI redistribution) had transient LV dilation during SV.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Preventing diaphragm fatigue in the ventilated patient.

Diaphragm fatigue is a physiologic consequence of acute and chronic respiratory conditions. By understanding the physiology of this phenomenon, the critical care nurse can prevent this respiratory complication in ventilated patients.

Critical Care↗