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Biomedical subjects

A E Thompson

Publications and source records attributed to A E Thompson.

At least 37 records · Page 2Linked to original sources
PubMed1993

Extracorporeal membrane oxygenation for cardiac rescue in children with severe myocardial dysfunction.

OBJECTIVE: To assess the experience and efficacy of extracorporeal membrane oxygenation (ECMO) for cardiac rescue in patients with presumptively lethal cardiac dysfunction at the Children's Hospital of Pittsburgh. DESIGN: Retrospective analysis of patient records from a 9-yr period. SETTING: A 22-bed tertiary care pediatric intensive care unit (ICU) with an average of 1,400 admissions per year. An average of 150 open cardiotomy surgeries are performed per year, and all postoperative and severely ill cardiac patients are cared for in the ICU. PATIENTS: A total of 29 pediatric ICU patients with myocardial failure received ECMO throughout the 9-yr study period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Demographic information, underlying cardiac defect, intraoperative and postoperative data, postoperative course, details of ECMO treatment, and outcome were collected. Comparison of survivors with nonsurvivors was performed using the Mann-Whitney U test for continuous variables. Twenty-three (79%) of 29 patients recovered myocardial function while undergoing ECMO, 18 (62%) of 29 patients were successfully decannulated, and 13 (45%) of 29 patients survived to hospital discharge. Long-term survival rate was 11 (38%) of 29 patients. Three (60%) of five bridge-to-heart transplant patients survived. Eleven (65%) of 17 patients who suffered cardiac arrest before ECMO, survived to discharge and nine (53%) of these 17 patients remain long-term survivors. Survival rate in patients who required cardiac massage for > 15 mins before cannulation was six (55%) of 11 patients. CONCLUSIONS: Patients with severe myocardial dysfunction who fail conventional therapy can be successfully supported with ECMO during the period of myocardial recovery. ECMO can also provide a viable circulatory support system in patients with prolonged cardiac arrest who fail conventional resuscitation techniques. ECMO is also an effective means of support as a mechanical bridge to heart transplantation.

Cardiac Output, Low↗
PubMed1993

A prospective, randomized study of continuous versus intermittent nebulized albuterol for severe status asthmaticus in children.

OBJECTIVES: a) to determine if continuous nebulization of albuterol is more effective than intermittent nebulization in the treatment of children with status asthmaticus and impending respiratory failure; b) to determine the effect of continuous nebulization and intermittent nebulization on duration of hospital stay and bedside respiratory therapy care. DESIGN: Prospective, randomized study. SETTING: A pediatric intensive care unit (ICU) in a university children's hospital. PATIENTS: Seventeen pediatric asthmatic patients with severe status asthmaticus, with impending respiratory failure (Woods asthma score > or = 5), and without evidence of cardiac or other preexisting lung disease were admitted to the pediatric ICU. The patients were randomized to receive continuous nebulization (n = 9) or intermittent nebulization (n = 8) of albuterol. INTERVENTIONS: The asthmatic patients were randomized into two groups. The continuous group received 0.3 mg/kg/hr of albuterol by continuous nebulization; the intermittent group received 0.3 mg/kg of albuterol over 20 mins every hour. All patients received aerosol therapy through the same delivery system. MEASUREMENTS: Responses to therapy were evaluated by following asthma score, arterial blood gas values, hemodynamics, FIO2, and arterial oxygen saturation initially and at 30 mins, 1 hr, 2 hrs, 4 hrs, then every 4 hrs for a 24-hr time period. Patients were determined to no longer be in impending respiratory failure when their asthma score was < 5 for four consecutive hours. Electrocardiograms, serum electrolyte values, and creatine phosphokinase total and MB fraction values were obtained before and after treatment. Hospital stay and respiratory therapy time, in relative value units (one relative value unit = 10 mins) were analyzed from data collected from therapist bedside flow sheets. RESULTS: The patient characteristics (demographics, hemodynamics, arterial blood gas values, asthma severity, corticosteroid use, theophylline, and beta 2-adrenergic receptor agonist administration) before entry into the study did not differ between groups. Patients in the continuous group improved more rapidly and were out of impending respiratory failure sooner than patients in the intermittent group (continuous group = 12 (median) hrs (range 4 to 24) vs. intermittent group = 18 (median) hrs (range 12 to 24; p = .03). Bedside respiratory therapy time evaluated by relative value units was less for patients who received continuous nebulization of albuterol (continuous group = 14 (median) relative value units (range 6 to 26) vs. intermittent group = 33 (median) relative value units (range 25 to 49; p = .001). Hospital stay was shorter for patients who received continuous nebulization of albuterol (continuous group = 80 [median] hrs [range 51 to 173] vs. intermittent group = 147 [median] hrs [range 95 to 256]; p = .043). Hemodynamics, serum potassium, and creatine phosphokinase concentrations did not differ before and after the study in either group. CONCLUSIONS: In children with impending respiratory failure due to status asthmaticus, continuous nebulization of albuterol is safe and results in more rapid clinical improvement than intermittent nebulization. Respiratory therapy required at the bedside and duration of hospital stay were substantially less for patients receiving continuous nebulization of albuterol, which suggests that continuous nebulization of albuterol is more cost effective than intermittent nebulization.

Adolescent↗
PubMed1993

Capgras' syndrome presenting with violence following heavy drinking.

Two cases of Capgras' syndrome are described in which patients committed serious acts of violence towards family members who had become the subject of delusional misidentification. The cases illustrate some typical features of Capgras' syndrome including its potential for dangerousness. Intoxication with alcohol is proposed as a precipitant for violence in these patients.

Adult↗
PubMed1992

Validity of a disposable end-tidal CO2 detector in verifying endotracheal tube placement in infants and children.

STUDY OBJECTIVE: To examine the validity of a disposable, colorimetric end-tidal CO2 detector in verifying endotracheal tube (ETT) placement in infants and children. DESIGN: The detector was studied prospectively in 151 intubations. SETTING: Operating room, ICU, and emergency department of a children's hospital. PARTICIPANTS: One hundred thirty-seven children undergoing endotracheal intubation for anesthesia (52), respiratory support (76), or CPR (23). INTERVENTIONS: After endotracheal intubation, tube position was verified, the detector was attached, and readings were obtained. MEASUREMENTS AND RESULTS: The detector correctly identified tube position (trachea, 124; esophagus, four) in all 120 patients who were not in cardiac arrest (P less than .01). In the cardiac arrest setting, all six esophageal intubations were correctly identified, but two of the 17 tracheal intubations were incorrectly interpreted as esophageal intubations (P less than .01). CONCLUSION: The detector accurately identifies ETT position in children with spontaneous circulation who weigh more than 2 kg. During CPR, a positive test correctly indicates that the ETT is in the airway, but a negative result (suggesting esophageal placement) requires an alternate means of confirming ETT position.

Adolescent↗
PubMed1992

Lung mechanics during and after extracorporeal membrane oxygenation for meconium aspiration syndrome.

OBJECTIVE: To determine whether abnormalities in lung mechanics detected in infants during the acute phase of meconium aspiration syndrome persist after treatment with extracorporeal membrane oxygenation (EMCO). DESIGN: Prospective, descriptive study. Prospective evaluation of airway function and lung mechanics during and after ECMO by pulmonary function testing at 1.8 +/- 0.5 days of EMCO (period 1), follow-up at 1.4 +/- 0.2 days (period 2), and 7.0 +/- 0.9 days (period 3) after decannulation from ECMO. SETTING: Tertiary care neonatal/pediatric ICU. PATIENTS: Twelve neonates undergoing ECMO treatment for severe meconium aspiration syndrome that was refractory to conventional mechanical ventilation. INTERVENTIONS: Maximum expiratory flow-volume curves were studied with the deflation flow-volume curve technique, and compliance and resistance of the respiratory system were studied with partial passive flow-volume curves. MEASUREMENTS AND MAIN RESULTS: Respiratory system compliance was the only index of respiratory mechanics that was significantly (p less than .05) improved (0.96 +/- 0.1 vs. 0.61 +/- 0.1 mL/cm H2O/kg) immediately after decannulation from ECMO compared with period 1. Clinically important (p less than .05) improvement in forced vital capacity (28.0 +/- 5.5 vs. 16.1 +/- 1.9 mL/kg), respiratory system compliance (1.01 +/- 0.2 vs. 0.61 +/- 0.1 mL/cm H2O/kg), and maximum expiratory flow at 25%/forced vital capacity (1.0 +/- 0.3 vs. 2.2 +/- 0.3) was evident only during period 3 compared with period 1. CONCLUSIONS: We conclude that improvements in the clinical condition and oxygenation, permitting successful decannulation from ECMO, are achieved before clinically important improvements in lung mechanics.

Acute Disease↗
PubMed1992

Extracorporeal membrane oxygenator rescue in children during cardiac arrest after cardiac surgery.

BACKGROUND: Conventional cardiopulmonary resuscitation (CPR) for cardiac arrest after open-heart surgery in children is often unsuccessful despite the ability to perform open-chest massage. The purpose of this study was to review our results with mechanical support as rescue therapy in children with sudden circulatory arrest after cardiac surgery. METHODS AND RESULTS: From 1981 through 1991, we have used mechanical support with an extracorporeal membrane oxygenator (ECMO) circuit for cardiac support in 33 children. Eleven of the 33 patients (age, 15 +/- 7 months) suffered cardiac arrest intractable to conventional open-chest massage 39 +/- 15 hours after an open-heart procedure. The mean duration of CPR was 65 +/- 9 minutes until ECMO flow was started. ECMO support was continued for 112 +/- 8 hours. One patient had ECMO discontinued due to bleeding (survived); three were discontinued from ECMO and died from neurological complications; and one died of cardiac dysfunction. Sepsis on ECMO was seen in one patient (survived). Overall early survival was seven of 11 (64%) with one patient requiring heart transplantation due to irreversible cardiac dysfunction. One child died late (1 month) after ECMO support. There were no long-term sequelae in the survivors. CONCLUSIONS: We conclude that ECMO rescue in children with postcardiotomy cardiac arrest is a feasible option in selected patients even after prolonged CPR (as long as 60 minutes).

Cardiac Surgical Procedures↗
PubMed1992

Utility of an end-tidal carbon dioxide detector during stabilization and transport of critically ill children.

Critically ill children often require endotracheal intubation prior to transport to a medical center. Correct endotracheal tube placement and maintenance during transport are essential. The utility of a portable colorimetric end-tidal CO2 detector during transport of critically ill children was evaluated. Fifty-eight children with spontaneous circulation (aged 1 day to 12 years, weight 0.9 to 26 kg) who underwent 59 intubations during transport by ground (n = 31) or air (n = 27) were studied. Tube position was confirmed by physical examination, arterial blood gas values, or arterial oxygen saturation, and sometimes by chest radiography. The detector was attached and readings were obtained after intubation; readings were repeated if endotracheal tube position was rechecked during transport. Fifty-seven of 58 tracheal positions and the 1 esophageal tube position were correctly identified. One false-negative result occurred in a severely hypocarbic 900-g premature newborn. On each occasion that the detector was used en route, the endotracheal tube position was correctly identified. It is concluded that the end-tidal CO2 detector is a useful tool for confirming endotracheal tube position during transport of critically ill children weighing more than 2 kg who are not in cardiopulmonary arrest.

Body Weight↗
PubMed1991

Correction of ulnar drift during silastic metacarpo-phalangeal joint arthroplasty.

In previous published accounts of silastic replacement arthroplasty of the M.P. joint of the finger in rheumatoid disease, dynamic splintage has been used for up to six months after operation to ensure correction of ulnar drift. We have investigated two methods of surgical correction in a prospective trial in consecutive patients. No dynamic splintage was used. Both resulted in correction of ulnar drift from an average of 34 degrees (maximum 92 degrees) to 8 degrees (maximum 32 degrees) in 86 fingers. The two methods both corrected ulnar drift well, but crossed intrinsic transfer gave a better range of active movement and is recommended as an alternative to dynamic splintage.

Activities of Daily Living↗
PubMed1991

Validity of a disposable end-tidal carbon dioxide detector in verifying endotracheal tube position in piglets.

BACKGROUND AND METHODS: the most reliable methods for confirming endotracheal tube placement are direct visualization of passage through the vocal cords and documentation of CO2 in the expired gas. We evaluated the use of a disposable colorimetric CO2 detector for verifying endotracheal tube position in small animals. The end-tidal CO2 (Petco2) detector was tested in 11 piglets with the endotracheal tube sequentially in the trachea, the esophagus, the esophagus with a carbonated beverage in the stomach, the esophagus after bag-mask ventilation. Endotracheal tube position was confirmed in all cases by direct visualization and capnometry. RESULTS: The Petco2 detector identified the tube placement accurately in all 54 (21 tracheal, 33 esophageal) intubations (p less than .001). CONCLUSIONS: This disposable Petco2 detector is highly sensitive and specific for verifying endotracheal tube placement in this nonarrest piglet model.

Animals↗
PubMed1991

Ten years of extracorporeal membrane oxygenation: neurodevelopmental outcome.

Cf the 87 survivors of extracorporeal membrane oxygenation over a 10-year period, 67 participated in a follow-up study which included neurologic examination (n = 67), cognitive testing (n = 67), and audiologic assessment (n = 33). Matched control subjects for those older than 5 years were also evaluated. Outcome was defined as normal for cognitive scores greater than or equal to 85 and normal neurologic examination results, suspect for cognitive scores 70 through 84 or nonfocal neurologic findings such as hypertonia/hypotonia, and abnormal for cognitive scores less than 70 or abnormal neurologic examination results. Of the 10 school-aged children studied, 9 were normal and there were no differences in mean cognitive scores between subjects and controls (IQ subjects = 109 +/- 12 [SD], IQ controls = 107 +/- 13). For preschoolers aged 2.7 through 4.11 years, the mean cognitive score was 91 +/- 11 and 7 (70%) were normal. For infants 6 through 30 months, the mean cognitive score was 101 +/- 22 and 27 (57%) were normal. A total of 7 children (21% of those studied) had abnormal audiologic assessments. Three children demonstrated mild high-frequency and 4 moderately severe high-frequency sensorineural hearing loss which was bilateral in 3 and of undetermined laterality in 1. Abnormal neurodevelopmental outcome was significantly associated with cerebral infarction and chronic lung disease. Outcome was not related to demographic or perinatal variables, illness severity prior to extracorporeal membrane oxygenation, or underlying diagnosis. Neurodevelopmental outcome among survivors of extracorporeal membrane oxygenation in this series is consistent with previous reports of morbidity among neonates with severe respiratory failure treated conventionally.

Child↗
PubMed1989

Otitis media in the pediatric intensive care unit: a prospective study.

Otitis media has been previously shown to be a source of sepsis in the pediatric intensive care unit; however, pneumatic otoscopy and other otologic instruments are not commonly used in the pediatric intensive care unit. We undertook a prospective study to determine the prevalence of otitis media, to assess the risk factors involved with the development of these nosocomial infections, and to identify the causative organisms. We conclude that otitis media is a common entity in the pediatric intensive care unit, that it is probably caused by prolonged dysfunction of the eustachian tube associated with oral and nasally-placed tubes and that the bacteriology reflects that of the hospital environment and not that of the community.

Child↗
PubMed1988

Percutaneous infraclavicular subclavian vein catheterization in critically ill infants and children.

The safety and risks of percutaneous infraclavicular subclavian vein catheterization, when performed by nonsurgical staff, were studied prospectively in 100 consecutive patients. The overall success rate was 92% (with one attempt, 45%; with two attempts, 85%). The procedure was performed under emergency conditions in 35% of the patients, with a success rate of 88.6%. The success rate was significantly lower in younger patients. Hemodynamic status, respiratory status, and level of expertise of the individual performing catheterization did not affect success rate. Most of the failures (six of eight) were related to presumed thrombosis from prior cannulation of the superior vena cava. Mean duration of catheterization was 7.5 +/- 5.8 days (+/- SD). Minor complications (n = 24) included hematomas, minor bleeding from subclavian artery puncture, and transient premature ventricular ectopic beats. Major complications (n = 6) were pneumothoraces (n = 4) and catheter-related infection (n = 2). The number of attempts made to catheterize the vessel and the level of expertise of the operator had the greatest effect on complication rates. No mortality was associated with this procedure. We have found percutaneous infraclavicular subclavian vein catheterization to be a rapid alternative to surgical cutdown for venous access during cardiopulmonary resuscitation. Pediatric residents can be trained, under direct supervision, to perform this procedure with a high success rate and a low complication rate.

Catheterization, Central Venous↗
PubMed1987

Isoenzymes of urinary N-acetyl-beta-D-glucosaminidase (NAG) in patients with renal transplants.

Renal transplant recipients were divided into five categories according to their clinical course from transplantation to their discharge from hospital. Total N-acetyl-beta-D-glucosaminidase (NAG) activity in urine was determined using a chromogenic substrate 2-methoxy-4-(2'-nitrovinyl)-phenyl 2-acetamido-2-deoxy-beta-D-glucopyranoside. The isoenzyme composition of the urine of each patient was determined by semi-automated DEAE-cellulose chromatography. Although raised NAG activity was found in stable transplant patients compared to controls, the level of activity was constant and no change in the isoenzyme profile was found. In reversible rejection there was a marked increase in the intermediate forms, particularly I2 and a concomitant fall in the relative amount of the A-form present but the profile became normal when the patient stabilised. Much more complex patterns were observed in patients who did not respond to treatment. Both the B and I forms were elevated with a fall in the A-form and in one case excretion of the serum As form was observed. The intermediate forms were always increased in rejection.

Acetylglucosaminidase↗