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Biomedical subjects

D A Notterman

Publications and source records attributed to D A Notterman.

9 recordsLinked to original sources
PubMed1992

Measurements of central blood vessels in infants and children: normal values.

In order to provide physicians interpreting vascular radiographic studies with normal data regarding central blood vessel size in children and to facilitate the design and adaptation of intravascular devices for pediatric use, we measured lengths and diameters of central blood vessels in 141 radiographic studies in 136 children. The diameters of the following vessels were determined: right and left internal jugular veins and common carotid arteries; the inferior vena cava and the descending thoracic aorta; right and left iliac veins; and right and left femoral veins and arteries. In addition, the lengths of the inferior vena cava and the descending aorta were also determined. Blood vessel dimensions were highly correlated with age, height, weight, and body surface area. The linear regression equations for each measured dimension against age, weight, height, and surface area are provided, along with a table of predicted vessel size as a function of age.

Adolescent↗
PubMed1992

Acute hypoxemic respiratory failure in infants and children: clinical and pathologic characteristics.

OBJECTIVE: To examine the clinical and pathologic features of acute hypoxemic respiratory failure in children. DESIGN: Retrospective review of medical records and pathologic material during a 44-month period. SETTING: Multidisciplinary pediatric ICU. PATIENTS AND METHODS: With the assistance of a computerized database, the medical records of 2,254 pediatric ICU admissions were evaluated to identify children with respiratory failure. Children with acute hypoxemic respiratory failure who met the following definition were selected for inclusion: a) PaO2 less than 75 torr (less than 10.0 kPa) with an FIO2 of greater than 0.5; b) diffuse bilateral infiltrates on chest radiograph; and c) exclusion of cardiogenic pulmonary edema clinically or by pulmonary artery catheterization. Patients were excluded if they did not receive tracheal intubation and assisted ventilation. The medical records were reviewed for demographic, clinical, and physiologic information. Pathologic findings from autopsy or lung biopsy were also reviewed. Patients were placed in one of six groups based on their underlying disorder. In addition, the presence of neutropenia, septic shock, or a history of bone marrow transplantation was noted as a coexisting condition. MAIN RESULTS: A total of 100 acute hypoxemic respiratory failure patients were identified (4.4% of all 2,254 pediatric ICU admissions; 50 male, 50 female). Mean age was 6.0 +/- 5.4 (SD) yrs (range 1 month to 18 yrs). The overall mortality rate was 72%. The mortality rate was not affected by the underlying disorder, but it was higher in the presence of septic shock (80% vs. 58%; odds ratio 2.8), neutropenia (88% vs. 64%; odds ratio 4.0), and bone marrow transplantation (95% vs. 66%; odds ratio 10.4). When multivariate regression analysis was performed using all coexisting conditions, human immunodeficiency virus status, and patient gender, only a history of bone marrow transplantation and gender appeared to affect outcome. Oxygenation ratio (PaO2/FIO2), alveolar-arterial oxygen tension difference, duration of exposure to high levels of oxygen, and airway pressure measurements indicated more severe derangement of pulmonary function in those patients who died. Cardiac function was similar in survivors and nonsurvivors. Respiratory failure occurred in 32 children with severe neutropenia (mean absolute neutrophil count 55 +/- 101 cells/mm3), including 16 children with an absolute neutrophil count of 0. Pulmonary tissue from 37 children was studied. Diffuse alveolar damage was observed in 24%; morphologic evidence of infectious pneumonitis was encountered in an additional 41%. CONCLUSIONS: Children with acute hypoxemic respiratory failure represent a heterogeneous subset of patients. In our group of patients, infectious pneumonitis was more commonly encountered than diffuse alveolar damage. The mortality rate of children with acute hypoxemic respiratory failure has not improved since 1980.

Acute Disease↗
PubMed1992

Fluid resuscitation in pediatrics.

Early recognition of hemodynamic instability in the pediatric patient, followed by prompt intervention, is the key to successful resuscitation. Fluid management for patients in shock must be adjusted according to the patient's age and size and the pathophysiology of the underlying condition. The identification, evaluation, and fluid therapy for children presenting with shock are reviewed.

Adolescent↗
PubMed1991

Inotropic agents. Catecholamines, digoxin, amrinone.

Three broad categories of pharmacologic support that enhance myocardial contractility and modify organ blood flow are reviewed. Appropriate selection among these compounds will minimize the occurrence of adverse effects. The catecholamines increase cardiac work and myocardial oxygen demand. In the setting of a failing ventricle, the increase in oxygen requirement may be balanced by improved coronary blood flow. Problems associated with catecholamines include tachycardia, induction of dysrhythmias, and unsuitable vasoconstriction. Epinephrine and isoproterenol are most likely to increase heart rate excessively. Norepinephrine is most likely to be associated with poor tissue perfusion. Amrinone, a bipyridine, has a favorable effect on oxygen balance in the failing ventricle and is unlikely to produce tachycardia or dysrhythmias. Principal concerns are the potential for accumulation in the patient with multiple organ system failure and the lack of pharmacokinetic information in critically ill patients, including children. Thrombocytopenia may be a problem as well. Digitalis glycosides are venerable drugs. Acute and chronic toxicity are problems that the intensivist is called on to treat frequently. Therapy with digitalis Fab fragments is now routine for severe intoxications and should improve outcome.

Amrinone↗
PubMed1990

Dopamine clearance in critically ill infants and children: effect of age and organ system dysfunction.

To learn if there are age-related differences in the pharmacokinetic behavior of dopamine, plasma dopamine clearance was determined in 27 acutely ill infants and children who were receiving a continuous intravenous infusion of the drug. Steady-state clearance was calculated from dopamine concentration in arterial blood. Dopamine clearance was 60.7 +/- 28.1 ml/kg/min. The age of the patient exerted an effect on clearance of dopamine (r = -0.63; p less than 0.05), and dopamine clearance was nearly twice as rapid in children younger than 2 years as it was in older children (82.3 +/- 27.7 ml/kg/min versus 45.9 +/- 17.0 mg/kg/min). Conjugated bilirubin exerted an age-independent effect on clearance of dopamine; clearance was 44.8 +/- 28.6 ml/kg/min in children with abnormal conjugated bilirubin (greater than or equal to 0.9 mg/dl) and 70.1 +/- 2.56 ml/kg/min in children with normal conjugated bilirubin (less than 0.9 mg/dl). Clearance was lowest (29.8 +/- 5.7 ml/kg/min) in the four children who had both hepatic and renal dysfunction. Age is an important determinant of dopamine clearance, explaining in part the clinical observation that infants and young children require higher infusion rates.

Adolescent↗
PubMed1990

Outcome after assisted ventilation in children with acquired immunodeficiency syndrome.

Twenty-two pediatric patients with AIDS required assisted ventilation during 27 pediatric ICU (PICU) admissions. Patients were retrospectively divided on the basis of whether they required assisted ventilation for acute respiratory failure (ARF) or for another reason. Sixteen (59%) courses of assisted ventilation were for ARF. The PICU mortality rate was 81% for the ARF group. Eleven (41%) courses of assisted ventilation were for reasons not involving ARF. The PICU mortality rate for the group without ARF was 9%, significantly lower (p less than .01) than for the ARF group. Pneumocystis carinii pneumonia (PCP) was documented during 48% of admissions. Occurrence of PCP did not affect mortality, nor was it more likely in those with than without ARF. Two patients with ARF survived to discharge from the hospital. Both died within 1 yr of ARF. Thus, the short-term prognosis for pediatric AIDS patients requiring assisted ventilation for ARF is extremely poor.

Acquired Immunodeficiency Syndrome↗
PubMed1989

A comparison of thermodilution and pulsed Doppler cardiac output measurement in critically ill children.

To evaluate the pulsed Doppler cardiac output method as a noninvasive means for determining cardiac output in critically ill children, we performed paired pulsed Doppler and thermodilution cardiac output determinations in 17 critically ill children. Commercially available equipment, specifically designed for this purpose, was employed. Forty paired thermodilution and pulsed Doppler determinations were made. There was a significant correlation between the two measurements (pulsed Doppler = 0.84 thermodilution + 0.39; r = 0.79, p less than 0.01). The ranges of thermodilution measurements (1.02 to 6.26 L/min; median 2.77 L/min) and pulsed Doppler measurements (1.13 to 6.35 L/min; median 2.57 L/min) were not different (p = 0.25). However, differences between individual paired thermodilution and pulsed Doppler measurements were large (-3.13 to 2.03 L/min; median 0.12 L/min), and the percentage difference between individual paired thermodilution and pulsed Doppler measurements ranged from 0.41% to 102.5% (median 12.7%). A discrepancy of 15% or more between thermodilution and pulsed Doppler was encountered in 18 (45%) of 40 of paired measurements (95% confidence interval: 29% to 61%), and one fourth of the paired measurements differed by more than 25%. We conclude that, as employed in this study, pulsed Doppler cardiac output determination is not sufficiently representative of the thermodilution output to be employed for hemodynamic monitoring in critically ill children.

Adolescent↗
PubMed1986

Effect of dose formulation on isoniazid absorption in two young children.

In an 8-month-old infant with tuberculous meningitis treatment with isoniazid was unsuccessful and was associated with lower than expected plasma concentrations of isoniazid (measured concentration 0.1 microgram/mL). The infant had received isoniazid as a crushed tablet admixed with apple sauce. Oral administration of the parenteral solution of isoniazid (Nydrazid, Squibb) mixed in apple juice produced a higher isoniazid concentration (2.9 micrograms/mL) and the child improved clinically. Pharmacokinetic studies in two subjects were performed following intramuscular injection of isoniazid and oral administration of (1) an isoniazid tablet crushed and mixed with apple sauce, (2) parenteral isoniazid solution mixed with apple juice, and (3) a commercially available syrup containing isoniazid and pyridoxine (P-I-N Forte, Lannett). Of the three oral preparations, the syrup produced the highest peak concentrations (8.3 and 6.9 micrograms/mL). The crushed tablets in apple sauce produced the lowest peak concentrations (1.4 and 2.4 micrograms/mL). Administration of crushed isoniazid tablets with food may be associated with impaired gastrointestinal absorption, lower than expected isoniazid concentrations, and treatment failure.

Administration, Oral↗