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Biomedical subjects

E B Cochran

Publications and source records attributed to E B Cochran.

18 recordsLinked to original sources
PubMed1992

Prevalence of, and risk factors for, upper gastrointestinal tract bleeding in critically ill pediatric patients.

OBJECTIVE: To determine the occurrence of, and risk factors for, the development of upper gastrointestinal (GI) tract bleeding in critically ill pediatric patients. DESIGN: Prospective, descriptive, comparative study. SETTING: ICU in a tertiary care pediatric hospital affiliated with a university. PATIENTS: All patients < 19 yrs of age who were admitted to the ICU for a 4-month period (n = 429) were eligible for inclusion. A total of 221 patients were excluded for reasons listed below. Thus, 208 patients were studied. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Patients were evaluated for overt upper GI bleeding as indicated by coffee ground material or bright red blood in gastric aspirates or black, tarry stools. Excluded were patients who were transferred out of the ICU within 24 hrs of admission, were receiving medications that would alter their risk for upper GI bleeding, or had a GI tract surgical procedure. Patients were categorized by diagnoses and analyzed for relative risk for upper GI bleeding. Of the 208 patients included, 25% had evidence of upper GI bleeding. There was no association between upper GI bleeding and age, weight, race, or sex. Diagnoses independently associated with an increased risk for upper GI bleeding were: circulatory shock, an operative procedure > or = 3 hrs in duration, and trauma. No clinically important sequelae were directly attributable to upper GI bleeding in this group of patients; however, intervention with antacids and histamine-2 receptor (H-2) antagonists likely decreased the progression of GI bleeding. CONCLUSIONS: Overt evidence of upper GI bleeding is not uncommon in critically ill pediatric patients. Certain diagnoses or risk factors may predispose these patients to develop upper GI bleeding.

Adolescent↗
PubMed1991

Laparoscopic appendectomy: three years' experience.

Laparoscopic appendectomy was performed on 109 patients over a 3-year-period--1988 to 1991. All procedures were uneventful and all patients resumed normal activity within a shorter period than had been experienced with open appendectomy. Patients had a superior cosmetic result and experienced significantly less postoperative discomfort.

Appendectomy↗
PubMed1991

Toxicities of parenteral nutrition in the critically ill patient.

Critically ill patients have unique nutritional substrate requirements. Although important advances have been made in understanding these requirements in the face of pathophysiologic and biochemical alterations induced by stress or trauma, nutrition-associated toxicities still occur. The importance of these toxicities to the critically ill patients cannot be over-stated. Many of these toxicities can be avoided by conservative use of selected nutrition substrates in specific subsets of the critically ill population. Practitioners must continue to anticipate and recognize parenteral nutrition-associated toxicities, however, as well as delineate any toxicity from the progression or exacerbation of disease.

Catheters, Indwelling↗
PubMed1990

Inability of inline pressure monitoring to predict or detect infiltration of peripheral intravenous catheters in infants.

Monitoring of inline intravenous pressure as a method for predicting or detecting infiltration of peripheral catheter sites in infants was evaluated. Inline intravenous pressure was measured every 30 minutes in infants less than 12 months of age who had standardized peripheral catheters through which they were receiving a continuous infusion. Pressure was measured by an inline pressure transducer, and the signal was recorded by a strip chart recorder. Physical activities or manipulations of the patients were recorded simultaneously with each pressure reading. The catheter site was inspected hourly for clinical signs of infiltration. There was no significant difference in baseline or final pressure measurements between patients whose catheter sites became infiltrated (n = 20) and patients whose catheter sites did not (n = 22). Likewise, changes in pressure from baseline did not differ between the infiltrated and noninfiltrated groups. At 12 hours before the final reading, pressures for the infiltrated group did not differ significantly from pressures for the noninfiltrated group, nor did these values differ from the respective baseline values. Over the final 12 hours of catheterization, mean slopes (changes in pressure over time) for the two groups did not differ significantly from 0 or from each other. Intrapatient specificity and sensitivity of the method and the false-alarm rate were clinically unacceptable. Monitoring of inline intravenous pressure is not useful for predicting or detecting infiltration of peripheral catheter sites in infants.

Catheterization, Peripheral↗
PubMed1989

Parenteral nutrition in the critically ill patient.

The metabolic alterations, nutritional and metabolic assessment, and nutritional requirements of critically ill patients are discussed, and parenteral nutrition support therapies are reviewed. Physiological alterations in the metabolism of the injured or septic patient are mediated through the interactions of neuroendocrine, cardiovascular, toxic, and starvation responses. These responses cause mobilization of nutritional substrates in an effort to maintain vital organ function and immune defenses. A patient's nutritional status can be determined from anthropometric measurements, creatinine excretion rate, and evaluations of protein stores and immune reserves and function; body weight is a poor indicator. Nitrogen-balance calculations are also useful for determining the adequacy of nutritional intake and the degree of metabolic stress. Early assessments of nutritional status may assist in identifying those patients for whom nutritional support interventions are needed. Nutritional requirements are altered by the metabolic responses to injury and sepsis. Studies suggest that use of nutrient solutions enriched for branched-chain amino acids may enhance nitrogen retention and that energy expenditures in injured or septic patients are only moderately elevated. Most nonprotein calories in parenteral nutrient solutions are provided as glucose, but lipids are an important source of energy in the critically ill patient who has high energy requirements or carbohydrate intolerance; however, clearance of lipids may be decreased. Fluid, electrolyte, and mineral status must be evaluated frequently. Critically ill patients have unique nutritional requirements, and parenteral nutrition support therapies for these patients are being investigated and refined.

Critical Care↗
PubMed1988

The influence of gestational age and preeclampsia on the presence and magnitude of serum endogenous digoxin-like immunoreactive substance(s).

Digoxin-like immunoreactive substance(s) has been measured in serum during pregnancy. Because of its presence in pregnancy, investigators have suggested that digoxin-like immunoreactive substance may play an etiologic role in the development of preeclampsia. The objectives of this study were to evaluate the relationship between maternal digoxin-like immunoreactive substance and gestational age and compare digoxin-like immunoreactive substance concentrations in patients with and without preeclampsia who were in the third trimester. Two hundred twenty patients were studied during either the first (n = 53), second (n = 56), or third (n = 111) trimester of pregnancy. Digoxin-like immunoreactive substance was undetectable in the serum of patients during the first trimester; however, 11% of second-trimester and 96% of third-trimester patients had measurable levels of serum digoxin-like immunoreactive substance (p less than 0.05). The mean +/- SEM concentration of digoxin-like immunoreactive substance in serum in third-trimester patients was 0.29 +/- 0.01 ng/ml (range 0 to 0.58 ng/ml). Gestational age at delivery was significantly lower in patients with preeclampsia than in those without preeclampsia (36.3 +/- 0.6 versus 38.8 +/- 0.4 weeks; p less than 0.001). In addition, there was no statistical difference in mean +/- SEM concentration of digoxin-like immunoreactive substance between 27 patients without preeclampsia (0.32 +/- 0.02 ng/ml) and 27 patients with preeclampsia (0.30 +/- 0.02 ng/ml; p = 0.47) matched for gestational age. We conclude that (1) digoxin-like immunoreactive substance appearance and increasing serum concentration during pregnancy are correlated with increasing gestational age and (2) there is no difference in digoxin-like immunoreactive substance values between patients with and without preeclampsia, which may exclude digoxin-like immunoreactive substance as a predictor of preeclampsia.

Adolescent↗
PubMed1988

Parenteral nutrition in pediatric patients.

Protein, calorie, fluid, fat, and micronutrient requirements of pediatric patients are reviewed, as are methods of nutritional assessment and complications associated with the use of parenteral nutrition in these patients. In general, preterm infants and neonates require greater per-kilogram amounts of protein, calories, fluid, and micronutrients than older children. In addition, preterm infants and neonates have deficiencies in enzymes that metabolize certain amino acids, making otherwise nonessential amino acids essential. These unique protein needs have been addressed in amino acid formulations designed specifically for this group of patients. Supplying the neonate with the calcium and phosphorus needed for bone growth can be difficult because of solubility limitations in parenteral nutrient solutions. The use of intravenous fat emulsion in infants with hyperbilirubinemia or pulmonary complications is controversial. However, only rarely does fat emulsion have to be completely withheld. Complications associated with parenteral nutrition in pediatric patients include infection, metabolic disorders (cholestasis, bone demineralization), and mechanical problems. Cholestasis induced by parenteral nutrition has been shown to be more common in low-birth-weight infants; however, the precise etiology is unknown and may be multifactorial. Basic requirements necessary to promote growth while pediatric patients are receiving parenteral nutrition have been determined. However, current studies are challenging what were thought to be standards of pediatric parenteral nutrition therapy.

Child↗
PubMed1987

Digoxin-like immunoreactive substance in pregnancy.

Our aims were to determine the potential usefulness of digoxin-like immunoreactive substances in the prediction of preeclampsia, to study the relationship between fetal production of these substances and maternal serum levels, and to evaluate the association between digoxin-like immunoreactive substances and plasma volume findings in preeclamptic pregnancies. Serum digoxin-like immunoreactive substance concentrations were measured in normotensive and preeclamptic pregnant women and in umbilical artery and vein blood samples. None of the patients in the first trimester (n = 53) and 11% of those in the second (n = 56) had detectable levels of this substance. However, 91% of the patients in the third trimester (n = 161) had positive results. The concentrations of digoxin-like immunoreactive substances in the preeclamptic group (n = 78) were significantly (p less than 0.005) lower than those of third-trimester (n = 83) normotensive patients (0.22 +/- 0.12 versus 0.32 +/- 0.15 ng/ml). However, there were no significant differences between the two groups regarding digoxin-like immunoreactive substance concentrations when matched for gestational age (41 patients in each group). Digoxin-like immunoreactive substance concentrations in umbilical vessels were significantly higher (p less than 0.001) than the corresponding maternal levels. Umbilical vessel digoxin-like immunoreactive substance levels demonstrated good correlation with fetal gestational age and birth weight in both normotensive and preeclamptic pregnancies. On the other hand, there was a poor (r = 0.02; p = 0.91) correlation between plasma volume findings and digoxin-like immunoreactive substance concentration. We conclude that the digoxin-like immunoreactive substance level may be of very little value in the prediction of preeclampsia. The presence of digoxin-like immunoreactive substance at greater concentrations in the umbilical cord blood samples suggests the possibility of the fetus as the source of this substance. Digoxin-like immunoreactive substances may not play a major role in plasma volume expansion during pregnancy.

Blood Proteins↗
PubMedDate not supplied

Comparison of a noninstrumented immunoassay for carbamazepine to high performance liquid chromatography and fluorescence polarization immunoassay.

The accuracy, precision, and potential clinical utility of a new whole blood, noninstrumented immunochromatographic assay (AccuLevel) for carbamazepine (CBZ) was evaluated in a multicenter trial including 100 pediatric and 205 adult patients. The AccuLevel assay, a fluorescence polarization immunoassay (FPIA), and high-performance liquid chromatography (HPLC) were used to determine CBZ concentration in samples from 111 female and 194 male patients aged 2-72 years (median 25 years). Mean +/- SD plasma CBZ concentrations in all patients were 7.4 +/- 3.0 micrograms/ml with the AccuLevel assay and 7.5 +/- 2.9 micrograms/ml with FPIA. In 204 patients, the mean concentration determined by the HPLC assay was 7.7 +/- 3.0 micrograms/ml, whereas concentrations determined by the AccuLevel and FPIA assays were 8.0 +/- 3.1 and 8.1 +/- 3.1 micrograms/ml, respectively. Concentrations determined by the AccuLevel and FPIA assays were significantly higher than those quantified by HPLC (p less than 0.05), but not different from each other. In addition, the AccuLevel assay was highly correlated with FPIA (r = 0.97) and HPLC (r = 0.98). Coefficients of variation for the AccuLevel assay at 8 micrograms/ml ranged from 6.8 to 7.5% for the three institutions. We conclude that the AccuLevel assay is a simple, reliable method for determining CBZ concentration in a small volume of whole blood and is an acceptable alternative for assessment of CBZ therapy and individualization of CBZ dosage in the physician's office or emergency room.

Adolescent↗
PubMedDate not supplied

Effect of the continuous administration of fat emulsion on the infiltration of intravenous lines in infants receiving peripheral parenteral nutrition solutions.

Animal data and anecdotal human experience suggest that vascular damage induced by the infusion of dextrose/amino acid solutions may be ameliorated by the concomitant administration of fat emulsion. We prospectively evaluated the effect of the continuous infusion of peripheral nutrition solutions with and without fat emulsion on the incidence of, probability of, and time to infiltration of peripheral venous lines in infants (median age: 1.0 month; range 1 day-11.9 months). Ninety-seven peripheral venous lines were studied in 53 infants who received 10% dextrose (n = 34), 10% dextrose/2% amino acids (n = 30), or 10% dextrose/2% amino acids/fat emulsion (n = 33). Solutions were administered by positive pressure infusion devices through Teflon catheters with similar gauge. Dextrose, amino acid, electrolyte, and mineral content was standardized for the dextrose/amino acid and dextrose/amino acid/fat emulsion groups. The three groups were similar with respect to age, race, gender, weight, administration of intravenous medications, and catheter site (p greater than 0.05). Patients receiving dextrose/amino acid or dextrose/amino acid/fat emulsion had greater rates of solution administration than those receiving dextrose alone (p less than 0.002). Infiltration occurred in 71% of dextrose, 66% of dextrose/amino acid, and 67% of dextrose/amino acid/fat emulsion solutions (p greater than 0.05). The probability of infiltration was greater for infants receiving dextrose/amino acid than for those receiving either dextrose or dextrose/amino acid/fat emulsion (p = 0.01). The mean +/- SEM length of time the intravenous sites were viable was significantly shorter for the dextrose/amino acid solutions (26.3 +/- 3.3 hr) compared to the dextrose (54.9 +/- 7.8 hr) and dextrose/amino acid/fat emulsion (43.6 +/- 4.2 hr) groups. No site complications were associated with the infiltration of any solution. We conclude that the incidence of infiltration among the three solution groups studied is not different. However, the time to infiltration is prolonged and the probability of infiltration is decreased following the infusion of either dextrose alone or dextrose/amino acid/fat emulsion solutions when compared to the administration of dextrose/amino acid solutions without concomitant fat emulsion infusion.

Amino Acids↗
PubMedDate not supplied

Prefilter and postfilter cysteine/cystine and copper concentrations in pediatric parenteral nutrition solutions.

Pediatric amino acid products contain lower concentrations of methionine and require the addition of L-cysteine HCl just before infusion. Reports of a potential interaction between cysteine and copper, a routine addition to parenteral nutrition solutions, have appeared in the literature. This study serially evaluated cysteine/cystine and copper concentrations pre- and postfilter (0.22 microns) in two parenteral nutrition formulations prescribed for normal fluid (NF) or fluid-restricted (FR) pediatric patients. Solutions were infused via a peristaltic pump in vitro for 24 hours. Pre- and postfilter samples were obtained immediately after the infusion began (time 0) and at 1, 2, 3, 4, 8, 12, 16, 20, and 24 hours during the infusion. At 24 hours pre- and postfilter, cysteine/cystine were quantitated at 87.3% and 85% of the initial concentrations, respectively, for the NF solution and 92% and 91.5% for the FR solution. Pre- and postfilter copper was quantitated at 87.5% and 92.5% of the initial concentrations, respectively, for the NF solution and 88.2% and 95.2% for the FR solution. The 24 hour area under the curve for cysteine/cystine was 88.4% for the NF solution and 96.4% for the FR solution. For copper, the area under the curve for the NF solution was 99% and 96.7% for the FR solution. There was no visual evidence of incompatibility or precipitation. We conclude that copper-containing parenteral nutrition solutions with L-cysteine HCl added immediately before infusion are relatively stable after compounding and infusion over 24 hours.

Copper↗