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J C Fackler

Publications and source records attributed to J C Fackler.

10 recordsLinked to original sources
PubMed1995

Predicting death in pediatric patients with acute respiratory failure. Pediatric Critical Care Study Group. Extracorporeal Life Support Organization.

OBJECTIVE: To estimate mortality risk in pediatric patients with acute hypoxemic respiratory failure (AHRF). DESIGN: Retrospective chart review. SETTING: Forty-one pediatric ICUs. SUBJECTS: Four hundred seventy children with AHRF. We defined AHRF as mechanical ventilation with positive end-expiratory pressure > or = 6 cm H2O and fraction of inspired oxygen greater than or equal to 0.5 for 12 or more hours. MEASUREMENTS: Physiologic and treatment variables were recorded every 12 h for 14 days. Cases were randomly assigned to score development and score validation subsets. Variables were assessed for their association with mortality in the development subset by logistic regression analysis. The analysis generated a series of logistic equations, which we called the Pediatric Respiratory Failure (PeRF) score, to estimate mortality risk at 12-h intervals over the first 7 days of treatment for AHRF. The predictive ability of the score was assessed in the validation subset by receiver operating characteristic curve area and goodness-of-fit chi 2. RESULTS: Mortality of the collected cases was 43%. The PeRF score included age, operative status, Pediatric Risk of Mortality score, fraction of inspired oxygen, respiratory rate, peak inspiratory pressure, positive end-expiratory pressure, PaO2, and PaCO2. Area under the receiver operating characteristic curve was 0.769 at entry and increased to greater than 0.8 after 36 h. When the score was applied to the validation subset of patients, goodness-of-fit chi 2 showed no significant difference between estimated and actual mortality between 0 and 96 h. CONCLUSIONS: The PeRF Score accurately estimated mortality risk in this retrospectively sampled group of high-risk pediatric patients with AHRF. This score may be useful in studies of newer therapies for pediatric AHRF, though prospective validation is necessary before it could be used to make clinical decisions.

Adolescent↗
PubMed1992

Retinal hemorrhages in newborn piglets following cardiopulmonary resuscitation.

OBJECTIVE: To determine whether conventional cardiopulmonary resuscitation causes retinal hemorrhages in piglets. DESIGN: Nonrandomized observations. SETTING: Animal physiology laboratory. PARTICIPANTS: Six 3.5- to 4.5-kg piglets. INTERVENTIONS: Fifty minutes of conventional, closed chest cardiopulmonary resuscitation. MEASUREMENTS/MAIN RESULTS: Intrathoracic venous pressure (right atrium) and intracranial venous pressure (sagittal sinus) were directly measured. At 5 minutes of cardiopulmonary resuscitation, the mean (+/- SEM) sagittal sinus pressure was 41 +/- 8 mm Hg and the mean right atrial pressure was 58 +/- 9 mm Hg. The pressures were sustained throughout the 50 minutes of cardiopulmonary resuscitation. At autopsy, there was no gross or microscopic evidence of retinal hemorrhages. CONCLUSION: These results support the conclusion that cardiopulmonary resuscitation does not cause retinal hemorrhages.

Animals↗
PubMed1992

Rethinking brain death.

OBJECTIVE: To evaluate whether current criteria for the diagnosis of brain death fulfill the requirement for the "irreversible cessation of all functions of the entire brain, including the brainstem." DATA SOURCES: Clinical, philosophical, legal, and public policy literature on the subject of brain death. DATA EXTRACTION/SYNTHESIS: We advance four arguments to support the view that patients who meet the current clinical criteria for brain death do not necessarily have the irreversible loss of all brain function. First, many clinically brain-dead patients maintain hypothalamic-endocrine function. Second, many maintain cerebral electrical activity. Third, some retain evidence of environmental responsiveness. Fourth, the brain is physiologically defined as the central nervous system, and many clinically brain-dead patients retain central nervous system activity in the form of spinal reflexes. We explore options for resolving these inconsistencies between the conceptual definition and the clinical criteria used to make the diagnosis of brain death. CONCLUSIONS: Brain death is a valid conception of death because it signifies the permanent loss of consciousness. Brain death criteria should therefore be based on the diagnosis of the permanent loss of consciousness rather than that of the loss of vegetative brain functions. Revision of our current "whole brain" definition of brain death to a "higher brain" standard should be considered.

Brain↗
PubMed1988

Age-specific characteristics of brain death in children.

Clinical and neuropathologic characteristics of 45 children who met criteria for brain death were analyzed. Children between 2 months and 1 year of age were compared with children older than 1 year and children older than 5 years. The observation period to fulfill brain death criteria was not different between the age groups. Deep tendon and spinal reflexes were preserved significantly less frequently in children younger than 1 year old. Diabetes insipidus and the necessity of inotropic support were significantly more frequent in children older than 5 years. Fifty-eight percent (26/45) of patients had no cerebral perfusion pressure before death. However, 18% (8/45) of patients never had a cerebral perfusion pressure below 40 mm Hg. No relationships could be shown between the clinical or physiologic factors and neuropathologic findings. We found no support for using different brain-death criteria for children between 2 months and 1 year of age.

Adolescent↗
PubMed1985

Epstein-Barr virus infection in a child with acquired immunodeficiency syndrome.

A 3-year-old girl, born to an intravenous-drug-dependent mother, had protracted diarrhea, failure to thrive, generalized lymphadenopathy, and recurrent fevers during the first six months of life. At 7 months of age, the Epstein-Barr virus (EBV) genome was detected in her saliva by DNA dot-blot hybridization using a cloned EBV probe. Spontaneous EBV+ lymphoblastoid cell lines had repeatedly developed from her peripheral blood lymphocytes over the subsequent 2 1/2 years. At 11 months of age, persistent tachypnea and a diffuse pulmonary infiltrate developed. Lung biopsy demonstrated a florid, peribronchiolar lymphocytic infiltrate and the EBV genome was identified in the lung tissue. Serum anti-EBV antibodies remained undetectable until 14 months of age. She had a T4+/T8+ ratio of less than 0.8 and serum antibody to human T-cell lymphotropic virus type III. The delayed seroresponse of this patient to symptomatic EBV infection suggests that reliance on EBV serology to diagnose EBV infection in immunocompromised hosts may be inappropriate, and other methods such as DNA probes should be used.

Acquired Immunodeficiency Syndrome↗