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Biomedical subjects

J Pfenninger

Publications and source records attributed to J Pfenninger.

At least 55 records · Page 3Linked to original sources
PubMed1985

[Residual lung function changes following adult respiratory distress syndrome (ARDS) in children].

Residual lung function abnormalities have been investigated in 9 children (4 boys and 5 girls) a mean 2.7 years after surviving severe adult respiratory distress syndrome (ARDS). All patients had been artificially ventilated for an average of 9.4 days with a FiO2 greater than 0.5 for 34 hours and maximal PEEP levels in the range of 8-20 cm H2O. Since the ARDS, 3 children had presented recurrent respiratory symptoms (moderate exertional dyspnea and cough) and 2 had had evidence of fibrosis on chest radiographs. In all patients abnormal lung functions were found, i.e. ventilation inequalities (8), hypoxemia (7), and obstructive (2) and restrictive (1) lung disease. A significant correlation between respirator therapy and residual lung function was found (duration of FiO2 greater than 0.5 in hours and inspiratory plateau pressure during respirator therapy vs. ventilation inequalities and hypoxemia).

Adolescent↗
PubMed1985

Long-term sequelae in children surviving adult respiratory distress syndrome.

Nine children surviving severe adult respiratory distress syndrome were studied 0.9 to 4.2 years after the acute illness. They had received artificial ventilation for a mean of 9.4 days, with an Fio2 greater than 0.5 during a mean time of 34 hours and maximal positive end expiratory pressure levels in the range of 8 to 20 cm H2O. Three children had recurrent respiratory symptoms (moderate exertional dyspnea and cough), and two had evidence of fibrosis on chest radiographs. All patients had abnormal lung function; the most prominent findings were ventilation inequalities, as judged by real-time moment ratio analysis of multibreath nitrogen washout curves (abnormal in eight of nine patients) and hypoxemia (seven of nine). Lung volumes were less abnormal; one patient had restrictive and two had obstructive disease. A significant correlation between intensive care measures (Fio2 greater than 0.5 in hours and peak inspiratory plateau pressure) and lung function abnormalities (moment ratio analysis and hypoxemia) was found. A possibly increased susceptibility of the pediatric age group to the primary insult or respiratory therapy of adult respiratory distress syndrome is suggested.

Adolescent↗
PubMed1984

Early prediction of outcome after severe head injury in children.

Forty children with severe head injury were studies retrospectively. All were admitted to the medical center within 6 hours after injury. Seventeen had Glasgow Coma Scales of 3 to 4 and 23 scales of 5 to 7. Computerised tomography (CT) findings and coagulation abnormalities in the first 12 and intracranial pressure (ICP) in the first 24 hours after injury were examined in relation to the final result. Compressed basal cisterns in CT, presence of moderate to severe consumption coagulopathy (CC) and moderate to severe intracranial hypertension (ICP greater than 20 mmHg) all correlated significantly with fatal outcome. In contrast, survivors usually had patent basal cisterns on CT, normal coagulation data or only moderate CC and slight to rarely moderate intracranial hypertension. It is concluded that by using the proposed criteria, early assessment of severity and prediction of outcome after severe paediatric head injury is possible. In contrast to the Glasgow Coma Scale these criteria are applicable and retain predictive power also in children who receive early and intensive ICP-lowering therapy.

Adolescent↗
PubMed1984

Effect of neurointensive care upon outcome following severe head injuries in childhood--a preliminary report.

From March 1978 till August 1981 neurointensive care was applied to 24 children with severe head injuries (Glasgow Coma Scale less than or equal to 7, mean 5 +/- 1) corresponding to 7% of a population with head injuries observed during the same period. The neurointensive care included continuous intracranial and arterial pressure monitoring and normalization of intracranial and cerebral perfusion pressure with intubation, hyperventilation, control of body temperature, dexamethason, barbiturates and osmotic agents. The follow-up time is 1.5 to 4.4 years (mean 2.5 years). The results obtained by check-ups every 3-6 months were analyzed as proposed by Lange-Cosack and Tepfer (1973) and used to group the children according to Jennett and Bond (1975). At the end of the follow-up four children were 1-5, twelve 6-14 years old and 3 older. Five patients (= 21%) died during the acute stage of head injury. Residual neurological signs were present in 42% of the children depending on the specific topics (cranial nerve deficits, hemiparesis, speech disorders, ataxic syndromes) at most in 1/4 of the cases. Minimal to distinct residual psychoorganic signs were found in 58%, an altered personality being somewhat more frequent than intelligence deficit or psychomotor retardation. Eleven of the twelve school children are back in school of whom are eight in regular and three in special schools. At a mean time of 1.5 years after the accident the EEG was normal in nine cases and displayed a slightly altered background activity and/or slow wave foci in eight and epileptiform foci in two cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Brain-stem auditory evoked potentials and early somatosensory evoked potentials in neurointensively treated comatose children.

Forty-three comatose children treated by invasive neurointensive care were examined by brain-stem auditory evoked potentials (BAEPs) and somatosensory evoked potentials (SEPs). The evoked potential (EP) results obtained were reviewed in conjunction with the clinical outcome. As a BAEP criterion, the V-I interpeak latency and, as an SEP criterion, the central conduction time (N20-N14 latency) were measured. A loss of BAEP and SEP components portended a poor prognosis. On the other hand, latency prolongations were seen in a third of patients who made a complete recovery. However, the SEP and BAEP have proved themselves as reliable methods in the judgment of the clinical state and the prognosis of intensively treated children with a hypoxic-ischemic encephalopathy or a head injury. The measurement of both BAEPs and SEPs was a more reliable prognostic aid than either EP measurement alone.

Adolescent↗
PubMed1983

Treatment and outcome of the severely head injured child.

Twenty-four children (aged 3 months to 14 years) with severe head injuries were treated by means of invasive neurointensive care for normalizing intracranial pressure (ICP) involving hyperventilation, control of body temperature, dexamethasone, barbiturates and continuous intracranial and arterial pressure monitoring. The Glasgow Coma Scale before initiation of treatment was 3-4 in 8, 5-6 in 9 and 7 in 7 patients. Moderately to severely elevated ICP was observed in 20 patients. Seven developed acute and subacute space occupying intracranial hematomas. Nineteen children (79%) survived, most often with good recovery and 5 (21%) died. Severely elevated ICP, presence of severe consumption coagulopathy and loss of components in brain auditory evoked potentials were significantly more frequent in the fatal group. We conclude that the prognosis of the severely head injured child can be improved by prompt resuscitation and aggressive neurointensive care but probably not, however, to the extent postulated in recent literature.

Adolescent↗
PubMed1982

[Adult respiratory distress syndrome (ARDS) after poisoning by local anesthetics].

Two children who received an overdose of nupercaine (cinchocainium chloratum) showed severe neurological and cardiovascular disturbances and developed adult respiratory distress syndrome (ARDS). Following initial cardiovascular resuscitation they underwent invasive neurointensive care and required controlled ventilation for a period of 6-15 days, initially with high positive end expiratory pressure (PEEP) for treatment of the ARDS. However, both survived and made a complete recovery.

Arrhythmias, Cardiac↗
PubMed1982

Radial artery catheterization by surgical exposure in infants.

56 radial arteries were cannulated by cutdown technique in 54 critically ill infants (age (mean +/- SD) 12.2 +/- 25.9 days, weight 2710 +/- 910 g) for continuous pressure monitoring and repeated blood sampling. 30 patients survived their illness, 24 died. The mean catheterization time in the survivors was 8.1 +/- 4.1 in the non-survivors 6.9 +/- 5.6 days. Most cannulae were removed electively. 27 of the surviving infants were followed up after 10.5 +/- 5.1 months. 25 (86%) vessels were patent, 4 (14%) occluded. No trophic changes of hands or fingers were noted. We concluded that radial artery cannulation by cutdown in infants is a quick and safe technique and is suitable in patients with severe peripheral vasoconstriction.

Arm↗
PubMed1982

Adult respiratory distress syndrome in children.

Twenty patients (age 2 weeks to 15 years) who fulfilled strict selection criteria for adult respiratory distress syndrome were identified during a 3 1/2-year period. The underlying disease was intra-abdominal infection/septicemia in seven, hypovolemic shock, near drowning, closed space burn, or cardiogenic shock caused by nupercaine intoxication in two each, and miscellaneous in five. The mean time of artificial ventilation with PEEP was 18 days (range 5 to 92), and the mean time of FIO2 greater than or equal to 0.5 while on the ventilatory 139 hours (range 12 to 648). PEEP levels were most often between 8 and 15 cm H2O. Eight patients had a pulmonary air leak. Eight patients died (40% mortality). Death was nearly always related to unresolved basic medical or surgical problems and multiple organ failure. Treatment of ARDS includes elimination of the cause of ARDS, early institution of mechanical ventilation with PEEP, prompt recognition and treatment of superimposed infections, and careful management of additional organ failures.

Adolescent↗
PubMed1982

Consumption coagulopathy after severe head injury in children.

Cases of three infants and 3 children with clinically manifest generalized bleeding due to a consumption coagulopathy disorder (CC) after severe head injury are described. Despite invasive neurointensive care for normalization of intracranial pressure and coagulation factor replacement therapy, all patients died due to severe brain swelling with uncal and brainstem herniation. Abnormal bleeding in a comatose, head-injured patient with laboratory finding compatible with CC appears to be an expression of a very severe injury with poor prognosis.

Brain Injuries↗
PubMed1982

Intensive care after fresh water immersion accidents in children.

Six children who remained in deep coma after immersion accidents in fresh water received therapy to maintain normal intracranial pressure (ICP). This involved controlled ventilation to ensure hypocapnia and hyperoxaemia, maintenance of low normothermia, fluid restriction, dexamethasone (1-1.5 mg/kg initially, 1-1.5 mg/kg/day as maintenance) and barbiturates (phenobarbitone and thiopentone). The latter were given in a wide range of dosage. Increased ICP was common to all patients, but could always be kept at acceptable levels. All patients suffered from pulmonary oedema; three developed broncho-pneumonia and two developed adult respiratory distress syndrome. All children survived with good recovery, two needed active rehabilitation for several months.

Accidents↗
PubMed1982

Cefuroxime in bacterial meningitis.

In order to find an alternative antimicrobial treatment for childhood bacterial meningitis 30 infants and children with meningitis, due to Haemophilus influenzae (n = 13), Neisseria meningitis (n = 9), Streptococcus pneumoniae (n = 5), or meningitis of unknown aetiology (n = 3), were treated with cefuroxime, 200 mg/kg a day, as the only antibiotic. Prompt clinical and bacteriological responses were noted and every patient was cured. Cefuroxime concentrations in cerebrospinal fluid ranged from 1.1 to 18.8 (mean 7.0) mg/l at the beginning and from 0.5 to 4.1 (mean 1.6) mg/l at the end of treatment. Three infants developed symptomatic sterile subdural effusions which were managed by repeated subdural aspirations while still on antibiotics. Cefuroxime concentrations in the subdural fluid ranged from 17.4 to 32.4 mg/l. At follow-up 2 patients had moderate unilateral hearing loss and one had mild ataxia. We conclude that cefuroxime is effective and safe for the treatment of childhood bacterial meningitis caused by any of these common organisms.

Cefuroxime↗
PubMed1982

Treatment of pneumothorax, pneumopericardium and pneumomediastinum.

Fifty-four patients with pneumothoraces were treated by tube thoracostomy. Three of these also suffered from pneumomediastinum, two from pneumopericardium, and one from pneumoperitoneum. Except for 2 pneumomediastina, all of these were drained. A chest drain was inserted after chest radiography or transillumination and/or localization of the extrapulmonary air by fine needle aspiration. The drain was placed surgically at the highest point of air accumulation, after creation of a long subcutaneous tunnel and perforation of the intercostal space by blunt dissection. Pressure upon vital structures by pathological air accumulations was relieved in all cases. On a few occasions a tension pneumothorax redeveloped despite there being a chest tube in place, and new chest tubes had to be inserted. No complications due to the procedure were observed.

Adolescent↗
PubMed1981

[Triage and treatment in juvenile drowning accidents].

Until 1977 the prognosis in childhood near drowning was rather poor. Many children died or survived permanently damaged by hypoxic encephalopathy. In the late seventies new methods of invasive neurointensive care were introduced in pediatric intensive care and were used in selected cases of near drowning. In one center (Hospital for Sick Children, Toronto) the prognosis in those children who remained comatose after the initial resuscitation was significantly improved with these methods. 14 personally observed cases of near-drowning are reported (1978-1980). During this time we were using invasive neurointensive care methods in selected cases (hyperventilation, cooling, barbiturates and others, combined with continuous intracranial pressure monitoring). Four children came under the category "clinical observation", 3 the category "artificial ventilation" (mainly for pulmonary reasons) and 5 the category "artificial ventilation and invasive neurointensive care". Two children were "brain dead" and showed significant cardiovascular instability at the time of ICU admission. Both died, while all the others survived: 11 were completely normal and 1 child was slightly retarded. We conclude that the prognosis in childhood near drowning can be greatly improved by triage, generous use of artificial ventilation and invasive neurointensive care in those children who remain deeply comatose after near drowning.

Barbiturates↗