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Biomedical subjects

L W Brink

Publications and source records attributed to L W Brink.

8 recordsLinked to original sources
PubMed1997

Extubation failure due to post-extubation stridor is better correlated with neurologic impairment than with upper airway lesions in critically ill pediatric patients.

The incidence of post-extubation stridor (PES) in a pediatric intensive care unit (PICU) and the need for reintubation is not known. Predictors of success on a subsequent extubation attempt and the efficacy of dexamethasone treatment prior to a subsequent extubation attempt are not established. In a prospective randomized double blind-controlled study in two PICU's in a university children's hospital setting, of 5,566 admissions over 35-months, we identified 32 patients who failed primary extubation and were reintubated for PES. Twenty-six patients were enrolled in the study and three subsequently excluded. Twelve were randomized to receive dexamethasone and 11 received sodium chloride placebo. Fifteen patients succeeded study extubation and eight failed. Of those receiving dexamethasone, nine patients succeeded and three failed. Of those receiving placebo, six patients succeeded and five failed. There was a poor correlation between anatomical abnormalities of the airway and failure of study extubation. Extubation failure was better correlated with neurologic impairment in the patients. We present a stridor score and demonstrate that it is an excellent predictor of success versus failure for the study extubation. Dexamethasone pre-treatment did not reduce stridor score. We are unable to conclude if dexamethasone pre-treatment reduces extubation failure. We speculate that neurologic impairment leads to extubation failure in critically ill pediatric patients.

Adrenal Cortex Hormones↗
PubMed1997

Anatomically sound, simplified approach to repair of "complete" atrioventricular septal defect.

BACKGROUND: There are few congenital anomalies of the heart that have benefited more from thorough anatomic analysis than the complex anomaly known as atrioventricular septal defect in the setting of common atrioventricular junction. Recent advances in understanding the anatomy of this lesion have led to alternative methods of repairing these defects. METHODS: The medical records of 21 consecutive patients undergoing repair of complete atrioventricular septal defect have been reviewed. Nine of these patients had a standard one- or two-patch repair, and 12 had direct closure of the ventricular element of the defect. RESULTS: Direct closure resulted in significantly shorter pump and cross-clamp times. Follow-up for an average of 34 months suggests that when direct closure can be performed, the results are comparable with those of the more standard technique. CONCLUSIONS: Our initial success with this approach is encouraging; however, longer follow-up is required to establish whether it will be broadly applicable.

Cardiac Surgical Procedures↗
PubMed1995

Effect of extracorporeal membrane oxygenation flow on pulmonary capillary blood flow.

OBJECTIVE: To validate a new application of the modified acetylene rebreathing method for pulmonary capillary blood flow in a swine extracorporeal membrane oxygenation (ECMO) model. DESIGN: Prospective, sequential measurements of pulmonary capillary blood flow, using a rebreathing technique, as affected by different flows through the ECMO circuit. SETTING: A cardiovascular hemodynamic research laboratory at a university medical center. SUBJECTS: Fifteen young mature farm swine (48 to 52 kg). INTERVENTIONS: Pulmonary capillary blood flow was measured using a modified rebreathing technique, and this measurement repeated at different flow rates through the extracorporeal membrane oxygenation circuit. Pulmonary artery flow rates were measured using both thermodilution and echo-Doppler techniques for comparison purposes. MEASUREMENTS AND MAIN RESULTS: Pulmonary capillary blood flow measurements, as assessed by modified acetylene rebreathing, compared well with both the thermodilution cardiac output measurement during normal circulation and the pulmonary artery flow probe measurement while the subjects received ECMO. Mean pulmonary capillary blood flow measured by acetylene rebreathing decreased from 89.72 +/- 6.97 (baseline) to 43.59 +/- 5.66 mL/kg/min as ECMO flow was maximized to 56.22 +/- 3.62 mL/kg/min. Decreasing the ECMO flow rate by half (to 28.23 +/- 3.45 mL/kg/min) caused an increase in mean pulmonary capillary blood flow to 53.79 +/- 6.16 mL/kg/min. When ECMO flow was discontinued, pulmonary capillary blood flow returned to a near baseline value of 71.68 +/- 7.05 mL/kg/min (mean values of pooled data for both closed- and open-chest animals [n = 15]). These measurements correlated well with both thermodilution cardiac output and pulmonary artery ultrasonic flow probe measurements. CONCLUSIONS: The modified acetylene rebreathing method is a valid and accurate method for the measurement of pulmonary capillary blood flow in the presence of ECMO flows. Pulmonary blood flow decreases as ECMO flow is increased, and the extent of decrease is directly proportional to the amount of flow through the extracorporeal circulation.

Animals↗
PubMed1993

Drowning and near-drowning.

The incidence, epidemiology, and pathophysiology of drowning and near-drowning are presented. Particular attention is paid to the neurologic and pulmonary pathophysiology indicators for monitoring and laboratory tests. Special attention to transportation of patients is given, and treatment in the field, emergency department, and pediatric intensive care unit is delineated.

Adolescent↗
PubMed1993

Air transport.

Air transport has become an integral element of pediatric transport programs. The use of both fixed-wing (airplane) and rotorwing (helicopter) aircraft has increased. Appropriate vehicles configured for the safe and effective transfer of pediatric and neonatal patients are available. As the acuity of patients requiring air transport has increased, more sophisticated and specialized training in the areas of flight physiology and transport medicine is required. The limitations of air transport and air transport vehicles must be understood to assure that the optimal modality is selected for a specific transport.

Aircraft↗
PubMed1992

Care of the pediatric organ donor.

Solid organ transplantation has become an accepted therapeutic option in pediatrics. Many previously fatal diseases have become current indications for organ transplantation. A major limitation to the growth of this therapeutic option is the availability of suitable organs. With organ supply falling far short of demand, recruitment of donors has been stressed. In addition to recruiting donors, physicians are responsible for maintaining optimal organ function in a beating heart organ donor to ensure that all organs that could potentially be harvested are in a condition suitable for transplant. Current information demonstrates numerous physiologic changes resulting from cerebral death. Therapeutic interventions must focus on maintenance of function in all potentially transplantable organs, including kidneys, heart, lungs, liver, and pancreas. Physicians should recognize the interventions that might compromise the use of an organ in transplant. Criteria for organ use are constantly changing, and the implications of different therapeutic interventions must still be evaluated.

Brain Death↗
PubMed1992

Transport of the critically ill patient with upper airway obstruction.

Upper airway obstruction is a life-threatening emergency requiring prompt evaluation and careful intervention. The pathophysiology of upper airway obstruction is reviewed. Assessment techniques and stabilization are discussed with specific attention to intervention and stabilization prior to transport.

Airway Obstruction↗