Biomedical subjects

Lynn D Martin

Publications and source records attributed to Lynn D Martin.

5 recordsLinked to original sources

PubMed2004

Continuous pentobarbital infusion in children is associated with high rates of complications.

PURPOSE: To evaluate the incidence and severity of complications related to continuous pentobarbital (PB) infusion for sedation in the Pediatric Intensive Care Unit (PICU). MATERIALS AND METHODS: We conducted a retrospective, chart review study. All patients admitted to the PICU from January 1997 through June 1998 who received continuous IV PB infusion for sedation (n = 8) were included. RESULTS: All patients were intubated and mechanically ventilated prior to PB infusion. PB was used only as a second line sedative after a combination of an opioid and benzodiazepine failed to achieve adequate sedation. After initiation of PB, we were able to decrease or discontinue benzodiazepines and/or opioid doses and discontinue neuromuscular blocking drugs in all patients. We observed a high incidence of complications (62.5%) related to PB or the phenobarbital treatment used for barbiturate weaning, including blood pressure instability (25%), oversedation (12.5%), drug reaction (12.5%) and neurologic sequelae (12.5%). Discontinuation of the drug was required in 25% of the cases. CONCLUSIONS: We found continuous PB infusion to be an effective sedative for children when other drugs fail. However, we observed a high rate of clinically significant complications requiring discontinuation of the drug.

Child↗

PubMed2004

Inspiratory work of breathing is not decreased by flow-triggered sensing during spontaneous breathing in children receiving mechanical ventilation: a preliminary report.

OBJECTIVE: To determine the effect of pressure-trigger (PT) and flow-trigger (FT) sensing on the work of breathing (WOB) during spontaneous, unsupported breathing in children receiving mechanical ventilation. DESIGN: Prospective clinical trial. SETTING: Pediatric intensive care unit at a tertiary care children's hospital. PATIENTS: Infants and children receiving mechanical ventilation for >24 hrs who were ready for extubation. INTERVENTIONS: During synchronized mandatory ventilation, WOB values for spontaneous, unsupported, non-synchronized mandatory ventilation patient breaths were measured using an esophageal balloon and FT or PT sensing on Servo 300 and PT sensing on Servo 900C ventilators assigned in random order. MEASUREMENTS AND MAIN RESULTS: Sixteen patients with a median age of 12.8 mos (25th-75th quartile [IQR], 8.1-38.2 mos), weight of 11.0 kg (IQR, 8.9-18.8 kg), and duration of mechanical ventilation of 7.5 days (IQR, 5.0-18.0 days) participated in the study. WOB for patient breaths using the Servo 300 FT sensing (0.8 J/L [IQR, 0.5-1.0]) was not significantly lower than WOB for PT sensing on Servo 300 (0.9 J/L [IQR, 0.4-1.3 J/L]) or the Servo 900C (0.9 J/L [IQR, 0.5-1.3 J/L]). However, when lung compliance was <0.75 mL.kg(-1).cm H(2)O(-1), WOB using the Servo 300 FT sensing (0.8 J/L [IQR, 0.6-1.1 J/L]) mechanism was significantly lower than those for PT sensing on both the Servo 300 (1.1 J/L [IQR, 0.9-1.3 J/L]) and Servo 900C (1.2 J/L [IQR, 1.1-1.5 J/L]) ventilators (p </=.017). CONCLUSIONS: FT may not decrease WOB compared with PT for unsupported spontaneous breathing in children receiving mechanical ventilation. However, when lung compliance is decreased, FT sensing may be advantageous in decreasing the WOB.

Child, Preschool↗

PubMed2004

Safety, pharmacokinetics, and pharmacodynamics of drotrecogin alfa (activated) in children with severe sepsis.

OBJECTIVE: In a phase 3 trial, recombinant human activated protein C (drotrecogin alfa [activated]) significantly reduced mortality in adult patients with severe sepsis. We have now performed a preliminary analysis of the safety, pharmacokinetics, and pharmacodynamics of drotrecogin alfa (activated) in pediatric patients with severe sepsis. DESIGN AND SETTING: Open-label, nonrandomized, sequential, 2-part study conducted in 11 medical centers in the United States and United Kingdom. PATIENTS: Eighty-three pediatric patients with severe sepsis aged term newborn (>or=38 weeks' gestation) to <18 years old. INTERVENTION: In part 1, drotrecogin alfa (activated) was administered as escalating doses of 6, 12, 24, and 36 micro g/kg per hour for 6 hours for each patient (n = 21). In part 2, drotrecogin alfa (activated) was infused at a rate of 24 micro g/kg per hour for 96 hours in 62 patients. MAIN OUTCOME MEASURES: Plasma clearance, plasma concentration, D-dimer, protein C, and antithrombin levels were measured, and adverse events were monitored. RESULTS: The trial enrolled 83 pediatric patients with severe sepsis, aged term newborn (>or=38 weeks' gestation) to <18 years. In part 1, a dose of 24 micro g/kg per hour produced steady-state plasma concentrations of activated protein C similar to those attained in equivalently dosed adult severe sepsis patients. For all pediatric patients dosed at 24 micro g/kg per hour, the median weight-normalized clearance was 0.45 L/hour/kg and the median steady-state concentration was 51.3 ng/mL. The mean plasma half-life was 30 minutes. Weight-normalized clearance in pediatric and adult patients did not differ significantly with age or weight. D-dimer levels decreased 26% from baseline to end of infusion. Baseline levels of protein C and antithrombin increased 79% and 24%, respectively, over the 96-hour treatment period in part 2. The incidence of serious bleeding during infusion and during the entire study period was 2.4% and 4.8%, respectively. CONCLUSIONS: Pediatric patients with severe sepsis manifest sepsis-induced coagulopathy including protein C deficiency comparable to that seen in adults with severe sepsis. The pharmacokinetics, pharmacodynamic effects, and safety profile of drotrecogin alfa (activated) in pediatric patients are similar to those previously published for adult patients. A large, phase 3, randomized, placebo-controlled study is ongoing to confirm these results and formally assess the safety and efficacy of drotrecogin alfa (activated) in children.

Adolescent↗

PubMed2003

Bronchodilator premedication does not decrease respiratory adverse events in pediatric general anesthesia.

PURPOSE: Upper respiratory infections (URI) presage perioperative respiratory complications, but thresholds to cancel surgery vary widely. We hypothesized that autonomically-mediated complications seen during emergence from anesthesia would be predicted by capnometry and reduced with preoperative bronchodilator administration. METHODS: Afebrile outpatient tertiary-care children (age two months to 18 yr, n = 109) without lung disease or findings, having non-cavitary, non-airway surgery for under three hours, were randomized to bronchodilator premedication vs placebo and had preoperative capnometry. After halothane via mask, laryngeal mask airway, or endotracheal tube, and regional anesthesia as appropriate, patients recovered breathing room air while cough, wheeze, stridor, laryngospasm, and cumulative desaturations were recorded for 15 min. RESULTS: In this specific population, there was no association between adverse events and either URI within six weeks (n = 76) or URI within seven days (n = 21). Neither albuterol nor ipratropium premedication decreased adverse events. Endotracheal intubation was associated with increased emergence desaturations and placebo nebulized saline increased emergence coughing. Neither anesthesiologists nor preoperative capnometry predicted adverse events. CONCLUSIONS: Adverse events were neither predicted nor prevented. In afebrile outpatient ASA I and II children with no lung disease or findings, having non-cavitary, non-airway surgery for under three hours, there was no association between either recent URI or active URI and desaturation, wheeze, cough, stridor, or laryngospasm causing desaturation (all P > 0.05). In this highly selected population of afebrile patients, the results suggest that anesthesiologists may proceed with surgery using specific criteria in the presence of a URI.

Anesthesia, General↗

PubMed2003

Endotracheal suctioning with or without instillation of isotonic sodium chloride solution in critically ill children.

BACKGROUND: Instillation of isotonic sodium chloride solution for endotracheal tube suctioning is controversial. Research has focused on the effect of such instillation in adults; no studies in children have been published. OBJECTIVES: (1) To describe differences in oxygen saturation depending on whether or not isotonic sodium chloride solution is instilled during suctioning and (2) to describe the rates of occlusion of endotracheal tubes and nosocomial pneumonia. METHODS: A convenience sample of 24 critically ill patients were enrolled before having suctioning and after informed consent had been given. Ages ranged from 10 weeks to 14 years. Patients were randomized to 1 of 2 groups. In group 1, subjects received between 0.5 and 2.0 mL of isotonic sodium chloride solution, depending on their age, once per suctioning episode. In group 2, subjects received no such solution. A total of 104 suctioning episodes were analyzed. Oxygen saturation was recorded at predetermined intervals before and for 10 minutes after suctioning. Occlusion of endotracheal tubes and rates of nosocomial pneumonia also were compared. RESULTS: Patients who had isotonic sodium chloride solution instilled experienced significantly greater oxygen desaturation 1 and 2 minutes after suctioning than did patients who did not. No occlusions of endotracheal tubes and no cases of nosocomial pneumonia occurred in either group. CONCLUSIONS: Results of this study support a growing body of evidence that instillation of isotonic sodium chloride solution during endotracheal tube suctioning may not be beneficial and actually may be harmful.

Adolescent↗