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Biomedical subjects

M Leijala

Publications and source records attributed to M Leijala.

At least 19 recordsLinked to original sources
PubMed1992

Superior vena caval and mixed venous oxyhemoglobin saturations in children recovering from open heart surgery.

Simultaneous superior vena caval (Scvo2) and mixed venous (Svo2) oxyhemoglobin saturation values in 15 children recovering from open heart surgery were compared to assess the value of superior vena caval blood samples in monitoring systemic oxygen supply/demand balance. Samples were obtained immediately following the operation and postoperatively every morning for 4 days. During the 4-day study period, the patients' cardiopulmonary functions improved, allowing partial weaning from respiratory and cardiovascular support. The lowest values of superior vena caval (46.7 +/- 8.4%) and mixed venous (63.7 +/- 10.9%) oxyhemoglobin saturation were measured immediately after the operation. At this time, 6 patients had abnormally low Scvo2 values, but normal Svo2 values. Both Scvo2 and Svo2 increased; the difference between them decreasing significantly during the study period (P less than 0.001). The results show that Scvo2 is consistently lower than Svo2 in children recovering from open heart surgery. This difference may be secondary to residual intracardiac left-to-right shunting of blood or to altered distribution of systemic blood flow. The saturation difference between the two venous samples decreases during postoperative recovery, making a superior vena caval blood sample an inadequate substitute for a mixed venous blood sample in calculating derived cardiopulmonary variables intended to reflect the function of the body as a whole. Because Scvo2 was frequently subnormal while Svo2 was in the normal range, monitoring of Svo2 could not be reliably used to rule out oxygen supply/demand imbalance during the early postoperative period in these patients.

Age Factors↗
PubMed1992

Bronchoscopy during the first month of life.

During the 6-year period from 1984 to 1989, 196 bronchoscopies were performed on 132 neonates. The indications were grouped into four categories: (1) difficulties in artificial ventilation or failure to wean the baby from the ventilator (52); (2) other respiratory difficulties (52); (3) audible stridor (16); and (4) routine preoperative or postoperative examination of esophageal atresia patients (12). The most common finding was laryngomalacia or tracheomalacia (31). Other findings were: obstructing tracheal or bronchial granulation or stricture (23), obstructing mucous plug (22), grave tracheobronchitis (11), tracheoesophageal H-fistula (5), laryngeal perforation (3), congenital laryngeal stenosis (2), and complete laryngotracheoesophageal cleft (1). Four patients had miscellaneous pathology. The findings were normal in 30 patients. A therapeutic procedure was included in 99 of the 196 bronchoscopies. Seven serious complications occurred during the operative bronchoscopies, two of them requiring immediate pulmonary surgery. All complications were successfully managed. In contrast, no complications occurred in the 97 purely diagnostic bronchoscopies. In experienced hands, bronchoscopy of the newborn is a safe and useful examination. Complications occur when therapeutic procedures are included. Therefore, operative bronchoscopy should only be performed in conditions in which immediate thoracotomy and pulmonary surgery can be performed.

Bronchial Diseases↗
PubMed1992

Spontaneous breathing and total body oxygen consumption in children recovering from open-heart surgery.

The effects of withdrawal of ventilatory support on cardiopulmonary function, oxygen consumption and carbon dioxide production were assessed in 25 infants and children within seven days (2.9 +/- 2.5 days; mean +/- SD) of an open heart operation, during weaning from ventilatory support. The average age of the patients was 3.4 +/- 3.5 years and weight 12.4 +/- 8.3 kg. Heart rate, blood pressure, arterial and central venous blood gas values, and oxyhemoglobin saturations were measured during controlled mechanical ventilation and during spontaneous breathing with continuous positive airway pressure. Simultaneously, VO2 and VCO2 were measured using indirect calorimetry. Withdrawal of ventilatory support effected an expected, significant decrease in arterial pH (7.42 +/- 0.10 to 7.37 +/- 0.06; p less than 0.001) and an increase in PaCO2 (34 +/- 6 to 40 +/- 5 mm Hg; p less than 0.0001), while arterial blood oxyhemoglobin saturation, heart rate, and blood pressure remained unchanged. A significant increase in central venous oxyhemoglobin saturation (67.9 +/- 11.9 to 74.8 +/- 8.3 percent; p less than 0.001) indicated improvement in systemic blood flow during spontaneous breathing. Average VO2 and VCO2 did not change significantly. A decrease in VO2 by more than 5 percent was seen in seven patients, an increase by more than 5 percent in nine, and a change within +/- 5 percent in nine patients. The change in VO2 was inversely related to the difference between measured and expected VO2 during mechanical ventilation (r = -0.73) and to body temperature (r = -0.69). The results indicate that factors other than the oxygen uptake by the respiratory muscles may have significant effects on total body VO2 in infants and children after open-heart surgery. Therefore, monitoring of VO2 during withdrawal of ventilatory support may not be an accurate indicator of respiratory work and oxygen cost of breathing in these patients.

Carbon Dioxide↗
PubMed1991

Lung mechanics and airway pressure transmission in infants after open heart surgery.

To evaluate the effects of positive airway pressure on lung mechanics and airway pressure transmission into the intrathoracic space, airway and intrathoracic pressure were recorded during stepwise lung inflation in 17 infants undergoing open heart surgery during the first year of life. Eleven of the 17 patients had cuffed tracheal tubes allowing calculation of lung and chest wall compliance. In 7 of these 11 patients, lung inflation to 2.5 ml/kg above functional residual capacity produced an improvement in initially low lung compliance. This volume increment required elevation of airway pressure by 4-11 cm H2O above ambient. Further lung inflation to 10 ml/kg did not effect an improvement in lung mechanics. In the remaining patients, initial lung compliance was high and remained unchanged throughout the range of lung inflation. Transmission of pressure into the intrathoracic space averaged 47 +/- 9% (mean +/- SD) and ranged from 33% to 61% when airway pressure was 10-15 cm H2O. The results indicate that the use of moderately elevated airway pressure is required to optimize lung distensibility in most infants immediately after open heart surgery. When evaluating circulatory effects of elevated airway pressure, assumption of a 50% pressure transmission is appropriate for clinical purposes. However, the observed wide range of pressure transmission warrants careful hemodynamic monitoring during continuous positive pressure breathing.

Female↗
PubMed1991

Breathing circuit respiratory work in infants recovering from respiratory failure.

OBJECTIVE: To compare cardiopulmonary function during spontaneous breathing with three continuous-flow breathing circuits. The major difference between these circuits was the degree of flow resistance offered by the exhalation valve. DESIGN: Randomized crossover trial. PATIENTS: Twelve infants less than 12 months of age recovering from respiratory failure of variable etiology. Only patients weighing 3 to 10 kg were studied. INTERVENTIONS: The patients were connected to each respiratory circuit in a random sequence, with 15 min allowed for equilibration before assessment of cardiopulmonary function. Airway pressure (Paw) and FIO2 were maintained unchanged. MEASUREMENTS AND MAIN RESULTS: Ventilation, gas exchange, or circulatory function were not altered significantly by changing the breathing circuit. However, Paw and esophageal pressure fluctuations were altered and were largest during breathing with the circuit that had an exhalation valve with high-flow resistance. The Paw fluctuation recorded while the patient was breathing with the flow-resistor circuit increased with weight and exceeded 2 cm H2O in all patients weighing greater than 4.5 kg. Paw fluctuation could be decreased by greater than 2 cm H2O in ten of 12 patients by using the threshold-resistor circuit. CONCLUSIONS: The results indicate a need for evaluating the characteristics of respiratory circuits used for spontaneous breathing in infants and children, to avoid unnecessary equipment-related increase in respiratory work.

Airway Resistance↗
PubMed1991

Surgery for ventricular septal defect.

Of 255 patients undergoing closure of ventricular septal defect (VSD), 48% were younger than 2 years, 59% had associated cardiac and 26% non-cardiac abnormality, 13% had multiple, and only 29% isolated VSD. VSD was closed via the left ventricular apex in seven cases, without increased morbidity or mortality. The three early and six late deaths occurred in patients with complicated defects. Pulmonary vascular occlusive disease caused four deaths (1 early, 3 late). At follow-up (mean c. 3, range 1-11 years), 79% of the patients were well, 10% had cardiac symptoms and 7.5% had symptoms from associated noncardiac anomalies. Reoperation for significant residual VSD was required in 12 cases (4 single and 8 multiple VSD). Complete, pacemaker-requiring A-V block was found in four patients (none with simple VSD closure). It is concluded that 1) concomitant cardiac and non-cardiac lesions are common in VSD, 2) mortality is closely related to such lesions and to pulmonary vascular occlusive disease, 3) the latter is a rare, but real cause of death, 4) left ventricular approach need not increase mortality or morbidity, 5) significant residual VSD is rare after single, but common in multiple VSD, and 6) risk of complete A-V block after simple VSD closure is very low.

Adolescent↗
PubMed1990

Bronchial epithelial inflammation in children with chronic cough after early lower respiratory tract illness.

We studied the ultrastructural findings in biopsies from the main carina of seven school-aged children who had had chronic cough for at least 3 months and who all had a history of early lower respiratory illness (LRI). They had their first LRI between birth and 7 yr of age (range, 5 to 11 yr). The cross-sectional area of the epithelium was quantified by point counting for the percentage area of intercellular spaces (ICS) denoting edema, and the numbers of both inflammatory cells (leukocytes, including eosinophils, and mast cells) and ciliated cells. The children (excluding the one using inhaled steroids) demonstrated nearly 17- and more than sevenfold increases in the mean area of ICS and number of inflammatory cells per epithelial area, respectively, and a nearly three-fold decrease in the mean number of ciliated cells per epithelial area compared with the biopsy specimens from the orifice of the right upper lobe bronchus of two healthy adults. In the children, the increase in inflammatory cells (greater than 91% were lymphocytes) was more prominent in the children with two LRI before the age of 1 yr. Our findings imply a close association of early LRI and later epithelial inflammation during chronic cough. Allergic mechanisms in the epithelial inflammation cannot be ruled out as six of the patients had, either alone or in combination, signs of atopia, positive family history of allergic rhinitis or asthma, and eosinophils or mast cells in the epithelium.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Value of C-reactive protein in reflecting the magnitude of complement activation in children undergoing open heart surgery.

The kinetics of C-reactive protein (CRP) were studied prospectively in 30 children (aged 21 days - 16 years) undergoing open heart surgery. CRP was related to the kinetics of total haemolytic complement, complement C3a and postoperative complications. Two (7%) patients died and ten (33%) had postoperative complications. The patients with complications were younger (p less than 0.035), underwent longer perfusions (p less than 0.001) and had longer aortic cross-clamping times (p less than 0.003). The mean peak CRP level after surgery (108 mg/l) was reached, on the average, in 43 h. No statistical difference in CRP concentrations was found between the complication and non-complication groups. Extensive complement activation was seen in every patient. CRP did not reflect the magnitude of complement activation induced by cardiopulmonary bypass. The patient sample was too small to draw reliable conclusions about the value of CRP in detecting postoperative complications after open heart surgery in children.

Adolescent↗
PubMed1989

Iatrogenic, unexpected and other vascular rings in children.

Between May 1955 and July 1987, 33 children with a vascular ring compression syndrome were treated at this institution. There were 4 iatrogenic, 2 unexpectedly found and 27 symptomatic congenital vascular rings. Accurate diagnosis is based on a water soluble iodine contrast dye oesophagogram, bronchoscopy and angiography which are complementary examinations. All symptomatic congenital vascular rings were treated successfully without mortality, but the mortality was 50% if the lesion was iatrogenic in origin or unexpectedly found during palliative or corrective cardiac surgery.

Aorta, Thoracic↗
PubMed1988

Pancreatitis after open heart surgery in children.

Between January 1981 and March 1986, we found 54 children with abnormal serum amylase values or clinical pancreatitis after open heart surgery. Of these 33, had increased serum amylase values only, and 19 had increased serum amylase values in conjunction with clinical pancreatitis. Two patients had haemorrhagic pancreatitis identified at autopsy. The mortality was 42.9% (9/21) in patients with pancreatitis compared to 9.1% (3/33) with amylasaemia only. Pancreatitis is a serious complication after complex open heart surgery in children. The aetiology is probably of vascular origin, and routine serum amylase screening is recommended.

Adolescent↗