We evaluated a portable blood gas analyzer for its speed, reliability, and usefulness during interhospital transportation of critically ill children in a prospective study. The accuracy of a portable blood gas analyzer (PBGA) was first established by comparing its results with values obtained from a standard blood gas analyzer. The speed, accuracy, and usefulness of the PBGA were then compared with those of standard analyzers at 10 referring hospitals during interhospital transportation of critically ill children. A highly significant linear correlation was demonstrated between values obtained using the PBGA and those derived from standard analyzers. The time required to obtain blood gas results was 2 min with the portable device, significantly less than the mean of 8.4 min +/- 6.4 min (range 1-24 min) required to get results from the laboratory facilities of the referring hospitals. Modification of treatment or adjustment to mechanical ventilation was required in 30% of transported patients based on blood gas results obtained immediately before departure from the referring hospital. We conclude that a portable blood gas analyzer provides rapid, reliable, and useful data that help to determine therapy for critically ill children awaiting interhospital transport.

Blood Gas Analysis↗

PubMedDate not supplied

Diagnosis and management algorithm of acute onset of central diabetes insipidus in critically ill children.

We devised a diagnosis and management algorithm for acute onset of central diabetes insipidus (CDI), and conducted a retrospective evaluation of its efficacy. Fourteen patients admitted to our pediatric intensive care unit (PICU) over a three year period were diagnosed with acute CDI secondary to various brain injuries. All patients were treated as per the algorithm guidelines. The initial dose of aqueous vasopressin ranged from 0.25 to 1.0 mU/kg/h. Low sodium content solution (0-0.5 normal saline) was used to replace urine output in excess of 3 ml/kg/h and for maintenance fluid therapy. The therapeutic goals included: urine output 2-3 ml/kg/h, urine specific gravity 1.010-1.020 and serum sodium 140-145 mEq/l. The pitressin dose was adjusted as deemed necessary to achieve the aforementioned goals. Our results indicate that urine specific gravity is the most sensitive parameter to respond to treatment. It was the best determinant of the adequacy of pitressin dose as it had the best linear correlation with it (r = 0.96; p = 0.009). Urine output was second best (r = 0.93; p = 0.02), whereas no linear correlation was established between pitressin dose and serum sodium concentration, nor with serum osmolality. We conclude that the algorithm developed and used by us for the management of CDI is generally efficacious. Changes in urine specific gravity follow changes in pitressin dose very closely and thus should be used as the primary parameter for determination of intravenous pitressin dose adjustment.

Acute Disease↗