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Ori Efrati

Publications and source records attributed to Ori Efrati.

25 records · Page 2Linked to original sources
PubMed2002

Inadequate asthma treatment practices and noncompliance in Israel.

Childhood asthma morbidity and mortality are increasing despite improvements in asthma therapy. The changes over the past decade in the guidelines for treatment of children with severe asthma have led to a reduction in admissions and readmissions to the pediatric intensive care unit (PICU). The Israeli medical infrastructure is exemplary in its capability of extending appropriate medical services to its entire population. Our objective was to look at the background of preventive maintenance treatment and treatment during an acute episode in children admitted to PICUs with severe asthma, and to identify areas that could be targeted for change. A 5-year retrospective chart audit on acute asthma admissions was conducted in two PICUs of general community hospitals representative of the provision of medical care in Israel. The prehospitalization preventive management and acute treatment prior to PICU admission were evaluated, and the number of admissions and readmissions was recorded. The index admission was the first episode of acute asthma for only 3% of the children: 25% of patients required readmission, and 15% of these to the PICU. In spite of a proven history of acute exacerbations of the disease, only 60% were on continuous treatment between attacks, and 29% of them had abruptly discontinued treatment, most of them shortly before the onset of the index attack. Inhaled steroids were used as maintenance and preventive treatment by less than one-third of the children, with the other two-thirds receiving mainly beta-2 agonists drugs. In conclusion, an unacceptably large proportion of asthmatic children do not receive the recommended maintenance and preventive treatment because of poor compliance, lack of education, or insufficient healthcare provision. This has probably led to avoidable recurrences of acute asthma exacerbations and unnecessary use of PICU facilities. These findings suggest that steps for implementing recommended guidelines and an educational program are needed.

Acute Disease↗
PubMed2002

Reversal of digital clubbing after lung transplantation in cystic fibrosis patients: a clue to the pathogenesis of clubbing.

Digital clubbing is a common sign in cystic fibrosis (CF) and in a variety of other diseases. However, its pathogenesis remains obscure. In diseases other than CF, regression of clubbing has been noted after cure of the underlying disease. The aim of this study was to assess whether clubbing is reversible in CF patients after lung transplantation. Digital clubbing was investigated in 3 CF patients, prior to and after lung transplantation. Distal phalangeal depth (DPD) and interphalangeal depth (IPD) of the index finger were measured using a skinfold caliper, and the DPD/IDP ratio was calculated. The mean DPD/IDP ratio was 1.08 +/- 0.05 prior to transplantation and 1.00 +/- 0.06, 0.96 +/- 0.06, 0.92 +/- 0.04, and 0.89 +/- 0.07 at 3, 6, 12, and 24 months after transplantation, respectively. In all 3 patients, the DPD/IDP ratio was greater than 1 before transplantation. In 2 patients, this ratio decreased to less than 1 within 3 months, and in the third patient within 9 months after surgery. We conclude that digital clubbing is reversible in CF patients who undergo lung transplantation. Regression was usually noted during the first 3 months posttransplantation. This could be explained either by adequate inactivation of a circulating clubbing-inducing molecule by the normal transplanted lungs, or by removal of the diseased lungs in which this presumably causative substance was produced.

Adult↗
PubMed2002

Predictors for mortality after prolonged mechanical ventilation after cardiac surgery in children.

PURPOSE: To identify early mortality-associated clinical risk factors preceding, during, and after cardiac surgery in children. MATERIALS AND METHODS: Of the 722 children admitted to our pediatric intensive care unit (PICU) from January 1992 to January 1997 after repair of congenital heart defects, 70 required 48 hours or more of mechanical ventilation. Their clinical records were analyzed for perioperative predictors of mortality. RESULTS: The children's ages were 3.6 +/- 4.1 years (range, 4 d-16 y). The overall mortality was 5.9%. Eleven of the 70 children (15.7%) who required mechanical ventilation for 48 hours or more did not survive compared with 30 of the 652 (4.6%) children ventilated for less than 48 hours. The preoperative predictors identified as being significantly associated with increased mortality were younger age (P <.05) and the presence of congestive heart failure (P <.01). The main cause of early postoperative mortality was multiorgan dysfunction (9 children, 81.8%), whereas septic complications also were responsible for late (< 1 wk postoperatively) death (the other 2 children, 17.2%). CONCLUSIONS: Younger age and congestive heart failure were the main preoperative predictors of mortality. Multiorgan dysfunction and septic complication were predictive of an increased risk for death after cardiac surgery. These factors should be investigated in greater depth to assist in guiding aggressive therapeutic approaches for combating early signs of organ system dysfunction and infectious complications in these high-risk patients.

Adolescent↗
PubMed2002

Endotracheal epinephrine: a call for larger doses.

UNLABELLED: Endotracheal administration of epinephrine 0.02 mg/kg (twice the IV dose) is recommended when IV access is unavailable during cardiopulmonary resuscitation. The standard IV dose has been considered too small for the endotracheal route by causing a detrimental decrease of arterial blood pressure (BP), presumably mediated by the beta-adrenergic receptor unopposed by alpha adrenergic vasoconstriction. We conducted a prospective, randomized, laboratory comparison of increasing doses of endotracheal epinephrine to ascertain the yet undetermined optimal dose of endotracheal epinephrine that would increase BP. After injecting normal saline (control), saline-diluted epinephrine (0.02, 0.035, 0.1, 0.2, and 0.3 mg/kg) was injected into the endotracheal tube of five anesthetized dogs at least 1 wk apart. Arterial blood samples for blood gases were collected before and at 14 time points up to 60 min after the drug administration. Heart rate and arterial BP were continuously monitored with a polygraph recorder. Only the 0.3 mg/kg dose successfully caused an increase in BP, observed 2 min after administration, and lasting for 10 min. An early decrease in BP was obviated only at a dose equivalent to 10-fold the currently recommended one. IMPLICATIONS: We conducted a prospective, randomized, laboratory comparison of increasing doses of endotracheal epinephrine to ascertain the yet undetermined optimal dose of endotracheal epinephrine that would increase arterial blood pressure (BP). A decrease in BP was obviated only at a dose equivalent to 10-fold the currently recommended one. Clinical studies using larger doses of endotracheal epinephrine and their use as first-line therapy in cardiac arrest are warranted.

Animals↗
PubMed2002

Long-term assessment of pulmonary function tests in pediatric survivors of acute respiratory distress syndrome.

BACKGROUND: The aim of the study was to evaluate long-term pulmonary function tests in pediatric survivors of acute respiratory distress syndrome (ARDS). MATERIAL/METHODS: Observational study based on a telephone poll of retrospectively identified post ARDS children who were hospitalized in a pediatric intensive care unit (PICU) in a general 1200-bed teaching, tertiary, regional referral center for children. RESULTS: Follow-up pulmonary function tests were achieved in only 7 children, with a mean age of 7.3+/-4.3 years (range 3-12) and following 5.6+/-4.3 years after PICU discharge. The etiology for ARDS included: lymphoma (n=2), pneumonia (n=2), aspiration (n=1), petrol ingestion (n=1) and snake envenomation (n=1). The children had been ventilated for 9.4+/-7.3 days and their worst PaO2/FiO2 ratio was 65.1+/-17.0 mm Hg. The follow-up pulmonary functions in all the children was within normal limits except for one child who had mildly reduced DLCO and one who had mild exercise-induced hypoxemia (oxyhemoglobin saturation of 94%). Neither of the two nor the others showed subjective symptoms or clinical physical limitations. CONCLUSIONS: Children who survive ARDS apparently enjoy long-term normal pulmonary function. Some, however, may present subclinical dysfunction that persists for many years after the acute episode and evoked only by sophisticated lung tests.

Child↗