Prolonged weakness after extended mechanical ventilation in a child.
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Bed Rest↗
Biomedical subjects
R C Pascucci
Publications and source records attributed to R C Pascucci.
Chest wall motion of infants during spinal anesthesia.
To test the extent to which diaphragmatic contraction moves the rib cage in awake supine infants during quiet breathing, we studied chest wall motion in seven prematurely born infants before and during spinal anesthesia for inguinal hernia repair. Infants were studied at or around term (postconceptional age 43 +/- 8 wk). Spinal anesthesia produced a sensory block at the T2-T4 level, with concomitant motor block at a slightly lower level. This resulted in the loss of most intercostal muscle activity, whereas diaphragmatic function was preserved. Rib cage and abdominal displacements were measured with respiratory inductance plethysmography before and during spinal anesthesia. During the anesthetic, outward inspiratory rib cage motion decreased in six infants (P less than 0.02, paired t test); four of these developed paradoxical inward movement of the rib cage during inspiration. One infant, the most immature in the group, had inward movement of the rib cage both before and during the anesthetic. Abdominal displacements increased during spinal anesthesia in six of seven infants (P less than 0.05), suggesting an increase in diaphragmatic motion. We conclude that, in the group of infants studied, outward rib cage movement during awake tidal breathing requires active, coordinated intercostal muscle activity that is suppressed by spinal anesthesia.
Anesthesia, Spinal↗
Comparison of a sidestream and mainstream capnometer in infants.
This study was designed to compare capnograms obtained from a sidestream and mainstream capnometer during rapid mechanical ventilation in infants. Ten infants were studied during elective anesthesia and surgery. Simultaneous recordings of exhaled CO2 were made with a sidestream and a mainstream machine; arterial blood gases were measured for comparison. The mean arterial to end-tidal CO2 difference (PaCO2-PetCO2) was approximately 5 torr with either technique; the correlation of PetCO2 with PaCO2 was slightly better with the mainstream analyzer (r2 = .895 vs. .654). The recordings obtained with the sidestream machine were grossly distorted, with flattening of the ascending limb (slope 37.3 vs. 153.3 torr/sec, sidestream vs. mainstream, p less than .001) and absence of the alveolar plateau. The mainstream analyzer gives a more accurate representation of the expired CO2 waveform in small children at rapid respiratory rates.
Carbon Dioxide↗
Head trauma in the child.
Head injury, either alone or in combination with multiple injuries, is common in children. Its pattern is different in children compared to adults, with diffuse cerebral swelling rather than localized hematoma being most common. The pathophysiology of pediatric head trauma is not yet clearly elucidated, but may be closely related to changes in the regulation of cerebral blood flow. The initial management and subsequent care of the child with severe brain injury are discussed from a multisystem viewpoint. The prognosis for children with severe head injury seems brighter than for adults, but there are not yet enough data to allow prediction of outcome in any individual case. Efforts to prevent, rather than treat, head injury in childhood are more likely to be beneficial.
Brain Injuries↗
Reye's syndrome.
Although most cases of Reye's syndrome that were initially reported were fatal, the overall mortality is now 20 to 30 per cent, with an even lower rate in some series. Improvement is due to both increased awareness of this disease and advances in care for the critically ill child. A good outcome depends on recognition of the early manifestations of the syndrome and appropriate initial therapy based on the stage of the disease.
Adolescent↗