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R D Truog

Publications and source records attributed to R D Truog.

At least 19 recordsLinked to original sources
PubMed1995

The cardiopulmonary resuscitation-not-indicated order: futility revisited.

This paper reviews the advent of unilateral do-not-resuscitate orders. Unilateral do-not-resuscitate policies presume that cardiopulmonary resuscitation is a medical therapy and that physicians have no obligation to undertake a medical therapy that does not offer achievable and appropriate goals. Four do-not-resuscitate policies from U.S. hospitals and some of the significant published proposals are reviewed. We conclude that anything other than a physiologic definition of futility is indefensible because of imposed value judgments, imprecise definitions of quantitative and qualitative futility, inexact data, lack of certitude of economic benefit, and the role of autonomy for the patient and physician.

Consensus↗
PubMed1995

The benefits of the explanation of the risks of anesthesia in the day surgery patient.

STUDY OBJECTIVE: To ascertain the benefits of the preoperative discussion of the risks of anesthesia with parents of ASA status I or II pediatric day surgery patients. DESIGN: Survey analysis. SETTING: Pediatric day surgery unit. PATIENTS: 54 parents of ASA status I or II pediatric day surgery patients between the ages of 7 months and 16 years. INTERVENTIONS: After informed consent for the anesthetic was obtained by a member of the anesthesiology team, the parent(s) were given a questionnaire on their feelings about the explanation of the risks of anesthesia. MEASUREMENTS AND MAIN RESULTS: The questionnaire evaluated how parents felt about their understanding of the risks of anesthesia, the effect of hearing the risks of anesthesia on their anxiety levels, and the benefits of hearing the risks of anesthesia. Over 90% of the parents felt that they understood the risks of anesthesia, that the discussion of the risks would have no effect on their decision to proceed with surgery, and that the explanation of the risks is desirable; 92% considered the explanation desirable either out of a sense of responsibility or because they welcomed better understanding. CONCLUSIONS: Our study suggests the benefits of the explanation of the risks of anesthesia appear to be rooted in satisfying parental responsibility and understanding, and not in providing information for decision making or anxiety relief. Anesthesiologists should not feed compelled to always detail all the risks, but should seek to satisfy individual parental needs.

Adolescent↗
PubMed1993

High-frequency oscillatory ventilation in pediatric respiratory failure.

OBJECTIVE: To evaluate the safety and effectiveness of high-frequency oscillatory ventilation using a protocol designed to achieve and maintain optimal lung volume in pediatric patients with respiratory failure. SETTING: Tertiary care pediatric ICU in a university hospital. DESIGN: A prospective, clinical study. PATIENTS: Seven patients aged 1 month to 15 yrs with diffuse alveolar disease and airleak with a variety of primary diagnoses, including pneumonia, adult respiratory distress syndrome, and pulmonary hemorrhage. INTERVENTIONS: After varying periods of conventional mechanical ventilation (16 to 216 hrs), patients were managed with high-frequency oscillatory ventilation using a "high-volume" strategy that consisted of incremental increases in mean airway pressure and lung volume to achieve an arterial oxygen saturation of > or = 90%, with an FIO2 of < or = 0.6. MEASUREMENTS AND MAIN RESULTS: Ventilatory settings, including FIO2 and mean airway pressure, hemodynamic parameters (cardiac index, systemic and pulmonary vascular resistance indices, oxygen delivery [DO2] and oxygen extraction ratio) and the oxygenation index (oxygenation index = [FIO2 x mean airway pressure x 100]/PaO2) were monitored during the transition to high-frequency oscillation and throughout the course of the high-frequency oscillatory ventilation with rapid and sustained reductions in mean airway pressure (p = .0001, repeated-measures analysis of variance [ANOVA]) and a trend toward decreasing oxygenation index (p = .08, repeated-measures ANOVA). In the four patients from whom hemodynamic data were obtained, there were no compromises of cardiac index or DO2 despite a significant increase in mean airway pressure (26 +/- 2 to 35 +/- 2 cm H2O) during conversion from conventional ventilation to high-frequency oscillation. CONCLUSIONS: High-frequency oscillatory ventilation, using a high-volume strategy, may be used safely and effectively in pediatric patients with respiratory failure and with high predicted mortality rates. High mean airway pressure during oscillatory ventilation does not appear to compromise DO2. Whether this technique can alter morbidity or mortality rates in this population awaits prospective randomized study.

Adolescent↗
PubMed1993

Prolonged administration of isoflurane to pediatric patients during mechanical ventilation.

We undertook a prospective study of the effectiveness and potential toxicities of isoflurane sedation in pediatric patients undergoing mechanical ventilation who required large doses of opioids for sedation were considered eligible. Ten patients (ages 3 wk to 19 yr) received continuous isoflurane sedation for a mean duration of 131 minimum alveolar concentration (MAC)-hours (range 13-497 MAC-hours). The mean peak inorganic fluoride (F-) concentration was 11.0 microM, and the highest F- concentration was 26.1 microM after 441 MAC-hours. Only one patient had a measured F- concentration greater than 20 microM. No abnormalities were noted in serum creatinine or osmolality. Creatinine clearances were available for five patients who received a mean of 193 MAC-hours of isoflurane (range 33-497 MAC-hours), and only one patient had a persistent decrease from baseline of more than 20%. Five patients demonstrated an abstinence syndrome which consisted of nonpurposeful movements and extreme agitation. All of these patients had received at least 70 MAC-hours of isoflurane. Our experience indicates that isoflurane can effectively provide sedation to pediatric patients for prolonged periods without significant adverse effects on cardiovascular, hepatic, or renal function.

Adult↗