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Biomedical subjects

T B Rice

Publications and source records attributed to T B Rice.

16 recordsLinked to original sources
PubMed2001

Stability of dopamine and epinephrine solutions up to 84 hours.

OBJECTIVES: The current practice of preparing fresh dopamine and epinephrine solutions every 24 hrs may lead to hemodynamic instability caused by the interruption of infusions with each change. We determined the stability of these catecholamines over an 84-hr period and whether stability was enhanced by dextrose-containing solutions. SETTING: Tertiary care teaching hospital. DESIGN: The stability of dopamine and epinephrine, each at three commonly used concentrations, was studied in three vehicles (10 gm/dl dextrose in water [D10W], 5 gm/dl dextrose in water [D5W], and 0.9% NaCl in water [NS]). To mimic clinical conditions, solutions were placed on syringe pumps infusing continuously into a closed system at ambient temperature for 84 hrs. MEASUREMENTS: Concentrations of dopamine in mg/ml and epinephrine in microg/ml were measured by high-performance liquid chromatography at 0, 24, 36, 48, 72, and 84 hrs. RESULTS: Dopamine and epinephrine concentrations did not change over the 84-hr period regardless of the vehicles in which the drugs were prepared. CONCLUSIONS: Clinically relevant concentrations of dopamine and epinephrine remain stable in dextrose- and saline-containing solutions for >or=84 hrs. These data suggest that solutions of these catecholamines may safely be used in clinical practice beyond the currently recommended 24 hrs.

Journal Article↗
PubMed1998

Suspected respiratory tract infection in the tracheostomized child: the pediatric pulmonologist's approach.

STUDY OBJECTIVES: It is difficult to determine, in the child with a long-term tracheostomy, when bacterial airway colonization has progressed to a respiratory infection requiring antibiotic treatment. Our aim was to investigate whether there is a consensus regarding this and related chronic care issues among clinicians treating these patients. DESIGN AND SETTING: A questionnaire asking about practices regarding use of tracheal aspirate cultures and antibiotics was distributed to 47 pediatric pulmonary centers. PARTICIPANTS: Individuals representing 34 centers (72%), caring for 10 to 400 patients, responded. INTERVENTIONS: None. RESULTS: At 65% of centers, management is variable, dependent on the patient's underlying condition. The most common indications to obtain a culture were change in secretions (91%) or fever without an obvious source (21 centers). Indications to treat with antibiotics included many leukocytes in secretions (21 centers) or a respiratory illness (18 centers). When treating, 97% prescribe antibiotics empirically, most often enterally; nine centers use inhaled antibiotics. In most centers (79%), management is often done by telephone. CONCLUSIONS: Although pediatric pulmonologists tend to have similar approaches to assessment and management of suspected respiratory tract infections in tracheostomized children, no clear consensus exists, and much of current practice is empirical. To optimize care of these patients, studies should be conducted to develop criteria to objectively differentiate bacterial airway "colonization" from "infection."

Adolescent↗
PubMed1997

Inhaled nitric oxide reduces the utilization of extracorporeal membrane oxygenation in persistent pulmonary hypertension of the newborn.

OBJECTIVE: To determine if the use of inhaled nitric oxide therapy reduces the need for extracorporeal membrane oxygenation (ECMO) in persistent pulmonary hypertension of the newborn. DESIGN: A matched cohort study with retrospective data extraction. SETTING: Pediatric and neonatal intensive care units at a medical school-affiliated children's hospital serving as a regional referral center for respiratory failure. PATIENTS: Records of all neonates transferred for rescue therapy for persistent pulmonary hypertension during the study period were analyzed, with inclusion in the study based on defined gas exchange parameters, and with exclusion from the study based on the presence of congenital heart disease, diaphragmatic hernia, or lethal chromosomal abnormality. Assignment to cohorts was based on availability of inhaled nitric oxide therapy: group 1 patients were admitted when inhaled nitric oxide was unavailable; group 2 patients were admitted when inhaled nitric oxide was available. INTERVENTIONS: Standard criteria (alveolar-arterial oxygen tension gradient of > 600 torr [> 80 kPa], or oxygenation index of > 40) were used to trigger initial evaluation for ECMO when these criteria were met for 2 hrs, and ECMO was initiated if these criteria continued to be met for 12 hrs, or if cardiovascular instability occurred. Ventilator management in all patients was directed to improve arterial oxygenation, such that ECMO criteria were no longer met. Patients in group 2 only were treated with inhaled nitric oxide after meeting ECMO evaluation criteria, and they continued to receive inhaled nitric oxide if a quantifiable improvement in gas exchange occurred. MEASUREMENTS AND MAIN RESULTS: Fifty patients qualified for inclusion in the analysis (29 patients in group 1, and 21 patients in group 2). In group 1, 21 (72%) patients met ECMO criteria, and 16 (76%) patients required ECMO therapy. In group 2, 16 (76%) patients met ECMO criteria, 15 patients received inhaled nitric oxide therapy, and only four (25%) patients required ECMO therapy (p = .003 compared with group 1). Treatment with inhaled nitric oxide resulted in an initial increase in PaO2, without adverse effects, in all of the treated patients. The reduction in ECMO utilization in group 2 was achieved with a higher rate of complication-free survival (survival without oxygen, requirement at 28 days, p = .018; survival without intracranial hemorrhage, p = .048), and a lower hospital cost per survivor (p = .021), compared with group 1 patients. CONCLUSION: In neonates with persistent pulmonary hypertension, therapy with inhaled nitric oxide reliably and safely improves oxygenation, thereby resulting in a decreased need for ECMO therapy, improved patient outcome, and lower hospital costs.

Administration, Inhalation↗
PubMed1991

Group A streptococcal supraglottitis: three case reports.

We report three cases of supraglottitis caused by Streptococcus pyogenes. In contrast to other reports of patients with severe clinical symptoms from supraglottitis with group A beta Streptococcus, our patients had mild disease that resolved rapidly and did not require endotracheal intubation. There is a broad spectrum of clinical illness with GABS supraglottitis.

Adolescent↗
PubMed1989

Accidental cocaine intoxication in a nine-month-old infant: presentation and treatment.

A case of a nine-month-old male who ingested cocaine is presented. The rarity of this type of ingestion, as well as the caretaker's denial of the presence of cocaine in the household, made rapid diagnosis of this infant's malady difficult. We present this case to alert physicians to the presentation and treatment of cocaine-intoxicated infants.

Accidents, Home↗
PubMed1989

Outcome of infants with cystic fibrosis requiring mechanical ventilation for respiratory failure.

Previous studies have documented a 75 to 80 percent mortality rate in infants (less than 12 months) with cystic fibrosis who present with RF/MV. We investigated the current outcome of these patients by comparing the outcome of five infants with cystic fibrosis and RF/MV between the years 1980 and 1986 with that of age-matched control subjects with cystic fibrosis and no respiratory failure. Recent Shwachman scores and the number of hospitalizations during the study period were used to assess outcome. All study cases were alive one to six years after the episode of RF/MV. Their mean Shwachman score (83 [range: 70 to 95]) did not differ from the recent mean Shwachman score (78 [range: 50 to 95]) of the control group. Number of hospitalizations did not differ between groups. We conclude that the outcome of infants with cystic fibrosis whose initial presentation is RF/MV is not as grave as once thought. If indicated, infants with cystic fibrosis and respiratory failure should be ventilated.

Cystic Fibrosis↗
PubMed1988

Ischemic hepatitis in children: diagnosis and clinical course.

Hepatic hypoperfusion can result in ischemic hepatitis, a clinical syndrome characterized by a sudden rise in serum transaminases followed by resolution to near normal levels within 7 to 10 days. Although described in adults, this syndrome has not been well defined in pediatric patients. We report 22 children who developed ischemic hepatitis during an acute illness. Fifteen of 22 patients had a documented hypotensive episode or no cardiac output before the onset of the ischemic hepatitis episode. Four of the seven patients without documented hypotension required pressor therapy to maintain their BP. SGOT showed a marked rise (mean 2294 IU/L, range 438 to 6652) from admission to 96 h (mean 34) with a rapid decline to near normal levels within 9 days (mean 5.1). Serum bilirubin levels also rose transiently, but generally not to the extent of transaminase levels. A clinically significant coagulopathy occurred in six patients. Although nine patients expired, none died as a direct result of the hepatic damage. Ischemic hepatitis can occur during illnesses associated with diminished hepatic blood flow and follows a characteristic course that usually can be differentiated from viral or drug-induced hepatitis on clinical and biochemical criteria.

Adolescent↗
PubMed1986

Airway burns in an infant following aspiration of microwave-heated tea.

Airway obstruction developed in an infant who sustained thermal burns to the oropharynx and trachea after he aspirated microwave-heated tea. Bronchoscopic examination revealed upper and lower airway hyperemia, edema and blister formation. Physicians should be aware of this potential hazard of microwave-heated fluid. Early assessment and stabilization of the airway is important following scald injuries to the face and oropharynx.

Airway Obstruction↗
PubMed1984

Paregoric intoxication with pulmonary edema in infancy.

This report describes a 3-week-old infant with paregoric intoxication and pulmonary edema. The pulmonary edema associated with opiod use is treatable even though the precise mechanism of its formation remains undefined. The report emphasizes that the medical rationale involved in the use of paregoric is unclear. The use of this preparation in pediatric patients should be abandoned in view of such serious complications.

Antidiarrheals↗
PubMed1984

Efficacy of a programmed calculator for constant-infusion medication calculations.

A program for calculation of constant-infusion vasoactive medications on a hand-held programmable calculator was evaluated in terms of accuracy and time saved v conventional means of calculation. All groups, with the exception of the pharmacists, showed a statistically significant improvement in accuracy and time saved when using the programmable calculator. These results indicate that use of the programmable calculator may significantly save time and reduce errors on dose calculation of potentially dangerous drugs in pediatric and neonatal intensive care units.

Cardiovascular Agents↗
PubMed1982

Calculator assisted determination of dilutions for continuous infusion ICU medications.

A program has been developed for simplification of initial dilution calculations for several rapidly metabolized, vasoactive drugs that must be administered by continuous infusion. Included in the program is the capability for serial recalculation of drug dosage or iv flow rate is well as a checking routine to reduce errors. This program was developed primarily for the pediatric age group, where dilution of drugs into a small volume of diluent, accurate dosage calculations, and low iv flow rates are frequently necessary.

Computers↗