PubMed Health⌕ Search

Biomedical subjects

W Butt

Publications and source records attributed to W Butt.

At least 19 recordsLinked to original sources
PubMed2001

A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension.

OBJECT: The object of our study was to determine, in children with traumatic brain injury and sustained intracranial hypertension, whether very early decompressive craniectomy improves control of intracranial hypertension and longterm function and quality of life. METHODS: All children were managed from admission onward according to a standardized protocol for head injury management. Children with raised intracranial pressure (ICP) were randomized to standardized management alone or standardized management plus cerebral decompression. A decompressive bitemporal craniectomy was performed at a median of 19.2 h (range 7.3-29.3 h) from the time of injury. ICP was recorded hourly via an intraventricular catheter. Compared with the ICP before randomization, the mean ICP was 3.69 mmHg lower in the 48 h after randomization in the control group, and 8.98 mmHg lower in the 48 hours after craniectomy in the decompression group (P=0.057). Outcome was assessed 6 months after injury using a modification of the Glasgow Outcome Score (GOS) and the Health State Utility Index (Mark 1). Two (14%) of the 14 children in the control group were normal or had a mild disability after 6 months, compared with 7 (54%) of the 13 children in the decompression group. Our conclusion was that when children with traumatic brain injury and sustained intracranial hypertension are treated with a combination of very early decompressive craniectomy and conventional medical management, it is more likely that ICP will be reduced, fewer episodes of intracranial hypertension will occur, and functional outcome and quality of life may be better than in children treated with medical management alone (P=0.046; owing to multiple significance testing P <0.0221 is required for statistical significance). This pilot study suggests that very early decompressive craniectomy may be indicated in the treatment of traumatic brain injury.

Brain Injuries↗
PubMed2001

Septic shock.

Infection is problematic because it affects many patients (adults and children), is a major cause of death in intensive care units (ICU) worldwide, and uses a large amount of hospital resources. The mortality rate among patients with septic shock varies but approximates 40% in infected patients admitted to ICUs. Because of the large number of adults dying of sepsis, many resources are expended. Children are physiologically different from adults, but nonetheless, many similarities exist with respect to the response to septic shock.

Animals↗
PubMed2001

Review of the use of somatosensory evoked potentials in the prediction of outcome after severe brain injury.

OBJECTIVE: Review the predictive powers of somatosensory evoked potentials (SEPs) in severe brain injury. DATA SOURCES: Publications in the scientific literature, manual review of article bibliographies, and questioning workers in the field. STUDY SELECTION: Studies addressing the prediction of outcome after severe brain injury using SEPs. DATA EXTRACTION: To determine the outcome of patients with either normal or bilaterally absent SEPs as categorized using the Glasgow Outcome Scale into favorable outcomes (good or moderate disability) or unfavorable outcomes (severe disability, vegetative, or dead). Studies were included if they were in English and allowed the determination of outcomes for all patients with normal or bilaterally absent SEPs. Papers were not considered if subjects were neonates, consisted of abstracts where all necessary details were unavailable, were case reports or duplications of other published studies, or dealt only with brain dead subjects. DATA SYNTHESIS: For all studies (n = 44), positive likelihood ratio, positive predictive value, and sensitivity were 4.04, 71.2%, and 59.0%, respectively, for normal SEPs (predicting favorable outcome) and 11.41, 98.5%, and 46.2%, respectively, for bilaterally absent SEPs (predicting unfavorable outcome). Summary receiver operating characteristic curve analysis detected a cut-off criterion effect for only blinded studies of bilaterally absent SEPs. Twelve patients (12/777) were identified with bilaterally absent SEPs who had favorable outcomes. These false positives are typically pediatric patients or have suffered traumatic brain injuries. We suggest criteria for the use of bilaterally absent SEPs in the prediction of poor outcome, which include absence of focal lesions, subdural or extradural fluid collections, and no decompressive craniotomy in previous 48 hrs. Using these criteria the data suggest that the false-positive rate is <0.5% for bilaterally absent SEPs. CONCLUSIONS: SEPs are powerful predictors of outcome, particularly poor outcome, if patients with focal lesions, subdural effusions, and those who have had recent decompressive craniotomies are excluded.

Adult↗
PubMed2001

Delivery across the blood-brain barrier of antisense directed against amyloid beta: reversal of learning and memory deficits in mice overexpressing amyloid precursor protein.

Amyloid beta protein (Abeta) may play a causal role in Alzheimer's disease. Previous work has shown that the learning and memory deficits that develop with aging in SAMP8 mice, a strain that overproduces Abeta, can be reversed with i.c.v. injections of an Abeta antisense phosphorothiolate oligonucleotide (Olg). Here, we showed that Olg radioactively labeled with (32)P (P-Olg) was transported intact across the blood-brain barrier (BBB) of mice by a saturable system, termed oligonucleotide transport system-1 (OTS-1). Multiple-time regression analysis found a blood-to-brain unidirectional influx rate for P-Olg of 1.4 +/- 0.39 microl/g-min and capillary depletion showed that P-Olg completely crossed the BBB to enter the parenchymal space of the brain. P-Olg was also shown to enter the cerebrospinal fluid. Transport was especially high into the hippocampus, with the percentage of the i.v. dose taken up by each gram of brain (0.865 +/- 0.115%) being about 1/100 of the i.c.v. dose. An i.v. dose of Olg 100 times that of the effective i.c.v. dose reversed the learning and memory deficits of aged SAMP8 mice. These studies show for the first time that phosphorothiolate oligonucleotides can be delivered to the brain in effective doses by intravenous administration.

Alzheimer Disease↗
PubMed1999

Severe brain injury in children: long-term outcome and its prediction using somatosensory evoked potentials (SEPs).

OBJECTIVE: To evaluate the outcome of children 1 and 5 years after severe brain injury (Glasgow Coma Score < 8) using a functional measure [Glasgow Outcome Scale (GOS)] and a health status measure (the Torrance Health State (HUI:1)) and to determine the ability of somatosensory evoked potentials (SEPs) to predict these long-term outcomes. DESIGN: Prospective study. SETTING: A 16-bed paediatric intensive care unit in a tertiary children's hospital. PATIENTS AND PARTICIPANTS: 105 children with severe brain injury. INTERVENTIONS: SEPs were recorded once in the first week after admission. Outcome was assessed 1 and 5 years after injury using the GOS and at 5 years after injury using HUI:1. MEASUREMENTS AND RESULTS: At 5 years, using the GOS, 46 (43.8%) children had a good outcome, 10 (9.5%) were moderately disabled, 2 (1.9%) severely disabled, 3 (2.9%) vegetative and 44 (41.9%) had died. At 5 years, 17 of 40 (42.5%) survivors from 1 year had changed outcomes: 12 had improved, 3 had worsened and 2 had died. For a normal SEP, positive predictive power was 85.4%, sensitivity 62.5%, specificity 87.8%, negative predictive power 67.2% and the positive likelihood ratio was 5.1. For bilaterally absent responses, positive predictive power was 90.9%, sensitivity 61.2%, specificity 94.6%; negative predictive power 73.6% and the positive likelihood ratio was 11.4. Outcomes using HUI:1 were: 30 (28.6%) had a good quality of life, 21 (20.0%) had a moderate quality of life, 7 (6.7%) a poor quality, 44 died (41.9%) and 3 (2.9%) survived in a state deemed worse than death. For a normal SEP, positive predictive power was 85.4%, sensitivity 68.6%, specificity 88.9%, negative predictive power 75.0% and the positive likelihood ratio was 6.2. For bilaterally absent responses, positive predictive power was 93.9%, sensitivity 57.4%, specificity 96.1%, negative predictive power 68.1% and the positive likelihood ratio was 14.6. CONCLUSION: The outcome for children with severe brain injury should be assessed 5 years after injury because important changes occur between 1 year and 5 years. Differences exist between outcomes assessed using the GOS and HUI:1 as they measure slightly different aspects of function. Consideration should therefore be given to using both measures. SEPs are excellent predictors of long-term outcome measured by either the GOS or the HUI:1.

Adolescent↗
PubMed1999

Tracheobronchial malacia and stenosis in children in intensive care: bronchograms help to predict oucome.

BACKGROUND: Severe tracheobronchial malacia and stenosis are important causes of morbidity and mortality in children in intensive care, but little is known about how best to diagnose these conditions or determine their prognosis. METHODS: The records of all 62 children in whom one or both of these conditions had been diagnosed by contrast cinetracheobronchography in our intensive care unit in the period 1986-95 were studied. RESULTS: Seventy four per cent of the 62 children had congenital heart disease; none was a preterm baby with airways disease associated with prolonged ventilation. Fifteen of the children had airway stenosis without malacia; three died because of the stenosis and two died from other causes. Twenty eight of the 47 children with malacia died; only eight children survived without developmental or respiratory handicap. All children needing ventilation for malacia for longer than 14 consecutive days died if their bronchogram showed moderate or severe malacia of either main bronchus (15 cases), or malacia of any severity of both bronchi (three additional cases); all children needing ventilation for malacia for longer than 21 consecutive days died if their bronchogram showed malacia of any severity of the trachea or a main bronchus (three additional cases). These findings were strongly associated with a fatal outcome (p<0.00005); they were present in 21 children (all of whom died) and absent in 26 (of whom seven died, six from non-respiratory causes). They had a positive predictive value for death of 100%, but the lower limit of the 95% confidence interval was 83.9% so up to 16% of patients meeting the criteria might survive. CONCLUSION: In this series the findings on contrast cinetracheobronchography combined with the duration of ventilation provided a useful guide to the prognosis of children with tracheobronchomalacia. The information provided by bronchoscopy was less useful.

Bronchial Diseases↗
PubMed1998

Pulse oximetry for assessment of pulsus paradoxus: a clinical study in children.

OBJECTIVE: To evaluate the relationship between intraarterial measured pulsus paradoxus (PP) and photoplethysmographic wave changes. SETTING: Tertiary pediatric intensive care unit. PATIENTS: 62 nonintubated children with or without respiratory disorders. DESIGN: Prospective, clinical study. MEASUREMENTS AND RESULTS: Simultaneous paper recordings of photoplethysmographic wave, arterial blood pressure, breathing cycle and electrocardiogram. The respiratory dependent changes of the plethysmographic respiratory wave (delta pleth, mm) were defined as the difference between the highest value of the upper peak of the wave (in expiration) and the lowest value of the upper peak (in inspiration). In each patient, ten consecutive breaths were averaged for analysis. Five recordings could not be evaluated (movement artifacts). In 57 children (median age 2.4 years, range 7 days to 17 years), the photoplethysmographic fluctuations (delta pleth, mm) correlated with PP (mm Hg). r = 0.85; 95% confidence interval (CI), 0.76 to 0.91. The sensitivity to detect a PP of > 10 mmHg with a plethysmographic fluctuation of > 8 mm was 89% (95% CI, 77 to 100%) and the specificity was 90% (95% CI, 79 to 100%). CONCLUSIONS: Pulse oximetry appears to be a rapid and easily performed, noninvasive method for the objective estimation of the degree of PP.

Adolescent↗
PubMed1997

Extracorporeal support for intractable cardiorespiratory failure due to meningococcal disease.

BACKGROUND: Meningococcal disease is still associated with considerable mortality, despite the use of early antibiotics and management in specialised intensive care units, due principally to early refractory myocardial depression and hypotension as well as severe acute respiratory distress syndrome. Extracorporeal membrane oxygenation (ECMO) is a complex technology that uses a modified "heart-lung" machine to provide temporary cardiac and respiratory support. We reviewed the UK and Australian experience of the use of ECMO in patients with refractory cardiorespiratory failure due to meningococcal disease. METHODS: The records from all 12 known patients supported with ECMO for meningococcal disease in the UK and Australia since 1989 were reviewed. FINDINGS: 12 patients (aged 4 months to 18 years, median 26 months) with meningococcal disease received ECMO over 8 years. In seven patients, ECMO was required early for cardiac support for intractable shock within 36 h of admission to intensive care. In the other five patients, ECMO was indicated for respiratory failure due to severe adult respiratory distress syndrome, which tended to occur later in the disease. The paediatric risk of mortality score ranged from 13 to 40 (median 29, median predicted risk of mortality 72%). Six of the 12 patients required cardiopulmonary resuscitation before ECMO and the other six were deteriorating despite maximal conventional therapy. Overall, eight of the 12 patients survived, with six leading functionally normal lives at a median of 1 year (range 4 months to 4 years) of follow-up. INTERPRETATION: ECMO might be considered to support patients with intractable cardiorespiratory failure due to meningococcal disease who are not responding to conventional treatment.

Adolescent↗
PubMed1997

Predictors of mortality and multiple organ failure in children with sepsis.

OBJECTIVES: To assess the markers of perfusion which best discriminate survivors from non-survivors of childhood sepsis and to compare the information derived from gastric tonometry with conventionally measured haemodynamic and laboratory parameters. DESIGN: Prospective clinical study of children with sepsis syndrome or septic shock. SETTING: Paediatric intensive care unit in a tertiary referral centre. PATIENTS: 31 children with sepsis syndrome or septic shock. INTERVENTIONS: A tonometer was passed into the stomach via the orogastric route. MEASUREMENTS AND MAIN RESULTS: The following data were recorded at admission, 12, 24 and 48 h: heart rate, mean arterial pressure, arterial pH, base deficit, arterial lactate, gastric intramucosal pH (pHi) and DCO2 (intramucosal carbon dioxide tension minus arterial partial pressure of carbon dioxide). The principal outcome measure was. The secondary outcome measure was the number of organ systems failing at 48 h after admission. There were 10 deaths and 21 survivors. No variable discriminated survival from death at presentation. Blood lactate level was the earliest discriminator of survival. Using univariate logistic regression, lactate discriminated survivors from those who died at 12 and 24 h after admission, but not at 48 h (p = 0.049, 0.044 and 0.062, respectively). The area under the receiver operating characteristic (ROC) curve for lactate was 0.81, 0.88 and 0.89 at 12, 24 and 48 h, respectively. At 12 h after admission, a blood lactate level > 3 mmol/l had a positive predictive value for death of 56% and a lactate level of 3 mmol/l or less had a positive predictive value for survival of 84%. At 24 h a lactate level > 3 mmol/l had a positive predictive value for death of 71% and a level of 3 mmol/l or less had a positive predictive value for survival of 86%. No other variable identified non-survivors from survivors at 12 h. Gastric tonometry could only be done on 19 of the 31 children, of whom 8 died and 11 survived. In these 19 children, DCO2 measured at 24 h, but not at 12 or 48 h, distinguished those who died from those who survived (p = 0.045 and p = 0.20, respectively). The area under the ROC curve for DCO2 measured at 24 h as a predictor of survival was 0.71. Neither the absolute value of pHi nor the trend of change in pHi at any time in the first 48 h identified survivors in this series. The mean arterial pressure distinguished survivors from non-survivors at 24 and 48 h (area under ROC curve = 0.80 and 0.78, respectively). The base deficit and heart rate did not identify non-survivors from survivors at any time in the first 48 h. CONCLUSIONS: Blood lactate level was the earliest predictor of outcome in children with sepsis. In this group of patients, gastric tonometry added little to the clinical information that could be derived more simply by other means.

Adolescent↗
PubMed1997

Early markers of major adverse events in children after cardiac operations.

OBJECTIVES: The purpose of this study was to determine the physiologic variables that predict major adverse events in children in the intensive care unit after cardiac operations. METHODS: A cohort observational study was conducted. At the time of admission to the intensive care unit and 4, 8, 12, and 24 hours later the following variables were recorded: mean arterial pressure, heart rate, cardiac index, oxygen delivery, mixed venous oxygen saturation, base deficit, blood lactate, gastric intramucosal pH, carbon dioxide difference (the difference between arterial carbon dioxide tension and gastric intraluminal carbon dioxide tension), and toe-core temperature gradient. Major adverse events were prospectively identified as cardiac arrest, need for emergency chest opening, development of multiple organ failure, and death. RESULTS: Ninety children were included in the study; 12 had major adverse events and there were 4 deaths. Blood lactate level, mean arterial pressure, and duration of cardiopulmonary bypass were the only significant, independent predictors of major adverse events when measured at the time of admission to the intensive care unit. The odds ratio (95% confidence intervals) for major adverse events if a lactate level was greater than 4.5 mmol/L was 5.1 (1.2 to 21.1), for admission hypotension 2.3 (0.5 to 9.8), and for a cardiopulmonary bypass time greater than 150 minutes 13.7 (3.3 to 57.2). Four hours after admission lactate and carbon dioxide difference, and 8 hours after admission lactate and base deficit, were independently significant predictors. The odds ratios for major adverse events if the blood lactate level was greater than 4 mmol/L at 4 and 8 hours were 8.3 (1.8 to 38.4) and 9.3 (1.9 to 44.3), respectively. At no time in the first 24 hours were cardiac output, oxygen delivery, mixed venous oxygen saturation, toe-core temperature gradient, or heart rate significant predictors of major adverse events. CONCLUSIONS: In the context of our current treatment strategies, the duration of cardiopulmonary bypass and blood lactate level, measured in the early postoperative period, were the best predictors of impending major adverse events.

Blood Pressure↗
PubMed1997

Extreme sodium derangement in a paediatric inpatient population.

OBJECTIVE: To determine the aetiology, symptoms and outcome of extreme sodium derangement in a paediatric inpatient population. METHODOLOGY: A retrospective study of children with extreme disturbance of their plasma sodium (> or = 165 mmol/L or < or = 115 mmol/L) admitted to a tertiary referral centre during a 72-month period. RESULTS: Twenty-seven cases of hypernatraemia and 21 of hyponatraemia were reviewed. Sodium disturbance developed after hospital admission in 27/57 cases (57%). Gastroenteritis was the most common cause of hypernatraemia (8/27; 30%), four of 27 (15%) had iatrogenic hypernatraemia. Water overload accounted for 8/21 (38%) cases of hyponatraemia. Neurologic symptoms occurred in 19/24 (79%) with hypernatraemia and in 11/19 (58%) with hyponatraemia. Ten (37%) with hypernatraemia and four (19%) with hyponatraemia died. A deterioration in functional status was seen in two patients with hypernatraemia. There was no apparent deterioration in the survivors with hyponatraemia. CONCLUSION: Extreme sodium disturbance often develops after admission to hospital and is caused by a variety of diseases and interventions. Neurologic symptoms are common and the mortality rate is high. The outcome in survivors is survivors is most likely to be dependent on the underlying disease process.

Child↗
PubMed1997

The DCO2 measured by gastric tonometry predicts survival in children receiving extracorporeal life support. Comparison with other hemodynamic and biochemical information. Royal Children's Hospital ECMO Nursing Team.

STUDY OBJECTIVE: To assess the role of gastric tonometry in monitoring children receiving extracorporeal life support (ECLS) and to determine if DCO2 or pHi in the weaning phase of ECLS predicts survival. DESIGN: A prospective study of consecutive patients treated with ECLS. SETTING: A tertiary pediatric ICU that is the ECLS referral center for Australia. PATIENTS: Twenty consecutive children receiving ECLS for cardiovascular or respiratory failure. INTERVENTIONS: All children were monitored throughout their ECLS course using a tonometer inserted into the stomach via the orogastric route. The PCO2 in the tonometer balloon was measured every 4 to 6 h and the pHi was calculated using the Henderson-Hasselbalch equation. The DCO2, which is the difference between PCO2 in tonometer saline solution and arterial blood, was calculated. We compared the ability of pHi, DCO2, heart rate, mean arterial pressure, arterial pH, base deficit, and blood lactate to predict death or survival during the weaning phase. Measurements were taken on the lowest level of support, which for veno-arterial extracorporeal membrane oxygenation and ventricular assist device was defined as the lowest ECLS pump flows, and on veno-venous extracorporeal membrane oxygenation was defined as the time of lowest ECLS gas flow. Predictive power was assessed using the receivor operating characteristic (ROC) analysis on the data collected at these times. RESULTS: In the weaning phase of ECLS, the pHi was significantly lower in children who died (pHi = 7.21; 95% confidence intervals, 7.14 to 7.28) than in those who survived (pHi = 7.38; 95% confidence intervals, 7.28 to 7.47). The DCO2 was significantly higher in children who died (23.6 mm Hg; 95% confidence intervals, 14.3 to 33.1) compared with survivors (4.7 mm Hg; 95% confidence intervals, -0.78 to 10.1). The area under the ROC curve was 0.95 for DCO2 (and 0.88 for pHi). pHi and DCO2 predicted survival better than base deficit (area under ROC curve, 0.82), blood lactate level (0.29), arterial pH (0.65), heart rate (0.62), and mean arterial pressure (0.74). CONCLUSIONS: DCO2 is a clinically meaningful measurement in children receiving ECLS. A high DCO2 was a good predictor of death in this series. Gastric tonometry may provide a useful measure of the adequacy of regional perfusion and oxygenation in this group of patients.

Acidosis↗
PubMed1996

The outcome of children admitted to intensive care with meningococcal septicaemia.

OBJECTIVE: To review our experience of children with meningococcal septicaemia, and to validate, in our group, severity scores used in different populations to predict outcome. DESIGN: Retrospective review of case notes and charts. PATIENTS: A total of 35 children were admitted to the paediatric intensive care unit (ICU) in the Royal Children's Hospital (RCH) in the 8 years between January 1985 and December 1992 with proven meningococcal septicaemia. RESULTS: Ages ranged from 4 months to 16 years, with a median age of 20 months. The median meningococcal score was 4 and the median PRISM score was 20, with scores above these being significantly associated with death (P < 0.0001). Thirty-two children (91%) received infusions of colloid for hypovolaemia and twenty-nine (83%) received one or more inotropic drugs. Twenty-one children (60%) required mechanical ventilation for a median of 16.5 h (range 7-574). Seven children (20%) underwent plasmapheresis. Six children (17%) underwent haemofiltration and two (6%), peritoneal dialysis. One patient received extracorporeal membrane oxygenation (ECMO) because of circulatory failure. Twenty-one children (60%) developed disseminated intravascular coagulation, renal failure and/or skin or limb necrosis. The overall survival was 66%, and all survivors are functionally normal. CONCLUSION: The mortality from the disease remains at 34% despite the technological advances in intensive care. The PRISM and meningococcal scores are useful in predicting outcome. Novel methods of treatment (e.g., plasmapheresis or ECMO) may be valuable.

Adolescent↗
PubMed1995

Somatosensory evoked potentials for prediction of outcome in acute severe brain injury.

The purpose of this study was to evaluate prospectively short-latency somatosensory evoked potentials (SEPs) as a predictor of outcome in acute, severe brain injury, and to compare this with the predictive power of the motor component of the Glasgow Coma Scale score and computed tomographic scan. Outcome was measured with the Glasgow Outcome Scale at a minimum of 6 months after injury. We studied 109 patients (aged 0.1 to 16.8 years) with SEPs within 4 days of the onset of coma. Four patients had absent SEPs and a favorable outcome by the Glasgow Outcome Scale (full recovery or moderate disability); two of these patients had meningitis with bilateral subdural effusions, one had a midbrain hemorrhage, and one had a decompressive craniectomy for uncontrolled intracranial hypertension. Normal SEPs had a positive predictive value for favorable outcome of 93% (95% confidence interval (CI), 77% to 99%), and absent SEPs had a positive predictive value for unfavorable outcome by the Glasgow Outcome Scale (severe disability, survival in a persistent vegetative state, or death) of 92% (95% CI, 80% to 98%). If the above identifiable clinical situations in which a physical barrier existed to impede cutaneous reception of the electrical impulse were excluded, the positive predictive value of absent SEPs for poor outcome reached 100% (95% CI, 92% to 100%). An absent motor response to painful stimulus also had 100% positive predictive value (95% CI, 84% to 100%) for unfavorable outcome; however, 23% of patients could not be evaluated because of the effects of muscle relaxants or sedatives. In patients with traumatic brain injury, results of computed tomography did not reliably predict outcome. Of the 59 patients with unfavorable outcome, 76% could be identified with SEPs compared with 36% with examination of motor function. We suggest that SEPs be performed in children with acute severe brain injury because they add an important tool to the physician's prognostic armamentarium. We conclude that in the absence of the above mentioned identifiable clinical situations, absent SEPs predict 100% unfavorable outcome, and this finding may warrant consideration of withdrawal of treatment in children with brain injuries.

Acute Disease↗
PubMed1995

Inferior vena cava pressure as an estimate of central venous pressure.

OBJECTIVE: To determine whether pressure in the inferior vena cava (IVC) is similar to central venous pressure. METHODOLOGY: Prospective measurement of both central venous pressure (CVP) and inferior vena cava pressure (IVCP) in the same child; each child had to have both catheters in situ. Two measurements of each pressure in reverse order (IVCP then CVP, and CVP then IVCP) were done and the mean of each was recorded. Comparison of the pressures was performed using the method of Bland and Altman. RESULTS: Thirty-nine children had pressures recorded. The CVP ranged from 3 to 17 mmHg. In 22 of 39 measurements IVCP was equal to CVP; in 33 of 39 measurements IVCP was different from CVP by 1 mm or less and in 37 of 39 measurements IVCP was different from CVP by 2 mm or less. The mean difference between IVCP and CVP was +0.33 mmHg, the 95% confidence interval was 2.26 to +2.93 mmHg. CONCLUSION: Measurement of IVCP is a good approximation to CVP and can be routinely used in clinical care of children who do not have raised intra-abdominal pressure.

Adolescent↗
PubMed1994

Predictors of survival for infants with congenital diaphragmatic hernia.

Over the past decade, the survival rate of infants with congenital diaphragmatic hernia (CDH) treated in the intensive care unit of the Royal Children's Hospital, Melbourne, has remained unchanged at 56% +/- 6%. Newer forms of treatment, such as extracorporeal membrane oxygenation (ECMO), high-frequency oscillation, and surfactant and nitric oxide therapy, are now available. The exact role of these therapies in the management of infants with CDH has not been determined. This study examines five clinical parameters derived from an infant's best preoperative ventilatory and blood gas data in the first 24 hours of life. One hundred twenty-five CDH infants were admitted to the intensive care unit between January 1, 1981 and December 31, 1991. Criteria for inclusion in the study were (1) CDH diagnosed within 6 hours of delivery, (2) ventilation before repair, and (3) no associated lethal congenital abnormality. Of the 90 cases studied in detail, there were 38 deaths (42% mortality rate). All five parameters were analyzed by receiver operating curve analysis to determine the optimum value of each parameter in predicting survival. An oxygenation index (MAP x FIO2/PaO2) of less than 0.08 predicted a 94% chance of survival, with a sensitivity of 96% and a specificity of 95%. Similarly, a modified ventilation index (PIP x RR x CO2/1,000) of less than 40 predicted a 91% chance of survival, with a sensitivity of 94% and a specificity of 86%. By stratifying each criterion according to outcome, three groups of infants were identified according to their response to conventional therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Hernia, Diaphragmatic↗