The Journal of pediatrics
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The Journal of pediatrics · Nov 1988
Comparative StudyThoracic electric bioimpedance measurement of cardiac output in the newborn infant.
To evaluate thoracic electric bioimpedance as a noninvasive method for measuring cardiac output, we compared the bioimpedance measurements with those obtained by means of the thermodilution indicator cardiac output technique in seven preterm and term lambs; we also studied 17 term and preterm infants. Sixty-seven simultaneous bioimpedance and thermodilution cardiac output measurements were obtained in the animals after intravascular volume expansion (saline solution infusion) and contraction (phlebotomy). ⋯ Extrapolating animal data to the neonates, we found the thoracic segment length recommended (the average of 29% of body length and electrode distance) to be accurate. These data indicate that bioimpedance cardiac output measurement (1) is comparable to measurement by the thermodilution indicator technique in the newborn animal and (2) may be suitable for use in infants and children.
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The Journal of pediatrics · Oct 1988
Randomized Controlled Trial Comparative Study Clinical TrialRapid intravenous rehydration by means of a single polyelectrolyte solution with or without dextrose.
We compared the efficacy and safety of a single polyelectrolyte solution, Dhaka solution (DS), containing 133 mmol/L sodium, 13 mmol/L potassium, 98 mmol/L chloride, and 48 mmol/L acetate with and without 139 mmol/L (25 gm/L) dextrose in the rapid (4 hours) rehydration of 67 patients with diarrhea and moderate or severe dehydration requiring parenteral fluid therapy. Of the 67 patient, 31 were randomly assigned to receive the dextrose-containing solution (DS + D) and 36 DS without dextrose. On admission to the hospital, the two groups of patients were similar with respect to enteric pathogens detected, proportion with hyponatremia, magnitude of dehydration as assessed by clinical criteria, serum protein or creatinine concentration, and plasma glucose levels. ⋯ No other complications were noted. Serum protein values 24 hours after admission were little changed from 4-hour values, suggesting that rehydration was complete at the end of 4 hours. We conclude that, in our patients, rehydration can be carried out safely and rapidly with the use of a single solution and that adding 139 mmol/L (25 gm/L) of dextrose to the solution can prevent hypoglycemia without producing an osmotic diuresis.
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The Journal of pediatrics · Sep 1988
Percutaneous infraclavicular subclavian vein catheterization in critically ill infants and children.
The safety and risks of percutaneous infraclavicular subclavian vein catheterization, when performed by nonsurgical staff, were studied prospectively in 100 consecutive patients. The overall success rate was 92% (with one attempt, 45%; with two attempts, 85%). The procedure was performed under emergency conditions in 35% of the patients, with a success rate of 88.6%. ⋯ No mortality was associated with this procedure. We have found percutaneous infraclavicular subclavian vein catheterization to be a rapid alternative to surgical cutdown for venous access during cardiopulmonary resuscitation. Pediatric residents can be trained, under direct supervision, to perform this procedure with a high success rate and a low complication rate.