Pediatr Crit Care Me
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Pediatr Crit Care Me · Jul 2004
Randomized Controlled Trial Clinical TrialNoninvasive positive-pressure ventilation in children with lower airway obstruction.
Mechanical ventilation of patients with severe lower airway obstruction presents significant risks; therefore, avoiding the intubation in these patients has been a principal goal of clinical management. Noninvasive positive-pressure ventilation has been shown to be effective in treating adults with chronic obstructive pulmonary disease, but its use has not been studied prospectively in children with acute obstructive lower airways disease. The objective of this study was to determine whether noninvasive mask ventilation improved respiratory function in children with asthma and other obstructive lower airways diseases. ⋯ We conclude that noninvasive ventilation can be an effective treatment for children with acute lower airway obstruction.
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Pediatr Crit Care Me · Jul 2004
Randomized Controlled Trial Clinical TrialInspiratory work of breathing is not decreased by flow-triggered sensing during spontaneous breathing in children receiving mechanical ventilation: a preliminary report.
To determine the effect of pressure-trigger (PT) and flow-trigger (FT) sensing on the work of breathing (WOB) during spontaneous, unsupported breathing in children receiving mechanical ventilation. ⋯ FT may not decrease WOB compared with PT for unsupported spontaneous breathing in children receiving mechanical ventilation. However, when lung compliance is decreased, FT sensing may be advantageous in decreasing the WOB.
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Pediatr Crit Care Me · Jul 2003
Randomized Controlled Trial Comparative Study Clinical TrialEffect of enalaprilat on postoperative hypertension after surgical repair of coarctation of the aorta.
Hypertension in pediatric patients after surgical repair of coarctation of the aorta can be difficult to control and may lead to morbidity. The renin-angiotensin system mediates at least part of this hypertension. Enalaprilat, the only intravenous angiotensin-converting enzyme inhibitor, is used to treat hypertension in pediatric patients in other settings. However, its effect on postoperative hypertension during the early postoperative period in patients undergoing surgical repair of coarctation of the aorta is unknown. ⋯ Conclusions are limited by a small cohort. Angiotensin-converting enzyme inhibitor therapy resulted in improved blood pressure control after coarctation repair. Further improvement of blood pressure control may be achievable by use of a larger dose of enalaprilat or a 4-hr enalaprilat-dosing interval.
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Pediatr Crit Care Me · Jan 2003
Randomized Controlled Trial Comparative Study Clinical TrialComparison of loss in lung volume with open versus in-line catheter endotracheal suctioning.
Disconnecting the endotracheal tube from the ventilator causes significant loss in lung volume, which is further exacerbated by suctioning. In-line catheter suction systems have putative benefits over open catheter suction by maintaining positive pressure, thereby minimizing hypoxemia and hemodynamic instability. However, there is a theoretical risk of generating large negative airway pressures and auto-cycling of the ventilator with in-line catheter suction systems. We studied the effects on lung volume with both these techniques. ⋯ The most significant loss in lung volume during suctioning occurs primarily during ventilator disconnection. Hence, open catheter suction results in greater lung volume loss when compared with in-line catheter suction. We suggest that in-line catheter suction is preferable, especially in patients with significant lung disease and who require high positive end-expiratory pressures, to avoid alveolar derecruitment and exacerbating hypoxemia during endotracheal tube suctioning.
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Pediatr Crit Care Me · Jan 2003
Randomized Controlled Trial Clinical TrialSerum creatinine and estimated creatinine clearance do not predict perioperatively measured creatinine clearance in neonates undergoing congenital heart surgery.
To describe changes in creatinine clearance (CrCl) in a small group of neonates who underwent surgery for repair of transposition of the great arteries or palliation of hypoplastic left heart syndrome. To determine whether serum creatinine, urine output, or the Schwartz formula accurately predict measured CrCl in these patients. ⋯ Perioperative CrCl is unpredictable in neonates with transposition of the great arteries and hypoplastic left heart syndrome. Serum creatinine, urine output, and the Schwartz formula do not accurately predict CrCl. Reliance on estimates of CrCl could result in toxic concentrations of drugs eliminated by the kidneys.