The Use of a Kinetic Therapy Rotational Bed in Pediatric Acute Respiratory Distress Syndrome: A Case Series.

Patients with acute respiratory distress syndrome (ARDS) commonly have dependent atelectasis and heterogeneous lung disease. Due to the heterogenous lung volumes seen, the application of positive end expiratory pressure (PEEP) can have both beneficial and deleterious effects. Alternating supine and prone positioning may be beneficial in ARDS by providing more homogenous distribution of PEEP and decreasing intrapulmonary shunt. In pediatrics, the pediatric acute lung injury and consensus conference (PALICC) recommended to consider it in severe pediatric ARDS (PARDS). Manually prone positioning patients can be burdensome in larger patients. In adults, the use of rotational beds has eased care of these patients. There is little published data about rotational bed therapy in children. Therefore, we sought to describe the use of a rotational bed in children with PARDS. We performed a retrospective case series of children who utilized a rotational bed as an adjunctive therapy for their PARDS. Patient data were collected and analyzed. Descriptive statistical analyses were performed and reported. Oxygenation indices (OI) pre- and post-prone positioning were analyzed. Twelve patients with PARDS were treated with a rotational bed with minimal adverse events. There were no complications noted. Three patients had malfunctioning of their arterial line while on the rotational bed. Oxygenation indices improved over time in 11 of the 12 patients included in the study while on the rotational bed. Rotational beds can be safely utilized in pediatric patients. In larger children with PARDS, where it may be more difficult to perform a manual prone position, use of a rotational bed can be considered a safe alternative.

Local ice-bag application and triceps surae muscle temperature during treadmill walking.

CONTEXT: Ice bags "to go" are a common practice in athletic training. OBJECTIVE: To determine the effect of submaximal exercise on tissue temperatures during a common ice-bag application. DESIGN: 2 X 5 fully repeated-measures design with treatment (cooling while resting, cooling while walking) and time (pretreatment, immediately after ice application, and at 10, 20, and 30 minutes during treatment) as the independent variables. SETTING: Laboratory setting. PATIENTS OR OTHER PARTICIPANTS: Sixteen healthy, physically active volunteers (age = 21.63 +/- 2.63 yrs, height = 68.97 +/- 4.00 cm, mass = 80.97 +/- 18.18 kg, calf skinfold = 21.1 +/- 9.3 mm). MAIN OUTCOME MEASURE(S): Left triceps surae intramuscular and skin temperatures, as measured by thermocouples to the nearest 0.1 degrees C, served as dependent measures. INTERVENTION(S): After collecting baseline temperatures, we secured a 1.0-kg ice bag to the calf using plastic wrap before the subject either rested prone or walked on a treadmill at 4.5 km/h for 30 minutes. RESULTS: Treatment did not (P < 0.10) affect the approximately 15 degrees C (P < 0.0001) surface temperature decrease, which remained depressed immediately upon ice-bag application (P < 0.05). Conversely, intramuscular temperature continually cooled (34 to 28 degrees C), while subjects rested (P < 0.0001), whereas no change took place during walking (P = 0.49). Moreover, at the 20- and 30-minute treatment intervals, the resting intramuscular temperatures were, respectively, 3.9 degrees C and 5.4 degrees C cooler than the walking intramuscular temperatures (P < 0.01). CONCLUSIONS: The current trend of wrapping "to go" ice bags to the leg is not likely to achieve deep tissue cooling despite surface temperature decreases.

Immunologic indicators of clinical progression during canine Leishmania infantum infection.

In both dogs and humans Leishmania infantum infection is more prevalent than disease, as infection often does not equate with clinical disease. Previous studies additively indicate that advanced clinical visceral leishmaniasis is characterized by increased production of anti-Leishmania antibodies, Leishmania-specific lymphoproliferative unresponsiveness, and decreased production of gamma interferon (IFN-gamma) with a concomitant increase of interleukin-10 (IL-10). In order to differentiate infection versus progressive disease for better disease prognostication, we temporally evaluated humoral and cellular immunologic parameters of naturally infected dogs. The work presented here describes for the first time the temporal immune response to natural autochthonous L. infantum infection in foxhounds within the United States. Several key changes in immunological parameters should be considered when differentiating infection versus clinical disease, including a dramatic rise in IgG production, progressive increases in antigen-specific peripheral blood mononuclear cell proliferation, and IFN-gamma production. Polysymptomatic disease is precluded by increased IL-10 production and consistent detection of parasite kinetoplast DNA in whole blood. This clinical presentation and the immuno-dysregulation mirror those observed in human patients, indicating that this animal model will be very useful for testing immunomodulatory anti-IL-10 and other therapies.