Subject(s)
Cantharidin/adverse effects , Irritants/adverse effects , Molluscum Contagiosum/drug therapy , Shock, Septic/chemically induced , Staphylococcal Infections/complications , Staphylococcal Infections/etiology , Administration, Topical , Cantharidin/administration & dosage , Child, Preschool , Humans , Irritants/administration & dosage , Male , Occlusive Dressings , Staphylococcus aureus/isolation & purification , Staphylococcus aureus/pathogenicityABSTRACT
Laerdal Infant Resuscitators (Laerdal Medical Co., NY) are commonly used as free-flow oxygen delivery devices during neonatal resuscitation in situations where oxygen but not mechanical ventilation is desired. This study evaluates the performance of these resuscitators as free-flow oxygen devices. Efficiency was measured by comparing oxygen flow entering the resuscitator to oxygen flow delivered by the resuscitator. Clinical impact was assessed by measuring simulated patient fiO2. Three randomly selected resuscitator bags were tested for oxygen delivery efficiency by comparing oxygen inflow to outflow over an inflow range of 1 to 15 liters per minute (lpm). Measured outflow was 18-24% of inflow, demonstrating that as much as 82% of the oxygen flow escapes via the safety air inlet, safety blow-off valves, and other leaks. With the patient valve assembly removed, efficiency improved to 53-59%. Simulated fiO2 ranged from 0.23 to 0.68 at 5 lpm oxygen flow. We conclude that use of the Laerdal Infant Resuscitator for the delivery of free-flow oxygen, even with the valve assembly removed, generates highly variable patient fiO2. The use of self-inflating bags for delivery of oxygen without manual ventilation should be reconsidered.
Subject(s)
Intermittent Positive-Pressure Ventilation/instrumentation , Oxygen/administration & dosage , Respiratory Distress Syndrome, Newborn/therapy , Resuscitation/instrumentation , Equipment Design , Equipment Safety , Humans , Infant , Infant, Newborn , Oxygen/metabolism , Reproducibility of Results , Resuscitation/methodsABSTRACT
We studied the hemodynamic responses of peritoneal dialysis (PD) in three children following open heart surgery. Hemodynamic measurements were made prior to a dialysis run, following the instillation of dialysis solution (20 ml/kg), and immediately prior to and 5 min after drainage of the peritoneal cavity. The same protocol was repeated 48 h later. There was a significant increase in right atrial pressure (RAP) and mean pulmonary artery pressure upon instillation of the dialysate into the peritoneal cavity (p less than 0.01). However, cardiac index, mean arterial blood pressure (MAP), systemic (SVRI) and pulmonary vascular resistances (PVRI), left atrial pressure (LAP), and oxygen saturation did not change significantly. There were no significant differences between responses in the initial study and that performed 48 h later. PD is associated with modest right-sided hemodynamic changes which, in this small group of patients, did not compromise patient care.
Subject(s)
Cardiac Surgical Procedures , Hemodynamics/physiology , Peritoneal Dialysis , Postoperative Care/methods , Acute Kidney Injury/prevention & control , Cardiac Surgical Procedures/adverse effects , Child, Preschool , Female , Humans , Infant, Newborn , Male , Postoperative Complications/prevention & controlABSTRACT
We studied the hemodynamic effects of acute alterations in PaCO2 in ten ventilator-dependent children after open heart surgery. Despite end-tidal CO2 monitoring, five children inadvertently developed PaCO2 greater than 50 torr during the study. Increasing and decreasing PaCO2 in these children resulted in significant parallel changes in cardiac index (CI), oxygen delivery, physiologic shunt, mean pulmonary pressure, and right ventricular stroke work index, and inverse changes in systemic vascular resistance index (p less than .01). No significant hemodynamic changes were observed with alterations in PaCO2 in children whose PaCO2 remained less than 50 torr. These findings are partly related to significantly larger reductions in PaCO2 which occurred in the hypercarbic children compared to the others (25 vs. 12 torr; p less than .001). Heart rate, mean arterial BP, and venous filling pressures did not change significantly in either group. We conclude that mean alterations in PaCO2 less than or equal to 12 torr (range 28 to 50) have no significant effect on CI in children after open heart surgery. However, moderate hypercarbia and its correction to a mean PaCO2 of 30 torr are associated with significant effects on central hemodynamics. Moreover, no significant changes in the commonly monitored physiologic variables were observed despite large variations in PaCO2.
Subject(s)
Carbon Dioxide/physiology , Heart Defects, Congenital/surgery , Hemodynamics , Pulmonary Gas Exchange , Carbon Dioxide/analysis , Child , Child, Preschool , Female , Humans , Infant , Male , Postoperative Period , Respiration, ArtificialABSTRACT
Anterior thigh, pretibial and midfoot surface temperatures (MFT) were measured by an infrared thermometer in 17 children after open heart surgery. Core temperature was measured by pulmonary artery thermistor and cardiac index (CI) by thermodilution. No significant relationship existed between the previous hour's urinary output (ml/m2.h) and either systemic vascular resistance index (SVRI) and CI. MFT was inversely related to SVRI (r = -5.3; p less than .0001) but not to CI. The core/peripheral temperature gradient correlated directly with SVRI (r = .38, p less than .01) and inversely with CI (r = -.28, p less than .05). There was no improvement in any of the correlation coefficients when hemodynamic variables were tested against temperature gradients from core to thigh and thigh to foot. Although these relationships are statistically significant, we conclude that they are not strong enough to be of value in predicting central hemodynamic status in children after heart surgery.
Subject(s)
Body Temperature , Cardiac Surgical Procedures , Hemodynamics , Child , Humans , Postoperative Period , Skin TemperatureABSTRACT
A novel surgical procedure was performed on a 2-day-old infant with hypoplastic left-heart syndrome. It consisted of partitioning the pulmonary trunk thereby creating two channels, one leading to the pulmonary arterial system and the other to the aorta, and atrial septectomy to relieve left atrial pressure and facilitate mixing of blood. The technique avoids the use of conduits.
Subject(s)
Aortic Valve/abnormalities , Mitral Valve/abnormalities , Palliative Care , Aorta, Thoracic/surgery , Ductus Arteriosus, Patent/surgery , Heart Septum/surgery , Humans , Infant, Newborn , Male , Pulmonary Artery/surgery , SyndromeABSTRACT
Many patients requiring direct examination of the upper airway and gastrointestinal tract under general anesthesia have chronic obstructive lung disease, yet virtually no work has been done to assess the adequacy of their ventilation during laryngoscopy and in the early postoperative period. This study demonstrates that, using the Carden tube, their blood gases are well maintained even when areas outside the endolarynx, such as the upper esophagus, are examined. The Carden tube is shown to be easy to insert and remove as well as permitting a superior view of the larynx. Also, this study pinpoints the period of maximum danger of respiratory failure as occurring postoperatively in the recovery room. This should be independent of the method of ventilation employed at surgery and indicates the need for cocainization of the vocal cords before extubation, as well as careful, early postoperative monitoring. The problems of ventilation during direct examination of the upper airway and gastrointestinal tract are discussed and alternative methods evaluated.
Subject(s)
Laryngoscopy , Lung Diseases, Obstructive/surgery , Respiration, Artificial , Adult , Aged , Anesthesia, General , Evaluation Studies as Topic , Female , Humans , Intraoperative Period , Laryngoscopes , Lung Diseases, Obstructive/diagnosis , Male , Middle Aged , Postoperative Period , Respiration, Artificial/instrumentationABSTRACT
The effectiveness and safety of the Carden tube-oxygen injector system for ventilation was studied in 18 high-risk patients with obstructive airways disease during microlaryngeal surgery. Blood gas studies during operation demonstrated a mean Pao2 of 65.6 kPa (493 torr) and a mean PaCO2 of 4.5 kPa (34 torr) during mechanical ventilation. No serious complications were noted during operation. Fifty per cent of the patients had postoperative hypercapnia and in two the trachea was re-intubated. Airway maintenance and ventilation are discussed in detail and it is concluded that the Carden tube-oxygen injector system is a safe and convenient method for ventilating the lungs of patients with pulmonary disease who require microlaryngeal surgery.
