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  • 1
    ISSN: 1432-1998
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1238
    Keywords: Acute respiratory distress syndrome ; Respiratory syncytial virus infection ; Bronchopulmonary dysplasia ; Nitric oxide ; Child
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To report the first case of ARDS in children treated with nitric oxide (NO) inhalation. Methods A 13-months infant presented with BPD and severe hypoxemia related to RSV infection and ARDS. Inhaled NO was delivered in the ventilatory circuit of a continuous flow ventilator (Babylog 8000, Dräger) in a concentration of 20–80 ppm for 7 days. NO and NO2 were continuously monitored (Polyton Draeger). Respiratory mechanics were evaluated by using the method of passive inflation by the ventilator. Results NO inhalation improved oxygenation (tcSaO2) and reduced respiratory system resistance without affecting arterial pressure. NO2 level remained below 5 ppm, and methaemoglobin level below 1%. The child survived without neurologic sequela. Conclusions Two mechanisms to explain oxygenation improvement can be suggested:selective improvement in perfusion of ventilated regions and bronchodilation.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-1238
    Keywords: Infectious purpura ; Fulminating meningococcemia ; Prognostic score
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The French Club of Pediatric Intensive Care has prospectively studied 90 cases of infectious purpura which were hospitalized in 1981; the purpose of this study was to determine prognostic factors. The statistical study (X2 test) of all these cases is in agreement with data in the literature and shows that the mortality is significantly higher when there is: shock (p〈0.001), coma (p〈0.05), ecchymotic or necrotic purpura (p〈0.01), temperature 〈36°C (p〈0.05), no clinical meningism (p〈0.001), white cell count 〈10,000/mm3 (p〈0.05), thrombocytopenia 〈100,000 (p〈0.01), fibrinogen 〈1.5 g/l (p〈0.001), kalemia 〉5 mEq/l (p〈0.01), spinal fluid cell count 〈20/mm3 (p〈0.01). Because shock is one of the main prognostic factors (23 deaths in 55 shocked patients, versus 2 in 35 non-shocked) we have performed another statistical study (with the Benzecri method) to determine a prognostic index for patients in shock. For its determination, five initial parameters are used: age, kalemia, white cell count, clinical meningism, platelet count. The predictive value for survival is 91%. The predictive value for death is 87%. The score was applied on the patients hospitalized in shock in 1982: the predictive value for survival is 75%, the predictive value for death is 61%.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 19 (1993), S. 73-74 
    ISSN: 1432-1238
    Keywords: Arnold-Chiari malformation ; Cardiorespiratory arrest ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report the first two fatal cases of suddden unprovoked cardiorespiratory arrest in children with previously undiagnosed Arnold-Chiari type 1 malformation. This diagnosis should be considered in children with unexplained cardiorespiratory arrest. The risk of sudden death in Arnold-Chiari type 1 malformation reinforces the indication for early neurosurgical procedure.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1432-1238
    Keywords: Key words Respiratory mechanics ; Mechanical ventilation ; Infants ; End-expiratory lung volume ; Dynamic elevation of FRC
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aim of the study was to compare measurements of the elevation of functional residual capacity (FRC) above the relaxation volume obtained in 34 mechanically ventilated infants (median weight 2.6 kg, range 1.2–9) from four different methods: (1) direct measurement of the complete exhalation volume after brief disconnection from the ventilator, (2) calculated measurement from total positive end-expiratory pressure (PEEP) measured by end-expiratory occlusion of the breathing circuit, (3) extrapolated evaluation from the mathematical model of Brody, (4) extrapolated evaluation from the passive expiration method. We considered the direct measurement (1) as the “gold standard”. Measurements obtained by total PEEP (2) and by the Brody's mathematical model (3) provided similar results than the direct measurement. Conversely, graphical extrapolation from the passive expiration method (4) underestimated the elevation of FRC. In conclusion, we suggest using the mathematical extrapolation from the Brody's model to evaluate the elevation of FRC in mechanically ventilated infants: this method is non-invasive, does not require disruption of gas flow, can be easily performed with all the neonatal ventilators, and allows continuous breath-by-breath measurements.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1432-1238
    Keywords: Key words Respiratory mechanics ; Monitor assessment ; Accuracy ; Interobserver agreement ; Ventilated child
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To evaluate a recently developed and manufactured device for monitoring respiratory parameters in mechanically ventilated children. Design: In vitro study using a lung model. Setting: University paediatric intensive care unit. Material and interventions: Evaluation of the accuracy of volume and pressure measurements, of the determination of respiratory system compliance (10 to 30 ml/cmH2O) and of resistance (20 and 50 cmH2O/l per s) by the inflation technique (volume- and pressure-controlled mode of ventilation); assessment of interobserver agreement for compliance (10, 15 ml/cmH2O) and resistance (20, 50 cmH2O/l per s) determinations (ANOVA, intraclass correlation coefficient). Measurements and results: The accuracy of volume measurements (No. 1 Fleisch pneumotachograph) was ≤ 5 % of true volumes up to 1 l (Flow: 30 l/min) even after the introduction of an endotracheal tube. The accuracy of pressure measurements up to 70 cmH2O was ≤ 2.5 % of the true values. Coefficients of variation of volume and pressure measurements were 〈 2 %. The accuracy of compliance and resistance determinations was, respectively, ≤ 17 and 25 % of the true values. No significant observer effect was found on compliance and resistance determinations. Indeed, mean differences in compliance and resistance determinations by pairs of observers were 〈 1 %. Intraclass correlation coefficients were 〉 0.98. Conclusions: The measuring error of volume, pressure, compliance and resistance determined using this monitoring system seems acceptable for monitoring purpose. Moreover, use of this system by members of the medical team can be recommended since results obtained by observers, even untrained ones, were similar. In vivo evaluation is now needed.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 12 (1986), S. 385-385 
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1432-1238
    Keywords: Infectious purpura ; Purpura fulminans ; Disseminated intravascular coagulation ; Protein C ; Protein S
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We studied, in 40 children (mean age: 52 months) with severe infectious purpura, the relationships between protein C (PC) and protein S (PS) levels, and shock, disseminated intravascular coagulation (DIC) and outcome. We determined, on admission, PC antigen (ELISA) and activity (chromogenic test), and total PS (ELISA). Results were expressed as % of normal adult values. Statistical analysis was performed with SAS. Thirty children were in shock, 20 had DIC. All children with DIC, and 10 without DIC were in shock. Of 20 children who were in shock and had DIC, 7 died and 3 had an amputation. PC antigen was significantly decreased in shock children (p〈0.05), in children with DIC (p〈0.0005). and in non-survivors (p〈0.05). PC activity was significantly decreased in shock children (p〈0.05), in children with DIC (p〈0.0005), and in non-survivors (p〈0.005). Total PS was not decreased in shock children, but was significantly decreased in children with DIC (p〈0.005), and in non-survivors (p〈0.005). We conclude that PC and PS levels were decreased in our children, and that PC levels were significantly decreased in the presence of shock, DIC, and fatal outcome. PC and antithrombin III (AT III) supplementation, should be evaluated in children with severe infectious purpura with shock and DIC.
    Type of Medium: Electronic Resource
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