Acute kidney failure: a pediatric experience over 20 years.

Background: Acute kidney failure in children is a catastrophic, life-threatening event.

Objective: To compare and contrast 2 decades of data, analyzing the underlying causes, associated multiple organ system failures, outcome of dialysis procedures, and other variables of interest.

Design: Retrospective examination of clinical data collected between January 1, 1979, and December 31, 1998.

Pediatric organ donation: impact of medical examiner refusal.

Objectives: To examine the national Pediatric Intensive Care Unit (PICU) experience regarding Medical Examiner (ME) refusal of organ procurement from potential donors. To review our experience regarding PICU mortalities, organ donation, and impact of the ME on the organ donation process.

Design: National survey of PICU directors requesting demographics, type of ME system, perceptions of ME responsiveness to organ donation, and data regarding potential donors and their outcomes.

Methemoglobin levels during prolonged combined nitroglycerin and sodium nitroprusside infusions in infants after cardiac surgery.

Nitroglycerin (NTG) and sodium nitroprusside (SNP) are routinely used perioperatively in infants with congenital heart defects. In this study, NTG and SNP were infused in the operating room to increase venous capacitance, reduce systemic and pulmonary afterload, facilitate weaning off cardiopulmonary bypass, stabilize hemodynamics for transport to the intensive care unit (ICU), and reduce the fluid resuscitation needed upon arrival in the ICU. Because of the risk for accumulation of methemoglobin (MetHb) and cyanmethemoglobin (cyan-MetHb) during prolonged continuous infusion of NTG and SNP, it was decided to (1) quantify ICU use, (2) measure % MetHb at 12-hour intervals, and (3) look indirectly for the accumulation of cyan-MetHb by comparing simultaneous pulse oximetry (SpO2) (Nellcor N-100 [Nellcor, Haywood, CO]) and CO-oximetry (SaO2) (Corning 270 [Corning, Medfield, MA]).

Atlantooccipital subluxation in a neonate with Down's syndrome. Case report and review of the literature.

Atlantooccipital subluxation (AOS) occurs in up to 63% of patients with Down's syndrome. However, presenting symptoms and the age at which preoperative screening becomes necessary have not been clearly delineated. Recently, a 16-day-old female with Down's syndrome and AOS presented to our institution.

Stridor: intracranial pathology causing postextubation vocal cord paralysis.

During an 18-month period in a pediatric intensive care unit, nine patients with vocal cord paralysis were identified using flexible bronchoscopy. When tracheally extubated, each child was found to have stridor. The children ranged in age from 17 days to 5 1/2 years.

Dependence of oxygen consumption on oxygen delivery in children with hyperdynamic septic shock and low oxygen extraction.

We studied the effect of increasing systemic oxygen delivery (DO2) by packed RBC (PRBC) transfusion on oxygen consumption (VO2) in children with hyperdynamic septic shock. After routine resuscitation with volume loading and pharmacologic support, patients were studied if they had significant derangements of oxygen transport variables defined as: baseline VO2 less than 180 ml/min.m2 and oxygen extraction (O2 extr) less than 24%.

Trending of impedance-monitored cardiac variables: method and statistical power analysis of 100 control studies in a pediatric intensive care unit.

The NCCOM3-R6 monitor continuously monitors cardiac output and five other cardiovascular variables from the thoracic electrical bioimpedance signal. We averaged data over 5-min intervals for 130 min in 100 control studies in 40 pediatric ICU patients, age 0.04 to 20.

Percutaneous catheterization of the axillary vein in infants and children.

The axillary vein was evaluated as an alternative access site for central venous catheterization in critically ill infants and children. Children were placed in the Trendelenberg position (when possible) with arm abducted 100 to 130 degrees. The vein was entered parallel and inferior to the artery.

Age-related differences in the use of morphine, diazepam, and pancuronium for mechanically ventilated children.

Mechanically ventilated children usually require a combination of sedation (morphine = M, diazepam = D) and paralysis (pancuronium = P) to minimize anxiety, discomfort, and the risks of self-extubation, tracheal injury, and pulmonary barotrauma. We sought to determine whether our use of MDP varied with patient age. Cases where the dosage of MDP would be influenced by neurological, hemodynamic, or painful diagnoses were excluded.

Organ blood flow and cardiovascular effects of high-frequency oscillation versus conventional ventilation in dogs with right heart failure.

Mongrel dogs underwent a large (apex to pulmonary valve) right ventriculotomy to produce right ventricular dysfunction. Right ventriculotomy decreased cardiac output from 2.47 +/- 0.

Acute mechanical ventilation: an index of the absolute need for pediatric intensive care unit beds.

Acute mechanical ventilation (MV) is an absolute indication for pediatric ICU (PICU) admission. Only 28% of PICU patients over an 8-yr period required acute MV, yet these accounted for 52.5% of total patient days.

Gastrografin aspiration in a 3 3/4-year-old girl.

A case of Gastrografin aspiration in a 3 3/4-year-old child admitted for multiple trauma is described.

Lack of evidence that formula-derived creatinine clearance approximates glomerular filtration rate in pediatric intensive care population.

During the four-year period from January 1980 to April 1984, 56 patients were admitted to the Pediatric Intensive Care Unit (PICU) whose care required timed urine collections using indwelling urinary catheters. The glomerular filtration rate derived from the clearance of endogenous creatinine with accurate timed urine volume is compared to that derived from the formula, 0.55 body length (cm)/plasma creatinine (mg/dl).

Postictal pulmonary edema in children.

Pulmonary edema complicating generalized tonic-clonic seizures has rarely been reported in children, although it has been well documented in adults. We report two patients, aged 8 and 9 years, who developed clinical and radiographic evidence of the condition. Fever, leukocytosis, and arterial hypoxemia are seen in the absence of cardiac dysfunction or infection.

An angiographic catheter technique for selective endobronchial intubation.

Three children requiring selective endobronchial intubation were treated with a technique utilizing an angiographic catheter as a guide for the endotracheal tube. The procedure was successful in all three children and there were no long-term complications. Performed properly the technique is rapid, safe and avoids uncontrolled attempts at endobronchial intubation or the need for a flexible fiberoptic bronchoscope.

The anatomical heterogeneity of hearts lacking a patent communication between the left atrium and the ventricular mass ('mitral atresia') in presence of a patent aortic valve.

Thirty-five hearts were studied with no patent communication between the left atrium and the ventricular mass ('mitral atresia'). In ten, an imperforate and hypoplastic membrane separated the left atrium from a hypoplastic left ventricle. The imperforate valve ranged from a tiny membrane with no evidence of tension apparatus, through a larger membrane supported by muscular columns in the ventricular inlet portion, to an aneurysmal imperforate sac attached to a single hypoplastic papillary muscle.

Urea nitrogen excretion in critically ill children.

Urinary urea nitrogen (UUN) excretion as an index of both total nitrogen excretion and protein catabolism was assayed in 32 children (aged 2 months to 15 years, median 6 years) (50% mechanically ventilated) during an intensive care unit course of one to ten days (median three days). The daily UUN excretion was 4.38 +/- 2.

Carotid artery bruits: prevalence survey and differential diagnosis.

From a 10% sampling of the Olmsted County, Minnesota, population, persons of age 45 years and older were selected randomly in predetermined age and sex groupings and examined for cervical murmurs. Five hundred nine persons representing approximately 1% of all persons in the population between 45 and 54 years old, 2.5% of those 55 to 64 years old, and 3.

Clinical implications of postoperative unilateral phrenic nerve paralysis.

Unilateral phrenic nerve paralysis (PNP) folowed 32 (1.7 percent) of 1,891 consecutive cardiac surgical procedures during an 8 year peroid. Diagnosis was based on radiographic criteria with comparison of preoperative and postoperative chest radiographs and was confirmed in all 21 evaluated by fluoroscopy.