Changes in mean airway pressure during HFOV influences cardiac output in neonates and infants.

Background: Changes in mean airway pressure affect cardiac output during conventional positive pressure ventilation. The effect of high-frequency oscillation ventilation (HFOV) on cardiac output is less studied.

Methods: A prospective study in a university hospital pediatric intensive care unit.

Successful EXIT (ex utero intrapartum treatment) procedure in a fetus diagnosed prenatally with congenital high-airway obstruction syndrome due to laryngeal atresia.

Congenital high-airway obstruction syndrome (CHAOS) is due to rare malformations and has been reported previously in only few cases. If the diagnosis can be made prenatally, the ex utero intrapartum treatment (EXIT) procedure may be life-saving. A healthy 28-year old nulli-para was referred because of isolated ascites found at gestational week 16 during routine ultrasound scan.

Age-dependent variations in white adipose tissue glycerol and lactate production after surgery measured by microdialysis in neonates and children.

In previous studies, we observed that lactate concentrations in interstitial white adipose tissue are higher in small infants than in adults. Moreover, no lipolysis following catecholamine challenge has been reported in neonates and small infants. Our aim was to determine with microdialysis whether the above mentioned age-dependent changes could be detected in situ after surgery.

Changes in stroke volume cause change in cardiac output in neonates and infants when mean airway pressure is altered.

Background: Based on early studies in the lamb, and in spite of more recent studies in humans, it has been the received opinion that neonates and infants can not change their stroke volume significantly, but are mainly dependent on changes in heart rate, to change cardiac output. To further evaluate the relationship between cardiac output and stroke volume during mechanical ventilation of neonates and infants, we have studied the effects on cardiac output and stroke volume by two different ways of changing mean airway pressure.

Methods: In one group, mean airway pressure was decreased by using a patient triggered mode: pressure support ventilation; in the other, mean airway pressure was increased by increasing positive end-expiratory pressure (PEEP).

Microdialysis for metabolic monitoring in neonates after surgery.

Microdialysis is a new method for continuous metabolic monitoring. We studied the possibility of using microdialysis in neonates treated in a paediatric intensive care unit after surgery. A microdialysis catheter was inserted in the abdominal subcutaneous adipose tissue in 14 neonates for a median of 93 h (range 24-106 h).

Pressure support ventilation increases cardiac output in neonates and infants.

Fifteen neonates and infants were investigated during pressure controlled ventilation (PCV) and pressure support ventilation (PSV) on a Servo 300 ventilator. Changes in cardiac output (aortic mean blood flow velocity) were assessed with the Doppler technique. During PSV cardiac output increased by 16% (P < 0.

Adenosine for per-operative blood pressure control in an infant with neuroblastoma.

We describe a child with a localised pelvic neuroblastoma and a hypertensive crisis during the first weeks of life due to elevated systemic norepinephrine of tumoural origin. In spite of treatment with high doses of alpha-blockers, blood pressure did not respond fully and the boy had a very unstable circulation. Surgery was performed at one month of age.

Inhaled nitric oxide in neonates and children with pulmonary hypertension.

Fourteen critically ill neonatal and paediatric intensive care patients with various primary diagnoses and signs of associated pulmonary hypertension received inhaled nitric oxide (NO), 20-80 ppm, after failure of conventional therapy to improve oxygenation. NO administration was found to be associated with a significant improvement in postductal arterial oxygen tension (pre-NO: 3.75 (SD 1.

Expression of beta 1- and beta 2-receptor genes and correlation to lipolysis in human adipose tissue during childhood.

beta 1- and beta 2-adrenoceptor (bar1 and bar2) mRNA levels were measured in adipose tissue obtained from children (between 1 month and 10 yr of age) and adults during inguinal hernia operations. Bar1 mRNA levels were constant in all age groups studied. In infants and children less than 7 yr old, bar2 levels were twice as high (P < 0.

Lack of lipolytic response in infants after endotracheal intubation.

The sympathoadrenal response to endotracheal intubation was investigated in nine infants 2-4 months old and in eight adults 23-45 years old at the start of inguinal hernia operations. In both infants and adults, heart rate and diastolic blood pressure increased significantly immediately after intubation. In both groups, moreover, there was a mean (SD) reduction in microvascular blood flow in the abdominal skin (infants -21 (14)%, adults -14 (7)%) and in the adipose tissue (infants -7 (4)%, adults -5 (4)%).

Early development in healthy children of serum opsonins against nonpathogenic Neisseria meningitidis.

In an earlier study, with the use of chemiluminescence (CL) and phagocytic killing, we could show that in the presence of serum from healthy adults polymorphonuclear leukocytes (PMNL) efficiently handle nonpathogenic Neisseria meningitidis strains, in sharp contrast to those associated with clinical disease. The major part of this difference was dependent on serum factors. In the present study 84 serum samples from children 1-3, 4-6, 7-9, and 10-14 years old were studied by the CL technique according to their ability to opsonize meningococci.

Long-term use of central venous catheters in paediatric oncology treatment.

During a 26-month period, 158 central venous catheters were inserted in 114 children (median age: 4.5 years) with malignant diseases. Polyurethane catheters were used, inserted either using a cut-down procedure or percutaneously in the external or internal jugular vein.

Low field magnetic resonance imaging of the central nervous system in 15 children with autistic disorder.

Fifteen children, 10 boys and 5 girls, with autistic disorder, were studied with low field magnetic resonance imaging (MRI). The age ranged from 2.7-13.

Circulatory monitoring of children during anaesthesia in low-field magnetic resonance imaging.

Anaesthesia for patients in a Magnetic Resonance Imaging (MRI) scanner provides some problems for the design of both the anaesthetic and the monitoring equipment. This report presents a technique for continuously displaying the heart rate during anaesthesia for children in an MRI scanner. The monitoring system used light to detect differences in skin capillary circulation, and the light was transferred to and from the patient via fiberoptic cables.

Changes in muscle sympathetic nerve activity, venous plasma catecholamines, and calf vascular resistance during mechanical ventilation with PEEP in humans.

The sympathetic reflex response to mechanical ventilation with PEEP was studied in conscious human volunteers (n = 8). Muscle sympathetic nerve activity (MSNA) was measured from the peroneal nerve, calf blood flow, forearm venous plasma catecholamines, blood pressure, heart rate, airway pressure, and end-tidal CO2 (%) during spontaneous breathing and during mechanical ventilation with 0-20 cmH2O PEEP. MSNA increased (P less than 0.

Effects of hypovolaemia or isoprenaline infusion on the sympathetic reflex response to PEEP ventilation in rats.

The aim of this investigation was to study vagally mediated sympathetic reflex responses to mechanical ventilation with positive end-expiratory pressure (PEEP), during hypovolaemia or during high inotropic stimulation of the heart by isoprenaline infusion. Renal sympathetic nerve activity (RSNA), heart rate and mean arterial pressure were studied during mechanical ventilation with zero end-expiratory pressure (ZEEP) and 5 and 10 cmH2O PEEP in chloralose anaesthetized Wistar rats. Experiments were performed on two groups of rats: eight animals were subjected to 10% blood volume depletion, and seven animals to infusion of isoprenaline.

Radial arterial catheters in children and neonates: a prospective study.

Over a 3-yr period (1982 to 1984), 533 arterial catheters were inserted in 476 patients admitted to the pediatric ICU or the operating room. Radial arterial catheterization with small-bore, 0.8-mm, 22-ga Teflon cannulas was the most common method (376 of 533 cannulations), and 296 of these catheters were inserted in patients less than 1 yr of age.

Cardiac receptor modulation of blood flow and fluid transport in feline jejunum.

The aim of the study is to determine the effects of selective cardiac receptor unloading on vascular resistance and net fluid transport in the small intestine. In anesthetized cats, cardiac receptors were unloaded by positive pressure ventilation (PPV). Arterial baroreceptor activity was artificially maintained constant.

Reflex changes in sympathetic nerve activity during mechanical ventilation with PEEP in sino-aortic denervated rats.

The aim of this study was to evaluate the role of cardiopulmonary receptors with vagal afferents in the reflex control of sympathetic nerve activity during mechanical ventilation with positive end-expiratory pressure (PEEP). Experiments were performed on 17 chloralose-anaesthetized rats. Changes in renal sympathetic nerve activity (RSNA), heart rate and mean arterial pressure were studied at zero end-expiratory pressure (ZEEP) and at 5 and 10 cm H2O PEEP in intact animals (n = 8), after sino-aortic denervation (n = 17) and after sino-aortic denervation plus vagotomy (n = 10).

Sympathetic nerve activity and central haemodynamics during mechanical ventilation with positive end-expiratory pressure in rats.

The aim of this study was to examine the effects of mechanical ventilation with increasing levels of positive end-expiratory pressure (PEEP) on sympathetic nerve activity (SNA), cardiac output (CO), stroke volume (SV), heart rate (HR), central blood volume (CBV), total peripheral resistance (TPR), mean arterial pressure (MAP), pulse pressure (PP) and right and left atrial transmural pressure in chloralose anaesthetized rats before and after vagotomy. Changing ventilatory pattern from spontaneous breathing (SB) to artificial ventilation with 10 cm H2O PEEP in intact animals caused a significant fall in CO, SV and CBV (42, 48 and 17%, respectively) and an increase in SNA, HR and TPR (90, 13 and 83%, respectively). The MAP increased slightly but significantly from 103 +/- 4 to 107 +/- 4 mmHg while PP decreased from 48 +/- 2 to 37 +/- 3, from spontaneous breathing (SB) to 10 cm H2O PEEP.