RESUMEN
Thirty-nine critically ill infants with pulmonary disease received tolazoline because of severe hypoxemia refractory to administration of 100% O2 and mechanical ventilation. Twenty-seven (69%) of the infants responded with an increase in PaO2 greater than or equal to 20 torr in the first umbilical arterial gas after completion of the initial ten-minute infusion (1 to 2 mg/kg) of the drug. A response was not correlated with survival. The overall survival was 46%, essentially unchanged from our previous report (44%). Infants with hyaline membrane disease had the poorest survival rate (33%). Complications associated with the use of tolazoline occurred in 82% of the infants. A hypotensive reaction, defined as a 25% decrease in mean arterial pressure from the pre-tolazoline level, occurred in 67% of the infants, and more commonly in the infants with RDS (87%). In 11 infants who did not respond to the initial dose of tolazoline, the dose was increased up to 10 mg/kg/hour; only one infant responded, and eight (73%) had a hypotensive reaction.
Asunto(s)
Hipoxia/terapia , Enfermedades del Recién Nacido/complicaciones , Enfermedades Pulmonares/complicaciones , Tolazolina/uso terapéutico , Dióxido de Carbono/sangre , Humanos , Enfermedad de la Membrana Hialina/complicaciones , Enfermedad de la Membrana Hialina/mortalidad , Hipoxia/tratamiento farmacológico , Hipoxia/etiología , Recién Nacido , Enfermedades del Recién Nacido/mortalidad , Inhalación , Enfermedades Pulmonares/mortalidad , Meconio , Oxígeno/sangre , Terapia por Inhalación de Oxígeno , Respiración Artificial , Síndrome de Dificultad Respiratoria del Recién Nacido/complicaciones , Síndrome , Tolazolina/efectos adversos , Arterias UmbilicalesRESUMEN
Infants under radiant warmers have large increases in insensible water loss compared with infants in single wall incubators. To answer the question of whether or not a minimal rate of oxygen consumption could be achieved under overhead radiant warmers, we measured oxygen consumption, carbon dioxide production, and abdominal skin, cheek, rectal, thigh, and environmental temperature in ten healthy newborn infants in incubators and radiant warmers, using each infant as his/her own control. The minimal VO2 ranged from 4.41 to 8.87 and from 4.35 to 9.06 cc/kg/minute in the incubator and radiant warmer, respectively. The differences were clearly not significant (paired Student t-test, P greater than 0.60). There were no significant differences between the respiratory quotients, VCO2, or abdominal skin, check, rectal or environmental temperatures. These data support the hypothesis that a thermoneutral environment can be provided with a radiant warmer and imply that large increases in insensible water loss can occur without affecting minimal oxygen consumption.