RESUMEN
To determine the effects of bladderbox alarms during venoarterial extracorporeal membrane oxygenation (va-ECMO) on cerebral oxygenation and hemodynamics, six lambs were prospectively treated with va-ECMO and bladderbox alarms were simulated. Changes in concentrations of oxyhemoglobin (deltacO2Hb), deoxyhemoglobin (deltacHHb), and total Hb (deltactHb) were measured using near infrared spectrophotometry. Fluctuations in Hb oxygenation index (deltaHbD) and cerebral blood volume (deltaCBV) were calculated. Heart rate (HR), mean arterial pressure (MAP), blood flow in the left carotid artery (Qcar), and central venous pressure (CVP) were registered. Bladderbox alarms were simulated by increasing the ECMO flow or partially clamping the venous cannula and resolved by decreasing the ECMO flow, unclamping the cannula, or intravascular volume administration. CBV, HbD, MAP, and Qcar decreased significantly during bladderbox alarms, whereas HR and CVP increased. After the bladderbox alarms, CBV and HbD increased significantly to values above baseline. For HbD, this increase was higher during intravascular volume administration.MAP, Qcar, and CVP recovered to preexperiment values but increased further with volume administration. HR was increased at the end of our measurements. We conclude that Bladderbox alarms during va-ECMO treatment result in significant fluctuations in cerebral oxygenation and hemodynamics, a possible risk factor for intracranial lesions.
Asunto(s)
Encéfalo/metabolismo , Oxigenación por Membrana Extracorpórea/métodos , Oxigenadores de Membrana , Animales , Velocidad del Flujo Sanguíneo/fisiología , Presión Sanguínea , Encéfalo/irrigación sanguínea , Frecuencia Cardíaca , Hemoglobinas/metabolismo , Flujo Sanguíneo Regional , Ovinos , Espectroscopía Infrarroja CortaRESUMEN
This study evaluated the relation between prior inhaled nitric oxide (iNO) and the time to initiation and duration of treatment with veno-arterial extracorporeal membrane oxygenation (ECMO) and the occurrence of hemorrhagic complications. A retrospective study was conducted in 59 human newborns treated for respiratory insufficiency with ECMO over a 5-year period. Patients received iNO before ECMO (iNO group) or not (control group). Both groups were compared for patient characteristics, postnatal age at the initiation of ECMO, duration of ECMO treatment, and hemorrhagic complications. There were no significant differences between the iNO group and the control group for patient characteristics and medication use before the ECMO treatment, except for norepinephrine. There was no significant difference for postnatal age at the initiation of ECMO and mean duration of ECMO treatment. We found no statistically significant difference in hemorrhagic complications between both groups. This persisted after correction for diagnosis and ECMO run-time in linear logistic regression analysis. Inhaled nitric oxide before ECMO did not result in a significant delay in the initiation of ECMO or longer duration of the ECMO. There was no significant relationship between the use of prior iNO and the occurrence of hemorrhagic complications during the ECMO treatment.
Asunto(s)
Broncodilatadores/administración & dosificación , Hemorragia Cerebral/etiología , Oxigenación por Membrana Extracorpórea/efectos adversos , Enfermedades del Prematuro/terapia , Óxido Nítrico/administración & dosificación , Administración por Inhalación , Hemorragia Cerebral/epidemiología , Humanos , Recién Nacido , Insuficiencia Respiratoria/terapia , Estudios RetrospectivosRESUMEN
PURPOSE: The aim of the study was to evaluate patient demographics, classification and location of the atresia, operative management, postoperative care, and outcome in 114 infants with jejunoileal atresia (JIA) over a period of more than 3 decades. METHODS: This was a retrospective case series in a tertiary care teaching hospital. Records of all patients with JIA treated at the authors' institution between 1971 and 2004 were examined. RESULTS: Sixty-two percent of atresia and stenosis was noted in the jejunum, 30% in the ileum, and 8% in both the jejunum and the ileum. Atresias and stenosis were classified as follows: 7% type 0, 16% type I, 21% type II, 24% type IIIa, 10% type IIIb, 22% type IV. Gastrointestinal anomalies were encountered in 24% of patients, genitourinary malformations in 9%, cystic fibrosis in 9%, neurologic anomalies in 6%, and congenital heart disease in 4%. Operative management included resection with primary anastomosis in 69% of all patients and temporary enterostomies in 26%. After operative management, 15% of children had resultant short bowel syndrome. Oral feeding was allowed on median day 7, and full energy expenditure via the enteric route was reached on median day 20. Forty-seven percent of infants required central venous line placement for total parenteral nutrition. Early postoperative complications occurred in 28% of patients with JIA and late postoperative complications in 17%. We observed a mortality rate of 11%. CONCLUSIONS: This is one of the largest series of neonates with JIA described. Short bowel syndrome seems to be the biggest problem resulting in longer hospital stay, more feeding problems, and higher morbidity and mortality rates. Management of children with short bowel syndrome has improved because of the use of total parenteral nutrition, new operative techniques, and better intensive care. In the last 15 years, survival has increased at the cost of the surviving children as we noted a higher percentage of late complications.
Asunto(s)
Íleon/anomalías , Atresia Intestinal/mortalidad , Atresia Intestinal/cirugía , Yeyuno/anomalías , Femenino , Humanos , Recién Nacido , Atresia Intestinal/clasificación , Masculino , Países Bajos/epidemiología , Nutrición Parenteral/métodos , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
OBJECTIVE: The objective of this study was to determine the relationship between the frequency and total volume of intravascular volume administration and the development of intracranial hemorrhage during venoarterial extracorporeal membrane oxygenation. METHODS: In a retrospective, matched, case-control study, 24 newborns who developed an intracranial hemorrhage during venoarterial extracorporeal membrane oxygenation treatment were compared with 40 control subjects. Both groups were analyzed for gestational age, gender, race, Apgar scores at 1 and 5 minutes, birth weight, cardiopulmonary resuscitation before venoarterial extracorporeal membrane oxygenation, age at the start of treatment, duration of treatment, worst arterial blood gas sample preceding treatment, activated clotting time values, need for platelet transfusions, mean blood pressure, and the use of inotropics and steroids before the treatment. For both groups, total number and volume of intravascular infusions of normal saline, pasteurized plasma protein solution, erythrocytes, and platelets during the first 24 hours of treatment were determined. Variables were analyzed in their relationship to intracranial hemorrhage by using univariate and multivariate conditional logistic regression. RESULTS: The only statistically significant difference in patient characteristics between the case patients and control subjects was arterial blood gas values. Newborns who developed intracranial hemorrhage during the treatment received both a statistically significantly higher number and a statistically significantly higher total volume of intravascular volume administrations compared with control patients. After adjustment for pH, Paco(2), and Pao(2) in the multivariate analysis, we found a significant relation between the development of intracranial hemorrhage and >8 infusions or >300 mL of volume infusion in the first 8 hours and >10 infusions in the first 24 hours of treatment. CONCLUSIONS: The number and total volume of intravascular volume administration in the first 8 and 24 hours of venoarterial extracorporeal membrane oxygenation treatment are statistically significantly related to the development of intracranial hemorrhage.
Asunto(s)
Proteínas Sanguíneas/efectos adversos , Transfusión de Eritrocitos/efectos adversos , Oxigenación por Membrana Extracorpórea/efectos adversos , Hemorragias Intracraneales/etiología , Transfusión de Plaquetas/efectos adversos , Cloruro de Sodio/efectos adversos , Proteínas Sanguíneas/administración & dosificación , Volumen Sanguíneo , Estudios de Casos y Controles , Femenino , Humanos , Recién Nacido , Infusiones Parenterales , Masculino , Estudios Retrospectivos , Factores de Riesgo , Cloruro de Sodio/administración & dosificaciónRESUMEN
BACKGROUND/PURPOSE: Several techniques have been described to repair giant omphaloceles. There is no procedure considered to be the criterion standard worldwide. The aim of the present prospective study was to analyze the early and late results of secondary closure of giant omphaloceles using the component separation technique (CST) in infants. METHODS: From January 2004 to January 2007, 10 consecutive pediatric patients with a giant omphalocele were treated at our department. Initially, patients were treated conservatively. After epithelialization of the omphalocele, the abdominal wall was reconstructed using CST. Patients were monitored for complications during admission, and all patients were seen for follow-up. RESULTS: Component separation technique was performed at median age of 6.5 months (range, 5-69 months). The median diameter of the hernia was 8 cm (range, 6-9 cm). There was no mortality. The postoperative course was uneventful in 7 patients. Complications were seen in 3 patients (infection, skin necrosis, and hematoma). Median hospital stay was 7 days. After median follow-up of 23.5 months (range, 3-39 month), no reherniations were found. CONCLUSIONS: The CST is a safe 1-stage procedure for secondary closure in children with a giant omphalocele without the need for prosthetic material and with good clinical outcome.
Asunto(s)
Hernia Umbilical/cirugía , Procedimientos de Cirugía Plástica/métodos , Recto del Abdomen/cirugía , Mallas Quirúrgicas , Pared Abdominal/fisiopatología , Pared Abdominal/cirugía , Preescolar , Estética , Femenino , Estudios de Seguimiento , Hernia Umbilical/diagnóstico , Humanos , Lactante , Masculino , Estudios Prospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resistencia a la Tracción , Resultado del TratamientoRESUMEN
OBJECTIVE: Evaluation of the influence of previous inhaled nitric oxide (iNO) treatment on the occurrence of clotting complications and disseminated intravascular coagulation during extracorporeal membrane oxygenation (ECMO). DESIGN: Retrospective study in newborns treated with venoarterial ECMO during a 5-yr period. SETTING: Neonatal intensive care unit of a university medical center. PATIENTS: A total of 59 newborns with severe respiratory insufficiency treated with venoarterial ECMO. INTERVENTIONS: Patients received iNO before ECMO (iNO group) or not (control group). MEASUREMENTS AND MAIN RESULTS: There were no differences between the groups for patient characteristics and medication use before ECMO, except for norepinephrine. After correction for diagnosis and duration of ECMO, significantly more clotting complications and disseminated intravascular coagulation as individual variables were seen in the iNO group. For the combination of clotting complications and disseminated intravascular coagulation, there was a significantly higher prevalence in the iNO group. CONCLUSIONS: In our population, we found a remarkable relationship between clotting complications or disseminated intravascular coagulation and iNO use before ECMO treatment, which needs further prospective research before conclusions can be drawn.
Asunto(s)
Trastornos de la Coagulación Sanguínea/inducido químicamente , Oxigenación por Membrana Extracorpórea , Óxido Nítrico/administración & dosificación , Vasodilatadores/administración & dosificación , Administración por Inhalación , Coagulación Intravascular Diseminada/inducido químicamente , Femenino , Humanos , Recién Nacido , Masculino , Cuidados Preoperatorios , Insuficiencia Respiratoria/terapia , Estudios RetrospectivosRESUMEN
The current report describes a case of an infant girl with a giant omphalocele in whom a new surgical technique was used for closing the abdominal wall after epithelialization of the omphalocele for 16 months. The technique used was translation of the muscular layers of the abdominal wall. The functional and cosmetic results appear superior compared with other suggested treatments used for this abdominal wall defect.
Asunto(s)
Hernia Umbilical/cirugía , Femenino , Hernia Umbilical/diagnóstico por imagen , Humanos , Recién Nacido , Embarazo , Ultrasonografía PrenatalRESUMEN
Compartment syndrome, rhabdomyolysis and the risk of acute renal failure are potential complications of the lithotomy position. A six-year-old girl is described who developed a compartment syndrome with rhabdomyolysis after prolonged surgery in the lithotomy position. This complication occurred three times over ten years in our hospital. Rhabdomyolysis may induce acute renal failure. The pathogenesis of rhabdomyolysis--induced renal failure has not yet been elucidated. However, forced diuresis by intravenous administration of mannitol and furosemide can prevent acute renal failure.
Asunto(s)
Lesión Renal Aguda/etiología , Síndromes Compartimentales/etiología , Complicaciones Posoperatorias , Rabdomiólisis/etiología , Procedimientos Quirúrgicos Urológicos/efectos adversos , Niño , Femenino , Humanos , Mioglobinuria , Postura , Rabdomiólisis/terapia , Incontinencia Urinaria/cirugíaRESUMEN
To obtain information on water and salt regulating hormones and volume homeostasis during neonatal extracorporeal membrane oxygenation (ECMO), serial determinations of atrial natriuretic peptide (ANP), plasma renin activity (PRA), aldosterone (Aldo), antidiuretic hormone (ADH), colloid-osmotic pressure (COP), osmolality (Osmol), and central venous pressure (CVP) before, during, and after neonatal ECMO in 10 neonates with meconium aspiration syndrome (MAS) were carried out. Mean gestational ages and birth weights were 41(+3) weeks (39(+6) - 42(+4)) and 4,063 gm (3,500-4700), respectively; mean age at start and duration of ECMO 29.3 (14-69) and 152.6 hr (92-267), respectively. Plasma ANP (mean +/- SD) was 67.8+/-69.1 pmol/L before, decreased to 33.3+/-22.1 (not significant) pmol/L during, and significantly increased to 274.6+/-131.8 pmol/L after ECMO (p < 0.05). ANP correlated positively with CVP (r = 0.63; p < 0.001). Pre-ECMO PRA, Aldo, and ADH were comparable to those described earlier in normal neonates, decreased during (p < 0.001 for Aldo; p < 0.05 for PRA and ADH) and either remained elevated (PRA, p < 0.001; Aldo, p < 0.05) or decreased (ADH) after ECMO. COP and Osmol remained unchanged. Neonatal ECMO for MAS is characterized by circulatory and osmotic equilibrium. It is suggested that circulating volume contracts during and expands after neonatal ECMO for MAS.