RESUMO
OBJECTIVE: To study prospectively the association of coffee intake with incident diabetes in the Puerto Rico Heart Health Program cohort, comprising 9824 middle-aged men (aged 35-79 years). METHODS: Of 9824 men, 3869 did not provide a fasting blood sample at baseline, 1095 had prevalent diabetes and 131 were not given fasting glucose tests at any subsequent study visit. Thus, the present analysis includes 4685 participants. Diabetes was ascertained at baseline and at two study visits between 1968 and 1975 using fasting glucose tests and self-reports of physician-diagnosed diabetes or use of insulin or hypoglycaemic medication. Logistic regression analysis was used to assess the association of coffee intake with risk of incident diabetes while adjusting for covariates (age, BMI, physical activity, smoking, education, alcohol intake, family history of diabetes, intakes of milk and sugar). RESULTS: Five hundred and nineteen participants met the criteria for incident diabetes. Compared with those reporting intake of 1-2 servings of coffee/d, coffee abstainers were at reduced risk (OR = 0.64; 95 % CI 0.43, 0.94). Among coffee drinkers, there was a significant trend of decreasing risk by intake (P = 0.02); intake of >/=4 servings/d was associated with an odds ratio of 0.75 (95 % CI 0.58, 0.97). CONCLUSIONS: Study findings support a protective effect of coffee intake on diabetes risk, while also suggesting that abstainers may be at reduced risk.
Assuntos
Café , Diabetes Mellitus Tipo 2/epidemiologia , Medição de Risco , Adulto , Idoso , Glicemia/análise , Índice de Massa Corporal , Estudos de Coortes , Diabetes Mellitus Tipo 2/prevenção & controle , Ingestão de Líquidos , Teste de Tolerância a Glucose , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Porto Rico/epidemiologiaRESUMO
OBJECTIVE: To determine the efficacy of partial liquid ventilation (PLV) by means of a medical-grade perfluorochemical liquid, perflubron (LiquiVent), in premature lambs with respiratory distress syndrome (RDS). Further, to determine the compatibility of perflubron with exogenous surfactant both in vitro and in vivo during PLV. DESIGN: Prospective, randomized, controlled study, with in vitro open comparison. SUBJECTS: Twenty-two premature lambs with RDS. INTERVENTIONS: In vitro assays were conducted on three exogenous surfactants before and after combination with perflubron. We studied four groups of lambs, which received one of the following treatment strategies: conventional mechanical ventilation (CMV); surfactant (Exosurf) plus CMV; PLV; or surfactant plus PLV. MEASUREMENTS AND MAIN RESULTS: In vitro surface tension, measured for three exogenous surfactants, was unchanged in each animal after exposure to perflubron. Lung mechanics and arterial blood gases were serially measured. All animals treated with PLV survived the 5 hours of experiment without complication; several animals treated with CMV died. During CMV, all animals had marked hypoxemia and hypercapnia. During PLV, arterial oxygen tension increased sixfold to sevenfold within minutes of initiation, and this increase was sustained; arterial carbon dioxide tension decreased to within the normal range. Compliance increased fourfold to fivefold during PLV compared with CMV. Tidal volumes were increased during PLV, with lower mean airway pressure. Resistance was similar for both CMV and PLV; there was no difference with surfactant treatment. CONCLUSIONS: We conclude that PLV with perflubron improves lung mechanics and gas exchange in premature lambs with RDS, that PLV is compatible with exogenous surfactant therapy, and that, as a treatment for RDS in this model, PLV is superior to the surfactant studied.
Assuntos
Produtos Biológicos , Fluorocarbonos/uso terapêutico , Fosforilcolina , Surfactantes Pulmonares/uso terapêutico , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Animais , Animais Recém-Nascidos , Terapia Combinada , Combinação de Medicamentos , Emulsões , Álcoois Graxos/uso terapêutico , Humanos , Hidrocarbonetos Bromados , Recém-Nascido , Oxigênio/sangue , Polietilenoglicóis/uso terapêutico , Estudos Prospectivos , Distribuição Aleatória , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , OvinosRESUMO
OBJECTIVE: To assess the experience and efficacy of extracorporeal membrane oxygenation (ECMO) for cardiac rescue in patients with presumptively lethal cardiac dysfunction at the Children's Hospital of Pittsburgh. DESIGN: Retrospective analysis of patient records from a 9-yr period. SETTING: A 22-bed tertiary care pediatric intensive care unit (ICU) with an average of 1,400 admissions per year. An average of 150 open cardiotomy surgeries are performed per year, and all postoperative and severely ill cardiac patients are cared for in the ICU. PATIENTS: A total of 29 pediatric ICU patients with myocardial failure received ECMO throughout the 9-yr study period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Demographic information, underlying cardiac defect, intraoperative and postoperative data, postoperative course, details of ECMO treatment, and outcome were collected. Comparison of survivors with nonsurvivors was performed using the Mann-Whitney U test for continuous variables. Twenty-three (79%) of 29 patients recovered myocardial function while undergoing ECMO, 18 (62%) of 29 patients were successfully decannulated, and 13 (45%) of 29 patients survived to hospital discharge. Long-term survival rate was 11 (38%) of 29 patients. Three (60%) of five bridge-to-heart transplant patients survived. Eleven (65%) of 17 patients who suffered cardiac arrest before ECMO, survived to discharge and nine (53%) of these 17 patients remain long-term survivors. Survival rate in patients who required cardiac massage for > 15 mins before cannulation was six (55%) of 11 patients. CONCLUSIONS: Patients with severe myocardial dysfunction who fail conventional therapy can be successfully supported with ECMO during the period of myocardial recovery. ECMO can also provide a viable circulatory support system in patients with prolonged cardiac arrest who fail conventional resuscitation techniques. ECMO is also an effective means of support as a mechanical bridge to heart transplantation.
Assuntos
Baixo Débito Cardíaco/terapia , Oxigenação por Membrana Extracorpórea , Baixo Débito Cardíaco/etiologia , Baixo Débito Cardíaco/mortalidade , Procedimentos Cirúrgicos Cardíacos , Cardiotônicos/uso terapêutico , Criança , Pré-Escolar , Oxigenação por Membrana Extracorpórea/mortalidade , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Complicações Pós-Operatórias , Estudos RetrospectivosRESUMO
Although airway and alveolar pressures are not instantly equal during positive-pressure ventilation, proximal mean airway pressure (Paw) is the simplest available indirect gauge of mean alveolar pressure (Palv). To ascertain the relation of Paw to Palv and the limits of agreement between the two measures, real-time curves of proximal airway pressure (at the hub of the endotracheal tube) and alveolar pressure were generated by repeated airway occlusion at numerous PEEP levels in four groups of ventilated lambs or piglets: normal controls, oleic acid-injured and serotonin stimulated lambs, and preparations with mechanically induced air trapping. From these curves, Paw and Palv were determined. In all groups, Paw proved to be a precise estimator of Palv during volume-regulated, time-cycled, continuous positive-pressure breathing.
Assuntos
Resistência das Vias Respiratórias , Respiração com Pressão Positiva , Animais , Animais Recém-Nascidos , Pneumopatias/induzido quimicamente , Pneumopatias/fisiopatologia , Pneumopatias/terapia , Ácidos Oleicos , Ovinos , SuínosRESUMO
In a prospective, 45-month study, we compared the complication rates of percutaneously placed femoral and nonfemoral central venous catheters in critically ill pediatric patients. Forty-one percent of the 395 central venous catheters placed during this interval were femoral. Noninfectious complications were recognized for 2.5% of femoral catheters and 2.1% of nonfemoral catheters. Only three complications occurred with catheter insertion, all during nonfemoral attempts. Systemic infections that were possibly attributable to the central venous catheter were found in 3.7% of patients with femoral catheters and 7.3% of those with nonfemoral catheters. Femoral venous catheterization offers several practical advantages for central access over other sites. The low incidence of complications documented in this study suggests that the femoral vein is the preferred site in most critically ill children when central venous catheterization is indicated.
Assuntos
Cateterismo Venoso Central/métodos , Adolescente , Infecções Bacterianas/etiologia , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateteres de Demora/efeitos adversos , Criança , Pré-Escolar , Desenho de Equipamento , Feminino , Artéria Femoral , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Artéria PulmonarRESUMO
The conventional method of pleural drainage is tube thoracotomy, accomplished by chest wall dissection and blunt puncture. While this method is successful, it is relatively traumatic. We have designed a pigtail catheter which may be inserted into the pleural space by a modified Seldinger technique. This 8.5-Fr polyurethane catheter has six side ports inside its circular distal end. An airtight plastic bag is attached to the insertion needle to confirm pleural placement. Nineteen catheters were inserted in 16 neonates and small children with either pneumothorax or pneumomediastinum. No complications were noted. All but one pneumothorax was successfully evacuated; however, the pneumomediastinum reaccumulated. Insertion proved to be safe, simple, and atraumatic. This pigtail pleural drainage catheter provides an alternative to standard tube thoracotomy.
Assuntos
Drenagem/instrumentação , Enfisema Mediastínico/terapia , Pneumotórax/terapia , Cateterismo/instrumentação , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Pleura , Pneumotórax/diagnóstico por imagem , RadiografiaRESUMO
At the Children's Hospital of Pittsburgh the extracorporeal membrane oxygenation program was started in 1980. The results of our experience from 1980 to 1985 were previously reported. In the past 2 years 39 additional newborn infants have been treated with this modality, with an overall survival rate of 79% (31/39). This survival rate is much better than that obtained in 33 neonates who had been treated in the previous 5 years (54%; p less than 0.05). A new aspect of our extracorporeal membrane oxygenation program is the use of total apneic lung rest for persisting pulmonary interstitial emphysema during support with the oxygenator. Six neonates were treated with this technique because of worsening pulmonary interstitial emphysema during extracorporeal circulation. Five of them survived. Another indication for extracorporeal membrane oxygenation in our pediatric population has been left ventricular or biventricular failure after cardiopulmonary bypass. Four of our seven patients treated for this indication are long-term survivors. At present, because of the impossibility of using other forms of left ventricular assist devices in the pediatric population, it seems that extracorporeal membrane oxygenation is the most effective treatment for left ventricular failure after cardiopulmonary bypass. From our experience, even in the absence of long-term follow-up of patients supported with extracorporeal membrane oxygenation, it appears that the benefits of this therapeutic modality far exceed the risks in the high-risk population for which it is being used.