RESUMO
We evaluated the relationship of global cerebral blood flow, cross-brain oxygen content difference, cerebral metabolic rate for oxygen, intracranial pressure, and cerebral perfusion pressure to functional neurologic outcome in 12 comatose children on 2 consecutive days after near-drowning. Five children survived with functional neurologic outcome; five died and two survived with severe neurologic damage. Children who survived with functional neurologic outcome had a significantly higher cross-brain oxygen content difference (7.89 +/- 2.62 vs 3.91 +/- 1.59 ml/dl; p = 0.028) at 24 hours and a higher cerebral metabolic rate for oxygen 48 hours after admission (3.19 +/- 2.86 vs 0.96 +/- 0.45 ml/100 gm per minute; p = 0.030) compared with those who died or survived in a damaged state. There were no significant differences in global cerebral blood flow, intracranial pressure, and cerebral perfusion pressure between groups at either 24 or 48 hours. Our preliminary data suggest that a higher cross-brain content difference value is an important early variable associated with functional neurologic recovery after near-drowning. However, a single cross-brain oxygen content difference value must be interpreted with caution because considerable variability may occur among patient groups.
Assuntos
Encéfalo/metabolismo , Circulação Cerebrovascular , Afogamento Iminente/fisiopatologia , Doenças do Sistema Nervoso/etiologia , Consumo de Oxigênio , Adolescente , Criança , Pré-Escolar , Coma/complicações , Coma/mortalidade , Coma/fisiopatologia , Coma/terapia , Humanos , Lactente , Pressão Intracraniana , Afogamento Iminente/complicações , Afogamento Iminente/mortalidade , Afogamento Iminente/terapia , Doenças do Sistema Nervoso/epidemiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
The tibial intraosseous (IO) site is useful for vascular access in paediatric resuscitation. However, alternate IO sites need to be considered for use in patients with lower extremity and abdominal trauma, and in those requiring multiple infusions. The infusion rates were determined at tibial, medial malleolar, distal femoral and humeral IO sites and at a peripheral intravenous (IV) site in 23 normovolemic and hypovolemic anaesthetised pigs (12 - 23 kg). IO cannulation was established with 18 gauge bone marrow needles and in peripheral vessels with ww gauge teflon catheters. Hypovolemia was established by acutely bleeding 2 mi/kg. Infusion rates were determined in random order under gravity and 300/mm Hg pressure. The infusion rates obtained (table given) were significantly different (MANOVA p = 0.0001) for gravity vs 300 mm Hg. Our study suggested 1) IV access is the most efficacious infusion method for volume resuscitation; 2) IO sites differ in the infusion rates obtained; 3) IO infusions provide reasonable alternatives for short-term vascular access (AU)