Journal of intensive care medicine
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Acute respiratory failure is a common complication of drug abuse. It is more likely to develop in the setting of chronic lung disease or debility in those with limited respiratory reserve. Drugs may acutely precipitate respiratory failure by compromising respiratory pump function and/or by causing pulmonary pathology. ⋯ Alcohol, cocaine, amphetamines, opiates, and benzodiazepines are the most commonly abused drugs that may induce events leading to acute respiratory failure. While decontamination and aggressive supportive measures are indicated, specific therapies to correct seizures, metabolic acidosis, pneumothorax, infections, bronchospasm, and agitation should be considered. Drug-related respiratory failure when due to CNS depression alone may portend well, but in patients with drug-related significant pulmonary pathology, a protracted course of illness may be anticipated.
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Arginine vasopressin is a peptide produced in the posterior pituitary whose primary physiologic role is fluid homeostasis. Recent investigations have demonstrated a therapeutic role for arginine vasopressin in adult cardiac arrest as well as adult and pediatric vasodilatory shock. We review the physiology of arginine vasopressin and examine the supporting data behind the developing clinical applications of this naturally produced peptide.
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J Intensive Care Med · Jul 2004
Comparative Study Clinical TrialPulse oximetry in children with congenital heart disease: effects of cardiopulmonary bypass and cyanosis.
The objective of this prospective, observational study with consecutive sampling was to assess the reliability, bias, and precision of Nellcor N-395 (N) and Masimo SET Radical (M) pulse oximeters in children with cyanotic congenital heart disease and children with congenital heart disease recovering from cardiopulmonary bypass-assisted surgery admitted to a cardiovascular operating suite and pediatric intensive care unit at a tertiary care community hospital. Forty-six children with congenital heart disease were studied in 1 of 2 groups: (1) those recovering from cardiopulmonary bypass with a serum lactic acid > 2 mmol/L, and (2) those with co-oximetry measured saturations (SaO(2)) < 90% and no evidence of shock. Measurements of SaO(2) of whole blood were compared to simultaneous pulse oximetry saturations (SpO(2)). ⋯ There was a significant difference in bias (ie, average SpO(2) - SaO(2)) and precision (+/- 1 SD) between oximeters (N, 1.1 +/- 3.3 vs M, -0.2 +/- 4.1; P < .001) in the postcardiopulmonary bypass group but no significant difference in bias and precision between oximeters in the cyanotic congenital heart disease group (N, 2.9 +/- 4.6 vs M, 2.8 +/- 6.2; P = .848). The Nellcor N-395 pulse oximeter failed more often immediately after cardiopulmonary bypass than did the Masimo SET Radical pulse oximeter. SpO2 measured with both oximeters overestimated SaO2 in the presence of persistent hypoxemia.
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J Intensive Care Med · May 2004
ReviewPediatric acute hypoxemic respiratory failure: management of oxygenation.
Acute hypoxemic respiratory failure (AHRF) is one of the hallmarks of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), which are caused by an inflammatory process initiated by any of a number of potential systemic and/or pulmonary insults that result in heterogeneous disruption of the capillary-pithelial interface. In these critically sick patients, optimizing the management of oxygenation is crucial. ⋯ Other strategies such as different levels of positive end expiratory pressure, altered inspiration to expiration time ratios, recruitment maneuvers, prone positioning, and extraneous gases or drugs may also affect clinical outcomes. This article reviews state-of-the-art strategies on the management of oxygenation in acute hypoxemic respiratory failure in children.
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J Intensive Care Med · May 2004
Case ReportsPreliminary experience with nesiritide in the pediatric population.
Nesiritide is a recombinant formulation of brain-type natriuretic factor. Preliminary experience in the adult population suggests that nesiritide may be an effective agent in the treatment of decompensated congestive heart failure. Given its physiologic effects, it may be an effective agent in the pediatric population; however, to date, there are no reports regarding its use in infants and children. ⋯ Although no direct measurement of cardiac output was feasible as none of the patients had a pulmonary artery catheter, other indicators of increased cardiac output were noted. These included improved peripheral perfusion with warming of the extremities and improvement of peripheral pulses in all of the patients, increased venous saturation in 2 of the patients, and maintenance of or increased urine output despite weaning or discontinuation of diuretics. In 3 of the patients, nesiritide was started as the primary agent to provide a decrease in systemic vascular resistance and augment cardiac output, while in the other 2 patients, nesiritide was used when other vasoactive agents failed to provide the desired effect or resulted in adverse effects.