Critical care medicine
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Critical care medicine · Nov 1988
A new infant ventilator for normal and high-frequency ventilation: influence of tracheal tube on distal airway pressure during high-frequency ventilation.
A new infant ventilator for both normal and high-frequency ventilation is described. High pressure gas delivered via a jet in the breathing limb of a T-piece, in which there are no valves, drives respiratory fresh gas (RFG), supplied to the tracheal tube from any low pressure source, into the lungs. ⋯ In this open valveless breathing system, desynchronized spontaneous and artificial ventilation occurred quietly without any marked variation in the airway pressures. This preliminary study on a new pneumatic system shows its potential for simplifying and improving infant ventilation.
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Critical care medicine · Nov 1988
Multicenter Study Clinical TrialPediatric risk of mortality (PRISM) score.
The Pediatric Risk of Mortality (PRISM) score was developed from the Physiologic Stability Index (PSI) to reduce the number of physiologic variables required for pediatric ICU (PICU) mortality risk assessment and to obtain an objective weighting of the remaining variables. Univariate and multivariate statistical techniques were applied to admission day PSI data (1,415 patients, 116 deaths) from four PICUs. ⋯ In all groups, the number and distribution of survivors and nonsurvivors in adjacent mortality risk intervals were accurately predicted: total validation group (chi 2(5) = 0.80; p greater than .95), each PICU separately (chi 2(5) range 0.83 to 7.38; all p greater than .10), operative patients (chi 2(5) = 2.03; p greater than .75), nonoperative patients (chi 2(5) = 2.80, p greater than .50), cardiovascular disease patients (chi 2(5) = 4.72; p greater than .25), respiratory disease patients (chi 2(5) = 5.82; p greater than .25), and neurologic disease patients (chi 2(5) = 7.15; p greater than .10). ROC analysis also demonstrated excellent predictor performance (area index = 0.92 +/- 0.02).
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Critical care medicine · Nov 1988
Comparative StudyUse of transthoracic bioimpedance to determine cardiac output in pediatric patients.
The use of a transthoracic bioimpedance monitor to determine cardiac output was evaluated in critically ill children. The children ranged in age from 10 months to 8 yr and their height and weight ranged from the third to the 97th percentile. Each child had a thermodilution catheter in place to monitor cardiac output. ⋯ This method of determining L was superior to using either measured thoracic length or the manufacturer's guidelines to obtain L and resulted in an excellent correlation between COTD and COBI (r = .94; p less than .05; n = 59). In children less than 125 cm in height, measured thoracic length alone was inadequate to use for L but provided a good approximation of L when multiplied by 1.25. This study suggests that the use of transthoracic bioimpedance to determine cardiac output compares favorably with thermodilution techniques and it is noninvasive.