Critical care medicine
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Critical care medicine · Jun 2000
Prospective study of airway management of children requiring endotracheal intubation before admission to a pediatric intensive care unit.
To prospectively identify complications related to airway management in children before pediatric intensive care unit (ICU) admission. ⋯ Emergency airway management in children can be fraught with problems. Most variances could be avoided by improved education regarding appropriate ET tube size, appropriate medication use, and improved training for evaluation of ET tube placement.
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To study the incidence and prognosis of thrombocytopenia in adult intensive care unit (ICU) patients. ⋯ Thrombocytopenia is common in ICUs and constitutes a simple and readily available risk marker for mortality, independent of and complementary to established severity of disease indices. Both a low nadir platelet count and a large fall of platelet count predict a poor vital outcome in adult ICU patients.
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To alert the physicians to the possibility of a late-onset inborn error of metabolism in an apparently previously healthy patient with acute clinical presentation. ⋯ The diagnosis of cblB methylmalonic aciduria was made in a postmortem patient who died with a misdiagnosis of insulin-dependent diabetes mellitus. Unclear biochemical findings and positive family history should strongly lead to suspicion of an inborn error of metabolism in an apparently previously healthy critically ill patient.
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Critical care medicine · Jun 2000
Albuterol delivery by metered-dose inhaler in a pediatric high-frequency oscillatory ventilation model.
To assess albuterol delivery by metered-dose inhaler (MDI) in a pediatric lung model ventilated by high-frequency oscillatory ventilation (HFOV). The percentage albuterol dose lost in the circuit's expiratory limb and the effects of operating frequency, inspiratory time, and use of a spacer were also determined. ⋯ These in vitro results suggest albuterol delivery by MDI in a pediatric model of HFOV is negligible, regardless of the operating frequency, inspiratory time, or use of a spacer or actuator.
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Critical care medicine · Jun 2000
Case ReportsPyroglutamic acidemia: a cause of high anion gap metabolic acidosis.
To report four cases of pyroglutamic acidemia in adults causing clinically significant acidosis. ⋯ Pyroglutamic acidemia (5-oxoprolinemia) is a rare cause of high anion gap metabolic acidosis that should be suspected in patients presenting with sepsis, hepatic, and/or renal dysfunction who are receiving drugs such as acetaminophen, flucloxacillin, and vigabatrin after the more common causes of a high anion gap acidosis have been excluded. Should pyroglutamic aciduria be present, known precipitants should be ceased, infection should be managed aggressively, and supportive management should be instituted.