Critical care medicine
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Critical care medicine · May 1986
Respiratory failure in patients with acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia.
Seven patients with acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii pneumonia were studied to define the pathophysiology of their respiratory failure. The patients had fever, cough, dyspnea, hypoxemia, and diffuse infiltrates on chest x-ray. Biopsies revealed a spectrum of alveolar filling, interstitial edema and infiltration, and fibrosis. ⋯ There was no correlation between the effect of PEEP on compliance and its effect on shunt. The data suggest that in patients with AIDS and P. carinii pneumonia, PEEP can decrease shunt by reducing the anatomic shunt, improving V/Q imbalance, and converting areas of anatomic shunt to areas of low V/Q. P. carinii pneumonia in patients with AIDS can produce a clinical and pathophysiologic pattern similar to that described in the adult respiratory distress syndrome.
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We retrospectively reviewed the results of 42 cardiopulmonary arrests occurring over 1 yr in the general ward of a pediatric hospital. These data were compared to those of a similar study done 10 yr previously in the same institution. Patients were divided into those having pure respiratory arrest and those who also had cardiac arrest. ⋯ During the more recent series, sepsis and upper airway problems produced fewer arrests. There was one neurologically damaged survivor in each study period. Our study confirms that the outcome of pediatric cardiac arrest is poor when arrest occurs in the hospital.
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Critical care medicine · May 1986
Outcome of children who are apneic and pulseless in the emergency room.
Mortality and neurologic morbidity were evaluated in children who were successfully resuscitated after being brought to an emergency room with continued apnea and pulselessness. Of 34 patients studied from June 1981 through August 1984, 27 died during the initial hospitalization and seven (21%) survived until hospital discharge. Of the seven surviving children who were discharged to a chronic care facility, five remain in a vegetative state. Possible explanations for this high mortality and neurologic morbidity are discussed.
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Critical care medicine · Apr 1986
Comparative StudyOutcome of pediatric patients with multiple organ system failure.
The association of multiple organ system failure (MOSF) with mortality was investigated in 831 consecutive admissions to a pediatric ICU. The incidence of MOSF (at least two organ system failures, OSF) was 27%. Of the 62 nonsurvivors, 60 (97%) had MOSF. ⋯ The mortality was 1% for one OSF, 11% for two OSF, 50% for three OSF, and 75% for four OSF. Comparison of these results with data from adult ICU patients indicates that the mortality and clinical course of MOSF in children is distinct from adults. MOSF is significantly associated with mortality in pediatric patients; however, it is not sufficiently discriminating to determine continuation or withdrawal of ICU support.