Critical care medicine
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Critical care medicine · May 1986
Randomized Controlled Trial Comparative Study Clinical TrialEffectiveness of dextran 70 versus Ringer's acetate in traumatic shock and adult respiratory distress syndrome.
During a 3-yr period, 31 adult victims of severe traumatic shock were enrolled in a prospective randomized investigation of the relative effectiveness of dextran 70 vs. Ringer's acetate to treat shock and protect against trauma-induced adult respiratory distress syndrome (ARDS). Fourteen patients were given dextran 70 and Ringer's acetate to compensate for interstitial fluid loss, and whole blood as required; the remaining 17 patients received three to four times the total fluid volume of Ringer's acetate given in the former group, and whole blood as required. ⋯ It is concluded that in the severely traumatized patient, a fluid program based on dextran 70 is superior to Ringer's acetate alone. Furthermore, patients should continue on a fluid program containing dextran 70 to counteract unrecognized hypovolemia. Our results support the assumption that early aggressive shock treatment with dextran 70, followed by continued dextran administration in the post-trauma period might prevent complications such as ARDS.
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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.