The Journal of pediatrics
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The Journal of pediatrics · Jul 1993
Adult respiratory distress syndrome in children: associated disease, clinical course, and predictors of death.
The adult respiratory distress syndrome is a common cause of respiratory failure; however, its incidence, risk factors, course, and mortality rate for children remain incompletely understood. A 24-month surveillance of pediatric intensive care admissions identified 60 children with adult respiratory distress syndrome constituting 2.7% of such admissions, 8% of total days spent in a pediatric intensive care unit, and 33% of deaths. The mortality rate was 62% (confidence interval, 48.2% to 73.9%). ⋯ An alveolar-arterial oxygen tension difference > 420 was the best early predictor of death (sensitivity 80%, specificity 87%, positive predictive value 87%, negative predictive value 80%, and odds ratio 26.7). We conclude that adult respiratory distress syndrome behaves clinically as a single disease regardless of the underlying cause; its course and outcome are dependent on the magnitude of alveolar injury. We speculate that strategies for minimizing secondary lung injury may benefit all patients with adult respiratory distress syndrome.
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The Journal of pediatrics · Jun 1993
Balloon atrial septostomy for left ventricular decompression in patients receiving extracorporeal membrane oxygenation for myocardial failure.
We describe the use of balloon atrial septostomy to decompress the left ventricle in four patients receiving extracorporeal membrane oxygenation for acute intractable myocardial failure. These patients were becoming clinically worse and had evidence of left ventricular and left atrial hypertension either by direct measurement or echocardiography. ⋯ Three of four patients improved after balloon atrial septostomy and survived. This procedure may be helpful in selected patients receiving extracorporeal membrane oxygenation for myocardial failure with evidence of increased left atrial pressure as a result of increased ventricular pressure.
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Local anesthetics are extremely useful for providing anesthesia and analgesia for infants and children of all ages. Despite the toxicity issues raised here, the overall safety record of local anesthetic use in pediatrics has been very good, and local anesthetic administration within safe guidelines should be encouraged. In the great majority of cases, toxic reactions have been associated with either inadvertent intravascular injection or unintentional overdosage by physicians who did not adequately consider issues related to systemic drug uptake, distribution, or clearance. Unlike opioids, which can be titrated according to clinical signs to a wide range of doses, local anesthetic administration must be strictly limited "by the numbers." Pediatricians, surgeons, emergency room physicians, and anesthesiologists need to be informed regarding limits for the administration of local anesthetics and management of toxic reactions.
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The Journal of pediatrics · May 1993
Case ReportsSelective and sustained pulmonary vasodilation with inhalational nitric oxide therapy in a child with idiopathic pulmonary hypertension.
Low doses of inhaled nitric oxide caused selective and sustained pulmonary vasodilation in an infant with pulmonary hypertension without causing systemic hypotension, despite the failure of treatment with other vasodilators.