Journal of pediatric surgery
-
Pediatric major resuscitation--respiratory compromise as a criterion for mandatory surgeon presence.
The American College of Surgeons Committee on Trauma has indicated that there are minimum criteria for a trauma surgeon to respond to a major resuscitation (MR) within 15 minutes. These criteria have been required for children without significant data to support their validity. Our hypothesis is that prehospital intubation/respiratory compromise (IRC) as a criterion to define an MR will be an accurate predictor. ⋯ Injured children with prehospital IRC are significantly more likely to die, have a higher ISS, and a longer ICU length of stay. Prehospital respiratory distress in injured children in our trauma system is a reasonable criterion to define an MR in children.
-
As a first step toward the development of an artificial placenta, we investigated the relationship between blood flow rate through an arteriovenous (A-V) circuit/oxygenator and both CO2 elimination and hemodynamic stability in a small animal model. ⋯ In this rabbit model, A-V blood flows at 25% to 30% of cardiac output allow full gas exchange without hemodynamic compromise. This model raises the possibility of using A-V support and an artificial placenta in newborns with respiratory failure.
-
We reviewed a single institution experience with extracorporeal membrane oxygenation (ECMO) in the perioperative management of cardiac transplantation. ⋯ ECMO can bridge children to cardiac transplantation. Survival is significantly impaired in bridge-to-transplant candidates stratified by pre-ECMO cardiac arrest. ECMO can also help transition from cardiopulmonary bypass after transplantation and provide effective support during acute rejection.
-
Comparative Study
Can we predict the failure of thoracostomy tube drainage in the treatment of pediatric parapneumonic collections?
Tube thoracostomy is a standard method of treating pediatric parapneumonic collections. Despite recent work denoting thoracoscopy as a superior method of treatment, few studies have looked at factors predictive of tube thoracostomy failure. We reviewed parapneumonic collections initially treated with tube thoracostomy to identify such factors. ⋯ Our results suggest that primary treatment of parapneumonic collections with tube thoracostomy is likely to be unsuccessful in patients who are symptomatic for more than a week or who have a concomitant medical condition. A more aggressive primary surgical intervention is suggested for this group.
-
Since the introduction of the closed technique for repair of pectus excavatum, increasing numbers of patients are presenting for surgery. However, controversy exists regarding the effects of repair on long-term cardiopulmonary outcome. This report details the effects over time of closed repair of pectus excavatum on pulmonary function, cardiac function, exercise tolerance, and the patient's perception of appearance and subjective ability to exercise. ⋯ These results corroborate previous studies which suggested that after closed repair of pectus excavatum there is an immediate subjective improvement in the ability to exercise which is paralleled by an improvement in cardiac output. However, there is an early postoperative decline in pulmonary function which does improve over time; however, this does not reach normal values for similar weight. Further studies are needed to determine whether these results are maintained, or whether after bar removal there is a further improvement in pulmonary status. These results do support the use of the closed repair of pectus excavatum for maintaining and possibly improving cardiopulmonary function in this patient population.