Journal of pediatric surgery
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Case Reports
Treatment of acute pulmonary failure with extracorporeal support: 100% survival in a pediatric population.
Since February 1990, five children, aged 10 days to 6.5 years, were treated with extracorporeal lung support at our hospital for acute, unrelenting pulmonary failure. Two had viral pneumonia: one with respiratory syncytial virus (RSV) bronchiolitis, and one with herpes simplex virus pneumonia, encephalitis, and disseminated intravascular coagulation. One presented with a febrile illness followed by a pulmonary hemorrhage. ⋯ Average duration of support was 330 hours (range, 89 to 840). Following completion of extracorporeal support, all children were successfully weaned from the ventilator with an average time to extubation of 23.2 days (range, 2 to 58 days). One child died of congestive heart failure following palliative surgery for a complex noncyanotic congenital cardiac lesion 35 days after successfully weaning from extracorporeal support for an acute febrile illness and pulmonary hemorrhage.(ABSTRACT TRUNCATED AT 250 WORDS)
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Extracorporeal membrane oxygenation (ECMO) is effective for newborns with pulmonary failure unresponsive to conventional therapy. However, ECMO for the older child and adult has been controversial and not widely utilized. Over 4 years, 24 patients (aged 4 months to 16 years; 11 boys, 13 girls) underwent venoarterial ECMO (duration, 7 to 19 days) for respiratory failure. ⋯ All patients with sternotomy, and 8 of 15 with neck and/or groin cannulation, required 1 to 5 explorations for hemorrhage while on ECMO. All survivors had primarily pulmonary failure; patients with combinations of pulmonary, cardiac, and renal failure did not survive. ECMO can be life-saving in the child with isolated pulmonary failure, but its efficacy in patients with multiorgan failure is uncertain.
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Long-term ventricular cerebrospinal fluid shunting can prove difficult in the neonatal population, particularly in those neonates who have had previous abdominal and vascular procedures. This article presents a technique of providing vascular access for ventriculoatrial shunting via the azygos vein for patients with limited vascular access and in whom ventriculoperitoneal shunting is not feasible.
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Six children with a mean age of 10.6 years (range, 7 to 16 years) underwent thoracotomy for pulmonary and esophageal procedures. Postoperatively, continuous paravertebral block using an infusion of bupivacaine via an extrapleural catheter was used. ⋯ There were no pulmonary complications and no complications related to the continuous extrapleural infusion. We conclude that continuous paravertebral block is an effective and safe method for ++post-thoracotomy pain relief in children.
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Because of the special qualities of a PVC endotracheal tube (smooth, soft, pliable but still with a patent lumen), it serves very well for the intubation of the esophagus or the duodenum through an established gastrostomy. In this article the use of endotracheal tubes in different manipulations of the esophagus and gastroduodenum is described.