Pediatr Crit Care Me
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Pediatr Crit Care Me · Nov 2011
Red blood cell-coupled tissue plasminogen activator prevents impairment of cerebral vasodilatory responses through inhibition of c-Jun-N-terminal kinase and potentiation of p38 mitogen-activated protein kinase after cerebral photothrombosis in the newborn pig.
Pediatric ischemic stroke is a poorly understood, yet clinically important, problem. The sole approved treatment for acute stroke is tissue-type plasminogen activator. However, tissue plasminogen activator vasoactivity aggravates hypoxia/ischemia-induced impairment of cerebrovasodilation in response to hypercapnia and hypotension in newborn pigs. Mitogen-activated protein kinase (a family of 3 kinases, extracellular signal-related kinase, p38, and c-Jun-N-terminal kinase) is upregulated after hypoxia/ischemia. Coupling of tissue plasminogen activator to red blood cells prevented hypoxia/ischemia-induced impairment of dilation and suppressed extracellular signal-related kinase mitogen-activated protein kinase activation. This study investigated the differential roles of mitogen-activated protein kinase isoforms in the effects of red blood cells-tissue plasminogen activator on cerebrovasodilation in a translationally relevant injury model, photothrombosis. ⋯ These data indicate that in addition to restoring perfusion, red blood cells-tissue plasminogen activator prevents impairment of cerebrovasodilation after photothrombotic injury through blockade of c-Jun-N-terminal kinase and potentiation of p38 mitogen-activated protein kinase. These data suggest tissue plasminogen activator coupling to red blood cells offers a novel approach to increase the benefit/risk ratio of thrombolytic therapy to treat central nervous system ischemic disorders.
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Pediatr Crit Care Me · Nov 2011
Lung aeration during ventilation after recruitment guided by tidal elimination of carbon dioxide and dynamic compliance was better than after end-tidal carbon dioxide targeted ventilation: a computed tomography study in surfactant-depleted piglets.
To test the hypothesis that tidal elimination of carbon dioxide and dynamic compliance guided lung recruitment and positive end-expiratory pressure titration in surfactant-depleted piglets result in improved aeration (repeated computed tomography scans) and reduced ventilation pressures compared to those of a control group with conventional end-tidal carbon dioxide targeted ventilation. ⋯ Aeration was significantly better after recruitment and positive end-expiratory pressure titration than in a control group managed by "conventional" end-tidal carbon dioxide targeted ventilation. An increase of the end-inspiratory pressure above the tidal elimination of carbon dioxide peak/plateau did not result in an increased amount of normally aerated lung. A recruitment maneuver resulted in a lower ventilatory amplitude for achieving a target tidal volume and better dynamic compliance at the end of the study period compared to those of the control group.
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Pediatr Crit Care Me · Nov 2011
Case ReportsProlonged venovenous extracorporeal membrane oxygenation in a child with leukemia and persistent bacteremia.
In patients who require extracorporeal membrane oxygenation for prolonged periods, it is uncertain whether nosocomial bacteremia that persists throughout an entire extracorporeal membrane oxygenation run can be associated with good outcomes. ⋯ Sustained bacteremia during an extracorporeal membrane oxygenation run should not be regarded as a reason to withdraw extracorporeal support, although efforts are clearly warranted to identify possible sources of sepsis and wean off extracorporeal membrane oxygenation at the earliest opportunity.
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Pediatr Crit Care Me · Nov 2011
Change in mean transit time, apparent diffusion coefficient, and cerebral blood volume during pediatric diabetic ketoacidosis treatment.
Cerebral edema is a devastating complication of pediatric diabetic ketoacidosis. We examined measures describing potential causes of whole brain and regional brain edema (mean transit time, apparent diffusion coefficient, and relative cerebral blood volume) during treatment of diabetic ketoacidosis in children. ⋯ In this study, whole brain mean transit time decreased and apparent diffusion coefficient increased, suggesting a vasogenic process between the two study periods during diabetic ketoacidosis treatment.
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Pediatr Crit Care Me · Nov 2011
Characterization of pediatric patients receiving prolonged mechanical ventilation.
To describe the characteristics and risk factors of pediatric patients who receive prolonged mechanical ventilation, defined as ventilatory support for >21 days. ⋯ Patients with prolonged mechanical ventilation have more complications and require more pediatric intensive care unit resources. Mortality in these patients duplicates that from those requiring shorter support.