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Zahraa JN Moler FW Annich GM Maxvold NJ Bartlett RH Custer JR 《Critical care medicine》2000,28(2):521-525
OBJECTIVES: To examine the Extracorporeal Life Support Organization (ELSO) registry database of infants and children with acute respiratory failure to compare outcome and complications of venovenous (VV) vs. venoarterial (VA) Extracorporeal Life Support (ECLS). DESIGN: Retrospective cohort study. SETTING: ELSO registry for pediatric pulmonary support. PATIENTS: All nonneonatal pediatric pulmonary support ECLS cases treated at U.S. centers and reported to the ELSO registry as of July 1997. Patients were excluded if they had one or more of the following diagnoses: hematologic-oncologic, cardiac, abdominal surgical, burn, metabolic, airway, or immunodeficiency disorder. INTERVENTIONS: Venoarterial or venovenous extracorporeal life support for severe pulmonary failure. MEASUREMENTS AND MAIN RESULTS: From 1986 to June of 1997, 763 pediatric patients met the inclusion criteria. Overall, 595 were initially managed with VA bypass, and 168 with VV bypass. The VA group was younger (mean +/- SD, 26.1+/-42.2 months for VA vs. 63.5+/-68.7 months for VV) and smaller (11.8+/-15.1 kg vs. 22.9+/-23.8 kg) (p<.001). There were no differences between groups in number of days on mechanical ventilation before ECLS, number of hours on ECLS, or number of hours on mechanical ventilation post-ECLS in survivors. Mean pH and Paco2 values, positive end-expiratory pressure, and mean airway pressure just before placing the patient on ECLS were also similar. VA-treated patients had higher Fio2 requirements (p = .034), lower Pao2 (p = .047), and lower Pao2/Fio2 ratio (p = .014) just before cannulation. There was a trend of higher peak inspiratory pressure in VA-treated patients (p = .053). Overall, survival rate was not different for the two groups (55.8% for VA vs. 60.1% for VV; p = .33). Central nervous system complications were not different between the two groups. Examination of the same variables was then conducted after dividing the patients into four subgroups. There were no significant differences in survival or complications during bypass between VV and VA modes of ECLS in any subgroup. Stepwise logistic regression modeling was performed to control for variables associated with the outcome survival for VV and VA-treated groups, and variables measured before bypass were identified as being associated with improved survival. There was a trend of improved survival in the VV-treated patients (p = .12). CONCLUSIONS: Overall survival of pediatric patients with acute respiratory failure supported by VA or VV ECLS was comparable. A randomized clinical trial may be useful in clarifying these observations. 相似文献
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Binkhathlan Ziyad Ali Raisuddin Qamar Wajhul Al-Lawati Hanan Lavasanifar Afsaneh 《Pharmaceutical research》2021,38(1):51-65
Pharmaceutical Research - We have previously reported on a polymeric micellar formulation of Cyclosporine A (CyA) based on poly(ethylene oxide)-block-poly(ε-caprolactone) (PEO5K-b-PCL13K)... 相似文献
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J Y Bobin T Al-Lawati L E Granero M Adham P Romestaing O Chapet S Issac J P Gerard 《European journal of surgical oncology》2003,29(8):676-681
AIMS: To report outcomes of adults with retroperitoneal sarcoma (RS) treated by surgery, external beam radiotherapy (EBRT) and intraoperative electron beam radiotherapy (IORT). METHODS: From July 1988 to February 2001; 24 patients with primary and recurrent RS were diagnosed and treated. The median dose and energy of IORT delivered was 15 Gy/9meV. EBRT dose varies between 45-50 Gy. RESULTS: There were five primary and 19 recurrent tumours. One primary and five recurrent tumours underwent R0 resection. There were 12 liposarcomas and 19 grade I tumours; 13 patients developed local recurrence and three developed distant metastases.Twenty-two patients received IORT associated with EBRT: 11 developed recurrences. Six patients developed Neurotoxicity (4 grade II and 2 grade III). Disease free survival and overall survival at 5 years was 28 and 56% respectively. CONCLUSIONS: EBRT with IORT treatment is a promising technique for local control. Lower recurrence rates are associated with radical (R0) surgical procedures. 相似文献
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Ahmed T. Alahmar Zahraa Ali Zahraa Muhsin Hadeel Qasim 《Middle East Fertility Society Journal》2018,23(4):346-349