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81.
Nikolaus Alexander Haas Christine Wegendt Rainer Schäffler Günther Kirchner Eva Welisch Katharina Kind Ute Blanz Deniz Kececioglu 《Clinical research in cardiology》2008,97(12):878-881
Intravenous (IV) amiodarone hydrochloride has proven to be a very effective antiarrhythmic treatment option for a variety
of ventricular and supraventricular arrhythmias in adults and paediatric patients. Amiodarone is known to have significant
side effects and these especially include profound hypotension in animals and adults, vasodilatation, negative inotropic effects,
and significant bradycardia especially when administered intravenously. Special caution is warranted in patients with decreased
contractility and end-stage heart failure. We present a case of accidental amiodarone overdose in a newborn treated for atrial
flutter resulting in cardiovascular collapse. The patient could be rescued by rapid initiation of VA-ECMO treatment. The patient
survived without neurological damage.
This case study was supported by hospital funding. 相似文献
82.
Platelet transfusions in the neonatal intensive care unit:factors predicting which patients will require multiple transfusions 总被引:7,自引:0,他引:7
Del Vecchio A Sola MC Theriaque DW Hutson AD Kao KJ Wright D Garcia MG Pollock BH Christensen RD 《Transfusion》2001,41(6):803-808
BACKGROUND: Previous studies suggest that recombinant thrombopoietin (rTPO) will increase platelet production in thrombocytopenic neonates. However, the target populations of neonates most likely to benefit should be defined. Studies suggest that rTPO will not elevate the platelet count until 5 days after the start of treatment. Therefore, the neonates who might benefit from rTPO are those who will require multiple platelet transfusions for more than 5 days. This study was designed to find means of prospectively identifying these patients. STUDY DESIGN AND METHODS: A historic cohort study of all patients in the neonatal intensive care unit (NICU) at the University of Florida who received platelet transfusions from January 1, 1997, through December 31, 1998, was conducted. RESULTS: Of the 1389 patients admitted to the NICU during the study period, 131 (9.4%) received platelet transfusions. Seventeen were treated with extracorporeal membrane oxygenation and were excluded from further analysis. Of the remaining 114 patients, 55 (48%) received one transfusion and 59 (52%) received more than one transfusion (21 had >4). None of the demographic factors examined predicted multiple platelet transfusions. However, two clinical conditions did; liver disease and renal insufficiency. Neonates who received one platelet transfusion had a relative risk of death 10.4 times that in neonates who received none (p = 0.0001). Neonates who received >4 platelet transfusions had a risk of death 29.9 times that in those who received no transfusions (p = 0.0001). CONCLUSION: NICU patients with liver disease or renal insufficiency who receive one platelet transfusion are likely to receive additional transfusions. Therefore, these patients constitute a possible study population for a Phase I/II rTPO trial. 相似文献
83.
Dr. K. Tsuno H. Terasaki T. Otsu T. Okamoto Y. Sakanashi T. Morioka 《Intensive care medicine》1993,19(2):70-72
We report the clinical application of a novel double lumen catheter for veno-venous extracorporeal lung assist (ECLA) and the use of a heparin-bonded hollow fiber membrane lung, in the treatment of newborn respiratory failure. The outer lumen of the double lumen catheter was 14 Fr and was used for blood drainage; while the inner 8 Fr catheter was used for blood return. The double lumen catheter was made of spiral wire reinforced polyurethane, with a wall thickness of 0.25 mm. The hollow fiber membrane was made of non-microporous polyolefin, and was not permeable to water or plasma. We used this system to treat a newborn patient with meconium aspiration syndrome. Heparin was infused continuously at a rate of 18–25 units/kg/h, equal to 1/3 of the usual amount when a non-heparin bonded ECLA system was used and maintaining the activated clotting time near 120 s. Bleeding from cutdown sites was negligible. Only the right internal jugular vein was sacrificed. The patient was successfully weaned from ECLA and appears normal one year following discharge. 相似文献
84.
Stephanie M. Cruz Patricio E. Lau Craig G. Rusin Candace C. Style Darrell L. Cass Caraciolo J. Fernandes Timothy C. Lee Christopher J. Rhee Sundeep Keswani Rodrigo Ruano Stephen E. Welty Oluyinka O. Olutoye 《Journal of pediatric surgery》2018,53(1):152-158
Background/purpose
The purpose of this study was to develop a computational algorithm that would predict the need for ECMO in neonates with congenital diaphragmatic hernia (CDH).Methods
CDH patients from August 2010 to 2016 were enrolled in a study to continuously measure cerebral tissue oxygen saturation (cStO2) of left and right cerebral hemispheres. NIRS devices utilized were FORE-SIGHT, CASMED and INVOS 5100, Somanetics. Using MATLAB©, a data randomization function was used to deidentify and blindly group patient's data files as follows: 12 for the computational model development phase (6 ECMO and 6 non-ECMO) and the remaining patients for the validation phase.Results
Of the 56 CDH patients enrolled, 22 (39%) required ECMO. During development of the algorithm, a difference between right and left hemispheric cerebral oxygenation via NIRS (ΔHCO) was noted in CDH patients that required ECMO. Using ROC analysis, a ΔHCO cutoff > 10% was predictive of needing ECMO (AUC: 0.92; sensitivity: 85%; and specificity: 100%). The algorithm predicted need for ECMO within the first 12 h of life and at least 6 h prior to the clinical decision for ECMO with 88% sensitivity and 100% specificity.Conclusion
This computational algorithm of cerebral NIRS predicts the need for ECMO in neonates with CDH.Level of evidence
II 相似文献85.
Klaus Distelmaier Dominik Wiedemann Christina Binder Thomas Haberl Daniel Zimpfer Gottfried Heinz Herbert Koinig Alessia Felli Barbara Steinlechner Alexander Niessner Günther Laufer Irene M. Lang Georg Goliasch 《The Journal of thoracic and cardiovascular surgery》2018,155(6):2471-2476
Objective
The overall therapeutic goal of venoarterial extracorporeal membrane oxygenation (ECMO) in patients with postcardiotomy shock is bridging to myocardial recovery. However, in patients with irreversible myocardial damage prolonged ECMO treatment would cause a delay or even withholding of further permanent potentially life-saving therapeutic options. We therefore assessed the prognostic effect of duration of ECMO support on survival in adult patients after cardiovascular surgery.Methods
We enrolled into our single-center registry a total of 354 patients who underwent venoarterial ECMO support after cardiovascular surgery at a university-affiliated tertiary care center.Results
Through a median follow-up period of 45 months (interquartile range, 20-81 months), 245 patients (69%) died. We observed an increase in mortality with increasing duration of ECMO support. The association between increased duration of ECMO support and mortality persisted in patients who survived ECMO support with a crude hazard ratio of 1.96 (95% confidence interval, 1.40-2.74; P < .001) for 2-year mortality compared with the third tertile and the second tertile of ECMO duration. This effect was even more pronounced after multivariate adjustment using a bootstrap-selected confounder model with an adjusted hazard ratio of 2.30 (95% confidence interval, 1.52-3.48; P < .001) for 2-year long-term mortality.Conclusions
Prolonged venoarterial ECMO support is associated with poor outcome in adult patients after cardiovascular surgery. Our data suggest reevaluation of therapeutic strategies after 7 days of ECMO support because mortality disproportionally increases afterward. 相似文献86.
Marcus D. Jarboe Samir K. Gadepalli Joseph T. Church Meghan A. Arnold Ronald B. Hirschl George B. Mychaliska 《Journal of pediatric surgery》2018,53(1):159-162
Purpose
The Avalon dual-lumen venovenous catheter has several advantages, but placement techniques and management have not been adequately addressed in the pediatric population. We assessed our institutional outcomes and complications using the Avalon catheter in children.Methods
We reviewed all pediatric patients who had Avalon catheters placed for respiratory failure at our institution, excluding congenital heart disease patients, from April 2009 to March 2016. All patients were managed using our standard ECMO protocol, and cannula position was followed by daily chest x-ray and intermittent echocardiography (ECHO). Data included demographics, diagnosis, PRISM3 predicted mortality, ECMO duration, complications, and survival. The primary outcome was the need for catheter repositioning.Results
Twenty-five patients were included, with mean age 8.3 ± 6.9 years and 15 ± 22 days of ECMO support. Overall survival was 68% (17/25). Fourteen patients (56%) underwent placement with fluoroscopy in addition to ultrasound and ECHO, primarily after 2013. Overall, thirteen patients (52%) had problems with cannula malposition. 9 of these (69%) required cannula repositioning. Three of 14 (21%) cannulas placed with fluoroscopy required repositioning, compared to 7/11 (64%) placed without fluoroscopy (p = 0.05).Conclusions
Complications are common with the Avalon catheter in children. Safe percutaneous access requires ultrasound guidance, and use of intraoperative fluoroscopy in addition to echocardiography decreases malposition rates.Level of evidence
IV (Prognosis study). 相似文献87.
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