Assuntos
Fatores Relaxantes Dependentes do Endotélio/uso terapêutico , Hipertensão Pulmonar/tratamento farmacológico , Doenças do Prematuro/tratamento farmacológico , Óxido Nítrico/uso terapêutico , Administração por Inalação , Displasia Broncopulmonar/prevenção & controle , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To characterize the clinical course, therapies, and outcomes of children with fatal and near-fatal asthma admitted to pediatric intensive care units (PICUs). STUDY DESIGN: This was a retrospective chart abstraction across the 8 tertiary care PICUs of the Collaborative Pediatric Critical Care Research Network (CPCCRN). Inclusion criteria were children (aged 1-18 years) admitted between 2005 and 2009 (inclusive) for asthma who received ventilation (near-fatal) or died (fatal). Data collected included medications, ventilator strategies, concomitant therapies, demographic information, and risk variables. RESULTS: Of the 261 eligible children, 33 (13%) had no previous history of asthma, 218 (84%) survived with no known complications, and 32 (12%) had complications. Eleven (4%) died, 10 of whom had experienced cardiac arrest before admission. Patients intubated outside the PICU had a shorter duration of ventilation (median, 25 hours vs 84 hours; P < .001). African-Americans were disproportionately represented among the intubated children and had a shorter duration of intubation. Barotrauma occurred in 15 children (6%) before admission. Pharmacologic therapy was highly variable, with similar outcomes. CONCLUSION: Of the children ventilated in the CPCCRN PICUs, 96% survived to hospital discharge. Most of the children who died experienced cardiac arrest before admission. Intubation outside the PICU was correlated with shorter duration of ventilation. Complications of barotrauma and neuromyopathy were uncommon. Practice patterns varied widely among the CPCCRN sites.
Assuntos
Asma/mortalidade , Unidades de Terapia Intensiva Pediátrica , Adolescente , Anestesia por Inalação , Asma/fisiopatologia , Asma/terapia , Gasometria , Criança , Pré-Escolar , Cuidados Críticos , Oxigenação por Membrana Extracorpórea , Feminino , Hospitalização , Humanos , Lactente , Intubação Intratraqueal , Masculino , Readmissão do Paciente , Respiração com Pressão Positiva , Respiração Artificial , Fenômenos Fisiológicos Respiratórios , Estado Asmático/mortalidade , Estado Asmático/fisiopatologia , Estado Asmático/terapia , Taxa de SobrevidaRESUMO
OBJECTIVE: To evaluate the safety of intravenous (IV) sildenafil, an inhibitor of cyclic guanosine monophosphate-specific phosphodiesterase, in treating near-term and term newborns with persistent pulmonary hypertension of the newborn (PPHN). STUDY DESIGN: This was an open-label, dose-escalation trial in newborns with PPHN and an oxygenation index (OI) > 15. Sildenafil was delivered by continuous IV infusion for at least 48 hours and up to 7 days. RESULTS: Five centers enrolled a total of 36 neonates with PPHN at a mean of 34 +/- 17 hours of age; 29 of these neonates were already receiving inhaled nitric oxide (iNO). A significant improvement in OI (28.7 to 19.3; P = .0002) was observed after 4 hours of sildenafil infusion in the higher dose cohorts. Thirty-five neonates survived; 1 neonate required extracorporeal membrane oxygenation (ECMO) support. In 4 neonates, sildenafil was stopped due to adverse events. Seven neonates were enrolled before developing the need for iNO. In these neonates, OI improved significantly by 4 hours after initiation of sildenafil infusion (24.6 to 14.7; P = .009); 6 neonates completed treatment without the need for iNO or ECMO. CONCLUSIONS: IV sildenafil was well tolerated, and acute and sustained improvements in oxygenation were noted in those neonates who received the higher infusion doses.
Assuntos
Síndrome da Persistência do Padrão de Circulação Fetal/tratamento farmacológico , Inibidores de Fosfodiesterase/administração & dosagem , Piperazinas/administração & dosagem , Sulfonas/administração & dosagem , Estudos de Coortes , Relação Dose-Resposta a Droga , Feminino , Humanos , Lactente , Recém-Nascido , Infusões Intravenosas , Masculino , Síndrome da Persistência do Padrão de Circulação Fetal/metabolismo , Síndrome da Persistência do Padrão de Circulação Fetal/fisiopatologia , Inibidores de Fosfodiesterase/farmacocinética , Projetos Piloto , Piperazinas/farmacocinética , Troca Gasosa Pulmonar , Purinas/administração & dosagem , Purinas/farmacocinética , Citrato de Sildenafila , Sulfonas/farmacocinética , Resultado do TratamentoRESUMO
OBJECTIVE: To test the hypothesis that postoperative length of stay (LOS) after infant heart surgery might be an easily measured surrogate marker for various events that culminate in later adverse cognitive outcome. METHODS: Among 160 eligible patients with D-transposition of the great arteries undergoing reparative surgery in infancy, 155 (97%) were reevaluated at age 8 years with IQ and achievement testing. We explored whether LOS quartiles were associated with these outcomes when adjusting for perioperative and sociodemographic variables. RESULTS: Longer cardiac intensive care unit (CICU) LOS quartiles were associated at age 8 years with lower full-scale IQ (P=.02), lower verbal IQ (P=.02), and with tendencies toward lower performance IQ (P=.08) and math achievement (P=.08) in adjusted models. Compared with patients in the first quartile of CICU LOS, those in the fourth quartile had mean scores for full-scale IQ that were lower by 7.2 points (P=.01); verbal IQ, 7.3 points (P=.02); performance IQ, 5.8 points (P=.05); and math achievement, 6.0 points (P=.07). Analyses on hospital LOS quartile were similar. CONCLUSIONS: Longer postoperative LOS is associated with worse later cognitive function, even when adjusted for perioperative events, perfusion times, and sociodemographic variables. Further research is necessary to determine the mechanisms underlying this relation.