Cost of extracorporeal life support in pediatric patients with acute respiratory failure

OBJECTIVES: To determine the impact of extracorporeal life support (ECLS) on mortality in pediatric patients with acute hypoxemic respiratory failure (AHRF) at our institution; and to calculate the hospital charges associated with the use of ECLS. DESIGN: Retrospective review of medical records and hospital charges. SETTING: Pediatric intensive care unit (ICU) of a university-affiliated children's hospital. PATIENTS: Twenty patients admitted to the pediatric ICU between 1991 and 1995 for AHRF who received ECLS as a part of their hospital course. INTERVENTIONS: Predicted mortality was calculated using the Pediatric Respiratory Failure score and was compared with survival at the time of hospital discharge. Hospital charges were used as a proxy for resource utilization. Cost-per-life-year-saved calculations were performed based on a normal life expectancy for survivors. MEASUREMENTS AND MAIN RESULTS: Twenty patients were identified. The median age was 4.83 yrs. The median duration of ECLS was 9 days, with 19.5 days in the pediatric ICU and 23.5 days for the entire hospital length of stay. The observed mortality rate for these patients was 20%. Median predicted mortality rate based on the Pediatric Respiratory Failure score calculation was 83%. The hospital charges incurred by these patients was a median of $199,096. Based on a normal life expectancy for survivors, this results in a cost of $4,190/life-year. CONCLUSIONS: ECLS for the pediatric patient with AHRF is done at a considerable cost. However, ECLS affects survival favorably, and compares favorably when considering cost/life-year calculations. The data presented in this study may serve as a benchmark for comparison with newer therapies (i.e., liquid ventilation, nitric oxide). These data also provide a framework for cost-based analyses at other ECLS institutions.     

Treatment and prophylaxis of acute disorders of the cerebral blood circulation in patients with diabetes mellitus

Experiments were conducted on young female rats with the aid of morphological, morphometric and histochemical methods; a study was made of the adrenal glands, mammary and the thyroid glands under conditions of castration and administration of synestrol, progesterone, both sex hormones, hydrocortisone. Sex hormones proved to produce a fulminant growth of the glandular tree against the background of reduction of the functional activity of the thyroid gland and relatively high indices of the hormonal activity of the fasciculo-reticular zone of the adrenal glands. A harmonious development of the glandular tree of the mammary glands was noted only under the effect of a simultaneous administration of synesterol and progesteron. A shift in the hormonal balance in the direction of synestrol caused the appearance of pathological deviations in the mammary glands by the type of cystic mastopathy. Under conditions of castration hydrocortisone produced a moderate stimulating influence on the mammary glands only in case of a prolonged action.     

Cisapride in the prophylaxis of equine post operative ileus

Cisapride and domperidone were both effective in restoring electrical and mechanical activity, coordination between gastric and small intestinal activity cycles and the stomach to anus transit time in three ponies in which post operative ileus was induced experimentally. Cisapride (0.1 mg/kg bodyweight intramuscularly) for three to eight doses prevented idiopathic post operative ileus in 22 clinical cases requiring colic surgery. The only side effects after cisapride were increased bowel sounds and slight, transient sounds of discomfort. No adverse side effects were seen in 16 cases following anastomosis or enterotomy. Cisapride appears safe and effective in the prophylaxis of equine post operative ileus.     

The causes and prophylaxis of postoperative gastrointestinal hemorrhage in patients with acute gastroduodenal bleeding

The work discusses the neurochemical correlates of rat brain dopamin-synaptic activity after injection of 0.5 mg/kg rudotel (medazepam) as compared with intact animals. The parameters of functioning of D2-receptors in [3H]-dopamine binding, the content of catecholamines and their metabolites (high-performance liquid chromatography with electrochemical detection) were studied in the dopaminergic system in different brain areas (the striatum, frontal cortex, amygdala, hippocampus, hypothalamus, and accumbence).     

Antifungal prophylaxis with itraconazole in neutropenic patients with acute leukaemia

The efficacy of antifungal prophylaxis with itraconazole capsules and its serum concentrations were evaluated in patients intensively treated for acute leukaemia. A consecutive group of patients without systemic antifungal prophylaxis (January 1993 to August 1994, period 1) was compared with another consecutive group of patients (period 2) who received itraconazole capsules (September 1994 to April 1995 400 mg/day, from May 1995 onwards 600 mg/day). All patients admitted with acute leukaemia and standard or high-dose chemotherapy were included into the study. Clinical endpoint was mortality from proven fungal infection. Seventy-six patients and 148 courses of cytotoxic chemotherapy were analysed in the control group as well as 47 patients and 112 treatment courses in the intervention group. Antifungal prophylaxis led to a significant decrease of mortality from invasive fungal infections (8.8%-0.9%, P = 0.005). The median trough concentration of itraconazole of all measurements was 520 ng/ml (range 230-793) in patients who received 400 mg/day and 760 ng/ml (370-1200) in patients receiving a dosage of 600 mg/day (P = 0.002). These findings suggest that itraconazole is an effective drug for antifungal prophylaxis but also that a considerable number of patients do not reach the desired trough levels (>500 ng/ml) with itraconazole capsules.     

Use of extracorporeal life support for adult patients with respiratory failure and sepsis

Na+,K+-ATPase activity is abundant on the basolateral infoldings of the strial marginal cells and contributes to the maintenance of the characteristic electrolyte composition of the endolymph. However, the stria vascularis of the cochlea is known not to be innervated. In order to clarify its humoral regulation by serotonin, the K+-p-nitrophenylphosphatase activity of strial marginal cells was investigated with a cerium-based method in normal guinea pigs and in guinea pigs treated with reserpine, 5-hydroxytryptamine or reserpine plus 5-hydroxytryptamine. K+-p-nitrophenylphosphatase activity was almost completely depressed 3-20 days after reserpine administration. Ten days after reserpinization, followed by repeated 5-hydroxytryptamine treatment, the enzyme activity was detectable. These results suggest that 5-hydroxytryptamine increases the phosphatase activity. Thus, the function of the stria vascularis in producing cochlear endolymph may be regulated by 5-hydroxytryptamine.     

The role of pharmacy in the management of patients with temporomandibular disorders and orofacial pain

OBJECTIVE: To provide information regarding the current understanding of the etiology and treatment, both nonpharmacologic and pharmacologic, of orofacial pain conditions including temporomandibular disorders (TMDs). This review briefly discusses the etiology and pathophysiology underlying the development of TMDs, generally accepted nonpharmacologic methods of treatment, and the most common current pharmacologic management approaches. DATA SOURCES: Current medical literature and the authors' clinical experiences. DATA SYNTHESIS: TMDs encompass a number of diagnostic subgroups that involve the masticatory musculature, the temporomandibular joint(s), and associated structures. More than 10 million individuals in the United States are affected by TMDs. Most current pharmacologic management approaches in the treatment of orofacial pain conditions, including TMDs, involve the use of antidepressants, anticonvulsants, muscle relaxants, corticosteroids, and nonsteroidal anti-inflammatory drugs. CONCLUSION: Inclusion of pharmacists who are knowledgeable in the nonpharmacologic and pharmacologic treatment approaches on the TMD management team would improve therapeutic monitoring, follow-up, and outcomes in these patients.     

The evaluation by indirect immunofluorescence of the incidence of respiratory syncytial virus in acute respiratory disorders in infants]

Diversity based on ribosomal RNA gene-restriction endonuclease digest patterns was detected amongst forty-seven strains of Campylobacter made up of 38 strains of Campylobacter jejuni and 9 strains of Campylobacter coli. Restriction digests of chromosomal DNA prepared by treating with Hae III were probed with an oligonucleotide specific for Campylobacter 16S ribosomal RNA genes. Seventeen distinct hybridization patterns, each indicating the presence of 2-4 copies of the 16S rRNA gene are encoded in Campylobacter DNA. Differences in fragment patterns were observed not only between members of two species, but also between individual strains of the same species. Ribopattern fragments of 8.71, 7.56, 2.81 and 1.0 kb were characteristic of the majority of C. jejuni, whereas 7.59 and 4.68 kb fragments were commonly present in C. coli. In conclusion, Hae III ribotyping was even more discriminatory than the Penner serotyping of C. jejuni and C. coli, as strains of the same serotype were distinguished.     

A method for quantum hemotherapy during the performance of extracorporeal detoxication operations

Percent Consonants Correct (PCC) was computed for spontaneous connected speech samples and responses on a single-word articulation test from 29 preterm children in preschool. Maturity of speech motor control was also assessed. Moderate intercorrelations of all measures are mentioned with regard to clinical implications.     

Open-lung biopsy in patients with acute respiratory distress syndrome

Occupational exposures contribute to the morbidity and mortality of many diseases. However, occupational diseases continue to be underrecognized even though they are responsible for an estimated 860,000 illnesses and 60,300 deaths each year. Family physicians can play an important role in improving the recognition of occupational disease, preventing progressive illness and disability in their own patients, and contributing to the protection of other workers similarly exposed. This role can be maximized if physicians raise their level of suspicion for workplace disease, develop skills in taking occupational histories and establish routine access to occupational health resources.     

Mechanisms of acute respiratory insufficiency in patients with hyperglycemic coma

Basic parameters of pulmonary gas exchange, central and pulmonary hemodynamics, and colloid osmotic pressure were investigated in 31 patients in diabetic hyperglycemic coma over the course of intensive care. Pulmonary gas exchange disorders were observed in all patients in the presence of increased shunting of the blood in the lungs and disorders of transcapillary liquid exchange. On the other hand, we failed to obtain data indicative of an increase in the volume of extravascular water in the lungs. However, it does not rule out the possibility of iatrogenic disorders of gas exchange during noncontrolled rehydration.     

Oxygen transport during extracorporeal oxygenation for the treatment of adult respiratory distress syndrome

An inventory of hemodynamic and respiratory measurements was obtained in two patients with acute respiratory failure syndrome prior to and during venoarterial extracorporeal membrane oxygenation for study of oxygen transport. As the inspired oxygen concentration fraction was reduced from 1.0 to 0.5 and paO2 was increased from less than 50 to physiologic ranges during extracorporeal membrane oxygenation, tachycardia and pulmonary hypertension were reversed. Total oxygen transport was reduced rather than increased. Oxygen consumption and oxygen extraction were not altered during extracorporeal membrane oxygenation. However, a striking reduction was observed in cardiac output. After reversal of anoxemia, the total of the cardiac output of the patient and the extracorporeal membrane oxygenation flow were less than the cardiac output of the patient prior to extracorporeal membrane oxygenation. These observations provide evidence that the beneficial effects of extracorporeal membrane oxygenation stem, at least in part, from a reduction of the work load on the heart. Since high cardiac output failure is observed during progression of adult respiratory distress syndrome, mechanical support of circulation during extracorporeal membrane oxygenation may be of primary therapeutic benefit.     

Drug inhalation therapy. Therapy for patients with respiratory disorders

We detected a high number of patients suffering from respiratory ailments which require successive hospital stays due to acute setbacks in their chronic respiratory ailments. The majority of these patients receive outpatient clinic treatment based on use of an inhaler. Given the direct relationship between the correct use of an inhaler and its effectiveness, we designed our project with the goal to discover the adroitness these patients have with an inhaler. The results of our study showed that 67% of the patients tested did not correctly use their inhaler, there by annulling or diminished the effectiveness of its use.     

The role of detrusor hypoxia in the pathogenesis of urination disorders in patients with benign prostatic hyperplasia

The system is designed for the long-term monitoring of critical patients with acute abdominal abnormalities at the intensive care and resuscitation units. It ensures input and long-term storage of history, anthropometric, and clinical data and laboratory and instrumental findings. The system allows a physician to have both primary information on the patient and results from examinations of the patient's circulation, respiration, and acid-base balance. The patient's major homeostatic systems were studied by using the original algorithms developed by means of mathematical statistic methods and an expert approach. Conclusions are produced on the display screen and printer in textual and graphic forms. Presenting all qualitative information as linear trends and polar diagrams makes it possible to contract data for visual control. The system evaluates the patient's status through prediction of odds ratio of good and poor prognoses.     

The role of dermabrasion and chemical peels in the treatment of patients with xeroderma pigmentosum

We describe our experience with two patients with xeroderma pigmentosum who underwent periodic trichloroacetic acid chemical peels. One also received a full-face dermabrasion. The effect of chemical peeling was more transient than dermabrasion but was associated with less morbidity. Both chemical peeling and dermabrasion provided a prophylactic effect against the development of skin malignancies; the latter had a more pronounced effect.     

The role of self-statements as a mediator in treatment for youth with anxiety disorders.

The authors investigated features of self-statements as predictors of anxiety in children with and without anxiety disorder (AD) and as a mediator of treatment of ADs in children. Children (N = 145) between the ages of 9 and 13 years participated (71 AD youth, 84 controls). Self-statements were classified by valence and content. Results indicated that children's anxious, but not positive or depressed, self-statements significantly predicted anxiety in children with and without AD. For children with AD, changes in anxious self-statements mediated treatment gains, replicating a previously reported finding. A states of mind ratio mediated only 1 outcome measure, and positive and depressive cognitions served no mediating role. The impact of anxious self-talk on children's adjustment and implications for cognitive theory of anxiety in children are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)