Exogenous Surfactant Treatment in Children with ARDS (Views : 1042 times)
Since the Food and Drug Administration (FDA) approved exogenous surfactant in the early 90s for the treatment of neonates with Hyaline Membrane Disease (HMD), many studies have focused on enlarging its indications for others types of lung injuries and for other age groups. Although in the past 20 years no studies have shown clear results about the efficacy of exogenous surfactant treatment in paediatric Acute Respiratory Distress Syndrome (ARDS), many of them were able to point out and better define very important aspects of this treatment like dosage, timing, ways of administration and usage of different types of surfactant (natural and synthetic). In this review we retrace the development of studies looking at the role of exogenous surfactant treatment in paediatric ARDS.
Key words: surfactant, ARDS, bronchoalveolar lavage.
Administration of protein C concentrates in patients without congenital deficit: a systematic review of the literature (Views : 1138 times)
Endogenous protein C levels are frequently decreased in septic patients, probably due to increased conversion to activated protein C. Protein C levels inversely correlate with morbidity and mortality of septic patients regardless of age, infecting microorganisms, presence of shock, disseminated intravascular coagulation, degree of hypercoagulation, or severity of illness. Taken together, these considerations suggest a strong correlation between protein C pathways and survival from severe sepsis/septic shock, and reinforce the rationale for the attempts to normalize plasma activity of protein C to improve survival, hamper coagulopathy, and modulate inflammation. We therefore conducted a systematic review of all manuscripts describing protein C concentrates administration in adult and pediatric populations. We identified 28 studies, for a total of 340 patients, 70 of whom died (20.6%). Septic patients were the most represented in this review of case reports and case series. In the majority of these patients sepsis was associated with meningitis, purpura fulminans or disseminated intravascular coagulation. No bleeding complications related to the study drug were reported and most studies underlined normalization of inflammatory markers and of coagulation abnormalities. We conclude that protein C concentrate is an attractive option in septic patients (especially those with meningitis, purpura fulminans, or disseminated intravascular coagulation) and that its cost-benefit ratio must be studied with a large multicenter randomized control trial, possibly including also high risk patients with septic shock and multiple organ failure.
Key words: protein C zymogen, bleeding, amputations, intensive care, critical care.
Leukocytes influence peripheral tissue oxygenation and perfusion in neonates (Views : 816 times)
Background. Leukocyte counts may influence peripheral (micro) circulation due to changes in rheology. The aim of this study was to investigate a possible association between leukocyte counts and peripheral tissue oxygenation/perfusion measured with near infrared spectroscopy (NIRS) in term and preterm neonates.
Methods. In this observational study we included term and preterm neonates within the first 2 months of life, in whom peripheral tissue NIRS measurements were performed and blood samples (leukocytes and C reactive protein (CRP)) taken to investigate clinical signs of infection. Tissue-oxygenation index (TOI), fractional oxygen extraction (FTEO), oxygen delivery (DO2), oxygen consumption (VO2) and vascular resistance (VR) were measured by NIRS and venous occlusion method. TOI, FTOE, DO2, VO2 and VR were correlated to leukocyte counts on the same day and maximal CRP levels within 24 hours (CRP max).
Results. In 180 infants, with a mean gestational age of 35.5±3.3 weeks, leukocyte counts were 16546± 8830/µl (median 14830; range 1790 to 67840) and CRP max was 8.0± 19.0 mg/l (median 0.0; range 0.0 to 110.0mg/l).
TOI was 71.1±5.5%, FTOE 28.5±6.1%, DO2 46.7±19.7, VO2 12.5±4.4 and VR 11.7±6.4.
Leukocyte counts correlated negatively (r= -0.21; p= 0.005) with TOI and positively (r=0.17; p=0.029) with VR. Correlations with CRP max did not reach significance.
Conclusion. We demonstrated that peripheral tissue oxygen consumption decreases and vascular resistance increases with increasing leukocyte counts.
Key words: near-infrared spectroscopy, neonate, microcirculation, leukocytes.
The effects of post-intubation hypertension in severe traumatic brain injury (Views : 937 times)
Introduction. The effect of post-intubation hypertension in severe traumatic brain injury (TBI) patients remains uncertain. We aimed to determine the relationship between post-intubation hypertension (mean arterial pressure (MAP) > 110mmHg) and outcomes in severe TBI.
Methods. In this retrospective cohort study, adults who presented with isolated TBI and a MAP ≥ 70mmHg were assessed. Data were retrieved from our institutional trauma registry and the admission list of our neurosurgical intensive care unit (ICU).
Results. We enrolled 126 patients, 81 of whom had a MAP ≤ 110 mmHg after intubation and were assigned to group 1; 45 patients who had a MAP > 110 mmHg were assigned to group 2. Only age (P = 0.008), heart rate (HR; P = 0.036), and MAP before intubation (P < 0.001) were significantly different between groups. We found no significant intergroup differences in mortality (35.8 vs. 35.6%, P = 1.000) or in the motor function of survivors at discharge (P = 0.333). The length of ventilator-dependent (median: 2.0 vs. 5.0 days; P = 0.003) and ICU stays (median: 4.5 vs. 10.0 days; P = 0.005) were significantly longer in group 2. Post-intubation hypertension remained significantly associated with longer ICU stay (≥ 7 days) and poor neurologic outcome (motor < 4 at discharge) after adjusting for other variables (post-intubation MAP >110 mmHg, P < 0.034, OR 3.119, 95% CI 1.087-8.953).
Conclusion. Post-intubation hypertension was associated with longer ventilator-dependent and ICU stays in patients with severe TBI.
Key words: endotracheal intubation, hemodynamics, blood pressure, mean arterial pressure, intracranial hemorrhage.
Cord blood interleukin-8 levels correlate with airway flow limitation at eight years of age in ex-very low birth weight infants (Views : 869 times)
Background. Exposure to prenatal inflammation increases the risk for development of bronchopulmonary dysplasia.
Aim. To evaluate the correlation between cord blood and gastric aspirate levels of interleukine-6 (IL-6) and interleukine-8 (IL-8) in preterm infants, and lung function at the age of 8 years.
Methods. Between 2000-2002 we recruited 129 infants of gestational age < 30 wks. The concentration of IL-6 and IL-8 were measured in gastric aspirate and cord blood. At the age of 8 years, 30 ex-preterm infants, with mean gestational age of 27 wks and mean birth weight of 955 g, returned for pulmonary function measurement. To exclude major bias, a comparison between the study group and non-responder group was done and showed no statistically significant difference with respect to perinatal characteristics, ventilation days, bronchopulmonary dysplasia and cytokine concentration.
Results. Pulmonary function test measurments in children born preterm were lower than in their term pairs. However, only the difference in forced mid-expiratory flow (FEF25-75%) was statisticaly significant. The concentration of IL-6 and IL-8 in cord blood and in gastric aspirate inversely correlated to all parameters of lung fuction at the age of 8 years, however only correlations between the concentration of IL-8 in cord blood and forced expired volume in one second/forced vital capacity (FEV1/FVC) (r = -0.38, p = 0.04) and FEF 25%-75% (r = -0.44, p = 0.02) were statistically significant.
Conclusion. These results show a negative correlation between the concentration of IL-8 in cord blood and FEF25%-75% and FEV1/FVC, which suggests the important role of IL-8 in early airway remodeling.
Key words: IL-8, lung function, preterm infant.