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PT J
AU Unterborn, J N
   Hill, N S
TI Options for mechanical ventilation in neuromuscular diseases.
SO Clinics in chest medicine
VL 15
IS 4
BP 765
EP 81
PD 1994-Dec
PY 1994
AB A variety of mechanical devices may be used to provide assistance when
   ventilation and cough are severely impaired by progressive respiratory
   weakness caused by neuromuscular disease. Traditionally, positive
   pressure ventilation via a tracheostomy has been used, but if upper
   airway function is adequate, a variety of noninvasive devices also may
   be considered. Although positive pressure ventilation is the preferred
   noninvasive mode for assisting ventilation, other modes may be selected
   depending on patient needs, preferences, and physical characteristics.
TC 11
ZB 7
Z8 0
ZS 0
Z9 11
SN 0272-5231
UT MEDLINE:7867290
PM 7867290
ER

PT J
AU Wang, T G
   Lin, K H
   Lien, I N
TI [General introduction to the clinical application of non-invasive
   respiratory aids].
SO Journal of the Formosan Medical Association = Taiwan yi zhi
VL 93 Suppl 3
BP S131
EP 41
PD 1994-Dec
PY 1994
AB Intermittent positive pressure ventilation via tracheostomy has been the
   most common method of providing ventilatory support for patients with
   respiratory failure since the late 1950s. It is the standard procedure
   for individuals who suffer from acute respiratory failure, impaired
   consciousness, and severe restrictive lung disease. However, numerous
   adverse complications from these invasive techniques have been reported
   in those who are long-term ventilator users. This paper describes the
   evolution and current application of non-invasive respiratory aids in
   both acute and long-term settings. The respiratory function can be aided
   by applying forces to the body or intermittent pressure to the air ways.
   The devices are negative pressure body ventilators which act on the body
   by creating negative pressure around the thorax and abdomen such devices
   effectively maintain the ventilation of individuals with respiratory
   failure, but have the shortcomings of bulkiness, high expense, and
   limitation on the users' activities. The non-invasive positive pressure
   ventilator applies intermittent pressure directly to the airway by a
   non-invasive interface; namely mouthpiece, nasal, or face masks. In this
   way, it can prevent patients from requiring either tracheostomy or
   endotracheal tube, but is not effective enough to ventilate patients
   with markedly decreased lung compliance because the high airway
   resistance provides air leakage from the non-invasive interface.
   Non-invasive respiratory aids should be the first choice to maintain
   ventilation for patients with respiratory failure secondary to
   neuromuscular disorder, because of their benefits of easy application,
   satisfactory results, fewer complications and early active
   rehabilitation. Increased understanding of non-invasive respiratory aids
   should assist in the management of patients with chronic respiratory
   failure.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0929-6646
UT MEDLINE:7606171
PM 7606171
ER

PT J
AU Fitting, J W
TI Respiratory muscles during ventilatory support.
SO The European respiratory journal
VL 7
IS 12
BP 2223
EP 5
DI 10.1183/09031936.94.07122223
PD 1994-Dec
PY 1994
AB Knowledge of the fate and behaviour of the respiratory muscles during
   ventilatory support is important for the guidance of clinical care. Full
   support facilitates muscle metabolic repletion, but exposes them to the
   risk of disuse atrophy. The effect of partial support varies according
   to the selected mode: assisted mechanical ventilation (AMV) and
   synchronized intermittent mechanical ventilation (SIMV) result in much
   less respiratory muscle rest than generally anticipated. On the other
   hand, inspiratory pressure support (IPS) is able to rest the respiratory
   muscles and to prevent fatiguing contractions. Opposite interventions
   have been proposed in case of difficult weaning: either to unload the
   respiratory muscles by using partial support, or to overload them
   according to a training programme. The optimal strategy is not known and
   may combine both approaches.
TC 6
ZB 2
Z8 0
ZS 0
Z9 6
SN 0903-1936
UT MEDLINE:7713207
PM 7713207
ER

PT J
AU Taly, A B
   Gupta, S K
   Vasanth, A
   Suresh, T G
   Rao, U
   Nagaraja, D
   Swamy, H S
   Rao, S
   Subbakrishna, D K
TI Critically ill Guillain Barre' syndrome.
SO The Journal of the Association of Physicians of India
VL 42
IS 11
BP 871
EP 4
PD 1994-Nov
PY 1994
AB Among the 153 patients fulfilling NINDS criteria for Guillain Barre'
   Syndrome (GBS) seen over 5.5 yrs, there were 47 (M:F 38.9) critically
   ill patients (age range 4 to 60 years). Antecedent event was recorded in
   25 patients and the peak deficit was attained over a mean period of 9.5
   days. Besides severe motor paralysis other salient features were: bulbar
   paralysis--42, sensory symptoms or signs--21, dysautonomia 31 and
   requirement for ventilatory assistance 45. CSF protein was raised in 63%
   cases. All the 17 patients who underwent electromyography had
   abnormalities of nerve conduction paramentes. Mean stay on the
   ventilator was 29.6 days and was not influenced by corticosteroid.
   Complications were frequent: pulmonary and urinary tract infection,
   dysautonomia, electrolyte disturbances, haemetmesis, bleeding from
   tracheostomy site and hepatic and renal failure. Mortality in steroids
   treated group (13/27) and the conservatively managed group (5/20) did
   not differ significantly. No discriminant factor emerged between
   survivors and non-survivors. Age and sex of the patients, presence of
   antecedent event, onset to peak interval and CSF protein level did not
   predict the need for ventilatory assistance, although these patients at
   admission had more frequent weakness of facial, bulbar, trunk, neck and
   proximal muscles of upper limbs and autonomic disturbances. Course of
   GBS remains unpredictable at the onset of the disease, warrants close
   supervision and meticulous supportive care and remains a therapeutic
   challenge.
TC 8
ZB 1
Z8 0
ZS 0
Z9 8
SN 0004-5772
UT MEDLINE:7868487
PM 7868487
ER

PT J
AU Leatherman, J
TI Life-threatening asthma.
SO Clinics in chest medicine
VL 15
IS 3
BP 453
EP 79
PD 1994-Sep
PY 1994
AB This article focuses on various issues related to acute,
   life-threatening episodes of asthma. The areas discussed include
   epidemiology, clinical assessment, pharmacologic treatment with
   bronchodilators and anti-inflammatory agents, endotracheal intubation,
   mechanical ventilation, adjunctive and nonconventional therapy used in
   the management of the mechanically ventilated asthmatic, and the
   prognosis of patients who require mechanical ventilation, including both
   short-term morbidity and long-term outlook.
TC 29
ZB 17
Z8 0
ZS 1
Z9 30
SN 0272-5231
UT MEDLINE:7982342
PM 7982342
ER

PT J
AU Stachniak, J
   Layon, A J
TI Closed head injury and the treatment of sequelae after a motor vehicle
   accident.
SO Journal of clinical anesthesia
VL 6
IS 5
BP 437
EP 49
DI 10.1016/S0952-8180(05)80020-0
PD 1994 Sep-Oct
PY 1994
AB Approximately 2 million closed head injuries (CHIs) occur yearly in the
   United States. Twenty-five percent of these injuries require
   hospitalization, and 70,000 to 90,000 of those hospitalized suffer
   long-term disability. This case conference details one such case of CHI
   in which the patient ultimately died. Close attention is given to the
   pathophysiology and treatment of this process. Commonly accepted, as
   well as investigational, modalities of therapy are discussed.
TC 4
ZB 4
Z8 0
ZS 0
Z9 4
SN 0952-8180
UT MEDLINE:7986520
PM 7986520
ER

PT J
AU Zeitouni, A G
   Manoukian, J
TI Severe complications of the anterior cricoid split operation and
   single-stage laryngotracheoplasty.
SO The Annals of otology, rhinology, and laryngology
VL 103
IS 9
BP 723
EP 5
PD 1994-Sep
PY 1994
AB The management of congenital and acquired subglottic stenosis has been
   considerably facilitated with the introduction of the anterior cricoid
   split operation and, more recently, the single-stage
   laryngotracheoplasty. These procedures are followed by a 1- to 2-week
   period of sedation, during which the patient is paralyzed and completely
   dependent on mechanical ventilation. Although these procedures have
   proven very successful at achieving decannulation, the postoperative
   period can be the source of significant complications. This is
   illustrated with 4 cases of severe postoperative complications. The
   possible pathophysiologic causes are discussed, and the literature
   concerning the postoperative complications of these procedures is
   reviewed. The avoidance of neuromuscular blockade must be weighed
   against the possible increased need for narcotics and increased risk of
   self-extubation. An intensive care unit setting proficient in the care
   of these patients is necessary for a successful outcome.
TC 14
ZB 5
Z8 0
ZS 0
Z9 14
SN 0003-4894
UT MEDLINE:8085734
PM 8085734
ER

PT J
AU Brown, B R
TI Understanding mechanical ventilation: patient monitoring, complications,
   and weaning.
SO The Journal of the Oklahoma State Medical Association
VL 87
IS 9
BP 411
EP 8
PD 1994-Sep
PY 1994
AB Mechanical ventilation can provide life saving support to critically ill
   patients with respiratory failure. The implementation of appropriate
   monitoring techniques and an awareness of potential complications can
   increase the safety of mechanical ventilation. Several efficacious
   weaning methods can be utilized and none is clearly superior to the
   others. The improper use of any weaning technique can result in
   respiratory muscle fatigue delaying extubation. Determining patient
   suitability for extubation is an inexact science. The physical
   examination during a spontaneous breathing trial and the use of the
   rapid shallow breathing index can assist the clinician in the difficult
   decision as to the timing of extubation.
TC 0
ZB 0
Z8 0
ZS 2
Z9 2
SN 0030-1876
UT MEDLINE:7996315
PM 7996315
ER

PT J
AU Op de Coul, A A
   Verheul, G A
TI Critical illness polyneuromyopathy.
SO Clinical neurology and neurosurgery
VL 96
IS 3
BP 261
EP 3
PD 1994-Aug
PY 1994
TC 2
ZB 2
Z8 0
ZS 0
Z9 2
SN 0303-8467
UT MEDLINE:7988098
PM 7988098
ER

PT J
AU Giostra, E
   Magistris, M R
   Pizzolato, G
   Cox, J
   Chevrolet, J C
TI Neuromuscular disorder in intensive care unit patients treated with
   pancuronium bromide. Occurrence in a cluster group of seven patients and
   two sporadic cases, with electrophysiologic and histologic examination.
SO Chest
VL 106
IS 1
BP 210
EP 20
DI 10.1378/chest.106.1.210
PD 1994-Jul
PY 1994
AB During six consecutive months, seven patients admitted to our ICU (15
   beds, general ICU, approximately 300 intubated patients per year) for
   acute respiratory failure requiring intubation and mechanical
   ventilation presented with a peculiar neuromuscular disorder. After the
   occurrence of this cluster group of patients, we detected two more
   similar but isolated cases in the following 18 months, ie, altogether 9
   patients in 2 years of observation, or 1.55 percent of all intubated
   patients in our ICU. Sedation was achieved using midazolam, curarization
   was effected with the neuromuscular non-depolarizing agent pancuronium
   bromide (PB), and corticosteroids were administered to eight patients.
   Shortly after discontinuation of sedation and curarization, we observed
   a persistent tetraparetic syndrome and/or peroneal palsy with a
   concomitant increase of serum creatine kinase (CK). None of the patients
   was septic or had the multisystem organ failure. A strong association
   between CK increase and PB administration was found, whereas no patient
   suffered severe liver or kidney failure. The duration of the neurologic
   deficit ranged from 4 to 52 weeks, with only partial recovery for some
   patients; the duration of dysfunction was apparently related to the
   total dose of corticosteroids received. Two patients had difficulty
   being weaned from the respirator and required tracheostomy.
   Electrophysiologic studies showed signs of axonal neuropathy and
   myopathic changes, ie, motor units of brief duration, small amplitude,
   overly abundant for the voluntary effort being exerted. Muscle biopsies
   showed significant myopathic alterations, with foci of muscle necrosis
   in most patients and minimal lymphocytic inflammation in one patient.
   The neurologic complication described differs from the polyneuropathy in
   critically ill patients. Furthermore, PB or corticosteroids or both
   appear to be the causal agents. The duration of the neuromuscular
   dysfunction may be related to concomitant steroid therapy. The CK enzyme
   seems to be a marker of the disorder. This disorder is associated with
   myopathic alterations and axonal degeneration in some patients.
   Pancuronium bromide should be used with caution, particularly when
   associated with steroids therapy, and it may cause difficulty in weaning
   patients from the respirator.
TC 53
ZB 22
Z8 2
ZS 1
Z9 55
SN 0012-3692
UT MEDLINE:8020274
PM 8020274
ER

PT J
AU DeMaio-Feldman, D
TI Somatosensory processing abilities of very low-birth weight infants at
   school age.
SO The American journal of occupational therapy : official publication of
   the American Occupational Therapy Association
VL 48
IS 7
BP 639
EP 45
PD 1994-Jul
PY 1994
AB OBJECTIVE: The purpose of this study was to examine the relationship
   between somatosensory processing abilities of children at school age and
   their earlier experiences in the intensive care nursery as very
   low-birth weight (VLBW) infants.
   METHOD: The subjects were 35 VLBW children at school age (20 girls, 15
   boys) who were free of congenital deformity and developmentally
   appropriate for gestational age. The subjects were part of an ongoing
   longitudinal study. Birth weight, number of days supported by mechanical
   ventilation, and number of days in the neonatal intensive care unit were
   examined in relation to somatosensory functions. Somatosensory functions
   measured were manual form perception, kinesthesia, finger
   identification, graphesthesia, and localization of tactile stimuli.
   RESULTS: VLBW children were significantly different on all measures of
   somatosensory processing when compared with the standardization group.
   CONCLUSION: Further research on the VLBW infant's somatosensory
   functioning will add to the existing body of knowledge concerning
   development and guide practice. The finding that the infants in this
   study, who did not have therapy intervention, later presented diminished
   somatosensory functioning supports the need to develop measures of
   somatosensory development for use in assessments and treatment during
   all developmental phases.
TC 4
ZB 3
Z8 0
ZS 0
Z9 4
SN 0272-9490
UT MEDLINE:7524327
PM 7524327
ER

PT J
AU Pilmer, S L
TI Prolonged mechanical ventilation in children.
SO Pediatric clinics of North America
VL 41
IS 3
BP 473
EP 512
PD 1994-Jun
PY 1994
AB Improvements in neonatal and pediatric intensive care have produced a
   growing population of children dependent on mechanical ventilation for
   survival. Long-term mechanical ventilation has become a realistic
   alternative to death from progressive respiratory failure for many
   children with chronic respiratory illness. This article reviews the
   pathophysiology, etiology, and management of chronic respiratory failure
   in childhood.
TC 20
ZB 5
Z8 0
ZS 2
Z9 22
SN 0031-3955
UT MEDLINE:7515174
PM 7515174
ER

PT J
AU Chad, D A
   Lacomis, D
TI Critically ill patients with newly acquired weakness: the
   clinicopathological spectrum.
SO Annals of neurology
VL 35
IS 3
BP 257
EP 9
DI 10.1002/ana.410350303
PD 1994-Mar
PY 1994
TC 31
ZB 15
Z8 0
ZS 0
Z9 31
SN 0364-5134
UT MEDLINE:8122877
PM 8122877
ER

PT J
AU Vender, J S
TI Sedation, analgesia, and neuromuscular blockade in critical care: an
   overview.
SO New horizons (Baltimore, Md.)
VL 2
IS 1
BP 2
EP 7
PD 1994-Feb
PY 1994
AB The practice of critical care medicine has progressed dramatically over
   the past several decades. With the advent of new pharmacological
   therapies and technological interventions, our ability to manage a
   multitude of pathophysiologic conditions has grown. As a consequence of
   these advances, we have recognized the potential to reduce the morbidity
   and mortality associated with many disease states that were previously
   irreversible. Associated with new therapeutic and diagnostic
   interventions are secondary side effects and complications. It is often
   the undesired sequela of all interventions that forces clinicians to
   periodically reevaluate to whom, why, how, and when we employ new drugs
   or procedures.
TC 6
ZB 3
Z8 0
ZS 0
Z9 6
SN 1063-7389
UT MEDLINE:7922427
PM 7922427
ER

PT J
AU Gronert, B J
   Brandom, B W
TI Neuromuscular blocking drugs in infants and children.
SO Pediatric clinics of North America
VL 41
IS 1
BP 73
EP 91
PD 1994-Feb
PY 1994
AB Neuromuscular blocking drugs are valuable adjuncts to the practice of
   pediatrics. Monitoring of drug effects is technically more difficult in
   the younger patient. Nevertheless, careful observation of drug effects
   will improve the usefulness of NMB and safeguard the patient from
   prolonged weakness. Although there are differences in neuromuscular
   function with age in the pediatric age range, the differences between
   the NMB currently available are greater than the differences between the
   patients. Thus, the only uniform finding across age and all drugs is
   that onset of drug effect is more rapid in the infant than in the child
   when circulatory function is normal. In general, children require more
   of all NMB on a mg/kg basis than do infants or adults to obtain the same
   effect. Children recover from NMB more rapidly than do patients of other
   ages. Infants, however, may recover more rapidly than do any other
   patients from the effects of drugs such as mivacurium which are
   metabolized in the plasma. Tables 4 and 5 summarize doses, onset of
   action, and duration of NMB. Please note in Table 4 that succinylcholine
   is only used for endotracheal intubation, whereas the other
   nondepolarizing muscle relaxants can be used for endotracheal intubation
   or to maintain some degree of muscle paralysis in the child whose
   trachea is already intubated. Nondepolarizing muscle relaxants (e.g.,
   mivacurium, ORG 9426, atracurium, vecuronium) are used both for initial
   bolus for endotracheal intubation and maintenance of muscle relaxation.
   Long-acting drugs (e.g., pancuronium, pipecuronium, and doxacurium),
   however, are used more commonly in small incremental doses to maintain
   muscle paralysis in patients already intubated. The advantages of these
   long-acting drugs are minimal cardiovascular side effects (i.e.,
   tachycardia or hypotension from histamine release) and longer dosing
   interval. In all children, the dosing interval should be adjusted to the
   needs of the individual. In children with renal insufficiency or in
   those receiving drugs which impair neuromuscular function (e.g.,
   aminoglycosides), the interval at which supplemental doses are required
   is longer than normal.
TC 11
ZB 7
Z8 0
ZS 0
Z9 11
SN 0031-3955
UT MEDLINE:8295808
PM 8295808
ER

PT J
AU Matsubara, S
   Okada, T
   Yoshida, M
TI Mitochondrial changes in acute myopathy after treatment of respiratory
   failure with mechanical ventilation (acute relaxant-steroid myopathy).
SO Acta neuropathologica
VL 88
IS 5
BP 475
EP 8
PD 1994
PY 1994
AB A case of acute myopathy was observed in the course of treatment of
   respiratory failure with mechanical ventilation combined with prolonged
   neuromuscular blockade and administration of corticosteroids. A muscle
   biopsy revealed degeneration of muscle fibres. Electron microscopy
   showed loss of thick filaments as well as nemaline rods, vacuoles and
   cytoplasmic bodies. The mitochondria were increased in number, many
   harbouring paracrystalline inclusions, which were hitherto unknown in
   this condition.
TC 9
ZB 6
Z8 1
ZS 0
Z9 11
SN 0001-6322
UT MEDLINE:7847078
PM 7847078
ER

PT J
AU Wheeler, W B
   Maguire, E L
   Kurachek, S C
   Lobas, J G
   Fugate, J H
   McNamara, J J
TI Chronic respiratory failure of infancy and childhood: clinical outcomes
   based on underlying etiology.
SO Pediatric pulmonology
VL 17
IS 1
BP 1
EP 5
DI 10.1002/ppul.1950170102
PD 1994-Jan
PY 1994
AB To assess whether underlying diagnosis affects morbidity and mortality
   outcomes in patients with chronic respiratory failure, we studied 55
   patients with chronic respiratory failure of infancy and childhood
   (CRFIC). Entry criteria included patients with chronic respiratory
   failure due to static neurologic or neuromuscular conditions or
   secondary to other disease processes considered likely to improve or
   resolve over time. Subjects were grouped into those having chronic lung
   disease (CLD, n = 22), neurologic or neuromuscular diseases (NM, n =
   21), or congenital abnormalities affecting the respiratory system (CA, n
   = 12). The average duration of follow-up was 21.3 months. There were no
   differences between groups in mortality with only four deaths (7%).
   Patients with CLD fared better than those with NM or CA in duration of
   ventilatory support, duration of tracheostomy, percentage of successful
   weaning from mechanical ventilation, and neurodevelopmental outcomes.
   Subjects with CLD had a significantly greater frequency of
   tracheomalacia (86%), feeding disorders (86%), and hypogammaglobulinemia
   G (77%). There were no differences between groups for respiratory
   readmissions or family dysfunction. We conclude that almost all patients
   with CRFIC will survive, but morbidity outcomes will vary based on the
   underlying diagnosis.
TC 19
ZB 6
Z8 0
ZS 0
Z9 19
SN 8755-6863
UT MEDLINE:7509054
PM 7509054
ER

PT J
AU Flume, P A
   Egan, T M
   Westerman, J H
   Paradowski, L J
   Yankaskas, J R
   Detterbeck, F C
   Mill, M R
TI Lung transplantation for mechanically ventilated patients.
SO The Journal of heart and lung transplantation : the official publication
   of the International Society for Heart Transplantation
VL 13
IS 1 Pt 1
BP 15
EP 21; discussion 22-3
PD 1994 Jan-Feb
PY 1994
AB As lung transplantation has become more successful, the selection
   criteria have broadened; however, some relative contraindications to
   lung transplantation are controversial. Some programs consider
   mechanical ventilation to be a major contraindication to lung
   transplantation because airway colonization with bacteria may lead to
   nosocomial infection and respiratory muscle deconditioning may
   necessitate prolonged postoperative ventilatory support. We report our
   experience of seven double lung transplant procedures on six patients
   requiring mechanical ventilation. Five patients with cystic fibrosis
   required preoperative mechanical ventilation for 7 to 19 days (mean,
   10.7 days). One patient with acute lung injury required 115 days of
   preoperative mechanical ventilatory support. Only the latter patient
   required prolonged (27 days) postoperative mechanical ventilation
   because of respiratory muscle weakness; the others were extubated in 1
   to 19 days (mean, 7.8 days). No early complications related to bacterial
   infection were seen. Two patients required temporary hemodialysis for
   transient kidney failure. Three patients had postoperative neurologic
   residua; one patient had a transient hemiparesis, and seizures developed
   in two patients. One patient died 3 months after transplantation from
   severe central nervous system complications with no evidence of
   pulmonary problems; and two patients died 17 months after
   transplantation, one of them receiving a second double lung transplant
   for obliterative bronchiolitis. Except for the patient who required
   prolonged preoperative ventilatory support, mechanical ventilation did
   not appear to play a role in the outcome of these patients. The
   posttransplantation hospital stay and hospital charges for patients
   requiring pretransplantation ventilatory support were not significantly
   different from those for other lung transplant recipients.(ABSTRACT
   TRUNCATED AT 250 WORDS)
TC 55
ZB 32
Z8 0
ZS 0
Z9 55
SN 1053-2498
UT MEDLINE:7513185
PM 7513185
ER

PT J
AU Buonocore, G
   Balestri, P
   Toti, P
   Bagnoli, F
TI A new case of severe congenital nemaline myopathy.
SO Acta paediatrica (Oslo, Norway : 1992)
VL 82
IS 12
BP 1082
EP 4
DI 10.1111/j.1651-2227.1993.tb12819.x
PD 1993-Dec
PY 1993
AB The case of a neonate with a rapidly fatal course of nemaline myopathy
   is reported. Neonatal history and clinical findings suggested a
   postasphyxia syndrome, but dependence on mechanical ventilation in the
   absence of severe brain damage or evidence of heart and lung involvement
   prompted us to perform a muscle biopsy. The typical rod-shaped bodies of
   nemaline myopathy were observed in skeletal and heart muscle which is
   unusual in infantile forms. Neonatal bone fractures, which have not been
   reported previously, were detected. Due to the rapid evolution of the
   neonatal form, many of these patients may die undiagnosed in the
   perinatal period, the families remaining unaware of the existence of the
   genetic disorder. Therefore, if severe hypotonia persists in a neonate,
   together with dependence on assisted breathing, specific examinations,
   such as muscle enzyme determination, NCV, EMG and if indicated, muscle
   biopsy should be performed to rule out neuromuscular disease.
RI Toti, Paolo/E-6358-2012
TC 5
ZB 3
Z8 0
ZS 0
Z9 5
SN 0803-5253
UT MEDLINE:8155933
PM 8155933
ER

PT J
AU Haslam, N
   Beck, A T
TI Categorization of major depression in an outpatient sample.
SO The Journal of nervous and mental disease
VL 181
IS 12
BP 725
EP 31
DI 10.1097/00005053-199312000-00003
PD 1993-Dec
PY 1993
AB Intake Beck Depression Inventory (BDI) item scores of 400 outpatient
   major depressives were submitted to a categorization algorithm developed
   for artificial intelligence applications. The algorithm maximizes a
   function of "category utility" that is preferable in several respects to
   available clustering methods, and has demonstrated its capacity to
   locate the most informative, or "basic," level of categorization. The
   analysis yielded four syndromal subtypes: a common, general depressive
   type; a common and relatively severe melancholic type; an infrequent
   type characterized by self-critical features, generalized anxiety, and
   an absence of melancholic features; and an infrequent, mild type
   distinguished by enervation and anhedonic features. Implications for the
   classification of depression are discussed.
RI Haslam, Nick/D-9026-2011
OI Haslam, Nick/0000-0002-1913-2340
TC 15
ZB 6
Z8 0
ZS 0
Z9 15
SN 0022-3018
UT MEDLINE:8254323
PM 8254323
ER

PT J
AU Tidwell, J
TI Pulmonary management of the ALS patient.
SO The Journal of neuroscience nursing : journal of the American
   Association of Neuroscience Nurses
VL 25
IS 6
BP 337
EP 42
PD 1993-Dec
PY 1993
AB Amyotrophic lateral sclerosis (ALS) is a chronic progressive motor
   neuron disease with a poor prognosis which eventually weakens and
   paralyzes the respiratory muscles. ALS is characterized by progressive
   degeneration of both cortical and alpha motor neurons of the final
   common pathway. Early symptoms usually begin with alpha motor neuron
   involvement and then progress to include cortical motor neuron
   involvement. Degeneration of respiratory nerve centers in the anterior
   horn at the C3-C5 levels results in respiratory muscle fatigue,
   respiratory failure and eventually death. Treatment consists of
   preventing respiratory complications and supporting lung function for as
   long as possible. One case example of a critically ill patient with ALS
   highlights nursing concerns. With advanced directives and durable power
   of attorney, the patient now has better means available for making known
   the decision of whether to accept or reject mechanical ventilation.
TC 3
ZB 1
Z8 0
ZS 0
Z9 3
SN 0888-0395
UT MEDLINE:8106826
PM 8106826
ER

PT J
AU Shaw, N J
   Cooke, R W
   Gill, A B
   Shaw, N J
   Saeed, M
TI Randomised trial of routine versus selective paralysis during
   ventilation for neonatal respiratory distress syndrome.
SO Archives of disease in childhood
VL 69
IS 5 Spec No
BP 479
EP 82
PD 1993-Nov
PY 1993
AB The strategy of non-selective neuromuscular paralysis was compared with
   that of synchronised (fast rate) ventilation and selective paralysis in
   infants receiving mechanical ventilation for respiratory distress
   syndrome with chronic lung disease as the primary outcome measure. One
   hundred and ninety three infants weighing under 2000 g were randomly
   allocated to receive either pancuronium during mechanical ventilation in
   the acute phase of respiratory distress syndrome (non-selective group)
   or synchronised ventilation (initial ventilatory rate at or above that
   of the infant's) (selective group). Infants in the selective group
   received pancuronium if they were consistently expiring during the
   inspiratory phase of the ventilator cycle. There was no significant
   difference between the groups with respect to birth weight, gestation,
   and sex distribution. There was no significant difference between the
   group with respect to death (selective 19%, non-selective 16%),
   pneumothorax (selective 14%, non-selective 14%), chronic lung disease
   (selective 49%), non-selective 47%), and oxygen dependency at 36 weeks'
   postmenstrual age (selective 32%, non-selective 39%). Routine paralysis
   of ventilated infants has potential complications that may be avoided by
   using synchronised ventilation. As the latter is not associated with an
   increased incidence of long term respiratory complications, it is
   concluded that it is the optimum strategy of the two for ventilating
   infants with respiratory distress syndrome.
TC 12
ZB 6
Z8 1
ZS 0
Z9 13
UT MEDLINE:8285749
PM 8285749
ER

PT J
AU Downes, J J
   Pilmer, S L
TI Chronic respiratory failure--controversies in management.
SO Critical care medicine
VL 21
IS 9 Suppl
BP S363
EP 4
DI 10.1097/00003246-199309001-00039
PD 1993-Sep
PY 1993
TC 3
ZB 1
Z8 0
ZS 0
Z9 3
SN 0090-3493
UT MEDLINE:7689944
PM 7689944
ER

PT J
AU Diaz, C E
   Deoras, K S
   Allen, J L
TI Chest wall motion before and during mechanical ventilation in children
   with neuromuscular disease.
SO Pediatric pulmonology
VL 16
IS 2
BP 89
EP 95
DI 10.1002/ppul.1950160203
PD 1993-Aug
PY 1993
AB Patients with neuromuscular disease can display paradoxic motion of the
   rib cage (RC) and abdomen (AB), which increases the work of breathing
   and predisposes to respiratory muscle fatigue. Long-term mechanical
   ventilation can reverse chronic hypercapnea and decrease the work of
   breathing in these patients. Changes in chest wall motion (CWM) that
   occur during mechanical ventilation have not been studied. We have
   assessed CWM using a calibrated respiratory inductive plethysmograph
   before and during mechanical ventilation in 5 children and young adults
   with neuromuscular disease and paradoxic breathing at rest. Asynchrony
   of CWM was quantitated by measuring the phase shift, theta, between RC
   and AB motion (0 degree = synchronous motion, 180 degrees = paradoxic
   motion). The volume contribution of the paradoxing compartment to tidal
   volume (PC/VT) was calculated. Before mechanical ventilation, mean +/-
   SEM VT was 122 +/- 17 mL, theta was 131 +/- 15 degrees C, and PC/VT was
   -27 +/- 6%. During mechanical ventilation, VT increased to 274 +/- 47 mL
   (P < 0.05), theta decreased to 41 +/- 14 degrees (P < 0.05), and PC/VT
   increased to +39 +/- 9% (P < 0.02). We conclude that mechanical
   ventilation improves RC/AB asynchrony and reverses the negative
   contribution to tidal volume of the paradoxing compartment in children
   and young adults with neuromuscular disease. This implies that
   mechanical ventilation assumes most or all the role of the respiratory
   pump in these patients, which provides a rationale for the use of
   chronic or nighttime ventilation in the treatment of respiratory muscle
   fatigue. Assessment of CWM may be useful in the determination of optimal
   ventilator settings in this population.
TC 13
ZB 3
Z8 0
ZS 0
Z9 13
SN 8755-6863
UT MEDLINE:8367222
PM 8367222
ER

PT J
AU Ramsay, D A
   Zochodne, D W
   Robertson, D M
   Nag, S
   Ludwin, S K
TI A syndrome of acute severe muscle necrosis in intensive care unit
   patients.
SO Journal of neuropathology and experimental neurology
VL 52
IS 4
BP 387
EP 98
DI 10.1097/00005072-199307000-00006
PD 1993-Jul
PY 1993
AB Four septic patients and one asthmatic patient are described who
   developed a severe paralytic disorder in an intensive care unit (ICU),
   associated with a rise in serum creatine kinase and a severe necrotizing
   myopathy. All cases had received non-depolarizing muscle blocking agents
   and large intravenous doses of glucocorticoids. Three patients developed
   myoglobinuria. No improvement or very little improvement in muscle
   function was noted in the four fatal cases. The single survivor
   recovered his strength after 6 months. This syndrome ("necrotizing
   myopathy of intensive care") provides one of the differential diagnoses
   for ICU-acquired weakness. The myopathy appears to have several
   interdependent causes and it is proposed that these should be classified
   as myonecrosis "priming" factors (glucocorticoids, myotropic infections,
   sepsis) and "triggering" factors (non-depolarizing muscle blocking
   agents).
TC 81
ZB 39
Z8 0
ZS 0
Z9 82
SN 0022-3069
UT MEDLINE:8355028
PM 8355028
ER

PT J
AU Chiang, L L
   Chen, S J
   Tsai, Y H
   Shieh, W B
TI [Long-term mechanical ventilation survey].
SO Changgeng yi xue za zhi / Changgeng ji nian yi yuan = Chang Gung medical
   journal / Chang Gung Memorial Hospital
VL 16
IS 2
BP 99
EP 104
PD 1993-Jun
PY 1993
AB Although home mechanical ventilation is common in western countries, it
   is still extremely rare in Taiwan. The objectives of this study are (1)
   to review retrospectively the types of disorders and outcomes of these
   patients requiring prolonged mechanical ventilation (MV), and (2) to
   survey the home status of twelve patients on home mechanical
   ventilation. From January 1990 to April 1992, one hundred fifteen
   patients receiving prolonged MV ( > or = 30 days & > or = 8-10 hrs/day)
   were studied in the medical intensive care unit at Chang Gung Memorial
   Hospital. Eighty-two patients (71.3%) for whom long-term MV were thought
   to be beneficial were divided into three groups by disorder: (1)primary
   pulmonary disorder (N = 55, 67.07%) (2) neuromuscular disorder (N = 18,
   21.95%), (3) brain stem disorder (N = 9, 10.98%). The outcomes of these
   eighty-two patients were as follows: expired, 37 (45.12%), completely
   weaned, 21 (25.61%), unweanable 24, including 12 (14.63%) hospitalized
   and 12 (14.63%) discharged home. The three outcomes of prolonged MV were
   significantly associated with the three types of disorder (P = 0.0035).
   Among these three disorders, duration of MV were longest in the
   neuromuscular group, whatever the outcome. There was significant
   difference in the duration of MV for the different outcomes of group I &
   group III. The mean duration at home for the twelve home MV patients (5
   male and 7 female, mean age +/- SD = 46.08 +/- 20.83 years old) was 9.93
   +/- 8.11 month, with the longest being 21.5 months. Four expired within
   two months of discharge to home, two patients had to be readmitted once
   (one C2-C5 spinal cord injury patient for pneumonia, and the other for
   brain stem deterioration). When comparing hospital stay, four patients
   improved in the maximal free time (the mean improvement, 5.75 +/- 3.11
   hours/day), seven remained unchanged, while one regressed.(ABSTRACT
   TRUNCATED AT 250 WORDS)
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
UT MEDLINE:8339161
PM 8339161
ER

PT J
AU Perera, W S
TI Changing trends in maternity care in Sri Lanka.
SO The Ceylon medical journal
VL 38
IS 2
BP 64
EP 71
PD 1993-Jun
PY 1993
AB Sri Lanka's health policy calls for health services to be accessible to
   all people, which requires appropriate training of physicians, nurses,
   and paramedicals.  Increasing the training and cadre of public health
   midwives allows Sri Lanka to make free domiciliary and field health
   services available to all parts of the country.  Sri Lanka must adopt
   realistic measures to improve guidance and supervision of midwives to
   derive maximum benefits.  Sri Lanka first instituted primary health care
   (PHC) in 1926 (Health Unit at Kalutara).  PHC provides 3 stages of
   maternal and child health care through home and/or clinic visits:
   prenatal care, trained assistance during delivery, and postpartum care.
   In most parts of Sri Lanka, 1 family health worker is available for
   every 3000 people.  Yet, maternal mortality is rather high.  A UNICEF
   study shows that family health workers register only about 50% of
   pregnant women.  A lack of personnel to provide maternal health services
   is a main reason for high maternal mortality.  Many medical officers
   (1979, 52%) have not done an internship in gynecology and obstetrics.
   Many (1979, 38%) are assigned to peripheral facilities where they
   practice obstetrics without any help from experienced physicians.  They
   are reluctant to do simple obstetric measures, e.g., removal of a
   retained placenta.  This reluctance keeps some physicians from admitting
   mothers in labor, so they transfer them to upper-level hospitals.  The
   Postgraduate Institute of Medicine needs to implement courses in
   obstetrics and gynecology so the district hospitals can have competent
   obstetricians on staff.  The leading causes of maternal death are, in
   order of frequency, hemorrhage, abortion complications, eclampsia,
   sepsis, and obstructed labor.  Anemia  and retained placenta are the
   reasons for hemorrhage.  Insufficient access to life-saving treatment in
   emergencies is the single most critical weakness in the maternal health
   care system, indicating a need to establish intensive care units.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0009-0875
UT MEDLINE:8370090
PM 8370090
ER

PT J
AU Bayer, R
   Dubler, N N
   Landesman, S
TI The dual epidemics of tuberculosis and AIDS: ethical and policy issues
   in screening and treatment.
SO American journal of public health
VL 83
IS 5
BP 649
EP 54
DI 10.2105/AJPH.83.5.649
PD 1993-May
PY 1993
AB As the recent increase in cases of tuberculosis is addressed, there is a
   danger that the need for increased protection of the public health will
   create a climate in which the rights of individuals with tuberculosis
   and human immunodeficiency virus (HIV) infection may be disregarded.
   This paper considers ethical and policy issues in the control of
   tuberculosis. The authors conclude that mandatory HIV testing is not
   critical to effective tuberculosis control, and that although
   individuals infected with HIV are at increased risk for developing
   tuberculosis, exclusionary employment practices are not justified.
   Because failure to complete the course of tuberculosis treatment
   increases the prospect that drug-resistant strains will develop, it is
   crucial to require all those who commence treatment to complete their
   therapy. To ensure the completion of treatment, special attention must
   be paid to the needs of the homeless, drug users, and those with
   psychiatric impairments. In addition, all tuberculosis patients should
   begin their posthospital care under direct observation. Patients who
   fail to complete treatment despite efforts to encourage and facilitate
   their cooperation should be subject to confinement after a hearing with
   full due process protections.
TC 34
ZB 11
Z8 0
ZS 0
Z9 34
SN 0090-0036
UT MEDLINE:8484443
PM 8484443
ER

PT J
AU Gorson, K C
   Ropper, A H
TI Acute respiratory failure neuropathy: a variant of critical illness
   polyneuropathy.
SO Critical care medicine
VL 21
IS 2
BP 267
EP 71
DI 10.1097/00003246-199302000-00020
PD 1993-Feb
PY 1993
AB OBJECTIVE: To describe a severe axonal polyneuropathy that follows acute
   respiratory failure and, in turn, causes continued ventilator dependence
   and paralysis after resolution of the primary illness.
   DESIGN: Retrospective chart review of three patients and prospective
   analysis of two patients.
   SETTING: Respiratory and neurologic ICUs of a general hospital.
   PATIENTS: Five critically ill patients after an episode of acute
   respiratory failure. Neuromuscular blocking drugs were used in four
   patients, intermittently in two patients, high doses of corticosteroids
   were briefly administered in four, four patients had multiple organ
   failure, three patients had sepsis, but weakness preceded these
   complications in two patients.
   INTERVENTIONS: None.
   MAIN RESULTS: All patients had moderate-to-severe limb weakness with
   reduced or absent reflexes. Sensation was relatively preserved and the
   spinal fluid protein concentrations were normal. Electrophysiologic
   studies showed a severe, acute axonal motor neuropathy in four patients
   and normal studies in the fifth that later demonstrated denervation.
   Sensory potentials were mildly or not affected. Two quadriparetic
   patients died at 2.5 months, one remained weak and ventilator dependent
   several months after onset, and two patients recovered to walk in 4 to 6
   months.
   CONCLUSIONS: Severe axonal motor neuropathy after acute respiratory
   failure probably represents a variant of "critical illness
   polyneuropathy" that can be recognized from the temporal course of a
   conversion from primarily pulmonary to a pattern of neuromuscular
   ventilatory failure.
TC 61
ZB 29
Z8 0
ZS 0
Z9 61
SN 0090-3493
UT MEDLINE:8428480
PM 8428480
ER

PT J
AU Christman, J W
   McCain, R W
TI A sensible approach to the nutritional support of mechanically
   ventilated critically ill patients.
SO Intensive care medicine
VL 19
IS 3
BP 129
EP 36
DI 10.1007/BF01720527
PD 1993
PY 1993
AB OBJECTIVES: The goal of this review is to educate physicians in the
   details of nutritional support of mechanically ventilated critically ill
   patients.
   DESIGN: The subtopics of this review include: introduction, goals of
   nutritional treatment, assessment of nutritional status, estimation of
   nutritional requirements, estimation of protein requirements,
   recommended approach to the initial nutritional regimen, route of
   nutrition, and monitoring the response to nutrition.
   SETTING: The information is primarily germane to the medical management
   of patients with acute respiratory failure superimposed on chronic lung
   disease and malnutrition.
   CONCLUSION: Malnutrition is prevalent in mechanically ventilated
   critically ill patients. Undernutrition is associated with respiratory
   muscle weakness and may contribute to ventilator dependency.
   Overnutrition may increase CO2 production and increase ventilatory
   demands. This review advocates a titrated approach to nutritional
   management based on protein balance. Careful monitoring is necessary to
   ensure a regimen which maintains or improves body protein composition.
   Preliminary data exists which indicates that careful nutritional support
   may improve clinical outcome but more information is needed to recommend
   a universal approach.
TC 28
ZB 8
Z8 2
ZS 1
Z9 31
SN 0342-4642
UT MEDLINE:8315119
PM 8315119
ER

PT J
AU Limthongkul, S
   Wongthim, S
   Udompanich, V
   Charoenlap, P
   Nuchprayoon, C J
TI Mechanical and non-mechanical ventilation of respiratory failure in
   chronic obstructive pulmonary disease.
SO Journal of the Medical Association of Thailand = Chotmaihet thangphaet
VL 76
IS 1
BP 1
EP 8
PD 1993-Jan
PY 1993
AB Among 182 episodes with ARF (PaCO2 > 50 torr) in 400 episodes of COPD
   patients who were admitted to Chulalongkorn Hospital during the period
   1982 to 1986, despite conservative treatment, 66 developed severe acute
   respiratory failure requiring assisted ventilation. Patients with a
   history of chronic cough, pneumonia as a precipitating factor and more
   severe ARF on admission, as indicated by palpitation, headache,
   cyanosis, alteration of consciousness, cor-pulmonale and decompensated
   acidosis (pH < 7.30), were likely to require mechanical ventilation.
   Indications for mechanical ventilation were carbon dioxide narcosis (43
   episodes), severe hypoxemia despite on a high FIO2 (one episode),
   various combination parameters of respiratory muscle fatigue,
   cardiovascular instability (22 episodes). The major complications of
   mechanical ventilation were pneumonia, sepsis, pneumothorax, UGI
   bleeding of 16, 8, 5 and 9 episodes, respectively. The average duration
   of assisted ventilation and hospitalization were 15.8 and 19.02 days,
   respectively. The mortality rate was 50 per cent in the mechanical
   ventilation group compared with 9.8 per cent in the non-mechanical
   ventilation group. Increased mortality rate was found in those with
   pneumonia as the precipitating factor (68.4 vs 14.3%, respectively, in
   comparing the two groups). Complications of mechanical ventilation,
   which included pneumonia, sepsis, fluid overload, hyponatremia and
   persistent acidosis, were high-risk factors for the non-surviving group.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 0125-2208
UT MEDLINE:8228688
PM 8228688
ER

PT J
AU Pozzi, E
   Gulotta, C
TI Classification of chest wall diseases.
SO Monaldi archives for chest disease = Archivio Monaldi per le malattie
   del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di
   clinica tisiologica e malattie apparato respiratorio, Universita di
   Napoli, Secondo ateneo
VL 48
IS 1
BP 65
EP 8
PD 1993
PY 1993
AB Several disorders of the thoracic cage are known to cause respiratory
   failure, by means of relatively simple mechanisms, such as the increased
   work of breathing, which results in alveolar hypoventilation. A variety
   of pathogenic mechanisms may be considered, as functions of the types of
   thoracic disorders present. As causes of these additional potential
   mechanisms, we considered the following: 1) ventilation-perfusion (V/Q)
   inhomogeneity; 2) inability to cough; 3) malformation or acquired defect
   of the respiratory centres; and 4) excess blood volume and fluid
   retention, which aggravate work of breathing and V/Q inhomogeneity. All
   of these disorders can be grouped into two major categories (which
   nevertheless have some of the pathophysiology in common): the mechanical
   syndrome and the neuromuscular or paralytic syndrome. In this paper we
   discuss chest wall diseases falling into the first category; namely,
   kyphoscoliosis, fibrothorax, thoracoplasty, ankylosing spondylitis and
   obesity-hypoventilation. Congenital deformities of the thoracic cage,
   which do not have important effects on ventilatory apparatus (e.g.
   pectus excavatum and pectus carinatum), were also considered.
TC 1
ZB 1
Z8 2
ZS 0
Z9 4
SN 1122-0643
UT MEDLINE:8472068
PM 8472068
ER

PT J
AU Schiavina, M
   Fabiani, A
TI Intermittent negative pressure ventilation in patients with restrictive
   respiratory failure.
SO Monaldi archives for chest disease = Archivio Monaldi per le malattie
   del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di
   clinica tisiologica e malattie apparato respiratorio, Universita di
   Napoli, Secondo ateneo
VL 48
IS 2
BP 169
EP 75
PD 1993
PY 1993
AB Thirty one patients in stable respiratory failure (arterial oxygen
   tension (PaO2) 67 +/- 20 mmHg (8.9 +/- 2.7 kPa) and arterial carbon
   dioxide tension (PaCO2) 59 +/- 10 mmHg 7.9 +/- 1.3 kPa)), secondary to
   non-obstructive ventilatory impairment, were treated by intermittent
   negative pressure ventilation (INPV), using a pneumowrap or poncho
   during the night. Daytime arterial blood gas measurements, taken before
   and after the ventilation, revealed a substantial improvement in PaO2,
   PaCO2 and maximal inspiratory pressure (Pimax). This improvement
   persisted during the six month follow-up of home nocturnal ventilation.
   The polysomnographic, recording during mechanical ventilation by poncho,
   in five patients, showed a general improvement in the quality and
   structure of sleep. All patients returned to normal arterial oxygen
   saturation (SaO2) values (> 90%), except for one. In three patients, the
   appearance of obstructive events was noted but the desaturation that
   they caused was, remarkably, lower than that caused by central events in
   baseline recording. We conclude that non-invasive treatment by INPV, in
   patients with neuromuscular and chest wall disease, is the method of
   choice as an alternative to intermittent positive pressure ventilation
   and to tracheostomy.
TC 7
ZB 5
Z8 0
ZS 0
Z9 7
SN 1122-0643
UT MEDLINE:8518781
PM 8518781
ER

PT J
AU Soryal, I
   Sinclair, E
   Hornby, J
   Pentland, B
TI Impaired joint mobility in Guillain-Barre syndrome: a primary or a
   secondary phenomenon?
SO Journal of neurology, neurosurgery, and psychiatry
VL 55
IS 11
BP 1014
EP 7
DI 10.1136/jnnp.55.11.1014
PD 1992-Nov
PY 1992
AB Three patients with Guillain-Barre syndrome had significant residual
   impairment of joint mobility. Pain in the limbs and axial skeleton was a
   prominent early feature, as were autonomic disturbances and bulbar
   involvement resulting in prolonged mechanical ventilation. All three
   patients developed marked joint stiffness and contractures despite
   having physiotherapy from the outset. The skeletal problems and
   complications became major components of disability despite improving
   neurological status.
TC 2
ZB 2
Z8 0
ZS 0
Z9 2
SN 0022-3050
UT MEDLINE:1469395
PM 1469395
ER

PT J
AU Gunawardana, R H
   Shanmuganathan, P S
   Ponniah, S
TI Intensive care experience in Guillain-Barre syndrome.
SO The Ceylon medical journal
VL 37
IS 3
BP 85
EP 7
PD 1992-Sep
PY 1992
AB In a retrospective study of 34 patients with acute Guillain-Barre
   syndrome admitted to an intensive care unit (ICU) during a six year
   period from January 1984 to December 1989, for bulbar paresis or
   impending respiratory failure, 4 required endotracheal intubation to
   protect the airway, and 27 required mechanical ventilation. A high
   incidence of respiratory complications was noted. Two patients died of
   cardiovascular instability. Close monitoring of respiratory and
   cardiovascular status is essential to ensure survival.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0009-0875
UT MEDLINE:1291139
PM 1291139
ER

PT J
AU Segredo, V
   Caldwell, J E
   Matthay, M A
   Sharma, M L
   Gruenke, L D
   Miller, R D
TI Persistent paralysis in critically ill patients after long-term
   administration of vecuronium.
SO The New England journal of medicine
VL 327
IS 8
BP 524
EP 8
DI 10.1056/NEJM199208203270804
PD 1992-Aug-20
PY 1992
AB BACKGROUND: The muscle relaxant vecuronium is sometimes administered to
   facilitate mechanical ventilation. Neuromuscular paralysis lasting up to
   seven days may occur after the termination of long-term administration
   (i.e., more than two days) of vecuronium in critically ill patients. We
   investigated the role of clinical factors and plasma concentrations of
   vecuronium and its metabolite in causing this prolonged neuromuscular
   blockade.
   METHODS: We studied 16 critically ill adult patients (8 women and 8 men)
   who had received vecuronium to facilitate mechanical ventilation for at
   least two consecutive days. Clinical factors and plasma concentrations
   of vecuronium and 3-desacetylvecuronium, the active metabolite of
   vecuronium, were compared in patients with and without prolonged
   neuromuscular blockade. In addition, we performed detailed
   pharmacokinetic studies in the patients without prolonged neuromuscular
   blockade.
   RESULTS: Seven of the 16 patients had prolonged neuromuscular blockade,
   lasting from six hours to more than seven days, after the termination of
   vecuronium therapy. These seven patients, six of whom were women, had
   higher plasma magnesium concentrations and lower arterial blood pH
   values than the nine patients without prolonged neuromuscular blockade.
   They also had higher plasma concentrations of 3-desacetylvecuronium and
   a higher frequency of renal failure (seven of seven patients vs. four of
   nine patients, P less than 0.03). In the patients without prolonged
   neuromuscular blockade, the mean (+/- SD) plasma clearance, elimination
   half-life, and volume of distribution of vecuronium were 2.5 +/- 1.0 ml
   per kilogram of body weight per minute, 299 +/- 154 minutes, and 1.1 +/-
   0.6 liters per kilogram, respectively.
   CONCLUSIONS: Prolonged neuromuscular blockade after the termination of
   long-term treatment with vecuronium is associated with metabolic
   acidosis, elevated plasma magnesium concentrations, female sex, and
   probably more important, the presence of renal failure and high plasma
   concentrations of 3-desacetylvecuronium.
TC 307
ZB 157
Z8 3
ZS 1
Z9 313
SN 0028-4793
UT MEDLINE:1353252
PM 1353252
ER

PT J
AU Paterson, D L
   King, M A
   Boyle, R S
   Pond, S M
   Whitby, M
   Wright, M
   Henderson, A
TI Severe botulism after eating home-preserved asparagus.
SO The Medical journal of Australia
VL 157
IS 4
BP 269
EP 70
PD 1992-Aug-17
PY 1992
AB OBJECTIVE: To present a case of adult botulism acquired in Queensland.
   CLINICAL FEATURES: After eating home-preserved asparagus, a 33-year-old
   man presented with internal and external ophthalmoplegia, bilateral
   facial nerve palsies, and descending muscle weakness culminating in a
   sudden respiratory arrest. Electrophysiological testing demonstrated
   normal nerve conduction velocities and an incremental response of evoked
   motor potentials on repetitive stimulation, confirming the clinical
   diagnosis of botulism.
   INTERVENTION AND OUTCOME: Treatment with trivalent antitoxin, oral
   treatment with vancomycin and supportive mechanical ventilation for four
   weeks resulted in complete clinical recovery. Plasmapheresis was also
   used but its contribution to the patient's improvement is dubious.
   CONCLUSIONS: Although botulism is rare in Australia, clinicians should
   be aware of the clinical presentation and the rapidity of confirmation
   of the diagnosis by electrophysiological testing. Patients should be
   nursed in an intensive care setting. Regular testing of vital capacity
   should be performed to determine the need for mechanical ventilation.
RI Paterson, David/A-9258-2010; Wright, Malcolm/D-9837-2012; Henderson, Alan/K-2846-2012; Whitby, Michael/B-7231-2011
TC 10
ZB 4
Z8 0
ZS 0
Z9 10
SN 0025-729X
UT MEDLINE:1435446
PM 1435446
ER

PT J
AU Kitchen, W H
   Rickards, A L
   Doyle, L W
   Ford, G W
   Kelly, E A
   Callanan, C
TI Improvement in outcome for very low birthweight children: apparent or
   real?
SO The Medical journal of Australia
VL 157
IS 3
BP 154
EP 8
PD 1992-Aug-3
PY 1992
AB OBJECTIVE: To determine whether improvement in the survival rate of
   infants with a birthweight of less than 1501 g was accompanied by an
   increase in the rate of neurological impairment or disability among the
   survivors.
   DESIGN, SETTING AND PATIENTS: Two cohorts of consecutive very low
   birthweight infants (birthweight less than 1501 g) in one tertiary
   perinatal centre were followed prospectively to eight years of age; for
   both cohorts, comparison groups of children of birthweight more than
   1501 g were randomly selected from hospital births.
   INTERVENTIONS: The first cohort was born before the introduction of
   assisted ventilation (1966-1970), the second after assisted ventilation
   was well established (1980-1982).
   MAIN OUTCOME MEASURES: Comparisons between cohorts, at eight years of
   age, of the survival rates and the rates of severe sensorineural
   impairments and disabilities.
   RESULTS: The survival rate for very low birthweight infants to eight
   years of age almost doubled between these cohorts, from 37.1% to 67.8%
   (odds ratio [OR], 3.4; 95% confidence interval [CI], 2.5-4.7; chi 2 =
   57.6; P much less than 0.0001). The biggest gain was the increase in
   non-disabled survivors at eight years of age, from 52.6% in the first
   cohort to 80.8% in the second cohort (OR, 3.5; 95% CI, 2.2-5.7; chi 2 =
   26.7; P less than 0.0001). Furthermore, the rate of severe disabilities
   in survivors fell substantially, from 13.6% to 4.1% (OR, 0.31; 95% CI,
   0.14-0.69; chi 2 = 8.3; P less than 0.01). Of specific impairments, the
   rate of severe sensorineural deafness fell substantially (3.2% to 0%:
   OR, 0.14, 95% CI, 0.02-0.81; chi 2 = 4.8; P less than 0.05), as did the
   rate of severe intellectual impairment (13.0% to 2.7%: OR, 0.25; 95% CI,
   0.11-0.57; chi 2 = 10.7; P less than 0.002). Only the rate of cerebral
   palsy increased, but not significantly (2.6% to 6.8%; OR, 2.6; 95% CI,
   0.89-7.6; chi 2 = 3.0).
   CONCLUSIONS: It has been possible to improve the survival rate of very
   low birthweight infants over time without increasing the number of
   severely disabled survivors. Whether the long-term outcome for these
   infants is continuing to improve with more recent advances in perinatal
   care remains to be determined.
TC 16
ZB 11
Z8 0
ZS 0
Z9 16
SN 0025-729X
UT MEDLINE:1386135
PM 1386135
ER

PT J
AU Singh, M
TI Priorities in child health.
SO Indian journal of pediatrics
VL 59
IS 4
BP 397
EP 9
DI 10.1007/BF02751547
PD 1992 Jul-Aug
PY 1992
AB A noted pediatrician in New Delhi, India, urges fellow pediatricians to
   promote the health and safeguard the interests of children.  He
   advocates the establishment of comprehensive genetic units in the
   pediatric departments in teaching hospitals in India to reap the
   benefits of the genetic revolution.  Specifically, advances in molecular
   genetics have led to advanced diagnostic and therapeutic concepts and
   uses (e.g., DNA probes to identify various pathogenic antigens and gene
   therapy).  India needs to develop its infrastructure and facilities to
   acquire technology for diagnosis, monitoring, and providing life support
   to children with life-threatening conditions.  For example, all teaching
   hospitals in India must set up neonatal  and pediatric intensive care
   units as soon as possible.  Since the government and hospital
   administrators fund expensive technology for coronary care units,
   postoperative intensive care units, and cancer hospitals, they can also
   afford to provide neonatal and pediatric intensive care units.  Hospital
   pediatric departments must create extensive child development centers to
   monitor child development in order to diagnose and treat early
   neuromotor disability.  Pediatricians should develop the art of child
   care which includes skills in listening, soothing, gaining confidence,
   explaining, and consoling as well as effective health education.  During
   each visit, they should educate the family about health and nutrition.
   The lack of political will is the major reason India cannot meet its
   maternal and child health (MCH) targets.  For example, the government
   allocates less than 2% of the gross national product to health and
   family welfare programs.  The government and physicians pay more
   attention to expanding cancer and coronary care hospitals than to
   promoting MCH.  Pediatricians should work together to do just that, but
   improved child health status cannot occur without addressing
   discrimination against female children.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0019-5456
UT MEDLINE:1280621
PM 1280621
ER

PT J
AU Coakley, J H
   Nagendran, K
   Ormerod, I E
   Ferguson, C N
   Hinds, C J
TI Prolonged neurogenic weakness in patients requiring mechanical
   ventilation for acute airflow limitation.
SO Chest
VL 101
IS 5
BP 1413
EP 6
DI 10.1378/chest.101.5.1413
PD 1992-May
PY 1992
AB We describe three patients who required mechanical ventilation for
   severe acute exacerbations of obstructive airways disease. When
   treatment with sedatives and muscle relaxants was withdrawn, they
   exhibited profound generalized weakness and consequently required
   prolonged ventilation despite resolution of the airway obstruction.
   Clinical features were variable, but none of the patients developed
   failure of other organs and infection was confined to the lungs. All had
   electrophysiologic evidence of a predominantly motor axonal syndrome.
   One patient in whom sensory action potentials were abnormal may
   represent an unusually severe case of critical illness neuropathy
   occurring in the absence of systemic sepsis and multiple organ failure.
   In the other two cases, this diagnosis is made less likely by the
   complete absence of sensory involvement and in these patients the lesion
   appeared to be either in the most distal portion of the motor neuron or
   at the neuromuscular junction. In all three patients, resolution was
   slow but eventually complete. The etiology of the condition is not
   clear, but it seems to be distinct from the acute myopathy previously
   described in asthmatics who had received mechanical ventilation. It is
   important to recognize this phenomenon to avoid erroneous conclusions
   about the likelihood of the patient recovering from ventilator
   dependence. A prolonged weaning period is to be expected in such cases.
TC 32
ZB 16
Z8 0
ZS 0
Z9 32
SN 0012-3692
UT MEDLINE:1582307
PM 1582307
ER

PT J
AU Faloona, J
   Walsh-Kelly, C M
TI Upper airway dysfunction--an unusual presentation of Guillain-Barre
   syndrome.
SO Annals of emergency medicine
VL 21
IS 4
BP 437
EP 9
DI 10.1016/S0196-0644(05)82668-X
PD 1992-Apr
PY 1992
AB We report the case of a 9-year-old boy who presented to the emergency
   department with dysphagia, respiratory distress, hoarseness, and
   generalized weakness. While in the ED, his respiratory status
   deteriorated, and he required intubation. At that time, he was found to
   have normal upper airway anatomy. He was admitted to the pediatric ICU
   and, within 24 hours, developed areflexia and muscle weakness; he was
   diagnosed with Guillain-Barre syndrome. Atypical presentations of
   Guillain-Barre syndrome are discussed, and the necessity of considering
   this diagnosis when evaluating patients with evidence of cranial nerve
   dysfunction or upper airway distress is emphasized.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 0196-0644
UT MEDLINE:1554187
PM 1554187
ER

PT J
AU Davis, A
   Wood, S
TI The epidemiology of childhood hearing impairment: factor relevant to
   planning of services.
SO British journal of audiology
VL 26
IS 2
BP 77
EP 90
DI 10.3109/03005369209077875
PD 1992-Apr
PY 1992
AB In the Nottingham District Health Authority we found that one in 943
   babies born between 1983-1986 have a sensorineural or mixed hearing
   impairment (at 50 dB HL or greater in the better ear averaged over the
   frequencies 0.5, 1, 2, 4 kHz) that is either congenital or progressive
   in nature. If this figure is broken down between non-neonatal intensive
   care unit babies and neonatal intensive care unit (NICU) graduates, we
   find that one in 174 NICU graduates have a hearing impairment compared
   with one in 1278 non-NICU babies. Excluding from the non-NICU baby
   population those with a known family history of hearing impairment, and
   those with a known relevant syndrome at birth, there is a 10.2 to 1 odds
   ratio for babies in NICU to have such hearing impairments compared to
   this restricted 'normal' baby population. In addition NICU babies with a
   hearing impairment were considerably more likely to have another
   disability (odds ratio 8.7 to 1). Acquired sensorineural or mixed
   impairments comprised about 9% of the children with impairments by 3
   years of age. Twenty per cent of the patients seen at the Children's
   Hearing Assessment Centre (CHAC) with better-ear impairment of 95 dB HL
   or greater had acquired hearing impairments. The mean age of referral
   for congenital hearing impairments was found to be a function of
   severity and NICU status. For children with better-ear hearing
   impairments of 80 dB HL or greater, the mean and median ages of referral
   were both 8 months (s.d. 4 months).
TC 116
ZB 76
Z8 0
ZS 0
Z9 117
SN 0300-5364
UT MEDLINE:1628120
PM 1628120
ER

PT J
AU Jansen, P W
   Perkin, R M
   Van Stralen, D
TI Mojave rattlesnake envenomation: prolonged neurotoxicity and
   rhabdomyolysis.
SO Annals of emergency medicine
VL 21
IS 3
BP 322
EP 5
DI 10.1016/S0196-0644(05)80898-4
PD 1992-Mar
PY 1992
AB An 11-year-old girl presented to the emergency department with
   hypoventilation and shock after being bitten by a Mojave rattlesnake.
   Intubation was required, and she improved rapidly after fluid
   resuscitation and antivenom administration. She was extubated four hours
   after envenomation and did well. The patient subsequently developed
   increased weakness and cranial nerve paresis and required reintubation
   for respiratory failure at 30 hours after envenomation despite
   administration of 30 vials of antivenom. She improved after
   administration of additional antivenom and was extubated ten hours
   later. Twenty-four hours after envenomation, signs of rhabdomyolysis
   were noted with myoglobinuria and a creatine phosphokinase level of
   96,400 units/L. Myoglobinuric renal failure was treated with mannitol,
   hydration, and alkalinization of the urine. The patient's renal and
   neurological functions improved steadily during the following three to
   four days. Neurotoxic and myotoxic effects of Mojave venom are known to
   occur but are not well documented in human beings. Recognition of
   potential complications from envenomation such as respiratory paralysis
   and rhabdomyolysis with myoglobinuric renal failure is critical.
TC 20
ZB 10
Z8 0
ZS 0
Z9 20
SN 0196-0644
UT MEDLINE:1536496
PM 1536496
ER

PT J
AU Vallet, B
   Fourrier, F
   Hurtevent, J F
   Parent, M
   Chopin, C
TI Myasthenia gravis and steroid-induced myopathy of the respiratory
   muscles.
SO Intensive care medicine
VL 18
IS 7
BP 424
EP 6
DI 10.1007/BF01694346
PD 1992
PY 1992
AB OBJECTIVE: We report a case of corticosteroid-induced myopathy with
   involvement of respiratory muscles observed in a myasthenic patient.
   PATIENT: A 37-years-old woman, under corticosteroid treatment for two
   years for typical myasthenia gravis was admitted to ICU for acute
   myasthenic respiratory failure. Weaning from mechanical ventilation
   remained impossible despite 4 plasma exchanges and azathioprine. The
   patient exhibited a progressive 12 kg weight loss with muscular weakness
   and atrophy.
   MEASUREMENTS AND RESULTS: Peripheral and diaphragmatic electromyography
   as well as histological study were consistent with a steroid-induced
   myopathy. Discontinuation of corticosteroid treatment was followed by a
   rapid weight gain with general improvement and allowed weaning from
   mechanical ventilation with a complete recovery.
   CONCLUSION: This case provides evidence that corticosteroid-induced
   myopathy may be observed in myasthenia gravis and may involve the
   respiratory muscles as well as the peripheral musculature.
TC 5
ZB 2
Z8 0
ZS 0
Z9 5
SN 0342-4642
UT MEDLINE:1469182
PM 1469182
ER

PT J
AU Shneerson, J
TI Home ventilation.
SO British journal of hospital medicine
VL 46
IS 6
BP 393
EP 5
PD 1991-Dec
PY 1991
AB Home ventilation has become practical recently because of improvements
   in the equipment available to support respiration in the long term. It
   is especially effective in neuromuscular and skeletal disorders, but may
   also have a limited place in chronic lung diseases. Both positive- and
   negative-pressure ventilators may be suitable for home ventilation.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0007-1064
UT MEDLINE:1760674
PM 1760674
ER

PT J
AU Engberg, I B
TI Giving up and withdrawal by ventilator treated patients: nurses'
   experience.
SO Intensive care nursing
VL 7
IS 4
BP 200
EP 5
PD 1991-Dec
PY 1991
AB If a patient on admission to the Intensive Care Unit (ICU) already seems
   to have given up and behaves in a withdrawn manner the nurses usually
   interpret it as an expression of the patient's personality. However the
   nursing care activities are more or less characterized by uncertainty
   and fear of misjudgements due to difficulties in interpreting the
   patient's wishes and needs. If this syndrome of giving up and withdrawal
   develops during ventilator treatment in the ICU nurses interpret the
   patient's behaviour as a sign of depression caused by exhaustion,
   awareness of severe illness, injuries or disabilities or loss of hope,
   meaning and will to live. The nurses' reactions are either to wait for
   spontaneous changes in the patient's behaviour or to make more active
   interventions, trying to support the patient and alleviate his/her
   condition. Most nurses feel helpless and powerless not knowing how to
   lessen and relieve the patient's suffering. Caring for these patients is
   often frustrating, stress-evoking and tiring for the nurses, especially
   if this syndrome is present for a long period. It is therefore important
   to do further studies to increase knowledge about the syndrome and its
   effects.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 0266-612X
UT MEDLINE:1765633
PM 1765633
ER

PT J
AU Carlson, K
TI In the line of duty.
SO Journal of post anesthesia nursing
VL 6
IS 6
BP 449
EP 450, 449
PD 1991-Dec
PY 1991
AB In light of recent events that have raised ethical and legal dilemmas in
   the health care field, the author explains that nurses now have a duty
   to participate in the debate over these issues and to educate the
   public.  The author, a staff nurse in the Abbott-Northwestern Hospital
   in Minneapolis, explains that the city has recently witnessed a series
   of events with ethical overtones that have captured national attention. 
   In one case, the hospital sought judicial guidance on whether an
   87-year-old comatose women--dependent on a ventilator for over a
   year--should continue to receive the costly and labor-intensive care
   simply because the family desired it.  Although the hospital argued that
   continuing to provide care would only prolong a futile life, the court
   ruled that only the family could make the decision of whether or not to
   continue care.  Coincidentally, around the same time as the court case,
   Minneapolis hosted the International Special Olympics, and event that
   brought together individuals with mental and physical disabilities for
   athletic competition.  The event illustrated that there is no consensus
   on the definition of a futile life.  In one other event that captured
   national headlines, 2 physicians admitted that they had continued to
   practice medicine despite knowing that they were infected with the AIDS
   virus.  These disclosures heightened the debate over mandatory HIV
   testing for health care workers--especially for health care workers who
   perform invasive procedures.  This debate has raised a number of issues:
   confidentiality, the safety of patients, as well as the safety of health
   care workers.  The author explains that such issues of life and death
   are often drowned in emotionalism and public hysteria.  Nurses have a
   duty to see that the public is educated.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0883-9433
UT MEDLINE:1748972
PM 1748972
ER

PT J
AU Tibballs, J
TI Diaphragmatic pacing: an alternative to long-term mechanical
   ventilation.
SO Anaesthesia and intensive care
VL 19
IS 4
BP 597
EP 601
PD 1991-Nov
PY 1991
AB Electrical percutaneous stimulation of the phrenic nerves was first
   employed in 1948 by Sarnoff to provide temporary artificial ventilation
   in patients with respiratory failure. However, the technique was limited
   by development of infection around the electrode. Short-term
   radiofrequency stimulation of the phrenic nerves was first utilised by
   Glenn in 1964 and adapted to long-term use in patients with central
   hypoventilation in 1968 and with traumatic quadriplegia in 1972. The
   technique employed alternate pacing of each hemidiaphragm with high
   frequency stimulation (25-30 Hz) with a respiratory rate of 12 to 17 per
   minute which, in a series of 17 quadriplegic adults, although initially
   successful, was self-limiting because of eventual damage to the nerves
   and diaphragms. More recently, continuous bilateral simultaneous low
   frequency (up to 8 Hz) stimulation with a respiratory rate of 5 to 9 per
   minute has not induced myopathic changes. This phenomenon has been
   attributed to: 1. the conversion of the mixture of slow and fast twitch
   fibres in the diaphragm to a uniform population of fatigue resistant
   fibres induced by low frequency stimulation, and 2. the reduction in the
   total current necessary to achieve adequate gas exchange when both
   diaphragms contract simultaneously with the less frequent stimulation at
   lower energy. Diaphragmatic pacing has been applied to infants and
   children with emphasis on the selection of patients and optimum setting
   of stimulus parameters. This communication presents a case report of
   diaphragmatic pacing in a child with a review of the principles of
   application. The advantages and disadvantages compared to mechanical
   ventilation are also discussed.
TC 16
ZB 7
Z8 1
ZS 0
Z9 17
SN 0310-057X
UT MEDLINE:1750649
PM 1750649
ER

PT J
AU Apte-Kakade, S
TI Rehabilitation of patients with quadriparesis after treatment of status
   asthmaticus with neuromuscular blocking agents and high-dose
   corticosteroids.
SO Archives of physical medicine and rehabilitation
VL 72
IS 12
BP 1024
EP 8
PD 1991-Nov
PY 1991
AB Patients with severe status asthmaticus who do not respond to intensive
   medical therapy are often given neuromuscular blocking agents to
   facilitate mechanical ventilation. Of 51 consecutive asthmatic patients
   treated with mechanical ventilation, 27 were treated with neuromuscular
   blocking agents. Of these 27 patients, all receiving high-dose
   intravenous steroids, four were noted to develop quadriparesis that was
   more severe distally. There was no cranial nerve or sensory involvement.
   These four patients were given physical and occupational therapy; three
   were transferred to the rehabilitation unit. Steady improvement in
   muscle strength was noted; independence in mobility and activities of
   daily living was achieved by the time of discharge. They were followed
   as outpatients until full recovery. Although the exact etiology of the
   complication is not known, acute steroid myopathy facilitated by the use
   of neuromuscular blocking agents is a likely cause. Based on the
   excellent recovery potential of these patients, early rehabilitation in
   this uncommon complication is strongly urged.
TC 13
ZB 8
Z8 0
ZS 0
Z9 13
SN 0003-9993
UT MEDLINE:1953316
PM 1953316
ER

PT J
AU Mercado, A
   Pedraza, L
   Mayol, P M
   Rodriguez Santana, R
   Tejeda, C
TI Joubert syndrome. Respiratory failure requiring home mechanical
   ventilation.
SO Boletin de la Asociacion Medica de Puerto Rico
VL 83
IS 10
BP 451
EP 5
PD 1991-Oct
PY 1991
AB A case of Joubert's Syndrome with respiratory insufficiency requiring
   mechanical ventilatory support is presented. The case illustrates the
   complex clinical, ethical and technical aspects in the management of
   patients with this syndrome and the feasibility of extending mechanical
   ventilatory support to the home setting. A caring, knowledgeable care
   team and a loving supportive family are required to properly continue
   treatment in the home in cases of this rare syndrome.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0004-4849
UT MEDLINE:1789891
PM 1789891
ER

PT J
AU Margolis, B D
   Khachikian, D
   Friedman, Y
   Garrard, C
TI Prolonged reversible quadriparesis in mechanically ventilated patients
   who received long-term infusions of vecuronium.
SO Chest
VL 100
IS 3
BP 877
EP 8
DI 10.1378/chest.100.3.877
PD 1991-Sep
PY 1991
AB The use of neuromuscular blocking agents, particularly pancuronium, in
   patients receiving mechanical ventilation has been reported to cause
   prolonged paralysis and atrophy. We describe two mechanically ventilated
   patients with asthma who developed prolonged muscular weakness and
   atrophy after receiving the shorter-acting agent vecuronium. These cases
   illustrate the potential of any neuromuscular blocking agent to cause
   these complications, especially in patients who are immobile, have
   decreased renal or liver function, or receive concomitant myotoxic
   agents.
TC 34
ZB 19
Z8 0
ZS 0
Z9 34
SN 0012-3692
UT MEDLINE:1679710
PM 1679710
ER

PT J
AU Dettenmeier, P A
   Jackson, N C
TI Chronic hypoventilation syndrome: treatment with non-invasive mechanical
   ventilation.
SO AACN clinical issues in critical care nursing
VL 2
IS 3
BP 415
EP 31
PD 1991-Aug
PY 1991
AB Chronic hypoventilation syndrome can be caused by many disease states,
   although it is more commonly seen in neuromuscular disorders. Assessment
   of hypoventilation includes measurement of carbon dioxide level,
   respiratory muscle strength, pulmonary function testing, and any other
   system involved, such as cardiac dysfunction or sleep abnormalities.
   Often, chronic hypoventilation is initially diagnosed during an episode
   of acute respiratory failure. The use of noninvasive ventilation with
   positive pressure, negative pressure, or gravitational devices can be an
   effective treatment option for some patients, thus obviating the need
   for a tracheostomy. Noninvasive ventilatory equipment such as the nasal
   or oral masks, mouthpieces, bi-level positive airway pressure, chest
   cuirasses, ponchos, or the iron lung, and the rocking bed or pneumobelt
   can each ventilate a certain type of patient adequately. Each has
   specific indications, advantages, and disadvantages and must be
   individualized to the patient's needs.
TC 2
ZB 0
Z8 0
ZS 0
Z9 2
SN 1046-7467
UT MEDLINE:1873118
PM 1873118
ER

PT J
AU Galloway, G
   Fedok, F G
   Wiegand, D A
   Towfighi, J
TI Sternohyoid muscle biopsy. A diagnostic technique in respiratory failure
   of neuromuscular origin.
SO Chest
VL 100
IS 2
BP 540
EP 3
DI 10.1378/chest.100.2.540
PD 1991-Aug
PY 1991
AB Patients with neuromuscular disease may develop respiratory failure
   requiring mechanical ventilation. We describe a sternohyoid muscle
   biopsy technique as a diagnostic aid in such patients undergoing
   tracheostomy for prolonged ventilatory support. The biopsy procedure is
   quick and without added discomfort or morbidity for the patient. Our
   preliminary observations in three patients suggest that the sternohyoid
   muscle biopsy may be a useful diagnostic tool in this selected group of
   patients.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0012-3692
UT MEDLINE:1713819
PM 1713819
ER

PT J
AU Luchi, J M
   Bennett, F C
   Jackson, J C
TI Predictors of neurodevelopmental outcome following bronchopulmonary
   dysplasia.
SO American journal of diseases of children (1960)
VL 145
IS 7
BP 813
EP 7
PD 1991-Jul
PY 1991
AB In infants with bronchopulmonary dysplasia, the influence of the
   severity of their pulmonary disease on neurodevelopmental outcome is
   unknown. Neurodevelopmental outcomes at a mean age of 36 months were
   assessed in 27 premature subjects who had bronchopulmonary dysplasia.
   Subjects had a mean birth weight of 940 g (range, 540 to 1690 g) and a
   mean gestational age of 27 weeks (range, 25 to 31 weeks). The duration
   of mechanical ventilation ranged from 22 to 128 days, and the duration
   of requirement of supplemental oxygen ranged from 34 to 1033 days. No
   significant correlations were found between duration of mechanical
   ventilation or oxygen therapy and overall neurodevelopmental outcome. In
   contrast, cranial ultrasound findings of intracranial hemorrhage and/or
   periventricular echodensity related specifically to poorer cognitive
   outcome. By age 3 years, severity of bronchopulmonary dysplasia is not a
   sufficient predictor of neurodevelopmental outcome. Intracranial
   hemorrhage and periventricular echodensity continue to be important
   predictors.
TC 28
ZB 20
Z8 0
ZS 1
Z9 28
SN 0002-922X
UT MEDLINE:1711774
PM 1711774
ER

PT J
AU Bone, R C
   Eubanks, D H
TI The basis and basics of mechanical ventilation.
SO Disease-a-month : DM
VL 37
IS 6
BP 321
EP 406
PD 1991-Jun
PY 1991
AB The development of mechanical ventilators and the procedures for their
   application began with the simple foot pump developed by Fell O'Dwyer in
   1888. Ventilators have progressed through three generations, beginning
   with intermittent positive pressure breathing units such as the Bird and
   Bennett device in the 1960s. These were followed by second-generation
   units--represented by the Bennett MA-2 ventilator--in the 1970s, and the
   third-generation microprocessor-controlled units of today. During this
   evolutionary process clinicians recognized Types I and II respiratory
   failure as being indicators for mechanical ventilatory support. More
   recently investigators have expanded, clarified, and clinically applied
   the physiology of the work of breathing (described by Julius Comroe and
   other pioneers) to muscle fatigue, requiring ventilatory support. A
   ventilator classification system can help the clinician understand how
   ventilators function and under what conditions they may fail to operate
   as desired. Pressure-support ventilation is an example of how industry
   has responded to a clinical need--that is, to unload the work of
   breathing. All positive pressure ventilators generate tidal volumes by
   using power sources such as medical gas cylinders, air compressors,
   electrically driven turbines, or piston driven motors. Positive
   end-expiratory pressures, synchronized intermittent mandatory
   ventilation, pressure support ventilation, pressure release ventilation,
   and mandatory minute ventilation, are examples of the special functions
   available on modern ventilators. Modern third-generation ventilators use
   microprocessors to control operational functions and monitors. Because
   these units have incorporated the experience learned from earlier
   ventilators, it is imperative that clinicians understand basic
   ventilator operation and application in order to most effectively
   prescribe and assess their use.
TC 5
ZB 3
Z8 0
ZS 0
Z9 5
SN 0011-5029
UT MEDLINE:2036934
PM 2036934
ER

PT J
AU Ellison, P H
   Greisen, G
   Foster, M
   Petersen, M B
   Friis-Hansen, B
TI The relation between perinatal conditions and developmental outcome in
   low birthweight infants. Comparison of two cohorts.
SO Acta paediatrica Scandinavica
VL 80
IS 1
BP 28
EP 35
DI 10.1111/j.1651-2227.1991.tb11725.x
PD 1991-Jan
PY 1991
AB We have compared the relations between perinatal conditions and
   developmental outcomes at age four years for two cohorts of children
   with birthweights 2,300 g or less, who did not develop cerebral
   palsy--one from Southeastern Wisconsin (children born 1975-76) and the
   other from Copenhagen (children born 1980-82). We examined the general
   effects of parental education and socioeconomic status, the use of
   Cesarean section, the degree of prematurity and neonatal complications
   on outcome. The methods of latent path structural analysis were used to
   form two models among 15 latent variables: one for children from
   Copenhagen and a similar model for children from Wisconsin. The impact
   of parental education and socioeconomic status was somewhat greater in
   Wisconsin. Several neonatal complications were related to outcome in
   Wisconsin: the early condition of the infant, use of a respirator,
   pneumothorax, and anemia/apnea. The only neonatal complication with a
   significant relation to outcome in Copenhagen was pneumothorax and to a
   much lesser degree major germinal layer haemorrhage. The degree of
   prematurity per se had a greater impact in Copenhagen. The use of
   Cesarean section and mechanical ventilation in the smallest infants was
   much more frequent in Denmark, but no association could be shown between
   this increased use and improved developmental outcome.
TC 2
ZB 1
Z8 0
ZS 0
Z9 2
SN 0001-656X
UT MEDLINE:1709328
PM 1709328
ER

PT J
AU Mallory, G B Jr
   Stillwell, P C
TI The ventilator-dependent child: issues in diagnosis and management.
SO Archives of physical medicine and rehabilitation
VL 72
IS 1
BP 43
EP 55
PD 1991-Jan
PY 1991
AB Infants, children, and adolescents with chronic respiratory failure are
   surviving in increasing numbers and, thereby, producing a significant
   population of ventilator-dependent pediatric patients. Chronic
   respiratory failure can occur as a complication of a wide variety of
   disease states; in pathophysiologic terms, it generally results from
   either decreased central nervous system output or inadequate force
   generated by the respiratory pump. Its laboratory hallmark is
   hypercapnia with or without hypoxemia. Stabilization of the patient with
   mechanical ventilatory support may permit long-term survival. Management
   of the ventilator-dependent pediatric patient is a complex task that
   must begin with an accurate prognostication of each patient's survival
   and quality of life. Once a decision is made concerning the practicality
   and appropriateness of long-term ventilatory support, informed choices
   must be made with respect to need for an artificial airway, mode of
   ventilation, and location of care. Many younger patients, especially
   those with intrinsic lung disease (like bronchopulmonary dysplasia), may
   require a hospital setting for long-term care, whereas others with
   neuromuscular or central disorders may benefit from being discharged to
   home. The patient's family must be thoroughly educated in the child's
   care, and they must be involved in decision-making. A multidisciplinary
   team of physicians, therapists, nurses, and other professionals is
   required to deliver optimal care. Outcome is good for most patients who
   are carefully selected.
TC 17
ZB 9
Z8 0
ZS 0
Z9 17
SN 0003-9993
UT MEDLINE:1985623
PM 1985623
ER

PT J
AU Op de Coul, A A
   Verheul, G A
   Leyten, A C
   Schellens, R L
   Teepen, J L
TI Critical illness polyneuromyopathy after artificial respiration.
SO Clinical neurology and neurosurgery
VL 93
IS 1
BP 27
EP 33
DI 10.1016/0303-8467(91)90005-A
PD 1991
PY 1991
AB Up to now, 71 critically ill patients have been reported with
   neuromuscular complications after artificial respiration. The authors
   review the literature and present data of a personal series of 22
   patients all suffering from severe flaccid tetraparesis and muscle
   atrophy, which developed after an average of two weeks artificial
   respiration. The prognosis was relatively good in those surviving the
   primary disease. The multiconditional causes are discussed with emphasis
   on the combination of polyneuropathy and myopathy. Tumor necrosis factor
   (TNF), a key mediator of sepsis, which also has an influence on muscle
   and nerves, is mentioned as a possible cause of this illness.
TC 41
ZB 18
Z8 0
ZS 0
Z9 41
SN 0303-8467
UT MEDLINE:1651187
PM 1651187
ER

PT J
AU Lieberman, R
   Wolff, T W
TI Guillain-Barre syndrome during childhood.
SO Journal of the American Podiatric Medical Association
VL 81
IS 1
BP 37
EP 9
PD 1991-Jan
PY 1991
AB Guillain-Barre syndrome is an acquired disease of the peripheral nervous
   system. The etiology appears to be autoimmune in nature. The major
   clinical features are progressive weakness and loss of reflexes, with
   respiratory failure being a serious complication. The prognosis for
   Guillain-Barre syndrome in children is good with proper intensive care
   and early detection of the disease.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 8750-7315
UT MEDLINE:1993976
PM 1993976
ER

PT J
AU Hill, A R
TI Respiratory muscle function in asthma.
SO Journal of the Association for Academic Minority Physicians : the
   official publication of the Association for Academic Minority Physicians
VL 2
IS 3
BP 100
EP 8
PD 1991
PY 1991
AB Asthma increases the load on the ventilatory pump by causing
   simultaneous increases in airway resistance, lung volume, and minute
   ventilation. The inspiratory muscles bear the majority of this load,
   whereas expiratory muscle recruitment is relatively minor. Respiratory
   muscle strength and endurance appear to be normal in stable asthmatics.
   During acute attacks, airway closure and expiratory airflow limitation
   result in a dynamic increase in end-expiratory lung volume. In turn,
   hyperinflation compromises the function of inspiratory muscles,
   especially that of the diaphragm, by reducing their force-generating
   capacity (muscle shortening) and impairing their mechanical advantage on
   the chest wall. Thus, exacerbations of asthma cause an acute increase in
   mechanical load together with decreased ventilatory capacity, thereby
   predisposing to inspiratory muscle fatigue and precipitating hypercapnic
   respiratory failure in severe cases. Management of ventilatory failure
   in asthma consists of mechanical unloading of the inspiratory muscles by
   positive pressure ventilation together with pharmacotherapy
   (anti-inflammatory and bronchodilating agents) to improve airway
   function. The strategy of mechanical ventilation is aimed at minimizing
   dynamic hyperinflation, which increases inspiratory muscle load as well
   as promotes barotrauma.
TC 11
ZB 7
Z8 0
ZS 1
Z9 11
SN 1048-9886
UT MEDLINE:1809452
PM 1809452
ER

PT J
AU Fields, A I
   Coble, D H
   Pollack, M M
   Kaufman, J
TI Outcome of home care for technology-dependent children: success of an
   independent, community-based case management model.
SO Pediatric pulmonology
VL 11
IS 4
BP 310
EP 7
DI 10.1002/ppul.1950110407
PD 1991
PY 1991
AB Case management is important for successful home care of
   technology-dependent, respiratory-disabled children. Traditionally, the
   medical model of hospital-based home care and case management has been
   used for these children. The outcome may be different from when using
   independent, community-based home care and case management. We evaluated
   the results of 28 technology-dependent children [23 receiving mechanical
   ventilation and 5 receiving continuous positive airway pressure (CPAP)]
   from 8 hospitals, who utilized an independent, community-based, case
   management group to coordinate home care. After 26.3 +/- 20.6 months of
   follow-up, 13 children (46%) remained technology-dependent, 10 (36%)
   were technology-independent, and 5 (18%), all with neurologic
   dysfunction, had died. Only one death was caused by a complication of
   technology. All children with congenital anomalies (n = 4), primary
   pulmonary disease (n = 8), and neuromuscular disease (n = 4) survived,
   and 9 (56%) were weaned from technological support. Children with
   chronic respiratory failure secondary to central neurologic dysfunction
   (n = 12) did poorly: 5 died, 6 remained technology-dependent, and only 1
   became independent of technology. Children with neuromuscular diseases
   tended to use less home care nursing at a lower home care cost. Parent
   satisfaction was high among those who responded (82%), indicating that
   the child, siblings, and family were better off with the child at home.
   These outcomes suggest that community-based home care and case
   management is a reasonable alternative to the hospital-based model.
TC 26
ZB 11
Z8 0
ZS 0
Z9 26
SN 8755-6863
UT MEDLINE:1758755
PM 1758755
ER

PT J
AU [Anonymous]
TI High-frequency oscillatory ventilation compared with conventional
   intermittent mechanical ventilation in the treatment of respiratory
   failure in preterm infants: neurodevelopmental status at 16 to 24 months
   of postterm age. The HIFI Study Group.
SO The Journal of pediatrics
VL 117
IS 6
BP 939
EP 46
PD 1990-Dec
PY 1990
AB The High-Frequency Intervention Trial was a 10-center randomized
   clinical trial to test the efficacy and safety of high-frequency
   oscillatory ventilation (HFO) in the treatment of neonates weighing 750
   to 2000 gm; 327 infants were assigned to HFO and 346 to conventional
   intermittent mechanical ventilation (IMV). Survival and lung morbidity
   rates were the same in the two groups. Bayley psychometric evaluations
   and CNS examination were performed at 16 to 24 months of postterm age in
   77% of the survivors (185 HFO and 201 IMV). There was no difference in
   growth or respiratory status at follow-up. Cerebral palsy was diagnosed
   in 19 (10%) HFO-treated infants and 23 (11%) IMV-treated infants. There
   was no difference in severity between the two groups. A significantly
   higher incidence of hydrocephalus (12% vs 6%) was present in the HFO
   group (p less than 0.05). Bayley index scores greater than 83 were
   scored in 57% of HFO-treated infants compared with 66% of IMV-treated
   infants. The proportion of children at follow-up with a normal
   neuro-developmental status (i.e., Bayley score greater than 83 and no
   major CNS defect) was significantly less in the HFO than in the IMV
   group (54 vs 65%; p less than 0.05). Both treatment groups showed a
   strong association between the presence of grade 3 or 4 intraventricular
   hemorrhage and the development of major CNS or cognitive defects. No
   significant long-term beneficial or deleterious effects were
   demonstrated in the use of HFO versus IMV for the treatment of
   respiratory failure in low birth weight premature infants, except that
   there were slightly more neurologic deficits in the HFO group related to
   the higher proportion of survivors with major intraventricular
   hemorrhage.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0022-3476
UT MEDLINE:1701005
PM 1701005
ER

PT J
AU Pascucci, R C
TI Prolonged weakness after extended mechanical ventilation in a child.
SO Critical care medicine
VL 18
IS 10
BP 1181
EP 2
DI 10.1097/00003246-199010000-00027
PD 1990-Oct
PY 1990
TC 25
ZB 13
Z8 0
ZS 0
Z9 25
SN 0090-3493
UT MEDLINE:2104519
PM 2104519
ER

PT J
AU Steljes, D G
   Kryger, M H
   Kirk, B W
   Millar, T W
TI Sleep in postpolio syndrome.
SO Chest
VL 98
IS 1
BP 133
EP 40
DI 10.1378/chest.98.1.133
PD 1990-Jul
PY 1990
AB Post-polio patients may develop additional neuromuscular and respiratory
   symptoms decades after the acute attack, the post-polio syndrome. We
   hypothesize some post-polio symptoms may be due to breathing disorders
   occurring during sleep. We performed polysomnography on 13 post-polio
   patients: group 1 (five patients) were those already on ventilatory
   assistance (rocking beds) and group 2 (eight patients), those without
   any assistance. Patients requiring new treatment were then evaluated on
   nasal CPAP or nasal mask ventilation. Group 1 patients, on rocking beds,
   demonstrated consistently poor sleep quality with decreased total sleep
   time, sleep efficiency, percentage stage 2, slow wave sleep, rapid eye
   movement sleep and an increase in the number of arousals and percentage
   stage 1 sleep. Respiratory abnormalities were also present and in all
   cases caused significant O2 desaturation. These patients did not respond
   to CPAP with the rocking bed. Repeat night-time polysomnography on nasal
   mask ventilation demonstrated an improvement in sleep structure and gas
   exchange. Three group 2 patients, (group 2a) had sleep within normal
   limits. The five remaining (group 2b) had poor sleep quality that was
   similar to but not as disrupted as group 1 patients. All but one patient
   demonstrated obstructive or mixed apnea and were treated effectively
   with nasal CPAP. One patient required nasal mask ventilation (due to
   mixed apnea and marked hypoventilation) to which there was a dramatic
   response. These patients demonstrated improved sleep quality and an
   improvement in daytime symptomatology. Sleep studies should be performed
   on post-polio patients with excessive daytime sleepiness and respiratory
   complaints. Those with obstructive and mixed apnea can often be treated
   with nasal CPAP. Those with hypoventilation syndrome and sleep apnea
   attributable to sleepiness and respiratory complaints. Those with
   obstructive and mixed apnea can often be treated with nasal CPAP. Those
   with hypoventilation syndrome and sleep apnea attributable to
   respiratory muscle weakness can be treated with nasal mask ventilation.
   Individuals already on respiratory assistance such as rocking beds who
   have features of respiratory failure can also be treated effectively
   with long-term nasal mechanical ventilation.
TC 45
ZB 15
Z8 0
ZS 1
Z9 45
SN 0012-3692
UT MEDLINE:2361379
PM 2361379
ER

PT J
AU Tobin, M J
TI Respiratory monitoring during mechanical ventilation.
SO Critical care clinics
VL 6
IS 3
BP 679
EP 709
PD 1990-Jul
PY 1990
AB Continuous monitoring of important respiratory indices has the potential
   for predicting catastrophes and for providing an opportunity for the
   timely institution of lifesaving measures. Pulmonary gas exchange can be
   assessed by indices derived from arterial blood gas measurements, but
   these are limited by their invasive and intermittent nature.
   Intra-arterial electrodes that provide a continuous recording of blood
   gases are under development and appear very promising. Specially
   designed pulmonary artery catheters permit continuous recording of mixed
   venous O2 saturation, whereas continuous, non-invasive recordings of
   arterial oxygenation can be obtained with pulse oximetry and
   transcutaneous electrodes. A satisfactory method of monitoring CO2
   tension does not exist. Measurements of respiratory drive can be
   obtained at the bedside, but their clinical usefulness remains unknown.
   Assessment of respiratory muscle strength is helpful in determining the
   need for mechanical ventilation, but a practical method of diagnosing
   respiratory muscle fatigue remains elusive. Recordings of the airway
   pressure waveform, calculation of thoracic compliance, and detailed
   examination of the pattern of breathing are helpful in assessing
   pulmonary mechanics. Although respiratory monitoring provides much
   useful information, it does not substitute for careful bedside
   examination.
TC 7
ZB 4
Z8 0
ZS 0
Z9 7
SN 0749-0704
UT MEDLINE:2199001
PM 2199001
ER

PT J
AU Limthongkul, S
   Wongthim, S
   Udompanich, V
   Charoenlap, P
   Nuchprayoon, C
TI Mechanical ventilation in status asthmaticus: experience with 75
   episodes.
SO Journal of the Medical Association of Thailand = Chotmaihet thangphaet
VL 73
IS 6
BP 321
EP 8
PD 1990-Jun
PY 1990
AB Mechanical ventilation in 75 out of 560 status asthmaticus episodes
   during a five-year period (1984-1988) at Chulalongkorn Hospital were
   analyzed. There were 58 patients with an average age of onset of first
   asthmatic attack of 18.5 years and an average age when requiring
   mechanical ventilation of 33 years, which is significantly younger than
   among those who did not require assisted ventilation. At the time of
   intubation, four patients were in sudden unexpected arrest and 19
   patients were urgently ventilated because of respiratory muscle fatigue
   or carbon dioxide narcosis; the remaining 52 patients required elective
   mechanical ventilation. The arterial blood gas of 52 patients revealed a
   pH of 7.11 +/- 0.66, PaCO2 of 58.0 +/- 5.5 mmHg, and HCO3 of 15.0 +/-
   5.8 mEg/L. Controlled mechanical ventilation was maintained for a mean
   of 38.68 hours. Fifty-one patients required intravenous diazepam
   (average dose = 24.3 mg) and 37 required morphine (average dose = 11.1
   mg) for good syncronization in controlling mechanical ventilation.
   Pneumothorax was the most common complication with four, nine and one
   episodes occurring prior to, during and after assisted ventilation,
   respectively. Four, one and two patients developed the complications of
   pneumonia, atelectasis of the left lung due to mucous plugging and upper
   gastrointestinal hemorrhage, respectively. There were six patients who
   died of complications: four of brain anoxia, one of pneumothorax and
   another of unexplained cause.
TC 2
ZB 1
Z8 0
ZS 0
Z9 2
SN 0125-2208
UT MEDLINE:2230627
PM 2230627
ER

PT J
AU Nicholson, A
   Rivlin, E
   Sims, D G
   Chiswick, M L
   D'Souza, S W
TI Developmental delay in congenital myotonic dystrophy after neonatal
   intensive care.
SO Early human development
VL 22
IS 2
BP 99
EP 103
DI 10.1016/0378-3782(90)90084-V
PD 1990-May
PY 1990
AB Six infants with congenital myotonic dystrophy survived after neonatal
   intensive care. In later childhood they were assessed by the Griffiths
   Mental Development Scales: five children were functioning in the mildly
   handicapped to borderline range of development (DQ 64.0 to 79.0) and the
   remaining child was severely delayed in development (DQ 33.0). The five
   children with higher DQ values had a history of ventilatory support of
   30 days or less after birth. By contrast, the remaining child with the
   lowest DQ value had been ventilated for 43 days. This study provides
   further evidence that prolonged ventilation after birth has prognostic
   significance in identifying severely affected cases with congenital
   myotonic dystrophy.
TC 5
ZB 3
Z8 0
ZS 0
Z9 5
SN 0378-3782
UT MEDLINE:1694755
PM 1694755
ER

PT J
AU Livingston, D H
   Richardson, J D
TI Pulmonary disability after severe blunt chest trauma.
SO The Journal of trauma
VL 30
IS 5
BP 562
EP 6; discussion 566-7
DI 10.1097/00005373-199005000-00006
PD 1990-May
PY 1990
AB Twenty-eight patients surviving severe chest injury were studied
   prospectively (Group I) to assess the timing of recovery and the degree
   of residual pulmonary dysfunction. Pulmonary function tests (PFT) were
   obtained within 2 weeks of discharge and serially at intervals of 3 to 6
   months. In addition, 16 patients injured 1 to 11 years previously (mean,
   33 months) were recalled to determine long-term respiratory disability
   (Group II). Standard spirometric pulmonary function measurements were
   obtained. The mean age (36 yrs) and ISS (34) were the same in both
   groups. The majority of patients required intubation and mechanical
   ventilation, averaging 21 days in Group I and 18 days in Group II. PFTs
   were markedly abnormal soon after injury, averaging 40 to 50% of
   predicted values for all tests performed. Rapid improvement in all
   parameters was noted by 4 months after discharge and pulmonary function
   had almost returned to normal by the last followup exam (average, 65 to
   90% of predicted). Results in Group II demonstrated continued
   improvement over long periods of followup. All patients who were
   employed preinjury had returned to work by 6 months after discharge
   except one. Long-term respiratory disability was present in less than 5%
   of patients studied. We conclude that recovery from severe chest injury
   occurs rapidly in most patients and serious long-term respiratory
   disability is uncommon. These results justify the commitment of major
   resources to the intensive care of patients with severe chest injuries.
TC 20
ZB 5
Z8 2
ZS 0
Z9 22
SN 0022-5282
UT MEDLINE:2342139
PM 2342139
ER

PT J
AU Shah, A C
   Trivedi, A M
   Vishwanath, N
   Pajankar, S P
   Nabar, S T
   Bhambure, N
   Deshmukh, S N
TI Intensive respiratory care service. Organisation, orientation, system
   and future. Our experience of management of 288 cases.
SO The Journal of the Association of Physicians of India
VL 38
IS 2
BP 140
EP 3
PD 1990-Feb
PY 1990
AB Between Jan. 1983 and Dec. 1986, 288 patients with acute respiratory
   failure of varied aetiologies were admitted to tetanus and respiratory
   care ward. One hundred and twenty patients (41.66%) had primary
   respiratory diseases, 107 (37.15%) of poisoning, 24 (8.3%) had
   neuromuscular diseases and 37 (12.48%) had miscellaneous disorders.
   Ventilatory support was given for more than 6 hours to 118 patients. The
   overall survival was 61.81% and on ventilator 38.13%. The mortality was
   high with ARDS (100%), miscellaneous (100%) pneumonia with septicaemia
   (75%) and COAD (54.28%). Patient with COAD had high mortality with
   acidosis (pH less than 7.1, P less than 0.01), hypotension (systolic BP
   less than 90 mm of Hg, p less than 0.05) and oliguria (urine out put
   less than 400 ml/24 hours, p less than 0.05). Organophosphorus compound
   was the commonest poison (89.75%) and patients who had moderate to
   severe hypoxia (pO2 less than 60 mm of Hg), hypotension and an interval
   of more than 4 hours between the consumption of poison and admission
   (all P less than 0.05) expired; 68.18% expired within the first 72
   hours. All the patients with primary neuromuscular paralysis and
   bronchial asthma survived. Hospital acquired infections (160 patients),
   retained secretions (108 patients) and hypotension (64 patients) were
   the commonest complications seen in the 288 patients. Staphylococcus
   aureus (32.14%) was the commonest organism isolated. Financial
   constraints, drug shortages and frequent failure of machines were other
   major problems in the intensive respiratory care unit.
TC 4
ZB 0
Z8 0
ZS 0
Z9 4
SN 0004-5772
UT MEDLINE:2380133
PM 2380133
ER

PT J
AU Rudek, M E
TI Parental perceptions of newborn pharmacologic paralysis.
SO Maternal-child nursing journal
VL 19
IS 3
BP 221
EP 37
PD 1990
PY 1990
AB This is a descriptive exploratory study of 9 parent-dyads who
   experienced pharmacologic paralysis of their newborn within a prior
   6-month period. Perceptual responses included feelings, values, and
   needs related to the pharmacologic paralysis therapy. Newborns receiving
   pharmacologic paralysis had direct dependence to the caretaker for
   mechanical ventilation, precise monitoring of physiological parameters,
   and extensive life support due to altered sensory-motor function and
   breathing. The appearance of the immobile newborn and the protocols for
   the administration of paralyzing agents, which eliminate excessive
   stimulation and handling, were suspected of impacting parental
   interaction. The convenience sample of parents was representative of
   three newborn critical care units. Open-ended, retrospective interviews
   were completed in either the parents' home or in a private room of the
   critical care complex. Physiologic complications precluded use of a
   prospective interview technique. Chart reviews and a background
   questionnaire provided demographic data. Data collection consisted of a
   parent-directed interview. Data were subjected to content analysis and
   descriptive statistics. The mother's and father's responses were coded
   separately. The identified common perceptual themes within the
   pharmacologic paralysis experience were empathy, normalcy, acceptance,
   and sedative association. Ancillary experiences include the perinatal
   period and newborn illness. Analysis of ancillary experiences revealed
   continued themes of empathy and normalcy as well as guilt, separation,
   shock and anxiety, and uncertainty. Nurses may provide parents whose ill
   newborn undergoes pharmacologic paralysis a supportive team approach and
   guidance within a framework of their feelings, values, and needs.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0090-0702
UT MEDLINE:2152103
PM 2152103
ER

PT J
AU Kaufert, J M
   Locker, D
TI Rehabilitation ideology and respiratory support technology.
SO Social science & medicine (1982)
VL 30
IS 8
BP 867
EP 77
DI 10.1016/0277-9536(90)90214-D
PD 1990
PY 1990
AB This paper examines the impact changing ventilation technology and the
   ideologies of rehabilitation medicine on the long term adaptations of
   people with post-polio respiratory disability. Multiple in-depth
   interviews with 10 respirator-dependent people indicates that cultural
   ideologies learned during rehabilitation continue to effect the adoption
   of technology and daily management of respiratory insufficiency.
   Adaptive strategies through which benefits of technology are maximized
   and the social costs minimized, have transformed rehabilitation
   ideologies and moderated the late, aging-related effects of
   poliomyelitis.
TC 7
ZB 0
Z8 0
ZS 0
Z9 7
SN 0277-9536
UT MEDLINE:2315752
PM 2315752
ER

PT J
AU Mahaney, N B
TI Restoration of play in a severely burned three-year-old child.
SO The Journal of burn care & rehabilitation
VL 11
IS 1
BP 57
EP 63
DI 10.1097/00004630-199001000-00013
PD 1990 Jan-Feb
PY 1990
AB The critical importance of play in a child's life and, more
   specifically, to successful adaptation to trauma and disability is
   illustrated in the case report of a severely burned 3-year-old. Loss of
   interest in play is frequently seen in depressed children and in
   children whose physical ability to play has been constrained by physical
   illness, injury, or acquired disability. Play is important to the
   development of cognition, affectivity, and social learning, dimensions
   central to coping behavior. The aim of therapeutic treatment of a child
   whose interest in and ability to play have significantly declined is to
   physically and psychologically mobilize the patient to restore play and
   to free up the emotions, enhancing the child's ability to actively
   participate in and optimally benefit from the rehabilitation program.
   Clinical analysis of a 3-year-old's symbolic play and therapeutic
   interventions are presented.
TC 3
ZB 3
Z8 0
ZS 0
Z9 3
SN 0273-8481
UT MEDLINE:2312593
PM 2312593
ER

PT J
AU Hill, A B
   Chiu, R C
TI Dynamic cardiomyoplasty for treatment of heart failure.
SO Clinical cardiology
VL 12
IS 12
BP 681
EP 8
PD 1989-Dec
PY 1989
AB Dynamic cardiomyoplasty is a new surgical procedure proposed for
   treatment of the failing heart. Clinically, the latissimus dorsi muscle
   is raised as a pedicled flap and wrapped around the heart. The skeletal
   muscle is transformed to produce a myocardium-like fatigue-resistant
   muscle. It is stimulated to contract in synchrony with the heart in hope
   of assisting the myocardial contraction. An R-wave synchronous pacemaker
   provides a pulse-train form of stimulation to simulate, for the skeletal
   muscle, the contractile characteristics of the myocardial syncytium. We
   have undertaken a critical review of the clinical results of dynamic
   cardiomyoplasty reported to date. Objective evidence of clinical
   improvement after dynamic cardiomyoplasty resulting from the contractile
   assistance of the myoplasty has been modest. Many of the beneficial
   results reported could be explained by concomitant procedures done, such
   as aneurysmectomy or coronary artery bypass grafting. Hemodynamic
   studies have failed to demonstrate consistent and convincing improvement
   as a result of the cardiomyoplasty stimulation. We have, however,
   identified an interesting subgroup of patients, in whom a striking
   hemodynamic response to cardiomyoplasty stimulation has been reported.
   These patients all possess large resting heart volumes characteristic of
   dilated cardiomyopathy. Thus, case selection may ultimately be one of
   the most important factors in determining the success of dynamic
   cardiomyoplasty for the treatment of heart failure.
TC 29
ZB 21
Z8 0
ZS 0
Z9 29
SN 0160-9289
UT MEDLINE:2692890
PM 2692890
ER

PT J
AU Darrah, W C
   Johnston, J R
   Mirakhur, R K
TI Vecuronium infusions for prolonged muscle relaxation in the intensive
   care unit.
SO Critical care medicine
VL 17
IS 12
BP 1297
EP 300
PD 1989-Dec
PY 1989
AB Neuromuscular blockade by vecuronium infusion is described in 13
   patients requiring ventilation in an ICU for periods of 15 to 68 h. A
   loading dose of vecuronium (0.1 mg/kg) was given, followed by continuous
   infusion adjusted to maintain approximately 90% block as assessed by the
   presence of one response to a Train-of-Four stimulation. The average
   infusion rate was 0.103 mg/kg.h. The average time to complete recovery
   of myoneural function, as assessed by an obviously sustained response to
   tetanic stimulation, after the termination of the vecuronium infusion
   was 28 min. There were no adverse cardiovascular or toxic effects noted
   as a result of vecuronium administration. Vecuronium administered by
   infusion produced satisfactory neuromuscular relaxation in patients
   requiring ventilation in the ICU.
TC 25
ZB 20
Z8 0
ZS 0
Z9 25
SN 0090-3493
UT MEDLINE:2574099
PM 2574099
ER

PT J
AU Nelson, D R
   Sachs, M I
   O'Connell, E J
TI Approaches to acute asthma and status asthmaticus in children.
SO Mayo Clinic proceedings
VL 64
IS 11
BP 1392
EP 402
PD 1989-Nov
PY 1989
AB Asthma is the most common chronic disease in pediatric patients and is
   the leading cause of childhood disability. The functional abnormalities
   of this disease--namely, airway obstruction and hyperresponsiveness--are
   consequences primarily of airway inflammation. Outpatient therapy for
   acute asthma, as well as therapy for status asthmaticus (episodes of
   asthma unresponsive to usually effective outpatient therapy and
   necessitating hospitalization), primarily addresses treatment of airway
   inflammation. The goal of office and emergency room management of acute
   asthma is reversal of airway obstruction by the administration of
   inhaled beta-adrenergic medications. The therapy for status asthmaticus
   consists of intravenously administered aminophylline, corticosteroids,
   nebulized beta-adrenergic agents, and oxygen. Respiratory failure, the
   inability to maintain adequate elimination of CO2, may be effectively
   treated by adding continuous nebulization of albuterol. Mechanical
   ventilation will still be necessary in the rare patient who does not
   respond to pharmacologic therapy. Acute exacerbations of asthma, as well
   as status asthmaticus, can best be prevented by establishing effective
   maintenance programs individualized for each patient.
TC 4
ZB 3
Z8 0
ZS 0
Z9 4
SN 0025-6196
UT MEDLINE:2687598
PM 2687598
ER

PT J
AU Hurst, J M
   Branson, R D
   Davis, K Jr
   Barrette, R R
TI Cardiopulmonary effects of pressure support ventilation.
SO Archives of surgery (Chicago, Ill. : 1960)
VL 124
IS 9
BP 1067
EP 70
PD 1989-Sep
PY 1989
AB Pressure support ventilation (PSV) is a newer mode of ventilatory
   support that augments the patient's spontaneous inspirations to a
   preselected peak inspiratory pressure. We studied the effects of adding
   low levels of PSV (5 to 10 cm H2O) in conjunction with intermittent
   mandatory ventilation (IMV) on 15 patients who required mechanical
   ventilation for flail chest and pulmonary contusion. Patients were
   selected for the study if, during weaning from IMV, the following
   criteria were met: (1) a PaCO2 level greater than 45 mm Hg, (2) a
   spontaneous respiratory rate (RR) greater than 30 breaths per minute,
   (3) a minute ventilation (VE) greater than 9.0 L/min, and (4)
   spontaneous tidal volumes (VT) of less than 2 mL/kg. The PSV was added
   to the IMV at a level that augmented spontaneous VT to greater than 4
   mL/kg. An average of 9 +/- 3 cm H2O of pressure support resulted in a
   fall in the level of PaCO2 (50 +/- 4 to 43 +/- 5 mm Hg), spontaneous RR
   (36 +/- 5 to 16 +/- 3 breaths per minute), VE (12 +/- 2 to 8.4 +/- 1.5
   L/min), and dead space-tidal volume ratio from (0.68 +/- 0.1 to 0.47 +/-
   0.05). Mean airway pressure and PaO2 both increased, but these changes
   were not statistically significant. Oxygen consumption was also
   unchanged. These results suggest that in patients who are difficult to
   wean due to respiratory muscle fatigue (characterized by increasing RR
   and decreasing VT), PSV normalizes lung volumes, improves ventilation,
   and may expedite the weaning process.
TC 22
ZB 16
Z8 0
ZS 0
Z9 22
SN 0004-0010
UT MEDLINE:2774910
PM 2774910
ER

PT J
AU Lacroix, J
   Infante-Rivard, C
   Jenicek, M
   Gauthier, M
TI Prophylaxis of upper gastrointestinal bleeding in intensive care units:
   a meta-analysis.
SO Critical care medicine
VL 17
IS 9
BP 862
EP 9
DI 10.1097/00003246-198909000-00003
PD 1989-Sep
PY 1989
AB A meta-analysis was performed of 15 randomized studies on the
   prophylaxis with cimetidine and/or ant-acids of upper GI bleeding
   acquired in the ICU. There were eight comparisons of a group receiving
   cimetidine with a control group, nine comparisons of a group receiving
   antacids with a control group, and ten comparisons of a group receiving
   cimetidine with a group receiving antacids. The incidence of upper GI
   bleeding ranged from 3.4% to 52.7% among 866 control patients who
   received either a placebo or no prophylaxis. In five of eight
   comparisons, cimetidine was significantly more effective than no
   treatment or a placebo to prevent occult and overt upper GI bleeding;
   the typical odds ratio was 0.32 (95% confidence interval 0.21 to 0.49).
   In six of nine comparisons, antacids were significantly more effective
   than no treatment or a placebo; the typical odds ratio was 0.12 (0.08 to
   0.19). Finally, antacids were significantly more effective than
   cimetidine in two of ten comparisons; the typical odds ratio was 1.61
   (0.97 to 2.65). However, weaknesses in the study designs, heterogeneity
   of treatment effects, the lack of strength of the accumulated evidence,
   and the fact that no utility has been shown in terms of reducing
   morbidity (shock, need for transfusion) or mortality, prevent any
   definitive conclusion in regard to compulsory use of upper GI bleeding
   prophylaxis for ICU patients.
TC 65
ZB 36
Z8 0
ZS 0
Z9 65
SN 0090-3493
UT MEDLINE:2670450
PM 2670450
ER

PT J
AU Green, M
TI Respiratory muscle rest.
SO The European respiratory journal. Supplement
VL 7
BP 578s
EP 580s
PD 1989-Jul
PY 1989
AB The respiratory muscles have great reserves, and under normal
   circumstances, in a fit person, it is probably impossible to fatigue
   them by activity. However, respiratory muscle fatigue can be induced
   experimentally, and with the stress of pulmonary disability, or with
   impairment of muscle function due to neuromuscular disease or skeletal
   deformity. Respiratory muscle fatigue contributes to respiratory failure
   and clinical deterioration. Resting the respiratory muscles can allow
   time for recovery but requires complete or partial artificial
   ventilation. Whilst positive pressure ventilation has been carried out
   for many years in Intensive Care Units, this technique is difficult in
   the long-term. Recently there has been renewed interest in non-invasive
   ventilatory support. Nocturnal ventilation in an iron lung can cause
   long-term improvement in acute and chronic respiratory failure of
   patients with neuromuscular or skeletal abnormalities. Such patients may
   be maintained with devices at home, such as a pneumosuit, a cuirass, or
   positive pressure ventilation via the nose. In patients with chronic
   pulmonary disease respiratory muscle rest may be helpful during acute
   exacerbations. However, the value of rest in chronic respiratory failure
   of end-stage pulmonary patients is as yet unproven.
TC 2
ZB 1
Z8 0
ZS 0
Z9 2
SN 0904-1850
UT MEDLINE:2803412
PM 2803412
ER

PT J
AU Schmidt, G A
   Hall, J B
TI Acute or chronic respiratory failure. Assessment and management of
   patients with COPD in the emergency setting.
SO JAMA
VL 261
IS 23
BP 3444
EP 53
DI 10.1001/jama.261.23.3444
PD 1989-Jun-16
PY 1989
AB Patients with acute or chronic respiratory failure exhibit severe
   pulmonary impairment as a baseline characteristic. Additional minor
   insults can precipitate cardiopulmonary failure that requires hospital
   admission and possibly mechanical ventilation. Our approach to these
   patients emphasizes evaluation of the imbalance between neuromuscular
   competence and mechanical load on the respiratory system. In this way,
   reversible factors can be identified and corrected before they progress
   to inspiratory muscle fatigue and respiratory failure. For cases in
   which deterioration is inexorable, guidelines for mechanical ventilation
   are given and approaches to eventual liberation from the ventilator are
   reviewed.
TC 32
ZB 19
Z8 0
ZS 0
Z9 32
SN 0098-7484
UT MEDLINE:2657124
PM 2657124
ER

PT J
AU Roland, E H
TI Neuromuscular disorders in the newborn.
SO Clinics in perinatology
VL 16
IS 2
BP 519
EP 47
PD 1989-Jun
PY 1989
AB This article outlines the approach to clinical evaluation of the
   hypotonic newborn with suspected neuromuscular disease. Specific
   conditions that affect primarily the anterior horn cell, peripheral
   nerve, neuromuscular junction, and skeletal muscle are reviewed in the
   context of current understanding of the development of the motor system.
   Thus, it may be speculated that the distinction between myopathies and
   neuronal disorders is somewhat artificial. The difficult ethical
   decision regarding long-term mechanical ventilation for severe neonatal
   neuromuscular disease is discussed briefly.
TC 4
ZB 2
Z8 0
ZS 0
Z9 4
SN 0095-5108
UT MEDLINE:2663314
PM 2663314
ER

PT J
AU Curran, F J
   Colbert, A P
TI Ventilator management in Duchenne muscular dystrophy and
   postpoliomyelitis syndrome: twelve years' experience.
SO Archives of physical medicine and rehabilitation
VL 70
IS 3
BP 180
EP 5
PD 1989-Mar
PY 1989
AB The ventilator management protocol followed over the last 12 years in 23
   patients with Duchenne muscular dystrophy (DMD) and six polio survivors
   with chronic respiratory failure (CRF) secondary to the late effects of
   poliomyelitis or postpolio syndrome (PPS) is reviewed. After the onset
   of respiratory failure, patients with DMD continued to show a classic
   course of progressive, generalized muscle weakness and a steadily
   declining vital capacity from an average of 482mL to 336mL. The DMD
   group required an average increase of 0.95 hours in their daily use of
   assisted ventilation per year. Their overall average length of survival
   was increased from 19 years 9 months to 25 years 9 months. Members of
   the postpolio group, to date, have shown no significant decrease in
   muscle strength nor have they needed more than nocturnal ventilation.
   Recommended evaluation and pulmonary follow-up for patients with CRF
   secondary to neuromuscular disease is outlined. Most of these patients
   can be managed for a number of years with body ventilators before a
   tracheotomy is necessary.
TC 45
ZB 30
Z8 0
ZS 0
Z9 45
SN 0003-9993
UT MEDLINE:2647055
PM 2647055
ER

PT J
AU Mali, M
   Tyler, P
   Brookfield, D S
TI Developmental outcome of high-risk neonates in North Staffordshire.
SO Child: care, health and development
VL 15
IS 2
BP 137
EP 45
DI 10.1111/j.1365-2214.1989.tb00610.x
PD 1989 Mar-Apr
PY 1989
AB The findings of the developmental outcome of a 2-year follow-up study
   (1982-1983) on 92 2 1/2-year-old children born in North Staffordshire
   District are reported. They were assessed by the Griffiths Mental
   Developmental Scales and all came from a defined geographical area. The
   babies were all cared for in the Neonatal Unit at the North
   Staffordshire Maternity Hospital. The group comprised infants weighing
   less than 1500 g and those of more than 1500 g who required ventilatory
   support for more than 48 hours. Nine (9.8%) children had major
   disabilities, including two with severe hearing impairment and two with
   visual impairment. Disabilities were not attributable to a congenital
   abnormality or illness acquired after discharge from the neonatal unit.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0305-1862
UT MEDLINE:2713967
PM 2713967
ER

PT J
AU Peters, S G
   Viggiano, R W
TI Home mechanical ventilation.
SO Mayo Clinic proceedings
VL 63
IS 12
BP 1208
EP 13
PD 1988-Dec
PY 1988
AB Recently, interest in the use of mechanical ventilation outside the
   hospital setting has been increasing. Patients with various types of
   chronic respiratory failure may benefit from this approach. Evaluation
   for long-term mechanical ventilation necessitates assessment of the
   underlying disease process, the goals of the medical team, and the needs
   of the patient and family. Externally applied negative-pressure devices
   can provide adequate ventilation for many patients, particularly those
   with neuromuscular diseases. Positive-pressure ventilation by means of a
   tracheostomy provides greater control of the airway, allows adjustment
   of tidal volume and minute ventilation, and may be delivered by portable
   equipment. Ongoing care and support services in the home must be
   provided. A variety of mechanical devices and new techniques of
   ventilator support have made home mechanical ventilation a realistic
   option for long-term care.
TC 8
ZB 6
Z8 0
ZS 0
Z9 8
SN 0025-6196
UT MEDLINE:3059079
PM 3059079
ER

PT J
AU Marlow, N
   Chiswick, M L
TI Neurodevelopmental outcome of babies weighing less than 2001 g at birth:
   influence of perinatal transfer and mechanical ventilation.
SO Archives of disease in childhood
VL 63
IS 9
BP 1069
EP 74
PD 1988-Sep
PY 1988
AB From 1976 to 1980, 1034 children who had weighed less than 2001 g at
   birth were cared for at the North Western regional neonatal intensive
   care unit. Of these, 315 babies were neonatal referrals and 91 were born
   in the unit after antenatal transfer from their district hospital.
   Significantly fewer of the babies referred as neonates survived (n =
   167, 53%) compared with 67 of the antenatal referrals (74%), and 490 of
   those born in the unit (78%). They also had a higher incidence of major
   handicaps (24 of 167, 14%) compared with six of 67 (9%) of the antenatal
   referrals and 35 of 490 (7%) of those born in the unit. To control for
   selection bias among neonatal referrals, the outcome of ventilated
   neonatal referrals was compared with that of ventilated babies born in
   the unit. The two groups were comparable for the incidence of a wide
   range of neonatal complications. No differences in rates of survival or
   handicap were found. We conclude that sick babies transferred after
   birth to regional neonatal intensive care units have similar short and
   long term outcomes to sick babies born in regional units.
RI Marlow, Neil/D-2918-2009
OI Marlow, Neil/0000-0001-5890-2953
TC 7
ZB 7
Z8 0
ZS 0
Z9 7
UT MEDLINE:2460033
PM 2460033
ER

PT J
AU Murciano, D
   Boczkowski, J
   Lecocguic, Y
   Emili, J M
   Pariente, R
   Aubier, M
TI Tracheal occlusion pressure: a simple index to monitor respiratory
   muscle fatigue during acute respiratory failure in patients with chronic
   obstructive pulmonary disease.
SO Annals of internal medicine
VL 108
IS 6
BP 800
EP 5
PD 1988-Jun
PY 1988
AB STUDY OBJECTIVE: To assess respiratory muscle fatigue in acute
   respiratory failure in patients with chronic obstructive pulmonary
   disease and evaluate its influence on weaning patients from mechanical
   ventilation.
   DESIGN AND PATIENTS: We studied the time course of tracheal occlusion
   pressure (P0.1) and high-to-low ratio of the diaphragmatic
   electromyogram in 16 patients in acute respiratory failure with chronic
   obstructive pulmonary disease.
   METHODS: All patients were intubated and studied during a 15-minute
   weaning period from ventilation. Minute ventilation (VE), arterial blood
   gases, P0.1 and high-to-low ratio of the diaphragm were measured every
   day from the onset to the end of acute failure (before extubation) at 5
   and 15 minutes into the weaning period. The diaphragmatic electromyogram
   was recorded with an esophageal electrode and the high-to-low ratio of
   the electrical signal analyzed to assess diaphragmatic fatigue.
   MEASUREMENTS AND MAIN RESULTS: In all patients P0.1 was markedly
   increased (7.1 +/- 2.4 cm H2O, mean +/- SE) on the first day of acute
   failure and did not change during weaning. In 11 patients, P0.1 had
   decreased to 4.7 +/- 1.8 cm H2O (P less than or equal to 0.002) before
   extubation (which was done after 5 to 9 days). In these patients, the
   high-to-low ratio of the diaphragm decreased rapidly-during the first
   minutes of weaning on the first day of acute failure and remained low
   throughout weaning, whereas before extubation no decrease in high-to-low
   ratio was seen during weaning. In 5 patients, P0.1 did not change
   significantly from the onset of acute failure and the high-to-low ratio
   remained low before extubation. These 5 patients had to be reintubated
   within 2 to 6 days. In both groups of patients, VE did not change
   significantly from the first to last day of acute failure (10.3 +/- 3
   compared with 10.7 +/- 2.1 min-1), whereas blood gases during room air
   breathing improved significantly from the first to last day of acute
   failure, respectively, in each group (arterial oxygen pressure [PaO2],
   33.5 +/- 1.5 compared with 44 +/- 9 mm Hg (P less than or equal to 0.05)
   and PaO2 56 +/- 2.3 compared with 49 +/- 2 mm Hg (P less than 0.005).
   CONCLUSIONS: Extubation should not be done in patients with respiratory
   muscle fatigue despite improvement in arterial blood gases and clinical
   status; and P0.1 provides a valid and simple index to assess the
   likelihood of respiratory muscle fatigue.
TC 85
ZB 49
Z8 2
ZS 0
Z9 87
SN 0003-4819
UT MEDLINE:3369770
PM 3369770
ER

PT J
AU Aldrich, T K
TI Respiratory muscle fatigue.
SO Clinics in chest medicine
VL 9
IS 2
BP 225
EP 36
PD 1988-Jun
PY 1988
AB Respiratory muscle fatigue is caused by excessive effort relative to the
   strength and endurance of the respiratory muscles. It can be manifested
   by reductions in respiratory drive (central fatigue), by impaired
   neuromuscular transmission (transmission fatigue), by decreased
   contractility (contractile fatigue), or by a combination of these
   factors. Respiratory muscle fatigue probably contributes to the
   difficulties some patients have with weaning from mechanical
   ventilation, the symptoms of exercise intolerance and dyspnea in chronic
   lung disease, and CO2 retention. Therapy depends on a reduction in the
   required level of respiratory effort and/or an improvement in
   respiratory muscle strength and endurance.
TC 48
ZB 33
Z8 1
ZS 0
Z9 49
SN 0272-5231
UT MEDLINE:2839316
PM 2839316
ER

PT J
AU Levine, S
   Henson, D
   Levy, S
TI Respiratory muscle rest therapy.
SO Clinics in chest medicine
VL 9
IS 2
BP 297
EP 309
PD 1988-Jun
PY 1988
AB This article discusses the role of respiratory muscle rest therapy in
   hypercapnic ventilatory failure and/or inspiratory muscle fatigue
   associated with primary lung disease, diseases of the chest wall, and
   neuromuscular diseases. Some animal data on the role of ventilatory
   muscle rest therapy in states characterized by a low cardiac output and
   arterial hypotension are also reviewed. Additionally, a method for
   quantitating the degree of respiratory muscle rest elicited by negative
   pressure ventilation devices is presented.
TC 15
ZB 13
Z8 0
ZS 0
Z9 15
SN 0272-5231
UT MEDLINE:3292129
PM 3292129
ER

PT J
AU Quinlan, D J
   Moodley, J
   Lalloo, B C
   Nathoo, U G
TI Guillain-Barre syndrome in pregnancy. A case report.
SO South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
VL 73
IS 10
BP 611
EP 2
PD 1988-May-21
PY 1988
AB Severe Guillain-Barre syndrome in a patient 33 weeks pregnant, who went
   into premature labour 48 hours after requiring mechanical ventilation,
   is described. The labour required augmentation with oxytocin and a
   healthy 2,100 g baby was delivered using forceps. Obstetrically, the
   patient had an uncomplicated puerperium. She required ventilation for 20
   days and after extensive physiotherapy was discharged with no
   disability. It is our opinion that the management of the gravid patient
   with Guillain-Barre syndrome does not differ much from that of
   non-pregnant patients with the disease. Supportive care in an intensive
   care unit remains the cornerstone of treatment and unnecessary obstetric
   intervention must be strongly resisted.
TC 7
ZB 4
Z8 0
ZS 0
Z9 7
SN 0256-9574
UT MEDLINE:3375913
PM 3375913
ER

PT J
AU Hendricks-Munoz, K D
   Walton, J P
TI Hearing loss in infants with persistent fetal circulation.
SO Pediatrics
VL 81
IS 5
BP 650
EP 6
PD 1988-May
PY 1988
AB Infants with the diagnosis of persistent fetal circulation were
   evaluated for hearing loss. From Jan 1, 1982, to Jan 1, 1984, 28 infants
   with this diagnosis were retrospectively identified, and 18 were
   evaluated by formal audiologic testing. Additionally, 22 infants were
   prospectively followed by serial auditory evaluation from Jan 1, 1984,
   to Jan 1, 1986. Of the 40 infants evaluated, 21 were identified as
   having hearing impairment (52.5%), 14 of whom required hearing aids. For
   82% of those retrospectively identified hearing-impaired infants who
   required hearing aids, parental concern was expressed for their lack of
   hearing acuity. This factor could have aided in the earlier recognition
   of these infants' impairment. Among those infants followed
   prospectively, formal audiologic testing, in some cases serially, was
   needed to diagnose a progressive hearing loss that was expressed at 6 to
   8 months after discharge from the neonatal intensive care unit.
   Perinatal factors associated with the development and management of
   persistent fetal circulation were identified and compared in infants
   with confirmed hearing loss and those with normal hearing. Variables
   related to those infants with hearing loss were as follows: degree of
   alkalosis, duration of ventilation, and possibly use of furosemide. We
   concluded from these results that infants with persistent fetal
   circulation have an extremely high incidence of sensorineural hearing
   loss and suggest serial formal audiologic evaluations to aid in
   detection of hearing-impaired infants.
TC 70
ZB 47
Z8 0
ZS 0
Z9 70
SN 0031-4005
UT MEDLINE:2451802
PM 2451802
ER

PT J
AU Gillis, J
   Grattan-Smith, T
   Kilham, H
TI Artificial ventilation in severe pertussis.
SO Archives of disease in childhood
VL 63
IS 4
BP 364
EP 7
PD 1988-Apr
PY 1988
AB A retrospective review was conducted of all children admitted to our
   intensive care unit over eight years with a diagnosis of pertussis that
   had been proved on culture. Altogether 789 children were seen as
   outpatients and inpatients. Twenty four of these children were admitted
   to the intensive care unit, 13 of whom required ventilatory support; two
   of the ventilated patients died. Intubation and ventilation were usually
   started for appreciable apnoea. Most patients requiring support were
   less than 3 months of age and required intervention within the first 16
   days of cough. For these patients ventilation was neither difficult nor
   prolonged. Coughing spasms were not a problem and intubation and
   ventilation appeared to attenuate the progress of the disease. The
   presence of severe bacterial pneumonia associated with difficult
   ventilation requiring neuromuscular paralysis indicated a poor
   prognosis. It is suggested that intubation and ventilation can be safely
   used in very severe pertussis infection and, because of their greater
   risk of hypoxic damage and death, it should not be reserved as a last
   resort in critically ill infants.
TC 9
ZB 3
Z8 0
ZS 0
Z9 9
UT MEDLINE:3365004
PM 3365004
ER

PT J
AU Grum, C M
   Chauncey, J B
TI Conventional mechanical ventilation.
SO Clinics in chest medicine
VL 9
IS 1
BP 37
EP 46
PD 1988-Mar
PY 1988
AB Mechanical ventilation has become a very common and well-accepted
   practice in modern intensive care units. The use of the mechanical
   ventilator has progressed from being a support system during surgery and
   for acutely ill patients to being used in both moderate and long-term
   life support in patients with inadequate ventilation. The sophistication
   of modern ventilators and the ability of trained respiratory therapists
   and nursing personnel have permitted this technology to explode. This is
   occurring at a time when there are still many controversies about the
   relative benefits and modes of action of conventional ventilation. As
   newer techniques are developed, it is mandatory that the application of
   these techniques be tempered with controlled clinical trials,
   documenting their effectiveness. The beneficial effects of new
   modalities must be documented as mechanical ventilation expands from use
   in the intensive care unit to use in standard medical wards and the
   patient's home. In these latter two settings, the vigilance of an
   intensive care unit is absent and the simplest method will be
   preferable. The requirement to demonstrate efficacy of new techniques
   with adequate studies is especially necessary now as the economics of
   health delivery have come under increasing scrutiny. Even more important
   than new technologies may be the efficacy of prolonged mechanical
   ventilation. A recent study by Spicher and White evaluated the outcome
   in 250 patients ventilated for 10 days or more at the Hershey Medical
   Center (Pennsylvania State University). The mortality, morbidity, and
   disability in patients in this study population requiring prolonged
   ventilation were extremely high. As these studies have pointed out,
   further evaluations of predictors of meaningful survival are necessary
   to avoid unnecessary human suffering and to best use limited resources.
TC 5
ZB 3
Z8 0
ZS 0
Z9 5
SN 0272-5231
UT MEDLINE:3280230
PM 3280230
ER

PT J
AU MacIntyre, N R
TI New forms of mechanical ventilation in the adult.
SO Clinics in chest medicine
VL 9
IS 1
BP 47
EP 54
PD 1988-Mar
PY 1988
AB Although mechanical ventilatory support in the 1980s clearly provides
   adequate gas exchange with minimal side effects, there remains a need
   for ventilation and oxygenation in those with severe gas exchange
   abnormalities, for reduced airway pressure effects in those at risk for
   barotrauma, for a better muscle reconditioning approach in those with
   muscle dysfunction, and for better ventilator-patient interactions
   (synchrony) in many patients receiving mechanical ventilatory support.
   The new approaches outlined previously address these issues. However,
   research and development for new and better techniques are needed.
   Specific areas that require better understanding include the effects of
   intrathoracic pressure on the lungs and the circulation, the matching of
   ventilation and perfusion under different support modes, the function of
   the respiratory muscles during fatigue and recovery, and the ventilatory
   reflexes operational during mechanical ventilation. Only with this
   information can we design the optimal ventilatory support system.
TC 16
ZB 10
Z8 0
ZS 0
Z9 16
SN 0272-5231
UT MEDLINE:3280231
PM 3280231
ER

PT J
AU Sporn, P H
   Morganroth, M L
TI Discontinuation of mechanical ventilation.
SO Clinics in chest medicine
VL 9
IS 1
BP 113
EP 26
PD 1988-Mar
PY 1988
AB The vast majority of patients who undergo mechanical ventilation are
   able to discontinue ventilatory assistance within a few days. Typically,
   patients who require only short-term mechanical ventilation do not have
   severe underlying lung disease, and the problem for which they require
   ventilatory support is most commonly rapidly reversible. In these
   patients on short-term ventilatory support, parameters of spontaneous
   ventilatory requirements and respiratory muscle strength, including
   minute ventilation, maximal voluntary ventilation, vital capacity, and
   maximal inspiratory pressure, are useful in predicting the success of
   discontinuation of mechanical ventilation. Ventilatory support can
   generally be discontinued by a variety of techniques in these patients
   without the need for weaning from the ventilator per se. The smaller
   group of patients in whom it is not possible to discontinue mechanical
   ventilation within less than 7 days comprises individuals who frequently
   have severe acute or chronic lung disease, multisystem extrapulmonary
   disease, or neuromuscular disease. After a period of prolonged
   mechanical ventilatory support, these complicated patients require a
   process of progressive weaning in which they gradually become able to
   support spontaneous ventilation. Spontaneous ventilatory parameters do
   not correlate well with weaning ability in patients on long-term
   ventilatory support. A systematic and comprehensive approach in which
   attention is focused on optimizing pulmonary and nonpulmonary factors
   that affect the weaning process provides the best chance for successful
   withdrawal of ventilatory support after long-term mechanical
   ventilation. Inadequate ventilatory drive, respiratory muscle weakness
   and fatigue, increased work of breathing, excessive CO2 production, and
   cardiac failure are potential mechanisms that may play a role in
   inhibiting successful weaning. Adverse factors relevant to each of these
   mechanisms must be addressed and corrected to whatever extent possible.
   Studies have not demonstrated the superiority of either classic T-piece
   weaning or IMV weaning methods in difficult-to-wean patients on
   long-term ventilatory support. Both techniques may be used successfully
   as long as all patient variables that may adversely affect weaning
   ability are corrected or optimized and close care and attention to the
   details of the weaning process itself are provided.(ABSTRACT TRUNCATED
   AT 400 WORDS)
TC 33
ZB 17
Z8 0
ZS 0
Z9 33
SN 0272-5231
UT MEDLINE:3280225
PM 3280225
ER

PT J
AU Vercken, J B
   Raphael, J C
   de Lattre, J
   Fromageot, C
   Fanjoux, J
TI Adult maltase acid deficiency myopathy: treatment with long-term home
   mechanical ventilation.
SO Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie
VL 42
IS 5
BP 343
EP 9
PD 1988
PY 1988
AB We report a study of an adult with a maltase acid deficiency myopathy. A
   restrictive respiratory syndrome due to respiratory muscle weakness is
   associated with paralysis of other muscular groups. In 1982 the patient
   presented with an alveolar hypoventilation, and mechanical ventilation
   was required after acute respiratory failure. The patient has received
   nocturnal mechanical ventilation by tracheostomy at home for 5 years.
   His clinical status gradually improved in parallel to amelioration of
   his respiratory condition. Functional respiratory tests improved:
   initial hypoxia-hypercapnia disappeared, vital capacity increased. The
   possible mechanisms underlying the improvement are discussed. Increase
   in pulmonary compliance is an argument to explain the functional
   improvement observed. Ventilatory response to carbon dioxide was
   abnormal whereas the ventilatory response to exercise and maxima minute
   ventilation test were normal. Results are consistent with a respiratory
   control impairment. The role of mechanical ventilation is difficult to
   assess in the improvement we observed.
TC 6
ZB 4
Z8 0
ZS 0
Z9 6
SN 0753-3322
UT MEDLINE:3056536
PM 3056536
ER

PT J
AU Schreiner, M S
   Downes, J J
   Kettrick, R G
   Ise, C
   Voit, R
TI Chronic respiratory failure in infants with prolonged ventilator
   dependency.
SO JAMA
VL 258
IS 23
BP 3398
EP 404
DI 10.1001/jama.258.23.3398
PD 1987-Dec-18
PY 1987
AB One hundred one infants with chronic respiratory failure (CRF) who
   required prolonged mechanical ventilation were cared for in the
   pediatric intensive care unit at The Children's Hospital of Philadelphia
   between January 1967 and December 1984. Chronic respiratory failure of
   infancy is a condition that requires mechanical ventilation for more
   than 28 days in the first year of life. Thirty-six children had severe
   bronchopulmonary dysplasia, 50 had congenital anomalies, and 15 had
   neuromuscular disorders. The mean duration of mechanical ventilation for
   the 101 patients was 12.3 months. Seventy-one children were alive, and
   53 (75%) of the 71 had been weaned from mechanical ventilation as of Dec
   31, 1984. Pulmonary insufficiency and cardiac failure were the
   predominant causes of death in 17 of 22 infants in the first two years
   after the onset of CRF; four of eight deaths that occurred beyond two
   years were caused by airway- and ventilator-related accidents.
   Mechanical ventilatory support was emphasized for as long as necessary
   to provide normal blood gas tensions, nutrition, growth, and development
   rather than weaning as rapidly as possible. This clinical experience
   demonstrates that it is feasible to save over 70% of infants with the
   severest forms of CRF and prolonged ventilator dependency.
TC 39
ZB 19
Z8 0
ZS 0
Z9 39
SN 0098-7484
UT MEDLINE:3682138
PM 3682138
ER

PT J
AU Maynard, F M
   Muth, A S
TI The choice to end life as a ventilator-dependent quadriplegic.
SO Archives of physical medicine and rehabilitation
VL 68
IS 12
BP 862
EP 4
PD 1987-Dec
PY 1987
AB A 17-year-old male sustained a C5/6 fracture dislocation and complete C5
   quadriplegia in a diving accident. Three days later sensory and motor
   function deteriorated and he required mechanical ventilation. Surgical
   exploration found no cause and a fusion was done. Neurologic function
   stabilized after three weeks with a C1 sensory level, no neck movement,
   and slight weakness of the tongue. Patient and family were followed
   closely by the spinal cord injury rehabilitation team from onset of
   injury. The patient was transferred to the ventilator-dependent
   pediatric rehabilitation program after ten weeks. Bowel, bladder, skin,
   and nutritional management were stabilized and taught to his parents who
   remained with him constantly. Communication was achieved with a "talking
   tracheostomy." He learned to use "Sip-n-Puff" control for driving an
   electric wheelchair and for Morse code input to a computer. He was
   passive but cooperative during hospitalization. Eight months after
   injury he was discharged to his home, which had been modified to meet
   his needs. A computer word processor, environmental control unit, and
   modified van were obtained; nursing care was provided around the clock.
   The patient enrolled in a community college course. Soon after discharge
   he contacted an attorney to explore legal actions for ending his life,
   which he considered intolerable. After obtaining medical and psychiatric
   reports, a court order was issued, which established his legal
   competence and directed people taking care of him to follow his
   directions. A few weeks later, 25 months after his injury, he privately
   said goodbye to his family, asked to be disconnected from the
   ventilator, and died. Medical and legal issues raised by this case are
   discussed.
TC 16
ZB 7
Z8 2
ZS 0
Z9 18
SN 0003-9993
UT MEDLINE:3426387
PM 3426387
ER

PT J
AU Oren, J
   Kelly, D H
   Shannon, D C
TI Long-term follow-up of children with congenital central hypoventilation
   syndrome.
SO Pediatrics
VL 80
IS 3
BP 375
EP 80
PD 1987-Sep
PY 1987
AB The long-term clinical course of six patients with congenital central
   hypoventilation syndrome is described. During the neonatal period, the
   patients had prolonged apneas and hypoventilation, in the absence of
   cardiac, pulmonary, or neuromuscular disease. After an initial period of
   respirator dependency, they became able to sustain normal gas exchange
   while awake. During sleep, however, profound hypoventilation developed,
   and tracheostomy and mechanical ventilation were required. Ventilatory
   responses to hypercapnia and hypoxia were depressed or absent and did
   not improve with time. One patient was able, at 2 years of age, to
   breathe spontaneously during sleep with only moderate hypoventilation.
   The others, now 4 to 14 years of age, still need ventilatory support
   during sleep. Complications, such as cardiac failure and hypoxic
   seizures, mostly occurred early in the course and resolved with
   correction of insufficient mechanical ventilation. Speech acquisition
   was possible with the use of a special stoma plug. All patients were
   managed at home, and with appropriate support, the parents were able to
   provide safe ventilatory care with low morbidity and no mortality.
RI Benneyworth, Brian/A-4667-2009
OI Benneyworth, Brian/0000-0002-4692-5303
TC 79
ZB 51
Z8 0
ZS 1
Z9 80
SN 0031-4005
UT MEDLINE:2442698
PM 2442698
ER

PT J
AU Tobin, M J
   Guenther, S M
   Perez, W
   Lodato, R F
   Mador, M J
   Allen, S J
   Dantzker, D R
TI Konno-Mead analysis of ribcage-abdominal motion during successful and
   unsuccessful trials of weaning from mechanical ventilation.
SO The American review of respiratory disease
VL 135
IS 6
BP 1320
EP 8
PD 1987-Jun
PY 1987
AB Respiratory muscle fatigue is considered a common cause of weaning
   failure but its detection is hampered by the lack of a satisfactory
   diagnostic test. Abdominal paradox has been proposed as a valuable
   clinical index of fatigue and thus its presence may lead to curtailment
   of weaning trials. However, sensitivity and specificity of this sign as
   a predictor of weaning outcome is unknown. We hypothesize that abnormal
   ribcage-abdominal (RC-Ab) motion is a common finding in the early stages
   of weaning and its presence does not inevitably imply an unsuccessful
   weaning outcome. We tested this hypothesis in patients undergoing a
   weaning trial: one group had a successful weaning outcome and were
   extubated (n = 10) and the other group failed the trial (n = 7). Normal
   RC-Ab motion was separately characterized in 17 healthy subjects.
   Employing a calibrated respiratory inductive plethysmograph,
   quantitative assessment of asynchrony and paradox was obtained by
   computing several indices from series of breaths at fixed time periods
   using the Konno-Mead method of analysis. During the weaning trial, both
   groups of patients displayed significant increases in asynchrony and Ab
   paradox compared to normal values. As a group, patients who failed the
   trial displayed significantly greater asynchrony and paradox of the RC
   and Ab than patients with a successful outcome. However, there was
   considerable overlap between the individual patients in the 2 study
   groups.(ABSTRACT TRUNCATED AT 250 WORDS)
TC 73
ZB 41
Z8 0
ZS 0
Z9 73
SN 0003-0805
UT MEDLINE:2954499
PM 2954499
ER

PT J
AU Greisen, G
   Munck, H
   Lou, H
TI Severe hypocarbia in preterm infants and neurodevelopmental deficit.
SO Acta paediatrica Scandinavica
VL 76
IS 3
BP 401
EP 4
DI 10.1111/j.1651-2227.1987.tb10489.x
PD 1987-May
PY 1987
AB We report significant neurological abnormality at 18 months of age in 3
   of 7 very low birth weight infants (less than or equal to 1,500 g), who
   during mechanical ventilation inadevertently became severely hypocarbic
   (arterial carbondioxide tension less than 2.0 kPa (15 mmHg)) at some
   time during the first 24 h of life. Although the number is small the
   outcome was significantly worse than the outcome in two fairly similar
   groups of infants selected as controls (p = 0.026). The infants in one
   of the control groups were also mechanically ventilated but remained
   normocapnic. Germinal layer haemorrhage (GLH) was more frequent among
   these infants compared with the severely hypocarbic infants (p = 0.022).
   The infants in the other control group was not mechanically ventilated.
   In all the severely hypocarbic infants the Bayley mental developmental
   index uncorrected for prematurity was at or below the median for the
   total sample (p = 0.01). The results suggest that neonatal cerebral
   ischaemia, for instance due to hypocarbia, is of greater prognostic
   significance than GLH.
TC 67
ZB 48
Z8 0
ZS 0
Z9 67
SN 0001-656X
UT MEDLINE:2440226
PM 2440226
ER

PT J
AU Lerman, R M
   Weiss, M S
TI Progressive resistive exercise in weaning high quadriplegics from the
   ventilator.
SO Paraplegia
VL 25
IS 2
BP 130
EP 5
PD 1987-Apr
PY 1987
AB Acutely high level quadriplegics may experience neuromuscular
   respiratory insufficiency secondary to loss of use of intercostal and
   abdominal muscles as well as partial involvement of the phrenic nerve.
   Frequently, these patients will require mechanical ventilation in the
   initial stages of their treatment. These patients may present difficulty
   with weaning off the ventilator. In addition, poor respiratory reserve
   increases the risk of episodic decompensation. We have instituted a
   progressive resistive exercise protocol (PRE) analogous to PRE commonly
   used in training skeletal muscle, to wean patients off the ventilator.
   This involves determining the patient's endurance to the development of
   fatigue while off the ventilator. Patients are re-evaluated weekly until
   they are weaned from the ventilator. Three case studies are reported in
   which this protocol was used. In addition to our standard respiratory
   therapy and physical therapy protocols, values for vital capacity and
   maximum inspiratory force at admission and post-weaning were recorded.
   After completion of the programme, none of the patients required
   re-intubation or subsequent mechanical ventilation. This method of
   diaphragm training may be useful in weaning high level quadriplegics
   from the ventilator.
TC 8
ZB 3
Z8 0
ZS 0
Z9 8
SN 0031-1758
UT MEDLINE:3588008
PM 3588008
ER

PT J
AU Sivak, E D
   Ahmad, M
   Hanson, M R
   Mitsumoto, H
   Wilbourn, A J
TI Respiratory insufficiency in adult-onset acid maltase deficiency.
SO Southern medical journal
VL 80
IS 2
BP 205
EP 8
DI 10.1097/00007611-198702000-00016
PD 1987-Feb
PY 1987
AB Although the adult form of acid maltase deficiency is characterized by
   weakness of the limb girdle muscles, weakness of the respiratory muscles
   out of proportion to that of the limb muscles may make the diagnosis
   less obvious. We present four patients aged 35 to 57 with respiratory
   muscle weakness associated with signs of cor pulmonale and symptoms of
   alveolar hypoventilation. Each had symptoms of fatigue, hypersomnolence,
   morning headache, and orthopnea, the cause of which was misdiagnosed.
   The key to diagnosis was paradoxic abdominal motion on inspiration. This
   finding, consistent with diaphragmatic paralysis, led to neurologic
   evaluation, electromyographic examination, and muscle biopsy to confirm
   the diagnosis. The symptoms of alveolar hypoventilation were reversed
   with chronic nocturnal ventilation, which assisted in rehabilitating
   some patients.
TC 5
ZB 5
Z8 0
ZS 0
Z9 5
SN 0038-4348
UT MEDLINE:3101201
PM 3101201
ER

PT J
AU Vincent, J L
   Cabolet, P
   Berre, J
   Serruys-Schoutens, E
   Kahn, R J
TI Bronchopulmonary superinfections in the critically ill.
SO Acta anaesthesiologica Belgica
VL 38
IS 1
BP 117
EP 22
PD 1987
PY 1987
AB Bacterial colonization of the airways can lead to nosocomial respiratory
   infections. The emergence of Gram-negative bacteria in the upper airways
   is usual in critical conditions. Antimicrobial therapy and especially
   bacterial adherence to the airways mucosa have been incriminated in the
   selection of Gram-negative bacteria becoming ultimately multiresistant.
   Transmission of bacteria by the hands of the ICU-personnel and
   aspiration of bacteria represent two important factors in the airway
   colonization. Bacterial clearance can simultaneously be impaired by
   debility and altered mental state. Pulmonary infections are especially
   common in peritonitis or after abdominal surgery. In a series of 30
   patients who had a complicated course after abdominal surgery, we
   observed that in all patients with acute respiratory failure, sputum
   cultus yielded at least one microorganism also recovered from cultus of
   the abdominal secretions. Acute respiratory failure was most commonly
   due to respiratory infection and carried a worse prognosis. Aspiration
   of bacteria from the gastrointestinal tract appears to represent the
   most common source of nosocomial bronchopulmonary superinfection in the
   critically ill.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0001-5164
UT MEDLINE:3591266
PM 3591266
ER

PT J
AU Hill, N S
TI Clinical applications of body ventilators.
SO Chest
VL 90
IS 6
BP 897
EP 905
DI 10.1378/chest.90.6.897
PD 1986-Dec
PY 1986
AB Interest has been increasing in providing ventilatory support in the
   home for patients with chronic respiratory failure, mainly with the use
   of positive pressure ventilation via a chronic tracheostomy. However,
   body ventilators that assist ventilation by applying intermittent
   negative or positive pressure to the thorax, abdomen, or airway without
   requiring an artificial airway, can offer distinct advantages for
   selected patients over systems requiring a permanent airway. These
   ventilators include the iron lung, portable lung (Portalung),
   pneumowrap, chest cuirass, pneumobelt, rocking bed, and positive
   pressure provided via a face or nose mask. They have successfully
   stabilized or reversed chronic hypercarbia when used intermittently in
   patients with slowly progressive chronic respiratory failure due to
   certain neuromuscular diseases and kyphoscoliosis. How they achieve this
   stabilization has not been clarified, but reversal of chronic
   respiratory muscle fatigue following periodic rest probably contributes.
   These ventilators are generally less effective than positive pressure
   ventilation through a tracheostomy and should be reserved for patients
   with relatively stable chronic respiratory failure and intact upper
   airways. However, they have the advantages of simpler operation and less
   expense, and they allow maintenance of a normal airway.
TC 71
ZB 44
Z8 0
ZS 0
Z9 71
SN 0012-3692
UT MEDLINE:3536343
PM 3536343
ER

PT J
AU Whitelaw, A
TI Death as an option in neonatal intensive care.
SO Lancet (London, England)
VL 2
IS 8502
BP 328
EP 31
PD 1986-Aug-9
PY 1986
AB Many paediatricians believe that there are circumstances in which
   infants should be allowed to die without having their lives prolonged by
   intensive care or surgery. During a four-year period, in a regional
   neonatal intensive-care unit, 75 infants were so seriously ill that
   withdrawal of treatment was discussed. 26 infants had severe acquired
   neurological damage, 26 had been born after extremely short gestation
   (25 weeks or less), and 23 had severe congenital abnormalities. The
   decision to withdraw treatment from a particular infant had to be
   unanimous among all the medical and nursing staff caring for that child
   and was based on a virtual certainty, not just of handicap, but of total
   incapacity--eg, microcephaly, spastic quadriplegia, and blindness. Of
   the 75 infants, the decision of the medical team was to withdraw
   treatment from 51. The parents of 47 infants accepted the decision and
   all these infants died. The parents of 4 infants chose continued
   intensive care, and 2 infants survived with disabilities. In the other
   24 cases, the medical decision was to continue treatment. Of these, 17
   survived and 7 died. When a thorough medical assessment had led to
   unanimous agreement among staff and parents that treatment should be
   withdrawn, its continuation on purely legal grounds is not justifiable.
AB A consultant neonatologist in the regional neonatal intensive care unit
   at London's Hammersmith Hospital contends that, when medical assessment
   of a seriously ill infant produces a prognosis of total incapacity and
   the decision to withdraw treatment is unanimously agreed upon by the
   unit staff and parents, there is no need for legal or infant care review
   committee involvement.  He supports his argument by analyzing a study of
   75 infants at Hammersmith Hospital to whom this policy was applied. 
   Withdrawal of treatment was recommended for 51 infants and implemented
   in 47, all of whom died.  Two of the four infants who were intensively
   treated at the parents' request survived, but with disabilities.  Of the
   24 infants for whom the medical decision was to continue treatment, 17
   survived, 9 with disabilities.
TC 55
ZB 31
Z8 0
ZS 1
Z9 56
SN 0140-6736
UT MEDLINE:2874336
PM 2874336
ER

PT J
AU Affleck, A T
   Lieberman, S
   Polon, J
   Rohrkemper, K
TI Providing occupational therapy in an intensive care unit.
SO The American journal of occupational therapy : official publication of
   the American Occupational Therapy Association
VL 40
IS 5
BP 323
EP 32
PD 1986-May
PY 1986
AB This paper includes information required for establishing and conducting
   an occupational therapy program in an intensive care unit. Three common
   problems in the intensive care unit are immobility and prolonged bed
   rest, sensory deprivation and stress, and prolonged mechanical
   ventilation. The resolution of these rehabilitation problems through
   occupational therapy intervention is addressed.
TC 1
ZB 0
Z8 0
ZS 0
Z9 1
SN 0272-9490
UT MEDLINE:3717268
PM 3717268
ER

PT J
AU Watson, D C Jr
   Bradley, L M
   Midgley, F M
   Scott, L P
TI Costs and results of cardiac operations in infants less than 4 months
   old. Are they worthwhile?
SO The Journal of thoracic and cardiovascular surgery
VL 91
IS 5
BP 667
EP 73
PD 1986-May
PY 1986
AB From 1979 through 1983, 328 of 1,388 pediatric cardiac operations
   involved patients undergoing their first procedure at less than 4 months
   of age. Of these, 220 patients had 265 nonductal procedures, and their
   case histories are reviewed for results and total hospital cost. Initial
   operative mortality was 20% (43 patients). Infants with lower operative
   age and operative weight tended to have closed procedures. Mortality and
   cure were not related to gestational age, birth weight, age at
   operation, number of operations, or type of operation. Lower operative
   weight was associated with a greater mortality. Evaluated survivors (142
   patients) were followed for a mean of 24 months. Fifteen percent (33
   patients) died during follow-up. Of survivors, 80% (114 patients) had
   optimized general health; a subset of 29% had normal cardiac function,
   and 17% were cured. Lower birth weight was associated with curable
   lesions and normalcy (p less than 0.04). Longer preoperative hospital
   stay and lower weight at operation were associated with higher hospital
   cost (p less than 0.05). Hospital cost was not related to type of
   operation, gestational age, birth weight, age at operation, mortality,
   cure, or normalcy. Acquired neurologic dysfunction and long-term
   disability were uncommon. The mean hospital cost for surviving infants
   was +80,000 (1984 dollars). Effective hospital cost per survivor was
   +110,000. Mortality, cure, and normal function after cardiac operations
   in infants less than 4 months of age were not related to gestational
   age, birth weight, or age at operation. Mortality was higher in patients
   with a lower weight at operation. Separation into distinct fiscal cost
   groups is not reasonable in this series. Because most survivors are in
   normal or optimized cardiac health, intensive cardiovascular care in
   this population is justified.
TC 9
ZB 5
Z8 0
ZS 0
Z9 9
SN 0022-5223
UT MEDLINE:3702475
PM 3702475
ER

PT J
AU Covert, C R
   Brodie, S B
   Zimmerman, J E
TI Weaning failure due to acute neuromuscular disease.
SO Critical care medicine
VL 14
IS 4
BP 307
EP 8
DI 10.1097/00003246-198604000-00015
PD 1986-Apr
PY 1986
AB Two patients who required ventilatory support for acute pulmonary
   disease failed to be weaned when they developed the Guillain-Barre
   syndrome. Respiratory muscle weakness was a major sign of their acute
   neuromuscular disease because the manifestations of critical illness
   obscured the progressive paralysis. Both cases illustrate the difficulty
   in diagnosing acute neuromuscular syndromes in critically ill patients.
TC 8
ZB 6
Z8 0
ZS 0
Z9 8
SN 0090-3493
UT MEDLINE:3082596
PM 3082596
ER

PT J
AU Ropper, A H
TI Severe acute Guillain-Barre syndrome.
SO Neurology
VL 36
IS 3
BP 429
EP 32
PD 1986-Mar
PY 1986
AB Six of 58 consecutive patients with Guillain-Barre syndrome had an
   acute, severe, and prolonged initial illness, with quadriplegia in 2 to
   5 days and mechanical ventilation for over 2 months. The average times
   in the ICU, on a ventilator, in the hospital, and in rehabilitation were
   62, 141, 157, and 148 days, respectively. Four were still bedbound and
   ventilated at 6 months. Three (5%) were limited to a chair, and three
   walked unsteadily or required foot splints 2 to 3 years after onset.
   Only 2 of 13 other ventilated patients with slower initial progression
   of weakness, and none of 38 nonventilated patients were chairbound 6
   months after onset (1 died at 2 months); all were walking independently
   by a year. Quadriplegia appearing over 2 to 5 days is associated with
   the most severe and prolonged weakness and, in some patients, leads to a
   permanent chairbound state. Improvement stops at 1 1/2 to 2 years.
TC 78
ZB 47
Z8 0
ZS 0
Z9 78
SN 0028-3878
UT MEDLINE:3951717
PM 3951717
ER

PT J
AU Maayan, C
   Springer, C
   Armon, Y
   Bar-Yishay, E
   Shapira, Y
   Godfrey, S
TI Nemaline myopathy as a cause of sleep hypoventilation.
SO Pediatrics
VL 77
IS 3
BP 390
EP 5
PD 1986-Mar
PY 1986
AB Two siblings, a 14.5-year-old boy and his 11.5-year-old sister, with
   congenital nemaline myopathy presented with severe respiratory failure
   and, in the case of the older patient, with cor pulmonale and systemic
   hypertension. The children were treated initially by continuous
   mechanical ventilation, but after a few weeks they only required
   ventilation at night. At the start of treatment, both were found to have
   a decreased ventilatory response to CO2 which apparently improved during
   4 to 5 years of follow-up treatment. It has not been possible to wean
   them from nocturnal mechanical ventilation, but during the daytime they
   attend school and function almost normally. It is postulated that
   respiratory failure in nemaline myopathy may not be related to the
   severity of the muscle weakness but may result from a disturbance of the
   feedback required for normal control of breathing.
TC 21
ZB 13
Z8 0
ZS 0
Z9 22
SN 0031-4005
UT MEDLINE:3081871
PM 3081871
ER

PT J
AU Greisen, G
TI Cerebral blood flow in preterm infants during the first week of life.
SO Acta paediatrica Scandinavica
VL 75
IS 1
BP 43
EP 51
DI 10.1111/j.1651-2227.1986.tb10155.x
PD 1986-Jan
PY 1986
AB Forty-two preterm infants of 28-33 weeks of gestation were studied once
   during the first week of life by 133-Xenon clearance after intravenous
   injection to estimate global cerebral blood flow. Count rates detected
   over the chest were corrected for chest wall contribution and used as
   arterial input function. A neonatal blood-brain partition coefficient of
   Xenon was used for the calculation of a mean flow estimator
   (CBF-infinity). The technique was internally validated by use of
   differently obtained arterial input functions. In 11 infants without
   respiratory distress, CBF-infinity was 19.8 ml/100 g/min +/- 5.3 SD. In
   24 infants treated with mechanical ventilation CBF-infinity was 11.8
   ml/100 g/min +/- 3.2 SD. In 7 infants treated with continuous positive
   airway pressure CBF-infinity was 21.3 ml/100 g/min +/- 12.0 SD. When the
   reduction of CBF-infinity associated with mechanical ventilation was
   taken into account, the 9 infants with subependymal/intraventricular
   haemorrhage had increased CBF-infinity. The effects of gestational age,
   birthweight, mode of delivery, postnatal age, mean arterial blood
   pressure, PaCO2, blood haemoglobin and phenobarbitone medication were
   also analysed and found inconsistent. In conclusion, CBF was lower than
   expected and in infants requiring mechanical ventilation the values were
   lower still.
TC 112
ZB 87
Z8 0
ZS 0
Z9 113
SN 0001-656X
UT MEDLINE:2420149
PM 2420149
ER

PT J
AU Colbert, A P
   Schock, N C
TI Respirator use in progressive neuromuscular diseases.
SO Archives of physical medicine and rehabilitation
VL 66
IS 11
BP 760
EP 2
PD 1985-Nov
PY 1985
AB A survey was conducted to acquire information on the current pattern of
   respiratory device usage for patients with progressive neuromuscular
   diseases. Questionnaires were sent to 240 directors of Muscular
   Dystrophy Association (MDA) clinics. Of the 132 respondents, 32 (24%)
   physicians provide no respiratory support systems, 44 (33%) prescribe
   such systems routinely, and 56 (42%) provide the devices under
   specialized circumstances. A wide variety of negative and positive
   pressure ventilators are employed for patients having diseases such as
   amyotropic lateral sclerosis, Duchenne muscular dystrophy, spinal
   muscular atrophy. In the MDA clinics responding, 495 patients were found
   to be receiving some form of assisted ventilation. Of that number, 214
   (43%) have permanent tracheostomies. We conclude that ventilators are
   being supplied to individuals with progressive neuromuscular disorders
   throughout the USA. However, there appear to be no standardized patient
   selection process or established protocol for respirator use in such
   cases.
TC 26
ZB 17
Z8 0
ZS 0
Z9 26
SN 0003-9993
UT MEDLINE:3904670
PM 3904670
ER

PT J
AU Swartz, M A
   Marino, P L
TI Diaphragmatic strength during weaning from mechanical ventilation.
SO Chest
VL 88
IS 5
BP 736
EP 9
DI 10.1378/chest.88.5.736
PD 1985-Nov
PY 1985
AB Respiratory muscle weakness is considered to be a factor in the
   inability to wean from mechanical ventilation. To assess this
   possibility, the present study examined the mechanical behavior of the
   diaphragm by measuring the change in transdiaphragmatic pressure (delta
   Pdi) during weaning. Nine "T-piece" weanings were carried out in seven
   patients with prior weaning failure and were terminated with the
   development of hypercapnia, hypoxemia, or severe tachypnea. Serial
   measurements of delta Pdi during these weans revealed that (1) in no
   case was there a decrease in delta Pdi at termination of weaning, and
   (2) in the subgroup of patients whose weaning failed because of
   hypercapnia, the increase in arterial carbon dioxide tension (mean
   increase of 12 mm Hg) was associated with a significant increase in
   delta Pdi, from the beginning (21.1 +/- 12.1 cm H2O) to the end (24.8
   +/- 13.4 cm H2O) of the trial (p less than 0.05). We conclude that
   failure to wean in these patients, in particular the development of
   carbon dioxide retention, was not due to failure of the diaphragm as a
   pressure generator.
TC 25
ZB 17
Z8 1
ZS 0
Z9 26
SN 0012-3692
UT MEDLINE:3931989
PM 3931989
ER

PT J
AU Millis, R M
   Wood, D H
   Trouth, C O
TI Amelioration of hypoxemia by neuromuscular blockade following brain
   injury.
SO Life sciences
VL 37
IS 8
BP 739
EP 47
DI 10.1016/0024-3205(85)90544-2
PD 1985-Aug-26
PY 1985
AB Brain injury has been commonly associated with respiratory failure and
   uncontrolled skeletal muscle activity. In the present study,
   neuromuscular (NM) blockade induced by injection of succinylcholine
   hydrochloride was used to block uncontrolled muscle contractions in dogs
   with brain injury caused by rapid elevation of intracranial pressure
   (ICP). Decerebrate posturing, a decrease in value (mean +/- SEM) of
   arterial oxygen tension (Pa02) of 26 +/- 1 torr, and an increase in
   arterial carbon dioxide tension (PaCO2) of 11 +/- 1 torr occurred in the
   dogs, which were supported by mechanical ventilation. The arterial
   hypoxemia developed independently of the decerebration; however, dogs
   that demonstrated decerebrate posturing exhibited significantly larger
   decreases in Pa02 than dogs that did not (P less than 0.01). NM blockade
   ameliorated the effects of elevated ICP on the arterial blood gases;
   i.e., the amount of hypoxemia in decerebrate dogs was significantly less
   in dogs subjected to NM blockade than in dogs not subjected to NM
   blockade. It is concluded that uncontrolled skeletal muscle activity
   that exacerbates arterial hypoxemia associated with brain injury is
   ameliorated by use of NM blockade as a therapeutic adjunct to mechanical
   ventilation.
TC 2
ZB 2
Z8 0
ZS 0
Z9 2
SN 0024-3205
UT MEDLINE:4021737
PM 4021737
ER

PT J
AU Shanks, A B
   Long, T
   Aitkenhead, A R
TI Prolonged neuromuscular blockade following vecuronium. A case report.
SO British journal of anaesthesia
VL 57
IS 8
BP 807
EP 10
DI 10.1093/bja/57.8.807
PD 1985-Aug
PY 1985
AB Vecuronium was used to provide muscle relaxation in a patient who
   subsequently developed prolonged neuromuscular blockade (8 h) after
   anaesthesia. The aetiology of this condition, and the possible role of
   vecuronium, are discussed.
TC 16
ZB 11
Z8 0
ZS 0
Z9 16
SN 0007-0912
UT MEDLINE:2861841
PM 2861841
ER

PT J
AU Ip, M S
   So, S Y
   Lam, W K
TI Respiratory problems in myasthenia gravis.
SO Annals of the Academy of Medicine, Singapore
VL 14
IS 3
BP 442
EP 5
PD 1985-Jul
PY 1985
AB We evaluated our experience involving 27 patients with myasthenia gravis
   with particular reference to the various respiratory problems
   encountered. These included restriction of ventilation, respiratory
   tract infections, aspiration due to bulbar weakness, respiratory failure
   requiring mechanical ventilation, and post-thymectomy pulmonary
   complications.
TC 2
ZB 2
Z8 0
ZS 0
Z9 2
SN 0304-4602
UT MEDLINE:4073811
PM 4073811
ER

PT J
AU Marini, J J
   Capps, J S
   Culver, B H
TI The inspiratory work of breathing during assisted mechanical
   ventilation.
SO Chest
VL 87
IS 5
BP 612
EP 8
DI 10.1378/chest.87.5.612
PD 1985-May
PY 1985
AB We quantified the mechanical work of breathing in six normal subjects
   during assisted mechanical ventilation. Using two volume-cycled
   ventilators of different design, we investigated the influence of minute
   ventilation (VE) and machine settings of trigger sensitivity and flow
   during CO2-driven hyperventilation to moderate and high levels (12-24
   L/min). Work estimates were derived from plots of esophageal and airway
   pressure against inflation volume. Peak flow and trigger sensitivity
   were important determinants of the energy expended, and for each
   combination of machine settings the work done by the subject per liter
   of ventilation increased with VE. During assisted ventilation the
   subject expended energy equivalent to 33-50 percent of the work of
   passive inflation, even under the most favorable conditions of VE,
   sensitivity and flow. Under the least favorable conditions of VE,
   sensitivity and flow, the subject's inspiratory work of breathing
   substantially exceeded the energy needed by the ventilator to inflate
   the passive thorax. These observations imply that exertion of the
   respiratory muscles continues throughout inflation during assisted
   mechanical ventilation and call attention to the possibility that
   inappropriate selection of ventilatory mode or machine settings may
   contribute to respiratory muscle fatigue and dyspnea.
TC 161
ZB 94
Z8 1
ZS 1
Z9 163
SN 0012-3692
UT MEDLINE:3987373
PM 3987373
ER

PT J
AU Splaingard, M L
   Frates, R C Jr
   Jefferson, L S
   Rosen, C L
   Harrison, G M
TI Home negative pressure ventilation: report of 20 years of experience in
   patients with neuromuscular disease.
SO Archives of physical medicine and rehabilitation
VL 66
IS 4
BP 239
EP 42
DI 10.1016/0003-9993(85)90157-1
PD 1985-Apr
PY 1985
AB Twenty years of experience using negative pressure devices (NPD) at home
   to ventilate 40 patients with neuromuscular disease is presented. The
   purpose of the study was to determine the costs, complications, and
   clinical outcome of this form of respiratory support, and to ascertain
   the reasons for failure to institute effective negative pressure
   ventilation (NPV) in nine patients. Emerson tank respirators, used
   mainly to rest respiratory muscles at night, and intermittent positive
   pressure breathing machines were used by 98% of patients at an average
   equipment cost of +2,700 annually. Patients in whom NPV was initiated on
   an elective rather than emergent basis saved an average of +12,000
   during their initial hospitalization. Life table analysis shows a
   five-year survival of 76%, and a 10-year survival of 61%. Complications
   were minor and occurred at an average rate of less than one per year per
   patient at home on NPV. Failure to achieve satisfactory NPV in nine
   patients was associated with age (six patients were younger than 3 years
   of age), or severe thoracocervical scoliosis, which prevented proper
   fitting of the NPD. For reasons of safety, economy, and quality of life,
   NPV at home is the preferred treatment for patients having neuromuscular
   disease who need respiratory assistance.
RI Splaingard, Mark/D-9206-2012
TC 79
ZB 47
Z8 0
ZS 0
Z9 79
SN 0003-9993
UT MEDLINE:3885906
PM 3885906
ER

PT J
AU d'Empaire, G
   Hoaglin, D C
   Perlo, V P
   Pontoppidan, H
TI Effect of prethymectomy plasma exchange on postoperative respiratory
   function in myasthenia gravis.
SO The Journal of thoracic and cardiovascular surgery
VL 89
IS 4
BP 592
EP 6
PD 1985-Apr
PY 1985
AB The effect of prethymectomy plasma exchange on postoperative mechanical
   ventilation requirement and length of stay in the intensive care unit
   were studied retrospectively in 37 patients with myasthenia gravis. We
   found a significantly decreased time on mechanical ventilation (mean
   1.02 +/- 0.40 versus 3.43 +/- 0.60 days) and a shorter stay in the
   intensive care unit (mean 3.09 +/- 0.99 versus 5.15 +/- 0.66 days) for
   11 patients with respiratory weakness who were treated with preoperative
   plasma exchange compared with 26 patients who did not receive plasma
   exchange. Patients with respiratory weakness who received prethymectomy
   plasma exchange required less time on mechanical ventilation (mean 1.02
   +/- 0.40 versus 2.73 +/- 0.88 days) and a shorter stay in the intensive
   care unit (mean 3.09 +/- 0.99 versus 4.46 +/- 1.08 days) than those
   patients without respiratory weakness who did not receive plasma
   exchange. Eleven patients met the criteria for plasma exchange but did
   not receive it. They required significantly more time on mechanical
   ventilation (mean 4.43 +/- 0.94 versus 1.02 +/- 0.40 days) and in the
   intensive care unit (mean 6.09 +/- 0.86 versus 3.09 +/- 0.99 days) than
   patients who received plasma exchange. Our results indicate that
   patients with severe forms of myasthenia gravis treated with
   prethymectomy plasma exchange require less mechanical ventilation and
   less time in the intensive care unit postoperatively.
TC 26
ZB 12
Z8 0
ZS 2
Z9 27
SN 0022-5223
UT MEDLINE:3982061
PM 3982061
ER

PT J
AU Izuora, G I
TI Aetiology of mental retardation in Nigerian children around Enugu.
SO The Central African journal of medicine
VL 31
IS 1
BP 13
EP 6
PD 1985-Jan
PY 1985
AB This study identifies the pattern of mental retardation in 291 Nigerian
   children in Enugu.  In 33.99% the etiology of mental retardation was
   congenital (present at birth), in 43.99% the cause was acquired and in
   the rest 23.02% no definite cause could be identified.  The results,
   problems of diagnosis and management in relation to Nigeria are
   discussed.  Massive support from the Government for improving the
   maternal and child welfare services as well as care for the mentally
   retarded children is solicited.  The high % of cases due to birth trauma
   (23.38%) and severe neonatal jaundice (8.59%) reflects the quality of
   maternal and child welfare services as well as the obstetric care in the
   area.  Full use of the available services and intensive health education
   in towns and villages could be most valuable.  The increasing
   association of mental retardation with epilepsy in Nigerian children has
   been noted in other studies in this hospital.  In the present study,
   epilepsy was found to cause mental retardation in 12.5% of cases in the
   acquired group and about 5% of the total number of cases.  Malnutrition
   as a cause of defective mental development has been noted by several
   authors.  However, in the present study, malnutrition could not be
   identified as a primary cause of mental retardation.  In the congenital
   group, the high representation of Down's syundrome is striking. 
   Children with this syndrome make up about 42.71% of the congenital group
   and 14% of the overall number of mentally retarded.  The majority of
   mothers were over 35 and multiparous.  The care of the mentally retarded
   child in Nigeria leaves much to be desired.  Except for a few states,
   there are no homes or centers for the furthering of these handicapped
   children.  Since the inception of the Pediatric Neurology Clinic in this
   hospital, efforts have focused on diagnosis and assessment.  Some
   children aged 5-12 years have been referred to a privately-owned
   Therapeutic Day Center in Enugu for early furthering and play therapy.
TC 4
ZB 0
Z8 0
ZS 0
Z9 4
SN 0008-9176
UT MEDLINE:3986890
PM 3986890
ER

PT J
AU Schmidt-Nowara, W W
   Altman, A R
TI Atelectasis and neuromuscular respiratory failure.
SO Chest
VL 85
IS 6
BP 792
EP 5
DI 10.1378/chest.85.6.792
PD 1984-Jun
PY 1984
AB Atelectasis occurred in 17 of 20 patients treated with assisted
   ventilation for respiratory failure due to neuromuscular disease. A
   retrospective review of chest roentgenograms and medical records
   indicated that atelectasis occurs early in the course of respiratory
   failure and has a predilection for the lower lobes. Atelectasis was
   associated with infection and persisted despite therapy, often for more
   than four weeks. This study demonstrates that atelectasis in this
   condition still occurs frequently despite modern practices of mechanical
   ventilatory assistance. Infection, occurring soon after intubation, is
   identified as the principal cofactor.
TC 23
ZB 9
Z8 0
ZS 0
Z9 24
SN 0012-3692
UT MEDLINE:6723392
PM 6723392
ER

PT J
AU Schmidt, C D
   Elliott, C G
   Carmelli, D
   Jensen, R L
   Cengiz, M
   Schmidt, J C
   Tolman, E D
   Clemmer, T P
TI Prolonged mechanical ventilation for respiratory failure: a cost-benefit
   analysis.
SO Critical care medicine
VL 11
IS 6
BP 407
EP 11
DI 10.1097/00003246-198306000-00001
PD 1983-Jun
PY 1983
AB To define the costs and benefits associated with prolonged mechanical
   ventilation, we studied retrospectively the records of 137 consecutive
   patients who required at least 48 h of ventilator support. The patients
   were physiologically unstable and required intensive care. Causes of
   respiratory failure included pulmonary diseases, post-operative
   complications, neuromuscular diseases, cardiac dysfunction, and GI
   disease. Forty-nine (36%) patients survived the hospitalization, and 38
   (28%) patients were alive 3 yr after receiving prolonged mechanical
   ventilation. The mean total hospital cost was +16,930/patient (U.S.
   dollars, 1976-1977). The cost-benefit averaged +1826/yr of extended
   life. These costs varied from +460/yr of extended life for patients with
   respiratory failure complicating asthma to +8026/yr for patients with
   cardiac dysfunction. The cost-benefit ratio increased sharply for men
   older than 56 yr and for women older than 75 yr. These data document the
   importance of the basic disease process and the patient's age in the
   cost-benefit relationship.
TC 37
ZB 16
Z8 0
ZS 0
Z9 37
SN 0090-3493
UT MEDLINE:6406144
PM 6406144
ER

PT J
AU Cohen, R S
   Stevenson, D K
   Malachowski, N
   Ariagno, R L
   Kimble, K J
   Hopper, A O
   Johnson, J D
   Ueland, K
   Sunshine, P
TI Favorable results of neonatal intensive care for very low-birth-weight
   infants.
SO Pediatrics
VL 69
IS 5
BP 621
EP 5
PD 1982-May
PY 1982
AB From 1961 to 1976, 229 infants with birth weights ranging from 751 to
   1,000 gm were admitted to the Stanford University Hospital Intensive
   Care Nursery. The overall neonatal mortality for these infants was 63%
   (144/229), and there were ten late deaths. Before 1967, no infant in
   this group who required mechanical ventilation survived; thereafter, 30%
   (34/114) of the ventilated patients survived. Of the 75 long-term
   survivors 60 participated in a high-risk infant follow-up program; these
   included 23 infants who had received mechanical ventilation. The mean
   birth weight of these infants was 928 +/- 67 (SD) gm. Seventeen children
   (28%) had significant morbidity: seven (12%) with severe handicaps and
   ten (17%) with moderate handicaps. During this same period, seven
   infants weighing less than 750 gm at birth were also observed. The three
   infants who had not required ventilatory support thrived; the other four
   infants had required respirators and were significantly handicapped.
   More recently, neonatal mortality for infants with birth weights from
   751 to 1,000 gm has improved: for 1977 to 1980, it was 28% (33/118).
   Furthermore, neonatal mortality for ventilated infants in this weight
   group was 27% (26/95). These data indicate an improved prognosis for
   very low-birth-weight infants, even with ventilatory support.
TC 38
ZB 25
Z8 0
ZS 0
Z9 38
SN 0031-4005
UT MEDLINE:7079021
PM 7079021
ER

PT J
AU Macklem, P T
TI The diaphragm in health and disease.
SO The Journal of laboratory and clinical medicine
VL 99
IS 5
BP 601
EP 10
PD 1982-May
PY 1982
AB The diaphragm consists of two separate muscles, the costal and crural
   parts, with different segmental innervation and different action on the
   rib cage. Diaphragmatic endurance is determined by the balance between
   energy supply and demand. Both an increase in demand and a decrease in
   supply of energy lead to diaphragmatic fatigue. Under conditions of
   reduced O2 transport to the body, the inspiratory muscles may command a
   disproportionate amount of the total body O2 consumption, particularly
   if the work of breathing is increased. Their energy demands may thus
   contribute significantly to the pathogenesis of cardiogenic shock and
   lactic acidosis. Inspiratory muscle fatigue can be diagnosed by
   observing and palpating: (1) abdominal paradox, a fall in abdominal
   pressure and an inward displacement of the abdomen during inspiration,
   and (2) respiratory alternans, a variation in abdominal pressure changes
   from breath to breath, reflected in variations in the inspiratory
   movements of rib cage and abdomen. Treatment consists in decreasing
   energy demands and increasing supplies. Artificial ventilation should be
   considered to accomplish the former. Methyl xanthines improve
   diaphragmatic contractility and specific diaphragmatic training programs
   improve diaphragmatic endurance.
TC 12
ZB 7
Z8 0
ZS 0
Z9 12
SN 0022-2143
UT MEDLINE:7069265
PM 7069265
ER

PT J
AU Bray, R J
   Morrell, P
TI A follow-up of the survivors of mechanical ventilation in a paediatric
   intensive care unit.
SO Intensive care medicine
VL 8
IS 4
BP 163
EP 8
DI 10.1007/BF01725732
PD 1982
PY 1982
AB Fifty-eight long-term survivors of mechanical ventilation have been
   traced and examined for evidence of auditory, visual, behavioural,
   developmental and central nervous system abnormalities. There were four
   children with serious neurological or intellectual handicaps, the causes
   of which did not seem to be related to deficiencies of their ventilator
   treatment but rather to events preceding ventilation or to the disease
   which had necessitated ventilation. There were an additional eight
   children who may have some intellectual damage. The occurrence of
   convulsions or hypoxic episodes during or preceding the period of
   treatment was significantly more common among the 12 children with a
   poor outcome, than those with a good outcome.
TC 0
ZB 0
Z8 0
ZS 0
Z9 0
SN 0342-4642
UT MEDLINE:6181111
PM 6181111
ER

PT J
AU Coradello, H
   Ponhold, W
   Lubec, G
   Pollak, A
TI Disappearance of bowel gas in newborn infants on mechanical ventilation.
SO Pediatric radiology
VL 12
IS 1
BP 11
EP 4
DI 10.1007/BF01221704
PD 1982
PY 1982
AB Loss of bowel gas was observed in 18 out of 49 neonates on mechanical
   ventilation (37%). Its occurrence was correlated to the outcome and to
   the use of sedative or neuromuscular paralysing drugs. None of the
   babies had gastrointestinal disorders requiring surgical intervention. A
   gasless abdomen was found in 6 our of 26 surviving neonates (23%) and in
   12 out of 23 neonates (52%) not surviving the respiratory illness.
   Absence of intestinal gas in unsedated or unparalysed babies (23%) as
   well as in Alodan treated babies (19%) was found with nearly equal
   frequency whereas its occurrence after neuromuscular paralysation with
   Alloferin was significantly higher (91%). Disappearance of intestinal
   gas pattern despite, normal gastrointestinal patency, occurring in
   mechanically ventilated neonates severely affected by respiratory
   distress of varying origin of after neuromuscular drug paralysation
   should be recognized.
TC 3
ZB 1
Z8 0
ZS 0
Z9 3
SN 0301-0449
UT MEDLINE:6460960
PM 6460960
ER

PT J
AU Ruiz, M P
   LeFever, J A
   Hakanson, D O
   Clark, D A
   Williams, M L
TI Early development of infants of birth weight less than 1,000 grams with
   reference to mechanical ventilation in newborn period.
SO Pediatrics
VL 68
IS 3
BP 330
EP 5
PD 1981-Sep
PY 1981
AB Growth, development, and neurologic status were assessed at 1 year of
   age in 38 infants of birth weight less than 1,000 gm who were born in
   1976 through 1978. Twenty had received mechanical ventilation as
   newborns, and this group had a significantly higher incidence of
   respiratory distress syndrome, seizures, cardiac arrest,
   bronchopulmonary dysplasia, and retrolental fibroplasia than those not
   ventilated. The ventilated infants had a high incidence (70%) of
   bronchopulmonary dysplasia and of retrolental fibroplasia (20% grade III
   or IV). Seven of eight infants with severe developmental delay (greater
   than 2 SD), six of nine with moderate delay (greater than 1 SD), and
   seven of eight with neurologic disability had received ventilation.
   There was no difference in growth between the ventilated and
   nonventilated children. Of the total group, 53% showed no problems.
TC 70
ZB 53
Z8 0
ZS 0
Z9 70
SN 0031-4005
UT MEDLINE:6168997
PM 6168997
ER

PT J
AU Aubier, M
   Trippenbach, T
   Roussos, C
TI Respiratory muscle fatigue during cardiogenic shock.
SO Journal of applied physiology: respiratory, environmental and exercise
   physiology
VL 51
IS 2
BP 499
EP 508
PD 1981-Aug
PY 1981
AB The effect of cardiogenic shock (tamponade) on respiratory muscles
   performance was studied in 13 dogs breathing spontaneously. These 13
   dogs were compared with 7 dogs artificially ventilated and paralyzed.
   Cardiac output amounted in both groups to 25-35% of the control value
   and was maintained constant. None of the dogs were hypoxic. All the
   spontaneously breathing dogs died on the average 140 +/- 15 min after
   the onset of cardiogenic shock, whereas the seven dogs artificially
   ventilated were all alive after 3 h and then killed. Death in the
   spontaneously breathing dogs was secondary to respiratory failure.
   Transdiaphragmatic pressure increased during the 1st h by 152 +/- 25% of
   control and then decreased by 286 +/- 18% in relation to the peak value
   before the death of the animals. No major changes in the mechanical
   properties of the respiratory system occurred. The decrease in
   transdiaphragmatic pressure occurred despite a marked increase per
   breath in the amplitude of the integrated electrical activity of the
   diaphragm and of the phrenic nerve. It is concluded that the ventilatory
   failure of cardiogenic shock is due to an impairment of the contractile
   process of the respiratory muscles. Artificial ventilation avoids
   respiratory failure and prolongs survival, which may bear important
   therapeutic implications.
TC 263
ZB 176
Z8 1
ZS 3
Z9 267
SN 0161-7567
UT MEDLINE:6790504
PM 6790504
ER

PT J
AU Kafer, E R
   Sugioka, K
TI Respiratory and cardiovascular responses to hypoxemia and the effects of
   anesthesia.
SO International anesthesiology clinics
VL 19
IS 3
BP 85
EP 122
DI 10.1097/00004311-198119030-00008
PD 1981
PY 1981
AB The normoxic ventilatory drive contributes to the normal level of
   ventilation, and the hypoxic ventilatory drive contributes to the
   maintenance of adequate gas exchange in the presence of
   ventilation/blood flow maldistribution and increased mechanical load to
   breathing. This respiratory drive arises principally from stimuli at the
   carotid chemoreceptors. The reflex cardiovascular responses to hypoxia
   also contribute to the delivery of O2 to vital organs, and their
   efficacy depends on the integrity of the respiratory response and the
   autonomic nervous system as well as the function of the vascular system.
   Prolonged exposure to hypoxemia from altitude, cyanotic congenital heart
   disease, and chronic pulmonary disease impair the ventilatory response
   to hypoxia. In addition, the respiratory and cardiovascular responses to
   hypoxemia are impaired by familial or acquired abnormalities of the
   autonomic effector system. There is growing evidence that impaired
   respiratory response to hypoxemia is a major factor in recurrent
   respiratory failure in obesity, obstructive pulmonary  disease,
   idiopathic or familial "hypoventilation," and contributes to
   disturbances in oxygenation during sleep [152, 189, 192, 202]. Although
   the ventilatory response to hypoxemia was traditionally thought to be
   resistant to the effects of inhalational anesthetics, barbiturates, and
   narcotics, there is abundant evidence that in fact the ventilatory
   response to hypoxia is more sensitive to depression by drugs than the
   ventilatory response to CO2. In addition, the hemodynamic responses to
   hypoxia are modified by anesthesia and anesthetic techniques. The
   clinical implications of these observations are wide. The ventilatory
   and cardiovascular response to hypoxemia will be altered, and usually
   depressed by age, disease processes, premedicant and anesthetic drugs,
   and autonomic blocking drugs. The cardiovascular responses will  be
   modified indirectly by altered ventilatory control due to neuromuscular
   blocking drugs and controlled ventilation. Thus, not only will the
   responses to hypoxemia be depressed by anesthesia but the early clinical
   hemodynamic signs will be modified or absent, or indeed the
   cardiovascular response will further impair oxygen delivery.
   Furthermore, it is not only anesthetic doses that impair the reflex
   respiratory responses, but also subanesthetic doses of inhalational
   anesthetics and premedicant doses of barbiturates and narcotics. Hence
   the patient in the perioperative period continues to have impaired
   respiratory response to hypoxemia. As anesthetic and surgical care
   extends to older patients, patients with systemic disease, and
   recipients of cardiovascular peripheral and central drugs, the clinical
   implications of the impairment of ventilatory and cardiovascular
   responses to hypoxia, and the maintenance of organ and system function,
   escalate. Only a few hesitant steps have been taken into this vast arena
   of clinical and experimental research.
TC 5
ZB 5
Z8 0
ZS 0
Z9 5
SN 0020-5907
UT MEDLINE:7026455
PM 7026455
ER

PT J
AU Greenberg, C
   Davies, S
   McGowan, T
   Schorer, A
   Drage, C
TI Acute respiratory failure following severe arsenic poisoning.
SO Chest
VL 76
IS 5
BP 596
EP 8
DI 10.1378/chest.76.5.596
PD 1979-Nov
PY 1979
AB A 47-year-old man had an episode of severe respiratory failure after
   acute intoxication with arsenic. Features of the initial clinical
   presentation included nausea, vomiting, and diarrhea, acute psychosis,
   diffuse skin rash, and marked pancytopenia. A peripheral neuropathy then
   developed which resulted in severe weakness of all muscles of the limbs,
   the shoulder and pelvis girdles, and the trunk. The neuropathy continued
   to progress despite treatment with dimercaprol (BAL in oil). Five weeks
   after the initial exposure, the patient was no longer able to maintain
   adquate ventilation and required mechanical ventilatory support.
   Improvement in the patient's neuromuscular status permitted successful
   weaning from the ventilator after one month of mechanical ventilation.
   Long-term follow-up revealed no further respiratory difficulty and slow
   improvement in the strength of the peripheral muscles.
TC 7
ZB 6
Z8 0
ZS 0
Z9 7
SN 0012-3692
UT MEDLINE:227646
PM 227646
ER

PT J
AU Marriage, K J
   Davies, P A
TI Neurological sequelae in children surviving mechanical ventilation in
   the neonatal period.
SO Archives of disease in childhood
VL 52
IS 3
BP 176
EP 82
PD 1977-Mar
PY 1977
AB The incidence of mental defect, visual and hearing disability, major
   neurological handicap, and such minor neurological handicap as can be
   detected on examination at 2--9 years without formal intelligence
   testing, is presented among survivors of neonatal mechanical ventilation
   at Hammersmith Hospital between the years 1966--1973 inclusive. 77(21%)
   of 367 children survived, over three-quarters of them being born
   elsewhere. 3 died before the age of 6 months, 2 suddenly and
   unexpectedly at home, the third accidentally. 1 child was lost to follow
   up. 11 (15%) of the remaining 73 children had neurological sequelae as
   defined. In two-thirds this was moderate to severe. Spastic diplegia may
   no longer be the commonest form of cerebral palsy among those of low
   birthweight, particularly those surviving severe neonatal illness.
TC 25
ZB 16
Z8 0
ZS 0
Z9 25
UT MEDLINE:848995
PM 848995
ER

PT J
AU Pruitt, B A Jr
   Erickson, D R
   Morris, A
TI Progressive pulmonary insufficiency and other pulmonary complications of
   thermal injury.
SO The Journal of trauma
VL 15
IS 5
BP 369
EP 79
PD 1975-May
PY 1975
AB Progressive pulmonary insufficiency appears to be a universal response
   to the lung to a variety of injuries which damage the
   pulmonary-capillary emdothelium. Persistent hyperventilation,
   unresponsive to the administration of oxygen, is the earliest clinical
   sign of this complication of trauma and should prompt close monitoring
   of pulmonary function (measurement of arterial blood gas and pH levels,
   Vd/Vt A-aDo2, minute ventilation, vital capacity and inspiratory force)
   to assess the severity of the disease, the need for mechanical
   ventilatory support and the effectiveness of treatment. Other pulmonary
   complications of burn injury range from carbon monoxide poisoning and
   narcotics overdosage in the immediate postburn period through marked
   hyperventilation directly related to burn size occurring in the absence
   of significant parenchymal change to later occurring hematogenous and
   airborne pneumonia. Inhalation injury, a chemical tracheobronchitis
   which significantly increases the mortality of a given-sized burn, may
   be present immediately postburn but clinically inapparent for 48-72
   hours. 133Xenon lung scans permit early diagnosis of this pulmonary
   injury and the timely institution of a graduated therapeutic response
   keyed to the severity of pulmonary disability. Knowledge of the
   pathogenesis of each of these complications is requisite for the
   physician caring for burn patients and permits the employment of
   rational preventive and therapeutic measures.
TC 89
ZB 50
Z8 0
ZS 0
Z9 89
SN 0022-5282
UT MEDLINE:1092877
PM 1092877
ER

PT J
AU Light, R W
   Bengfort, J L
   George, R B
TI The adult respiratory distress syndrome and pancuronium bromide.
SO Anesthesia and analgesia
VL 54
IS 2
BP 219
EP 23
PD 1975 Mar-Apr
PY 1975
AB The institution and maintenance of artificial ventilation for a patient
   with the adult respiratory distress syndrome (ARDS) is frequently
   difficult because the hypoxic patient is often confused, agitated, or
   combative. Pancuronium bromide, a recently introduced neuromuscular
   blocking agent, was used to facilitate artificial ventilation in 6
   patients with ARDS. As compared with morphine sulfate and diazepam,
   pancuronium bromide has fewer cardiovascular and central-nervous system
   effects. It also has fewer cardiovascular effects than does curare, and
   its prolonged administration does not lead to a desensitization
   neuromuscular block as is seen with succinylcholine. However, continuous
   high-quality nursing care is necessary if this drug is used.
TC 15
ZB 7
Z8 0
ZS 0
Z9 15
SN 0003-2999
UT MEDLINE:1092207
PM 1092207
ER

PT J
AU Jenkins, R B
   Witorsch, P
   Smyth, N P
TI Aspects of treatment of crisis in myasthenia gravis.
SO Southern medical journal
VL 63
IS 10
BP 1127
EP 30
PD 1970-Oct
PY 1970
TC 5
ZB 4
Z8 0
ZS 0
Z9 5
SN 0038-4348
UT MEDLINE:5485583
PM 5485583
ER

EF