Effects of fluid resuscitation on cerebral tissue oxygenation changes in a piglet model of hemorrhagic shock

AbstractBackgroundAcute blood loss linked to severe hypovolemia and hemorrhagic shock is a critical condition in pediatric intensive care. This study was to investigate the role of various fluid resuscitation approaches to cerebral tissue oxygenation using a piglet model of hemorrhagic shock.MethodsThirty piglets received blood removal to induce hemorrhagic shock, and then were randomly assigned to a control group (no treatment), a control-normal saline (NS) group (treated with bolus normal saline 10mL/kg only), or one of three treatment groups treated with 15mL/kg/dose fluid every 30min with either whole blood (WB), lactated Ringer’s solution (LR), or NS in addition to an initial bolus of saline. The piglets’ physiological profiles, arterial blood gases, and regional cerebral oxygen saturation (rScO2) levels were recorded, fractional tissue oxygen extraction was calculated, and blood hemoglobin levels were measured.ResultsThe results showed that no matter whether treated with only one dose of bolus NS (control-NS group) or with extra WB, LR, or NS, all the treated animals had a significantly higher survival rate, mean arterial blood pressure (MAP), arterial oxygen tension, arterial oxygen saturation, and rScO2 than the control group (p<0.05). Animals treated with WB all survived the full experimental period, and their hemoglobin levels, MAP, and rScO2 were the highest comparing to all other groups (p<0.05).ConclusionEffective resuscitation using a high concentration of inspired oxygen and adequate fluid infusion, either as a single-dose bolus of NS or combining this with a subsequent transfusion of WB, LR, or NS, helped to stabilize the cardiovascular condition of the tested young subjects and improved cerebral tissue oxygenation over the emergent first four hours. Furthermore, WB was the best fluid choice when used in addition to the bolus NS challenge for maintaining better brain tissue oxygenation when treating hemorrhagic shock

Clinical Manifestations Vary with Different Age Spectrums in Infants with Kawasaki Disease

Background. Kawasaki disease (KD) is an acute systemic vasculitis with unknown etiology. The diagnosis of KD depends on clinical manifestations. The prevalence of coronary artery abnormality (CAA) is 11.0% and results in cardiac sequelae, such as myocardial infarction or coronary aneurysm, which are the most serious complications in KD. Methods. We divided KD's children into different age groups: ≤6 months old, 7 months to 1 year old, and >1 year old, respectively. Different parameters were compared in each group. Results. Infants ≤6 months old are less likely to fulfill KD's major diagnostic criteria within 10 days, are prone to develop incomplete KD with the lowest cholesterol level, and have the greatest chance to have CAA and the laboratory features associated with CAA, such as the longest time needed to confirm CA diagnosis, lower hemoglobin level, lower albumin level, and higher platelet count. Infants <1 year old develop higher percentage of leukocytosis and sterile pyuria. But this group has fewer patients with neck lymphadenopathy

The Specific Characteristics in Children with Obstructive Sleep Apnea and Cor Pulmonale

Background. The prevalence of obstructive sleep apnea (OSA) in the pediatric population is currently estimated at 1-2% of all children. The purpose of this study was to investigate the clinical and hemodynamic characteristics in pediatric patients with cor pulmonale and OSA. Methods. Thirty children with the diagnosis of OSA were included. These patients consisted of 26 male and 4 female children with a mean age of 7 ± 4 years old. Five of those children were found to be associated with cor pulmonale, and 25 had OSA but without cor pulmonale. Results. The arousal index was much higher in children with OSA and cor pulmonale. The children with OSA and cor pulmonale had much lower mean and minimal oxygen saturation and a higher incidence of bradycardia events. All 5 patients with OSA and cor pulmonale underwent an adenotonsillectomy, and the pulmonary arterial pressure dropped significantly after the surgery. Conclusion. This study demonstrated that the OSA pediatric patients with cor pulmonale had the different clinical manifestations and hemodynamic characteristics from those without cor pulmonale. The adenotonsillectomy had excellent results in both the OSA pediatric patients with and without cor pulmonale

Heparinization on pericardial substitutes can reduce adhesion and epicardial inflammation in the dog

AbstractObjective: Primary concerns about currently available pericardial substitutes include adhesion and epicardial reaction. The purpose of this study is to evaluate host reaction to pericardial substitutes with and without incorporating slow heparin release. Methods: To avoid biologic variation among these pericardial patches, we made a composite of six membranes. The composite membrane consisted of epoxy-fixed patches with (1) or without (2) ionically bound heparin, a glutaraldehyde-fixed patch with (3) or without (4) ionically bound heparin, an expanded polytetrafluoroethylene patch (5), and a polyester polymeric patch (6). Ten recipient dogs weighing from 12 to 19 kg (mean 13.6 kg) were used to assess the composite membranes as pericardial substitutes. The implanted composite membranes were retrieved 1 week (one dog), 2 weeks (one dog), 4 weeks (one dog), 8 weeks (one dog), and 12 weeks (six dogs) after implantation. Results: Overall, the synthetic patches had a more notable inflammatory reaction than the biologic patches with or without ionically bound heparin. The heparin-bound patches caused significantly less inflammation than their nonheparinized counterparts. The heparinized porcine patches cross-linked with different compounds were found to have less fibrous formation than the nonheparinized patches and the synthetic patches. Conclusions: Heparinized pericardial substitutes may cause less adhesion and inflammatory reaction than nonheparinized material. (J Thorac Cardiovasc Surg 1998;115:1111-20

Pyomyositis During Induction Chemotherapy for Acute Lymphoblastic Leukemia

Herein, we report on the correct diagnosis and effective treatment procedures for pyomyositis, a very rare complication that remains a diagnostic challenge in children being treated for acute lymphoblastic leukemia (ALL). We report the case of a 10-year-old girl suffering from pyomyositis with ALL. Correct diagnosis is usually delayed because the initial symptom of pyomyositis, usually local pain, is similar to the common side effect of vincristine, a drug necessary for ALL induction therapy. We summarize the procedures taken to reach a timely diagnosis and therapeutic success

Multifocal Atrial Tachycardia in 2 Children

The incidence of multifocal atrial tachycardia (MAT) is very low and accounts for less than 1% of supraventricular tachycardia in infants and children. In this report, the clinical characteristics, medical treatment and outcome of MAT in 2 children are described. The first patient presented with tachycardia and respiratory failure since the day after birth. First, he received amiodarone, propranolol, and digoxin and then amiodarone alone. The heart rhythm converted to sinus rhythm 2 weeks after hospitalization. Although nonsustained MAT was occasionally observed when the infant suffered from pulmonary infection, the frequency of recurrent MAT decreased as the infant grew up. The second patient was a 5-year-old girl. She had congenital heart disease with double outlets of right ventricle (DORV), patent ductus arte-riosus, coarctation of aorta, and ventricular and atrial septal defects. She underwent total correction at the age of 4 years. MAT was noted 3 months after the operation with the presentation of congestive heart failure. The heart rate slowed down and returned to normal sinus rhythm within several hours after amiodarone use. The symptoms and signs of congestive heart failure also disappeared. The patient took amiodarone regularly, and no tachycardia was detected during the follow-up period. MAT is considered to be a relatively benign arrhythmia with likely good outcome if there is no severe underlying illness. It can be well controlled under appropriate drugs, and a long period of follow-up is suggested. If pharmacologic intervention is required, we suggest that amiodarone may be an excellent choice

Acute Pulmonary Reperfusion Hemorrhage: A Rare Complication After Oversized Percutaneous Balloon Valvuloplasty for Pulmonary Valve Stenosis

Balloon valvuloplasty became the treatment of choice for valvular pulmonary stenosis following its first description in 1982 by Kan et al, and has almost replaced surgical pulmonary valvotomy in the present day. It is a safe and effective method for children for relief of right ventricular obstruction. The results of the procedure are excellent, without significant complications. This report describes the case of a 12-year-old boy who received successful balloon valvuloplasty for critical pulmonary valve stenosis complicated by an episode of acute pulmonary hemorrhage. Because of cyanosis, hypotension and bradycardia, he received emergent endotracheal intubation with 100% oxygen supplement and the highest infusion rate of inotropic agents. Venoarterial mode extracorporeal membrane oxygenation was indicated for life support due to the persistent high oxygenation index. Extracorporeal membrane oxygenation played a key role in the survival of this patient during the course of treatment

Diagnostic Application of Multidetector-Row Computed Tomographic Coronary Angiography to Assess Coronary Abnormalities in Pediatric Patients: Comparison With Invasive Coronary Angiography

Multidetector-row computed tomographic (MDCT) coronary angiography has been validated for noninvasive assessment of coronary anatomy. However, we have less experience in diagnosing children with congenital or acquired coronary artery abnormalities by MDCT. We compared the results of MDCT with invasive coronary angiography (ICA) on identifying coronary abnormalities in infants, children, and adolescents with coronary artery abnormalities, including aneurysm, coronary fistula, or anomalous left coronary artery from pulmonary artery (ALCAPA). Methods: From January 2002 to December 2009, patients with congenital or acquired coronary abnormalities underwent either ICA, MDCT, or both studies for assessment of coronary anatomy. We reviewed all patients’ clinical diagnosis, coronary abnormalities identified by MDCT or ICA, and analyzed the advantages and disadvantages between those two methods. Results: Thirty-three patients (20 males and 13 females) with a mean age of 10.3 years (range: 18 days to 25 years) had coronary abnormalities, including coronary artery aneurysm in Kawasaki disease (n=15), coronary artery fistula (n=12), myocardial bridge (n=2), and ALCAPA (n=4). In 17 patients only referred for ICA, 5 coronary aneurysms (3 on left main coronary artery, 1 on left anterior descending artery segment proximal, 1 on right coronary artery segment proximal), 11 coronary artery fistulas, and 2 ALCAPAs were detected. Sixteen patients received MDCT study, and 14 coronary artery aneurysms (4 on right coronary artery, 5 on left main coronary artery, 4 on left anterior descending artery, 1 on left circumflex artery), 3 myocardial bridges, 1 coronary artery fistulas, and 2 ALCAPAs were assessed. Ten patients with Kawasaki disease-related coronary lesions received MDCT study, and totally 102 (78.5%) segments permitted visualization with accurate diagnostic image quality. In this study, there were 11 patients with indication for conventional ICA spared invasive angiography after precise assessment by MDCT. Conclusion: We conclude that MDCT is a good and useful modality for assessment of congenital or acquired coronary abnormalities in pediatric patients. However, MDCT cannot replace invasive cardiac catheterization and ICA because of lack of therapeutic role