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2. Monitoring

Author

Venkataraman, Shekhar T., Sarnaik, Ashok P., editor, Venkataraman, Shekhar T., editor, and Kuch, Bradley A., editor

Published
2022
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5. Ventilator Graphics

Author

Venkataraman, Shekhar T., Kuch, Bradley A., Sarnaik, Ashok P., editor, Venkataraman, Shekhar T., editor, and Kuch, Bradley A., editor

Published
2022
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7. Ventilators and Modes

Author

Venkataraman, Shekhar T., Kuch, Bradley A., Sarnaik, Ashok P., Sarnaik, Ashok P., editor, Venkataraman, Shekhar T., editor, and Kuch, Bradley A., editor

Published
2022
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9. Respiratory Care Equipment

Author

Kuch, Bradley A., Venkataraman, Shekhar T., Sarnaik, Ashok P., editor, Venkataraman, Shekhar T., editor, and Kuch, Bradley A., editor

Published
2022
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12. Heart–Lung Interactions

Author

Venkataraman, Shekhar T., Munoz, Ricardo A., editor, Morell, Victor O., editor, da Cruz, Eduardo M., editor, Vetterly, Carol G., editor, and da Silva, Jose Pedro, editor

Published
2020
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19. Personalized lung-protective ventilation in children - Is it possible?

Author

Venkataraman, Shekhar T.

Subjects
ADULT respiratory distress syndrome treatment, LUNG injuries, MECHANICAL ventilators, POSITIVE end-expiratory pressure, INDIVIDUALIZED medicine, ARTIFICIAL respiration, MEDICAL protocols, REACTIVE oxygen species, OXYGEN in the body, CHILDREN
Abstract

Mechanical ventilation, while life-saving, can be associated with risks of exacerbating existing lung injury or causing new injury. An understanding of how mechanical ventilation can injure the lung and other systems is important to develop an optimal ventilatory approach. Over the past 70 years, different mechanisms that can cause lung injury have been described with putative suggestions for lung protection. Which mechanisms are operating in a particular patient is difficult to ascertain at the bedside. Guidelines have been formulated for both adults and children for the management of patients on mechanical ventilation with acute respiratory distress syndrome. Lung protection is the main objective of these guidelines. Lung disease is not homogeneous within the lung, and between patients with the same diagnosis. Response to ventilatory parameters also differs based on the distribution of injured and uninjured lungs, being beneficial in some but harmful in others. The impact of mechanical ventilation on the cardiovascular system and other systems is also variable. It is important to understand that these guidelines are one-size-fits-all therapeutic suggestions. While guidelines are useful, it is important to personalize mechanical ventilation based on the patient's lung mechanics and their response to adjustments of the ventilatory parameters. This chapter will review the current knowledge of the factors that contribute to injury to the lungs from mechanical ventilation. At the end of the review, I have formulated a personalized approach to lung protection during invasive mechanical ventilation for patients with parenchymal lung disease - a consensus of one. [ABSTRACT FROM AUTHOR]

Published
2023
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21. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system

Author

Han, Yong Y., Carcillo, Joseph A., Venkataraman, Shekhar T., Clark, Robert S.B., Watson, R. Scott, Nguyen, Trung C., Bayir, Hulya, and Orr, Richard A.

Subjects
Death -- Causes of, Mortality -- Statistics, Mortality -- United States, Physicians -- Services, Medical errors
Abstract

Objective. In response to the landmark 1999 report by the Institute of Medicine and safety initiatives promoted by the Leapfrog Group, our institution implemented a commercially sold computerized physician order entry (CPOE) system in an effort to reduce medical errors and mortality. We sought to test the hypothesis that CPOE implementation results in reduced mortality among children who are transported for specialized care. Methods. Demographic, clinical, and mortality data were collected of all children who were admitted via interfacility transport to our regional, academic, tertiary-care level children's hospital during an 18-month period. A commercially sold CPOE program that operated within the framework of a general, medical-surgical clinical application platform was rapidly implemented hospital-wide over 6 days during this period. Retrospective analyses of pre-CPOE and post-CPOE implementation time periods (13 months before and 5 months after CPOE implementation) were subsequently performed. Results. Among 1942 children who were referred and admitted for specialized care during the study period, 75 died, accounting for an overall mortality rate of 3.86%. Univariate analysis revealed that mortality rate significantly increased from 2.80% (39 of 1394) before CPOE implementation to 6.57% (36 of 548) after CPOE implementation. Multivariate analysis revealed that CPOE remained independently associated with increased odds of mortality (odds ratio: 3.28; 95% confidence interval: 1.94-5.55) after adjustment for other mortality covariables. Conclusions. We have observed an unexpected increase in mortality coincident with CPOE implementation. Although CPOE technology holds great promise as a tool to reduce human error during health care delivery, our unanticipated finding suggests that when implementing CPOE systems, institutions should continue to evaluate mortality effects, in addition to medication error rates, for children who are dependent on time-sensitive therapies. administration, computer software, health care delivery/access, interhospital transport, outcome. ABBREVIATIONS. CPOE, computerized physician order entry; CHP, Children's Hospital of Pittsburgh; ADE, adverse drug event; PRISM, Pediatric Risk of Mortality; OR, odds ratio; CI, confidence interval., In their landmark report To Err is Human: Building a Safer Health System, members of the Institute of Medicine estimated that medical errors contributed to between 44 000 and 98 [...]

Published
2005

22. Contributors

Author

Ackerman, Veda L., primary, Adelson, P. David, additional, Agbeko, Rachel S., additional, Almodovar, Melvin C., additional, Alonso, Estella M., additional, Aneja, Raj K., additional, Angus, Derek C., additional, Argent, Andrew C., additional, Aspesberro, Francois P., additional, Bakar, Adnan M., additional, Bambach, Barbara, additional, Bass, Lee M., additional, Bayir, Hülya, additional, Beaulieu, Pierre, additional, Bell, Michael J., additional, Bender, M.A., additional, Benson, Jeffrey C., additional, Benton, Wade W., additional, Berg, Robert A., additional, Berkowitz, Darryl H., additional, Bhutta, Omar J., additional, Biagas, Katherine C., additional, Blatt, Julie, additional, Blowey, Douglas L., additional, Blumer, Jeffrey L., additional, Bradley, John S, additional, Brandom, Barbara W., additional, Brodsky, Linda, additional, Brogan, Thomas V., additional, Brothers, Adam W., additional, Bunchman, Timothy E., additional, Burd, Randall S., additional, Burns, Jeffrey, additional, Bush, Sean P., additional, Bystrak, Louis L., additional, Campbell, Angela J.P., additional, Cannavino, Christopher R., additional, Carcillo, Joseph A., additional, Carrillo-Lopez, Hector, additional, Cassara, Antonio, additional, Caty, Michael G., additional, Charpie, John R., additional, Chavez, Adrian, additional, Christenson, John C., additional, Clark, Jonna D., additional, Clark, Robert S.B., additional, Clement, Katherine C., additional, Coalson, Jacqueline J., additional, Coopersmith, Craig M., additional, Coppola, Christopher P., additional, Corey, Seth J., additional, Cox, Peter N., additional, Cummings, James J., additional, Curley, Martha A.Q., additional, Czosnyka, Marek, additional, D’Angelis, Christopher A., additional, Dahmer, Mary K., additional, Dalton, Heidi J., additional, Davis, Peter J., additional, Morena, M. Theresa de la, additional, Oliveira, Cláudio Flauzino de, additional, Dhanani, Sonny, additional, Dobyns, Emily L., additional, Donner, Elizabeth J., additional, Doughty, Lesley, additional, Dreyfuss, Didier, additional, Duncan, Christine, additional, Durand, Philippe, additional, Duthie, Susan, additional, Eigen, Howard, additional, Maamoun El-Dawy, Waleed M., additional, Elliott, Steven, additional, Emery, Helen M., additional, Escobar, Mauricio A., additional, Evans, Jacqueline M., additional, Felmet, Kate, additional, Fineman, Jeffrey R., additional, Fink, Ericka L., additional, Fiser, Richard T., additional, Fish, Frank A., additional, Fletcher, James E., additional, Forbes, Michael J., additional, Fort, Amber E., additional, Fost, Norman, additional, Frader, Joel E., additional, Franzon, Deborah E., additional, Fricker, F. Jay, additional, Friess, Stuart, additional, Fuhrman, Bradley P., additional, Garcia-Casal, Xiomara, additional, Gauvin, France, additional, Gaynor, J. William, additional, Gilad, Eli, additional, Gilbert, James C., additional, Glaser, Nicole S., additional, Goldstein, Stuart L., additional, Goodman, Denise M., additional, Graciano, Ana Lía, additional, Gunnarsson, Björn, additional, Hahn, Cecil D., additional, Hall, Mark, additional, Hamilton, Melinda Fiedor, additional, Han, Yong Y., additional, Hanson, Cherissa, additional, Harding, Cary O., additional, Hartman, Mary E., additional, Hazelzet, Jan A., additional, Heard, Christopher M.B., additional, Heine, Ann Marie, additional, Hernan, Lynn J., additional, Hertzig, Jeremy S., additional, Heulitt, Mark J., additional, Hoffman, Julien I.E., additional, Huhta, James C., additional, Ichord, Rebecca, additional, Inglis, Andrew, additional, Linggi Irby, Gretchen A., additional, Jacobs, Brian, additional, Jardine, David, additional, Jarillo-Quijada, Alberto, additional, Javouey, Etienne, additional, Jefferis Kirk, Christa C., additional, Johns, James A., additional, Joshi, Prashant, additional, Kagan, Richard J., additional, Kannankeril, Prince J., additional, Kanter, Robert K., additional, Karam, Oliver, additional, Kasten, Kevin R., additional, Kelly, Michael, additional, Khanna, Paritosh C., additional, Kochanek, Patrick M., additional, Kocis, Keith C., additional, Kocoshis, Samuel A., additional, Koves, Ildiko H., additional, Kulik, Thomas J., additional, Kumar, Vasanth H., additional, Lacroix, Jacques, additional, Lakshminrusimha, Satyan, additional, Langley, Joanne M., additional, Laussen, Peter C., additional, Levin, Daniel L., additional, Lewis-Newby, Mithya, additional, Lieh-Lai, Mary W., additional, Lindsey, Daphne, additional, Litalien, Catherine, additional, Lynch, Robert E., additional, Makley, Amy T., additional, Marcin, James P., additional, Mariscalco, Mary Michele, additional, Markovitz, Barry, additional, Martin, Lynn D., additional, Maxvold, Norma J., additional, Mazur, Paula M., additional, McArthur, Jennifer A., additional, McLaughlin, Jerry, additional, McLaughlin, Gwenn E., additional, Redwine, Karen McNiece, additional, Mehta, Nilesh M., additional, Mehta, Renuka, additional, Melvin, Ann J., additional, Menon, Sharad, additional, Mian, Ayesa N., additional, Michelson, Kelly, additional, Michienzi, Kelly A., additional, Moloney-Harmon, Patricia A., additional, Monagle, Paul, additional, Moss, Michele M., additional, Mou, Steven S., additional, Muenzer, Jared T., additional, Nadkarni, Vinay, additional, Nakagawa, Thomas A., additional, Naran, Navyn, additional, Nguyen, Trung, additional, Nicholson, Carol E., additional, Nielsen, Katie R., additional, Northway, Tracie, additional, Norwood, Victoria F., additional, Notterman, Daniel A., additional, Nowak, Jeffrey E., additional, Oishi, Peter, additional, Orr, Richard A., additional, Ouellette, Yves, additional, Parakininkas, Daiva, additional, Parker, Margaret M., additional, Pearson-Shaver, Tony, additional, Pérez Fontán, J. Julio, additional, Peters, Mark, additional, Pihoker, Catherine, additional, Pinsk, Maury N., additional, Pollack, Murray M., additional, Pon, Steven, additional, Quasney, Michael, additional, Rajasekaran, Surender, additional, Rampersad, Sally E., additional, Ranjit, Suchitra, additional, Reade, Erin P., additional, Reese Jr., James J., additional, Relvas, Monica, additional, Remy, Kenneth E., additional, Ricard, Jean-Damien, additional, Rice, Tom B., additional, Ridling, Debra Ann, additional, Roberts, Joan S., additional, Ross, Ashley S., additional, Roth, Kimberly R., additional, Rotta, Alexandre T., additional, Rowin, Mark E., additional, Roy, John, additional, Rubino, Christopher M., additional, Ruppel, Randall A., additional, Rushton, Cynda H., additional, Ryan, Rita M., additional, Salonia, Rosanne, additional, Salvin, Joshua, additional, Sanders Jr., Ronald C., additional, Sarnaik, Ajit A., additional, Sarnaik, Ashok P., additional, Saumon, Georges, additional, Sawin, Robert, additional, Scanlon, Matthew C., additional, Schenkman, Kenneth A., additional, Schexnayder, Stephen M., additional, Schleien, Charles L., additional, Schwartz, George J., additional, Schwartz, Steven M., additional, Shann, Frank, additional, Shaw, Dennis W.W., additional, Shemie, Sam D., additional, Shoykhet, Mish, additional, Sivarajan, V. Ben, additional, Skippen, Peter W., additional, Slonim, Anthony D., additional, Smith, Laurie, additional, Smith, Lincoln S., additional, Standage, Stephen W., additional, Steinberg, Joel B., additional, Steinhorn, David M., additional, Stojanovski, Sasko D., additional, Storm, Elizabeth A., additional, Stroud, Michael H., additional, Sturgill, Marc G., additional, Sutton, Robert M., additional, Symons, Jordan M., additional, Tailounie, Muayyad, additional, Talano, Julie-An, additional, Tamburro Jr., Robert, additional, Tasker, Robert C., additional, Thompson, Ann E., additional, Tilton, Ann H., additional, Tinmouth, Alan, additional, Tobias, Joseph D., additional, Tobin, Nicole H., additional, Todres, I. David, additional, Tucci, Marisa, additional, Ulate, Kalia P., additional, Valentine, Kevin M., additional, Vaughan, David J., additional, Venkataraman, Shekhar T., additional, Visoiu, Mihaela, additional, von Saint André–von Arnim, Amélie, additional, Wainwright, Mark S., additional, Wakeham, Martin K., additional, Watson, R. Scott, additional, Webb, Ashley N., additional, Weigle, Carl, additional, Weimer, Maria B., additional, Wessel, David L., additional, Wetzel, Randall C., additional, Wong, Hector R., additional, Wood, Ellen G., additional, Woolf, Alan D., additional, Woytash, James J., additional, Yanay, Ofer, additional, Zaritsky, Arno, additional, Zerr, Danielle M., additional, and Zimmerman, Jerry J., additional

Published
2011
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25. Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: a randomized controlled trial

Author

Randolph, Adrienne G., Wypij, David, Venkataraman, Shekhar T., Hanson, James H., Gedeit, Rainer G., Meert, Kathleen L., Luckett, Peter M., Forbes, Peter, Lilley, Michelle, Thompson, John, Cheifetz, Ira M., Hibberd, Patricia, Wetzel, Randall, Cox, Peter N., and Arnold, John H.

Subjects
Artificial respiration -- Methods, Children -- Care and treatment
Abstract

Most children can be weaned off a mechanical ventilator in two days or less, regardless of the method used. This was the conclusion of a study of 182 children who were weaned off a ventilator using three different methods. Weaning means the patient is gradually given less ventilator support and begins breathing on his or her own.

Published
2002

30. Contributors

Author

Adelson, P. David, primary, Allen, David B., additional, Alonso, Estella M., additional, Alper, Gülay Pinar, additional, Angus, Derek C., additional, Anthone, Sidney, additional, Argent, Andrew, additional, Arnold, John H., additional, Bambach, Barbara, additional, Bayir, Hülya, additional, Beaulieu, Pierre, additional, Beitz, Laurie O., additional, Beltrán, Jorge R., additional, Benton, Wade W., additional, Berg, Robert A., additional, Bergman, Ira, additional, Blatt, Julie, additional, Blowey, Douglas L., additional, Blumer, Jeffrey L., additional, Bradley, John S., additional, Brandom, Barbara W., additional, Brecher, Martin L., additional, Brilli, Richard J., additional, Brisseau, Guy F., additional, Brogan, Thomas V., additional, Bunchman, Timothy E., additional, Bush, Sean P., additional, Carcillo, Joseph, additional, Carrel, Aaron L., additional, Carrillo-Lopez, Hector, additional, Cartwright, Victoria, additional, Carvajal, Hugo F., additional, Castillo, Leticia, additional, Caty, Michael G., additional, Cengiz, Pelin, additional, Chang, Anthony C., additional, Charpie, John R., additional, Chávez, Adrián, additional, Chesney, Russell W., additional, Cimino, Michael A., additional, Clark, Robert S.B., additional, Coalson, Jacqueline J., additional, Cook, D. Ryan, additional, Coopersmith, Craig M., additional, Coppola, Christopher P., additional, Corey, Seth J., additional, Cox, Peter N., additional, Culver, Kathleen, additional, Cummings, James J., additional, Curley, Martha A.Q., additional, Czosnyka, Marek, additional, Dalton, Heidi J., additional, Dauger, Stéphane, additional, Davis, Peter J., additional, Deshler, Jenina, additional, Dhanani, Sonny, additional, Dick, Rhonda M., additional, Dobyns, Emily L., additional, Donner, Elizabeth J., additional, Dreyfuss, Didier, additional, Durand, Philippe, additional, Duthie, Susan, additional, Ellenbogen, Richard G., additional, Evans, Jacqueline, additional, Fackler, James C., additional, Felmet, Kathryn, additional, Fineman, Jeffrey R., additional, Fiser, Debra H., additional, Fish, Frank A., additional, Fletcher, James E., additional, Fontán, J. Julio Pérez, additional, Forbes, Michael L., additional, Fost, Norman, additional, Frader, Joel E., additional, Franzon, Deborah, additional, Fricker, F. Jay, additional, Friedman, Aaron L., additional, Fuhrman, Bradley P., additional, Gauvin, France, additional, Gilad, Eli, additional, Gilbert, James C., additional, Giroir, Brett P., additional, Goldstein, Stuart L., additional, Graham, James, additional, Green, Jerril W., additional, Green, Thomas P., additional, Greene, Stephanie, additional, Griffith, James A., additional, Grossi, Mauro, additional, Gunnarsson, Björn, additional, Hagen, Scott A., additional, Hahn, Cecil D., additional, Hallstrom, Craig, additional, Han, Yong Y., additional, Harding, Cary O., additional, Harmon, William G., additional, Harry, Eric, additional, Hartman, Mary E., additional, Heard, Christopher, additional, Hernan, Lynn, additional, Heulitt, Mark J., additional, Hickey, Robert W., additional, Hoffman, Julien I.E., additional, Hofmann, Karen T., additional, Hollman, Gregory A., additional, Huhta, James C., additional, James, Hector E., additional, Jardine, David, additional, Jarillo, Alberto, additional, Javouey, Etienne, additional, Johns, James A., additional, Johnson, Kristin K., additional, Johnston, Michael V., additional, Jones, Deborah P., additional, Joshi, Prashant, additional, Kannankeril, Prince J., additional, Kanter, Robert K., additional, Kellum, John A., additional, Kelly, Michael, additional, Kochanek, Patrick M., additional, Kocoshis, Samuel A., additional, Kulik, Thomas J., additional, Kumar, Vasanth H., additional, Lacroix, Jacques, additional, Lai, Yichen, additional, Langley, Joanne M., additional, Lau, Stanley T., additional, Laussen, Peter, additional, Lee, Yi-Horng, additional, Lieh-Lai, Mary W., additional, Lindsay, D. Michael, additional, Litalien, Catherine, additional, Luban, Naomi L.C., additional, Lynch, Robert E., additional, Maffei, Frank, additional, Marcin, James P., additional, Mariscalco, Mary Michele, additional, Markovitz, Barry P., additional, Martin, Lynn D., additional, Matlow, Anne G., additional, Mayer, John E., additional, Mazur, Paula, additional, McKenzie, E. Dean, additional, McLaughlin, Gwenn E., additional, Mehta, Nilesh, additional, Mehta, Renuka, additional, Melvin, Ann J., additional, Mercier, Jean-Christophe, additional, Michelson, Kelly, additional, Michienzi, Kelly A., additional, Moloney-Harmon, Patricia A., additional, Morin, Frederick C., additional, Moss, Michele, additional, Nadkarni, Vinay, additional, Nicholson, Carol E., additional, Norwood, Victoria F., additional, Notterman, Daniel, additional, Nugent, Alan, additional, Oishi, Peter, additional, Olivar, Victor, additional, Orr, Richard A., additional, Ouellette, Yves, additional, Parakininkas, Daiva, additional, Parker, Margaret M., additional, Pearson-Shaver, Anthony L., additional, Petruzzi, Mary Jane F., additional, Pinsk, Maury N., additional, Pollack, Murray M., additional, Pon, Steven, additional, Pong, Alice, additional, Primak, Lara, additional, Prince, Audra, additional, Ricard, Jean-Damien, additional, Rice, Tom B., additional, Richards, Gail E., additional, Ridling, Debra Ann, additional, Roberts, Joan, additional, Roth, Kimberly, additional, Rotta, Alexandre T., additional, Rubens, Daniel, additional, Rubenstein, Jeffrey S., additional, Rubino, Christopher M., additional, Ruppel, Randall, additional, Safar, Peter J., additional, Sarnaik, Ashok P., additional, Sarner, Joel B., additional, Saumon, Georges, additional, Scanlon, Matthew C., additional, Schenkman, Kenneth, additional, Schexnayder, Stephen M., additional, Schleien, Charles L., additional, Sentongo, Timothy A., additional, Shanley, Thomas P., additional, Shann, Frank, additional, Shaw, Dennis W.W., additional, Shemie, Sam D., additional, Skippen, Peter, additional, Slonim, Anthony D., additional, Smith, Laurie, additional, Smith, Lincoln, additional, Steinhorn, David M., additional, Storm, Waldemar E., additional, Sturgill, Marc, additional, Sweetser, Marianne T., additional, Symons, Jordan M., additional, Tasker, Robert C., additional, Thompson, Ann E., additional, Tilton, Ann Henderson, additional, Tobin, Nicole H., additional, Todres, I. David, additional, Trinkaus, Peter, additional, Vaughan, David J., additional, Venkataraman, Shekhar T., additional, Villanueva, Rapheus C.Q., additional, Wankum, Patricia C., additional, Watson, R. Scott, additional, Waz, Wayne R., additional, Weigle, Carl G.M., additional, Weimer, Maria B., additional, Weinberger, Ed, additional, Wessel, David L., additional, West, William T., additional, Wetzel, Randall C., additional, Whitby, Dale, additional, Wong, Hector R., additional, Wood, Ellen G., additional, Woolf, Alan D., additional, Woytash, James, additional, Yanay, Ofer, additional, Zaritsky, Arno, additional, Zerr, Danielle M., additional, and Zimmerman, Jerry J., additional

Published
2006
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33. Role of laboratory in the management of phenylbutazone poisoning

Author

Virji, Mohamed A., Venkataraman, Shekhar T., Lower, Darla R., and Rao, Kalipatnapu N.

Subjects
Nonsteroidal anti-inflammatory drugs -- Adverse and side effects, Phenylbutazone -- Adverse and side effects, Drugs -- Care and treatment, Drugs -- Health aspects, Environmental issues, Health, Pharmaceuticals and cosmetics industries
Abstract

We report a rare case of intentional overdose of phenylbutazone in a 15-yr-old female. The patient exhibited symptoms of phenylbutazone toxicity and the presence of the drug was confirmed by gas chromatography mass-spectrometry (GC-MS) analysis of the initial urine sample. The patient underwent plasmapheresis to remove the drug from the circulation. Semiquantitation of sequential serum samples by GC-MS revealed elimination of phenylbutazone by day 5 of admission at which time the plasmapheresis was discontinued. Elevated blood urea nitrogen (BUN) and creatinine returned to normal. Analysis of biomarkers for liver necrosis and regeneration in sequential serum samples revealed the restoration of normal liver function by day 5. This case further confirms our previous observations that biomarkers for liver necrosis and regeneration can predict the outcome of patients with liver damage due to toxins. Key Words: Phenylbutazone; Kidney; Plasmapheresis; GC/MS; Biomarkers; Liver; Necrosis; Regeneration., INTRODUCTION Phenylbutazone is a non-steroidal anti-inflammatory agent that is no longer used in human medicine because of the frequency of toxic effects, in particular of bone marrow suppression. It is [...]

Published
2003

37. Dynamic Airway Driving Pressure and Outcomes in Children With Acute Hypoxemic Respiratory Failure.

Author

Rauf, Abdul, Sachdev, Anil, Venkataraman, Shekhar T., and Dinand, Veronique

Subjects
PNEUMONIA treatment, INTENSIVE care units, LENGTH of stay in hospitals, KRUSKAL-Wallis Test, STATISTICS, RESPIRATORY insufficiency, CONFIDENCE intervals, POSITIVE pressure ventilation, DENGUE, AIRWAY (Anatomy), POSITIVE end-expiratory pressure, MULTIPLE regression analysis, MULTIVARIATE analysis, RESPIRATORY measurements, RETROSPECTIVE studies, TERTIARY care, EXTRACORPOREAL membrane oxygenation, ASPIRATION pneumonia, MANN Whitney U Test, FISHER exact test, ARTIFICIAL respiration, TREATMENT effectiveness, HOSPITAL mortality, SEPSIS, SEVERITY of illness index, DESCRIPTIVE statistics, CHI-squared test, LOGISTIC regression analysis, STATISTICAL models, ODDS ratio, DATA analysis software, HYPOXEMIA, ACUTE diseases, COMORBIDITY, CHILDREN
Abstract

BACKGROUND: Limited adult data suggest that airway driving pressure might better reflect the potential risk for lung injury than tidal volume based on ideal body weight, and the parameter correlates with mortality in ARDS. There is a lack of data about the effect of driving pressure on mortality in pediatric ARDS. This study aimed to evaluate the effect of driving pressure on morbidity and mortality of children with acute hypoxemic respiratory failure. METHODS: This retrospective cohort study was performed in a tertiary level pediatric ICU. Children who received invasive mechanical ventilation for acute hypoxemic respiratory failure (defined as ... < 300 within 24 h after intubation), in a 2-y period were included. The cohort was divided into 2 groups based on the highest dynamic driving pressure (DP, calculated as the difference between peak inspiratory pressure and PEEP) in the first 24 h, with a cutoff value of 15 cm H2O. RESULTS: Of the 380 children who were mechanically ventilated during the study period, 101 children who met eligibility criteria were enrolled. Common diagnoses were pneumonia (n = 51), severe sepsis (n = 24), severe dengue (n = 10), and aspiration pneumonia (n = 7). In comparison to the group with high DP (ie, ≤ 15 cm H2O), children in the group with low DP (ie, < 15 cm H2O) had significantly lower median (interquartile range) duration of ventilation (5 [4-6] d vs 8 [6-11] d, P < .001], ICU length of stay (6 [5-8] d vs 12 [8-15] d, P < .001], and more ventilator-free days at day 28 (23 [20-24] vs 17 [0-22] d, P < .001). Logistic regression analysis also suggested driving pressure as an independent predictor of morbidity after adjusting for confounding variables. However, there was no statistically significant difference in mortality between the 2 groups (17% in low ΔP vs 24% in high ΔP, P = .38). Subgroup analysis of 65 subjects who fulfilled ARDS criteria yielded similar results with respect to mortality and morbidity. CONCLUSIONS: Below a threshold of 15 cm H2O, DP was associated with significantly decreased morbidity in children with acute hypoxemic respiratory failure. [ABSTRACT FROM AUTHOR]

Published
2021
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40. Femoral vascular catheterization in critically ill infants and children

Author

Venkataraman, Shekhar T., Thompson, Ann E., and Orr, Richard A.

Subjects
Critically ill children -- Care and treatment, Catheterization -- Complications, Health
Abstract

Inserting a catheter into a child's femoral artery or vein appears to be relatively safe with few complications. Catheters are often inserted in critically ill children to monitor their condition or provide treatment. Researchers evaluated the safety and complications of femoral artery or vein catheterization in 110 critically ill children. The success rate exceeded 90% and complications occurred in 15% to 16% of the children overall. Most complications were not serious and resolved without treatment. A review of other studies found very low rates of infection and other complications in catheterized children.

Published
1997

47. Contributors

Author

Abecassis, Isaac Josh, Agbeko, Rachel S., Adelson, P. David, Alder, Matthew N., Al Ibrahim, Omar, Almodovar, Melvin C., Aminoff, Alexandra R., Amlie-LeFond, Catherine, Angus, Derek C., Arvedson, Joan C., Aspesberro, Francois, Baatz, John E., Baden, Harris P., Badugu, Srinivasarao, Bakar, Adnan M., Banker, Katherine, Bass, John L., Bayir, Hülya, Beaulieu, Pierre, Becker, Lance B., Bell, Michael J., Bender, M.A., Benton, Wade W., Berg, Robert A., Biagas, Katherine V., Bishop, Naomi B., Blatt, Julie, Blowey, Douglas L., Blumer, Jeffrey L., Bonow, Robert H., Brandom, Barbara W., Brilli, Richard J., Brogan, Thomas V., Bronicki, Ronald A., Browd, Samuel R., Bunchman, Timothy E., Burns, Jeffrey P., Caglar, Derya, Campbell, Sally, Carcillo, Joseph A., Carrillo-Lopez, Hector, Cashen, Katherine, Cassara, Antonio, Charpie, John R., Chavez, Adrian, Chun, Robert H., Clark, Jonna Derbenwick, Clark, Robert S.B., Clement, Katherine C., Conlon, Thomas, Conway, Edward E., Jr., Coopersmith, Craig M., Corey, Seth J., Cox, Peter N., Curley, Martha A.Q., Czosnyka, Marek, Dalton, Heidi J., Damian, Mihaela, Davis, Peter J., de Prost, Nicolas, Deutschman, Clifford S., Dezfulian, Cameron, Diekema, Douglas S., Doctor, Allan, Doherty, Meaghan, Dorfman, Molly V., Downes, John J., Dreyfuss, Didier, Duncan, Christine, Dupree, Phylicia D., Eigen, Howard, El-Hassan, Nahed, Eriksson, Carl O., Felmet, Kate, Fineman, Jeffrey R., Fink, Ericka L., Fish, Frank A., Fitzgerald, Tamara N., Flynn, Joseph T., Pérez Fontán, J. 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Published
2017
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48. Cumulative fluid intake minus output is not associated with ventilator weaning duration or extubation outcomes in children*

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Randolph, Adrienne G., primary, Forbes, Peter W., additional, Gedeit, Rainer G., additional, Arnold, John H., additional, Wetzel, Randall C., additional, Luckett, Peter M., additional, O???Neil, Mary E., additional, Venkataraman, Shekhar T., additional, Meert, Kathleen L., additional, Cheifetz, Ira M., additional, Cox, Peter N., additional, and Hanson, James H., additional

Published
2005
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