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Titolo:
PULMONARY HEMORRHAGE - A NOVEL COMPLICATION AFTER EXTRACORPOREAL LIFE-SUPPORT
Autore:
GORETSKY MJ; MARTINASEK D; WARNER BW;
Indirizzi:
CHILDRENS HOSP,MED CTR,DIV PEDIAT SURG,3333 BURNET AVE CINCINNATI OH 45229 CHILDRENS HOSP,MED CTR,DIV PEDIAT SURG CINCINNATI OH 45229 UNIV CINCINNATI,COLL MED,DEPT SURG CINCINNATI OH 00000
Titolo Testata:
Journal of pediatric surgery
fascicolo: 9, volume: 31, anno: 1996,
pagine: 1276 - 1281
SICI:
0022-3468(1996)31:9<1276:PH-ANC>2.0.ZU;2-W
Fonte:
ISI
Lingua:
ENG
Soggetto:
EXOGENOUS SURFACTANT THERAPY; MEMBRANE-OXYGENATION; INTRACRANIAL HEMORRHAGE; SYNTHETIC SURFACTANT; PREMATURE-INFANTS; CONTROLLED TRIAL; ECMO;
Keywords:
PULMONARY HEMORRHAGE; EXTRACORPOREAL LIFE SUPPORT; ALVEOLAR-ARTERIAL OXYGEN GRADIENT; OXYGEN INDEX; MEAN AIRWAY PRESSURE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
31
Recensione:
Indirizzi per estratti:
Citazione:
M.J. Goretsky et al., "PULMONARY HEMORRHAGE - A NOVEL COMPLICATION AFTER EXTRACORPOREAL LIFE-SUPPORT", Journal of pediatric surgery, 31(9), 1996, pp. 1276-1281

Abstract

Pulmonary hemorrhage (PH) occurs infrequently as a complication in neonates with respiratory failure. Major PH has been observed at the authors' institution in several neonates after ''successful'' completion of extracorporeal life support(ECLS)therapy. The authors sought to determine the incidence of PH and the risk factors associated with this unique and newly described morbidity after ECLS. The hospital records of all patients who had PH after ECLS were reviewed. The control patients were the first three infants who underwent ECLS just before each PHcase. PH was defined as the occurrence of bloody tracheal secretions associated with a deterioration in pulmonary status, Demographics, ventilator/ECLS parameters, fluid management, coagulation, and laboratorystudies were evaluated in the pre-ECLS, during ECLS, and in the post-ECLS period. From 1985 to 1993, 13 (6%) of 214 neonates suffered majorPH, at a mean time of 43.2 +/- 9.2 hours after the ECLS course. The overall mortality rate for children with PH was 38%, compared with 5% among the control patients. In the pre-ECLS phase, patients with PH required more fluid (153.6 +/- 20.2 mL/kg/d v 106.8 +/- 10.2 mL/kg/d) andwere acidemic for a longer period (2.3 +/- 1.2 hours v 0.6 +/- 0.2 hours; pH < 7.25). No differences were noted in AaDo(2) or oxygenation index criteria. During ECLS; inotropes were required more often (23% v 0%; P < .01) because hypotension was more common (77% v 33%; P < .05). Activated clotting times (ACT) and heparin requirements were equivalent for the two groups. After ECLS the patients with PH required longerventilatory assistance (184.9 +/- 48.2 hours v 83.4 +/- 16.7 hours) and supplemental oxygen (24.3 +/- 3.0 days v 17.2 +/- 1.9 days). No coagulation abnormalities were identified at the time of PH. Higher SGPT (185.4 +/- 146.4 U/L v 22.6 +/- 3.5 U/L; P < .05) and BUN (69.3 +/- 7.5 mg/dL v 47.2 +/- 5.9 mg/dL; P < .05) also were noted for the patients with PH. PH represents an important and novel morbidity in neonates after ECLS. Prolonged acidosis, a high fluid requirement before ECLS, the need for blood pressure support during ECLS, and evidence of renaland/ or hepatic dysfunction serve to identify patients who have a high risk for the development of this complication. Copyright (C) 1996 byW.B. Saunders Company

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 08/04/20 alle ore 12:00:52