X

Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
  • 1
    Online Resource
    Online Resource
    Cerebral Oxygen Metabolism Before and After RBC Transfusion in Infants Following Major Surgical Procedures
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Pediatric Critical Care Medicine Vol. 19, No. 4 ( 2018-04), p. 318-327
    Details
    In: Pediatric Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 19, No. 4 ( 2018-04), p. 318-327
    Abstract: Although infants following major surgery frequently require RBC transfusions, there is still controversy concerning the best definition for requirement of transfusion in the individual patient. The aim of this study was to determine the impact of RBC transfusion on cerebral oxygen metabolism in noncardiac and cardiac postsurgical infants. Design: Prospective observational cohort study. Setting: Pediatric critical care unit of a tertiary referral center. Patients: Fifty-eight infants (15 after pediatric surgery and 43 after cardiac surgery) with anemia requiring RBC transfusion were included. Interventions: RBC transfusion. Measurements and Main Results: We measured noninvasively regional cerebral oxygen saturation and microperfusion (relative cerebral blood flow) using tissue spectrometry and laser Doppler flowmetry before and after RBC transfusion. Cerebral fractional tissue oxygen extraction and approximated cerebral metabolic rate of oxygen were calculated. Fifty-eight RBC transfusions in 58 patients were monitored (15 after general surgery, 24 after cardiac surgery resulting in acyanotic biventricular physiology and 19 in functionally univentricular hearts including hypoplastic left heart following neonatal palliation). The posttransfusion hemoglobin concentrations increased significantly (9.7 g/dL vs 12.8 g/dL; 9.7 g/dL vs 13.8 g/dL; 13.1 g/dL vs 15.6 g/dL; p 〈 0.001, respectively). Posttransfusion cerebral oxygen saturation was significantly higher than pretransfusion (61% [51–78] vs 72% [59–89] ; p 〈 0.001; 58% [35–77] vs 71% [57–88] ; p 〈 0.001; 51% [37–61] vs 58% [42–73] ; p = 0.007). Cerebral fractional tissue oxygen extraction decreased posttransfusion significantly 0.37 (0.16–0.47) and 0.27 (0.07–039), p = 0.002; 0.40 (0.2–0.62) vs 0.26 (0.11–0.57), p = 0.001; 0.42 (0.23–0.52) vs 0.32 (0.1–0.42), p = 0.017. Cerebral blood flow and approximated cerebral metabolic rate of oxygen showed no significant change during the observation period. The increase in cerebral oxygen saturation and the decrease in cerebral fractional tissue oxygen extraction were most pronounced in patients after cardiac surgery with a pretransfusion cerebral fractional tissue oxygen extraction greater than or equal to 0.4. Conclusion: Following RBC transfusion, cerebral oxygen saturation increases and cerebral fractional tissue oxygen extraction decreases. The data suggest that cerebral oxygenation in postoperative infants with cerebral fractional tissue oxygen extraction greater than or equal to 0.4 may be at risk in instable hemodynamic or respiratory situations.
    Type of Medium: Online Resource
    ISSN: 1529-7535
    URL: Article
    DOI: 10.1097/PCC.0000000000001483
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2070997-3
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 2
    Online Resource
    Online Resource
    Whole liver transplantation in children under 10 kg: How to minimize the high risks of a still challenging procedure
    Wiley ; 2022
    In:  Pediatric Transplantation Vol. 26, No. 3 ( 2022-05)
    Details
    In: Pediatric Transplantation, Wiley, Vol. 26, No. 3 ( 2022-05)
    Abstract: Whole liver transplantation in infants 〈 10 kg is a rare procedure with moderate outcomes (67%–79% graft survival at 1 year) and high rates of vascular complications (hepatic artery thrombosis 5–26%). Methods Retrospective single‐center analysis of whole liver transplantation in infants 〈 10 kg and systematic review of the literature focused on survival rates and surgical complications. Results Between January 2005 and December 2020, 175 liver transplantations in 173 children were performed at our center. A total of 92 (53%) children weighed less than 10 kg; 19 (21%) of them underwent WLT and constitute the study population. Median age of the recipients was 10 months (21 days–24 months) and median body weight 6.5 (3.1–9.8) kg. Median age of the donors was 5 (1–84) months and median body weight 6.1 (4–21) kg. Median donor‐to‐recipient body weight ratio was 1.2 (range: 0.6–4.5). Postoperatively, neither hepatic artery nor portal vein thrombosis occurred. A biliary complication occurred in 4 cases: 1 bile leak (early), 3 anastomotic stenoses (1 delayed and 2 late), and 1 non‐anastomotic stenosis (late). Patient survival rate at 1, 5, and 10 years was 100%, 92%, and 92%, respectively. Overall, death‐censored graft survival after 1, 5, and 10 was 100%. Conclusion Our results are excellent in terms of complications and graft and patient survival. This involves not only high‐end surgical performance but also close interdisciplinary perioperative cooperation based on strong standard operating procedures and mainly focused on fluid management, hemostasiology, and strict monitoring of vessel patency.
    Type of Medium: Online Resource
    ISSN: 1397-3142 , 1399-3046
    URL: Issue
    URL: Article
    DOI: 10.1111/petr.v26.3
    DOI: 10.1111/petr.14222
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2008614-3
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 3
    Online Resource
    Online Resource
    Successful on-ECLS Repair of CDH and Omphalocele in a Newborn
    Georg Thieme Verlag KG ; 2023
    In:  European Journal of Pediatric Surgery Reports Vol. 11, No. 01 ( 2023-01), p. e15-e19
    Details
    In: European Journal of Pediatric Surgery Reports, Georg Thieme Verlag KG, Vol. 11, No. 01 ( 2023-01), p. e15-e19
    Abstract: Both congenital diaphragmatic hernias (CDHs) and omphaloceles show relevant overall mortality rates as individual findings. The combination of the two has been described only sparsely in the literature and almost always with a fatal course. Here, we describe a term neonate with a rare high-risk constellation of left-sided CDH and a large omphalocele who was successfully treated on extracorporeal life support (ECLS). Prenatally, the patient was diagnosed with a large omphalocele and a left CDH with a lung volume of ∼27% and an observed to expected lung-to-head ratio of 30%. Due to respiratory insufficiency, an ECLS device was implanted. As weaning from ECLS was not foreseeable, the female infant underwent successful surgery on ECLS on the ninth day of life. Perioperative high-frequency oscillatory ventilation and circulatory and coagulation management under point-of-care monitoring were the main anesthesiological challenges. Over the following 3 days, ECLS weaning was successful, and the patient was extubated after another 43 days. Surgical treatment on ECLS can expand the spectrum of therapy in high-risk constellations if potential risks are minimized and there is close interdisciplinary cooperation.
    Type of Medium: Online Resource
    ISSN: 2194-7619 , 2194-7627
    URL: Article
    DOI: 10.1055/s-0043-1767734
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2023
    detail.hit.zdb_id: 2727310-6
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 4
    Online Resource
    Online Resource
    Soil water solutes reduce the critical micelle concentration of quaternary ammonium compounds
    Springer Science and Business Media LLC ; 2020
    In:  Environmental Science and Pollution Research Vol. 27, No. 36 ( 2020-12), p. 45311-45323
    Details
    In: Environmental Science and Pollution Research, Springer Science and Business Media LLC, Vol. 27, No. 36 ( 2020-12), p. 45311-45323
    Abstract: Quaternary alkyl ammonium compounds (QAACs) are produced in large quantities for use as surfactants and disinfectants and also found in soils, sediments, and surface waters, where they are potentially involved in the selection of antibiotic resistance genes. Micelle formation influences fate and effects of QAACs. The critical micelle concentration (CMC) of six homologs of benzylalkylammonium chlorides (BAC) was determined in deionized water, 0.01 M CaCl 2 solution, and aqueous soil extracts, using both spectrofluorometric and tensiometric methods. Additionally, eight organic model compounds were employed at concentrations of 15 mg C L −1 as background solutes in order to test the effect of dissolved organic carbon (DOC) on CMCs. Results found CMCs decreased with an increasing length of the alkyl chain from 188 mM for BAC-C8 to 0.1 mM for BAC-C18. Both methods yielded similar results for measurements in water and CaCl 2 solution; however, the spectrofluorescence method did not work for soil extracts due to fluorescence quenching phenomena. In soil extracts, CMCs of BAC-C12 were reduced below 3.7 mM, while the CMC reduction in soil extracts was less pronounced for BAC-C16. Besides ionic strength, molecular structures of BACs and dissolved organic compounds also affected the CMC. The number of carboxyl groups and small molecular weights of the DOC model compounds reduced the CMCs of BAC-C12 and BAC-C16 at pH 6. This study highlights that CMCs can be surpassed in soil solution, pore waters of sediments, or other natural waters even at (small) concentrations of QAACs typically found in the environment.
    Type of Medium: Online Resource
    ISSN: 0944-1344 , 1614-7499
    URL: Article
    DOI: 10.1007/s11356-020-10188-2
    RVK:
    AR 10100
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2014192-0
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 5
    Online Resource
    Online Resource
    Analgesia and Sedation Protocol for Mechanically Ventilated Postsurgical Children Reduces Benzodiazepines and Withdrawal Symptoms—But Not in All Patients
    Georg Thieme Verlag KG ; 2017
    In:  European Journal of Pediatric Surgery Vol. 27, No. 03 ( 2017-06), p. 255-262
    Details
    In: European Journal of Pediatric Surgery, Georg Thieme Verlag KG, Vol. 27, No. 03 ( 2017-06), p. 255-262
    Abstract: Background We demonstrated recently that the implementation of a nurse-driven analgesia and sedation protocol (pediatric analgesia and sedation protocol [pASP]) for mechanically ventilated nonpostsurgical patients reduces the total dose of benzodiazepines and the withdrawal symptoms significantly. It has not been investigated if these results can also be expected in the group of patients undergoing surgery. Objectives To evaluate the effects of the pASP in mechanically ventilated postsurgical children regarding drug dosage, duration of mechanical ventilation, length of stay, and rate of withdrawal symptoms. Methods This is a two-phase prospective observational control study. The preimplementation group was managed by the physician's order and the postimplementation group was managed with the pASP including COMFORT-B, nurse interpretation of sedation, and Sophia observation withdrawal symptoms scale scoring. Measurements and Main Results One hundred and sixteen patients were included before and one hundred and ten patients after implementation. The pASP had no effect on length of pediatric intensive care unit stay or duration of mechanical ventilation. The protocol reduced total (5.0 mg/kg [0.5–58.0] vs 4.0 mg/kg [0.0–47.0] ; p = 0.021) and daily doses (4.4 mg/kg/d [1.1–33.9] vs 2.9 mg/kg/d [0.0–9.9] ; p  〈  0.001) of benzodiazepines significantly. No difference was observed in total and daily doses of opioids (5.0 mg/kg [0.1–67.0] vs 3.0 mg/kg [0.1–71.0] ; p = 0.81) and (0.7 mg/kg/d [0.0–7.0] vs. 0.8 mg/kg/d [0.0–3.7] ; p = 0.35), respectively. Rate of withdrawal symptoms was significantly lower after implementation (35.3 vs 20.0%; p = 0.01), but not in patients after solid organ transplantation or oncological patients. Conclusion The nurse-driven analgesia and sedation protocol is an effective procedure to reduce the total doses of benzodiazepines and occurrence of withdrawal symptoms in postsurgical children, which are naïve to opioids or benzodiazepines.
    Type of Medium: Online Resource
    ISSN: 0939-7248 , 1439-359X
    URL: Article
    DOI: 10.1055/s-0036-1586202
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2017
    detail.hit.zdb_id: 2059082-9
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 6
    Online Resource
    Online Resource
    Ketamine Infusion as a Counter Measure for Opioid Tolerance in Mechanically Ventilated Children: A Pilot Study
    Springer Science and Business Media LLC ; 2017
    In:  Pediatric Drugs Vol. 19, No. 3 ( 2017-6), p. 259-265
    Details
    In: Pediatric Drugs, Springer Science and Business Media LLC, Vol. 19, No. 3 ( 2017-6), p. 259-265
    Type of Medium: Online Resource
    ISSN: 1174-5878 , 1179-2019
    URL: Article
    DOI: 10.1007/s40272-017-0218-4
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2017
    detail.hit.zdb_id: 2043681-6
    SSG: 15,3
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 7
    Online Resource
    Online Resource
    Nurse‐driven pediatric analgesia and sedation protocol reduces withdrawal symptoms in critically ill medical pediatric patients
    Wiley ; 2015
    In:  Pediatric Anesthesia Vol. 25, No. 8 ( 2015-08), p. 786-794
    Details
    In: Pediatric Anesthesia, Wiley, Vol. 25, No. 8 ( 2015-08), p. 786-794
    Abstract: While several analgesia and sedation guidelines and protocols have been developed and implemented for adults, there is still little evidence of clinical use of analgesia and sedation protocols and the impact on withdrawal symptoms in critically ill children. Objective The aim of this study was to evaluate the effects of a nurse‐driven goal‐directed analgesia and sedation protocol for mechanically ventilated pediatric patients ( pASP ) on duration of mechanical ventilation, pediatric intensive care unit ( PICU ) length of stay, total doses of opioids and benzodiazepines, and occurrence of withdrawal symptoms. Patients and Methods This is a before and after protocol implementation study in a 14‐bed medical–surgical–cardiac pediatric intensive care unit at a university children's hospital. A total of 337 medical pediatric patients requiring mechanical ventilation with PICU length of stay for at least 24 h were included. Prior to implementation of the protocol, analgesia and sedation was managed by the attending physician's order. Afterwards, postimplementation, nurses managed analgesia and sedation following a pASP , including COMFORT ‘behavioral’ Scale, Nurse Interpretation Sedation Scale, and Sophia Observation Withdrawal Symptoms Scale. Results One hundred and sixty‐five patients were included in the 15‐month period before and 172 patients were included in the 15‐month period after implementation of the pASP . Median duration of mechanical ventilation was 2.02 (0.96–25.0) days in the group preceding protocol implementation and 1.71 (0.96–66.0) days afterwards ( P  = 0.23). Median PICU length of stay was 5.8 (1–37.75) days in the preimplementation and 5.0 (1–120) days in the postimplementation group ( P  = 0.14). Total doses of opioids and benzodiazepines were 3.9 mg·kg −1 ·day −1 (0.1–70) vs 3.1 mg·kg −1 ·day −1 (0.05–56); P  = 0.38 and 5.9 mg·kg −1 ·day −1 (0–82.0) vs 4.2 mg·kg −1 ·day −1 (0–66); P  = 0.009 after implementation. Incidence of withdrawal was significantly lower over the postimplementation period (12.8% vs 23.6%; P  = 0.005). Conclusion Implementation of a nurse‐driven pASP reduced the total dose of benzodiazepines and the occurrence of withdrawal symptoms significantly.
    Type of Medium: Online Resource
    ISSN: 1155-5645 , 1460-9592
    URL: Issue
    URL: Article
    DOI: 10.1111/pan.2015.25.issue-8
    DOI: 10.1111/pan.12649
    Language: English
    Publisher: Wiley
    Publication Date: 2015
    detail.hit.zdb_id: 2008564-3
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 8
    Online Resource
    Online Resource
    Nurse‐driven analgesia and sedation in pediatric patients with univentricular hearts requiring extracorporeal life support after first‐stage palliation surgery: A pilot study
    Wiley ; 2017
    In:  Pediatric Anesthesia Vol. 27, No. 12 ( 2017-12), p. 1261-1270
    Details
    In: Pediatric Anesthesia, Wiley, Vol. 27, No. 12 ( 2017-12), p. 1261-1270
    Abstract: Few data are available regarding requirements of sedation and analgesia in children during extracorporeal life support. Aims The aim of this study was to evaluate if children with functionally univentricular hearts on extracorporeal life support after first‐stage palliation surgery have higher requirement of analgesics and sedatives compared with children without extracorporeal life support using a goal‐directed nurse‐driven analgesia and sedation protocol. Methods This prospective observational matched case‐control pilot study was conducted at a cardiac pediatric intensive care unit of a tertiary referral center. Seventeen patients with functionally univentricular hearts including hypoplastic left heart syndrome who were on extracorporeal life support after first‐stage palliation surgery were enrolled from July 2012 to January 2017. Seventeen matched patients served as controls. Doses of morphine, midazolam, clonidine, and muscle relaxants as well as sedation scores ( COMFORT behavior scale and the nurse interpretation of sedation scale) were assessed according to a nurse‐driven protocol every 8 hours up to 120 hours after first‐stage palliation surgery. Results Sedation scores were equal in the extracorporeal life support group and in the control group at most points in time. There was no significant difference in cumulative doses of morphine and midazolam. However, children of the extracorporeal life support group received higher doses of midazolam and morphine at some points in time. Conclusion A nurse‐driven protocol for analgesia and sedation of children with extracorporeal life support is feasible. Patients with extracorporeal life support do not need deeper sedation levels and have not higher cumulative sedation requirements than children without extracorporeal life support.
    Type of Medium: Online Resource
    ISSN: 1155-5645 , 1460-9592
    URL: Issue
    URL: Article
    DOI: 10.1111/pan.2017.27.issue-12
    DOI: 10.1111/pan.13274
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 2008564-3
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
  • 9
    Online Resource
    Online Resource
    Pre‐ and postnatal findings in a patient with a recombinant chromosome rec(8)(qter→q21.11::p23.3→qter) due to a paternal pericentric inversion inv(8)(p23.3q21.11) and review of the literature
    Wiley ; 2020
    In:  American Journal of Medical Genetics Part A Vol. 182, No. 11 ( 2020-11), p. 2680-2684
    Details
    In: American Journal of Medical Genetics Part A, Wiley, Vol. 182, No. 11 ( 2020-11), p. 2680-2684
    Abstract: Recombinant chromosome 8 (Rec8) syndrome (San Luis Valley [SLV] syndrome; OMIM #179613) is a rare chromosome disorder associated with intellectual disability, congenital heart defects, variable skeletal and urogenital anomalies, and dysmorphic features. It is characterized by a partial terminal deletion of 8p and a partial terminal duplication of 8q, which is usually due to meiotic recombination of a pericentric inversion of chromosome 8 of a healthy carrier parent. There are only few reports of cases with breakpoints defined at the molecular level by molecular karyotyping. We report on a case of Rec8 syndrome with previously unreported breakpoints in a male fetus with intrauterine growth restriction, hypogenesis of the corpus callosum, bilateral cleft lip/palate, and congenital heart defect. Cytogenetic analysis revealed a recombinant chromosome 8 [46,XY,rec(8)(qter→q21.11::p23.3→qter)] secondary to a paternal pericentric inversion [46,XY,inv(8)(p23.3q21.11)]. Molecular karyotyping correspondingly showed a terminal copy number loss of 1.4 Mb (arr[hg19] 8p23.3(158048_1514749)×1) and a terminal copy number gain of chromosome band 8q21.11q24.3 of 69.8 Mb (arr[hg19] 8q21.11q24.3(76477367_146295771)×3). To our knowledge, this is the fourth reported case diagnosed prenatally. We describe the postnatal clinical course of the male newborn. Furthermore, we review and compare the phenotypic features and breakpoints of 74 reported Rec8/SLV cases.
    Type of Medium: Online Resource
    ISSN: 1552-4825 , 1552-4833
    URL: Issue
    URL: Article
    DOI: 10.1002/ajmg.a.v182.11
    DOI: 10.1002/ajmg.a.61804
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 1493479-6
    SSG: 12
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Online Resource
    Open Access Request
    Availability (electronic / print)
Nothing or not found what you are looking for? Please check your search query or use the Interlibrary Loan Search.
Close ⊗
This website uses cookies and the analysis tool Matomo. Further information can be found on the KOBV privacy pages