Andrea Lotze - Academia.edu (original) (raw)

Papers by Andrea Lotze

Research paper thumbnail of Neonatology Friday, May 29TH, 1987 South Ballroom 10: 45�12

Research paper thumbnail of Serial Lecithin/Sphingomyelin Ratios and Surfactant/Albumin Ratios in Tracheal Aspirates from Term Infants with Respiratory Failure Receiving Extracorporeal Membrane Oxygenation

Serial tracheal aspirate samples were obtained for deter- mination of lecithin/sphingomyelin (US)... more Serial tracheal aspirate samples were obtained for deter- mination of lecithin/sphingomyelin (US) ratios from 47 term infants in respiratory failure. Phospholipids were extracted with Foich solution (chloroform:methanol, 2:1 by vol) and analyzed by HPLC with use of a silica column and a mobile phase of acetonitrile:methanol:water (48:31: 21, by vol). Surfactantlalbumin (S/A) ratios were deter- mined with the TDx Fetal

Research paper thumbnail of Surfactant (beractant) therapy for infants with congenital diaphragmatic hernia on ECMO: Evidence of persistent surfactant deficiency

J Pediat Surg, 1994

Infants with congenital diaphragmatic hernia (CDH) on extracorporeal membrane oxygenation (ECMO) ... more Infants with congenital diaphragmatic hernia (CDH) on extracorporeal membrane oxygenation (ECMO) can have initial lung atelectasis which, in survivors, gradually improves over time. To test the hypothesis that these patients could benefit from surfactant therapy, infants with CDH (born at > 34 weeks' gestation) on ECMO received either four doses of modified bovine lung surfactant extract (beractant) (surfactant group, n = 9) or an equal volume of air (control group, n = 8). Tracheal aspirate surfactant protein-A (SP-A) concentrations were initially low, and then increased over time in both CDH groups (P = .0021); however, levels remained low when compared with those of infants on ECMO who had other diagnoses (P = .04). Lung compliance (CL), time to extubation, time on oxygen, and total no. of hospital days were not different between the two groups. Infants with CDH had persistently elevated right ventricular pressure (RVP) at cessation of bypass when compared with non-CDH infants on ECMO (RVP = 53.25 mm Hg +/- 19.52 in the CDH group, 32.90 +/- 10.63 in the non-CDH group; P = .0121). The findings suggest that the postnatal surfactant deficiency may be more persistent in CDH infants than in non-CDH infants on ECMO. However, CDH remains a multifactorial condition, with delayed improvement, because of persistence of pulmonary hypertension, difficulties with vascular remodeling, degree of lung hypoplasia, or compromised respiratory mechanics.

Research paper thumbnail of Surfactant content in children with inflammatory lung disease

Critical Care Medicine

To determine surfactant profiles of tracheal secretions in mechanically ventilated children with ... more To determine surfactant profiles of tracheal secretions in mechanically ventilated children with respiratory failure secondary to bacterial pneumonia, viral pneumonitis, adult respiratory distress syndrome (ARDS), and cardiopulmonary bypass. Prospective, cohort study. Tertiary, multidisciplinary, pediatric intensive care unit. One hundred twenty pediatric patients with respiratory failure requiring mechanical ventilation. Routine tracheal aspirates were collected from children with bacterial pneumonia, viral pneumonitis, ARDS, postcardiopulmonary bypass, and a postsurgical control group. Samples were obtained on days 1, 2, 3, after every week of intubation and on the day of extubation. The tracheal aspirates were analyzed by high-performance liquid chromatography for lecithin/sphingomyelin rations and by enzyme-linked immunosorbent assay for surfactant proteins A and B. Lung compliance and the oxygenation index were measured on each day of sample collection. On day 1, patients with ...

Research paper thumbnail of Extracorporeal Membrane Oxygenator Therapy

Research paper thumbnail of A novel questionnaire to assess activity in patients after hip arthroplasties

Orthopade, 2006

ZusammenfassungHintergrund Die Aktivität der unteren Extremität war bislang nur mit teuren elekt... more ZusammenfassungHintergrund Die Aktivität der unteren Extremität war bislang nur mit teuren elektronischen Schrittzählern exakt messbar. Ziel war es deshalb, einen praktikablen Fragebogen zur Messung der Aktivität von Prothesenpatienten zu entwickeln.Material und Methode DerTägliche Würzburger Bewegungsaktivitätsfragebogen(TWB) wurde in mehreren Schritten entwickelt und die Evaluierung erfolgte an 3 Patientengruppen mit Koxarthrose (160 Patienten und 855 Untersuchungstagen). Es wurden die psychometrischen Kennwerte überprüft.Ergebnisse Die Retestreliabilität (ICC) des TWB liegt

Research paper thumbnail of Surfactant protein A concentrations in tracheal aspirate fluid from infants requiring extracorporeal membrane oxygenation

The Journal of Pediatrics, 1990

To understand the lung abnormalities leading to respiratory failure in infants, we measured 35,00... more To understand the lung abnormalities leading to respiratory failure in infants, we measured 35,000-dalton surfactant protein A concentrations in tracheal aspirate fluid collected daily from 25 infants receiving extracorporeal membrane oxygenation (ECMO). Surfactant protein A concentrations were standardized per milligrams of total protein present in the aspirate. Among the 23 survivors with complete data, the surfactant protein A concentration increased significantly with time (p <0.0001). Concurrent increases in lung compliance (p <0.0001) and radiographic scores (p <0.0001) were also observed. This increase in surfactant protein A content may reflect lung recovery from barotrauma and oxygen toxic effects or be a response to the primary pulmonary disease process. The two infants who did not survive extracorporeal membrane oxygenation failed to demonstrate these trends. (J PEDIATR 1990;116:435-40)

Research paper thumbnail of Multicenter study of surfactant (beractant) use in the treatment of term infants with severe respiratory failure

The Journal of Pediatrics, 1998

Objective: The purpose of this study was to determine whether surfactant (beractant) administrati... more Objective: The purpose of this study was to determine whether surfactant (beractant) administration to term newborns in respiratory failure and at risk for requiring extracorporeal membrane oxygenation (ECMO) treatment would significantly reduce the incidence of severe complications through 28 days of age and the need for ECMO.

Research paper thumbnail of Improved pulmonary outcome after exogenous surfactant therapy for respiratory failure in term infants requiring extracorporeal membrane oxygenation

The Journal of Pediatrics, 1993

A blinded, randomized, controlled study was designed to test whether multipledose surfactant ther... more A blinded, randomized, controlled study was designed to test whether multipledose surfactant therapy would Improve pulmonary o~Jtcome In term Infants with resplratory failure, resulting in a shortened period of extracorporeal membrane oxygenation (ECMO). Infants >34 weeks of geslational age In severe resplratory failure and receiving ECMO were stratified by diagnosis and then randomly assigned to the treatment or the control group. Four doses of modified bovine lung surtactant extract (beractant) were admlnlstered to the surfactant group (n = 28), and an equal volume of air was administered to the control group (n = 28). Lung compliance was Inltlally low In both groups; after treatment, values were hlgher wlth time In the surfactant group (F = 5.40, p = 0.026). The ECMO treatment period was significantly shorter in the surfactant group (mean+ SD: 407 _+ 33 hours vs 439 __+. 54 hours for the control group; U = 232, p = 0.023). Tracheal aspirate concentrations of surtactant protein A were low in both groups, and then Increased steadily to a higher level In the surtactant group (F = 2.58, p = 0.04). The overall Incidence of complications after ECMO was decreased In the surtactant group (48% vs 46% for the control group; chl-square value = 5.004, p = 0.025). Radiographic scores, echocardlographlc findings, Incidence of Intracranlal or pulmonary hemorrhage and bronchopulmonary dysplasla, time to extubatlon, duration of oxygen therapy, and duration of hospitalization did not differ between the two groups. Beractant In thls population Improved pulmonary mechanics, Increased surfactant protein A content In tracheal aspirate, decreased lime on ECMO duration, and reduced disease complications. (J PEDIATR 1993;t22:26t-8) Atelectasis and decreased lung compliance are commonly observed in newborn infants treated with extracorporeal membrane oxygenation. In a population of term infants (mean gestational age = 39 weeks) in respiratory failure who were on an ECMO regimen, early tracheal aspirate levels of surfactant protein A were comparable to those of sick, preterm neonates with hyaline membrane disease. 1,2

Research paper thumbnail of Extracorporeal membrane oxygenation therapy in neonates with septic shock

Journal of Pediatric Surgery, 1990

Neonatal septic shock has significant morbidity and mortality with current therapeutic measures. ... more Neonatal septic shock has significant morbidity and mortality with current therapeutic measures. At Children&#39;s National Medical Center, from June 1984 to October 1986, 10 of 100 patients treated with venoarterial extracorporeal membrane oxygenation (ECMO) had a documented diagnosis of septic shock. All of these infants fulfilled criteria consistent with 80% mortality using conventional intensive medical management. However, the survival rate for the septic neonates in this study was 100%. Compared with other groups of infants treated with ECMO, these septic neonates required significantly more ventilatory support after ECMO and had a higher incidence of chronic lung disease (30% v 12%). The septic neonates were also at higher risk for intracranial hemorrhage than the other infants treated with ECMO (40% v 26%). The necessity for prolonged intubation after ECMO for patients with septic shock suggests that this condition may be associated with additional structural damage not seen with meconium aspiration syndrome or respiratory distress syndrome. Nevertheless, for neonatal patients with septic shock unresponsive to conventional medical management, ECMO must be considered a viable alternative treatment.

Research paper thumbnail of Surfactant (beractant) therapy for infants with congenital diaphragmatic hernia on ECMO: Evidence of persistent surfactant deficiency

Journal of Pediatric Surgery, 1994

Infants with congenital diaphragmatic hernia (CDH) on extracorporeal membrane oxygenation (ECMO) ... more Infants with congenital diaphragmatic hernia (CDH) on extracorporeal membrane oxygenation (ECMO) can have initial lung atelectasis which, in survivors, gradually improves over time. To test the hypothesis that these patients could benefit from surfactant therapy, infants with CDH (born at &gt; 34 weeks&#39; gestation) on ECMO received either four doses of modified bovine lung surfactant extract (beractant) (surfactant group, n = 9) or an equal volume of air (control group, n = 8). Tracheal aspirate surfactant protein-A (SP-A) concentrations were initially low, and then increased over time in both CDH groups (P = .0021); however, levels remained low when compared with those of infants on ECMO who had other diagnoses (P = .04). Lung compliance (CL), time to extubation, time on oxygen, and total no. of hospital days were not different between the two groups. Infants with CDH had persistently elevated right ventricular pressure (RVP) at cessation of bypass when compared with non-CDH infants on ECMO (RVP = 53.25 mm Hg +/- 19.52 in the CDH group, 32.90 +/- 10.63 in the non-CDH group; P = .0121). The findings suggest that the postnatal surfactant deficiency may be more persistent in CDH infants than in non-CDH infants on ECMO. However, CDH remains a multifactorial condition, with delayed improvement, because of persistence of pulmonary hypertension, difficulties with vascular remodeling, degree of lung hypoplasia, or compromised respiratory mechanics.

Research paper thumbnail of Stunned myocardium in an infant treated with extracorporeal membrane oxygenation

Journal of Pediatric Surgery, 1988

This report describes a case of postischemic myocardial dysfunction that was successfully treated... more This report describes a case of postischemic myocardial dysfunction that was successfully treated with ECMO.

Research paper thumbnail of Lung compliance as a measure of lung function in newborns with respiratory failure requiring extracorporeal membrane oxygenation

Critical Care Medicine, 1987

Extracorporeal membrane oxygenation (ECMO) can now be used as an alternative mode of therapy for ... more Extracorporeal membrane oxygenation (ECMO) can now be used as an alternative mode of therapy for infants 2.0 kg or more with life-threatening respiratory failure. Current criteria for removal from ECMO are limited. We attempted to determine whether lung compliance (CL) could be used as a sensitive indicator of the neonates&#39; lung improvement while they are on ECMO, as well as a predictor of their ability to tolerate removal from bypass. We obtained serial CL measurements in 13 infants, all of whom weaned successfully from ECMO. All had an initial CL on ECMO of 0.5 ml/cm H2O X kg or less (mean = 0.3), with a final CL of 0.8 ml/cm H2O X kg or more (mean = 1.7). The average change in CL from the initial to the final measurement was 0.6 ml/cm H2O X kg or more (mean = 1.5). CL findings correlated well with estimated bypass, expressed as a percent of cardiac output, and a radiographic score of pulmonary abnormality (r = -.66, p less than .0001, and r = -.52, p less than .0001, respectively). We conclude that CL measurements can be used to monitor clinical improvement in infants on ECMO, to predict their successful removal from bypass, and ultimately to shorten their total time spent on bypass.

Research paper thumbnail of Surfactant content in children with inflammatory lung disease

Critical Care Medicine, 1996

To determine surfactant profiles of tracheal secretions in mechanically ventilated children with ... more To determine surfactant profiles of tracheal secretions in mechanically ventilated children with respiratory failure secondary to bacterial pneumonia, viral pneumonitis, adult respiratory distress syndrome (ARDS), and cardiopulmonary bypass. Prospective, cohort study. Tertiary, multidisciplinary, pediatric intensive care unit. One hundred twenty pediatric patients with respiratory failure requiring mechanical ventilation. Routine tracheal aspirates were collected from children with bacterial pneumonia, viral pneumonitis, ARDS, postcardiopulmonary bypass, and a postsurgical control group. Samples were obtained on days 1, 2, 3, after every week of intubation and on the day of extubation. The tracheal aspirates were analyzed by high-performance liquid chromatography for lecithin/sphingomyelin rations and by enzyme-linked immunosorbent assay for surfactant proteins A and B. Lung compliance and the oxygenation index were measured on each day of sample collection. On day 1, patients with bacterial pneumonia, viral pneumonitis, and ARDS had decreased lecithin/sphingomyelin ration (p &lt; .001), and those patients with bacterial pneumonia and viral pneumonitis had decreased surfactant protein A/protein concentration (p &lt; .001). The lecithin/sphingomyelin ratios and surfactant protein A/protein concentration were significantly different among the groups (p &lt; .001), with the bacterial pneumonia and viral pneumonitis groups having higher lecithin/sphingomyelin ratios and increased surfactant protein concentrations before extubation. Pulmonary compliance was lower and the oxygenation index was higher than controls (p &lt; .001) in patients with bacterial pneumonia, viral pneumonitis, and ARDS. Pulmonary compliance was correlated weakly with lecithin/sphingomyelin ratio (r2 = .11, p &lt; .001) and surfactant protein A/protein concentration (r2 = .03, p &lt; .05). Surfactant protein B was similar in the diagnostic groups. Surfactant content in tracheal secretions from cardiopulmonary bypass patients was equivalent to controls. Abnormal tracheal aspirate surfactant phospholipids and surfactant protein A were noted in children with bacterial pneumonia, viral pneumonitis, and ARDS, but not in children on cardiopulmonary bypass.

Research paper thumbnail of Neonatology Friday, May 29TH, 1987 South Ballroom 10

Critical Care Medicine, 1987

Research paper thumbnail of Steady-state dopamine clearance in critically ill infants and children

Critical Care Medicine, 1988

Little is known about dopamine pharmacokinetics in pediatric patients, especially in critically i... more Little is known about dopamine pharmacokinetics in pediatric patients, especially in critically ill infants and children who often receive treatment with dopamine. Arterial plasma concentrations of dopamine were measured in 27 patients who were hemodynamically stable and received dopamine for at least one hour. The dopamine levels were measured using liquid chromatography with electrochemical detection. Dopamine clearance averaged 96.2 +/- 55.4 ml/kg.min in 13 patients in the neonatal ICU, and 58.8 +/- 51 ml/kg.min in 14 patients in the pediatric ICU. Six patients had renal (BUN greater than 25 mg/dl, or creatinine greater than 1.2 mg/dl) or hepatic (liver enzymes greater than 3 times normal) dysfunction. Dopamine clearance in these patients (25.1 +/- 17.2 ml/kg.min) was substantially lower than in the other patients (p less than .01). Neither postnatal nor gestational age correlated with dopamine clearance. Substantial interindividual variation was observed in steady-state dopamine clearance in critically ill infants and children, and plasma dopamine could not be predicted accurately from the dopamine infusion rate. Because of the more than three-fold prolongation of dopamine clearances in patients with hepatic or renal dysfunction, these patients may be more likely to suffer toxic effects of dopamine at the usual drug infusion rates.

Research paper thumbnail of Surfactant Content in Children with Acute Viral Bronchiolitis

Critical Care Medicine, 1995

Research paper thumbnail of Echo Therapy for Infants with Overwhelming Sepsis

Pediatric Research, 1987

ABSTRACT Neonates with fulminant bacterial infections can die in septic shock despite aggressive ... more ABSTRACT Neonates with fulminant bacterial infections can die in septic shock despite aggressive medical therapy. From 6/84 to 11/86, 10 infants with septic shock were treated at CHNMC with veno- arterial extracorporeal membrane oxygenation (ECMO). All infants had failed to respond to conventional intensive medical management and met ECMO entry criteria predictive of &gt; 80% mortality risk. Diagnosis was by positive blood cultures in 7 infants. One infant had negative blood cultures but Wellcogens were positive for GBS antigen. Two infants had negative cultures, but perinatal hx&#39;s were compatible with septic shock. Eight infants had total WBC&#39;s &lt;6,600 prior to ECMO. All ten infants survived with ECMO therapy. Morbidity among these infants included: (1) ICH in 4 infants, 2 which were severe; (2) oxygen dependence beyond one month in 3 infants. The risk of ICH was higher in the septic shock infants than in our ECMO population in general (40% vs 26%). Likewise, the risk for chronic lung disease was higher in the septic shock infants than in our ECMO population (30% vs 15%). In our experience ECMO is a valid therapy for infants with septic shock unresponsive to other therapies.

Research paper thumbnail of Neonatology Friday, May 29TH, 1987 South Ballroom 10: 45�12

Research paper thumbnail of Serial Lecithin/Sphingomyelin Ratios and Surfactant/Albumin Ratios in Tracheal Aspirates from Term Infants with Respiratory Failure Receiving Extracorporeal Membrane Oxygenation

Serial tracheal aspirate samples were obtained for deter- mination of lecithin/sphingomyelin (US)... more Serial tracheal aspirate samples were obtained for deter- mination of lecithin/sphingomyelin (US) ratios from 47 term infants in respiratory failure. Phospholipids were extracted with Foich solution (chloroform:methanol, 2:1 by vol) and analyzed by HPLC with use of a silica column and a mobile phase of acetonitrile:methanol:water (48:31: 21, by vol). Surfactantlalbumin (S/A) ratios were deter- mined with the TDx Fetal

Research paper thumbnail of Surfactant (beractant) therapy for infants with congenital diaphragmatic hernia on ECMO: Evidence of persistent surfactant deficiency

J Pediat Surg, 1994

Infants with congenital diaphragmatic hernia (CDH) on extracorporeal membrane oxygenation (ECMO) ... more Infants with congenital diaphragmatic hernia (CDH) on extracorporeal membrane oxygenation (ECMO) can have initial lung atelectasis which, in survivors, gradually improves over time. To test the hypothesis that these patients could benefit from surfactant therapy, infants with CDH (born at &gt; 34 weeks&#39; gestation) on ECMO received either four doses of modified bovine lung surfactant extract (beractant) (surfactant group, n = 9) or an equal volume of air (control group, n = 8). Tracheal aspirate surfactant protein-A (SP-A) concentrations were initially low, and then increased over time in both CDH groups (P = .0021); however, levels remained low when compared with those of infants on ECMO who had other diagnoses (P = .04). Lung compliance (CL), time to extubation, time on oxygen, and total no. of hospital days were not different between the two groups. Infants with CDH had persistently elevated right ventricular pressure (RVP) at cessation of bypass when compared with non-CDH infants on ECMO (RVP = 53.25 mm Hg +/- 19.52 in the CDH group, 32.90 +/- 10.63 in the non-CDH group; P = .0121). The findings suggest that the postnatal surfactant deficiency may be more persistent in CDH infants than in non-CDH infants on ECMO. However, CDH remains a multifactorial condition, with delayed improvement, because of persistence of pulmonary hypertension, difficulties with vascular remodeling, degree of lung hypoplasia, or compromised respiratory mechanics.

Research paper thumbnail of Surfactant content in children with inflammatory lung disease

Critical Care Medicine

To determine surfactant profiles of tracheal secretions in mechanically ventilated children with ... more To determine surfactant profiles of tracheal secretions in mechanically ventilated children with respiratory failure secondary to bacterial pneumonia, viral pneumonitis, adult respiratory distress syndrome (ARDS), and cardiopulmonary bypass. Prospective, cohort study. Tertiary, multidisciplinary, pediatric intensive care unit. One hundred twenty pediatric patients with respiratory failure requiring mechanical ventilation. Routine tracheal aspirates were collected from children with bacterial pneumonia, viral pneumonitis, ARDS, postcardiopulmonary bypass, and a postsurgical control group. Samples were obtained on days 1, 2, 3, after every week of intubation and on the day of extubation. The tracheal aspirates were analyzed by high-performance liquid chromatography for lecithin/sphingomyelin rations and by enzyme-linked immunosorbent assay for surfactant proteins A and B. Lung compliance and the oxygenation index were measured on each day of sample collection. On day 1, patients with ...

Research paper thumbnail of Extracorporeal Membrane Oxygenator Therapy

Research paper thumbnail of A novel questionnaire to assess activity in patients after hip arthroplasties

Orthopade, 2006

ZusammenfassungHintergrund Die Aktivität der unteren Extremität war bislang nur mit teuren elekt... more ZusammenfassungHintergrund Die Aktivität der unteren Extremität war bislang nur mit teuren elektronischen Schrittzählern exakt messbar. Ziel war es deshalb, einen praktikablen Fragebogen zur Messung der Aktivität von Prothesenpatienten zu entwickeln.Material und Methode DerTägliche Würzburger Bewegungsaktivitätsfragebogen(TWB) wurde in mehreren Schritten entwickelt und die Evaluierung erfolgte an 3 Patientengruppen mit Koxarthrose (160 Patienten und 855 Untersuchungstagen). Es wurden die psychometrischen Kennwerte überprüft.Ergebnisse Die Retestreliabilität (ICC) des TWB liegt

Research paper thumbnail of Surfactant protein A concentrations in tracheal aspirate fluid from infants requiring extracorporeal membrane oxygenation

The Journal of Pediatrics, 1990

To understand the lung abnormalities leading to respiratory failure in infants, we measured 35,00... more To understand the lung abnormalities leading to respiratory failure in infants, we measured 35,000-dalton surfactant protein A concentrations in tracheal aspirate fluid collected daily from 25 infants receiving extracorporeal membrane oxygenation (ECMO). Surfactant protein A concentrations were standardized per milligrams of total protein present in the aspirate. Among the 23 survivors with complete data, the surfactant protein A concentration increased significantly with time (p <0.0001). Concurrent increases in lung compliance (p <0.0001) and radiographic scores (p <0.0001) were also observed. This increase in surfactant protein A content may reflect lung recovery from barotrauma and oxygen toxic effects or be a response to the primary pulmonary disease process. The two infants who did not survive extracorporeal membrane oxygenation failed to demonstrate these trends. (J PEDIATR 1990;116:435-40)

Research paper thumbnail of Multicenter study of surfactant (beractant) use in the treatment of term infants with severe respiratory failure

The Journal of Pediatrics, 1998

Objective: The purpose of this study was to determine whether surfactant (beractant) administrati... more Objective: The purpose of this study was to determine whether surfactant (beractant) administration to term newborns in respiratory failure and at risk for requiring extracorporeal membrane oxygenation (ECMO) treatment would significantly reduce the incidence of severe complications through 28 days of age and the need for ECMO.

Research paper thumbnail of Improved pulmonary outcome after exogenous surfactant therapy for respiratory failure in term infants requiring extracorporeal membrane oxygenation

The Journal of Pediatrics, 1993

A blinded, randomized, controlled study was designed to test whether multipledose surfactant ther... more A blinded, randomized, controlled study was designed to test whether multipledose surfactant therapy would Improve pulmonary o~Jtcome In term Infants with resplratory failure, resulting in a shortened period of extracorporeal membrane oxygenation (ECMO). Infants >34 weeks of geslational age In severe resplratory failure and receiving ECMO were stratified by diagnosis and then randomly assigned to the treatment or the control group. Four doses of modified bovine lung surtactant extract (beractant) were admlnlstered to the surfactant group (n = 28), and an equal volume of air was administered to the control group (n = 28). Lung compliance was Inltlally low In both groups; after treatment, values were hlgher wlth time In the surfactant group (F = 5.40, p = 0.026). The ECMO treatment period was significantly shorter in the surfactant group (mean+ SD: 407 _+ 33 hours vs 439 __+. 54 hours for the control group; U = 232, p = 0.023). Tracheal aspirate concentrations of surtactant protein A were low in both groups, and then Increased steadily to a higher level In the surtactant group (F = 2.58, p = 0.04). The overall Incidence of complications after ECMO was decreased In the surtactant group (48% vs 46% for the control group; chl-square value = 5.004, p = 0.025). Radiographic scores, echocardlographlc findings, Incidence of Intracranlal or pulmonary hemorrhage and bronchopulmonary dysplasla, time to extubatlon, duration of oxygen therapy, and duration of hospitalization did not differ between the two groups. Beractant In thls population Improved pulmonary mechanics, Increased surfactant protein A content In tracheal aspirate, decreased lime on ECMO duration, and reduced disease complications. (J PEDIATR 1993;t22:26t-8) Atelectasis and decreased lung compliance are commonly observed in newborn infants treated with extracorporeal membrane oxygenation. In a population of term infants (mean gestational age = 39 weeks) in respiratory failure who were on an ECMO regimen, early tracheal aspirate levels of surfactant protein A were comparable to those of sick, preterm neonates with hyaline membrane disease. 1,2

Research paper thumbnail of Extracorporeal membrane oxygenation therapy in neonates with septic shock

Journal of Pediatric Surgery, 1990

Neonatal septic shock has significant morbidity and mortality with current therapeutic measures. ... more Neonatal septic shock has significant morbidity and mortality with current therapeutic measures. At Children&#39;s National Medical Center, from June 1984 to October 1986, 10 of 100 patients treated with venoarterial extracorporeal membrane oxygenation (ECMO) had a documented diagnosis of septic shock. All of these infants fulfilled criteria consistent with 80% mortality using conventional intensive medical management. However, the survival rate for the septic neonates in this study was 100%. Compared with other groups of infants treated with ECMO, these septic neonates required significantly more ventilatory support after ECMO and had a higher incidence of chronic lung disease (30% v 12%). The septic neonates were also at higher risk for intracranial hemorrhage than the other infants treated with ECMO (40% v 26%). The necessity for prolonged intubation after ECMO for patients with septic shock suggests that this condition may be associated with additional structural damage not seen with meconium aspiration syndrome or respiratory distress syndrome. Nevertheless, for neonatal patients with septic shock unresponsive to conventional medical management, ECMO must be considered a viable alternative treatment.

Research paper thumbnail of Surfactant (beractant) therapy for infants with congenital diaphragmatic hernia on ECMO: Evidence of persistent surfactant deficiency

Journal of Pediatric Surgery, 1994

Infants with congenital diaphragmatic hernia (CDH) on extracorporeal membrane oxygenation (ECMO) ... more Infants with congenital diaphragmatic hernia (CDH) on extracorporeal membrane oxygenation (ECMO) can have initial lung atelectasis which, in survivors, gradually improves over time. To test the hypothesis that these patients could benefit from surfactant therapy, infants with CDH (born at &gt; 34 weeks&#39; gestation) on ECMO received either four doses of modified bovine lung surfactant extract (beractant) (surfactant group, n = 9) or an equal volume of air (control group, n = 8). Tracheal aspirate surfactant protein-A (SP-A) concentrations were initially low, and then increased over time in both CDH groups (P = .0021); however, levels remained low when compared with those of infants on ECMO who had other diagnoses (P = .04). Lung compliance (CL), time to extubation, time on oxygen, and total no. of hospital days were not different between the two groups. Infants with CDH had persistently elevated right ventricular pressure (RVP) at cessation of bypass when compared with non-CDH infants on ECMO (RVP = 53.25 mm Hg +/- 19.52 in the CDH group, 32.90 +/- 10.63 in the non-CDH group; P = .0121). The findings suggest that the postnatal surfactant deficiency may be more persistent in CDH infants than in non-CDH infants on ECMO. However, CDH remains a multifactorial condition, with delayed improvement, because of persistence of pulmonary hypertension, difficulties with vascular remodeling, degree of lung hypoplasia, or compromised respiratory mechanics.

Research paper thumbnail of Stunned myocardium in an infant treated with extracorporeal membrane oxygenation

Journal of Pediatric Surgery, 1988

This report describes a case of postischemic myocardial dysfunction that was successfully treated... more This report describes a case of postischemic myocardial dysfunction that was successfully treated with ECMO.

Research paper thumbnail of Lung compliance as a measure of lung function in newborns with respiratory failure requiring extracorporeal membrane oxygenation

Critical Care Medicine, 1987

Extracorporeal membrane oxygenation (ECMO) can now be used as an alternative mode of therapy for ... more Extracorporeal membrane oxygenation (ECMO) can now be used as an alternative mode of therapy for infants 2.0 kg or more with life-threatening respiratory failure. Current criteria for removal from ECMO are limited. We attempted to determine whether lung compliance (CL) could be used as a sensitive indicator of the neonates&#39; lung improvement while they are on ECMO, as well as a predictor of their ability to tolerate removal from bypass. We obtained serial CL measurements in 13 infants, all of whom weaned successfully from ECMO. All had an initial CL on ECMO of 0.5 ml/cm H2O X kg or less (mean = 0.3), with a final CL of 0.8 ml/cm H2O X kg or more (mean = 1.7). The average change in CL from the initial to the final measurement was 0.6 ml/cm H2O X kg or more (mean = 1.5). CL findings correlated well with estimated bypass, expressed as a percent of cardiac output, and a radiographic score of pulmonary abnormality (r = -.66, p less than .0001, and r = -.52, p less than .0001, respectively). We conclude that CL measurements can be used to monitor clinical improvement in infants on ECMO, to predict their successful removal from bypass, and ultimately to shorten their total time spent on bypass.

Research paper thumbnail of Surfactant content in children with inflammatory lung disease

Critical Care Medicine, 1996

To determine surfactant profiles of tracheal secretions in mechanically ventilated children with ... more To determine surfactant profiles of tracheal secretions in mechanically ventilated children with respiratory failure secondary to bacterial pneumonia, viral pneumonitis, adult respiratory distress syndrome (ARDS), and cardiopulmonary bypass. Prospective, cohort study. Tertiary, multidisciplinary, pediatric intensive care unit. One hundred twenty pediatric patients with respiratory failure requiring mechanical ventilation. Routine tracheal aspirates were collected from children with bacterial pneumonia, viral pneumonitis, ARDS, postcardiopulmonary bypass, and a postsurgical control group. Samples were obtained on days 1, 2, 3, after every week of intubation and on the day of extubation. The tracheal aspirates were analyzed by high-performance liquid chromatography for lecithin/sphingomyelin rations and by enzyme-linked immunosorbent assay for surfactant proteins A and B. Lung compliance and the oxygenation index were measured on each day of sample collection. On day 1, patients with bacterial pneumonia, viral pneumonitis, and ARDS had decreased lecithin/sphingomyelin ration (p &lt; .001), and those patients with bacterial pneumonia and viral pneumonitis had decreased surfactant protein A/protein concentration (p &lt; .001). The lecithin/sphingomyelin ratios and surfactant protein A/protein concentration were significantly different among the groups (p &lt; .001), with the bacterial pneumonia and viral pneumonitis groups having higher lecithin/sphingomyelin ratios and increased surfactant protein concentrations before extubation. Pulmonary compliance was lower and the oxygenation index was higher than controls (p &lt; .001) in patients with bacterial pneumonia, viral pneumonitis, and ARDS. Pulmonary compliance was correlated weakly with lecithin/sphingomyelin ratio (r2 = .11, p &lt; .001) and surfactant protein A/protein concentration (r2 = .03, p &lt; .05). Surfactant protein B was similar in the diagnostic groups. Surfactant content in tracheal secretions from cardiopulmonary bypass patients was equivalent to controls. Abnormal tracheal aspirate surfactant phospholipids and surfactant protein A were noted in children with bacterial pneumonia, viral pneumonitis, and ARDS, but not in children on cardiopulmonary bypass.

Research paper thumbnail of Neonatology Friday, May 29TH, 1987 South Ballroom 10

Critical Care Medicine, 1987

Research paper thumbnail of Steady-state dopamine clearance in critically ill infants and children

Critical Care Medicine, 1988

Little is known about dopamine pharmacokinetics in pediatric patients, especially in critically i... more Little is known about dopamine pharmacokinetics in pediatric patients, especially in critically ill infants and children who often receive treatment with dopamine. Arterial plasma concentrations of dopamine were measured in 27 patients who were hemodynamically stable and received dopamine for at least one hour. The dopamine levels were measured using liquid chromatography with electrochemical detection. Dopamine clearance averaged 96.2 +/- 55.4 ml/kg.min in 13 patients in the neonatal ICU, and 58.8 +/- 51 ml/kg.min in 14 patients in the pediatric ICU. Six patients had renal (BUN greater than 25 mg/dl, or creatinine greater than 1.2 mg/dl) or hepatic (liver enzymes greater than 3 times normal) dysfunction. Dopamine clearance in these patients (25.1 +/- 17.2 ml/kg.min) was substantially lower than in the other patients (p less than .01). Neither postnatal nor gestational age correlated with dopamine clearance. Substantial interindividual variation was observed in steady-state dopamine clearance in critically ill infants and children, and plasma dopamine could not be predicted accurately from the dopamine infusion rate. Because of the more than three-fold prolongation of dopamine clearances in patients with hepatic or renal dysfunction, these patients may be more likely to suffer toxic effects of dopamine at the usual drug infusion rates.

Research paper thumbnail of Surfactant Content in Children with Acute Viral Bronchiolitis

Critical Care Medicine, 1995

Research paper thumbnail of Echo Therapy for Infants with Overwhelming Sepsis

Pediatric Research, 1987

ABSTRACT Neonates with fulminant bacterial infections can die in septic shock despite aggressive ... more ABSTRACT Neonates with fulminant bacterial infections can die in septic shock despite aggressive medical therapy. From 6/84 to 11/86, 10 infants with septic shock were treated at CHNMC with veno- arterial extracorporeal membrane oxygenation (ECMO). All infants had failed to respond to conventional intensive medical management and met ECMO entry criteria predictive of &gt; 80% mortality risk. Diagnosis was by positive blood cultures in 7 infants. One infant had negative blood cultures but Wellcogens were positive for GBS antigen. Two infants had negative cultures, but perinatal hx&#39;s were compatible with septic shock. Eight infants had total WBC&#39;s &lt;6,600 prior to ECMO. All ten infants survived with ECMO therapy. Morbidity among these infants included: (1) ICH in 4 infants, 2 which were severe; (2) oxygen dependence beyond one month in 3 infants. The risk of ICH was higher in the septic shock infants than in our ECMO population in general (40% vs 26%). Likewise, the risk for chronic lung disease was higher in the septic shock infants than in our ECMO population (30% vs 15%). In our experience ECMO is a valid therapy for infants with septic shock unresponsive to other therapies.