Showing papers by "Robert H. Bartlett published in 1985"

Extracorporeal circulation in neonatal respiratory failure: a prospective randomized study.

Abstract: A prospective controlled randomized study of the use of extracorporeal membrane oxygenation to treat newborns with respiratory failure was carried out using the "randomized play-the-winner" statistical method. In this method the chance of randomly assigning an infant to one treatment or the other is influenced by the outcome of treatment of each patient in the study. If one treatment is more successful, more patients are randomly assigned to that treatment. A group of 12 infants with birth weight greater than 2 kg met objective criteria for high mortality risk. One patient was randomly assigned to conventional treatment (that patient died); 11 patients were randomly chosen for extracorporeal membrane oxygenation (all survived). Intracerebral hemorrhage occurred in one of 11 surviving children. Extracorporeal membrane oxygenation allows lung rest and improves survival compared to conventional ventilator therapy in newborn infants with severe respiratory failure.

Venovenous perfusion in ECMO for newborn respiratory insufficiency. A clinical comparison with venoarterial perfusion.

Abstract: Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) has been successful in the treatment of newborns less than 1 week of age and greater than 2000 gm birthweight with respiratory failure resistant to current medical and surgical management While VA ECMO supports the heart as well as the lungs, it has the disadvantage of requiring carotid artery ligation and the possibility of perfusing air bubbles or particles into the arterial tree We have treated 11 newborns with respiratory failure with venovenous (VV) ECMO returning the oxygenated blood to a cannula in the distal iliac vein We compared these patients with 16 patients treated during the same period of time with VA ECMO Three of the 11 VV patients required conversion to VA ECMO because of inadequate oxygenation and unstable hemodynamic situations Ten of the 11 VV patients survived Eleven of the 16 VA patients survived The better survival in these patients treated with VV ECMO is attributed to their more favorable initial condition compared to patients treated with VA ECMO The disadvantages of VV ECMO include a longer operative time to place the cannulas, groin wound problems, and persistent leg swelling along with the necessity to convert some patients to VA ECMO Although this experience demonstrates that newborns with severe respiratory failure can be supported with VV ECMO, the complications and lack of practical advantages over VA lead us to recommend VA ECMO for routine clinical use at present

Cranial Sonography of the Infant Treated with Extracorporeal Membrane Oxygenation

Abstract: Neonates with severe but reversible pulmonary disease may require therapy beyond conventional ventilatory care. Extracorporeal membrane oxygenation (ECMO) serves as a temporary artificial lung for such infants. Since anticoagulation with systemic heparin is required in the extracorporeal circuit, antecedent hemorrhage may be exacerbated or new hemorrhage precipitated in ECMO patients. While the “usual” periventricular/intraventricular hemorrhage seen in a premature infant may develop, contrasting hemorrhages of unusual extent, uncommon location, or demonstrating unique alterations in internal sonographic character may be precipitated, presumably due to the requisite anticoagulation. Representative examples of such variations are presented along with guidelines for the use of cranial sonography in selecting and monitoring ECMO patients.

Cranial sonography of the infant treated with extracorporeal membrane oxygenation

Abstract: Neonates with severe but reversible pulmonary disease may require therapy beyond conventional ventilatory care. Extracorporeal membrane oxygenation (ECMO) serves as a temporary artificial lung for such infants. Since anticoagulation with systemic heparin is required in the extracorporeal circuit, antecedent hemorrhage may be exacerbated or new hemorrhage precipitated in ECMO patients. While the "usual" periventricular/intraventricular hemorrhage seen in a premature infant may develop, contrasting hemorrhages of unusual extent, uncommon location, or demonstrating unique alterations in internal sonographic character may be precipitated, presumably due to the requisite anticoagulation. Representative examples of such variations are presented along with guidelines for the use of cranial sonography in selecting and monitoring ECMO patients.

Management of acute and chronic disorders of the trachea and subglottis

Abstract: During a 14 year period, 22 patients with stricture, acute laryngeal injury, and cancer were treated Nine patients had postintubation tracheal stenosis and underwent tracheal resection with good to excellent results Six patients had strictures after tracheostomy In one patient, stenosis occurred after repair and repeated dilatation was necessary He subsequently had to undergo repeat tracheostomy, but the tube was later removed and his symptoms disappeared Our current preference for suture is either 3-0 polypropylene or polyglycolic acid Acute separation of the trachea can occur with trauma to the neck, either by garrotting or direct blunt force The diagnosis is suspected when endotracheal intubation is impossible and a step off below the larynx and crepitation exists Emergency tracheostomy is necessary, however, and primary repair can be delayed for up to 24 hours if other conditions require attention Tracheal resection for squamous cell carcinoma is possible, but only a small group of patients may be surgical candidates