Objective: Transcranial Doppler (TCD) is a sensitive technique for circulatory arrest diagnosis in brain death when patterns such as reverberant flow and short systolic spikes are observed. In infants, the nonossified fontanelles compensate for intracranial hypertension. We describe TCD patterns in infants with brain death, different from adults, with the hemodynamic modifications induced by anterior fontanelle compression. Method: TCD was performed in 2 infants with diagnosed brain death admitted to the neonatal intensive care unit. Results: TCD showed a large peak ‘reverberant’ flow, with a high peak systolic velocity and a consistent retrograde component, away from the brain. Compression of the anterior fontanelle induced, at first, a reduction in systolic flow with the subsequent appearance of the characteristic short systolic spikes. Upon compression removal, a brief increase in the systolic flow was observed before the prompt reappearance of the reverberant flow. Conclusion: TCD for brain death diagnosis should be done cautiously in infants. In these cases, reverberating flow may be indicative of circulatory arrest even if with a large peak and with a high peak systolic velocity. Heavy fontanelle compression may reproduce the classical adult TCD patterns of brain death, thus supporting the diagnosis of cerebral circulatory arrest.
Shock is a clinical disorder that challenges caregivers in the neonatal intensive care unit. The predominant cause of shock in neonates is sepsis. This article provides an overview of the current treatment of septic shock with particular emphasis on newer vasoactive drugs (milrinone, levosimendan and vasopressin) to support cardiovascular dysfunction.
High-flow humidified nasal cannula (HFNC) is often\ud
used to relieve respiratory distress in children with acute\ud
pulmonary disease, although its effects on respiratory mechanics\ud
have not been objectively studied. The purpose of this study was\ud
to test the feasibility of measuring pharyngeal (PP) and\ud
esophageal (Pes) pressures of young children on HFNC oxygen\ud
therapy through a specifically designed new monitoring,\ud
acquisition, and elaboration system (MAES). Through MAES we\ud
recorded and elaborated Pes and PP tracings obtained through\ud
esophageal and pharyngeal catheters in a group of young children\ud
hospitalized in a Pediatric Intensive Care Unit because of\ud
respiratory distress. All traces were recorded during spontaneous\ud
breathing and on HFNC 1 and 2 L/kg/min. To determine the\ud
onset and the end of inspiration, the Pes and PP signals were\ud
synchronized with the inspiratory flow obtained by a flow\ud
transducer placed in the HFNC circuit. Direct measurement of\ud
inspiratory flow by a face mask pneumotachograph also allowed\ud
for inspiratory tidal volume (TV) measurement which was used\ud
together with Pes curve to build Campbell’s diagram as well as\ud
the static lung and chest wall recoil curves required for pressure\ud
time product (PTP) evaluation. Using MAES we were able to\ud
obtain: time interval between the beginning of inspiratory effort\ud
and inspiration (Tdelay), TV, intrinsic positive end expiratory\ud
pressure (PEEPi), total inspiratory Pes variation (ΔPes),\ud
transpulmonary pressure at end of inspiration (Ptpei), dynamic\ud
lung compliance (CLdyn), total lung resistance (RLtot) along with\ud
all the relevant components of the inspiratory work of breathing\ud
(WOB) and PTP. We believe that this new system will allow\ud
clinicians for a bedside monitoring of respiratory distress in\ud
infants treated with HFNC and to modify flow rates accordingly.\ud
Index Terms—biological system modeling, biomedica
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