ABSTRACT
To assess whether underlying diagnosis affects morbidity and mortality outcomes in patients with chronic respiratory failure, we studied 55 patients with chronic respiratory failure of infancy and childhood (CRFIC). Entry criteria included patients with chronic respiratory failure due to static neurologic or neuromuscular conditions or secondary to other disease processes considered likely to improve or resolve over time. Subjects were grouped into those having chronic lung disease (CLD, n = 22), neurologic or neuromuscular diseases (NM, n = 21), or congenital abnormalities affecting the respiratory system (CA, n = 12). The average duration of follow-up was 21.3 months. There were no differences between groups in mortality with only four deaths (7%). Patients with CLD fared better than those with NM or CA in duration of ventilatory support, duration of tracheostomy, percentage of successful weaning from mechanical ventilation, and neurodevelopmental outcomes. Subjects with CLD had a significantly greater frequency of tracheomalacia (86%), feeding disorders (86%), and hypogammaglobulinemia G (77%). There were no differences between groups for respiratory readmissions or family dysfunction. We conclude that almost all patients with CRFIC will survive, but morbidity outcomes will vary based on the underlying diagnosis.
Subject(s)
Respiratory Insufficiency/epidemiology , Child , Child, Preschool , Congenital Abnormalities/epidemiology , Developmental Disabilities/epidemiology , Female , Follow-Up Studies , Humans , Infant , Lung Diseases/complications , Lung Diseases/epidemiology , Male , Morbidity , Nervous System Diseases/complications , Nervous System Diseases/epidemiology , Neuromuscular Diseases/complications , Neuromuscular Diseases/epidemiology , Respiration, Artificial , Respiratory Insufficiency/etiology , Time FactorsABSTRACT
INTRODUCTION: Pediatric Emergency Air Transports (PEATs) at Massachusetts General Hospital, Boston, Massachusetts, were reviewed between November 1986 and December 1987. Severity of illness, complications, and outcome of PEATs were compared with ground transports. Factors associated with PEAT survival were identified. METHODS: Severity of illness was measured using a modified Denver Patient Status Category (DPSC) method and the Therapeutic Intervention Scoring System (TISS). There were 35 PEATs (30 helicopter, five fixed-wing) and 96 ground transports. RESULTS: Mean severity of illness for patients was greater in PEAT than for the ground transport (PEAT DPSC score=4.23+/-1.06 versus ground DPSC=3.57+/-0.89 [SD], p=.0005). The PEAT mortality was associated with a greater mean severity of illness (TISS survivors=19.1+/-11.4 versus non-survivors=44.3+/-9.5, p=.0001), but not with: the presence of an on-flight physician; transport delay; transport duration; age; sex; history of chronic illness; or intra-transport medical complications. CONCLUSIONS: Compared to ground transports, PEATs were used for higher risk patients.
Subject(s)
Aircraft , Emergency Service, Hospital/standards , Severity of Illness Index , Adolescent , Adult , Ambulances , Child , Child, Preschool , Female , Humans , Male , Massachusetts , New England , Retrospective Studies , Risk Factors , Survival Rate , Trauma Severity IndicesABSTRACT
Neonatal aortoiliac insufficiency caused by a distended urinary bladder is an unusual occurrence that can be difficult to distinguish from aortoiliac thrombosis. Real-time sonography can permit recognition of the abnormality, demonstration of the related pathophysiology, and exclusion of other causes of aortoiliac occlusion.
