Harold I. Lecks

The management of respiratory failure in childhood status asthmaticus. Experience with 30 episodes and evolution of a technique

Abstract The allergy and anesthesiology services of Childrens Hospital of Philadelphia have, since 1961, managed 22 children in 30 episodes of status asthmaticus severe enough to need ventilatory assistance. The technique evolved with experience, starting with tracheal intubation followed by (1) general anesthesia and manual ventilation, 4 episodes; (2) mechanically assisted ventilation with a pressure-flow cycled ventilator (Bird Mark VIII) under heavy sedation, 7 episodes; (3) controlled mechanical ventilation (Bird Mark VIII) with d-tubocurarine and light sedation, 11 episodes; (4) controlled ventilation starting with a Bird Mark VIII and changing to a volume-cycled ventilator (Emerson), 3 episodes; and currently (5) controlled ventilation with the Emerson under light sedation and d-tubocurarine, 5 episodes. The criteria for respiratory failure in children with status asthmaticus are presented. Adjunctive therapy has included intravenous fluids with sodium bicarbonate, antibiotics, bronchodilators, corticosteroids, and vigorous chest physiotherapy, followed by sterile endobronchial aspiration. Currently we monitor ECG and directly transduced central venous and peripheral arterial prcssure displayed on an oscilloscope. Arterial pH, P co 2 , base excess, and P o 2 are determined frequently, and there is continuous clinical observation in the intensive care unit. There have been 18 complications, including one death. Every patient was amnesic for the period of assisted ventilation. The technique is an effective method of supporting life in children in respiratory failure caused by status asthmaticus until the attack subsides. A trained team, constantly available, is necessary.

The metabolic, circulatory, and bronchomotor responses of asthmatic children to epinephrine infusion: Pharmacologic effects

Abstract In our study, 7 chronically ill asthmatic children received epinephrine at a metered rate of 4 to 8 μg per minute for 60 minutes by intravenous infusion. Blood specimens were obtained at 15 minute intervals for one hour before, at 10 minute interval during, and at 15 minute intervals for one hour after the infusion and analyzed for glucose, free fatty acids, and ketones. Blood pressure and pulse rates were monitored during the total period of observation. Pulmonary function tests (maximal and maximal mid-expiratory flow rates) were made prior to, during, and after epinephrine infusion. The data were compared with those of 4 control subjects of comparable age and weight for fasting levels, rate of rise to maximum point achieved during the infusion, the rate of return to normal, and a comparison of initial level with those at the end of the recovery period. A discriminant analysis by computer failed to demonstrate a significant difference in metabolic response between the asthmatic and control patients. Four of 7 children with asthma revealed a better than 20 per cent improvement in the maximal mid-expiratory flow rate after infusion. The asthmatic subjects tended to show a greater mean pulse rate rise when the preinfusion to peak response period was compared with that of the control.

Pulmonary Surfactants, Segmental Atelectasis, and Bronchial Asthma:

Address reprint requests to Harold I. Lecks, M.D., Children’s Hospital of Philadelphia, 1740 Bainbridge St., Philadelphia, Pa. 19146. ~-N-~ 1 0the medical mind, the term &dquo;bronchial asthma&dquo; tends to be associated exclusively with increased airway resistance caused by spasm, edema and secretions in the tracheobronchial tree, with little thought given to the dynamic changes which occur in the lung parenchyma during the acute attack. It is the purpose of this presentation to focus attention upon the area of the lung distal to the bron -

Basophil degranulation tests in atopic allergic states: A pilot study of ragweed pollen sensitive patients

Abstract Of 22 patients with clinically active hay fever and positive skin tests to ragweed pollen extract, 27 per cent gave positive basophil tests with the use of the same extract. One half of these positive test reactors had received hyposensitization therapy One of 12 nonallergic controls gave a positive basophil test with the same extract. The basophil test, as performed by the methods described, does not lend itself to practical application in the detection of the ragweed-sensitive patient.

Serous Otitis Media Reflections on Pathogenesis and Treatment

From The Children’s Hospital of Philadelphia and The University of Pennsylvania School of Medicine. *Allergist, The Children’s Hospital of Philadelphia; , Assistant Professor of Pediatrics, University of Pennsylvania School of Medicine. * Associate Allergist, The Children’s Hospital of Philadelphia; Instructor in Pediatrics, University of Pennsylvania School of Medicine. t Associate Allergist, The Children’s Hospital of Philadelphia; Instructor in Pediatrics, University of Pennsylvania School of Medicine. Mailing address: Children’s Hospital of Philadelphia, 1740 Bainbridge St., Philadelphia, Pa. 19146. SEROUS otitis media was defined initially EI~..C.~~J~

Explosive Asthma in the Infant and Young Child Under Two Years Clinical Features, Anatomic and Physiologic Peculiarities

Associate Clinical Professor of Pediatrics, University of Pennsylvania School of Medicine and Allergist. The Children’s Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, Pa. 19104. I N CLINICAL APPEARANCE, bronchial asthma in childhood has many faces and appears to be most unique in patients under two years of age. For example, the onset is oftimes explosive and fulminating, imparting panic to both the parent and child, and occasionally bewilderment to the examining physician as the nature of the respiratory illness. It accounts for approximately 1.4 per cent of all hospital admissions to the Children’s Hospital of Philadelphia. It is the

Management of Severe Atopic Dermatitis

Despite extensive investigations, no primary defect has been uncovered. For these patients the prognosis is usually poor. Perhaps the most severely affected group of infants is the one described by Hill 33 and designated by him as the atopic erythroderma group which comprises about 7 per cent of all children with atopic dermatitis, and having a distinct pattern of illness. Usually the eruption is evident in the immediate newborn period, and is characterized by a diffuse erythema of lobster red intensity affecting the entire integument. The skin may be somewhat thickened with a superimposed fine branny desquamation, and scratching may