Richard Orr

• University of Pittsburgh

Advances in cardiology, intensive care, and surgical techniques have led to the survival of children with previously lethal congenital cardiac defects [1–6]. A large number of these children present to local community hospitals, nurseries, and emergency rooms for their initial stabilization before being transferred to regional tertiary care centers...

Background: Shock index, the ratio of heart rate to systolic blood pressure that changes with age, is associated with mortality in adults after trauma and in children with sepsis. We assessed the utility of shock index to predict sepsis diagnosis and survival in children requiring interfacility transport to a tertiary care center. Methods: We st...

Tachycardia and diastolic hypotension have been associated with β-2 agonist use. In the setting of β-agonist-induced chronotropy and inotropy, diastolic hypotension may limit myocardial blood flow. We hypothesized that diastolic hypotension is associated with β-agonist use and that diastolic hypotension and tachycardia are associated with biochemic...

Intravascular hemolysis and resulting plasma-free hemoglobin elevation has been associated with acute kidney injury via several mechanisms. Proximal tubular injury due to iron compound deposition and nitric oxide sequestration with subsequent impairment of the microcirculation and hypoperfusion are specific adverse effects of intravascular hemolysi...

To describe changes in hemodynamic variables, sedation, and pain score after discontinuation of prolonged infusions of dexmedetomidine in a pediatric population of critically ill cardiac patients. Retrospective case series of patients who received continuous infusions of dexmedetomidine for longer than 3 days in a pediatric cardiac intensive care u...

Objective. Infants with critical congenital heart disease (CHD) can have genetic and other extracardiac malformations, which add to the short- and long-term risk of morbidity and perhaps mortality. We sought to examine our center's practice of screening for extracardiac anomalies and to determine the yield of these tests among specific cardiac diag...

Advancements in the preoperative management of patients with single-ventricle physiology continue to evolve. Previous reports have questioned the benefit of using inhaled nitrogen in single-ventricle patients, suggesting that this therapeutic modality may not provide adequate systemic cardiac output. The objective of this study was to review our in...

Postoperative tachyarrhythmias remain a common complication after congenital cardiac operations. Dexmedetomidine (DEX), an α-2 adrenoreceptor agonist, can have a therapeutic role in supraventricular tachyarrhythmias for cardioversion to sinus rhythm or heart rate control. Whether routine perioperative use of DEX decreases the incidence of supravent...

Shock is a major preventable cause of morbidity and mortality in children referred to emergency care. The recently updated American College of Critical Care Medicine guidelines for the management of newborns and children with septic shock emphasize the role of emergency care in improving survival and functional outcomes. Implementation of these gui...

To characterize the effects of dexmedetomidine on the pulmonary artery pressure in patients after congenital cardiac surgery. Prospective observational pilot study. Pediatric cardiac intensive care unit at a university hospital. Twenty-two patients who received dexmedetomidine after cardiothoracic surgery. None. An echocardiogram was performed at t...

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Advances in cardiology, intensive care, and surgical techniques have led to the survival of children with previously lethal congenital cardiac defects [1–3]. A large number of these children present to local community hospitals, nurseries, and emergency for their initial stabilization before being transferred to regional tertiary care centers for m...

Thromboembolic events are a serious complication occurring in critically ill children admitted to the cardiac intensive care unit. Although enoxaparin is one of the current anticoagulants of choice, dosages in children are extrapolated from adult guidelines. Recent data suggest that this population may need a higher dose than what is currently reco...

Assessment of electrocardiographic (ECG) effects of dexmedetomidine. Prospective observational study including children 0-17 years of age with congenital heart disease (CHD) and children following cardiothoracic surgery. Patients who did not receive dexmedetomidine were used as a control group. All patients had two ECGs: one baseline, pre-dexmedeto...

We analyzed the role of magnesium sulfate (MgSO(4)) supplementation during cardiopulmonary bypass in pediatric patients undergoing cardiac surgery, assessing the incidence of hypomagnesemia and the incidence of junctional ectopic tachycardia. We performed a randomized, double-blind, controlled trial in 99 children. MgSO(4) or placebo was administer...

To test the hypothesis that pediatric shock is a common cause of death and functional morbidity and that pediatric advanced life support (PALS)/advanced pediatric life support (APLS) resuscitation in the community hospital setting improves child health outcomes. This study included all children consecutively transported to 5 regional, tertiary care...

The goal was to test the hypothesis that interfacility transport performed by a pediatric critical care specialized team, compared with nonspecialized teams, would be associated with improved survival rates and fewer unplanned events during the transport process. A single-center, prospective, cohort study was performed between January 2001 and Sept...

To assess clinical response of dexmedetomidine alone or in combination with conventional sedatives/analgesics after cardiac surgery. Retrospective study. Pediatric cardiac intensive care unit. Infants and neonates after cardiac surgery. We identified 80 patients including 14 neonates, at mean age and weight of 4.1 +/- 3.1 months and 5.5 +/- 2 kg, r...

Thrombocytopenia-associated multiple organ failure (TAMOF) is a poorly understood syndrome in critically ill children. A disintegrin and metalloprotease with thrombospondin motifs (ADAMTS-13), formerly known as von Willebrand factor (VWF) cleaving protease, is decreased in adults with VWF-mediated thrombotic microangiopathy, and intensive plasma ex...

Describe risk factors associated with successful and early extubation in the pediatric cardiac intensive care unit. Retrospective chart review. University hospital, cardiac intensive care unit. Review of 212 consecutive surgical admissions from January 2003 to January 2004, excluding deaths. Preoperative, intraoperative, and postoperative variables...

Early recognition and treatment of pediatric shock, regardless of diagnostic category, saves lives. This article emphasizes the early recognition of tachycardia, prolonged capillary refill, and hypotension at triage, and sets out a time-sensitive 3-step process, which includes establishment of emergency vascular access, goal-directed stepwise admin...

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In this report, we describe our experience with the use of dexmedetomidine in spontaneously breathing as well as in mechanically ventilated patients, after congenital cardiac and thoracic surgery. Retrospective case series. University hospital, pediatric cardiac intensive care unit. Thirty-three spontaneously breathing and five mechanically ventila...

In response to the landmark 1999 report by the Institute of Medicine and safety initiatives promoted by the Leapfrog Group, our institution implemented a commercially sold computerized physician order entry (CPOE) system in an effort to reduce medical errors and mortality. We sought to test the hypothesis that CPOE implementation results in reduced...

To determine whether multiplying the internal diameter of the endotracheal tube (ETT) by 3 (3x ETT size) is a reliable method for determining correct depth of oral ETT placement in the pediatric population. Prospective, observational. University-affiliated, 12-bed pediatric intensive care unit. Orally intubated pediatric intensive care unit patient...

Experimental and clinical studies of septic shock support the concept that early resuscitation with fluid and inotropic therapies improves survival in a time-dependent manner. The new American College of Critical Care Medicine-Pediatric Advanced Life Support (ACCM-PALS) Guidelines for hemodynamic support of newborns and children in septic shock rec...

Interfacility transport of pediatric and neonatal patients for advanced or specialty medical care is an integral part of our medical delivery system. Assessment of current services and planning for the future are imperative. As part of this process, the American Academy of Pediatrics and the Section on Transport Medicine held the second National Pe...

Objective: To test the hypothesis that pretransport variables can predict in-hospital mortality that will correlate with major interventions and unplanned events during interfacility transport. Methods: A cohort of children (n = 2,253) transported by a specialized pediatric team to a children's hospital were studied. At the time of referral, dat...

Introduction: Little is published regarding Interfacility transport of children with septic shock (SS). We hypothesized that therapies outlined by the new ACCM Guidelines for Hemodynamic Support of Pediatric Septic Shock would be needed during transport. Methods: 7yr review of SS children transported to a tertiary-care center. SS ≡ ACCP/SCCM Consen...

Introduction: The benefit of pediatric specialty care transport teams has not been determined. Yet, tertiary centers expend valuable critical care resources for the transport of infants and children, assuming that this provides optimal care in the transport environment. We tested the hypothesis that transport performed by specialty care personnel r...