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Abstract

that the increased margin favored the TAD by 20% as compared to the SGD (SGD0.51-TAD 0.31). Mann-Whitney test was used to evaluate differences in cost per dressing type U=118, p 001, and number of dressing changes required by dressing type U=601, p=.01. Both results favored the TAD. Kendall's tau correlation revealed that the costs were significantly greater in patients who received SGD τ (79), p<.001. Skin irritation was measured using a color scale and skin tears were measured using the Payne-Martin skin tear assessment tool. Patients did not differ by dressing type in the development of skin irritation (U = 763, p= .693), or development of skin tears (U = 761.5, p = .584). Conclusions: Based on these findings use of TAD can be recommended as not inferior to the current practice of using gauze and tape.Introduction: Children requiring ECLS for acute respiratory failure from critical pertussis pneumonia have an extremely poor prognosis. The purpose of this study is to assess the influence of clinical factors including initial ECLS mode (VV-venovenous or VA-venoarterial) and duration of pre-ECLS mechanical ventilation on outcome in this critically ill patient population. Methods: The Extracorporeal Life Support Organization's registry was retrospectively queried for pediatric patients (age 30 days to 18 years) with the diagnosis of pertussis from 1986 to 2012. Demographic, clinical, and outcome data were extracted. Only first runs were included. Patients were divided into survivors and nonsurvivors. Regression analysis was used to assess the impact of various clinical factors as well as ECLS mode and the duration of pre-ECLS mechanical ventilation on mortality. Results are expressed as an odds ratio (OR) and 95% confidence interval (CI); p<0.05 was considered significant. Results: There were 146 patients with 52 survivors (35.6%) and 94 non-survivors (64.4%). There were no significant differences between the groups with respect to age, weight, gender, race, and pre-ECLS ventilation type, and pre-ECLS hemodynamics. There were 18.5% VV and 79.5% VA primary cannulations. There was no difference between the survivors and non-survivors with respect to ECLS mode (33.3% vs. 36.2%, p=.96). Survivors had a longer duration of pre-ECLS ventilation (95 ± 65 vs. 82 ± 125, p=0.003). In multivariate regression models, lower pre-ECLS peak inspiratory pressure (PIP) (OR 0.96, 95%CI 0.92-1.00, p=0.047), higher pre-ECLS SaO2 (OR 1.06, 95%CI 1.02-1.10, p=0.004), no vasodilator drug use (OR 4.51, p=0.041), and higher HCO3 (OR 1.08, 95%CI 1.01-1.16, p=0.018) showed a significant increased odds of survival. ECLS mode (VA: OR 1.2, 95% CI 0.28-5.1, p=0.81) and duration of pre-ECLS mechanical ventilation (OR 1.0, 95% CI 1.0-1.01, p=0.233) did not. Conclusions: Children requiring ECLS for pertussis pneumonia have a low survival which is best predicted by the severity of physiologic derangement. Early initiation of ECLS may not improve outcome, however this may reflect earlier utilization of ECLS in more critically ill patients. Additionall...