Jornal de pediatria
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Jornal de pediatria · Nov 2007
ReviewGlycemic control and insulin therapy in sepsis and critical illness.
To review the literature about the pathophysiology of hyperglycemia and glycemic control in children and adults with sepsis and critical illness. ⋯ Glycemic control is a novel therapeutic option in critical care. Conflicting evidence in adults means that before we apply this approach to pediatrics it will need to be assessed in clinical trial.
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Jornal de pediatria · Nov 2007
ReviewHemodynamic and metabolic effects of vasopressin infusion in children with shock.
Vasopressin is a neuropeptide hormone which has been used clinically for more than 50 years and plays a major role in circulatory homeostasis and in the regulation of serum osmolality. Recent work has emphasized its role in the treatment of septic shock. This paper reviews the physiology of this neurohormone and the available evidence in favor of its use as a vasodilator for children in shock. ⋯ The evidence is restricted. Most studies are retrospective and include a small number of patients. Nevertheless, there is significant experience concerning the use of vasopressin in Pediatrics. Vasopressin has a beneficial clinical effect in children and can be indicated in the treatment of refractory vasodilatory shock, after adequate volume resuscitation and when high doses of other vasopressors are not effective.
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To review diagnostic criteria and treatment of adrenal insufficiency in pediatric patients with severe sepsis and septic shock. ⋯ Adrenal insufficiency is common in children with severe sepsis and septic shock and may contribute to the development of catecholamine-refractory shock. However, doubts still persist regarding the efficacy of replacement therapy with low-doses steroids.
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Jornal de pediatria · Nov 2007
The impact of admission to a pediatric intensive care unit assessed by means of global and cognitive performance scales.
To assess the impact of admission to the pediatric intensive care unit (ICU) at the Hospital de Clínicas de Porto Alegre, RS, Brazil on children's cognitive and global performance. ⋯ Although affected by the elevated degree of morbidity at admission, the impact of the ICU stay was more significant in the global than in the cognitive domain. In the same manner, both risk of death at admission and length of stay had a significant effect on the morbidity of severely ill patients.