Intensive care medicine
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Specific regulations regarding oversight of research in children vary from country to country, but most share common principles derived from major consensus documents. Whereas the permissibility of research on adults depends heavily upon the informed consent of the subject, the regulation of research in pediatrics is focused primarily upon protection of the subjects from research risks. ⋯ After identifying and isolating the research interventions, a three-step approach is helpful for evaluating the "net risks" of the research: (1) Separate each component of the research into discrete interventions. (2) Any intervention for which the benefits equal or exceed the risks is ethically justified. (3) For interventions in which the risks exceed the benefits, the "net risk" for each intervention needs to be justified, as follows: (a) the interventions may not exceed the locally defined threshold for pediatric research (e.g., not greater than a minor increment more than minimal risk, as in the U. S. regulations); and (b) the scientific value of the study for improving the care of future children must be sufficient to justify the sum of the net risks of the research interventions.
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Intensive care medicine · Jan 2008
Comparative StudyHigh-frequency percussive ventilation attenuates lung injury in a rabbit model of gastric juice aspiration.
To test the effects of high-frequency percussive ventilation (HFPV) compared with high-frequency oscillatory ventilation (HFOV) and low-volume conventional mechanical ventilation (LVCMV), on lung injury course in a gastric juice aspiration model. ⋯ HFPV, like HFOV and protective CMV, improves respiratory mechanics and oxygenation, and attenuates lung damage. The HFPV provides attractive lung protection, but further studies should confirm these results before introducing HFPV into the clinical arena.
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Intensive care medicine · Jan 2008
One single dose of etomidate negatively influences adrenocortical performance for at least 24h in children with meningococcal sepsis.
To investigate the effect of one single bolus of etomidate used for intubation on adrenal function in children with meningococcal sepsis. ⋯ Our data imply that even one single bolus of etomidate negatively influences adrenal function for at least 24h. It might therefore increase risk of death.