Journal of intensive care medicine
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J Intensive Care Med · Sep 2004
Review Case ReportsPulmonary artery rupture induced by a pulmonary artery catheter: a case report and review of the literature.
Placement and use of pulmonary artery catheters (PACs) carry potential risks. The authors describe a case of a patient who developed massive hemoptysis after placement of a PAC that caused a rupture of the pulmonary artery with pseudoaneurysm formation. Treatment was successfully achieved with transcatheter coil embolization. ⋯ Patients with this complication may be asymptomatic or may present with variable amounts of hemoptysis immediately or days after using a PAC. The gold standard diagnostic test is pulmonary angiography, and the treatment of choice for most patients is transcatheter embolization. Physicians and other health care personnel handling these catheters should be familiar with the specific PAC balloon's inflation limits to avoid complications that may injure the patient.
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J Intensive Care Med · Sep 2004
The occurrence of posttraumatic stress disorder in patients following intensive care treatment: a cross-sectional study in a random sample.
Posttraumatic stress disorder (PTSD) can now be applied to patients who have just had intensive care treatment. The authors tested whether the reliability of the diagnosis depends on the measuring instrument used and whether the occurrence of PTSD is related to the presence of preexisting psychic disorders or to a worsening of the patients' general condition. The authors examined 41 former patients of an intensive care unit (ICU) with the Posttraumatic Scale (PTSS-10) and, afterward, with the Structured Clinical Interview (SCID). ⋯ With the PTSD module of the SCID, a structured diagnostic tool is available. Almost twice as many PTSD cases were diagnosed among the subjects with the PTSS-10 as with SCID. Post-ICU PTSD occurred more frequently among patients with prior psychiatric diseases; however, it was not dependent on exacerbation of the patient's Apache II scores.
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J Intensive Care Med · Sep 2004
Recombinant factor VIIa to control excessive bleeding following surgery for congenital heart disease in pediatric patients.
The purpose of this article is to evaluate the efficacy of recombinant factor VII (rFVIIa) in the treatment of bleeding following cardiac surgery in a pediatric population. The study included a case series of postcardiac surgical patients with chest tube output of = 4 mL/kg/h for the initial 3 postoperative hours who received rFVIIa. Chest tube output for the 3 hours before and the 3 hours after rFVIIa was compared using a paired t test. ⋯ No adverse effects were noted. Recombinant factor VIIa decreased chest tubing bleeding following cardiac surgery in children. Given its potential therapeutic impact, rFVIIa warrants further investigation in the pediatric cardiac population.
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J Intensive Care Med · Sep 2004
ReviewExtracorporeal life support in pediatric and neonatal critical care: a review.
Extracorporeal life support (ECLS) is a modified form of cardiopulmonary bypass used to provide prolonged tissue oxygen delivery in patients with respiratory and/or cardiac failure. The first large-scale success of ECLS was achieved in the management of term newborns with respiratory failure. ECLS has become an accepted therapeutic modality for neonates, children, and adults who have failed conventional therapy and in whom cardiac and/or respiratory insufficiency is potentially reversible. ⋯ The use of ECLS for neonatal respiratory failure, pediatric respiratory failure, and cardiac support are outlined. Management of the ECLS patient is discussed in detail, and outcome of these patients is reviewed. Finally, current trends and future implications of ECLS in neonatal and pediatric critical care are addressed.
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J Intensive Care Med · Sep 2004
Comparative StudyProtocol-driven ventilator management in children: comparison to nonprotocol care.
The purpose of this study was to compare ventilator weaning time, time to spontaneous breathing, and overall ventilator hours duration with use of a ventilator management protocol (VMP) versus standard nonprotocol-based care in a pediatric intensive care unit. A multidisciplinary task force developed a comprehensive protocol for ventilator management with four specific phases: initial ventilator set up and adjustment, weaning, minimal settings, and spontaneous mode prior to extubation. Medical records of ventilated patients both before and after protocol implementation were reviewed. ⋯ No significant differences were seen in extubation failure, use of corticosteroids, or use of racemic epinephrine between groups. Use of an institution-specific VMP developed by a multidisciplinary team was associated with significantly reduced ventilator weaning time and time to spontaneous breathing. Further studies are needed.