Seminars in pediatric surgery
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Semin. Pediatr. Surg. · Feb 2015
ReviewInnovations and controversies in the monitoring of pediatric patients in the ICU.
In recent years, the number of monitoring options for ICU clinicians has continued to proliferate, but there has been limited information regarding their value in shortening length of stay, averting complications including death, or improving functional outcomes. However, innovative new approaches hold the promise of integrating data sets to help clinicians avert complications and to detect evolving organ dysfunction earlier.
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Acute kidney injury (AKI) affects 3.9/1000 at-risk children in the United States, a number that has been increasing as critically ill and injured children have access to improved care and the diagnosis of AKI is being made more accurately. Children with AKI have a higher mortality and hospital length of stay as compared to children without AKI. Renal replacement therapy can improve outcomes in these patients. This article reviews the pathophysiology of AKI and the modalities, indications, and outcomes of renal replacement for children with AKI.
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Burn injuries affect approximately a million children in the United States on an annual basis. Moderate to severe burns require hospitalization, usually under the direction of a Pediatric Surgical service. ⋯ This article provides an overview of the initial evaluation and resuscitative measures for pediatric burn patients, most current wound care, indications for grafting, and the role of nutrition, including use of pharmacologic adjuncts. Use of colloid solutions, indications for use of skin substitutes, and transfer criteria will also be addressed.
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Semin. Pediatr. Surg. · Feb 2015
ReviewOptimal timing of congenital diaphragmatic hernia repair in infants on extracorporeal membrane oxygenation.
Extracorporeal membrane oxygenation (ECMO) is a vital pre-operative adjunct for the stabilization of patients with severe congenital diaphragmatic hernia (CDH) that develop cardiorespiratory failure. The optimal timing of diaphragmatic repair in patients with CDH that require ECMO remains controversial. This article offers a review of the data available addressing the risks and outcomes of patients who require ECMO support with regard to timing of repair.
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Semin. Pediatr. Surg. · Feb 2015
ReviewControversies in nutritional support for critically ill children.
Nutritional support for critically ill infants and children is of paramount importance and can greatly affect the outcome of these patients. The energy requirement of children is unique to their size, gestational age, and physiologic stress, and the treatment algorithms developed in adult intensive care units cannot easily be applied to pediatric patients. This article reviews some of the ongoing controversial topics of fluid, electrolyte, and nutritional support for critically ill pediatric patients focusing on glycemic control and dysnatremia. The use of enteral and parenteral nutrition as well as parenteral nutritional-associated cholestasis will also be discussed.