The Journal of pediatrics
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The Journal of pediatrics · Mar 2004
Comparative StudyThe use of cuffed versus uncuffed endotracheal tubes in pediatric intensive care.
To report our experience with cuffed endotracheal tubes (ETT) in a large cohort of critically ill children. Study design We prospectively collected data over a 1-year period concerning long-term intubation on 860 critically ill children admitted to our intensive care unit. Tube sizes were dictated by the modified Cole formula for uncuffed ETT (age [y]/4+4 mm ID) and chosen one-half size less for cuffed ETT. Cuff pressure was regularly monitored to maintain a small leak at peak inspiratory pressure. The choice of ETT was made by the physician responsible for the initial airway management. ⋯ Our data suggest that the traditional teaching in pediatric anesthesia and intensive care, including current pediatric life support recommendations, need to be reviewed for children to benefit from the advantages of modern low-pressure cuffed ETT during critical illnesses.
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The Journal of pediatrics · Mar 2004
Use of telemedicine to provide pediatric critical care inpatient consultations to underserved rural Northern California.
To report a novel application of telemedicine and to assess the resulting quality and satisfaction of care. Study design An existing telemedicine program was evaluated through the use of a nonconcurrent cohort design. Cohorts of patients were compared by means of the Pediatric Risk of Mortality, version III (PRISM III), to adjust for severity of illness and assess risk-adjusted mortality rates. Satisfaction and quality of care surveys administered to the pediatric patient's parents and providers were also analyzed. ⋯ This study demonstrates that a regional pediatric ICU-based telemedicine program providing live interactive consultations to a rural adult ICU can provide quality care that is considered highly satisfactory to a select group of critically ill pediatric patients.