The Journal of pediatrics
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The Journal of pediatrics · Jun 2004
Multicenter StudyGrowth of pediatric intensive care units in the United States from 1995 to 2001.
To describe the growth and distribution of pediatric intensive care unit (PICU) beds in the United States from 1995 to 2001 and the characteristics of PICUs in 2001. ⋯ The number of PICU beds is growing more rapidly than the rate of pediatric population growth. The impetus for this growth is unclear.
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The Journal of pediatrics · Jun 2004
Clinical TrialSuppression of adrenal function in children with acute lymphoblastic leukemia following induction therapy with corticosteroid and other cytotoxic agents.
To evaluate adrenal function in children with acute lymphoblastic leukemia (ALL) after induction therapy with corticosteroid and other cytotoxic agents. Study design Children with ALL (N=24) were treated with prednisolone (40 mg/m(2) per day) for 28 days during the induction phase followed by 1 week of oral dexamethasone every 4 weeks. A low-dose (1 microg) adrenocorticotropin (ACTH) test was performed 2 weeks after discontinuation of prednisolone; it was repeated 2 weeks later and then every 4 weeks in patients with adrenal suppression until normal response was achieved. ⋯ About 50% of children with ALL developed adrenal suppression 2 weeks after a 4-week induction therapy with prednisolone. The suppression could persist through 20 weeks and may hinder an adequate adrenal response during acute febrile illness.
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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.