Pediatr Crit Care Me
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Pediatr Crit Care Me · Oct 2000
Evaluation of an opiate-weaning protocol using methadone in pediatric intensive care unit patients.
To evaluate the efficacy of a standardized opiate-weaning protocol using methadone compared with methadone weaning before protocol development. ⋯ Pediatric intensive care unit patients requiring prolonged opiate use can be weaned by using methadone with minimal signs of withdrawal. Use of a standardized weaning protocol decreased time for weaning without increasing the frequency rate of withdrawal symptoms.
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Pediatr Crit Care Me · Oct 2000
Organ donation in children: role of the pediatric intensive care unit.
Children waiting for organ transplants continue to die because of the shortage of available organs. Studies of organ donation in children are scarce. The evaluation of the organ donation experience in a pediatric tertiary care hospital may identify factors that influence actual organ donation rates and lead to strategies to improve pediatric organ donation. ⋯ Despite an encouraging 63% consent rate for organ donation when families are approached, only 41% of potential donors proceeded to actual donation. Strategies for a prospective pediatric study should focus on mandatory request, multicultural issues, and aggressive postconsent medical management and procurement. The pivotal role of the pediatric intensive care unit practitioner should be emphasized.
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Pediatr Crit Care Me · Oct 2000
Relevance of diagnostic diversity and patient volumes for quality and length of stay in pediatric intensive care units.
Investigation of associations of the diagnostic diversity and volumes with efficiency and quality of care. ⋯ Patient volumes encountered in a PICU are important for maintaining quality and efficiency of care. In low-volume units, fewer diagnoses and higher volumes were both associated with higher efficiencies. In high volume units, diagnosis-specific volumes were generally large enough for achieving diagnosis-independent efficiency. Diagnostic mix was not associated with PICU mortality ratios, but higher PICU volumes were associated with lower mortality rates.
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Pediatr Crit Care Me · Oct 2000
End-of-life decision-making and satisfaction with care: parental perspectives.
To evaluate parents' perceptions of the process by which decisions are made to limit or withdraw life support from critically ill children, and to evaluate parents' perceptions of their child's death in the pediatric intensive care unit (ICU) and their satisfaction with the care provided. ⋯ Recommendations of physicians, nature of illness and expected neurologic recovery are important to parents making end-of-life decisions for their children. The establishment of trust is crucial in guiding parents through the decision-making process. Parental presence at the time of a child's death, the provision of adequate information, and a sympathetic environment may facilitate a healthy grief response.
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Pediatr Crit Care Me · Oct 2000
Assessment of respiratory drive and muscle function in the pediatric intensive care unit and prediction of extubation failure.
Extubation failure can result from poor respiratory drive, impaired respiratory muscle function, or excessive inspiratory load. Measurement of airway pressure changes either during tidal breathing or after end-expiratory occlusion allows assessment of respiratory drive and muscle function. ⋯ Assessment of P0.1 was the most useful airway pressure measurement in predicting extubation failure. Assessment of P0.1 may help to characterize children likely to fail extubation.