Pediatr Crit Care Me
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Pediatr Crit Care Me · Jan 2003
Randomized Controlled Trial Clinical TrialErythropoietin therapy in children with bronchiolitis and anemia.
Critically ill children with bronchiolitis often require red blood cell transfusions. Anemia normally results in increased circulating erythropoietin concentrations; however, critical illness has been associated with a blunted erythropoietin response. Treatment with erythropoietin decreases the need for red blood cell transfusion in several disease states. We hypothesized that critically ill children with bronchiolitis and anemia would have a circulating erythropoietin deficiency and that treatment with exogenous erythropoietin would increase reticulocyte count and hematocrit and reduce red blood cell transfusion requirements. ⋯ Despite a favorable reticulocyte and circulating erythropoietin response, red blood cell transfusion requirements were not significantly diminished by erythropoietin treatment in children with bronchiolitis and respiratory failure. Erythropoietin cannot be routinely recommended for this patient population.
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Pediatr Crit Care Me · Jan 2003
Comparative StudySedation monitoring of children by the Bispectral Index in the pediatric intensive care unit.
To compare the Bispectral Index with clinical sedation assessment using the Ramsay score in normal sedated and paralyzed critically ill children. ⋯ The Bispectral Index correlates well with the Ramsay score in the normal sedated child. The Ramsay score and bedside nurse assessment are inadequate for monitoring the depth of sedation in paralyzed children. The Bispectral Index is a useful adjunct in assessing sedation in a paralyzed patient.
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Pediatr Crit Care Me · Jan 2003
Nosocomial urinary tract infections in children in a pediatric intensive care unit: a follow-up after 10 years.
To define nosocomial urinary tract infection (NUTI) rates in a pediatric intensive care unit, and determine whether practice recommendations have been sustained after 10 yrs. ⋯ NUTIs in children in our pediatric intensive care unit were associated with previous cardiovascular surgery and with urinary tract catheterization of at least 3 days. The need for careful fluid monitoring by catheterization must be balanced against the increased risk of catheter-related urinary tract infection. Removal of urinary catheters at the earliest opportunity will prevent many infections. Ongoing education or innovative strategies will be required to sustain optimal practice.
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Pediatr Crit Care Me · Jan 2003
Randomized Controlled Trial Clinical TrialSerum creatinine and estimated creatinine clearance do not predict perioperatively measured creatinine clearance in neonates undergoing congenital heart surgery.
To describe changes in creatinine clearance (CrCl) in a small group of neonates who underwent surgery for repair of transposition of the great arteries or palliation of hypoplastic left heart syndrome. To determine whether serum creatinine, urine output, or the Schwartz formula accurately predict measured CrCl in these patients. ⋯ Perioperative CrCl is unpredictable in neonates with transposition of the great arteries and hypoplastic left heart syndrome. Serum creatinine, urine output, and the Schwartz formula do not accurately predict CrCl. Reliance on estimates of CrCl could result in toxic concentrations of drugs eliminated by the kidneys.