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
Randomized Controlled Trial Comparative Study Clinical TrialInterpretation of digital radiographs by pediatric critical care physicians using Web-based bedside personal computers versus diagnostic workstations.
To determine whether the interpretations of digital radiographs by pediatric critical care physicians displayed on the bedside personal computer differ from the interpretations of images displayed on the diagnostic workstation. ⋯ With the exception of diffuse chest abnormalities, pediatric critical care physicians can use the Web-based bedside personal computer for clinical decision-making with the confidence that the decisions will be similar to those made on the diagnostic workstation.
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Pediatr Crit Care Me · Jan 2003
ReviewInnovative practices of ventilatory support with pediatric patients.
The recognition that alveolar overdistension rather than peak inspiratory airway pressure is the primary determinant of lung injury has shifted our understanding of the pathogenesis of ventilator-induced side effects. In this review, contemporary ventilatory methods, supportive treatments, and future developments relevant to pediatric critical care are reviewed. ⋯ The methods proposed require confirmation through large controlled clinical trials that can assess the efficacy reported in pilot studies and case reports and define the optimal method(s) to treat individual pathologies in the various pediatric age groups.
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Pediatr Crit Care Me · Jan 2003
Prospective study of potassium-associated acute transfusion events in pediatric intensive care.
Transfusion of packed red blood cells containing high concentrations of potassium have been associated with fetal and neonatal arrhythmia and hyperkalemic cardiac arrest. This study sought to determine the biochemical and associated clinical effects of packed red blood cells transfusion in critically ill children. ⋯ This prospective study found no significant change in patient potassium concentration and no acute adverse events related to transfusion in critically ill children, including those receiving packed red blood cells by bolus. Larger prospective studies are required to evaluate the acute effects of rapid and central venous transfusion in critically ill children.