Pediatr Crit Care Me
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Pediatr Crit Care Me · May 2004
Multicenter Study Comparative StudyForgoing life-sustaining treatments in children: a comparison between Northern and Southern European pediatric intensive care units.
This study was conducted to determine how the decision-making process to forgo life support differs between southern and northern European pediatric intensive care units. ⋯ The decision-making process appears to be similar between northern and southern European countries. The respective contributions of the parents and the medical staff in the final decision itself seem to be identical between northern and southern countries. However, in northern European countries, the level of parents' information about the decision-making process appears higher and the decision is more often documented in the medical chart.
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Pediatr Crit Care Me · May 2004
Case ReportsJading in the pediatric intensive care unit: Implications for healthcare providers of medically complex children.
To discuss the phenomenon of jading within the context of the pediatric intensive care unit. ⋯ Jading describes a process of exhaustion whereby apathy, cynicism, and callousness replace the drive to be responsive, to make a difference, and to care. The issue of jading has become an increasing area of concern in the pediatric intensive care unit, due in part to recurring, prolonged admissions, combined with the perception, at times, that continued medical care is fruitless. With a better understanding of the phenomenon of jading, and by reconsidering their own responses, pediatric intensive care unit practitioners can avoid becoming jaded.
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Pediatr Crit Care Me · May 2004
Defining acidosis in postoperative cardiac patients using Stewart's method of strong ion difference.
To define the true incidence and nature of acidosis in pediatric patients postcardiac surgery, using Stewart's direct method of measuring strong ion difference. We also wished to compare the ability of standard indirect methods (base deficit, lactate, anion gap, and corrected anion gap) to accurately predict tissue acidosis. ⋯ Metabolic acidosis occurs frequently postcardiac surgery and is largely due to raised unmeasured acids and less commonly raised lactate. Hyperchloremia is common, particularly after cardiopulmonary bypass. Base deficit correlates poorly with true tissue acidosis, and corrected anion gap offers the most accurate bedside alternative to Stewart's method of tissue acid calculation.
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Pediatr Crit Care Me · May 2004
Clinical TrialLoss of consciousness: when to perform computed tomography?
To determine the diagnostic value of physical examination (including neurologic exam) for positive computed tomography scan findings in children with closed head injury, Glasgow Coma Scale score 13-15 in the emergency department, and loss of consciousness or amnesia. ⋯ Detailed clinical examination is of no diagnostic value in detecting intracranial injuries found on head computed tomography scan. Patients with observed loss of consciousness or amnesia and Glasgow Coma Scale 13-15 should have a head computed tomography scan as part of their evaluation to avoid missing an intracranial injury.