Pediatr Crit Care Me
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Pediatr Crit Care Me · Mar 2005
Clinical TrialInterleukin-6, interleukin-8, and a rapid and sensitive assay for calcitonin precursors for the determination of bacterial sepsis in febrile neutropenic children.
Children with cancer often develop febrile illnesses after cytotoxic chemotherapy. Determining which children have serious bacterial infections in this vulnerable period would be valuable. We evaluated the ability of a rapid and sensitive assay for the concentration of calcitonin precursors (CTpr) as a sensitive diagnostic marker for bacterial sepsis in febrile, neutropenic children and determined the utility of measuring cytokines to improve the predictive value of this approach. ⋯ Our data show the utility of a rapid and sensitive assay for CTpr combined with interleukin-8 as a highly sensitive and specific diagnostic marker of bacterial sepsis in febrile, neutropenic children. The use of these markers as a clinical tool may allow for better prognostication for clinicians and may eventually lead to more targeted therapies for this heterogeneous population.
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Pediatr Crit Care Me · Mar 2005
Risk factors for extubation failure in mechanically ventilated pediatric patients.
To describe the incidence of extubation failure and its associated risk factors among mechanically ventilated children. ⋯ Extubation failure was more frequent among young infants who received prolonged ventilatory support and intravenous sedation, used CPAP, had impaired lung oxygenation, and required inotropic therapy.
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Pediatr Crit Care Me · Mar 2005
Supplemental inhaled gases alter tidal volume delivery and measurement.
Supplemental inspired nitrogen (N(2)) or carbon dioxide (CO(2)) is commonly used to balance pulmonary blood flow in patients with single-ventricle physiology. The objective of this study was to assess if supplemental inspired gas alters delivery or measurement of tidal volume (V(T)) by a ventilator. ⋯ The addition of supplemental inspired gas directly into the ventilator circuit can alter tidal volume delivery or measurement by a ventilator. The extent and magnitude of the alterations are determined by lung compliance. Variable effects of supplemental gas administration may confound ventilator management of patients with single-ventricle physiology.
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Pediatr Crit Care Me · Mar 2005
Intratracheal pressure: a more accurate reflection of pulmonary airway pressure in pediatric patients with respiratory failure.
Peak inflation pressure (PIP) on many ventilators (P(vent)), measured distal to the exhalation limb or Y-piece of the breathing circuit, is assumed as the pressure applied to the airways and lungs. However, in vitro studies show P(vent) data are spurious. There are no studies evaluating the accuracy of P(vent) data for pediatric patients with acute respiratory failure. We hypothesized that intratracheal airway pressure (P(T)) is more accurate than P(vent) and that by using P(vent), abnormally increased imposed resistive work of breathing (WOBi) may go undetected. ⋯ P(vent) significantly overestimates PIP. Moreover, P(vent) data does not allow for recognition of increased WOBi for many patients. Clinicians need to be aware of the limitations of P(vent) data and consider using ETTs that allow measurement of P(T), a more accurate reflection of pulmonary airway pressure.
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Pediatr Crit Care Me · Mar 2005
Cost-effectiveness of exogenous surfactant therapy in pediatric patients with acute hypoxemic respiratory failure.
To determine whether the use of exogenous surfactant (Infasurf) in pediatric acute hypoxemic respiratory failure is cost-effective. ⋯ For the majority of pediatric patients with acute hypoxemic respiratory failure, exogenous surfactant is cost-effective. If the use of this medication becomes standard care, a greater variety of packaging sizes could lead to decreased acquisition costs and increase the number of patients for whom this treatment is cost-effective.