Pediatr Crit Care Me
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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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Oxygen-filled self-inflating resuscitators are used by some as a source of oxygen for spontaneously breathing patients. In this application, the bag is not compressed and oxygen is assumed to flow freely from the patient outlet through a mask positioned loosely over the patient's face. We tested 11 resuscitators to determine the delivery of oxygen from the patient outlet using different inlet flows. ⋯ Self-inflating resuscitators deliver a significantly lower flow of oxygen than the provided inlet flow and should not be relied on to deliver a precise amount of flow of oxygen to spontaneously breathing patients.
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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.
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Pediatr Crit Care Me · Mar 2005
Case ReportsHeparin-induced thrombocytopenia in the pediatric intensive care unit population.
To report the occurrence of heparin-induced thrombocytopenia (HIT), discuss its pathophysiology, and outline an approach to management in the pediatric intensive care unit (ICU) patient. ⋯ Although well described in the adult literature, there have been a limited number of reports of HIT in pediatric-aged patients. Given its potential for morbidity, HIT should be considered in the differential diagnosis of thrombocytopenia in the pediatric ICU patient.
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Pediatr Crit Care Me · Mar 2005
The impact of pediatric intensive care unit volume on mortality: a hierarchical instrumental variable analysis.
To evaluate the relation between annual pediatric intensive care unit (PICU) admission volume and mortality. ⋯ Although there is an association between lower severity-adjusted mortality among higher volume PICUs, our data suggest that best outcomes are among mid- to large-sized PICUs. These data support minimum annual admission criteria for PICUs but raise the concern that PICUs with very high annual admission volumes may operate beyond an ideal capacity.