Pediatr Crit Care Me
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Pediatr Crit Care Me · Mar 2005
Case ReportsHyperosmolar solutions in continuous renal replacement therapy for hyperosmolar acute renal failure: a preliminary report.
To demonstrate the efficacy of hyperosmolar dialysis and prefilter replacement fluid solutions for continuous renal replacement therapies in the correction of hyperosmolar disorders in acute renal failure. ⋯ Hyperosmolar dialysis or prefilter replacement fluid solutions can affect a slow decline in both the serum sodium and plasma osmolality in cases of hyperosmolar acute renal failure.
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Pediatr Crit Care Me · Mar 2005
ReviewHeliox administration in the pediatric intensive care unit: an evidence-based review.
To provide a comprehensive, evidence-based review of helium-oxygen gas mixtures (heliox) in the management of pediatric respiratory diseases. ⋯ Heliox administration is most effective during conditions involving density-dependent increases in airway resistance, especially when used early in an acute disease process. Any beneficial effect of heliox should become evident in a relatively short period of time. The medical literature supports the use of heliox to relieve respiratory distress, decrease the work of breathing, and improve gas exchange. No adverse effects of heliox have been reported. However, heliox must be administered with vigilance and continuous monitoring to avoid technical complications.
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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.