Pediatr Crit Care Me
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Pediatr Crit Care Me · May 2005
ReviewWhat have we learned from observational studies on neonatal sepsis?
To assess how observational studies on neonatal sepsis can help define the knowledge base required for neonatal randomized, clinical trials. ⋯ Future observational studies must address three key issues. They should begin with a clear analytic and sampling plan that pays careful attention to the proper use and reporting of multivariate analyses. Second, they must explicitly address two subpopulations: critically ill newborns with negative cultures and asymptomatic newborns with positive cultures. Finally, they should be theory driven and provide empirical physiologic data that permit situating their results in the context of the evolving systemic inflammatory response syndrome and PIRO (predisposition, infection, host response, organ dysfunction) models.
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Pediatr Crit Care Me · May 2005
Multicenter StudyEvolution of the medical practices and modes of death on pediatric intensive care units in southern Brazil.
To study the possible change on mode of deaths, medical decision practices, and family participation on decisions for limiting life-sustaining treatments (L-LST) over a period of 13 yrs in three pediatric intensive care units (PICUs) located in southern Brazil. ⋯ We observed that the modes of deaths in southern Brazilian PICUs changed over the last 13 yrs, with an increment in L-LST. However, this change was not uniform among the studied PICUs and did not reach the levels described in countries of the Northern Hemisphere. Family participation in the L-LST decision-making process has increased over time, but it is still far behind what is observed in other parts of the world.
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The purpose of this review is to review how pediatric trauma may predispose children to sepsis. ⋯ Patients with multiple traumatic injuries are frequently admitted to the intensive care unit, and because head injury is the most common ailment, unconscious patients with a combination of injuries that include head injury will regularly require mechanical ventilation and central venous access and are at risk for life-threatening nosocomial infections. Outside of pulmonary contusions, organ-specific causes of infection are infrequent.
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Pediatr Crit Care Me · May 2005
ReviewSeverity of illness and organ dysfunction scoring in children.
To describe predictive and descriptive general scores that can be used to estimate the severity of illness in critically ill children. ⋯ Pediatric Risk of Mortality III, Pediatric Index of Mortality 2, and Pediatric Logistic Organ Dysfunction scores are the best available tools to estimate the severity of illness in critically ill children.
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Pediatr Crit Care Me · May 2005
Multicenter StudyExtubation failure in pediatric intensive care incidence and outcomes.
To evaluate the hypotheses that children requiring reintubation are at an increased risk of prolonged hospitalizations, congenital heart disease, and death compared with age- and disease-severity-matched control patients. ⋯ In the present trial, 4.1% of mechanically ventilated children failed extubation. Pediatric intensive care unit patients with failed extubation have longer hospital, pediatric intensive care unit, and ventilator courses but are not at increased risk of death relative to nonfailed extubation patients.