Pediatr Crit Care Me
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Pediatr Crit Care Me · May 2005
Case ReportsUse of recombinant factor VIIa for refractory hemorrhage during extracorporeal membrane oxygenation.
To describe the outcome and treatment of two patients with recombinant factor VIIa (rFVIIa) for severe hemorrhage associated with extracorporeal membrane oxygenation (ECMO). ⋯ The efficacy of rFVIIa in reducing intractable bleeding postcardiac surgery and in other coagulopathic states is being investigated. Despite theoretical concerns of thrombosis, these cases illustrate that there may be a role for the cautious use of rFVIIa in treating severe and intractable hemorrhage associated with ECMO.
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Pediatr Crit Care Me · May 2005
Routine enteral nutrition in neonates on extracorporeal membrane oxygenation.
To evaluate over a 5-yr period the feasibility and tolerance of a protocol of routine enteral nutrition in neonates requiring extracorporeal membrane oxygenation (ECMO). ⋯ Neonates on ECMO in this series tolerated enteral feeding well and did not show serious adverse effects. Overall, it is our experience that routine use of enteral feeding in critically ill neonates on VA-ECMO is feasible.
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To review the past, present, and future definitions of sepsis and the systemic inflammatory response syndrome in children. ⋯ The potential value and inconsistencies of the current pediatric-specific sepsis definitions are discussed. Future direction of the definitions and their applications are presented.
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Development of formal systems of critical care follow-up is an essential expansion of critical care services. ⋯ The benefit of integrating critical care services in the prehospital setting, in the form of triage, transport, and educational efforts, has been demonstrated. Establishing greater critical care follow-up is the next logical step in the care continuum. Intensivists should assist outpatient and intermediate care providers to improve patient care while simultaneously creating a crucial feedback mechanism for quality improvement and research efforts within intensive care.
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Pediatr Crit Care Me · May 2005
Editorial CommentVariability in end-of-life care--how much is too much?