Pediatr Crit Care Me
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Pediatr Crit Care Me · Nov 2006
Urinary S100B concentrations are increased after brain injury in children: A preliminary study.
S100B is a renally excreted protein concentrated in glial cells of the nervous system. Increases in serum S100B concentrations reflect brain injury. However, increases in serum are rapid and transient and therefore may be of limited use in certain patients. Urinary S100B concentrations may be able to provide information about brain injury in this subgroup of patients. ⋯ Increases in urinary S100B are found in the majority of children with acute brain injury and an increased serum S100B. Urinary S100B concentrations peak later than serum concentrations, suggesting that measurement of urinary S100B may be helpful in subjects in whom early serum S100B is unavailable. Urinary and/or serum S100B concentrations may be useful to assist in the prediction of outcome after pediatric brain injury.
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Pediatr Crit Care Me · Nov 2006
Healthcare-associated infection in pediatric patients on extracorporeal life support: The role of multidisciplinary surveillance.
To describe the use of a multidisciplinary approach to sepsis surveillance and evaluate impact on outcome. ⋯ ECMO support is a high-risk setup for nosocomial infection, in particular for cardiac patients with open sternum for whom antibiotic prophylaxis is justified. Multidisciplinary surveillance offers an excellent approach for quality improvement in this challenging field.
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Pediatr Crit Care Me · Nov 2006
Is there a "right" way to wean my patient from the ventilator? A critical appraisal of Randolph et al: Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: A randomized controlled trial (JAMA 2002; 288:2561-2568).
To review the findings and discuss the implications of mechanical ventilator weaning protocols in children. ⋯ The majority of children are weaned from mechanical ventilation over a short period of time. Weaning protocols may not shorten this brief duration of weaning but may have other advantages such as improved collaboration between healthcare team members. Future research into the effects of sedation on weaning from mechanical ventilation is needed in children.
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Pediatr Crit Care Me · Nov 2006
Case ReportsUse of fenoldopam to increase urine output in a patient with renal insufficiency secondary to septic shock: A case report.
We describe the use of fenoldopam to increase urine output in a pediatric patient with sepsis, heart failure, oliguria, and volume overload. ⋯ Fenoldopam increased urine output in a pediatric patient who was in septic shock and oliguria. The mechanism for this effect is unclear, and further trials are necessary to determine the role of fenoldopam in this patient population.
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Pediatr Crit Care Me · Nov 2006
Case ReportsAcute thiamine deficiency in diabetic ketoacidosis: Diagnosis and management.
Persistent encephalopathy in a patient with diabetic ketoacidosis is often feared as a sign of cerebral edema. Although thiamine deficiency is a rare diagnosis in children, marginal nutritional status and osmotic diuresis may be risk factors. The objective was to describe a heretofore unreported cause of encephalopathy in a child with diabetic ketoacidosis and review the mechanisms and pathophysiology of thiamine deficiency in this clinical scenario. ⋯ The clinical improvement as well as lab investigations suggests that thiamine deficiency was the cause of this child's encephalopathy. Because potential mechanisms exist for thiamine deficiency in diabetes mellitus and institution of insulin and glucose therapy may stress thiamine body stores, thiamine deficiency should be considered in children with diabetic ketoacidosis whose encephalopathy does not improve with improvement of biochemical status.