Pediatr Crit Care Me
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Pediatr Crit Care Me · Jul 2006
Hyperglycemia is a marker for poor outcome in the postoperative pediatric cardiac patient.
Hyperglycemia in critical care populations has been shown to be a risk factor for increased morbidity and mortality. Minimal data exist in postoperative pediatric cardiac patients. The goal of this study was to determine whether hyperglycemia in the postoperative period was associated with increased morbidity or mortality. ⋯ Hyperglycemia in the postoperative period was associated with increased morbidity and mortality in postoperative pediatric cardiac patient. Strict glycemic control may improve outcomes in this patient population.
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Pediatr Crit Care Me · Jul 2006
Clinical TrialSpontaneous breathing trial predicts successful extubation in infants and children.
To assess the value of a spontaneous breathing trial (SBT) using a flow-inflating bag in predicting extubation success. Secondary goals were to evaluate the positive and negative predictive accuracy of a 15-min SBT. ⋯ A 15-min flow-inflating bag SBT represents a practical, reliable bedside test that has 95% sensitivity for predicting extubation success in pediatric ICU patients. A trial failure is associated with but does not accurately predict extubation failure.
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Pediatr Crit Care Me · Jul 2006
Extracorporeal membrane oxygenation after stage I reconstruction for hypoplastic left heart syndrome.
Although extracorporeal membrane oxygenation (ECMO) is an acceptable strategy for children with refractory cardiac dysfunction after cardiac surgery, its role after stage I reconstruction for hypoplastic left heart syndrome and its variants is controversial. Our objective is to describe the outcome of "nonelective" ECMO after stage I reconstruction. ⋯ In our experience, ECMO after stage I reconstruction can be life saving in about a third of infants with otherwise fatal conditions. It is particularly useful in potentially reversible conditions such as acute shunt thrombosis and transient depression of ventricular function.
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Pediatr Crit Care Me · Jul 2006
Altered cerebrovascular responses after exposure to venoarterial extracorporeal membrane oxygenation: role of the nitric oxide pathway.
Previous studies in our laboratory on newborn lambs have shown cerebral autoregulation impairment after exposure to venoarterial extracorporeal membrane oxygenation (VA ECMO), with additional studies showing an altered cerebrovascular response to NG-nitro-L-arginine methyl ester in lamb cerebral vessels in this same model. ⋯ Cerebral arteries exposed to VA ECMO had impaired myogenic responses combined with altered endothelial function. The endothelial alteration seems to be mediated through the nitric oxide pathway, with recovery noted after addition of a nitric oxide donor. It can be postulated that these changes may reflect the mechanisms for the impairment of cerebral autoregulation previously reported in this lamb model.
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Pediatr Crit Care Me · Jul 2006
Clinical TrialHigh-frequency oscillatory ventilation in pediatric patients with acute respiratory failure.
To evaluate the effectiveness of high-frequency oscillatory ventilation (HFOV) in pediatric patients with acute respiratory failure, failing conventional ventilation. ⋯ In pediatric patients with acute respiratory failure, failing conventional ventilation, HFOV improves gas exchange in a rapid and sustained fashion. However, randomized controlled trials are needed to identify its benefits over conventional modes of mechanical ventilation.