Pediatr Crit Care Me
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Pediatr Crit Care Me · Sep 2006
Case ReportsA child with anterior mediastinal mass supported with veno-arterial extracorporeal membrane oxygenation.
To demonstrate the utility of rescue with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and to demonstrate the feasibility of administration of chemotherapy during VA-ECMO in a child with an anterior mediastinal mass. ⋯ VA-ECMO can be successfully used to support patients with cardiopulmonary failure during initial diagnosis of an anterior mediastinal mass. In addition, we have demonstrated that successful chemotherapy can be administered while the patient is supported on VA-ECMO.
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Pediatr Crit Care Me · Sep 2006
Comparative StudyComparison between clinical diagnoses and autopsy findings in a pediatric intensive care unit in São Paulo, Brazil.
To verify the frequency of discrepancies between clinical diagnoses and autopsy findings in patients from a pediatric intensive care unit and to look for predictive factors of the discrepancies. ⋯ Although diagnoses of both cause of death and underlying disease were accurate in most cases before death, some autopsies revealed findings that would have changed intensive care unit therapy. Nonbacterial infections and pulmonary thromboembolism should always be considered when managing critically ill patients with underlying disease. Autopsy examinations continue to provide important information, especially in the pediatric intensive care unit setting, despite the advances in diagnostic technology.
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Pediatr Crit Care Me · Sep 2006
CommentConsidering the use of induced hypothermia in a pediatric patient with traumatic brain injury: a critical appraisal of two meta-analyses.
To review whether induced hypothermia after traumatic brain injury affects morbidity and mortality based on the results of two meta-analyses. ⋯ The discrepancies in the results of these contemporaneous meta-analyses may stem, in part, from differences in their trial selection strategies as well as from sources of trial heterogeneity. Nevertheless, McIntyre et al. uncovered the equivalent of a dose-dependent reduction in the risk of death with induced hypothermia, supporting further study of this neuroprotective strategy. Although these meta-analyses included trials containing adult patients, a phase II trial of induced hypothermia in pediatric traumatic brain injury has established its feasibility and safety in infants and children. As in adult patients, induced hypothermia for traumatic brain injury in children can be considered an optional therapy for refractory intracranial hypertension but should not be regarded as standard of care.
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Pediatr Crit Care Me · Sep 2006
Randomized Controlled Trial Multicenter StudyProne positioning can be safely performed in critically ill infants and children.
To describe the effects of prone positioning on airway management, mechanical ventilation, enteral nutrition, pain and sedation management, and staff utilization in infants and children with acute lung injury. ⋯ Our data show that prone positioning can be safely performed in critically ill pediatric patients and that these patients can be safely managed while in the prone position for prolonged periods of time.
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Pediatr Crit Care Me · Sep 2006
Epidemiology and early predictive factors of mortality and outcome in children with traumatic severe brain injury: experience of a French pediatric trauma center.
To describe the results of an integrated pre- and in-hospital approach to critical care in a large population of children with severe traumatic brain injury and to identify the early predictors of their outcome. ⋯ Initial hypotension, Glasgow Coma Scale, and Injury Severity Score are independent predictors of outcome in children with traumatic brain injury. Threshold values can be calculated for predicting poor outcome. These variables can be easily and detected early in this population and used for quality assessment.