Pediatr Crit Care Me
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Pediatr Crit Care Me · Nov 2007
Case ReportsMetabolic acidosis as an underlying mechanism of respiratory distress in children with severe acute asthma.
1) To alert the clinician that increasing rate and depth of breathing during treatment of acute asthma may be a manifestation of metabolic acidosis with hyperventilation rather than worsening airway obstruction; and 2) to describe the frequency of metabolic acidosis with hyperventilation in children with severe acute asthma admitted to our pediatric intensive care unit. ⋯ Metabolic acidosis with hyperventilation manifesting as respiratory distress can occur in children with severe acute asthma. A pathophysiologic rationale exists for the contribution of beta2-adrenergic agents to the development of this acid-base disorder. Failure to recognize metabolic acidosis as the underlying mechanism of respiratory distress may lead to inappropriate intensification of bronchodilator therapy. Supportive care and tapering of beta2-adrenergic agents are recommended to resolve this condition.
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Pediatr Crit Care Me · Nov 2007
Use of recombinant activated factor VII in intractable bleeding during pediatric neurosurgical procedures.
To report the use of recombinant activated factor VII (NovoSeven; Novo Nordisk A/S, Bagsvaerd, Denmark) in children undergoing major neurosurgical procedures and experiencing massive uncontrolled hemorrhagic shock. ⋯ These four patients support the use of recombinant activated factor VII as a useful adjunct to control massive life-threatening bleeding during pediatric neurosurgical procedures when other means failed. However, the data are still limited in children, and more extensive research is needed to define the indications of recombinant activated factor VII in massive surgical hemorrhage in low-weight children.
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Pediatr Crit Care Me · Nov 2007
Extubation after cardiothoracic surgery in neonates, children, and young adults: One year of institutional experience.
Describe risk factors associated with successful and early extubation in the pediatric cardiac intensive care unit. DESIGN:: Retrospective chart review. SETTING:: University hospital, cardiac intensive care unit. MEASUREMENTS AND MAIN ⋯ Extubation without the need for reintubation can be achieved in nearly all children following cardiothoracic surgery. The majority of successful extubations can be achieved within 24 hrs of surgery.
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Pediatr Crit Care Me · Nov 2007
Physician team management affects goal achievement in the intensive care unit.
There are few investigations evaluating the impact of physician management and leadership skills on patient care. Our objective was to determine whether there were perceived differences in management and leadership performance within a group of intensivists and to correlate these differences with processes of care outcomes. ⋯ Management and leadership performance of attending intensivists can be measured and is associated with efficiency of care as assessed by accomplishment of daily patient goals. Attendings differ in their management and leadership performances.
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Pediatr Crit Care Me · Nov 2007
Extubation after cardiothoracic surgery in neonates, children, and young adults: one year of institutional experience.
Describe risk factors associated with successful and early extubation in the pediatric cardiac intensive care unit. ⋯ Extubation without the need for reintubation can be achieved in nearly all children following cardiothoracic surgery. The majority of successful extubations can be achieved within 24 hrs of surgery