Pediatr Crit Care Me
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Pediatr Crit Care Me · Mar 2007
Analysis of the evidence for the lower limit of systolic and mean arterial pressure in children.
Systolic blood pressure (SBP) and mean arterial pressure (MAP) are essential evaluation elements in ill children, but there is wide variation among different sources defining systolic hypotension in children, and there are no normal reference values for MAP. Our goal was to calculate the 5th percentile SBP and MAP values in children from recently updated data published by the task force working group of the National High Blood Pressure Education Program and compare these values with the lowest limit of acceptable SBP and MAP defined by different sources. ⋯ We developed new estimates for values of 5th percentile SBP and created a table of normal MAP values for reference. SBP is significantly affected by height, which has not been considered previously. Although the estimated lower limits of SBP are lower than currently used to define hypotension, these values are derived from normal healthy children and are likely not appropriate for critically ill children. Our data suggest that the current values for hypotension are not evidence-based and may need to be adjusted for patient height and, most important, for clinical condition. Specifically, we suggest that the definition of hypotension derived from normal children should not be used to define the SBP goal; a higher target SBP is likely appropriate in many critically ill and injured children. Further studies are needed to evaluate the appropriate threshold values of SBP for determining hypotension.
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Pediatr Crit Care Me · Mar 2007
Determining pediatric intensive care unit quality indicators for measuring pediatric intensive care unit safety.
The measurement of quality and patient safety continues to gain increasing importance, as these measures are used for both healthcare improvement and accountability. Pediatric care, particularly that provided in pediatric intensive care units, is sufficiently different from adult care that specific metrics are required. BODY: Pediatric critical care requires specific measures for both quality and safety. Factors that may affect measures are identified, including data sources, risk adjustment, intended use, reliability, validity, and the usability of measures. The 18-month process to develop seven pediatric critical care measures proposed for national use is described. Specific patient safety metrics that can be applied to pediatric intensive care units include error-, injury-, and risk-based approaches. ⋯ Measurement of pediatric critical care quality and safety will likely continue to evolve. Opportunities exist for intensivists to contribute and lead in the development and refinement of measures.
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Pediatr Crit Care Me · Mar 2007
Case ReportsMassive ibuprofen overdose requiring extracorporeal membrane oxygenation for cardiovascular support.
Ibuprofen is rarely associated with severe toxicity. We report a massive ibuprofen overdose that resulted in refractory hypotension requiring extracorporeal membrane oxygenation (ECMO) for cardiovascular support. ⋯ Although ibuprofen overdose typically has few consequences, severe hypotension, renal failure, and gastrointestinal bleeding can occur. We report the first known case of successful ECMO therapy for ibuprofen overdose.
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Pediatr Crit Care Me · Mar 2007
Case ReportsManagement of abdominal compartment syndrome during extracorporeal life support.
To describe the successful use of a peritoneal dialysis catheter for emergent decompression of abdominal compartment syndrome during extracorporeal life support for septic shock. ⋯ Although the standard therapy for abdominal compartment syndrome is decompressive laparotomy, a minimally invasive percutaneous approach may be effective and should be considered in selected patients.
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Pediatr Crit Care Me · Mar 2007
Case ReportsHyperkalemia and cardiac arrest following succinylcholine administration in a 16-year-old boy with acute nonlymphoblastic leukemia and sepsis.
To report a case of potentially lethal hyperkalemia related to succinylcholine administration. ⋯ Succinylcholine may cause dangerous arrhythmias in septic and immobilized children. The alternative nondepolarizing agents should be used in such cases.