Pediatr Crit Care Me
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Pediatr Crit Care Me · Jul 2007
The use of repeated head computed tomography in pediatric blunt head trauma: factors predicting new and worsening brain injury.
Opinion is divided on the value of repeat head computed tomography for guiding clinical management of pediatric patients with blunt head trauma. This study describes the prevalence of worsening brain injury on repeat computed tomography, predictors of worsening computed tomography findings, and the frequency of neurosurgical intervention after the repeat computed tomography. ⋯ Repeat head computed tomography imaging is frequently used. About 30% of repeated computed tomographies showed new or worsening brain injury. However, worsening brain injury on repeat computed tomography rarely resulted in neurosurgical intervention. Patients with moderate or severe head injury and intraparenchymal injuries were more likely to show worsening brain injury and undergo neurosurgical intervention.
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Pediatr Crit Care Me · Jul 2007
Have changes in ventilation practice improved outcome in children with acute lung injury?
To describe the changes that have occurred in mechanical ventilation in children with acute lung injury in our institution over the last 10-15 yrs and to examine the impact of these changes, in particular of the delivered tidal volume on mortality. ⋯ The changes in the clinical practice of mechanical ventilation in children in our institution reflect those reported for adults. In our experience, mortality among children with acute lung injury was reduced by 40%, and tidal volume was independently associated with reduced mortality and an increase in ventilation-free days.
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Pediatr Crit Care Me · Jul 2007
Case ReportsFatal acute fibrinous and organizing pneumonia in an infant: The histopathologic variability of acute respiratory distress syndrome.
The histopathologic pattern of acute fibrinous and organizing pneumonia (AFOP) has been described recently in cases of acute respiratory distress syndrome (ARDS) in adults and differs from the well-recognized pattern of classic diffuse alveolar damage (DAD). The objective of this study was to determine whether similar appearances can be seen in infant ARDS. ⋯ The histopathologic features of AFOP may be seen in some cases of infant ARDS. The variability in the histopathology of ARDS raises questions as to the pathogenesis and clinical correlates of these different patterns.
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Pediatr Crit Care Me · Jul 2007
Association of nursing workload and unplanned extubations in a pediatric intensive care unit.
To estimate nursing workload from the patient acuity level (PAL) assigned to patients in a pediatric intensive care unit (PICU) and to determine its influence on unplanned extubations. ⋯ The likelihood of an unplanned extubation increased with higher patient/nurse and patient acuity/nurse ratios. Successful interventions to reduce the frequency of this medical error may need to address both nurse demand methodology and workload.
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Pediatr Crit Care Me · Jul 2007
Going back for more: an evaluation of clinical outcomes and characteristics of readmissions to a pediatric intensive care unit.
To determine mortality, length of stay, and factors associated with readmissions to the pediatric intensive care unit (PICU). ⋯ Patients readmitted to the PICU during the same hospitalization have significantly adverse outcomes. The study highlights important factors associated with PICU readmissions that can be incorporated into efforts to reduce mortality and resource utilization associated with readmission of critically ill children.