Pediatr Crit Care Me
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Pediatr Crit Care Me · Nov 2008
Cranial computed tomographic findings in a large group of children with drowning: diagnostic, prognostic, and forensic implications.
The primary aim of this study is to better define both the type and incidence of cranial computed tomography (CT) abnormalities in children following submersion injury. ⋯ These data from the largest study of CT findings in pediatric drowning clearly illustrate that following submersion injury, intra- or extra-axial bleeding is not seen on cranial CT. Furthermore, an abnormal CT scan at any time was associated with a poor outcome (death or persistent vegetative state). The CT findings and the presenting Glasgow Coma Scale of patients with drowning differ from those of patients who have suffered abusive head trauma.
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Pediatr Crit Care Me · Nov 2008
Exploring parents' environmental needs at the time of a child's death in the pediatric intensive care unit.
Many childhood deaths in the United States occur in intensive care settings. The environmental needs of parents experiencing their child's death in a pediatric intensive care unit must be understood to design facilities that comfort at the time of death and promote healing after loss. The purpose of this study is to explore parents' environmental needs during their child's hospitalization and death in the pediatric intensive care unit. ⋯ The pediatric intensive care unit environment affects parents at the time of their child's death and produces memories that are vivid and long lasting. Positive environmental memories can contribute to comfort during bereavement whereas negative memories can compound an already devastating experience. Parents' perspectives of the pediatric intensive care unit environment can provide insight for adapting existing spaces and designing new facilities.
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To develop a reliable predictor of major adverse events after pediatric cardiac surgery, with the aim of reducing mortality of cardiac extracorporeal life support through earlier, more accurate patient selection. ⋯ Lactate and Scvo2 are the only postoperative measurements with predictive power for major adverse events. Forming a ratio of the two (Scvo2/lactate), seems to improve predictive power, presumably by combining their individual predictive strengths. Both measures have excellent specificities but lower sensitivities. Predictive power of single measures is only fair but can be improved, in high risk patients, by monitoring repeated measures over time.
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Pediatr Crit Care Me · Nov 2008
Experience with intravenous enoxaparin in critically ill infants and children.
Subcutaneous administration of enoxaparin is often difficult in special populations, such as premature infants and critically ill children with severe edema. The difficulty achieving adequate anticoagulation in these patients has led to the employment of intravenous enoxaparin in some cases. However, little pharmacodynamic data are available for determining the appropriate dosing and monitoring (by anti-Factor Xa levels) of intravenous enoxaparin. The objective of this study is to report our experience with the use of intravenous enoxaparin in pediatric patients in the intensive care unit. ⋯ Our data show that the pharmacodynamics of intravenous administration is different from subcutaneous administration and deserves further study.
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Pediatr Crit Care Me · Nov 2008
Intercontinental differences in end-of-life attitudes in the pediatric intensive care unit: results of a worldwide survey.
To examine intercontinental differences in end-of-life practices in pediatric intensive care units. ⋯ This study confirms that important intercontinental differences exist toward end-of-life issues in pediatric intensive care. Although the legal and ethical situation is rapidly evolving, a certain degree of paternalism seems to persist among European and South-American caregivers. This study suggests that ethical principles depend on the cultural roots of countries or continents, emphasizing the need to foster dialogue on end-of-life issues around the world to learn from each other and improve end-of-life care in pediatric intensive care units.