Pediatr Crit Care Me
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To review the physiology and the published literature on the role of vasopressin in shock in children. ⋯ Vasopressin offers promise in shock and cardiac arrest in children. However, in view of the limited experience with vasopressin, it should be used with caution. Results of a double-blind, randomized controlled trial in children with vasodilatory shock will be available soon.
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Pediatr Crit Care Me · Jul 2008
Procalcitonin and C-reactive protein as markers of bacterial infection in critically ill children at onset of systemic inflammatory response syndrome.
To compare the accuracy of procalcitonin and C-reactive protein as diagnostic markers of bacterial infection in critically ill children at the onset of systemic inflammatory response syndrome (SIRS). ⋯ Procalcitonin is better than C-reactive protein for differentiating bacterial from nonbacterial SIRS in critically ill children, although the accuracy of both tests is moderate. Diagnostic accuracy could be enhanced by combining these tests with bedside clinical judgment.
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Pediatr Crit Care Me · Jul 2008
Serum level of cardiac troponin I in pediatric patients with sepsis or septic shock.
To evaluate serum level of contractile protein troponin I (cTnI) within the 24 hrs of sepsis and septic shock diagnosis in children and to correlate with the outcome (discharge from hospital or death). ⋯ Evaluation of serum levels of cTnI within the first 24 hrs of diagnosis of sepsis or septic shock in children was not better than creatine kinase MB isoenzyme or clinical evaluation, to predict the outcome (death or discharge from hospital) of septic process.
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Pediatr Crit Care Me · Jul 2008
Alterations in glucose homeostasis in the pediatric intensive care unit: Hyperglycemia and glucose variability are associated with increased mortality and morbidity.
Critically ill patients with alterations in glucose equilibrium may experience adverse outcomes. We sought to describe the distribution of blood glucose values in the absence of insulin therapy and to evaluate the association of hyperglycemia, hypoglycemia, and glucose variability with mortality and morbidity of critically ill children. ⋯ We found a relationship between blood glucose level and PICU patient outcomes. The relationship is similar to that found in adults and raises the question whether attention to control of blood glucose will improve outcomes in critically ill children.
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Pediatr Crit Care Me · Jul 2008
CommentStage I palliation for hypoplastic left heart syndrome: Is a right ventricle to pulmonary artery conduit associated with improved outcomes? Critical appraisal of Cua et al: Early postoperative outcomes in a series of infants with hypoplastic left heart syndrome undergoing stage I palliation operation with either modified Blalock-Taussig shunt or right ventricle to pulmonary artery conduit (Pediatr Crit Care Med 2006; 7:238-244).
To review the findings and discuss the implications of studies comparing Norwood procedure with either modified Blalock-Taussig shunt (NW-BT) or right ventricle to pulmonary artery conduit (NW-RVPA) in stage I palliation of hypoplastic left heart syndrome (HLHS). ⋯ NW-RVPA has theoretical advantages over NW-BT and is associated with excellent outcome results. However, available data are insufficient to prove benefit in terms of mortality or morbidity. A multicenter randomized trial is currently being conducted, which should provide more conclusive information.