Pediatr Crit Care Me
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Pediatr Crit Care Me · Jan 2009
Comparative StudyMeropenem use and colonization by antibiotic-resistant Gram-negative bacilli in a pediatric intensive care unit.
The carbapenems are broad-spectrum beta-lactam antibiotics with activity against most organisms encountered in the pediatric intensive care unit (PICU). In anticipation of their increased use in critically ill children, we measured the effect of sustained meropenem use on the pattern of Gram-negative bacillus colonization in patients admitted to a tertiary care PICU. ⋯ There was no statistically detectable effect on the prevalence of colonization by Gram-negative organisms resistant to one or more classes of broad-spectrum parenteral antibiotics, or to colonization by organisms resistant specifically to meropenem, when meropenem was the preferred antibiotic in a PICU.
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Pediatr Crit Care Me · Jan 2009
Multicenter StudyHigh-alert medications in the pediatric intensive care unit.
To identify pediatric intensive care unit (PICU) clinicians' perceptions of high-alert medications and to develop a PICU-specific, high-alert medications list. We hypothesize that a PICU-specific list will include medications not identified on the Institute for Safe Medications Practices list and that the high-alert medications identified will differ by PICU clinician type (physicians, nurses, pharmacists). ⋯ PICU clinicians identified high-alert medications not identified on the Institute for Safe Medications Practices list. Risks of the identified high-alert medications were attributed to a wide range of different stages in the medication process as well as clinicians' varying experiences in the medication process.
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Pediatr Crit Care Me · Jan 2009
Adequate agreement between venous oxygen saturation in right atrium and pulmonary artery in critically ill children.
To determine the agreement between venous oxygen saturation in right atrium (Srao2) and pulmonary artery (Svo2) in critically ill pediatric patients. ⋯ The concordance analysis performed allows to conclude that there is an appropriate agreement between Svo2 and Srao2. This finding may become clinically relevant considering the difficulties associated to the use of PAC in children.
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Pediatr Crit Care Me · Jan 2009
Comparative StudyEchocardiography, not chest radiography, for evaluation of cannula placement during pediatric extracorporeal membrane oxygenation.
Optimal cannula position is essential during extracorporeal membrane oxygenation (ECMO). We hypothesize that echocardiography is superior to chest radiography in diagnosing abnormal cannula position during ECMO. ⋯ Echocardiography appears to be superior to chest radiography for assessing ECMO cannula position in our institution. A prospective study, including cost analysis, comparing chest radiography and echocardiography, is needed to definitely determine the preferred diagnostic test or sequence of tests to establish ECMO cannula position.
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Pediatr Crit Care Me · Jan 2009
Comparative StudySerial lactate measurements using microdialysis of interstitial fluid do not correlate with plasma lactate in children after cardiac surgery.
Serial postoperative blood lactate (BL) concentrations have been shown to predict outcome of children after congenital heart surgery (CHS), and interventions aimed at lowering lactate can improve the outcome of these children. The cumulative blood loss for diagnostic purposes, such as repetitive arterial blood sampling in the intensive care unit, contributes, especially in small children, to anemia. Techniques to limit blood loss can therefore be of use. Microdialysis is a technique to monitor tissue chemistry in various clinical settings, and we hypothesized that it may be a valuable alternative for frequent blood sampling to monitor lactate in children after CHS. ⋯ Serial lactate measurements in microdialysis fluid of subcutaneous adipose tissue are feasible, but cannot be used as a reliable interchangeable method for plasma lactate analysis in children after CHS at this time. Whether this technique has its own place in the assessment of the overall hemodynamic status and tissue perfusion in children after CHS needs to be addressed in future studies.