Pediatr Crit Care Me
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Pediatr Crit Care Me · May 2009
Profile and consequences of children requiring prolonged mechanical ventilation in three Brazilian pediatric intensive care units.
To describe the characteristics of children submitted to prolonged mechanical ventilation (MV), and evaluate their mortality, and associated factors as well as the potential impact at admissions to the pediatric intensive care unit (PICU). ⋯ A small group of children admitted to the PICU requires prolonged MV. The elevated mortality rate is associated with higher ventilatory parameters and vasoactive drug support on the 21st day of MV. Stable children requiring prolonged MV in the PICU potentially prevent additional admissions of a large number of acute and unstable patients.
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Pediatr Crit Care Me · May 2009
Pediatricians' attitudes toward resuscitation in children with chronic illnesses.
Do not attempt resuscitation (DNAR) orders are becoming more common in children with chronic illnesses. In this study, we compare pediatricians' attitudes about DNAR orders in four venues. Our hypotheses are: 1) venue matters: acceptance of DNAR varies by where the arrest occurs; 2) specialty affiliation matters: acceptance of DNAR varies by pediatric specialization; and 3) the personal influences the professional: pediatricians are more likely to respect and recommend a DNAR if they would choose DNAR for their own child. ⋯ DNAR decisions have become well accepted in the pediatric community for both end-of-life and poor quality of life cases.
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Pediatr Crit Care Me · May 2009
Case ReportsA novel use of etomidate for intentional adrenal suppression to control severe hypercortisolemia in childhood.
To describe a novel use for etomidate in critically ill children. Etomidate induction of anesthesia in children is controversial due to adrenal suppression; we review this controversy and describe a therapeutic application of this "side effect" using a continuous etomidate infusion in pediatric intensive care to deliberately suppress critically elevated endogenous cortisol. ⋯ The adrenal suppression caused by etomidate, so controversial in the care of the critically ill at present, can be therapeutically used for short-term control of severe hypercortisolemia in children.