Pediatr Crit Care Me
-
Pediatr Crit Care Me · Nov 2010
CommentGlucose variability and survival in critically ill children: allostasis or harm?
To assess whether individual blood glucose variability in critically ill children is associated with increased mortality and to define the temporal patterns of blood glucose variability during critical illness in children. ⋯ Glucose variability is common in critically ill children and is associated with increased mortality. Whereas early alterations in blood glucose may represent allostasis, later fluctuations in blood glucose may represent an alteration of autoregulation with resulting higher mortality. Control of variability may need to be incorporated into glycemic control regimens.
-
Pediatr Crit Care Me · Nov 2010
Outcomes of hematopoietic stem cell transplant patients who received continuous renal replacement therapy in a pediatric oncology intensive care unit.
To assess the long-term benefits of continuous renal replacement therapy (CRRT) in this patient population and to analyze factors associated with survival. Hematopoietic stem cell transplantation is being utilized as curative therapy for a variety of disorders. However, organ dysfunction is commonly associated with this therapy. Continuous renal replacement therapy (CRRT) is increasingly being used in the treatment of this multiorgan dysfunction. ⋯ In this single-center study, CRRT was not associated with long-term survival in pediatric allogeneic hematopoietic stem cell transplantation patients. Clinical data exist, both before and during CRRT, that may be associated with length of survival. Lower C-reactive protein levels at CRRT end were associated with longer survival, suggesting that the ability to attenuate inflammation during CRRT may afford a survival advantage. These findings require confirmation in a prospective study.
-
Pediatr Crit Care Me · Nov 2010
Comment Multicenter Study Comparative StudyComparison of the effectiveness and safety of two insulin infusion protocols in the management of hyperglycemia in critically ill children.
To compare the effectiveness and safety of a paper-based and a computerized algorithm used for tight glycemic control. ⋯ YIIP is less effective but is as safe as ePi in achieving tight glycemic control. We are awaiting the results of two multicenter trials designed to determine the survival benefit of tight glycemic control in children. Further studies are needed to determine the clinical significance of the different glucose metrics in critically ill patients.