Pediatr Crit Care Me
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Pediatr Crit Care Me · Mar 2010
Educational preparation and postgraduate training curriculum for pediatric critical care nurse practitioners.
Nurse practitioners (NPs) in pediatric intensive care units have increased dramatically over recent years. Although state regulations are changing pediatric nurse practitioner certification, licensure and credentialing requirements, available acute care, and critical care educational programs are limited. Thus, entry-level practitioners continue to have varied clinical experience and educational preparation. ⋯ The orientation curriculum presented here may serve as a resource for NPs and collaborating physicians who are developing a training program for entry-level practitioners.
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Pediatr Crit Care Me · Mar 2010
Case ReportsThe critically ill child with novel H1N1 influenza A: a case series.
To describe the presentation, course, and outcome of critically ill children with novel H1N1 influenza disease. ⋯ Underlying chronic illness (especially respiratory illness) seems associated with critical novel H1N1 influenza disease in children. Respiratory manifestations are highly variable among patients and within a single patient involving both bronchoconstriction and alveolar disease. Therapies must be individualized and rapidly adjusted. The duration of critical illness was not different between early and late treatment groups. Whether this is reflective of sample size or indicative of the importance of therapeutic intervention at any time early during infection in critically ill patients is unclear. Bacterial superinfection was more common than previously reported for seasonal influenza A. Moderate novel H1N1 influenza disease, including respiratory failure and hypotension, had 100% survival in our series.
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To assess the adequacy of preparedness planning for an influenza pandemic by modeling the pediatric surge capacity of healthcare facility and pediatric intensive care unit (PICU) requirements over time. Governments and Public Health authorities have planned preparedness activities and training for a flu pandemic. PICU facilities will be the limiting factor in healthcare provision for children but detailed analyses for needs and demands in PICU care have not been published. ⋯ We recommend that a model, with assumptions that can be adapted with new information obtained during early stages of the pandemic that is evolving, be an integral part of a preparedness plan for a pandemic influenza with new human transmissible agent like influenza A virus.
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Pediatr Crit Care Me · Mar 2010
Number of sites of perinatal Candida colonization and neutropenia are associated with nosocomial candidemia in the neonatal intensive care unit patient.
To determine the role of perinatally acquired Candida colonization to invasive Candida infection (candidemia) and to assess risk factors associated with Candida colonization and candidemia in neonatal intensive care unit patients. ⋯ Maternal vaginal candidiasis and vaginal birth are risk factors for neonatal colonization. When controlling for illness severity, the number of sites colonized with Candida at birth contributes to neonatal nosocomial candidemia. Early neutropenia increases the risk further. These findings offer opportunities for prevention of Candida infection in neonatal intensive care unit patients.
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Pediatr Crit Care Me · Mar 2010
Neurally adjusted ventilatory assist in children: an observational study.
To assess patient safety and to evaluate operator acceptance to the technology of neurally adjusted ventilatory assist. ⋯ We feel that neurally adjusted ventilatory assist would be safe and potentially efficacious to ventilate infants and children. It has the potential for improved patient-ventilator synchrony, decreasing airway pressures, and it might lead to earlier extubation.