Pediatr Crit Care Me
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Pediatr Crit Care Me · Jan 2011
Effects of flow rate and airleak at the nares and mouth opening on positive distending pressure delivery using commercially available high-flow nasal cannula systems: a lung model study.
Use of high-flow humidified nasal cannulas to deliver continuous positive airway pressure in children is increasing. Data on the relationship between the flow values and the corresponding pressures are limited. The purpose of this experiment was to evaluate the relationship between the device, intraprong, and proximal airway pressures and the flow values in a neonatal/pediatric test lung model, using the Vapotherm 2000i and Fisher-Paykel humidified nasal cannulas devices. ⋯ High flow humidified nasal cannulas systems may deliver uncontrolled continuous positive airway pressure to infants. This, along with the potentially large nares and mouth leak effects on any form of continuous positive airway pressure, renders the effective humidified nasal cannulas delivered continuous positive airway pressure particularly unpredictable.
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Pediatr Crit Care Me · Jan 2011
Safety and efficacy of intravenous labetalol for hypertensive crisis in infants and small children.
To determine the efficacy and safety of labetalol for hypertensive crisis in children ≤ 24 months of age. ⋯ Continuous intravenous labetalol infusion is efficacious for treatment of hypertensive crisis in children ≤ 24 months of age. Aside from patients presenting with ischemic or traumatic brain injury, labetalol was safe to use in this population for hypertensive emergencies and had a satisfactory adverse effect profile. Labetalol may reach dose saturation at a much lower dose in young children in comparison to adults. Clinicians should use caution when initiating labetalol infusions in young patients with brain injury.
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To outline the journey of a mother of a critically ill child in her quest for care for her infant. This article outlines the barriers faced, disappointments, and the indignity of poverty. Questions and commentary relating to the care of the critically ill in resource-limited environments underline the issues she faces. Critical illness is very common in the developing world with most childhood deaths occurring in Asia and sub-Saharan Africa. These areas are handicapped by limited access to critical care and intensive care facilities. This paper is not intended to review preventive strategies and simple inexpensive treatments that may prevent diseases and diminish critical illnesses. ⋯ Critical illness is common in areas of the world plagued with minimal resources to deal with its ravages. Parents try to do what is best for their critically ill children, but navigation of systems and lack of resources are daunting propositions. On any given day, this story or versions of it occurs in many parts of Africa and in low income countries in general. I saw similar scenes several times daily in Uganda and Kenya and, although the issues are slightly different in South Africa, failures of healthcare processes resulted in similar adverse outcomes in all areas. This is a mother's story.
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Pediatr Crit Care Me · Jan 2011
Editorial CommentAre we there yet? Improved patient survival with mock codes.