Pediatr Crit Care Me
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Pediatr Crit Care Me · Nov 2011
Randomized Controlled TrialRandomized controlled trial for intermittent versus continuous propofol sedation for pediatric brain and spine magnetic resonance imaging studies.
Intermittent bolus propofol is an effective agent for pediatric magnetic resonance imaging sedation but requires constant vigilance and dose titration. Magnetic resonance imaging-compatible infusion pumps may make it possible to continuously infuse propofol, achieving a steady level of sedation at a lower total dose. This study investigates total propofol dose, recovery time, and magnetic resonance image quality in children receiving intermittent vs. continuously infused propofol sedation in children undergoing brain and spine magnetic resonance imaging studies. ⋯ Compared to intermittent bolus dosing, continuous propofol infusion provides lesser dose exposure without impacting recovery time or quality of the magnetic resonance imaging study.
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Pediatr Crit Care Me · Nov 2011
Pediatric emergency mass critical care: the role of community preparedness in conserving critical care resources.
Public health emergencies require resources at state, regional, federal, and often international levels; however, community preparedness is the crucial first step in managing these events and mitigating their consequences, particularly for children. Community preparedness can be optimized through system-wide planning that includes integrating multiple points of contact, such as the community, prehospital care, health facilities, and regional level of care assets.Citizen readiness, call centers, alternate care facilities, emergency medical services, and health emergency operations centers linked to community incident command systems should be considered as important options for delivery of population-based care. Early collaboration between pediatric clinicians and public health authorities is essential to ensure that pediatric needs are addressed in community preparedness for mass critical care events. ⋯ The Pediatric Emergency Mass Critical Care Task Force recommends active promotion of programs to ensure an informed citizenry; education of children and families in Centers for Disease Control and Prevention community mitigation strategies; emphasis on community-level preparedness empowering the public to provide self care; use of 9-1-1 telephone triage with pre-established protocols and in coordination with emergency medical services; and advocacy for healthcare coalitions and other creative operational concepts that provide guidance and protocols for care of the pediatric population.
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Pediatr Crit Care Me · Nov 2011
Survivors of septic shock caused by Neisseria meningitidis in childhood: psychosocial outcomes in young adulthood.
To investigate long-term psychosocial outcomes in young adults who survived septic shock caused by Neisseria meningitidis (meningococcal septic shock) during childhood. ⋯ Despite favorable outcomes for the majority of meningococcal septic shock patients in the long term, an important minority (5% to 20%) still struggles with ongoing problems as to behavioral/emotional problems, intellectual functioning, biographical characteristics, and illness-related physical or social consequences.
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Pediatr Crit Care Me · Nov 2011
Randomized Controlled TrialFactors associated with pediatric critical care attending follow-up with families after the death of a patient: a national survey with an experimental design.
To evaluate components of the family-physician relationship that affect the likelihood of self-reported physician follow-up with bereaved families. ⋯ Pediatric critical care attending physicians were more likely to report following-up with a bereaved family and attend a funeral in a vignette portraying a trustful relationship between the family and staff.
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Pediatr Crit Care Me · Nov 2011
Randomized Controlled TrialValue of continuous glucose monitoring for minimizing severe hypoglycemia during tight glycemic control.
Tight glycemic control can potentially reduce morbidity and mortality in the intensive care unit but increases the risk of hypoglycemia. The most effective means to avoid hypoglycemia is to obtain frequent blood glucose samples, but this increases the burden to nursing staff. The objective of this study was to assess the ability of a real-time continuous glucose monitor to reduce hypoglycemia (blood glucose <60 mg/dL [3.3 mmol/L]) during standard care or tight glycemic control effected with a proportional integral derivative insulin titration algorithm. ⋯ The real-time continuous glucose monitor in combination with proportional integral derivative control can reduce hypoglycemia during tight glycemic control. The real-time continuous glucose monitor can also reduce hypoglycemia during standard care. However, false alarms increase the overall nursing workload.