Pediatr Crit Care Me
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Epidemics of acute respiratory disease, such as severe acute respiratory syndrome in 2003, and natural disasters, such as Hurricane Katrina in 2005, have prompted planning in hospitals that offer adult critical care to increase their capacity and equipment inventory for responding to a major demand surge. However, planning at a national, state, or local level to address the particular medical resource needs of children for mass critical care has yet to occur in any coordinated way. This paper presents the consensus opinion of the Task Force regarding supplies and equipment that would be required during a pediatric mass critical care crisis. ⋯ The Task Force endorsed the view that supplies and equipment must be available for a tripling of capacity above the usual peak pediatric intensive care unit capacity for at least 10 days. The recommended size-specific pediatric mass critical care equipment stockpile for two types of patients is presented in terms of equipment needs per ten mass critical care beds, which would serve 26 patients over a 10-day period. Specific recommendations are made regarding ventilator capacity, including the potential use of high-frequency oscillatory ventilation and extracorporeal membrane oxygenation. Other recommendations include inventories for disposable medical equipment, medications, and staffing levels.
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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
Is there a difference in clinical outcomes, inflammation, and hypermetabolism between scald and flame burn?
Severe thermal injury induces inflammatory and hypermetabolic responses that are associated with morbidity and mortality. However, it is not well-documented whether the causes of burns affect inflammation, hypermetabolism, and morbidity. The aim of the present study was to determine whether there is a difference in degree of inflammation, hypermetabolism, endocrine and acute-phase response, and clinical outcome between pediatric patients with scald and flame burns. ⋯ The type of burn affects hypermetabolism, inflammation, acute-phase responses, and mortality postburn.
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Pediatr Crit Care Me · Nov 2011
Very high serum ferritin levels are associated with increased mortality and critical care in pediatric patients.
To determine whether an elevated serum ferritin level is independently associated with mortality and receipt of critical care in pediatric patients. ⋯ In this pediatric population, with serum ferritin levels of >3000 ng/mL, there was increased risk for both receipt of critical care and subsequent death.
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Pediatr Crit Care Me · Nov 2011
Comparative StudyWhich pressure to believe? A comparison of direct arterial with indirect blood pressure measurement techniques in the pediatric intensive care unit.
To determine the accuracy of arterial blood pressure monitoring using 1) direct arterial; 2) automated oscillometric; and 3) sphygmomanometer/Doppler ultrasound measurements in pediatric intensive care patients comparing methods 1) and 2) with 3), the gold standard used to define normal blood pressure. ⋯ Outside the normotensive range, the automated readings were higher during hypotension and lower during hypertension compared with the arterial and Doppler ultrasound methods. The arterial blood pressure was closer to the gold standard Doppler ultrasound blood pressure in all three blood pressure groups.