Pediatr Crit Care Me
-
Pediatr Crit Care Me · Nov 2011
National survey of bedside ultrasound use in pediatric critical care.
The use of bedside ultrasound in critically ill adults has become standard practice. The current state of bedside ultrasound use in pediatric critical illness is unknown. The purpose of this study was to describe the use of bedside ultrasound in critically ill children with an emphasis on its use for establishing central vascular access. We also sought to describe current methods of training for bedside ultrasound use in pediatric critical care. ⋯ This national survey of the use of bedside ultrasound in pediatric critical care reveals widespread use of the technology. When using bedside ultrasound for vascular access, the preferred site is the internal jugular vein. Despite widespread use of bedside ultrasound, formal training that occurs routinely in other subspecialties is lacking. This survey provides meaningful demographic data that can be useful in planning future prospective studies and implementing formal training in bedside ultrasound for pediatric critical care fellows.
-
Pediatr Crit Care Me · Nov 2011
Case ReportsEndovascular treatment of near-fatal neonatal superior vena cava syndrome.
We describe the endovascular management of an 8-wk-old previously healthy female who developed superior vena cava syndrome secondary to Pseudomonas septic shock and disseminated intravascular coagulation. Doppler ultrasound confirmed near-total thrombotic occlusion of the superior vena cava and right internal jugular vein. She was taken emergently for cardiac catheterization, which confirmed the large superior vena cava thrombus extending into the right internal jugular vein and innominate vein with almost complete occlusion of the innominate vein. The superior vena cava to right atrium gradient was 14 mm Hg with very little antegrade flow into the right atrium, right femoral artery occlusion, and branch pulmonary artery emboli. Intervention involved serial balloon dilation inflations across the superior vena cava and innominate vein with improvement in the superior vena cava to right atrium gradient to 5 mm Hg and significant improvement in left ventricular function. Anticoagulation included heparin infusion for 48 hrs followed by enoxaparin for 1 month, alteplase for 48 hrs, eptifibatide (glycoprotein IIb/IIIa inhibitor) for 9 days followed by aspirin. ⋯ Daily head ultrasounds were performed without evidence of intracranial hemorrhage. All thromboses resolved within 3 wks. Her organ function recovered and she was discharged to home. The etiology of her colitis is still unknown. At 9-month follow-up, she was doing well with no residual organ dysfunction.
-
Pediatr Crit Care Me · Nov 2011
Case ReportsUse of tissue plasminogen activator to treat intracardiac thrombosis in extremely low-birth-weight infants.
Intracardiac thrombosis is a life-threatening complication of extreme prematurity. We describe the use of tissue plasminogen activator to treat intracardiac thrombosis in extremely low-birth-weight preterm infants. ⋯ Tissue plasminogen activator may safely be used to treat intracardiac thrombosis in extremely low-birth-weight preterm infants. Close monitoring of therapy is imperative. Further data are required to confirm the safety of tissue plasminogen activator in preterm infants.
-
Pediatr Crit Care Me · Nov 2011
Hospital-acquired viral infection increases mortality in children with severe viral respiratory infection.
To investigate the association of method of acquisition (hospital-acquired vs. community-acquired) and mortality in children with severe viral respiratory infection. ⋯ Our results suggest that in children with severe viral respiratory infection, hospital acquisition of infection is associated with increased mortality even after adjusting for chronic medical conditions that predispose to an increased risk of complications from viral illness.
-
Pediatr Crit Care Me · Nov 2011
Vancomycin pharmacokinetic-pharmacodynamic parameters to optimize dosage administration in critically ill children.
Critically ill children may present changes in pharmacokinetic parameters and may not reach effective concentrations of vancomycin with current dosages. The objective of this study is to calculate vancomycin pharmacokinetic parameters in critically ill children and to estimate area under the curve at 24 hrs/minimal inhibitory concentration reached for Staphylococcus aureus. ⋯ Critically ill children show changes in pharmacokinetic parameters. Serum concentration monitorization is necessary for dosage individualization. Most children do not reach an area under the curve at 24 hrs/minimal inhibitory concentration >400 with current dosage.