Pediatr Crit Care Me
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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.
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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
Case ReportsRecurrent delirium after surgery for congenital heart disease in an infant.
The objective of this article is to describe a case of recurrent delirium after cardiac surgery in an infant. ⋯ Delirium is a common, but often unrecognized, diagnosis in the intensive care unit. Its early recognition and treatment may prevent unnecessary use of narcotics and benzodiazepines, decrease length of stay and may improve long-term neurocognitive function. This case report describes an infant who developed discrete, consecutive episodes of delirium following surgery for congenital heart disease. Both episodes were treated effectively with olanzapine.
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Bedside ultrasound, as performed by the intensivist, is gaining in popularity and has become a powerful tool to understand the physiological state of the critically ill patient and to decrease procedural risks. This review assesses clinical applications of bedside ultrasound in the pediatric intensive care unit. ⋯ Variable, per individual studies. MAIN RESULTS/CONCLUSIONS: Bedside ultrasound, as practiced by the pediatric intensivist, has the potential to improve pediatric critical care medicine, but data supporting its use is limited. Further studies are needed to explore applications, with specific emphasis on the training and experience of ultrasound operators. There is a need for a standardized educational curriculum, and questions remain as to the optimal mode of education and quality assurance of ultrasound operators.