Pediatr Crit Care Me
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Pediatr Crit Care Me · Jul 2011
EditorialThe PICU perspective on monitoring hemodynamics and oxygen transport.
Alterations of hemodynamics and oxygen transport balance are very common scenarios in the pediatric intensive care unit (PICU), and these alterations are as heterogeneous and diverse in nature as are the patient populations that typically exist in the PICU. Accordingly, the PICU perspective on monitoring of hemodynamics and oxygen transport balance in critically ill children must be understood in this context of heterogeneity and diversity. We provide an interpretation of the evidence supporting various monitoring strategies as presented in the The Pediatric Cardiac Intensive Care Society Evidence Based Review and Consensus Statement on Monitoring of Hemodynamics and Oxygen Transport Balance from a Pediatric Intensive Care perspective.
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Pediatr Crit Care Me · Jul 2011
CommentA critical appraisal of Vlasselaers D, Milants I, Desmet L, et al: intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study. Lancet 2009; 373:547-556.
To review findings and discuss implications of strict glycemic control in children. ⋯ This was a well-designed single-center trial that serves as proof of concept. The effects of intensive insulin therapy on mortality require further investigation, and its practice may need refinement to reduce the risk of hypoglycemia. In the meantime, targeting age-adjusted fasting glucose ranges cannot be routinely recommended in critically ill children.
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Pediatr Crit Care Me · Jul 2011
ReviewBiomonitors of cardiac injury and performance: B-type natriuretic peptide and troponin as monitors of hemodynamics and oxygen transport balance.
Serum biomarkers, such as B-type natriuretic peptide and troponin, are frequently measured in the cardiac intensive care unit. A review of the evidence supporting monitoring of these biomarkers is presented.
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Pediatr Crit Care Me · Jul 2011
ReviewMonitoring of standard hemodynamic parameters: heart rate, systemic blood pressure, atrial pressure, pulse oximetry, and end-tidal CO2.
Continuous monitoring of various clinical parameters of hemodynamic and respiratory status in pediatric critical care medicine has become routine. The evidence supporting these practices is examined in this review. ⋯ Use of heart rate, electrocardiography, noninvasive and arterial blood pressure, atrial pressure, pulse oximetry, and end-tidal carbon dioxide monitoring in the pediatric critical care unit is commonplace; this practice, however, is not supported by well-controlled clinical trials. Despite the majority of literature being case series, expert opinion would suggest that use of routine pulse oximetry and end-tidal carbon dioxide is the current standard of care. In addition, literature would suggest that invasive arterial monitoring is the current standard for monitoring in the setting of shock. The use of heart rate, electrocardiography. and atrial pressure monitoring is advantageous in specific clinical scenarios (postoperative cardiac surgery); however, the evidence for this is based on numerous case series only.