Pediatr Crit Care Me
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Pediatr Crit Care Me · Jul 2011
EditorialThe cardiac intensive care unit perspective on hemodynamic monitoring of oxygen transport balance.
The purpose of this consensus statement is to present the available evidence supporting the use of a variety of hemodynamic monitors in a pediatric population. Each article within this supplement and the presentations at the Eighth International Conference of the Pediatric Cardiac Intensive Care Society provide the evidence to support recommendations for the use of each monitoring modality. The purpose of this editorial is to interpret the evidence provided elsewhere in this supplement from the perspective of cardiac critical care.
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Pediatr Crit Care Me · Jul 2011
ReviewEchocardiography as a hemodynamic monitor in critically ill children.
Echocardiography is a widely used modality to assess myocardial structure and function in pediatric intensive care settings. While the use of echocardiography for diagnostic purposes remains important, its use as a hemodynamic monitoring tool has not been well established. ⋯ To date, the literature on echocardiography in pediatric critical care is limited. The purpose of this review is to examine the scientific evidence for the usefulness of echocardiography as a hemodynamic monitoring tool in pediatric critical care.
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Pediatr Crit Care Me · Jul 2011
Association of bacterial pneumonia and respiratory failure in children with community-acquired influenza infection.
To investigate the association of bacterial pneumonia and respiratory failure in children with community-acquired influenza infection presenting to a pediatric intensive care unit. ⋯ Our findings suggest that bacterial pneumonia was associated with increased odds of respiratory failure in both previously healthy children and those with chronic medical conditions. Early aggressive therapy should be considered for patients with severe influenza.
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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.
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Pediatr Crit Care Me · Jul 2011
Comparative StudyIn vitro performance comparison of the Sensormedics 3100A and B high-frequency oscillatory ventilators.
The Sensormedics 3100A and 3100B are widely used to provide high-frequency oscillatory ventilation in clinical practice. Infants and children <35 kg are typically oscillated with the 3100A and >35 kg with the 3100B. This study compares the effect of ventilator and patient parameters on delivered tidal volume during high-frequency oscillatory ventilation of a test lung with these devices. ⋯ Multiple variables contribute to the delivered tidal volume during high-frequency oscillatory ventilation, including ventilator model selection and endotracheal tube size. It is possible that real-time, clinical monitoring of delivered tidal volume during high-frequency oscillatory ventilation would allow better titration and maximize performance of these ventilators in caring for critically ill patients.