Pediatr Crit Care Me
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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
ReviewThe Collaborative Pediatric Critical Care Research Network Critical Pertussis Study: collaborative research in pediatric critical care medicine.
To provide an updated overview of critical pertussis to the pediatric critical care community and describe a study of critical pertussis recently undertaken. ⋯ Research is urgently needed to provide an evidence base that might optimize management for critical pertussis, a serious, disabling, and too often fatal illness for U.S. children and those in the developing world.
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Pediatr Crit Care Me · Jul 2011
Randomized Controlled TrialPrevention of neonatal late-onset sepsis associated with the removal of percutaneously inserted central venous catheters in preterm infants.
Indwelling central venous catheters are the most important risk factors for the development of sepsis attributable to coagulase-negative staphylococci among preterm infants admitted to neonatal intensive care units. In addition, removal of a central venous catheter also may cause coagulase-negative staphylococci sepsis, which may be prevented by the short-term administration of an anti-staphylococcal agent during the procedure of removal. The administration of a specific anti-staphylococcal agent (cefazolin) was evaluated for the prevention of central venous catheter removal-associated coagulase-negative staphylococci sepsis. ⋯ Two doses of the anti-staphylococcal agent cefazolin during the procedure of removal of a percutaneously inserted central venous catheter were effective in the prevention of coagulase-negative staphylococci sepsis. It is recommended to include this regimen in the guidelines on management of central venous catheters in very-low-birth-weight infants.
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Pediatr Crit Care Me · Jul 2011
ReviewNear-infrared spectroscopy as a hemodynamic monitor in critical illness.
Near-infrared spectroscopy has moved from a research tool to a widely used clinical monitor in the critically ill pediatric patient over the last decade. The physiological and clinical evidence supporting this technology in practice is reviewed here. ⋯ Class II, level B evidence supports the conclusion that near-infrared spectroscopy offers a favorable risk-benefit profile and can be effective and beneficial as a hemodynamic monitor for the care of critically patients.
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After its introduction in 1970, the use of the pulmonary artery catheter became a central part of the management of critically ill patients in adult and pediatric intensive care units. However, because it was introduced as a class II device, efficacy for its safety and clinical benefit did not exist during the early years of use. This review describes the pulmonary artery catheter and reviews the literature supporting its use. ⋯ The evidence supporting the use of the pulmonary artery catheter is mostly limited to level IV (nonrandomized, historical controls, and expert opinion) and level V (case series, uncontrolled studies, and expert opinion). A higher level of evidence supports the use of the pulmonary artery catheter in selected pediatric patients, especially those with pulmonary arterial hypertension and shock refractory to standard fluid resuscitation and vasoactive agents. There are no data to suggest that use of the pulmonary artery catheter increases mortality in children.