Pediatr Crit Care Me
-
Pediatr Crit Care Me · Jul 2011
Monitoring in pediatric cardiac critical care: a worldwide perspective.
Our ability to directly monitor the mechanisms that govern cellular function, oxygen use, and survival is minimal. Therefore, in critically ill children, surrogate markers are used to try to detect evolving or established hypoxia. ⋯ These tools include standard invasive hemodynamic monitoring with electrocardiography, lactate measurement, central venous oxygen saturation, and echocardiography. Ultimately, monitoring is only useful when the clinician observes a specific value or trend and has the expertise to act appropriately.
-
Pediatr Crit Care Me · Jul 2011
Flexible bronchoscopy for children on extracorporeal membrane oxygenation for cardiac failure.
To describe the safety and use of flexible bronchoscopy in the management of respiratory complications in patients on extracorporeal membrane oxygenation for cardiac failure. ⋯ In patients requiring extracorporeal membrane oxygenation for cardiac failure, flexible bronchoscopy can be performed safely, provide important diagnostic information to the bedside clinician, and, perhaps, therapeutic benefit to the patient.
-
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.
-
Pediatr Crit Care Me · Jul 2011
EditorialThe nursing perspective on monitoring hemodynamics and oxygen transport.
Maintenance of adequate systemic oxygen delivery requires careful clinical assessment integrated with hemodynamic measurements and calculations to detect and treat conditions that may compromise oxygen delivery and lead to life-threatening shock, respiratory failure, or cardiac arrest. The bedside nurse constantly performs such assessments and measurements to detect subtle changes and trends in patient condition. The purpose of this editorial is to highlight nursing perspectives about the hemodynamic and oxygen transport monitoring systems summarized in the Pediatric Cardiac Intensive Care Society Evidence- Based Review and Consensus Statement on Monitoring of Hemodynamics and Oxygen Transport Balance. There is no substitute for the observations of a knowledgeable and experienced clinician who understands the patient's condition and potential causes of deterioration and is able to evaluate response to therapy.
-
The hemodynamic evaluation and monitoring in the critically ill newborn (particularly the premature infant) poses unique challenges because of urgency, size limitations, and the persistence of fetal shunt channels. Echocardiography and other noninvasive methods are currently the mainstay of hemodynamic assessment. ⋯ There is a need for evaluating a number of assessments as targets of goal-directed therapy in the unstable newborn infant. We provide an interpretation of the evidence supporting various monitoring strategies.