Pediatr Crit Care Me
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Pediatr Crit Care Me · Nov 2012
The need for and feasibility of a pediatric ventilation trial: reflections on a survey among pediatric intensivists*.
To explore what design would be reasonable, acceptable, and feasible for a pediatric trial investigating the effect of low tidal volume ventilation. ⋯ Actual expert opinion favored investigating the effect of 6 mL/kg vs.10 mL/kg on mortality. Such a design suffers from various serious criticisms. Therefore, and in our opinion, a pediatric Acute Respiratory Distress Syndrome Network trial is not realistic.
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Pediatr Crit Care Me · Nov 2012
Safety and efficacy of prolonged dexmedetomidine use in critically ill children with heart disease*.
To evaluate the safety and efficacy of prolonged dexmedetomidine administration (≥ 96 hrs) in critically ill children with heart disease. ⋯ Prolonged dexmedetomidine administration in children with heart disease appears to be safe and is associated with decreased opioid and benzodiazepine requirement and decreased inotropic support.
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Pediatr Crit Care Me · Nov 2012
Improved outcomes for stem cell transplant recipients requiring pediatric intensive care.
Survival for hematopoietic stem cell transplant patients requiring pediatric intensive care unit admission may be improving. This study was conducted to review outcomes for patients undergoing hematopoietic stem cell transplantation requiring admission to our pediatric intensive care unit and to identify variables impacting survival. ⋯ We report a 63% survival to pediatric intensive care unit discharge, with 45% surviving at a median follow-up of over 2 yrs for all hematopoietic stem cell transplantation patients admitted to our pediatric intensive care unit over a 6-yr period. Our data suggest improved survival outcomes for this high risk patient population.
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Pediatr Crit Care Me · Nov 2012
Case ReportsBrain tissue oxygenation-guided management of diabetic ketoacidosis induced cerebral edema*.
Type 1 diabetes mellitus is the most common chronic disease of childhood. Diabetic ketoacidosis is a well-known complication of diabetes mellitus and can be associated with devastating cerebral edema resulting in severe long-term neurologic disability. Despite the significant morbidity and mortality associated with this condition, relatively few treatments are recommended for these patients. The authors present two patients in which they used both intracranial pressure and brain tissue oxygenation monitoring to manage diabetic ketoacidosis-associated cerebral edema with favorable neurologic outcomes. ⋯ Multimodal neuromonitoring of both intracranial pressure and brain tissue oxygenation during episodes of clinically apparent diabetic ketoacidosis-associated cerebral edema allows for the detection and treatment of episodes of elevated intracranial pressure and/or brain tissue hypoxia that may be of clinical significance.