Pediatr Crit Care Me
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Pediatr Crit Care Me · Jul 2012
Comparative StudyComparing the clinical severity of the first versus second wave of 2009 Influenza A (H1N1) in a New York City pediatric healthcare facility.
We previously reported the epidemiology of 2009 Influenza A (H1N1) in our pediatric healthcare facility in New York City during the first wave of illness (May-July 2009). We hypothesized that compared with the first wave, the second wave would be characterized by increased severity of illness and mortality. ⋯ At our pediatric healthcare facility in New York City, fewer children were hospitalized with 2009 Influenza A (H1N1) during the second wave, but both waves had a similar spectrum of illness severity and low mortality rate.
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Pediatr Crit Care Me · Jul 2012
Nutritional status and complications in children with diabetic ketoacidosis.
Diabetic ketoacidosis in children continues to be an important cause of morbidity and mortality, especially in developing economies as a result of malnutrition, a high rate of infections, and delay in seeking timely medical care. Malnutrition also increases the risk of diabetic ketoacidosis-related complications. The objective of this study was to assess the nutritional status of patients presenting with diabetic ketoacidosis and correlate it with the incidence of complications at presentation and those encountered during the course of illness. ⋯ The incidence and severity of therapy-related hypokalemia and hypoglycemia were significantly higher in the malnourished as compared to the normally nourished diabetic ketoacidosis. Other diabetic ketoacidosis-related complications and outcome were similar in both the groups.
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Pediatr Crit Care Me · Jul 2012
Development of a bedside tool to predict time to death after withdrawal of life-sustaining therapies in infants and children.
To generate a preliminary bedside predictor of rapid time-to-death after withdrawal of support in children to help identify potential candidates for organ donation after circulatory death. ⋯ This tool is a reasonable preliminary predictor for death within 30 or 60 mins after withdrawal of support in terminally ill or injured children and might assist in identifying potential pediatric candidates for donation after circulatory death, although prospective validation is required.
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Pediatr Crit Care Me · Jul 2012
Prolonged extracorporeal membrane oxygenation for children with respiratory failure.
Extracorporeal membrane oxygenation is used to support children with respiratory failure. When extracorporeal membrane oxygenation duration is prolonged, decisions regarding ongoing support are difficult as a result of limited prognostic data. ⋯ Survival declines with duration of extracorporeal membrane oxygenation. Male gender and inadequate cardiorespiratory status during extracorporeal membrane oxygenation increased the risk of death. Prolonged support with extracorporeal membrane oxygenation appears reasonable unless multiorgan failure develops.
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The aim of this review is to identify clinical conditions currently treated in a pediatric population referred to the Alfred hyperbaric unit, to describe outcomes, and detail any complications occurring during treatment or transfer between units. ⋯ Provision of hyperbaric oxygen to children with significant illness is feasible and associated with a low risk of complications. The most difficult aspect of managing pediatric hyperbaric oxygen therapy is in the coordination of the treatment with ongoing surgical and intensive care management. The lack of pediatric staff and facilities in major hyperbaric units necessitates multiple transfers for appropriate treatment.