Pediatr Crit Care Me
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Pediatr Crit Care Me · Nov 2014
Pediatric Severe Sepsis: Current Trends and Outcomes From the Pediatric Health Information Systems Database.
To 1) describe the characteristics and outcomes over time of PICU patients with severe sepsis within the dedicated U.S. children's hospitals, 2) identify patient subgroups at risk for mortality from pediatric severe sepsis, and 3) describe overall pediatric severe sepsis resource utilization. ⋯ In this largest reported pediatric severe sepsis cohort to date, prevalence increased from 2004 to 2012 while associated mortality decreased. Age, cardiovascular comorbidity, and organ dysfunction were significant prognostic factors. Pediatric severe sepsis remains an important cause for PICU admission and mortality and leads to a substantial burden in healthcare costs. Individual center's prevalence and volume are associated with improved outcomes.
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Pediatr Crit Care Me · Nov 2014
ReviewSedation Guidelines, Protocols, and Algorithms in PICUs: A Systematic Review.
To evaluate the impact of sedation guidelines, protocols, and algorithms on clinical outcomes in PICUs. ⋯ Despite widespread recommendation for the use of sedation guidelines, protocols, and algorithms in critically ill children, our systematic review revealed a paucity of high-quality evidence to guide this practice. More robust studies are urgently needed for this important aspect of PICU care.
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Pediatr Crit Care Me · Nov 2014
Comparative StudyComparative Effectiveness of Digoxin and Propranolol for Supraventricular Tachycardia in Infants.
Supraventricular tachycardia is the most common arrhythmia in infants, and antiarrhythmic medications are frequently used for prophylaxis. The optimal prophylactic antiarrhythmic medication is unknown, and prior randomized trials have been underpowered. We used data from a large clinical registry to compare efficacy and safety of digoxin and propranolol for infant supraventricular tachycardia prophylaxis. We hypothesized that supraventricular tachycardia recurrence is less common on digoxin when compared with propranolol. ⋯ Digoxin was associated with fewer episodes of supraventricular tachycardia recurrence but more frequent hypotension in hospitalized infants relative to propranolol.
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Pediatr Crit Care Me · Nov 2014
Predictors of Mortality in Pediatric Patients on Venoarterial Extracorporeal Membrane Oxygenation.
Currently, there are no established echocardiographic or hemodynamic predictors of mortality after weaning venoarterial extracorporeal membrane oxygenation in children. We wished to determine which measurements predict mortality. ⋯ Failure to augment velocity-time integral or an increase in oxygenation index during the extracorporeal membrane oxygenation weaning is associated with poor outcomes in children. We propose that these measurements should be performed during extracorporeal membrane oxygenation wean, as they may discriminate who will require alternative methods of circulatory support for survival.