Pediatr Crit Care Me
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Pediatr Crit Care Me · Oct 2015
Observational StudyCerebrovascular Pressure Reactivity in Children With Traumatic Brain Injury.
Traumatic brain injury is a significant cause of morbidity and mortality in children. Cerebral autoregulation disturbance after traumatic brain injury is associated with worse outcome. Pressure reactivity is a fundamental component of cerebral autoregulation that can be estimated using the pressure-reactivity index, a correlation between slow arterial blood pressure, and intracranial pressure fluctuations. Pressure-reactivity index has shown prognostic value in adult traumatic brain injury, with one study confirming this in children. Pressure-reactivity index can identify a cerebral perfusion pressure range within which pressure reactivity is optimal. An increasing difference between optimal cerebral perfusion pressure and cerebral perfusion pressure is associated with worse outcome in adult traumatic brain injury; however, this has not been investigated in children. Our objective was to study pressure-reactivity index and optimal cerebral perfusion pressure in pediatric traumatic brain injury, including associations with outcome, age, and cerebral perfusion pressure. ⋯ In pediatric patients with traumatic brain injury, pressure-reactivity index has prognostic value and can identify cerebral perfusion pressure targets that may differ from treatment protocols. Our results suggest but do not confirm that cerebral perfusion pressure targeting using pressure-reactivity index as a guide may positively impact on outcome. This question should be addressed by a prospective clinical study.
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Pediatr Crit Care Me · Oct 2015
Review Meta AnalysisUltrasound Imaging Reduces Failure Rates of Percutaneous Central Venous Catheterization in Children.
Ultrasound imaging has been shown to be beneficial for percutaneous central venous cannulation in systematic reviews of randomized controlled trials in adult patients, but not in pediatrics. The aim of this updated review was to determine whether percutaneous central venous catheterization with the aid of ultrasound reduces cannulation failure in children. ⋯ The meta-analysis of five nonrandomized studies showed that the rate of cannulation failure was significantly lower with real-time ultrasound guidance than anatomic landmark technique (odds ratio, 0.44 [95% CI, 0.27-0.72]; p = 0.001). The combination of nine randomized controlled trials also showed lower failure rates with either the real-time ultrasound guidance or the prelocation technique over the landmark technique (odds ratio, 0.22 [95% CI, 0.07-0.69]; p = 0.0003) and fewer arterial punctures in the ultrasound group (odds ratio, 0.31 [95% CI, 0.09-1.08]; p = 0.07). However, seven out of nine studies were assessed as having high risk of bias. Since the lower cannulation failure and less frequent chance of arterial puncture with ultrasound were predominantly shown in studies at high risk of bias, further definitive and adequately powered studies with clear outcomes are needed.
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Pediatr Crit Care Me · Oct 2015
ReviewFluid Bolus Therapy-Based Resuscitation for Severe Sepsis in Hospitalized Children: A Systematic Review.
To review systematically data from randomized and nonrandomized studies of fluid bolus therapy in hospitalized children with septic shock. ⋯ There are only limited data to support the use of fluid bolus therapy in hospitalized children. Prospective observational data and randomized controlled trials are urgently needed to evaluate this therapy in resource rich settings.
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Pediatr Crit Care Me · Oct 2015
Practice Patterns in Pediatric Critical Care Medicine: Results of a Workforce Survey.
To obtain current data on practice patterns of the U.S. pediatric critical care medicine workforce. ⋯ These data provide a description of the typical intensivist and a snapshot of the current pediatric critical care medicine workforce, which may be experiencing a mild-to-moderate undersupply. The results are useful for assessing the current workforce and valuable for future planning.