Pediatr Crit Care Me
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Pediatr Crit Care Me · Feb 2015
Multicenter StudyAssociation of bleeding and thrombosis with outcome in extracorporeal life support*.
Changes in technology and increased reports of successful extracorporeal life support use in patient populations, such as influenza, cardiac arrest, and adults, are leading to expansion of extracorporeal life support. Major limitations to extracorporeal life support expansion remain bleeding and thrombosis. These complications are the most frequent causes of death and morbidity. As a pilot project to provide baseline data for a detailed evaluation of bleeding and thrombosis in the current era, extracorporeal life support patients were analyzed from eight centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. ⋯ Bleeding and thrombosis remain common complications in patients undergoing extracorporeal life support. Further research to reduce or eliminate bleeding and thrombosis is indicated to help improve patient outcome.
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Pediatr Crit Care Me · Feb 2015
Randomized Controlled Trial Comparative StudyComparison Between Noninvasive Mechanical Ventilation and Standard Oxygen Therapy in Children Up to 3 Years Old With Respiratory Failure After Extubation: A Pilot Prospective Randomized Clinical Study.
The effectiveness of noninvasive positive-pressure ventilation in preventing reintubation due to respiratory failure in children remains uncertain. A pilot study was designed to evaluate the frequency of extubation failure, develop a randomization approach, and analyze the feasibility of a powered randomized trial to compare noninvasive positive-pressure ventilation and standard oxygen therapy post extubation for preventing reintubation within 48 hours in children with respiratory failure. ⋯ The study indicates that a larger randomized trial comparing noninvasive positive-pressure ventilation and standard oxygen therapy in children with respiratory failure is feasible, providing a basis for a future trial in this setting. No differences were seen between groups. The number of excluded patients was high.
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Pediatr Crit Care Me · Feb 2015
Randomized Controlled Trial Multicenter StudyRetention of pediatric resuscitation performance after a simulation-based mastery learning session: a multicenter randomized trial.
Using simulation-based mastery learning, residents can be trained to achieve a predefined performance standard in resuscitation. After mastery is achieved, performance degradation occurs over time. Prior investigations have shown performance retention of 12-14 months following intensive simulation-based mastery learning sessions. We sought to investigate the duration of mastery-level resuscitation performance retention after a single 1- to 2-hour simulation-based mastery learning session. ⋯ Residents displayed significant improvements in resuscitation performance after a single simulation-based mastery learning session, but performance declined over time, with less than 60% retaining mastery-level performance at 6 months. Our results suggest that relatively frequent refresher training is needed after a single simulation-based mastery learning session. Additional research is needed to determine the duration of performance retention following any specific simulation-based mastery learning intervention.
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Pediatr Crit Care Me · Feb 2015
ReviewRisk Factors Associated With Iatrogenic Opioid and Benzodiazepine Withdrawal in Critically Ill Pediatric Patients: A Systematic Review and Conceptual Model.
Analgesia and sedation are common therapies in pediatric critical care, and rapid titration of these medications is associated with iatrogenic withdrawal syndrome. We performed a systematic review of the literature to identify all common and salient risk factors associated with iatrogenic withdrawal syndrome and build a conceptual model of iatrogenic withdrawal syndrome risk in critically ill pediatric patients. ⋯ Given the state of existing evidence, well-designed prospective studies are required to better characterize iatrogenic withdrawal syndrome in critically ill pediatric patients. This review provides data to support the construction of a conceptual model of iatrogenic withdrawal syndrome risk that, if supported, could be useful in guiding future research.