Pediatr Crit Care Me
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Determine the relationship between the volume of burn admissions and outcomes for children with burns. ⋯ Higher volume pediatric burn centers had lower mortality, particularly at larger burn sizes. The lower mortality of children a high volume centers could reflect greater experience, resource, and specialized expertise in treating pediatric patients.
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Pediatr Crit Care Me · May 2015
Measurement of Salivary Cortisol Level for the Diagnosis of Critical Illness-Related Corticosteroid Insufficiency in Children.
To compare serum total, serum free and salivary cortisol in critically ill children. ⋯ Serum free and salivary cortisol values correlate in critically ill children. Salivary cortisol can be used as a surrogate for serum free cortisol in critically ill pediatric patients. Salivary cortisol is a cost-effective and less invasive measure of bioavailable cortisol and offers an alternate and accurate method for assessing critical illness-related corticosteroid insufficiency in children.
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Pediatr Crit Care Me · May 2015
Routine Medical Emergency Team Assessments of Patients Discharged From the PICU: Description of a Medical Emergency Team Follow-Up Program.
This study describes one follow-up program in the Ontario Rapid-Response System project consisting of routine medical emergency team visits of patients discharged from the PICU consisting of two planned visits within 48 hours following discharge. Study purpose was to describe interventions provided and the patient characteristics associated with medical emergency team utilization. ⋯ Routine medical emergency team visits following PICU discharge reduced the risk of early readmission. Our results suggest that one in seven patients in the follow-up program receive major medical emergency team support. We suggest a follow-up program with at least one routine medical emergency team visit within the first 24 hours of discharge with a second planned visit reserved for complex postsurgical patients.
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Pediatr Crit Care Me · May 2015
Cardiac Dysfunction Following Brain Death in Children: Prevalence, Normalization, and Transplantation.
Cardiac dysfunction has been reported to occur in as much as 42% of adults with brain death, and may limit cardiac donation after brain death. Knowledge of the prevalence and natural course of cardiac dysfunction after brain death may help to improve screening and transplant practices but adequately sized studies in pediatric brain death are lacking. The aims of our study are to describe the prevalence and course of cardiac dysfunction after pediatric brain death. ⋯ The frequency of cardiac dysfunction in children with brain death is high. Serial transthoracic echocardiograms in patients with cardiac dysfunction showed improvement of cardiac function in most patients, suggesting that initial decisions to procure should not solely depend on the initial transthoracic echocardiogram examination results.
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Pediatr Crit Care Me · May 2015
Therapeutic Plasma Exchange May Improve Hemodynamics and Organ Failure Among Children With Sepsis-Induced Multiple Organ Dysfunction Syndrome Receiving Extracorporeal Life Support.
To determine the effect of therapeutic plasma exchange on hemodynamics, organ failure, and survival in children with multiple organ dysfunction syndrome due to sepsis requiring extracorporeal life support. ⋯ The use of therapeutic plasma exchange in children on extracorporeal life support with sepsis-induced multiple organ dysfunction syndrome is associated with organ failure recovery and improved hemodynamic status. Initiating therapeutic plasma exchange early in the hospital course was associated with greater improvement in organ dysfunction and decreased requirement for vasoactive and/or inotropic agents.