Pediatr Crit Care Me
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The following review will describe the use of focused cardiac ultrasound performed by noncardiologists and its role as an acute hemodynamic monitoring tool in pediatric cardiac critical care. ⋯ The use of focused cardiac ultrasound has grown tremendously over recent years, and is increasingly being performed and interpreted by intensivists, anesthesiologists, and emergency medicine physicians. These imaging techniques are useful in establishing etiologies of cardiac dysfunction and should compliment the physical examination and standard hemodynamic monitoring.
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Pediatr Crit Care Me · Aug 2016
Cardiopulmonary Bypass-Induced Inflammatory Response: Pathophysiology and Treatment.
The objectives of this review are to discuss the pathophysiology of the pro-inflammatory response to the cardiopulmonary bypass circuit, the impact of ischemia reperfusion injury on post-operative organ function, the compensatory anti-inflammatory response and the evidence for immune-modulatory strategies and their impact on outcomes. ⋯ Innovations such as the development of more biocompatible surfaces and miniaturized circuits, as well as the increasing expertise of surgeons, anesthesiologists and perfusionists has transformed cardiac surgery and the use of cardiopulmonary bypass into a relatively routine procedure with favorable outcomes. Despite these refinements, the attendant inflammatory response to bypass, ischemia reperfusion injury and the compensatory anti-inflammatory response contribute to post-operative morbidity and mortality. Additional studies are needed to further delineate the impact of immunomodulatory strategies on outcomes.
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Pediatr Crit Care Me · Aug 2016
Aortic and Mitral Valve Disease and Left Ventricular Dysfunction in Children.
In this review, we will discuss aortic stenosis, aortic regurgitation, mitral regurgitation, and mitral stenosis. We will review the etiology, anatomy, pathophysiology, presentation, and treatment of aortic and mitral valve disease. Age and lesion specific treatments are outlined based on the severity of valve disease with an aim at long-term preservation of left ventricular function. ⋯ Mitral and aortic valve disease leads to unique hemodynamic burdens that can impact left ventricular function, quality of life, and longevity. The primary challenge in the management of mitral and aortic valve disease is to apply appropriate medical management and identify that point in time at which the surgery is necessary. Although guidelines have been established for the management of aortic and mitral valve disease in adults, the challenges of early presentation, maintenance of growth potential, and apparent increased tolerance of hemodynamic burden in children makes decision making challenging.
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Pediatr Crit Care Me · Aug 2016
Observational StudyTemporal Trends of Respiratory Syncytial Virus-Associated Hospital and ICU Admissions Across the United States.
To describe the regionality and seasonality of respiratory syncytial virus-associated hospital and ICU admissions for 10 consecutive years using a national database. ⋯ Wide variations in regional and seasonal patterns in hospital and ICU admissions were noted in children with respiratory syncytial virus-associated acute respiratory illness across the United States. Results from our study help us better understand the seasonality and regionality of respiratory syncytial virus infection in the United States with the goal to decrease the financial impact on our already stressed healthcare system by being better prepared for respiratory syncytial virus season.