Pediatr Crit Care Me
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Pediatr Crit Care Me · Mar 2017
Multiple Organ Dysfunction Syndrome: A Challenge for the Pediatric Critical Care Community.
The multiple organ dysfunction syndrome is highly prevalent among critically ill children both at the time of their admission and throughout their PICU stay. It is associated with a wide variety of clinical conditions and diagnoses. In addition to its prevalence, it is closely associated with mortality, and the risk of death seems to increase as the number of failing organs increases. ⋯ However, despite being first described 4 decades ago, much remains to be learned about this syndrome including its triggering events, pathophysiology, and genetic predispositions. In addition, a better understanding of the influence of age and development on its occurrence and severity is needed as neonates and infants seem to be differentially afflicted. In an attempt to begin to address these issues, the Pediatric Trauma and Critical Illness Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development convened experts in the field at a 2-day workshop to discuss this syndrome, identify key knowledge gaps, and consider potential opportunities for future research.
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Pediatr Crit Care Me · Mar 2017
Suspected Cerebral Edema in Diabetic Ketoacidosis: Is There Still a Role for Head CT in Treatment Decisions?
Neurologic deterioration associated with cerebral edema in diabetic ketoacidosis is typically sudden in onset, progresses rapidly, and requires emergent treatment. The utility of brain imaging by head CT in decisions to treat for cerebral edema has not been previously studied. The objective of this study was to describe the characteristics of pediatric patients with diabetic ketoacidosis who develop altered mental status and evaluate the role of head CT in this cohort. ⋯ In this single-center retrospective study, there was no evidence that decisions about treatment of patients with diabetic ketoacidosis and suspected cerebral edema were enhanced by head CT, and head CT may have led to a significant delay in hyperosmolar therapy.
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Pediatr Crit Care Me · Mar 2017
Comparative StudyVolume-Targeted Ventilation in the Neonate: Benchmarking Ventilators on an Active Lung Model.
Mechanically ventilated neonates have been observed to receive substantially different ventilation after switching ventilator models, despite identical ventilator settings. This study aims at establishing the range of output variability among 10 neonatal ventilators under various breathing conditions. ⋯ All machines deviate significantly in volume output and ventilation regulation. These differences depend on ventilation type, respiratory force, and patient behavior, preventing the creation of a simple conversion table between ventilator models. Universal neonatal tidal volume targets for mechanical ventilation cannot be transferred from one ventilator to another without considering necessary adjustments.
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Pediatr Crit Care Me · Mar 2017
Observational StudyDoppler Ultrasonography of the Central Retinal Vessels in Children With Brain Death.
The purpose of this observational study is to explore if bedside Doppler ultrasonography of the central retinal vessels has the potential to become an ancillary study to support the timely diagnosis of brain death in children. ⋯ This study supports that the combination of qualitative waveform analysis and quantitative blood flow variables of the central retinal vessels may have the potential to be developed as an ancillary study for supporting the diagnosis of brain death in children.
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Pediatr Crit Care Me · Mar 2017
Editorial CommentClinical Trials in Pediatric Sepsis: What's the (End) Point?