Pediatr Crit Care Me
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Pediatr Crit Care Me · Jun 2017
Randomized Controlled Trial Multicenter StudyA Randomized Controlled Trial of Corticosteroids in Pediatric Septic Shock: A Pilot Feasibility Study.
To determine the feasibility of conducting a randomized controlled trial of corticosteroids in pediatric septic shock. ⋯ This study suggests that a large randomized controlled trial on early use of corticosteroids in pediatric septic shock is potentially feasible. However, the frequent use of empiric corticosteroids in otherwise eligible patients remains a significant challenge. Knowledge translation activities, targeted recruitment, and alternative study designs are possible strategies to mitigate this challenge.
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Pediatr Crit Care Me · Jun 2017
ReviewDifferentiating Delirium From Sedative/Hypnotic-Related Iatrogenic Withdrawal Syndrome Lack of Specificity in Pediatric Critical Care Assessment Tools.
To identify available assessment tools for sedative/hypnotic iatrogenic withdrawal syndrome and delirium in PICU patients, the evidence supporting their use, and describe areas of overlap between the components of these tools and the symptoms of anticholinergic burden in children. ⋯ Although important studies have demonstrated apparent high prevalence of iatrogenic withdrawal syndrome and delirium in the PICU population, the overlap in these scoring systems presents potential difficulty in distinguishing syndromes, both clinically and for research purposes.
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Pediatr Crit Care Me · Jun 2017
A Method to Account for Variation in Congenital Heart Surgery Length of Stay.
We sought to develop a risk-adjustment methodology for length of stay in congenital heart surgery, as none exist. ⋯ We developed a statistically valid procedure-based categorical variable and multivariable model for length of stay of congenital heart surgeries. The Surgical Length Categories and important a priori and postoperative factors may be used to pursue a predictive tool for length of stay to inform scheduling and bed management practices.
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Pediatr Crit Care Me · Jun 2017
Clinical TrialFluid Overload and Kidney Injury Score: A Multidimensional Real-Time Assessment of Renal Disease Burden in the Critically Ill Patient.
Interruptive acute kidney injury alerts are reported to decrease acute kidney injury-related mortality in adults. Critically ill children have multiple acute kidney injury risk factors; although recognition has improved due to standardized definitions, subtle changes in serum creatinine make acute kidney injury recognition challenging. Age and body habitus variability prevent a uniform maximum threshold of creatinine. Exposure of nephrotoxic medications is common but not accounted for in kidney injury scores. Current severity of illness measures do not include fluid overload, a well-described mortality risk factor. We hypothesized that a multidimensional measure of renal status would better characterize renal severity of illness while maintaining or improving on correlation measures with adverse outcomes, when compared with traditional acute kidney injury staging. ⋯ A multidimensional score of renal disease burden was significantly associated with adverse PICU outcomes. Further studies will evaluate Fluid Overload Kidney Injury Score as a warning and decision support tool to impact patient-centered outcomes.
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Pediatr Crit Care Me · Jun 2017
Multicenter Study Observational StudyRelationship of Hospital Costs With Mortality in Pediatric Critical Care: A Multi-Institutional Analysis.
With increasing emphasis on high "value" care, we designed this study to evaluate the relationship between hospital costs and patient outcomes in pediatric critical care. ⋯ This large observational study did not demonstrate any relationship between hospital costs and patient outcomes in children with critical illness. Further efforts are needed to evaluate quality-cost relationship and high value care in critically ill children across centers of varying volume by linking data from clinical and administrative databases.