Pediatr Crit Care Me
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Pediatr Crit Care Me · Mar 2018
Observational StudyHyperoxia and Hypocapnia During Pediatric Extracorporeal Membrane Oxygenation: Associations With Complications, Mortality, and Functional Status Among Survivors.
To determine the frequency of hyperoxia and hypocapnia during pediatric extracorporeal membrane oxygenation and their relationships to complications, mortality, and functional status among survivors. ⋯ Hyperoxia is common during pediatric extracorporeal membrane oxygenation and associated with mortality. Hypocapnia appears to occur less often and although associated with complications, an association with mortality was not observed.
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Pediatr Crit Care Me · Mar 2018
A Systematic Review of Risk Factors Associated With Cognitive Impairment After Pediatric Critical Illness.
To identify risk factors associated with cognitive impairment as assessed by neuropsychologic tests in neurotypical children after critical illness. ⋯ Identifying risk factors for poor cognitive outcomes post critical illness may help healthcare teams modify patient risk and/or provide follow-up services to improve long-term cognitive outcomes in high-risk children.
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Pediatr Crit Care Me · Mar 2018
Observational StudyAssessment of Myocardial Function and Injury by Echocardiography and Cardiac Biomarkers in African Children With Severe Plasmodium falciparum Malaria.
Perturbed hemodynamic function complicates severe malaria. The Fluid Expansion as Supportive Therapy trial demonstrated that fluid resuscitation, involving children with severe malaria, was associated with increased mortality, primarily due to cardiovascular collapse, suggesting that myocardial dysfunction may have a role. The aim of this study was to characterize cardiac function in children with severe malaria. ⋯ Elevation of cardiac index, due to increased stroke volume, in severe malaria is a physiologic response to circulatory compromise and correlates with anemia. Following whole blood transfusion and antimalarial therapy, cardiac index in severe malarial anemia returns to normal. The majority (> 96%) of children with severe malaria have preserved myocardial systolic function. Although there is evidence for myocardial injury (elevated cardiac troponin I), this does not correlate with cardiac dysfunction.
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Pediatr Crit Care Me · Mar 2018
Observational StudyReducing Ischemic Injury From Indwelling Peripheral Arterial Catheters in a Pediatric Cardiac ICU: A Quality Improvement Initiative.
To reduce the number of ischemic arterial catheter injuries in children with congenital or acquired heart disease. ⋯ Our project included 1,945 arterial catheters encompassing 7,197 catheter days. During the preintervention period, on average, 3.1 patients per month experienced an arterial catheter-related injury compared with 1.9 patients per month following intervention, a reduction of 38.7% (3.1 vs 1.9; p = 0.01). The rate of injury per 1,000 arterial catheter days was reduced from 16.7 pre intervention to 7.52 post intervention, a 55% overall reduction (16.7 vs 7.52; p = 0.0001). The rate of concerning arterial catheter nursing assessment based on our definition was reduced by 18.0% following our intervention cycles (25.5% vs 20.9%; p = 0.001) CONCLUSIONS:: Implementation of a quality improvement initiative and changing local practices reduced arterial catheter-associated harm in children with congenital and acquired heart disease requiring care in a cardiac ICU.
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Pediatr Crit Care Me · Mar 2018
The Importance of Parental Connectedness and Relationships With Healthcare Professionals in End-of-Life Care in the PICU.
Support from healthcare professionals in a PICU is highly valuable for parents of dying children. The way they care for the patients and their families affects the parents' initial mourning process. This study explores what interaction with hospital staff is meaningful to parents in existential distress when their child is dying in the PICU. ⋯ Parents whose children died in the PICU value personal connectedness to doctors and nurses when coping with existential distress. Medical and nursing training programs should raise awareness of parents' need for contact in all interactions but especially in times of crisis and apprehension.