Pediatr Crit Care Me
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Pediatr Crit Care Me · Apr 2018
ReviewReview of Routes to Administer Medication During Prolonged Neonatal Resuscitation.
During neonatal cardiopulmonary resuscitation, early establishment of vascular access is crucial. We aimed to review current evidence regarding different routes for the administration of medications during neonatal resuscitation. ⋯ Based on animal studies, endotracheal tube administration of medications requires a higher dose than that by peripheral intravascular access or umbilical venous catheter. Epinephrine via laryngeal mask airway is feasible as a noninvasive alternative approach for drug delivery. Intraosseous access should be considered in situations with difficulty in establishing other access. Randomized controlled clinical trials in neonates are required to compare all access possibilities described above.
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To describe the use of low-dose bolus epinephrine in critically ill children during an acute hypotensive episode or prearrest condition. ⋯ Provision of low-dose bolus epinephrine during periods of acute hypotension can result in a significant increase in mean arterial blood pressure and heart rate. This dosing strategy may provide temporary stabilization while other therapies are added or adjusted, but further research is needed.
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Pediatr Crit Care Me · Apr 2018
Pulmonary Dead Space Fraction and Extubation Success in Children After Cardiac Surgery.
1) Determine the correlation between pulmonary dead space fraction and extubation success in postoperative pediatric cardiac patients; and 2) document the natural history of pulmonary dead space fractions, dynamic compliance, and airway resistance during the first 72 hours postoperatively in postoperative pediatric cardiac patients. ⋯ Initial postoperative dead space fraction correlates with the length of mechanical ventilation in two ventricle patients but not in single ventricle patients. Lower preextubation dead space fractions are a strong predictor of successful extubation in two ventricle patients after cardiac surgery, but may not be as useful in single ventricle patients.
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Pediatr Crit Care Me · Apr 2018
Optimal Insertion Depth for Endotracheal Tubes in Extremely Low-Birth-Weight Infants.
To determine the optimal endotracheal tube insertion depth in extremely low-birth-weight infants based on the association between endotracheal tube depth and gestational age, body weight, body length, and head and chest circumferences at birth. ⋯ In extremely low-birth-weight infants, a linear association exists between endotracheal tube insertion depth and gestational age, body weight, body length, chest, and head circumferences at birth. Although body weight is the most accurate method for predicting endotracheal tube insertion depth, body length is also appropriate and is more favorable than body weight in delivery room resuscitation. Although no substitute for radiologic confirmation exists, a tape measure that can convert body length to endotracheal tube depth may be helpful.