Pediatr Crit Care Me
-
Pediatr Crit Care Me · Apr 2018
Furosemide Response Predicts Acute Kidney Injury After Cardiac Surgery in Infants and Neonates.
Cardiac surgery-induced acute kidney injury occurs frequently in neonates and infants and is associated with postoperative morbidity/mortality; early identification of cardiac surgery-induced acute kidney injury may be crucial to mitigate postoperative morbidity. We sought to determine if hourly or 6-hour cumulative urine output after furosemide in the first 24 hours after cardiopulmonary bypass could predict development of cardiac surgery-induced acute kidney injury and other deleterious outcomes. ⋯ Urine output response to furosemide within 24 hours of cardiopulmonary bypass predicts cardiac surgery-induced acute kidney injury development and other important morbidity in children younger than 90 days old; prospective validation is warranted.
-
Pediatr Crit Care Me · Apr 2018
Dexmedetomidine as Single Continuous Sedative During Noninvasive Ventilation: Typical Usage, Hemodynamic Effects, and Withdrawal.
Dexmedetomidine use in pediatric critical care is increasing. Its prolonged effects as a single continuous agent for sedation are not well described. The aim of the current study was to describe prolonged dexmedetomidine therapy without other continuous sedation, specifically the hemodynamic effects, discontinuation strategies, and risk factors for withdrawal. ⋯ Dexmedetomidine use for noninvasive positive pressure ventilation sedation in pediatric critical care has predictable hemodynamic effects including bradycardia and hypertension. Although withdrawal was associated with higher cumulative dose, these symptoms were effectively managed with short-term enteral clonidine.
-
Pediatr Crit Care Me · Apr 2018
Observational StudyReorganizing Care With the Implementation of Electronic Medical Records: A Time-Motion Study in the PICU.
To assess caregivers' patient care time before and after the implementation of a reorganization of care plan with electronic medical records. ⋯ The reorganization of care with the implementation of an ICU-specific electronic medical record in the PICU did not change total patient care provided but improved nursing productivity, resulting in improved efficiency. Documentation time was significantly increased, and concern over reduced oral communication arose, which should be a focus for future electronic improvement strategies.
-
To understand how routine bedside clinical neurologic assessments are performed in U.S. PICUs. ⋯ Routine neurologic assessments are reported to be conducted in nearly all academic PICUs in the United States with fellowship training programs although the content, frequency, and triggers for communication vary between institutions. Most physicians felt that the current paradigms for neurologic assessments are suboptimal. These data suggest that optimizing and standardizing routine bedside nursing neurologic assessments may be warranted.
-
Pediatr Crit Care Me · Apr 2018
Repeat Rapid Response Events in Children: Characteristics and Outcomes.
We describe the characteristics and outcomes of pediatric repeat rapid response events within a single hospitalization. We hypothesized that triggers for repeat rapid response and initial rapid response events are similar, and repeat rapid response events are associated with high prevalence of medical complexity and worse outcomes. ⋯ Prevalence of medical complexity was high in patients with repeat rapid response compared with that reported for pediatric hospitalizations. Triggers between initial and repeat rapid response events correlated. Transfer to ICU was more likely after repeat rapid response and among repeat rapid response, events with ICU readmissions had a longer length of ICU and hospital stay. Mortality for the repeat rapid response cohort was higher than that for overall rapid responses in our center and per published reports from other centers.