Pediatr Crit Care Me
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Pediatr Crit Care Me · Aug 2018
No Requirement for Targeted Theophylline Levels for Diuretic Effect of Aminophylline in Critically Ill Children.
To determine the relationship between theophylline trough levels and urine output in critically ill children administered aminophylline as adjunctive diuretic therapy. ⋯ Aminophylline administration provided a measure of increased diuresis, regardless of dosage, and theophylline trough levels. Therefore, achieving a prescribed therapeutic trough level may not be necessary for full diuretic effect. Because, as opposed to the diuretic effect, the side effect profile of aminophylline is dose-dependent, low maintenance dosing may optimize the balance between providing adjunctive diuretic effect while minimizing the risk of toxicity.
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Pediatr Crit Care Me · Aug 2018
Observational StudyKnowledge Accrual Following Participation in Pediatric Fundamental Critical Care Support Course in Gaborone, Botswana.
To describe provider characteristics, knowledge acquisition, perceived relevance, and instruction quality of the Society of Critical Care Medicine's Pediatric Fundamentals of Critical Care Support course pilot implementation in Botswana. ⋯ Pediatric Fundamentals of Critical Care Support training significantly increased provider knowledge to care for hospitalized seriously ill or injured children in Botswana. Knowledge accrual is most significant among early career providers and is not limited by previous pediatric resuscitation or emergency training. Further contextualization of the course to use equipment relevant to providers work environment may increase the value of training.
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Pediatr Crit Care Me · Aug 2018
Observational StudyHemodynamic Tolerance to IV Clonidine Infusion in the PICU.
Clonidine is an antihypertensive drug used for analgosedation in the PICU. Lack of reliable data on its hemodynamic tolerance limits its use. This study explores the hemodynamic tolerance of IV clonidine infusion in a broad population of children with high severity of disease. ⋯ Although administration of clonidine is often associated with bradycardia and hypotension, these complications do not seem clinically significant in a mixed PICU population with a high degree of disease severity. Clonidine may have a vasoactive-inotropic sparing effect.
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Pediatr Crit Care Me · Aug 2018
Ethical, Cultural, Social, and Individual Considerations Prior to Transition to Limitation or Withdrawal of Life-Sustaining Therapies.
As part of the invited supplement on Death and Dying in the PICU, we reviewed ethical, cultural, and social considerations for the bedside healthcare practitioner prior to engaging with children and families in decisions about limiting therapies, withholding, or withdrawing therapies in a PICU. Clarifying beliefs and values is a necessary prerequisite to approaching these conversations. Striving for medical consensus is important. ⋯ Engaging additional supportive services early can aid with understanding or resolving disagreement. There is wide variation globally in ethical permissibility, cultural, and societal influences that impact the clinician, child, and parents. Thoughtful consideration to these issues when approaching decisions about limitation or withdrawal of life-sustaining therapies will help to reduce emotional, spiritual, and ethical burdens, minimize misunderstanding for all involved, and maximize high-quality care delivery.
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Pediatr Crit Care Me · Aug 2018
Death and Dying 1987-2017: The Destination Is the Same, the Journey Is Different.
A personal reflection on the changing landscape with regard to case mix, care, and staffing and how mortality and expectations have evolved over the past 30 years in a multidisciplinary Pediatric Critical Care Unit in a Quaternary level academic institution in Canada. ⋯ Many of the preventable deaths have been prevented with Public Health initiatives. Death now is increasingly in complex patients with complicated treatment regimes in a society that has increasingly unrealistic expectations of what modern medicine can do. Many of these complex children do not die but are dependent on our technology and skill set-something we are often ill prepared for.