Pediatr Crit Care Me
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Pediatr Crit Care Me · Dec 2019
Pediatric Chronic Critical Illness: Gaps in Inpatient Intrateam Communication.
The number of children with medical complexity and prolonged hospitalizations is rising. Strategies to adapt acute care approaches for this population are falling behind clinical demand. This study aimed to identify how inpatient team communication practices match the needs of teams caring for these patients and families, and to identify priority areas for improvement. ⋯ Acute care inpatient communication practices require modification to meet the needs of healthcare professionals who provide longitudinal care to children with repeated and prolonged hospitalizations. Improvement strategies should prioritize building collaboration, continuity, and communication skills among healthcare professionals.
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Pediatr Crit Care Me · Dec 2019
Prediction and Comparison of Fentanyl Infusion Pharmacokinetics in Obese and Nonobese Children.
To compare fentanyl infusion pharmacokinetic variables in obese children and nonobese children. ⋯ CLS may increase less than proportional to weight in obese children greater than 6-year-olds, while volume of distribution at steady state increases more than proportional to weight in all obese children compared with nonobese children. Weight-based dosing in obese children may cause an increase in steady-state concentration while prolonging the time to steady state. Exploring alternative dosing strategies for obese children is warranted.
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Pediatr Crit Care Me · Dec 2019
Editorial CommentWhich Is the Best Outcome in Pediatric Critical Trials?
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Pediatr Crit Care Me · Dec 2019
Multicenter StudyOutcomes Associated With Multiple Organ Dysfunction Syndrome in Critically Ill Children With Hyperglycemia.
Patterns and outcomes of multiple organ dysfunction syndrome are unknown in critically ill children with hyperglycemia. We aimed to determine whether tight glycemic control to a lower vs. higher range influenced timing, duration, or resolution of multiple organ dysfunction syndrome as well as characterize the clinical outcomes of subgroups of multiple organ dysfunction syndrome in children enrolled in the Heart And Lung Failure-Pediatric INsulin Titration trial. ⋯ Tight glycemic control target range was not associated with differences in the proportion of new, progressive, or recurrent multiple organ dysfunction syndrome. New or progressive multiple organ dysfunction syndrome was associated with poor clinical outcomes, and progressive multiple organ dysfunction syndrome was associated with worse outcomes than new multiple organ dysfunction syndrome. In future studies, new multiple organ dysfunction syndrome and progressive multiple organ dysfunction syndrome may need to be considered separately, as they represent distinct subgroups with different, potentially modifiable risk factors. Patients with recurrent multiple organ dysfunction syndrome represent a newly characterized, high-risk group which warrants attention in future research.