Pediatr Crit Care Me
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Pediatr Crit Care Me · May 2020
An International Survey Comparing Different Physician Models for Health Care Delivery to Critically Ill Children With Heart Disease.
To explore relationships between the training background of cardiac critical care attending physicians and self-reported perceived strengths and weaknesses in their ability to provide clinical care. ⋯ Our survey demonstrates that intensivists trained in critical care are more comfortable with critical care skills, cardiology-trained intensivists are more comfortable with cardiology skills, and dual-trained physicians are comfortable with both critical care skills and cardiology skills. These findings may help inform future efforts to optimize the educational curriculum and training pathways for future cardiac intensivists. These data may also be used to shape continuing medical education activities for cardiac intensivists who have already completed their training.
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Pediatr Crit Care Me · May 2020
Multicenter StudyFactors Associated With Diagnostic Error on Admission to a PICU: A Pilot Study.
Diagnostic errors can harm critically ill children. However, we know little about their prevalence in PICUs and factors associated with error. The objective of this pilot study was to determine feasibility of record review to identify patient, provider, and work system factors associated with diagnostic errors during the first 12 hours after PICU admission. ⋯ Our pilot study found four patients with diagnostic error out of 50 children admitted nonelectively to a PICU. Retrospective record review using a structured tool to identify diagnostic errors is feasible in this population. Pilot data are being used to inform a larger and more definitive multicenter study.
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Pediatr Crit Care Me · May 2020
ReviewMonitoring of Respiratory Muscle Function in Critically Ill Children.
This review discusses the different techniques used at the bedside to assess respiratory muscle function in critically ill children and their clinical applications. ⋯ Physiologic techniques are useful to precisely assess respiratory muscle function and to individualize and optimize the management of mechanical ventilation in children. Among all the available techniques, the measurements of esophageal pressure and electrical activity of the diaphragm appear particularly helpful in the era of individualized ventilatory management.
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Pediatr Crit Care Me · May 2020
Multicenter Study Observational StudyDaily Practice of Mechanical Ventilation and Weaning in Turkish PICUs: A Multicenter Prospective Survey.
To investigate conventional mechanical ventilation weaning characteristics of patients requiring conventional mechanical ventilation support for greater than 48 hours within the PICU. ⋯ Pediatric patients requiring conventional mechanical ventilation with a diagnosis of sepsis and high initial peak inspiratory pressures may require longer conventional mechanical ventilation weaning prior to extubation. Causative factors and optimal weaning for this cohort needs further consideration.
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Pediatr Crit Care Me · May 2020
ReviewThe Endothelial Glycocalyx: A Fundamental Determinant of Vascular Permeability in Sepsis.
Sepsis is a significant cause of morbidity and mortality. Children with sepsis often have alterations in microcirculation and vascular permeability. Our objective is current evidence regarding the role of the endothelial glycocalyx as a determinant of capillary leakage in these patients. ⋯ The endothelial glycocalyx is a fundamental component of the endothelium and an important determinant of the mechanotransduction and vascular permeability in patients with sepsis. Studies are needed to evaluate the role of the different types of solutions used in fluid bolus, vasoactive support, and other interventions described in pediatric sepsis on microcirculation, particularly on endothelial integrity and the glycocalyx.