Pediatr Crit Care Me
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Pediatr Crit Care Me · Nov 2021
Observational StudyCharacterizing Sleep Disruption and Delirium in Children After Cardiac Surgery: A Feasibility Study.
Patients in the pediatric cardiac ICU are frequently exposed to pharmacologic and environmental factors that predispose them to sleep disturbances and may increase the risk of delirium. In this pilot study, we sought to demonstrate the feasibility of actigraphy monitoring in pediatric cardiac ICU patients to investigate the association between sleep characteristics and delirium development. ⋯ Actigraphy monitoring in conjunction with delirium screening is feasible in infants and children admitted to the pediatric cardiac ICU after cardiac surgery. Our data suggest that most children in the pediatric cardiac ICU experience severe sleep disruption and delirium is common. These pilot data provide important insights for the design of a large-scale observational study to investigate potential causal relationships between sleep disruption and delirium in the pediatric cardiac ICU.
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Pediatr Crit Care Me · Nov 2021
Observational StudyFrequency of Extracorporeal Membrane Oxygenation Support and Outcomes After Implementation of a Structured PICU Network in Neonates and Children: A Prospective Population-Based Study in the West of France.
To describe the frequency and outcomes on the use of extracorporeal membrane oxygenation (ECMO) among critically ill neonates and children within a structured pediatric critical care network in the West of France. To assess the optimality of decision-making process for patients primarily admitted in non-ECMO centers. ⋯ Our local results suggest that a structured referral network for neonatal and pediatric ECMO in the region of Western France facilitated escalation of care with noninferior (or similar) early mortality outcome. Our data support establishing referral networks in other equivalent regions.
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Pediatr Crit Care Me · Nov 2021
Trends in Pediatric Patient-Ventilator Asynchrony During Invasive Mechanical Ventilation.
To explore the level and time course of patient-ventilator asynchrony in mechanically ventilated children and the effects on duration of mechanical ventilation, PICU stay, and Comfort Behavior Score as indicator for patient comfort. ⋯ The level of patient-ventilator asynchrony increased over time was not related to patient discomfort and inversely related to the duration of mechanical ventilation.
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Pediatr Crit Care Me · Nov 2021
Clinical Deterioration and Neurocritical Care Utilization in Pediatric Patients With Glasgow Coma Scale Score of 9-13 After Traumatic Brain Injury: Associations With Patient and Injury Characteristics.
To define the clinical characteristics of hospitalized children with moderate traumatic brain injury and identify factors associated with deterioration to severe traumatic brain injury. ⋯ A substantial subset of children (21%) presenting with moderate traumatic brain injury at a Level 1 pediatric trauma center experienced deterioration in the first 48 hours, requiring additional resource utilization associated with increased cost of care. Deterioration was independently associated with an increased international normalized ratio higher Injury Severity Score, and a lower admission Glasgow Coma Scale score.
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Pediatr Crit Care Me · Nov 2021
Transfusion Practices in Pediatric Cardiac Surgery Requiring Cardiopulmonary Bypass: A Secondary Analysis of a Clinical Database.
To describe blood component usage in transfused children with congenital heart disease undergoing cardiopulmonary bypass surgery across perioperative settings and diagnostic categories. ⋯ Children with congenital heart disease undergoing cardiopulmonary bypass surgery are transfused many blood components both intraoperatively and postoperatively. Multiple blood components are transfused intraoperatively at seemingly normal/low-normal pretransfusion values. Pediatric evidence guiding blood component transfusion in this population at high risk of bleeding and with limited physiologic reserve is needed to advance safe and effective blood conservation practices.