Pediatr Crit Care Me
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Pediatr Crit Care Me · Mar 2022
Observational StudyAgreement Between Peak Inspiratory Pressure in Decelerating-Flow Ventilation and Plateau Pressure in Square-Flow Ventilation in Pediatric Acute Respiratory Distress Syndrome.
Acute respiratory distress syndrome guidelines suggest limiting plateau pressures to 28-30 cm H2O. Plateau pressure is most accurately measured in square-flow modes, such as volume control. In children, decelerating-flow modes, such as pressure-regulated volume control and pressure control, are more common. Consequently, plateau pressures are rarely obtained, and pressure limits are instead provided for peak inspiratory pressure. The degree to which peak inspiratory pressure in decelerating-flow overestimates plateau pressure is unknown. Therefore, we assessed the correlation and accuracy of peak inspiratory pressure in decelerating-flow ventilation for approximating plateau pressure during square-flow ventilation. ⋯ Peak inspiratory pressure measured during decelerating-flow ventilation may be an adequate surrogate of plateau pressure in pediatric acute respiratory distress syndrome when inspiratory flow approaches zero. Practitioners should be aware that peak inspiratory pressures in decelerating-flow may not be substantially higher than plateau pressures.
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Pediatr Crit Care Me · Mar 2022
Postoperative Acute Kidney Injury in Williams Syndrome Compared With Matched Controls.
Cardiovascular manifestations occur in over 80% of Williams syndrome (WS) patients and are the leading cause of morbidity and mortality. One-third of patients require cardiovascular surgery. Renal artery stenosis (RAS) is common in WS. No studies have assessed postoperative cardiac surgery-related acute kidney injury (CS-AKI) in WS. Our objectives were to assess if WS patients have higher risk of CS-AKI postoperatively than matched controls and if RAS could contribute to CS-AKI. ⋯ The OR of CS-AKI is increased in pediatric patients with WS compared with controls. CS-AKI was associated with VIS at the sixth postoperative hour. Increases in RPP and mean arterial pressure were associated with decreased odds of CS-AKI.
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Pediatr Crit Care Me · Mar 2022
Driving Pressure Is Associated With Outcome in Pediatric Acute Respiratory Failure.
Driving pressure (ratio of tidal volume over respiratory system compliance) is associated with mortality in acute respiratory distress syndrome. We sought to evaluate if such association could be identified in critically ill children. ⋯ Higher driving pressure was independently associated with increased time to extubation in mechanically ventilated children. Dynamic assessments of driving pressure should be cautiously interpreted.
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Pediatr Crit Care Me · Mar 2022
Anthropology in the PICU: Addressing the Local Worlds of Families in an Otherwise Foreign Land.
Critical illness is a scary, and often previously unknown, experience for children and their families. To best assist pediatric critically ill patients and their caregivers, it is imperative to understand their local worlds outside of the PICU and what matters to them most. Anthropology, and its ethnographic lens and mode of inquiry, is an underutilized aspect of multidisciplinary care and research in pediatric critical care but has much to offer as exemplified herein.
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Pediatr Crit Care Me · Mar 2022
Observational StudyPrevalence of and Associations With Avascular Necrosis After Pediatric Sepsis: A Single-Center Retrospective Study.
Avascular necrosis (AVN) is a rare, but serious, complication after sepsis in adults. We sought to determine if sepsis is associated with postillness diagnosis of AVN, as well as potential-associated risk factors for AVN in children with sepsis. ⋯ Although rare, sepsis was associated with a higher risk of subsequent AVN than suspected bacterial infection in children. Older age, malignancy, unknown site of infection, and minimum platelet count were potential risk factors for AVN after sepsis.