Pediatr Crit Care Me
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Pediatr Crit Care Me · Jan 2003
Case ReportsSubarachnoid hemorrhage in a child with status asthmaticus: significance of permissive hypercapnia.
To report an 11-yr-old boy with acute status asthmaticus being managed with permissive hypercapnia who developed a subarachnoid hemorrhage during the course of his illness. ⋯ We conclude that this patient suffered subarachnoid hemorrhage in association with the use of permissive hypercapnia in the settling of severe asthma.
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Pediatr Crit Care Me · Jan 2003
Randomized Controlled Trial Comparative Study Clinical TrialComparison of loss in lung volume with open versus in-line catheter endotracheal suctioning.
Disconnecting the endotracheal tube from the ventilator causes significant loss in lung volume, which is further exacerbated by suctioning. In-line catheter suction systems have putative benefits over open catheter suction by maintaining positive pressure, thereby minimizing hypoxemia and hemodynamic instability. However, there is a theoretical risk of generating large negative airway pressures and auto-cycling of the ventilator with in-line catheter suction systems. We studied the effects on lung volume with both these techniques. ⋯ The most significant loss in lung volume during suctioning occurs primarily during ventilator disconnection. Hence, open catheter suction results in greater lung volume loss when compared with in-line catheter suction. We suggest that in-line catheter suction is preferable, especially in patients with significant lung disease and who require high positive end-expiratory pressures, to avoid alveolar derecruitment and exacerbating hypoxemia during endotracheal tube suctioning.
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Pediatr Crit Care Me · Jan 2003
Randomized Controlled Trial Clinical TrialSerum creatinine and estimated creatinine clearance do not predict perioperatively measured creatinine clearance in neonates undergoing congenital heart surgery.
To describe changes in creatinine clearance (CrCl) in a small group of neonates who underwent surgery for repair of transposition of the great arteries or palliation of hypoplastic left heart syndrome. To determine whether serum creatinine, urine output, or the Schwartz formula accurately predict measured CrCl in these patients. ⋯ Perioperative CrCl is unpredictable in neonates with transposition of the great arteries and hypoplastic left heart syndrome. Serum creatinine, urine output, and the Schwartz formula do not accurately predict CrCl. Reliance on estimates of CrCl could result in toxic concentrations of drugs eliminated by the kidneys.