Pediatr Crit Care Me
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Pediatr Crit Care Me · Apr 2001
Frequency of change of ventilator circuit in premature infants: Impact on ventilator-associated pneumonia.
Ventilator-associated pneumonia (VAP) is associated with substantial mortality. The frequency of changing the ventilator circuit (VC) might influence the occurrence rate of VAP. In premature infants receiving ventilatory support, the question regarding the frequency of changing VC is as yet unsettled. DESIGN: A prospective, randomized, and controlled trial in 60 premature neonates receiving ventilatory support. INTERVENTIONS: We investigated the impact of two VC change regimens on VAP in premature infants, either every 24 hrs or every 72 hrs. In each patient, the humidifier, inspiratory tube, and expiratory tube were changed and cultured at the assigned intervals along with cultures of tracheal aspirates. Blood cultures were obtained whenever there was clinical evidence of pneumonia or sepsis. MEASUREMENTS AND MAIN ⋯ Extending the VC-change interval in premature infants from 24 hrs to 72 hrs is safe and cost-effective.
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Pediatr Crit Care Me · Apr 2001
The costs associated with nosocomial bloodstream infections in the pediatric intensive care unit.
To assess the operational and subsidiary costs and length of stay (LOS) attributable to nosocomial bloodstream infections (BSI) in a pediatric intensive care unit (PICU). DESIGN: Matched case-control study. SETTING: Sixteen bed PICU in a 250-bed tertiary-care pediatric hospital. PATIENTS: Cases with BSI were prospectively identified from PICU patients who developed a nosocomial BSI from August 1996 to July 1998. Controls were PICU patients who were matched for age, severity of illness, diagnosis, and admission date who did not develop a nosocomial BSI. ⋯ The costs and LOS associated with nosocomial BSI in patients admitted to the PICU were significantly higher than controls.
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Pediatr Crit Care Me · Jan 2001
Amrinone in pediatric refractory septic shock: An open-label pharmacodynamic study.
To investigate the short-term hemodynamic effects of amrinone in pediatric patients with refractory septic shock. DESIGN: Open-label, clinical trial. SETTING: Pediatric intensive care unit. PATIENTS: Nine patients admitted with a diagnosis of septic shock receiving stable doses of vasopressors and inotropes. INTERVENTIONS: Pediatric patients with septic shock and a pulmonary artery catheter were treated with amrinone in a stepwise fashion at 5, 10, and 15 &mgr;g/kg/min. MEASUREMENTS AND MAIN ⋯ In this short-term, dose-response study in children with refractory septic shock, amrinone improved cardiac index and oxygen delivery in pediatric patients with refractory septic shock without increasing myocardial work.
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Pediatr Crit Care Me · Jan 2001
Comparison of resource utilization and outcome between pediatric and adult intensive care unit patients.
To compare resource utilization and outcomes between cohorts of pediatric and adult intensive care unit (ICU) patients from a single institution. DESIGN: Prospective, observational cohort study. SETTING: A large, urban, tertiary care medical center. PATIENTS: A total of 780 patients consecutively admitted to the pediatric ICU, adult medical ICU, and adult surgical ICU. MEASUREMENTS AND MAIN ⋯ Pediatric critical care patients have better short-term and longer-term survival compared with adult patients. The difference in survival is accounted for by the lower survival of adult medical patients. Despite the survival differences, pediatric and adult ICU patients incur similar hospital costs, and the proportions of patients who receive active ICU interventions are similar.
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To determine the incidence of pulmonary fat embolism after the intraosseous (IO) infusion of normal saline and drugs and to determine whether pulmonary capillary blood is a predictor of lung fat embolism. DESIGN: A randomized, prospective, animal study. SETTING: Animal research laboratory of a university hospital. SUBJECTS: Twenty-eight mixed breed piglets (average weight 30.9 kg). Interventions and Methods: Animals were anesthetized, intubated, mechanically ventilated, and instrumented. IO needles were placed in the tibial bone. Animals were assigned to one of four groups: Group 1 received fluid (20 mL/kg) under 300 mm Hg pressure (n = 6); group 2 received fluid (20 mL/kg) at free flow under gravity (n = 6); group 3 received 100 mL of fluid over 20 mins (n = 8); and group 4 received 100 mL of fluid over 7 mins (n = 8). MEASUREMENTS AND MAIN ⋯ Fat embolism is common; however, the method of IO fluid administration does not influence the number of emboli. Our study therefore implies that the risk of fat embolization is of concern, but its clinical relevance is unclear. Until the clinical significance of pulmonary fat emboli and the prevalence of fat emboli syndrome are delineated more precisely, the IO route is an effective but not necessarily safe route for delivery of fluids and drugs.