Pediatr Crit Care Me
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Pediatr Crit Care Me · Jan 2001
A comparison of propofol and ketamine/midazolam for intravenous sedation of children.
To compare ketamine and propofol sedation in children undergoing diagnostic and therapeutic procedures. DESIGN: Retrospective study. SETTING: A six-bed pediatric intensive care unit and a pediatric hematology oncology clinic. PATIENTS: From 1996 to 1998, 405 procedures were performed on patients between 1 month and 22 yrs of age. INTERVENTIONS: All patients but one were sedated intravenously with either propofol or ketamine; those who received ketamine also received midazolam and either atropine or glycopyrrolate. Vital signs were monitored continuously. Procedures included bone marrow biopsies, lumbar punctures, esophagoduodenoscopies, colonoscopies, and other miscellaneous procedures. A pediatric intensivist performed all sedations. MEASUREMENTS AND MAIN ⋯ Both propofol and ketamine provided safe and effective sedation for the short, painful procedures performed. Because the patients who received propofol awakened almost twice as quickly as the patients who received ketamine, the sedation service operated more efficiently when propofol was used. The major complication rates for propofol and ketamine were small, and the differences between the two groups were not statistically significant. We conclude that with proper monitoring, intravenous propofol can be used safely and effectively for short procedures in the pediatric setting.
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Pediatr Crit Care Me · Jan 2001
Complications of central venous catheterization in critically ill children.
Analysis of central venous catheterization complications in different access sites with the Seldinger technique. Patients and Methods: A prospective study (May 1992 through December 1996) of 308 central venous catheterizations in children of different ages in a pediatric intensive care unit. ⋯ Central venous catheterization can be performed readily in children of all ages with an acceptable degree of risk. The immediate complications were more frequent and severe for subclavian vein catheterization, and the highest risk factor was the number of attempts at catheter insertion. Although the most frequent late complications were mechanical, which were higher for the femoral access and long-indwelling catheters, femoral catheters can be left indwelling for longer periods if routine ultrasound follow-up is performed. Infectious complications were independent of the venous access site or the duration of catheterization.
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To investigate the frequency, predisposing factors, clinical presentation, and outcome of abdominal compartment syndrome (ACS) in critically ill pediatric patients. DESIGN: A prospective study over a 5-yr period. SETTING: Pediatric intensive care unit of a tertiary care, university hospital. PATIENTS: All patients admitted to the pediatric intensive care unit were screened for the presence of ACS and were treated with a uniform protocol. ACS was defined as abdominal distention with intra-abdominal pressure (IAP) > 15 mm Hg, accompanied by at least two of the following: oliguria or anuria; respiratory decompensation; hypotension or shock; metabolic acidosis. MEASUREMENTS AND MAIN ⋯ Although relatively infrequent compared with adults, ACS occurs in critically ill children. Timely decompression of the abdomen results in uniform improvement, but overall mortality is still high. In contrast with adults, children with ACS have diverse primary diagnoses, with a significant number of primary extra-abdominal-mainly central nervous system-conditions. Ischemia and reperfusion injury appear to be the major mechanisms for development of ACS in children. Clinical presentation is similar to adults, but children may develop ACS at a lower IAP (as low as 16 mm Hg).
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Pediatr Crit Care Me · Oct 2000
Organ donation in children: role of the pediatric intensive care unit.
Children waiting for organ transplants continue to die because of the shortage of available organs. Studies of organ donation in children are scarce. The evaluation of the organ donation experience in a pediatric tertiary care hospital may identify factors that influence actual organ donation rates and lead to strategies to improve pediatric organ donation. ⋯ Despite an encouraging 63% consent rate for organ donation when families are approached, only 41% of potential donors proceeded to actual donation. Strategies for a prospective pediatric study should focus on mandatory request, multicultural issues, and aggressive postconsent medical management and procurement. The pivotal role of the pediatric intensive care unit practitioner should be emphasized.
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Pediatr Crit Care Me · Oct 2000
Relevance of diagnostic diversity and patient volumes for quality and length of stay in pediatric intensive care units.
Investigation of associations of the diagnostic diversity and volumes with efficiency and quality of care. ⋯ Patient volumes encountered in a PICU are important for maintaining quality and efficiency of care. In low-volume units, fewer diagnoses and higher volumes were both associated with higher efficiencies. In high volume units, diagnosis-specific volumes were generally large enough for achieving diagnosis-independent efficiency. Diagnostic mix was not associated with PICU mortality ratios, but higher PICU volumes were associated with lower mortality rates.