Pediatr Crit Care Me
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Pediatr Crit Care Me · Apr 2002
National survey on the use of sedatives and neuromuscular blocking agents in the pediatric intensive care unit.
To describe the sedative and neuromuscular blocking agents (NMBA) that are currently used in pediatric intensive care units across the country and to assess the use of written protocols for their use, criteria used for selecting these agents, monitoring practices, and clinicians responsible for making therapeutic decisions in the pediatric intensive care units. DESIGN: A questionnaire was mailed to pediatric attending physician members of the Society of Critical Care Medicine practicing in the United States in January 1997. A cover letter was also enclosed that explained the purpose of the survey and asked the respondent to forward the questionnaire to a colleague if unable to complete. ⋯ Clinicians continue to use the opioids and benzodiazepines most often for sedation in the pediatric intensive care units, but newer agents are being used more often and warrant further investigation. The use of written protocols is very low, possibly because of the lack of guidelines in the literature on pediatric intensive care unit sedation and neuromuscular blockade. Development and implementation of protocols for the selection, use, and monitoring of sedatives and NMBA through a multidisciplinary team approach may be a beneficial way to provide safe and cost-effective therapy to critically ill pediatric patients.
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Pediatr Crit Care Me · Apr 2002
Noninvasive positive-pressure ventilation in pediatric status asthmaticus.
To describe the use of noninvasive positive-pressure ventilation in children with status asthmaticus. DESIGN: Brief report. SETTING: Pediatric intensive care unit in two tertiary institutions. SUBJECTS: Children with severe acute asthma and hypercarbic respiratory failure. INTERVENTIONS: Noninvasive positive-pressure ventilation using a bilevel positive-pressure (BIPAP) device. MEASUREMENTS AND MAIN ⋯ In three children with status asthmaticus, BIPAP seemed to improve ventilation and gas exchange, culminating in resolution of hypercarbic respiratory failure. A prospective, randomized, and controlled study is required to determine its role in pediatric status asthmaticus.
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Pediatr Crit Care Me · Apr 2002
Pediatric fiberoptic bronchoscopy: Clinical experience with 2,836 bronchoscopies.
To report 21 yrs of experience with pediatric flexible fiberoptic bronchoscopy in infants and children, explore newer applications, delineate potential complications, and make recommendations for its future application. DESIGN: Retrospective review. SETTING: A 20-bed pediatric critical care unit in a tertiary care, university-based children's hospital. PATIENTS: A total of 2,836 pediatric and infant fiberoptic bronchoscopies, performed over a course of 21 yrs, were reviewed. Measurement and MAIN ⋯ Pediatric flexible fiberoptic bronchoscopy is a safe diagnostic and interventional tool, even in young or extremely premature infants. Although the rate of serious complications in this report is low, general anesthetic agents and incorporation of laryngeal mask airway is advocated for severe mucoid impaction, transbronchial biopsy, and chronic pulmonary infiltrates, which may necessitate extensive bronchoalveolar lavage.
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Pediatr Crit Care Me · Jan 2002
Noninvasive ventilation in the treatment of acute respiratory failure induced by all-trans retinoic acid (retinoic acid syndrome) in children with acute promyelocytic leukemia.
To evaluate the feasibility of noninvasive ventilation through a nasal mask in the treatment of acute respiratory failure induced by all-trans retinoic acid. ⋯ Noninvasive ventilation by a nasal mask can offer effective ventilatory support and improve gas exchange in the treatment of acute respiratory failure in pediatric hematologic patients. In addition, noninvasive ventilation may decrease the risk of life-threatening complications associated with endotracheal intubation and conventional mechanical ventilation in patients with hematologic malignancies.
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Pediatr Crit Care Me · Jan 2002
Cerebrospinal fluid procalcitonin and severe traumatic brain injury in children.
To determine the relationship between cerebrospinal fluid procalcitonin concentration and severe traumatic brain injury in children. ⋯ Cerebrospinal fluid procalcitonin concentration is increased in children after traumatic brain injury. The attenuated increase in cerebrospinal fluid procalcitonin among victims of abusive head trauma warrants further study because it may reflect impairment of endogenous neuroprotective mechanisms or delay in seeking medical attention. The significance of these observations remains to be determined as future studies elucidate the physiologic and mechanistic properties of procalcitonin.