Pediatr Crit Care Me
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Pediatr Crit Care Me · Oct 2001
Respiratory syncytial virus infections in the pediatric intensive care unit: clinical characteristics and risk factors for adverse outcomes.
To describe the clinical characteristics of infants admitted to a pediatric intensive care unit (PICU) with respiratory syncytial virus (RSV) infection, including the prevalence of indications for RSV passive antibody prophylaxis (as currently recommended by the American Academy of Pediatrics), and to identify risk factors that predict adverse outcomes among this population. ⋯ A minority of infants admitted to our PICU for severe RSV disease meet currently recommended indications for RSV passive antibody prophylaxis. Risk factors that predict prolonged durations of ventilation, PICU stay, or hospital stay among this population include congenital heart disease, chronic lung disease, upper airway abnormalities, and noncardiac congenital malformations.
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Pediatr Crit Care Me · Oct 2001
Efficacy of an enteral 10-day methadone wean to prevent opioid withdrawal in fentanyl-tolerant pediatric intensive care unit patients.
To demonstrate the efficacy of a 10-day, single daily dose, enteral methadone weaning protocol for the prevention of opioid withdrawal symptoms in pediatric patients after prolonged fentanyl exposure. ⋯ Opioid withdrawal symptoms in pediatric intensive care unit patients after prolonged fentanyl exposure can be avoided by using an enteral, 10-day, single daily dose methadone weaning protocol.
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Pediatr Crit Care Me · Oct 2001
The impact of molecular biology on the practice of pediatric critical care medicine.
Molecular biology is increasingly affecting all areas of clinical medicine, including pediatric critical care medicine. Recent advances in genomics will allow for a more in-depth understanding of disease processes that are relevant to the pediatric intensivist, such as sepsis, the acute respiratory distress syndrome, and multiple organ dysfunction syndrome. In turn, understanding critical illness at the genomic level may allow for more effective stratification of patient subclasses and targeted, patient-specific therapy. ⋯ Finally, prospects for gene therapy, although quite challenging at present, may be applicable to the intensive care unit in the near future. With these rapid advancements in molecular biology, it is imperative that all pediatric critical care practitioners become, at least, familiar with the field and its related technology. Hopefully, clinician-scientists involved in pediatric critical care will also shape the direction of these future prospects.
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Pediatr Crit Care Me · Jul 2001
The Th1 versus Th2 cytokine profile in cerebrospinal fluid after severe traumatic brain injury in infants and children.
To further characterize the Th1 (proinflammatory) vs. the Th2 (antiinflammatory) cytokine profile after severe traumatic brain injury (TBI) by quantifying the ventricular cerebrospinal fluid concentrations of Th1 cytokines (interleukin [IL]-2 and IL-12) and Th2 cytokines (IL-6 and IL-12) in infants and children. DESIGN: Retrospective study. SETTING: University children's hospital. PATIENTS: Twenty-four children hospitalized with severe TBI (admission Glasgow Coma Scale score, <13) and 12 controls with negative diagnostic lumbar punctures. INTERVENTIONS: All TBI patients received standard neurointensive care, including the placement of an intraventricular catheter for continuous drainage of cerebrospinal fluid. MEASUREMENTS AND MAIN ⋯ This study confirms that IL-6 levels are increased in cerebrospinal fluid after TBI in infants and children. It is the first report of increased IL-12 levels in cerebrospinal fluid after TBI in infants and children. Further, it is the first to report on IL-2 and IL-4 levels in pediatric or adult TBI. These data suggest that selected members of both the Th1 and Th2 cytokine families are increased as part of the endogenous inflammatory response to TBI. Finally, in that both IL-6 and IL-12 (but neither IL-2 nor IL-4) can be produced by astrocytes and/or neurons, a parenchymal source for cytokines in the brain after TBI may be critical to their production in the acute phase after TBI.
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Pediatr Crit Care Me · Jul 2001
Survival and renal function in pediatric patients following extracorporeal life support with hemofiltration.
To determine variables associated with survival in pediatric patients treated with hemofiltration while receiving extracorporeal life support and to determine the probability for recovery of renal function among survivors. DESIGN: Retrospective database analysis. SETTING: University of Michigan pediatric nephrology database. PATIENTS: All pediatric patients treated with continuous hemofiltration while on extracorporeal life support at the University of Michigan between January 1990 and May 1999. A pediatric patient was defined as any child between birth and 18 yrs of age, including children treated in both the pediatric intensive care unit and neonatal intensive care unit. Indications for extracorporeal life support included both cardiac and pulmonary failure. INTERVENTIONS: Data analysis of patients who were treated with hemofiltration while on extracorporeal life support. Hemofiltration includes both ultrafiltration and hemofiltration with countercurrent dialysis. MEASUREMENTS AND MAIN ⋯ In patients receiving hemofiltration while on extracorporeal life support, survival is comparable to that reported in other extracorporeal life support or hemofiltration populations. Decreased survival in these patients may be associated with the use of vasopressor infusions and the occurrence of complications. Recovery of renal function occurs in most survivors.