Pediatr Crit Care Me
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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.
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Pediatr Crit Care Me · Oct 2000
End-of-life decision-making and satisfaction with care: parental perspectives.
To evaluate parents' perceptions of the process by which decisions are made to limit or withdraw life support from critically ill children, and to evaluate parents' perceptions of their child's death in the pediatric intensive care unit (ICU) and their satisfaction with the care provided. ⋯ Recommendations of physicians, nature of illness and expected neurologic recovery are important to parents making end-of-life decisions for their children. The establishment of trust is crucial in guiding parents through the decision-making process. Parental presence at the time of a child's death, the provision of adequate information, and a sympathetic environment may facilitate a healthy grief response.
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Pediatr Crit Care Me · Oct 2000
Assessment of respiratory drive and muscle function in the pediatric intensive care unit and prediction of extubation failure.
Extubation failure can result from poor respiratory drive, impaired respiratory muscle function, or excessive inspiratory load. Measurement of airway pressure changes either during tidal breathing or after end-expiratory occlusion allows assessment of respiratory drive and muscle function. ⋯ Assessment of P0.1 was the most useful airway pressure measurement in predicting extubation failure. Assessment of P0.1 may help to characterize children likely to fail extubation.
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Pediatr Crit Care Me · Jul 2000
Biochemical, cellular, and molecular mechanisms in the evolution of secondary damage after severe traumatic brain injury in infants and children: Lessons learned from the bedside.
To present a state-of-the-art review of mechanisms of secondary injury in the evolution of damage after severe traumatic brain injury in infants and children. DATA SOURCES: We reviewed 152 peer-reviewed publications, 15 abstracts and proceedings, and other material relevant to the study of biochemical, cellular, and molecular mechanisms of damage in traumatic brain injury. Clinical studies of severe traumatic brain injury in infants and children were the focus, but reports in experimental models in immature animals were also considered. Results from both clinical studies in adults and models of traumatic brain injury in adult animals were presented for comparison. DATA SYNTHESIS: Categories of mechanisms defined were those associated with ischemia, excitotoxicity, energy failure, and resultant cell death cascades; secondary cerebral swelling; axonal injury; and inflammation and regeneration. ⋯ A constellation of mediators of secondary damage, endogenous neuroprotection, repair, and regeneration are set into motion in the brain after severe traumatic injury. The quantitative contribution of each mediator to outcome, the interplay between these mediators, and the integration of these mechanistic findings with novel imaging methods, bedside physiology, outcome assessment, and therapeutic intervention remain an important target for future research.
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Pediatr Crit Care Me · Jul 2000
Comparison of predictors of extubation from mechanical ventilation in children.
Unsuccessful extubation from mechanical ventilation increases mortality and morbidity. Therefore, the identification of an accurate predictor of successful extubation is desirable. This study was designed to determine whether the results of easily performed respiratory measurements, particularly if reported as "combined extubation" indices, were better predictors of extubation failure in a pediatric population than were readily available clinical data. DESIGN: Prospective observational study. SETTING: Tertiary pediatric intensive care unit. PATIENTS: All children who required mechanical ventilation for >/=24 hrs during a 12-month period and whose parents gave informed written consent. INTERVENTIONS: Respiratory function measurements were made (on average) 7 hrs (range, 0.2-25.0 hrs) before extubation. Arterial blood gas results were obtained immediately before extubation. The values of each predictor associated with maximum sensitivity and specificity were determined, and the areas under receiver operator characteristic curves were compared to determine the most accurate predictor of successful extubation. MEASUREMENTS AND MAIN ⋯ Volume measurements during pediatric mechanical ventilation may facilitate successful extubation.