Pediatr Crit Care Me
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Pediatr Crit Care Me · Sep 2020
Evaluation of Bivalirudin As an Alternative to Heparin for Systemic Anticoagulation in Pediatric Extracorporeal Membrane Oxygenation.
Heparin is the universal anticoagulant for patients receiving extracorporeal membrane oxygenation support. However, heparin has many disadvantages, especially in young children, who develop heparin resistance. Recently our center has used bivalirudin, a direct thrombin inhibitor, for systemic anticoagulation in pediatric extracorporeal life support. Bivalirudin binds directly to thrombin with no need for antithrombin III and it inhibits both circulating and clot-bound thrombin. In this study, we sought to evaluate our experience with bivalirudin in pediatric extracorporeal life support. ⋯ This study showed that the use of bivalirudin in pediatric extracorporeal membrane oxygenation support is feasible, safe, reliable, and cost-effective in comparison to heparin. Further prospective randomized clinical trials are necessary to confirm our observations.
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Pediatr Crit Care Me · Sep 2020
Observational StudyAge-Based Percentiles of Measured Mean Arterial Pressure in Pediatric Patients in a Hospital Setting.
To develop and validate age-specific percentile curves of measured mean arterial pressure for children in a hospital setting. ⋯ This is the first study reporting age-specific quantiles of measured mean arterial pressure in children in a hospital setting. The percentile curves may guide care in illnesses when perfusion pressure is critical and serve as parameter for bedside and electronic record-based response to clinical change. Future work to correlate threshold mean arterial pressure values with outcomes would be feasible based on quantile curves.
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Pediatr Crit Care Me · Sep 2020
Association Between Elevated RBC Distribution Width and Multiple Organ Dysfunction in Pediatric Critical Illness.
RBC distribution width, a part of the complete blood count, has been shown in several published studies to be a strong biomarker of adverse outcomes. We sought to determine the association between admission RBC distribution width value and clinical outcomes including multiple organ dysfunction, mechanical ventilation days, PICU length of stay, and hospital length of stay in children admitted to the PICU. ⋯ PICU admission RBC distribution width values greater than 15.7% obtained upon admission to the PICU in patients who have not received a RBC transfusion are associated with multiple organ dysfunction syndrome in the first 7 days of admission, increased duration of mechanical ventilation, and increased hospital length of stay.
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Pediatr Crit Care Me · Sep 2020
Standardization of the Perioperative Management for Neonates Undergoing the Norwood Operation for Hypoplastic Left Heart Syndrome and Related Heart Defects.
In-hospital complications after the Norwood operation for single ventricle heart defects account for the majority of morbidity and mortality. Inpatient care variation occurs within and across centers. This multidisciplinary quality improvement project standardized perioperative management in a large referral center. ⋯ This initiative successfully implemented a standardized perioperative care guideline for neonates undergoing the Norwood operation at a large center. Positive statistical process control centerline shifts in Guideline Adherence Score, length of postoperative mechanical ventilation, and cardiac ICU length of stay were demonstrated. A higher percentage were successfully extubated by postoperative day 2. Establishment of standard processes can lead to best practices to decrease major adverse events.