Pediatr Crit Care Me
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Pediatr Crit Care Me · Sep 2020
Randomized Controlled Trial Multicenter StudyDexmedetomidine Sedation in Mechanically Ventilated Critically Ill Children: A Pilot Randomized Controlled Trial.
To assess the feasibility, safety, and efficacy of a sedation protocol using dexmedetomidine as the primary sedative in mechanically ventilated critically ill children. ⋯ A sedation protocol using dexmedetomidine as the primary sedative was feasible, appeared safe, achieved early, light sedation, and reduced midazolam requirements. The findings of this pilot study justify further studies of sedative agents in critically ill children.
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Pediatr Crit Care Me · Sep 2020
Meta AnalysisUltrasonographic Optic Nerve Sheath Diameter Measurement to Detect Intracranial Hypertension in Children With Neurological Injury: A Systematic Review.
Ultrasound measured optic nerve sheath diameter is a noninvasive, nonirradiating tool for estimating intracranial hypertension. The objective of this systematic review and meta-analysis is summarization of the current evidence for accuracy of ultrasound measured optic nerve sheath diameter in detecting intracranial hypertension in pediatric patients. ⋯ We are unable to identify a threshold value in ultrasound measured optic nerve sheath diameter for the determination of intracranial hypertension in children. Even though the ultrasound measured optic nerve sheath diameter measurement is highly sensitive to the presence of increased intracranial pressure, the test has only moderate specificity. Therefore, other confirmatory methods and further investigation is necessary in the clinical care of children. The technique is likely not sufficiently precise for clinical use in the absence of other confirmatory methods, and further investigation is necessary to determine clinical protocols for its use in children.
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Pediatr Crit Care Me · Sep 2020
Multicenter StudyJoining Datasets Without Identifiers: Probabilistic Linkage of Virtual Pediatric Systems and PEDSnet.
To 1) probabilistically link two important pediatric data sources, Virtual Pediatric Systems and PEDSnet, 2) evaluate linkage accuracy overall and in patients with severe sepsis or septic shock, and 3) identify variables important to linkage accuracy. ⋯ We demonstrated the use of probabilistic linkage to accurately join two complementary pediatric critical care datasets at a single academic PICU in the absence of protected health information. Combining datasets with curated diagnoses and granular measurements can validate patient acuity metrics and facilitate multicenter machine learning algorithms. We anticipate these methods will generalize to other common PICU diagnoses.
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Pediatr Crit Care Me · Sep 2020
Closing the Gap: Optimizing Performance to Reduce Interruptions in Cardiopulmonary Resuscitation.
The American Heart Association recommends minimizing pauses of chest compressions and defines high performance resuscitation as achieving a chest compression fraction greater than 80%. We hypothesize that interruption times are excessively long, leading to an unnecessarily large impact on chest compression fraction. ⋯ This lays the groundwork for studying inefficiency during cardiopulmonary resuscitation associated with chest compression interruptions. The framework we created allows for the determination of significant avoidable interruption time. By further elucidating the nature of interruptions, we can design and implement targeted interventions to improve patient outcomes.
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Pediatr Crit Care Me · Sep 2020
Multicenter Study Observational StudyDelirium Detection Based on the Clinical Experience of Pediatric Intensivists.
To estimate the frequency of delirium detected by pediatric intensivists, based only on their clinical experience, without a valid and reliable tool. ⋯ The low frequency of delirium detection and the insufficient criteria used for the diagnosis in these units suggest flaws in the recognition of delirium and probably the occurrence of underdiagnosis/misdiagnosis when it is based only on clinical experience, without the use of a valid and reliable tool.