Pediatr Crit Care Me
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Pediatr Crit Care Me · Jun 2020
Observational StudySurvival and Mid-Term Neurologic Outcome After Extracorporeal Cardiopulmonary Resuscitation in Children.
Extracorporeal cardiopulmonary resuscitation in children with refractory cardiac arrest has been shown to improve survival, however, risk factors associated with mortality and neurologic impairments are not well defined. We analyzed our recent institutional experience with pediatric extracorporeal cardiopulmonary resuscitation to identify variables associated with survival and neurocognitive outcome. ⋯ Extracorporeal cardiopulmonary resuscitation is a valuable tool for the treatment of children with refractory cardiac arrest and a favorable neurologic outcome can be achieved in the majority of survivors even after prolonged resuscitation. Mortality after extracorporeal cardiopulmonary resuscitation in postcardiac surgery children is associated with procedural complexity.
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Pediatr Crit Care Me · Jun 2020
Observational StudyHospital-Associated Venous Thromboembolism in a Pediatric Cardiac ICU: A Multivariable Predictive Algorithm to Identify Children at High Risk.
Critically ill children with cardiac disease are at significant risk for hospital-associated venous thromboembolism, which is associated with increased morbidity, hospital length of stay, and cost. Currently, there are no widely accepted guidelines for prevention of hospital-associated venous thromboembolism in pediatrics. We aimed to develop a predictive algorithm for identifying critically ill children with cardiac disease who are at increased risk for hospital-associated venous thromboembolism as a first step to reducing hospital-associated venous thromboembolism in this population. ⋯ We developed a multivariable predictive algorithm to help identify children who may be at high risk of hospital-associated venous thromboembolism in the pediatric cardiac ICU.
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Pediatr Crit Care Me · Jun 2020
Platelet Inhibition With IV Glycoprotein IIb/IIIa Inhibitor to Prevent Thrombosis in Pediatric Patients Undergoing Aortopulmonary Shunting.
Shunt thrombosis, a potential complication of aortopulmonary shunting, is associated with high mortality. Commonly used oral antiplatelet drugs such as aspirin demonstrate variable absorption and inconsistent antiplatelet effect in critically ill patients early after surgery. IV glycoprotein IIb/IIIa inhibitors are antiplatelet agents with rapid and reproducible effect that may be beneficial as a bridge to oral therapy. ⋯ IV glycoprotein IIb/IIIa inhibitor as a bridge to oral antiplatelet therapy is safe in pediatric patients after aortopulmonary shunting. Dosing considerations should include both age and renal function. Randomized trials are warranted to establish efficacy compared with current anticoagulation practices.
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Pediatr Crit Care Me · Jun 2020
Implementation of an Evidence-Based Guideline of Enteral Nutrition for Infants With Congenital Heart Disease: A Controlled Before-and-After Study.
To describe the implementation process of a nutrition risk screening and assessment guideline for infants with congenital heart disease and to assess the impact of nurses' behavior and the effect on infants' outcomes. ⋯ Using the integrated-Promoting Action on Research Implementation in Health Services framework contributed to a successful implementation of the nutrition guideline. The nurses' knowledge, attitude, and behavior toward the nutrition guideline were positive resulting in a significantly higher nutrition assessments in infants with moderate or high nutritional risk.
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To reduce the frequency of non-ICU arrests through the implementation of an intramural collaborative focused on patient deterioration. ⋯ The Late Rescue Collaborative is an effective tool to improve patient safety by reducing non-ICU arrests.