Pediatr Crit Care Me
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Pediatr Crit Care Me · Jun 2018
Hospital Variation in Intensive Care Resource Utilization and Mortality in Newly Diagnosed Pediatric Leukemia.
To evaluate hospital-level variability in resource utilization and mortality in children with new leukemia who require ICU support, and identify factors associated with variation. ⋯ Wide hospital-level variability in ICU resource utilization and mortality exists in the care of children with leukemia requiring ICU support. Hospital payer mix is associated with some mortality variability. Additional study into how ICU support could be standardized through clinical practice guidelines, impact of payer mix on hospital resources allocation to the ICU, and subsequent impact on patient outcomes is warranted.
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Pediatr Crit Care Me · Jun 2018
Neutrophil Extracellular Traps in Children With Meningococcal Sepsis.
Children with meningococcal sepsis are highly at risk for fulminant disease, multiple organ failure, and death. Recently, neutrophil extracellular traps levels have been indicated as a marker for severity in different kinds of sepsis. Our aim was to study the role of neutrophil extracellular traposis in meninogococcal sepsis in children. ⋯ Children admitted to PICU for meningococcal sepsis have higher neutrophil extracellular traps levels at admission and after 24 hours than controls. Neutrophil extracellular traps levels were not associated with outcome, cell-free DNA, or other inflammatory markers. These neutrophil extracellular traps may be induced by N. meningitidis, since these are strong neutrophil extracellular traposis inducers.
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Pediatr Crit Care Me · Jun 2018
Observational StudyCardiac Index Changes With Fluid Bolus Therapy in Children With Sepsis-An Observational Study.
Fluid bolus therapy is the initial recommended treatment for acute circulatory failure in sepsis, yet it is unknown whether this has the intended effect of increasing cardiac index. We aimed to describe the effect of fluid bolus therapy on cardiac index in children with sepsis. ⋯ Fluid bolus therapy for pediatric sepsis is associated with a transient increase in cardiac index. Fluid responsiveness is variable and, when present, not sustained. The efficacy of fluid bolus therapy for achieving a sustained increase in cardiac index in children with sepsis is limited.
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Pediatr Crit Care Me · Jun 2018
Clinical Trial Observational StudyPerformance Under Stress Conditions During Multidisciplinary Team Immersive Pediatric Simulations.
The primary objective was to determine whether technical and nontechnical performances were in some way correlated during immersive simulation. Performance was measured among French Emergency Medical Service workers at an individual and a team level. Secondary objectives were to assess stress response through collection of physiologic markers (salivary cortisol, heart rate, the proportion derived by dividing the number of interval differences of successive normal-to-normal intervals > 50 ms by the total number of normal-to-normal intervals [pNN50], low- and high-frequency ratio) and affective data (self-reported stress, confidence, and dissatisfaction), and to correlate them to performance scores. ⋯ There was a positive correlation between leader (Behavioral Assessment Tool) and team (Clinical Teamwork Scale and Team Average Performance Assessment Scale) performances. These performance scores were positively correlated with self-confidence and negatively correlated with dissatisfaction.
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Pediatr Crit Care Me · Jun 2018
Interhospital Transport of Critically Ill Children to PICUs in the United Kingdom and Republic of Ireland: Analysis of an International Dataset.
International data on characteristics and outcomes of children transported from general hospitals to PICUs are scarce. We aimed to 1) describe the development of a common transport dataset in the United Kingdom and Ireland and 2) analyze transport data from a recent 2-year period. ⋯ Variations exist in United Kingdom and Ireland services for critically ill children needing interhospital transport. Future studies should assess the impact of these variations on long-term patient outcomes taking into account treatment provided prior to transport.