Pediatr Crit Care Me
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Pediatr Crit Care Me · Aug 2016
Acute Kidney Injury and Cardiorenal Syndromes in Pediatric Cardiac Intensive Care.
The objectives of this review are to discuss the definition, diagnosis, and pathophysiology of acute kidney injury and its impact on immediate, short-, and long-term outcomes. In addition, the spectrum of cardiorenal syndromes will be reviewed including the pathophysiology on this interaction and its impact on outcomes. ⋯ The field of cardiac intensive care continues to advance in tandem with congenital heart surgery. As mortality has become a rare occurrence, the focus of cardiac intensive care has shifted to that of morbidity reduction. Acute kidney injury adversely impact outcomes of patients following surgery for congenital heart disease as well as in those with heart failure (cardiorenal syndrome). Patients who become fluid overloaded and/or require dialysis are at a higher risk of mortality, but even minor degrees of acute kidney injury portend a significant increase in mortality and morbidity. Clinicians continue to seek methods of early diagnosis and risk stratification of acute kidney injury to prevent its adverse sequelae.
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Pediatr Crit Care Me · Aug 2016
Shunt Lesions Part I: Patent Ductus Arteriosus, Atrial Septal Defect, Ventricular Septal Defect, and Atrioventricular Septal Defect.
This review summarizes the current understanding of the pathophysiology and perioperative management of patent ductus arteriosus, atrial septal defect, ventricular septal defect, and atrioventricular septal defect. ⋯ The four congenital cardiac lesions that are the subject of this review, patent ductus arteriosus, atrial septal defect, ventricular septal defect, and atrioventricular septal defect, are the most commonly found defects causing a left-to-right shunt. These defects frequently warrant transcatheter or surgical intervention. Although the perioperative care is relatively straightforward for many of these patients, there are a number of management strategies and complications associated with each intervention. The treatment outcomes for all of these lesions are very good in the current era.
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Pediatr Crit Care Me · Aug 2016
Observational StudyExtracorporeal Membrane Oxygenation for Pediatric Respiratory Failure: Risk Factors Associated With Center Volume and Mortality.
Recent analyses show higher mortality at low-volume centers providing extracorporeal membrane oxygenation. We sought to identify factors associated with center volume and mortality to explain survival differences and identify areas for improvement. ⋯ Among neonates, investigation for intraventricular hemorrhage prior to extracorporeal membrane oxygenation and preservation of renal function are important factors for improvement. Earlier initiation of extracorporeal membrane oxygenation and careful attention to preservation of organ function are important to improve survival for children.
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Pediatr Crit Care Me · Aug 2016
Cardiopulmonary Resuscitation in Congenital and Acquired Heart Disease.
The Pediatric Advanced Life Support recommendations were developed for otherwise healthy infants and children with normal cardiac anatomy. Patients with acquired and congenital heart disease require specific considerations that may differ from the Pediatric Advanced Life Support recommendations. Our aim is to present prearrest, arrest, and postarrest considerations that are unique to children with congenital and acquired heart disease. ⋯ A clear understanding of the underlying anatomy and physiology of congenital and acquired heart disease is imperative in order to employ the appropriate modifications to the current Pediatric Advanced Life Support recommendations and to optimize outcomes.
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Pediatr Crit Care Me · Aug 2016
Observational StudyTemporal Trends of Respiratory Syncytial Virus-Associated Hospital and ICU Admissions Across the United States.
To describe the regionality and seasonality of respiratory syncytial virus-associated hospital and ICU admissions for 10 consecutive years using a national database. ⋯ Wide variations in regional and seasonal patterns in hospital and ICU admissions were noted in children with respiratory syncytial virus-associated acute respiratory illness across the United States. Results from our study help us better understand the seasonality and regionality of respiratory syncytial virus infection in the United States with the goal to decrease the financial impact on our already stressed healthcare system by being better prepared for respiratory syncytial virus season.