Pediatr Crit Care Me
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Pediatr Crit Care Me · Oct 2015
Multicenter StudyRisk Factors for Delayed Enteral Nutrition in Critically Ill Children.
Delayed enteral nutrition, defined as enteral nutrition started 48 hours or more after admission to the PICU, is associated with an inability to achieve full enteral nutrition and worse outcomes in critically ill children. We reviewed nutritional practices in six medical-surgical PICUs and determined risk factors associated with delayed enteral nutrition in critically ill children. ⋯ Institutions in this study initiated enteral nutrition for a high percentage of patients by 48 hours of admission. Noninvasive positive-pressure ventilation was most strongly associated with delay enteral nutrition. A better understanding of these risk factors and assessments of nutritional requirements should be explored in future prospective studies.
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Pediatr Crit Care Me · Oct 2015
ReviewFluid Bolus Therapy-Based Resuscitation for Severe Sepsis in Hospitalized Children: A Systematic Review.
To review systematically data from randomized and nonrandomized studies of fluid bolus therapy in hospitalized children with septic shock. ⋯ There are only limited data to support the use of fluid bolus therapy in hospitalized children. Prospective observational data and randomized controlled trials are urgently needed to evaluate this therapy in resource rich settings.
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Pediatr Crit Care Me · Oct 2015
Observational StudyStimulant Toxicity in Children: A Retrospective Study on 147 Patients.
To evaluate the signs/symptoms of different stimulant toxicities in children to determine differences among them. ⋯ More studies are warranted to evaluate the frequency and outcome of this poisoning in children. Educational preventive programs are also recommended.
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Pediatr Crit Care Me · Oct 2015
Observational StudyCerebrovascular Pressure Reactivity in Children With Traumatic Brain Injury.
Traumatic brain injury is a significant cause of morbidity and mortality in children. Cerebral autoregulation disturbance after traumatic brain injury is associated with worse outcome. Pressure reactivity is a fundamental component of cerebral autoregulation that can be estimated using the pressure-reactivity index, a correlation between slow arterial blood pressure, and intracranial pressure fluctuations. Pressure-reactivity index has shown prognostic value in adult traumatic brain injury, with one study confirming this in children. Pressure-reactivity index can identify a cerebral perfusion pressure range within which pressure reactivity is optimal. An increasing difference between optimal cerebral perfusion pressure and cerebral perfusion pressure is associated with worse outcome in adult traumatic brain injury; however, this has not been investigated in children. Our objective was to study pressure-reactivity index and optimal cerebral perfusion pressure in pediatric traumatic brain injury, including associations with outcome, age, and cerebral perfusion pressure. ⋯ In pediatric patients with traumatic brain injury, pressure-reactivity index has prognostic value and can identify cerebral perfusion pressure targets that may differ from treatment protocols. Our results suggest but do not confirm that cerebral perfusion pressure targeting using pressure-reactivity index as a guide may positively impact on outcome. This question should be addressed by a prospective clinical study.