Pediatr Crit Care Me
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Pediatr Crit Care Me · Mar 2015
Randomized Controlled TrialLonger RBC Storage Duration Is Associated With Increased Postoperative Infections in Pediatric Cardiac Surgery.
Infants and children undergoing open heart surgery routinely require multiple RBC transfusions. Children receiving greater numbers of RBC transfusions have increased postoperative complications and mortality. Longer RBC storage age is also associated with increased morbidity and mortality in critically ill children. Whether the association of increased transfusions and worse outcomes can be ameliorated by use of fresh RBCs in pediatric cardiac surgery for congenital heart disease is unknown. ⋯ Longer RBC storage duration was associated with increased postoperative nosocomial infections. This association may be secondary in part, to the large doses of stored RBCs transfused, from single-donor units. Washing the oldest RBCs was associated with increased morbidity, possibly from increased destruction of older, more fragile erythrocytes incurred by washing procedures. Additional studies examining the effect of RBC storage age on postoperative infection rate in pediatric cardiac surgery are warranted.
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Pediatr Crit Care Me · Mar 2015
Standardizing Postoperative PICU Handovers Improves Handover Metrics and Patient Outcomes.
To improve handover communication and patient outcomes for postoperative admissions to a multidisciplinary PICU. ⋯ Postoperative communication and patient outcomes can be improved and sustained over time with implementation of a standardized handover protocol.
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Pediatr Crit Care Me · Mar 2015
Autologous Bone Marrow Mononuclear Cells Reduce Therapeutic Intensity for Severe Traumatic Brain Injury in Children.
The devastating effect of traumatic brain injury is exacerbated by an acute secondary neuroinflammatory response, clinically manifest as elevated intracranial pressure due to cerebral edema. The treatment effect of cell-based therapies in the acute post-traumatic brain injury period has not been clinically studied although preclinical data demonstrate that bone marrow-derived mononuclear cell infusion down-regulates the inflammatory response. Our study evaluates whether pediatric traumatic brain injury patients receiving IV autologous bone marrow-derived mononuclear cells within 48 hours of injury experienced a reduction in therapeutic intensity directed toward managing elevated intracranial pressure relative to matched controls. ⋯ IV autologous bone marrow-derived mononuclear cell therapy is associated with lower treatment intensity required to manage intracranial pressure, associated severity of organ injury, and duration of neurointensive care following severe traumatic brain injury. This may corroborate preclinical data that autologous bone marrow-derived mononuclear cell therapy attenuates the effects of inflammation in the early post-traumatic brain injury period.
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Pediatr Crit Care Me · Mar 2015
Hemorrhagic Complications in Pediatric Cardiac Patients on Extracorporeal Membrane Oxygenation: An Analysis of the Extracorporeal Life Support Organization Registry.
To determine the prevalence of and risk factors for hemorrhagic complications in children with cardiac disease requiring extracorporeal membrane oxygenation. ⋯ In this large, multicenter analysis, hemorrhagic complications occurred in nearly half of children with heart disease on extracorporeal membrane oxygenation and were associated with a significant mortality risk. Several factors were associated with hemorrhagic complications in cardiac surgical patients including pre-extracorporeal membrane oxygenation mediastinal exploration, greater surgical complexity, early postoperative cannulation, and longer bypass times. Whether these risks can be mitigated by modifying or delaying systemic anticoagulation requires further investigation.
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Pediatr Crit Care Me · Mar 2015
Fluid Overload at 48 Hours Is Associated With Respiratory Morbidity but Not Mortality in a General PICU: Retrospective Cohort Study.
Recent evidence suggests that fluid overload may be deleterious to critically ill children. The purpose of this study was to investigate the association of early fluid overload with respiratory morbidity and mortality in patients admitted to a general PICU. ⋯ Fluid overload at 48 hours was associated with oxygenation index at 48 hours and invasive ventilation days in survivors in a general PICU population. There was no association of fluid overload at 48 hours with mortality.