Pediatr Crit Care Me
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Pediatr Crit Care Me · Feb 2015
Association of Left Ventricular Systolic Function and Vasopressor Support With Survival Following Pediatric Out-of-Hospital Cardiac Arrest.
To characterize the association of hospital discharge survival with left ventricular systolic function evaluated by transthoracic echocardiography and vasoactive infusion support following return of spontaneous circulation after pediatric out-of-hospital cardiac arrest. ⋯ In patients receiving transthoracic echocardiography within the first 24 hours following return of spontaneous circulation after pediatric out-of-hospital cardiac arrest, decreased left ventricular systolic function and vasopressor use were common. Decreased left ventricular systolic function was associated with increased mortality.
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To characterize the epidemiology of burn injury in pediatric patients and identify factors associated with mortality based on burn severity. ⋯ This is the first in-depth study of pediatric burn injuries in combat. Children with severe burns (total body surface area > 39% or > 29% if < 5 yr) had a high mortality and required significant resources in a setting that is not primarily resourced for long-term care of severe pediatric burn injury. Extraordinary measures are therefore used for the long-term care of these burned children within the war zones of Iraq and Afghanistan.
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Pediatr Crit Care Me · Feb 2015
Clinical TrialBacteremia and Pneumonia in a Tertiary PICU: An 11-Year Study.
To describe trends in aetiology and resistance patterns and patient outcomes of bacteraemia and pneumonia in a PICU over an 11-year period. We also describe interventions aimed at reducing multi-resistant infections and other serious bacterial infections in the PICU. ⋯ Multiresistant bacterial sepsis and persistent or recurrent sepsis are major threats in pediatric intensive care and are associated with disproportionally high death rates. Our study describes a model for monitoring these serious infections and the effects of infection control interventions in the PICU.
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Pediatr Crit Care Me · Feb 2015
Acetazolamide therapy for metabolic alkalosis in critically ill pediatric patients.
Despite a paucity of supporting literature, acetazolamide is commonly used in critically ill children with metabolic alkalosis (elevated plasma bicarbonate [pHco-3] and pH). The objective of this study was to assess the change in 18 hours after initiation of acetazolamide therapy. ⋯ Acetazolamide reduces pHco-3 concentration in critically ill, mechanically ventilated children overall, but it did not do so in cardiac patients in our cohort, even in comparison with noncardiac patients of a similar age. These findings do not support the current use of acetazolamide for metabolic alkalosis in critically ill children with congenital heart disease. Further study is required to determine why these cardiac patients respond differently to acetazolamide than noncardiac patients and whether this response impacts important clinical outcomes, for example, weaning mechanical ventilation.
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Pediatr Crit Care Me · Feb 2015
Unplanned admissions to a pediatric cardiac critical care unit: a review of 2 years' experience.
Unplanned admissions to the pediatric cardiac ICU may be a large and high-risk group. Our study describes the frequency of unplanned pediatric cardiac ICU admissions, their admission data, and outcomes. ⋯ Unplanned admissions accounted for over one third of all admissions and had a high mortality rate. The majority of these occur at night, which may affect staffing models. Acute deterioration leading to unplanned admission, rather than readmission status, may be the driving factor in increased mortality. However, the risk of readmission, lower renal function, or other indices may identify patients at higher risk of an unplanned admission. Continued efforts to identify patients at risk for unplanned admissions are warranted given the outcomes in this cohort.