Pediatr Crit Care Me
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Pediatr Crit Care Me · Oct 2014
Multicenter StudyNurse Decision Making Regarding the Use of Analgesics and Sedatives in the Pediatric Cardiac ICU.
To describe nurse decision making and patient responses associated with the administration of analgesics and sedatives in the pediatric cardiac ICU. ⋯ Pediatric cardiac ICU nurses use many nonspecific indicators to describe patient level of comfort collectively. Decisions for managing patient comfort were influenced by their patients' overall hemodynamic stability.
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Pediatr Crit Care Me · Oct 2014
ReviewIntegrating Palliative Care Into the PICU: A Report From the Improving Palliative Care in the ICU Advisory Board.
This review highlights benefits that patients, families and clinicians can expect to realize when palliative care is intentionally incorporated into the PICU. ⋯ Palliative care should begin at the time of a potentially life-limiting diagnosis and continue throughout the disease trajectory, regardless of the expected outcome. Although the PICU is often used for short term postoperative stabilization, PICU clinicians also care for many chronically ill children with complex underlying conditions and others receiving intensive care for prolonged periods. Integrating palliative care delivery into the PICU is rapidly becoming the standard for high quality care of critically ill children. Interdisciplinary ICU staff can take advantage of the growing resources for continuing education in pediatric palliative care principles and interventions.
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Pediatr Crit Care Me · Oct 2014
Observational StudyTranscranial Doppler-Based Assessment of Cerebral Autoregulation in Critically Ill Children During Diabetic Ketoacidosis Treatment.
Impaired cerebral autoregulation may be associated with poor outcome in diabetic ketoacidosis. We examined change in cerebral autoregulation during diabetic ketoacidosis treatment. ⋯ Impaired cerebral autoregulation was common early during diabetic ketoacidosis treatment. Although the majority improved during diabetic ketoacidosis treatment, 17% of subjects had impairment between 36 and 72 hours after start of insulin therapy. The observed impaired cerebral autoregulation appears specific to the diabetic ketoacidosis process in patients with type I diabetes.
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Pediatr Crit Care Me · Oct 2014
Observational StudyA Single Nucleotide Polymorphism in the Corticotropin Receptor Gene Is Associated With a Blunted Cortisol Response During Pediatric Critical Illness.
The cortisol response during critical illness varies widely among patients. Our objective was to examine single nucleotide polymorphisms in candidate genes regulating cortisol synthesis, metabolism, and activity to determine if genetic differences were associated with variability in the cortisol response among critically ill children. ⋯ The A allele at rs1941088 in the MC2R gene, which encodes the adrenocorticotropic hormone (corticotropin, ACTH) receptor, is associated with a low cortisol response in critically ill children. These data provide evidence for a genetic basis for a portion of the variability in cortisol production during critical illness. Independent replication of these findings will be important and could facilitate development of personalized treatment for patients with a low cortisol response to severe illness.
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Pediatr Crit Care Me · Oct 2014
Abdominal Near-Infrared Spectroscopy Measurements Are Lower in Preterm Infants at Risk for Necrotizing Enterocolitis.
Near-infrared spectroscopy is a noninvasive method of measuring local tissue oxygenation (StO2). Abdominal StO2 measurements in preterm piglets are directly correlated with changes in intestinal blood flow and markedly reduced by necrotizing enterocolitis. The objectives of this study were to use near-infrared spectroscopy to establish normal values for abdominal StO2 in preterm infants and test whether these values are reduced in infants who develop necrotizing enterocolitis. ⋯ This study establishes normal values for abdominal StO2 in preterm infants and demonstrates decreased values and increased variability in those with necrotizing enterocolitis. Abdominal near-infrared spectroscopy monitoring of preterm infants may be a useful tool for early diagnosis and guiding treatment of necrotizing enterocolitis.