Pediatr Crit Care Me
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Pediatr Crit Care Me · Oct 2014
Predictors of acute symptomatic seizures after intracranial hemorrhage in infants*.
To determine the prevalence of acute symptomatic seizures in infants with supratentorial intracranial hemorrhage, to identify potential risk factors, and to determine the effect of acute seizures on long-term morbidity and mortality. ⋯ Despite seizure prophylaxis, infants with supratentorial intracranial hemorrhage are at high risk for acute symptomatic seizures. This is regardless of the etiology of hemorrhage. Younger patients, women, patients with parenchymal injury, and patients presenting with seizure are most likely to develop acute seizures. Although the benefits of seizure prophylaxis have not been studied in this specific population, these results suggest that it is an important component of acute care following intracranial hemorrhage.
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Pediatr Crit Care Me · Oct 2014
Antithrombin Concentrate in Pediatric Patients Requiring Unfractionated Heparin Anticoagulation: A Retrospective Cohort Study.
To describe antithrombin levels, altered unfractionated heparin effect (anti-factor Xa activity and activated partial thromboplastin time), and adverse effects post administration of a single high dose of antithrombin concentrate. ⋯ This is the largest study of antithrombin concentrate evaluation in children. Administration of antithrombin concentrate increases anti-factor Xa activity with lower administered unfractionated heparin doses.
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Pediatr Crit Care Me · Oct 2014
Observational StudyLong-Term Dexmedetomidine Use and Safety Profile Among Critically Ill Children and Neonates.
To determine whether long-term dexmedetomidine dosing is associated with lower opioid and benzodiazepine use without risk of significant hemodynamic changes and/or withdrawal. ⋯ Hemodynamic effects of dexmedetomidine did not limit long-term use in this diverse population. After the addition of dexmedetomidine, opioid and benzodiazepine doses did not significantly escalate, and patients were more comfortable as evidenced by decreasing comfort scores. Withdrawal from dexmedetomidine may be an issue and manifests as agitation, tremors, and decreased sleep.
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Pediatr Crit Care Me · Oct 2014
Respiratory Secretion Analyses in the Evaluation of Ventilator-Associated Pneumonia: A Survey of Current Practice in Pediatric Critical Care.
Ventilator-associated pneumonia is among the most common nosocomial infections in the PICU. Respiratory secretion cultures and Gram stains are frequently obtained for diagnosis and to guide therapy, but their specificity is questionable. We conducted a scenario-based survey of pediatric intensivists to assess their antibiotic use in response to hypothetical tracheal aspirate culture and Gram stain results. ⋯ The majority of pediatric intensivists would obtain respiratory secretion cultures and Gram stains in the evaluation of an intubated child with fever and leukocytosis and initiate antibiotics guided by the results. The specificity of respiratory secretion cultures and Gram stains for the diagnosis of ventilator-associated pneumonia requires critical evaluation as this diagnosis is responsible for more than half of antibiotic use in the PICU.
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Pediatr Crit Care Me · Oct 2014
Fatalities Above 30,000 Feet: Characterizing Pediatric Deaths on Commercial Airline Flights Worldwide.
We conducted this study to characterize in-flight pediatric fatalities onboard commercial airline flights worldwide and identify patterns that would have been unnoticed through single case analysis of these relative rare events. ⋯ Pediatric in-flight fatalities are rare, but death occurs most commonly in infants and in subjects with a preexisting medical condition. The number of fatalities involving seemingly previously healthy children under the age of 2 years (lap infants) is intriguing and could indicate a vulnerable population at increased risk of death related to in-flight environmental factors, sleeping arrangements, or yet another unrecognized factor.