Pediatr Crit Care Me
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Pediatr Crit Care Me · Sep 2014
ReviewUnderstanding the Global Epidemiology of Pediatric Critical Illness: The Power, Pitfalls, and Practicalities of Point Prevalence Studies.
The point prevalence methodology is a valuable epidemiological study design that can optimize patient enrollment, prospectively gather individual-level data, and measure practice variability across a large number of geographic regions and healthcare settings. The objective of this article is to review the design, implementation, and analysis of recent point prevalence studies investigating the global epidemiology of pediatric critical illness. ⋯ Point prevalence studies in pediatric critical care can efficiently provide valuable insight on the global epidemiology of disease and practice patterns for critically ill children.
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Pediatr Crit Care Me · Sep 2014
Higher Doses of Low-Molecular-Weight Heparin (Enoxaparin) Are Needed to Achieve Target Anti-Xa Concentrations in Critically Ill Children.
To demonstrate that low-molecular-weight heparin (enoxaparin) can be used in critically ill pediatric patients to achieve target anti-factor Xa concentrations and determine appropriate dosing corrected for age and illness severity. ⋯ Enoxaparin can be used to reach recommended target range of anti-factor Xa concentrations in the PICU patient. However, younger patients and patients with higher illness severity are less likely to achieve target concentrations using currently recommended dosing and may require higher doses of enoxaparin to reach target anti-factor Xa concentrations. Starting enoxaparin dose at least 1.3 mg/kg dosed every 12 hours for treatment of thromboembolic disease in critically ill patients aged 61 days to 1 year or those requiring inotropic support should be confirmed in prospective study.
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Pediatr Crit Care Me · Sep 2014
ReviewIntensive Care Treatment of Uncontrolled Status Epilepticus in Children: Systematic Literature Search of Midazolam and Anesthetic Therapies.
A systematic literature search and review of the best evidence for intensive care treatment of refractory status epilepticus in children using continuous infusion of midazolam or anesthetic agents. ⋯ The data on intensive care treatment of pediatric refractory status epilepticus are of poor quality, yet they show a hierarchy in strategies: early midazolam, then barbiturates, and then trial of other anesthetic strategies. In addition, using a solely clinical endpoint for seizure control may be missing significant seizure burden in pediatric refractory status epilepticus.
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Pediatr Crit Care Me · Sep 2014
Nonrespiratory Pediatric Logistic Organ Dysfunction-2 Score Is a Good Predictor of Mortality in Children With Acute Respiratory Failure.
Multiple organ dysfunction, not respiratory failure, is the major cause of death in children with acute lung injury or acute respiratory distress syndrome. This study was undertaken to estimate the predictive value of death of the nonrespiratory Pediatric Logistic Organ Dysfunction-2 in children with acute respiratory failure. ⋯ Our study demonstrates that the nonrespiratory Pediatric Logistic Organ Dysfunction-2 score of the entire PICU stay is highly predictive of death in children with acute respiratory failure of whom 94.3% were invasively ventilated. The nonrespiratory Pediatric Logistic Organ Dysfunction-2 score could represent the nonrespiratory organ failure definition tool whose development was recommended in the international expert recommendations on pediatric acute respiratory distress syndrome.