Pediatr Crit Care Me
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Pediatr Crit Care Me · Feb 2014
Assessment of Hemoglobin Threshold for Packed RBC Transfusion in a Medical-Surgical PICU.
Results of a large multicenter randomized clinical trial published in 2007 demonstrated no benefit in using a liberal versus conservative RBC transfusion threshold in stable critically ill children. Using the conservative threshold decreased the number of RBC transfusions without increasing adverse outcomes. We aimed to determine if wide dissemination of this evidence altered the hemoglobin threshold used for RBC transfusions in our pediatric medical-surgical ICU. ⋯ Although transfusion thresholds in potentially stable critically ill children in our PICU significantly decreased after dissemination of best available evidence, 71% of patients were transfused at a hemoglobin threshold more than 7 g/dL.
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Pediatr Crit Care Me · Feb 2014
Observational StudyEarly Postoperative Fluid Overload Precedes Acute Kidney Injury and Is Associated With Higher Morbidity in Pediatric Cardiac Surgery Patients.
Fluid overload has been independently associated with increased morbidity and mortality in pediatric patients with renal failure, acute lung injury, and sepsis. Pediatric patients who undergo cardiopulmonary bypass are at risk for poor cardiac, pulmonary, and renal outcomes. They are also at risk of fluid overload from cardiopulmonary bypass, which stimulates inflammation, release of antidiuretic hormone, and capillary leak. This study tested the hypothesis that patients with fluid overload in the early postcardiopulmonary bypass period have worse outcomes than those without fluid overload. We also examined the timing of the association between postcardiopulmonary bypass acute kidney injury and fluid overload. ⋯ Early postoperative fluid overload is independently associated with worse outcomes in pediatric cardiac surgery patients who are 2 weeks to 18 years old. Patients with fluid overload have higher rates of postcardiopulmonary bypass acute kidney injury, and the occurrence of fluid overload precedes acute kidney injury. However, acute kidney injury is not consistently associated with fluid overload.
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Pediatr Crit Care Me · Feb 2014
Observational StudySurvey of In-House Coverage by Pediatric Intensivists: Characterization of 24/7 In-Hospital Pediatric Critical Care Faculty Coverage.
To characterize the current state of 24/7 in-hospital pediatric intensivist coverage in academic PICUs, including perceptions of faculty and trainees regarding the advantages and disadvantages of in-hospital coverage. ⋯ Although concerns exist regarding the effect of 24/7 in-hospital coverage on faculty, the majority of pediatric intensivists and critical care trainees responded that in-hospital coverage by intensivists is good for patient care. The majority of intensivists also state that they would prefer to work at an institution with in-hospital coverage. Further research is needed to objectively delineate the effects of in-hospital coverage on both patients and faculty.
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Pediatr Crit Care Me · Feb 2014
Vasopressin as a Rescue Therapy for Refractory Pulmonary Hypertension in Neonates: Case Series.
To determine the effect of vasopressin therapy on the efficacy of oxygenation and arterial pressure in infants with severe persistent pulmonary hypertension of the newborn. ⋯ Although there is limited experience of vasopressin use in persistent pulmonary hypertension of the newborn infants, our case series suggests it to be a potential adjunctive therapy for improving the efficacy of oxygenation and systemic hypotension. A prospective randomized trial is needed to confirm its efficacy and safety in the management of severe persistent pulmonary hypertension of the newborn.
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Pediatr Crit Care Me · Feb 2014
A Canadian Survey of Perceived Barriers to Initiation and Continuation of Enteral Feeding in PICUs.
Clinicians believe nutrition support is important; however, delivery of enteral nutrition may be delayed or interrupted due to a lack of guidelines or perceived contraindications to administration. The aim of this national survey was to examine the knowledge and perceived barriers among clinicians which prevent enteral nutrition administration to PICU patients. ⋯ Overall, there is high variability among clinicians regarding acceptable procedural and clinical barriers to enteral nutrition administration; this may be improved by a standardized feeding protocol. Therefore, further research must be conducted to provide clinicians with evidence to support their practices for enteral nutrition administration.