Pediatr Crit Care Me
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Pediatr Crit Care Me · Jan 2014
Pediatric Intensive Care in South Africa: An Account of Making Optimum Use of Limited Resources at the Red Cross War Memorial Children's Hospital*.
To develop explicit criteria for patient admission in order to optimize utilization of PICU facilities in the face of increasing demand outstripping resources. ⋯ Development and implementation of explicit policies for utilization of PICU resources provide a "reasonable" process for fair and equitable utilization of scarce resources. The factors that have to be considered while developing these policies may extend beyond the priorities of individual patients. Implementation is still fraught with problems. Development of explicit admission policies that consider the needs of individual patients and also the longer term development of healthcare services may enable the retention of small but essential services.
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Pediatr Crit Care Me · Jan 2014
Impact of positive end-expiratory pressure on cardiac index measured by ultrasound cardiac output monitor*.
To evaluate the impact of different levels of positive end-expiratory pressure on cardiac index in children receiving mechanical ventilation. To explore the effect of lung recruitment on the relationship between positive end-expiratory pressure and cardiac output. ⋯ In hemodynamically stable mechanically ventilated children, although there is a statistically significant decrease in cardiac output as positive end-expiratory pressure is increased between 0 and 12 cm H2O, the mean change is less than 10%, and this is likely not clinically significant. In the presence of lung disease, intensive care physicians should feel less reluctant in their use of positive end-expiratory pressure for hemodynamically stable patients.
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Pediatr Crit Care Me · Jan 2014
Observational StudyMultimodal Monitoring for Hemodynamic Categorization and Management of Pediatric Septic Shock: A Pilot Observational Study.
To evaluate the cardiovascular aberrations using multimodal monitoring in fluid refractory pediatric septic shock and describe the clinical characteristics of septic myocardial dysfunction. ⋯ Bedside echocardiography provided crucial information leading to the recognition of septic myocardial dysfunction and uncorrected hypovolemia that was not apparent on clinical assessment. With invasive blood pressure monitoring, echocardiography affords a simple noninvasive tool to determine the cause of low cardiac output and the physiological basis for adjustment of therapy in patients who remain in shock despite 40 mL/kg fluid.
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Pediatr Crit Care Me · Jan 2014
Extracorporeal Cardiopulmonary Resuscitation Outcomes in Term and Premature Neonates.
Extracorporeal cardiopulmonary resuscitation appears to improve survival in patients with acute refractory cardiopulmonary failure. This analysis was performed to determine survival outcomes and predictors of in-hospital mortality for term and preterm neonates who received extracorporeal cardiopulmonary resuscitation. ⋯ Overall survival for neonates receiving extracorporeal cardiopulmonary resuscitation is similar to older pediatric patients but decreases with lower gestational age and weight. Despite this, many low-birth weight neonates survive to hospital discharge.
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Pediatr Crit Care Me · Jan 2014
Comparative StudyDetermination of Umbilical Venous Catheter Tip Position With Radiograph.
To compare the cardiac silhouette method with the vertebral body method in predicting the umbilical venous catheter tip position on ultrasound; to measure the length of the target zone for the umbilical venous catheter tip; and to determine the time taken for a neonatologist to ascertain position of the umbilical venous catheter tip with ultrasound. ⋯ For radiograph and ultrasound scans performed within an hour of each other, the cardiac silhouette method more accurately predicts umbilical venous catheter tip than vertebral body level and methods described in previous studies. Catheters are frequently malpositioned. The length of the target zone for optimal umbilical venous catheter tip position is short. Ultrasound assessment of umbilical venous catheter tip position is quick.