Pediatr Crit Care Me
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Pediatr Crit Care Me · Oct 2013
Is Shock Index Associated With Outcome in Children With Sepsis/Septic Shock?*
To investigate the association between PICU shock index (the ratio of heart rate to systolic blood pressure) and PICU mortality in children with sepsis/septic shock. To explore cutoff values for shock index for ICU mortality, how change in shock index over the first 6 hours of ICU admission is associated with outcome, and how the use of vasoactive therapy may affect shock index and its association with outcome. ⋯ Shock index may have promise as a marker of mortality in children with sepsis/septic shock. Although there is no clear cutoff shock index to identify risk of mortality, given the higher risk of mortality as shock index increases, children with elevated shock index may benefit from more aggressive resuscitation and higher level of care.
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Pediatr Crit Care Me · Oct 2013
Randomized Controlled Trial Multicenter StudyAltered Circulating Leukocytes and Their Chemokines in a Clinical Trial of Therapeutic Hypothermia for Neonatal Hypoxic Ischemic Encephalopathy*
To determine systemic hypothermia's effect on circulating immune cells and their corresponding chemokines after hypoxic ischemic encephalopathy in neonates. ⋯ Our data are consistent with chemokine-associated systemic immunosuppression with hypothermia treatment. In hypothermic neonates, persistence of lower leukocyte counts after rewarming is observed in infants with more severe CNS injury.
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Pediatr Crit Care Me · Oct 2013
Multicenter StudyDifferences in Medical Therapy Goals for Children With Severe Traumatic Brain Injury-An International Study.
To describe the differences in goals for their usual practice for various medical therapies from a number of international centers for children with severe traumatic brain injury. ⋯ There were marked differences in medical goals for children with severe traumatic brain injury across our international consortium, and these differences seemed to be greatest in areas with the weakest evidence in the literature. Future studies that determine the superiority of the various medical therapies outlined within our survey would be a significant advance for the pediatric neurotrauma field and may lead to new standards of care and improved study designs for clinical trials.
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Pediatr Crit Care Me · Oct 2013
Multicenter Study Observational StudyA Comparison of Quality Improvement Practices at Adult and Pediatric Trauma Centers*
Quality assurance practices are structured performance improvement and patient safety processes designed to continuously monitor, evaluate, and improve the performance of a trauma program. These practices are integral in the provision of quality injury care, and yet no comprehensive description of existing quality improvement practices used by pediatric trauma centers is available. Therefore, we compared the quality improvement programs used in adult and pediatric trauma centers by performing a reanalysis of our recent survey of trauma quality improvement practices in Canada, United States, Australia, and New Zealand. ⋯ Opportunities for the improvement of pediatric quality improvement programs exist including a need to determine the optimal structure for trauma quality improvement, develop patient-centered quality indicators of injury care, measure long-term outcomes, and create measures of secondary injury prevention.