Pediatr Crit Care Me
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Pediatr Crit Care Me · Sep 2013
Randomized Controlled Trial Multicenter StudyThe Relationship of Fluid Administration to Outcome in the Pediatric Calfactant in Acute Respiratory Distress Syndrome Trial*
Adult studies have demonstrated the relationship between fluid overload and poor outcomes in acute lung injury/acute respiratory distress syndrome. The approach of pediatric intensivists to fluid management in acute lung injury/acute respiratory distress syndrome and its effect on outcomes is less clear. In a post hoc analysis of our Calfactant in Acute Respiratory Distress Syndrome trial, we examined the relationship of fluid balance to in-hospital outcomes in subjects with acute lung injury/acute respiratory distress syndrome. ⋯ Pediatric intensivists generally follow a "liberal" approach to fluid management in children with acute lung injury/acute respiratory distress syndrome. Illness severity or oxygenation disturbance did not explain differences in fluid accumulation but such accumulation was associated with worsening oxygenation, a longer ventilator course, and increased mortality. A more conservative approach to fluid management may improve outcomes in children with acute lung injury/acute respiratory distress syndrome.
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Pediatr Crit Care Me · Sep 2013
Multicenter StudyPaediatric Index of Mortality 3: An Updated Model for Predicting Mortality in Pediatric Intensive Care.
To provide an updated version of the Paediatric Index of Mortality 2 for assessing the risk of mortality among children admitted to an ICU. ⋯ Paediatric Index of Mortality 3 provides an international standard based on a large contemporary dataset for the comparison of risk-adjusted mortality among children admitted to intensive care.
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Pediatr Crit Care Me · Sep 2013
Randomized Controlled TrialOptimizing Patient-Ventilator Synchrony During Invasive Ventilator Assist in Children and Infants Remains a Difficult Task.
To document and compare the prevalence of asynchrony events during invasive-assisted mechanical ventilation in pressure support mode and in neurally adjusted ventilatory assist in children. ⋯ Asynchrony events are frequent during pressure support in children despite adjusting the cycling off criteria. Neurally adjusted ventilatory assist allowed for an almost ten-fold reduction in asynchrony events. Further studies should determine the clinical impact of these findings.
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Pediatr Crit Care Me · Sep 2013
Randomized Controlled TrialEffect of Mechanical Cleaning of Endotracheal Tubes With Sterile Urethral Catheters to Reduce Biofilm Formation in Ventilator Patients.
To investigate the effectiveness of mechanical cleaning with sterile urethral catheters to prevent formation of biofilms on endotracheal tubes. ⋯ Mechanical cleaning with sterile urethral catheters reduced bacterial colonization, prevented formation of endotracheal tube biofilm, and reduced the occurrence of ventilator-associated pneumonia.
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Pediatr Crit Care Me · Sep 2013
Decreased Expression of Serum and Microvascular Vascular Endothelial Growth Factor Receptor-2 in Meningococcal Sepsis.
To determine the skin microvessel expression of vascular endothelial growth factor receptor 2 and serum-soluble vascular endothelial growth factor receptor 2 levels in children with meningococcal sepsis. ⋯ Microvascular expression of vascular endothelial growth factor receptor 2 and serum-soluble vascular endothelial growth factor receptor 2 levels are decreased in children with sepsis. Serum-soluble vascular endothelial growth factor receptor 2 levels are inversely correlated with disease severity indicated by Pediatric Risk of Mortality III score and survival. Decreased vascular endothelial growth factor receptor 2 expression may hinder natural recovery from sepsis-associated microvascular injury and the effectiveness of therapeutic strategies targeting vascular endothelial growth factor-vascular endothelial growth factor receptor 2 signaling in sepsis patients.