Pediatr Crit Care Me
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The extracorporeal membrane oxygenation circuit is made of a number of components that have been customized to provide adequate tissue oxygen delivery in patients with severe cardiac and/or respiratory failure for a prolonged period of time (days to weeks). A standard extracorporeal membrane oxygenation circuit consists of a mechanical blood pump, gas-exchange device, and a heat exchanger all connected together with circuit tubing. ⋯ Contemporary extracorporeal membrane oxygenation circuits have greater biocompatibility and allow for more prolonged cardiopulmonary support time while minimizing the procedure-related complications of bleeding, thrombosis, and other physiologic derangements, which were so common with the early application of extracorporeal membrane oxygenation. Modern era extracorporeal membrane oxygenation circuitry and components are simpler, safer, more compact, and can be used across a wide variety of patient sizes from neonates to adults.
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Pediatr Crit Care Me · Jun 2013
The impact of a quality improvement intervention to reduce nosocomial infections in a PICU.
To evaluate whether a quality improvement intervention could reduce nosocomial infection rates in a PICU and improve patient outcomes. ⋯ A multifaceted quality improvement intervention reduced nosocomial infection rates, hospital length of stay, and mortality in our PICU. The effects of the intervention were sustained over time.
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Pediatr Crit Care Me · Jun 2013
Observational StudyResponse of cardiac endocrine function to surgery stress is age dependent in neonates and children with congenital heart defects: consequences in diagnostic and prognostic accuracy of brain natriuretic peptide measurement.
The aim of this study was to evaluate the diagnostic and prognostic accuracy of brain natriuretic peptide assay in neonates and children undergoing surgery for congenital heart disease. ⋯ Baseline cardiac endocrine function and its response to surgical stress are dependent on age in neonates and children, undergoing cardiac surgery for congenital heart disease. Brain natriuretic peptide shows a good diagnostic and prognostic accuracy in this setting, with different features in either neonates or infants/children subsets.
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The field of extracorporeal support is moving forward rapidly. New technology, improved experience with a variety of patients, and successful outcomes in groups previously excluded from extracorporeal life support are increasing the use of this technique in patient support. ⋯ Collaboration between investigators, rigorous scientific data collection and analysis, and careful short- and long-term outcomes for patients receiving extracorporeal life support are imperative to avoid improper use of this high-resource, high-cost technology and to establish the efficacy of new devices and techniques. Bleeding and thrombosis remain devastating complications and efforts to reduce complications and improve anticoagulation regimens or eliminate the need for anticoagulation would be of major benefit to the field.