Pediatr Crit Care Me
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Pediatr Crit Care Me · Mar 2013
ReviewMeasuring cystatin C to determine renal function in neonates.
The incidence of acute kidney injury in neonates is high and associated with up to a 50% mortality rate. The purpose of this review was to determine the feasibility of using serum cystatin C measurements to assist clinicians in making early and accurate diagnoses of acute kidney injury in neonates. ⋯ Cystatin C has all of the theoretical properties needed to be an ideal marker of renal function. It can be used to determine baseline renal function on day 1 and is increasingly being used to determine renal function in sick neonates. In the majority of studies, the day 1 cystatin C level ranged between 1 and 2 mg/L, which gradually declined in the first year of life. However, the number of available studies evaluating cystatin C in sick neonates is currently limited, and there are also no studies linking cystatin C levels in sick babies with short-term and long-term outcomes.
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Ischemia depletes antioxidant reserves and impairs mitochondrial electron transport. Oxygen within blood reperfusing ischemic tissue can form free radicals, worsen oxidative stress, and exacerbate tissue injury (reperfusion injury). One strategy for limiting reperfusion injury is to limit delivery of "luxuriant" oxygen during or after reperfusion. Resuscitation guidelines for children with cardiac arrest recommend early weaning of supplemental oxygen as tolerated. There are currently no studies demonstrating the frequency and outcomes of hyperoxia and hypoxia after pediatric cardiac arrest. ⋯ Hyperoxia occurs commonly within the first 24 hours of management in children resuscitated from cardiac arrest.
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Pediatr Crit Care Me · Mar 2013
Clinical TrialExtracorporeal membrane oxygenation and cerebral blood flow velocity in children.
To determine how extracorporeal membrane oxygenation affects cerebral blood flow velocity and to determine whether specific changes in cerebral blood flow velocity may be associated with neurologic injury. ⋯ In children who did not suffer clinically apparent neurologic injury, cerebral blood flow velocities were lower than normal while on extracorporeal membrane oxygenation support and increased after decannulation. However, children who developed cerebral hemorrhage had higher than normal cerebral blood flow velocities noted for days prior to clinical recognition of bleeding. Cerebral blood flow velocity measurement may represent a portable, noninvasive way to predict cerebral complications of extracorporeal membrane oxygenation and deserves further study.
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Pediatr Crit Care Me · Mar 2013
High-dose barbiturates for refractory intracranial hypertension in children with severe traumatic brain injury.
To evaluate high-dose barbiturates as a second-tier therapy for pediatric refractory intracranial hypertension complicating severe traumatic brain injury. ⋯ Addition of high-dose barbiturates achieved control of refractory intracranial hypertension in almost 30% of treated children. Control of refractory intracranial hypertension was associated with increased likelihood of an acceptable long-term outcome.
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Pediatr Crit Care Me · Mar 2013
Transfusion of leukocyte-depleted RBCs is independently associated with increased morbidity after pediatric cardiac surgery.
To test the hypothesis that transfusion of leukocyte-depleted RBC preparations within the first 48 hours of PICU stay was independently associated with prolonged duration of mechanical ventilation, irrespective of surgery type and disease severity. ⋯ Transfusion of leukocyte-depleted RBCs within the first 48 hours of PICU stay after cardiac surgery is independently associated with prolonged duration of mechanical ventilation.