Pediatr Crit Care Me
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Describe the roles and respective responsibilities of PICU healthcare professionals in end-of-life care decisions faced by PICU parents. ⋯ Our results describe a framework for healthcare professionals' roles in parental end-of-life care decision making in the pediatric ICU that includes directive, value-neutral, and organizational roles. More research is needed to validate these roles. Actively ensuring attention to these roles during the decision-making process could improve parents' experiences at the end of a child's life.
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Pediatr Crit Care Me · Jan 2013
Obstruction of the superior vena cava after neonatal extracorporeal membrane oxygenation: association with chylothorax and outcome of transcatheter treatment.
Obstruction of the superior vena cava is one of the potential complications of neonatal extracorporeal membrane oxygenation. Chylothorax is a known complication of surgery involving the thoracic cavity in children, and of extracorporeal membrane oxygenation. The aim of this study was to evaluate the association between chylothorax and superior vena cava obstruction after neonatal extracorporeal membrane oxygenation. ⋯ Among neonates treated with extracorporeal membrane oxygenation, superior vena cava obstruction is associated with an increased risk of chylothorax. In neonates with chylothorax after extracorporeal membrane oxygenation, evaluation for superior vena cava obstruction may be warranted. Although mortality is high in this population, transcatheter treatment can relieve superior vena cava obstruction and facilitate symptomatic improvement.
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Pediatr Crit Care Me · Jan 2013
Factors associated with mortality in pediatric patients requiring extracorporeal life support for severe pneumonia.
In children with respiratory failure secondary to pneumonia, extracorporeal life support can be lifesaving. Our goal was to identify variables associated with mortality in children with pneumonia requiring extracorporeal life support. ⋯ In children with severe pneumonia receiving extracorporeal life support, prognostic factors associated with increased risk of death included extracorporeal life support treatment exceeding 14 days, arterial cannulation, longer duration of mechanical ventilation, and decreased ability to wean ventilator FIO2 over the first 24 hrs on extracorporeal life support. Analysis of the Extracorporeal Life Support Organization registry can identify prognostic variables, which may influence medical decision making, resource utilization, and family counseling.
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Pediatr Crit Care Me · Jan 2013
CommentCritical appraisal of Zabrocki et al: Extracorporeal membrane oxygenation for pediatric respiratory failure: survival and predictors of mortality. Crit Care Med 2011; 39:364-370.
To review the findings and discuss the implications of pediatric respiratory failure treated with extracorporeal membrane oxygenation. ⋯ This study confirms that precannulation diagnoses and variables play a role in prognosis when pediatric patients with respiratory failure are treated with extracorporeal membrane oxygenation. Results of this investigation demonstrate that survival is improving in patients without comorbidities and that patients can be mechanically ventilated for up to 14 days prior to extracorporeal support initiation before mortality is increased.
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To describe whether Berlin Heart EXCOR Pediatric pump changes in the ICU are associated with infection, hemodynamic and ventilatory instability, and neurologic injury. ⋯ Berlin Heart EXCOR Pediatric pump changes in the pediatric intensive care unit appear to be a safe procedure when conducted by a highly specialized team.