Pediatr Crit Care Me
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Pediatr Crit Care Me · Nov 2012
Predictors of failure in infants with viral bronchiolitis treated with high-flow, high-humidity nasal cannula therapy*.
Viral bronchiolitis is an acute infection and inflammatory disease of the respiratory tract, with infants typically presenting with the most severe symptoms. Medical management of bronchiolitis is mostly supportive. Several preliminary studies suggest potential benefit from the use of high-flow nasal cannula systems. Although high-flow nasal cannula is a well-established modality in the newborn intensive care unit, its use in the pediatric intensive care unit for acute respiratory failure is far less established. The objective of this study was to identify any laboratory and clinical variables that may predict high-flow nasal cannula failure in management of bronchiolitis in the pediatric intensive care unit. ⋯ History of prematurity and the patient's age did not increase a patient's risk of failure. Nonresponders to high-flow nasal cannula therapy were on the onset, more hypercarbic, were less tachypnic prior to the start of high-flow nasal cannula, and had no change in their respiratory rate after the initiation of high-flow nasal cannula therapy. Nonresponders had higher pediatric risk of mortality scores in the first 24 hrs.
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Pediatr Crit Care Me · Nov 2012
Neonatal incubators: a toxic sound environment for the preterm infant?*.
High sound pressure levels may be harmful to the maturing newborn. Current guidelines suggest that the sound pressure levels within a neonatal intensive care unit should not exceed 45 dB(A). It is likely that environmental noise as well as the noise generated by the incubator fan and respiratory equipment may contribute to the total sound pressure levels. Knowledge of the contribution of each component and source is important to develop effective strategies to reduce noise within the incubator. ⋯ The sound levels, especially at low frequencies, within a modern incubator may reach levels that are likely to be harmful to the developing newborn. Much of the noise is at low frequencies and thus difficult to reduce by conventional means. Therefore, advanced forms of noise control are needed to address this issue.
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Pediatr Crit Care Me · Nov 2012
The need for and feasibility of a pediatric ventilation trial: reflections on a survey among pediatric intensivists*.
To explore what design would be reasonable, acceptable, and feasible for a pediatric trial investigating the effect of low tidal volume ventilation. ⋯ Actual expert opinion favored investigating the effect of 6 mL/kg vs.10 mL/kg on mortality. Such a design suffers from various serious criticisms. Therefore, and in our opinion, a pediatric Acute Respiratory Distress Syndrome Network trial is not realistic.
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Pediatr Crit Care Me · Nov 2012
Safety and efficacy of prolonged dexmedetomidine use in critically ill children with heart disease*.
To evaluate the safety and efficacy of prolonged dexmedetomidine administration (≥ 96 hrs) in critically ill children with heart disease. ⋯ Prolonged dexmedetomidine administration in children with heart disease appears to be safe and is associated with decreased opioid and benzodiazepine requirement and decreased inotropic support.
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Pediatr Crit Care Me · Nov 2012
Improved outcomes for stem cell transplant recipients requiring pediatric intensive care.
Survival for hematopoietic stem cell transplant patients requiring pediatric intensive care unit admission may be improving. This study was conducted to review outcomes for patients undergoing hematopoietic stem cell transplantation requiring admission to our pediatric intensive care unit and to identify variables impacting survival. ⋯ We report a 63% survival to pediatric intensive care unit discharge, with 45% surviving at a median follow-up of over 2 yrs for all hematopoietic stem cell transplantation patients admitted to our pediatric intensive care unit over a 6-yr period. Our data suggest improved survival outcomes for this high risk patient population.