Pediatr Crit Care Me
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Pediatr Crit Care Me · Jul 2012
ReviewExtracorporeal life support: an update of Rogers' Textbook of Pediatric Intensive Care.
The field of extracorporeal life support, which has focused predominantly on extracorporeal membrane oxygenation in the past, is undergoing rapid expansion following years of stagnation as newer devices and improved technology have become available. Additionally, new cannulae and cannulation techniques have allowed extracorporeal life support to be expanded to many groups who would have been excluded from support in the past. ⋯ Continued examination of the criteria and circumstances where extracorporeal life support is applied as well as outcomes which include morbidity, cost effectiveness, and quality of life are needed areas of continued research. Increasing collaborations between all centers performing extracorporeal life support throughout the world should remain a priority to further research and understanding of this complex field.
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Pediatr Crit Care Me · Jul 2012
Randomized Controlled TrialEffect of body position on ventilation distribution in preterm infants on continuous positive airway pressure.
Although continuous positive airway pressure is used extensively in neonatal intensive care units, and despite the belief that positioning is considered vital to the maintenance of good lung ventilation, no data exist on regional ventilation distribution in infants on continuous positive airway pressure ventilatory support. ⋯ This study presents the first results on regional ventilation distribution in preterm infants on continuous positive airway pressure using electrical impedance tomography. Gravity had little impact on regional ventilation distribution in preterm infants on continuous positive airway pressure or in spontaneously breathing infants in the supine or prone position, indicating that ventilation distribution in preterm infants is not gravity-dependent but follows an anatomical pattern. AUSTRALIA NEW ZEALAND CLINICAL TRIALS REGISTRY:: ACTRN12606000210572.
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Pediatr Crit Care Me · Jul 2012
Randomized Controlled TrialSafety, efficacy, and tolerability of early initiation of noninvasive positive pressure ventilation in pediatric patients admitted with status asthmaticus: a pilot study.
Although noninvasive positive pressure ventilation is increasingly used for respiratory distress, there is not much data supporting its use in children with status asthmaticus. The objective of this study was to determine safety, tolerability, and efficacy of early initiation of noninvasive positive pressure ventilation in addition to standard of care in the management of children admitted with status asthmaticus. ⋯ Early initiation of noninvasive positive pressure ventilation, along with short acting β-agonists and systemic steroids, can be safe, well-tolerated, and effective in the management of children with status asthmaticus.
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Pediatr Crit Care Me · Jul 2012
ReviewDexmedetomidine and ketamine: an effective alternative for procedural sedation?
Although generally effective for sedation during noninvasive procedures, dexmedetomidine as the sole agent has not been uniformly successful for invasive procedures. To overcome some of the pitfalls with dexmedetomidine as the sole agent, there are an increasing number of reports regarding its combination with ketamine. This article provides a descriptive account of the reports from the literature regarding the use of a combination of dexmedetomidine and ketamine for procedural sedation. ⋯ The available literature except for one trial is favorable regarding the utility of a combination of ketamine and dexmedetomidine for procedural sedation. Future studies with direct comparisons to other regimens appear warranted for both invasive and noninvasive procedures.
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Pediatr Crit Care Me · Jul 2012
Evaluation of asymmetric dimethylarginine, arginine, and carnitine metabolism in pediatric sepsis.
Increased plasma concentrations of the endogenous nitric oxide synthase inhibitor, asymmetric dimethylarginine, decreased arginine bioavailability, and mitochondrial dysfunction have been reported in adult sepsis. We studied whether asymmetric dimethylarginine, arginine, and carnitine metabolism (a measure of mitochondrial dysfunction) are altered in pediatric sepsis and whether these are clinically useful biomarkers. ⋯ Asymmetric dimethylarginine was decreased in pediatric sepsis and was inversely associated with inflammation and organ dysfunction. This suggests that inhibition of nitric oxide synthase by asymmetric dimethylarginine accumulation is unlikely to impact sepsis pathophysiology in septic children despite decreased arginine bioavailability. We did not find an association of asymmetric dimethylarginine with altered carnitine metabolism nor were asymmetric dimethylarginine, arginine, and acylcarnitine:free carnitine useful as clinical biomarkers.