Pediatr Crit Care Me
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Pediatr Crit Care Me · May 2012
Comparative Study2009 pandemic influenza A (H1N1) in critically ill children in Cincinnati, Ohio.
To compare the clinical features, management, and outcome of critically ill children with H1N1 to children with seasonal influenza from the previous three influenza seasons. ⋯ In contrast to other studies, we found that critically ill children with H1N1 had a significantly lower morbidity and mortality compared to children with seasonal influenza.
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Pediatr Crit Care Me · May 2012
Comparative StudyNeurally triggered breaths have reduced response time, work of breathing, and asynchrony compared with pneumatically triggered breaths in a recovering animal model of lung injury.
Our objective was to compare response time, pressure time product as a reflection of work of breathing, and incidence and type of asynchrony in neurally vs. pneumatically triggered breaths in a spontaneously breathing animal model with resolving lung injury. ⋯ Neurally triggered breaths have reduced asynchrony, trigger delay, and pressure time product, which may indicate reduced work of breathing associated with less effort to trigger the ventilator and faster response to effort. Further study is required to demonstrate if these differences will lead to decreased days of ventilation and less use of sedation in patients.
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Pediatr Crit Care Me · May 2012
Two-dimensional speckle tracking imaging detects impaired myocardial performance in children with septic shock, not recognized by conventional echocardiography.
Sepsis is common in children and often results in cardiac dysfunction. Assessment of patients with sepsis-associated myocardial depression using ejection fraction and fractional shortening with conventional echocardiography is load dependent and often reveals cardiac dysfunction only after clinical deterioration has occurred. Speckle tracking imaging is a novel technology that can assess deformation and strain by tracking displacement of acoustic markers in the myocardium. We hypothesize that speckle tracking imaging will detect cardiac impairments during sepsis that are not appreciated by conventional echocardiography. ⋯ Speckle tracking imaging detected a number of significantly impaired measures of ventricular performance in children with sepsis, not appreciated by conventional echocardiography. This technology may improve our understanding and identification of myocardial depression in the critically ill septic child.
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Pediatr Crit Care Me · May 2012
Fluid overload is associated with impaired oxygenation and morbidity in critically ill children.
Fluid overload is common in the critically ill and is thought to contribute to oxygenation failure and mortality. Since increasing disease severity often requires more fluid for resuscitation, it is unclear whether fluid overload is a causative factor in morbidity or is simply an indicator of disease severity. ⋯ This is the first study to report that positive fluid balance adversely affected the pediatric intensive care unit course in children who did not receive renal replacement therapy. While timely administration of fluids is lifesaving, positive fluid balance after hemodynamic stabilization may impact organ function and negatively influence important outcomes in critically ill patients.
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Pediatr Crit Care Me · May 2012
Comparative StudyComparative effects of bronchoalveolar lavage with saline, surfactant, or perfluorocarbon in experimental meconium aspiration syndrome.
Today, in meconium aspiration syndrome, treatment focuses on bronchoalveolar lavage, because it removes meconium and proinflammatory factors from airways. This technique might be more effective if different solutions were used such as saline solution, a protein-free surfactant, or a perfluorocarbon, because these would be less inhibited by meconium proteins. ⋯ In lambs with meconium aspiration syndrome, bronchoalveolar lavage with diluted lucinactant is an effective therapy producing significant improvements in gas exchange, pulmonary hypertension, and pulmonary mechanics. In addition, bronchoalveolar lavage with perfluorocarbon appears to confer some advantages over lavage with equal volumes of saline or no lavage.