Pediatr Crit Care Me
-
Pediatr Crit Care Me · Jan 2012
Comparative StudyExtracorporeal membrane oxygenation support for intractable primary arrhythmias and complete congenital heart block in newborns and infants: short-term and medium-term outcomes.
To describe the experience with extracorporeal membrane oxygenation support for intractable primary arrhythmias in newborns and infants. ⋯ The requirement of extracorporeal membrane oxygenation support in newborns and infants with intractable arrhythmia is rare. Extracorporeal membrane oxygenation support does potentially carry morbidity; however, to prevent arrhythmia-related mortality, extracorporeal membrane oxygenation support and/or extracorporeal cardiopulmonary resuscitation should be considered in the management of hemodynamically unstable primary arrhythmias as an emergent lifesaving procedure.
-
Pediatr Crit Care Me · Jan 2012
Comparative StudyRelationship between hyperglycemia and outcome in children with severe traumatic brain injury.
To determine the relationship between hyperglycemia and outcome in infants and children after severe traumatic brain injury. ⋯ In children with severe traumatic brain injury, hyperglycemia beyond the initial 48 hrs is associated with poor outcome. This relationship was observed in both our analysis of mean blood glucose concentrations as well as among the patients with episodic severe hyperglycemia. This observation suggests a relationship between hyperglycemia and outcome from traumatic brain injury. However, only a prospective study can answer the important question of whether manipulating serum glucose concentration can improve outcome after traumatic brain injury in children.
-
Previous simulation studies suggest that temporary pediatric mass critical care approaches would accommodate plausible hypothetical sudden-impact public health emergencies. However, the utility of sustained pediatric mass critical care responses in prolonged pandemics has not been evaluated. The objective of this study was to compare the ability of a typical region to serve pediatric intensive care unit needs in hypothetical pandemics, with and without mass critical care responses sufficient to triple usual pediatric intensive care unit capacity. DESIGN, SETTING, PATIENTS, AND INTERVENTIONS: The Monte Carlo simulation method was used to model responses to hypothetical pandemics on the basis of national historical evidence regarding pediatric intensive care unit admission and length of stay in pandemic and nonpandemic circumstances. Assuming all ages are affected equally, federal guidelines call for plans to serve moderate and severe pandemics requiring pediatric intensive care unit care for 457 and 5,277 infants and children per million of the population, respectively. ⋯ Mass critical care approaches would be essential to extend care to the majority of infants and children in a severe pandemic. However, some patients needing critical care still could not be accommodated, requiring consideration of rationing.
-
Pediatr Crit Care Me · Jan 2012
Comparative StudyIdentifying factors to minimize phlebotomy-induced blood loss in the pediatric intensive care unit.
Phlebotomy-induced blood loss in critically ill children is common, contributes to anemia, and may be avoidable. We aimed to identify factors associated with phlebotomy-induced blood loss. ⋯ Blood drawn in excess of phlebotomy requirements exceeds the blood volume loss drawn for phlebotomy by two fold. Using indwelling catheters for phlebotomy often requires a discard volume to be drawn before obtaining the laboratory sample. Consolidating phlebotomy tests and using a closed system may decrease the amount of blood overdrawn and minimize overall phlebotomy-induced blood loss.
-
Pediatr Crit Care Me · Jan 2012
Comparative StudyNutrition support and deficiencies in children with severe traumatic brain injury.
Adequate nutrition support is considered important to recovery after pediatric traumatic brain injury. The 2003 Pediatric Guidelines recommend initiation of nutrition within 72 hrs after traumatic brain injury. We examined our local experience with nutritional support in severe pediatric traumatic brain injury patients (cases) and non-traumatic brain injury patients (controls). ⋯ Nutritional support was initiated in most patients within 72 hrs of pediatric intensive care unit admission. Although daily caloric and protein goals were not achieved in the first 2 wks of pediatric intensive care unit stay and nutritional deficiencies were common, earlier start of nutritional support was associated with involvement of a nutritionist and with meeting both caloric and protein goals by pediatric intensive care unit day 7.