Pediatr Crit Care Me
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Pediatr Crit Care Me · Nov 2011
Case ReportsRecurrent delirium after surgery for congenital heart disease in an infant.
The objective of this article is to describe a case of recurrent delirium after cardiac surgery in an infant. ⋯ Delirium is a common, but often unrecognized, diagnosis in the intensive care unit. Its early recognition and treatment may prevent unnecessary use of narcotics and benzodiazepines, decrease length of stay and may improve long-term neurocognitive function. This case report describes an infant who developed discrete, consecutive episodes of delirium following surgery for congenital heart disease. Both episodes were treated effectively with olanzapine.
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Bedside ultrasound, as performed by the intensivist, is gaining in popularity and has become a powerful tool to understand the physiological state of the critically ill patient and to decrease procedural risks. This review assesses clinical applications of bedside ultrasound in the pediatric intensive care unit. ⋯ Variable, per individual studies. MAIN RESULTS/CONCLUSIONS: Bedside ultrasound, as practiced by the pediatric intensivist, has the potential to improve pediatric critical care medicine, but data supporting its use is limited. Further studies are needed to explore applications, with specific emphasis on the training and experience of ultrasound operators. There is a need for a standardized educational curriculum, and questions remain as to the optimal mode of education and quality assurance of ultrasound operators.
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Pediatr Crit Care Me · Nov 2011
Benchmarking, public reporting, and pay-for-performance: a mixed-methods survey of California pediatric intensive care unit medical directors.
We sought to assess the attitudes of pediatric intensive care unit medical directors in California regarding the need for, the validity of, and the potential impact of benchmarking, public reporting, and pay-for-performance on pediatric critical care. ⋯ Pediatric intensive care unit medical directors sometimes express contradictory opinions about the merits of shared benchmarking efforts and express concerns across a range of logistic, methodological, and policy issues. These findings raise fundamental questions about how to create clinical performance standards that facilitate quality improvement in the face of a seriously divided constituency. Further, we propose that pediatric intensive care unit medical directors play more active roles in the development, implementation, and communication of shared state-wide data collection.
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Pediatr Crit Care Me · Nov 2011
Inhaled nitric oxide improves systemic microcirculation in infants with hypoxemic respiratory failure.
To investigate the effect of inhaled nitric oxide on the systemic microcirculation. We hypothesized that inhaled nitric oxide improves the systemic microcirculation. Inhaled nitric oxide improves outcome in infants with persistent pulmonary hypertension of the newborn diagnosed by improving pulmonary blood flow and oxygenation. It reduces pulmonary vascular resistance without decline in systemic blood pressure. Inhaled nitric oxide is also utilized in the treatment of acute hypoxemic respiratory failure in children and adults. It is thought to improve regional ventilation perfusion by regional selective pulmonary vasodilation. ⋯ Inhaled nitric oxide improves the systemic microcirculation in children with hypoxemic respiratory failure.
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Pediatr Crit Care Me · Nov 2011
Incidence and risk factors associated with venous thrombotic events in pediatric intensive care unit patients.
To evaluate the incidence and risk factors associated with venous thromboembolism (VTE) in children admitted to pediatric intensive care units (PICUs). ⋯ Children admitted to the PICU have an increased risk of VTE. The presence of a CVC is the strongest risk factor for VTE in this PICU population. Children with VTE were younger, sicker, stayed longer in PICU, and had a higher mortality rate.