Pediatr Crit Care Me
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Pediatr Crit Care Me · Nov 2011
Electrical activity of the diaphragm during extubation readiness testing in critically ill children.
To investigate the electrical activity of the diaphragm during extubation readiness testing. ⋯ Patients who generate higher diaphragmatic activity in relation to tidal volume may have better preserved diaphragmatic function and a better chance of passing the extubation readiness test as opposed to patients who generate lower diaphragmatic activity in relation to tidal volume, indicating diaphragmatic weakness. Electrical activity of the diaphragm also may be a useful adjunct to assess neuromuscular drive in ventilated children.
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Pediatr Crit Care Me · Nov 2011
Treatment and triage recommendations for pediatric emergency mass critical care.
This paper will outline the Task Force recommendations regarding treatment during pediatric emergency mass critical care, issues related to the allocation of scarce resources, and current challenges in the development of pediatric triage guidelines. ⋯ Recommendations are divided into three operational sections. The first section provides pediatric emergency mass critical care recommendations for hospitals that normally provide care to pediatric patients. The second section provides recommendations for pediatric emergency mass critical care at hospitals that do not routinely provide care to pediatric patients. The final section provides a discussion of issues related to developing triage algorithms and protocols and the allocation of scarce resources during pediatric emergency mass critical care.
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An emergency mass critical care event puts significant strains on all healthcare resources, including equipment, supplies, and manpower; it leads to extraordinary stresses on healthcare providers, many of whom will be expected to deliver care outside of their usual scope of practice. Education and educational resources will be critically important for training providers and diminishing the stress, anxiety, and chaos of delivering pediatric emergency mass critical care. This article suggests educational tools, as well as potential resources, that need to be developed to cope with a pediatric emergency mass critical care event. ⋯ Identifying educational needs to prepare for a pediatric emergency mass critical care event is essential for all healthcare organizations. Educational strategies and tactics should be developed at multiple levels for a comprehensive approach to preparing for pediatric emergency mass critical care.
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Pediatr Crit Care Me · Nov 2011
Intracranial pressure monitoring in childhood meningitis with coma: a national survey of neurosurgeons in the United States.
To describe the beliefs and attitudes of U.S. neurosurgeons regarding the use of intracranial pressure monitors among comatose children with meningitis. ⋯ Most neurosurgeons are willing to consider monitoring intracranial pressure among comatose children with meningitis in the presence of abnormal findings on computed tomography scan and with older patient age. These findings are instructive in view of the current uncertainty and equipoise in clinical practice regarding intracranial pressure monitoring in these critically ill children.
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Pediatr Crit Care Me · Nov 2011
Case ReportsSuccessful use of extracorporeal membrane oxygenation for pH1N1-induced refractory hypoxemia in a child with hypoplastic left heart syndrome.
To report the first successful use of extracorporeal membrane oxygenation for acute respiratory distress syndrome secondary to 2009 pH1N1 influenza A infection in a child status post the Fontan operation for hypoplastic left heart syndrome. ⋯ Extracorporeal membrane oxygenation can be successfully applied for refractory respiratory failure, even in the setting of significant underlying comorbidity. With emerging data to support the role of extracorporeal membrane oxygenation in improving mortality for refractory hypoxemia secondary to pH1N1, it is prudent to strongly consider the use of extracorporeal support in patients with underlying diseases or comorbidities that may have previously precluded them from being candidates for this therapy.