Pediatr Crit Care Me
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Pediatr Crit Care Me · Nov 2011
Case ReportsNeurogenic stunned myocardium presenting as left ventricular hypertrabeculation in childhood: a variant of Takotsubo cardiomyopathy?
To report the first case of neurogenic stunned myocardium presenting with heart left ventricle noncompaction requiring intensive care in the perioperative period of tension tumor-induced hydrocephalus. ⋯ This report describes a unique presentation of myocardial stunning in association with an intracranial illness, namely, a hypertensive hydrocephalus complicating an intracranial neoplasm.
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Pediatr Crit Care Me · Nov 2011
Patient safety culture in a Dutch pediatric surgical intensive care unit: an evaluation using the Safety Attitudes Questionnaire.
Nowadays, the belief is widespread that a safety culture is crucial to achieving patient safety, yet there has been virtually no analysis of the safety culture in pediatric hospital settings so far. Our aim was to measure the safety climate in our unit, compare it with benchmarking data, and identify potential deficiencies. ⋯ Although on most domains the safety culture in our unit was good when compared to benchmark data, there is still room for improvement. This requires us to continue working on interventions intended to improve the safety culture, including crew resource management training, safety briefings, and senior executive walk rounds. More research is needed into the impact of creating a safety culture on patient outcomes.
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Pediatr Crit Care Me · Nov 2011
Case ReportsProlonged venovenous extracorporeal membrane oxygenation in a child with leukemia and persistent bacteremia.
In patients who require extracorporeal membrane oxygenation for prolonged periods, it is uncertain whether nosocomial bacteremia that persists throughout an entire extracorporeal membrane oxygenation run can be associated with good outcomes. ⋯ Sustained bacteremia during an extracorporeal membrane oxygenation run should not be regarded as a reason to withdraw extracorporeal support, although efforts are clearly warranted to identify possible sources of sepsis and wean off extracorporeal membrane oxygenation at the earliest opportunity.
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Pediatr Crit Care Me · Nov 2011
Critical evaluation of emergency stockpile ventilators in an in vitro model of pediatric lung injury.
Modern health care systems may be inadequately prepared for mass casualty respiratory failure requiring mechanical ventilation. Current health policy has focused on the "stockpiling" of emergency ventilators, though little is known about the performance of these ventilators under conditions of respiratory failure in adults and children. In this study, we seek to compare emergency ventilator performance characteristics using a test lung simulating pediatric lung injury. ⋯ Multiple ventilators are available for the provision of ventilation to children with respiratory failure in a mass casualty scenario. Few of these ventilators possess the minimum alarm functionality and consistently deliver the prescribed tidal volume that allows for safe and effective ventilation of critically ill pediatric patients. These findings will help clinicians understand the performance and limitations of available ventilators intended for use in children.
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Pediatr Crit Care Me · Nov 2011
The association of age, illness severity, and glycemic status in a pediatric intensive care unit.
Tight glycemic control in critically ill children is controversial. The benefits of controlling hyperglycemia may be offset by the risk of hypoglycemia on the immature brain. Both age and severity of illness may influence the risks and benefits of tight glycemic control. We hypothesize that rates of hypoglycemia (blood glucose <60 mg/dL) and hyperglycemia (blood glucose >150 mg/dL) in children will correlate with age and illness severity. ⋯ The youngest patients are at higher risk for spontaneous hypoglycemia, whereas hyperglycemia occurs more often in the older ages. Higher rates of hypo-/hyperglycemia were noted in sicker patients and in those requiring more therapeutic interventions. Our results suggest that special consideration should be given to the safety of the youngest patients given their higher risk of hypoglycemia if an investigation of tight glycemic control is performed.