Pediatr Crit Care Me
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Pediatr Crit Care Me · Nov 2011
A spontaneous breathing trial with pressure support overestimates readiness for extubation in children.
To evaluate the performance of an extubation readiness test based on a spontaneous breathing trial using pressure support. ⋯ A spontaneous breathing trial using pressure support set at higher levels for smaller endotracheal tubes overestimates readiness for extubation in children and contributes to a higher failed extubation rate. The objective data obtained during an extubation readiness test may help to identify patients who will benefit from extubation to noninvasive ventilation.
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Pediatr Crit Care Me · Nov 2011
Postmortem studies in the contemporary pediatric intensive care unit.
To describe the implementation of an educational program that achieved high compliance with autopsy requests and consents in a pediatric intensive care unit. To evaluate the concordance between clinical diagnoses and autopsy findings and to identify patient characteristics in which postmortem diagnosis elucidated the primary disease process. ⋯ It is feasible to produce a sustainable increase in the rate of postmortem studies within an organization. Autopsy results added new information to almost half of the patients, particularly those who died soon after admission. A pediatric intensive care unit strategy to increase and maintain compliance with autopsy requests is an important practice with favorable clinical and educational repercussions.
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Pediatr Crit Care Me · Nov 2011
Serratia marcescens outbreak in a neonatal intensive care unit related to the exit port of an oscillator.
To interrupt transmission of Serratia marcescens colonization in a neonatal intensive care unit and determine the source of ongoing transmission. ⋯ Implementation and adherence to infection control measures is essential to prevent transmission of opportunistic pathogens among ventilated infants. Oscillators can generate droplets that travel farther than 1 m from the source.
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Epidemics of acute respiratory disease, such as severe acute respiratory syndrome in 2003, and natural disasters, such as Hurricane Katrina in 2005, have prompted planning in hospitals that offer adult critical care to increase their capacity and equipment inventory for responding to a major demand surge. However, planning at a national, state, or local level to address the particular medical resource needs of children for mass critical care has yet to occur in any coordinated way. This paper presents the consensus opinion of the Task Force regarding supplies and equipment that would be required during a pediatric mass critical care crisis. ⋯ The Task Force endorsed the view that supplies and equipment must be available for a tripling of capacity above the usual peak pediatric intensive care unit capacity for at least 10 days. The recommended size-specific pediatric mass critical care equipment stockpile for two types of patients is presented in terms of equipment needs per ten mass critical care beds, which would serve 26 patients over a 10-day period. Specific recommendations are made regarding ventilator capacity, including the potential use of high-frequency oscillatory ventilation and extracorporeal membrane oxygenation. Other recommendations include inventories for disposable medical equipment, medications, and staffing levels.