Pediatr Crit Care Me
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Pediatr Crit Care Me · Nov 2011
Pediatric emergency mass critical care: focus on family-centered care.
Pediatric emergency mass critical care during disasters requires modifications to standard healthcare operations. Modification of standards for pediatric emergency mass critical care should include incorporation of family-centered care principles. Family-centered care, which is an integral aspect of current pediatric practice, encourages active participation of the child's family in medical care delivery. While family-centered care should be practical in most disasters, whether we can operationalize it in pediatric emergency mass critical care is unknown. However, every effort to adhere to the principles should be made. This manuscript addresses some of the basic tensions that exist between creating efficient disaster-related standards and offering family-centered care by augmenting the concepts outlined elsewhere in the supplement with practical suggestions on incorporating family-centered care. In addition, this manuscript demonstrates how family-centered care benefits not only children and families, but also the staff providing care to pediatric patients in disasters. ⋯ This paper offers a list of practical suggestions for incorporating family-centered care principles into each of the following healthcare settings during a disaster, including a pediatric emergency mass critical care event: emergency medical services transport, emergency departments, pediatric intensive care units, general pediatric wards, and alternative sites. Disaster and pediatric emergency mass critical care responses must incorporate family-centered care principles to the extent possible in a variety of healthcare settings.
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Pediatr Crit Care Me · Nov 2011
Case ReportsMesentric oxygen saturations in premature twins with and without necrotizing enterocolitis.
To report the use of near-infrared spectroscopic monitoring to recognize mesenteric oxygen desaturations in a preterm neonate with necrotizing enterocolitis as well as the demonstration of reassuring mesenteric tissue perfusion in a twin sibling with an uncomplicated course. ⋯ The use of optical oximetry to monitor mesenteric tissue saturation may provide a measure of bowel perfusion that could enhance clinical management in at-risk preterm neonates.
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Pediatr Crit Care Me · Nov 2011
Case ReportsVentricular assist device as a bridge to transplant, and extracorporeal membrane oxygenation for primary graft failure in a child with hemophilia A.
To report the management of hemophilia in a patient with dilated cardiomyopathy during application of the Berlin-Heart biventricular assist. ⋯ Selection of anticoagulant therapy as a function of patient status in terms of bleeding and surgical-wound scarring progress is vital for the proper functioning of support techniques (Berlin-Heart biventricular assist and extracorporeal membrane oxygenation) in hemophiliac patients. Collagen dressings placed on surgical wounds achieved good functional and aesthetic results, as well as mechanically isolating the scars from the exterior.
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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
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.