Pediatr Crit Care Me
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Pediatr Crit Care Me · Jul 2011
Randomized Controlled TrialPrevention of neonatal late-onset sepsis associated with the removal of percutaneously inserted central venous catheters in preterm infants.
Indwelling central venous catheters are the most important risk factors for the development of sepsis attributable to coagulase-negative staphylococci among preterm infants admitted to neonatal intensive care units. In addition, removal of a central venous catheter also may cause coagulase-negative staphylococci sepsis, which may be prevented by the short-term administration of an anti-staphylococcal agent during the procedure of removal. The administration of a specific anti-staphylococcal agent (cefazolin) was evaluated for the prevention of central venous catheter removal-associated coagulase-negative staphylococci sepsis. ⋯ Two doses of the anti-staphylococcal agent cefazolin during the procedure of removal of a percutaneously inserted central venous catheter were effective in the prevention of coagulase-negative staphylococci sepsis. It is recommended to include this regimen in the guidelines on management of central venous catheters in very-low-birth-weight infants.
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Pediatr Crit Care Me · Jul 2011
ReviewNear-infrared spectroscopy as a hemodynamic monitor in critical illness.
Near-infrared spectroscopy has moved from a research tool to a widely used clinical monitor in the critically ill pediatric patient over the last decade. The physiological and clinical evidence supporting this technology in practice is reviewed here. ⋯ Class II, level B evidence supports the conclusion that near-infrared spectroscopy offers a favorable risk-benefit profile and can be effective and beneficial as a hemodynamic monitor for the care of critically patients.
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After its introduction in 1970, the use of the pulmonary artery catheter became a central part of the management of critically ill patients in adult and pediatric intensive care units. However, because it was introduced as a class II device, efficacy for its safety and clinical benefit did not exist during the early years of use. This review describes the pulmonary artery catheter and reviews the literature supporting its use. ⋯ The evidence supporting the use of the pulmonary artery catheter is mostly limited to level IV (nonrandomized, historical controls, and expert opinion) and level V (case series, uncontrolled studies, and expert opinion). A higher level of evidence supports the use of the pulmonary artery catheter in selected pediatric patients, especially those with pulmonary arterial hypertension and shock refractory to standard fluid resuscitation and vasoactive agents. There are no data to suggest that use of the pulmonary artery catheter increases mortality in children.
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Pediatr Crit Care Me · Jul 2011
Clinical TrialEfficacy and safety of lung recruitment in pediatric patients with acute lung injury.
To assess the safety and efficacy of a recruitment maneuver, the Open Lung Tool, in pediatric patients with acute lung injury and acute respiratory distress syndrome. ⋯ Using the modified open lung tool recruitment maneuver, pediatric patients with acute lung injury may safely achieve improved oxygenation and ventilation with these benefits potentially lasting up to 12 hrs postrecruitment maneuver.
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Hemodynamic monitoring in critically ill patients has been considered part of the standard of care in managing patients with shock and/or acute lung injury, but outcome benefit, particularly in pediatric patients, has been questioned. There is difficulty in validating the reliability of monitoring devices, especially since this validation requires comparison to the pulmonary artery catheter, which has its own problems as a measurement tool. Interpretation of the available evidence reveals advantages and disadvantages of the available hemodynamic monitoring devices.