Pediatr Crit Care Me
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Pediatr Crit Care Me · Jul 2011
ReviewLactate and acid base as a hemodynamic monitor and markers of cellular perfusion.
: The intra- and postoperative monitoring of lactate and acid-base has been advocated in pediatric cardiac critical care as surrogate markers of cardiac output, oxygen delivery, and cellular perfusion. Many clinicians use lactate and base excess routinely as markers of tissue perfusion and to assess the effectiveness of their intervention. This review discusses the strengths and weaknesses of using these measurements in pediatric cardiac critical care. ⋯ : Many factors other than tissue hypoxia may contribute to hyperlactemia in critical illness. Although the presence of hyperlactemia on admission appears to be associated with intensive care unit mortality and morbidity in some retrospective analyses, significant overlap between survivors and nonsurvivors means that nonsurvivors cannot be predicted from admission lactate measurement. Persistently elevated postoperative lactate is associated with increased morbidity and mortality in the pediatric cardiac population. To date there is no randomized control trial of goal-directed therapy in adult or pediatric cardiac care that includes normalization of lactate as a target. Overall equivalent time measurements of base excess, anion gap, and pH have a low predictive value for morbidity and mortality in children after cardiac surgery. Lactate is one of a cluster of markers of cellular perfusion and oxygen delivery. Alone, as a single measurement, it has minimal predictive value and is nondiscriminatory for survival.
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Pediatr Crit Care Me · Jul 2011
ReviewBiomonitors of cardiac injury and performance: B-type natriuretic peptide and troponin as monitors of hemodynamics and oxygen transport balance.
Serum biomarkers, such as B-type natriuretic peptide and troponin, are frequently measured in the cardiac intensive care unit. A review of the evidence supporting monitoring of these biomarkers is presented.
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Pediatr Crit Care Me · Jul 2011
ReviewHemodynamic monitoring by transpulmonary thermodilution and pulse contour analysis in critically ill children.
To summarize the physiologic principles underlying the hemodynamic monitoring using the PiCCO device (Pulsion, Munich, Germany) incorporating the transpulmonary thermodilution technique, the pulse contour cardiac output, and estimation of the arterial pressure variation method. Analysis and review of the current literature. ⋯ The PiCCO device may be a useful adjunct for hemodynamic monitoring in critically ill children. Further studies are needed to clarify the reliability and clinical value of pulse contour method and extravascular lung water measurement.
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Pediatr Crit Care Me · Jul 2011
Brain-systemic temperature gradient is temperature-dependent in children with severe traumatic brain injury.
To understand the gradient between rectal and brain temperature in children after severe traumatic brain injury. We hypothesized that the rectal temperature and brain temperature gradient will be influenced by the child's body surface area and that this relationship will persist over physiologic temperature ranges. ⋯ Brain temperature and rectal temperature are generally well-correlated in children with traumatic brain injury. This relationship is different at the extremes of the physiologic temperature range, with the temperature gradient reversed during brain hypothermia and hyperthermia. Given that studies showing neuroprotection from hypothermia in animal models of brain injury generally target brain temperature, our data suggest the possibility that, if brain temperature were the therapeutic target in clinical trials, this would result in somewhat higher systemic temperature and potentially fewer side effects. This relationship may be exploited in future clinical trials to maintain brain hypothermia (for neurologic protection) at slightly higher systemic temperatures (and potentially fewer systemic side effects).
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Pediatr Crit Care Me · Jul 2011
Comparative Study Clinical TrialEvaluation of a new pediatric continuous oximetry catheter.
To evaluate the accuracy of central venous oxygen saturation recordings from a new in-line pediatric oximetry catheter. ⋯ In this limited number of patients, use of the PediaSat venous oximetry catheter was safe and had good agreement with co-oximetry-measured values.