Pediatr Crit Care Me
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Pediatr Crit Care Me · Mar 2011
Tracheal tube airleak in clinical practice and impact on tidal volume measurement in ventilated neonates.
To determine the prevalence, size, and factors affecting tracheal tube (TT) leak in clinical practice and their influence on the displayed tidal volume (Vt) in ventilated newborn infants using uncuffed TTs. Monitoring of Vt is important for implementation of lung-protective ventilation strategies but becomes meaningless in the presence of large TT airleaks. ⋯ TT leak is highly variable, and TT leak of >40% with clinically relevant Vt errors occurred in nearly half of all ventilated neonates. Preterm infants of low birth weight and with small-diameter TTs ventilated for a long period were at greater risk of TT leak.
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Pediatr Crit Care Me · Mar 2011
The use of bumetanide for oliguric acute renal failure in preterm infants.
To determine the effects of bumetanide in preterm infants with oliguric acute renal failure (OARF). ⋯ Bumetanide therapy significantly increased urine output within 24-48 hrs, but its use was associated with a transient increase in serum creatinine level. Bumetanide can be used in preterm infants to reverse oliguria when therapy with furosemide fails. Prospective, randomized, controlled trials with long-term follow-up in preterm infants are necessary to establish the usefulness of bumetanide for OARF.
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Pediatr Crit Care Me · Mar 2011
Use of therapeutic plasma exchange as a rescue therapy in 2009 pH1N1 influenza A--an associated respiratory failure and hemodynamic shock.
Acute pneumonitis with acute lung injury is a cause of significant mortality related to the 2009 pH1N1 influenza A virus. Widespread lung inflammation and increased pulmonary vascular permeability has been noted on autopsy. Also, many of these patients present with significant hemodynamic compromise suggesting systemic cytokine release. Therefore, attenuating circulating cytokines, and other mediators, by blood purification techniques is a theoretically attractive strategy. We report the use therapeutic plasma exchange in three children with 2009 H1N1 related acute lung injury with severe hemodynamic compromise that had failed conventional therapeutic interventions. ⋯ This very limited case series suggest there may be a role for therapeutic plasma exchange as a rescue therapy in severe shock and acute lung injury related to pH1N1 that has not responded to traditional therapy.
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Pediatr Crit Care Me · Mar 2011
Effect of deep hypothermic circulatory arrest followed by low-flow cardiopulmonary bypass on brain metabolism in newborn piglets: comparison of pH-stat and α-stat management.
To compare the effects of pH-stat and α-stat management before deep hypothermic circulatory arrest followed by a period of low-flow (two rates) cardiopulmonary bypass on cortical oxygenation and selected regulatory proteins: Bax, Bcl-2, Caspase-3, and phospho-Akt. ⋯ In this deep hypothermic circulatory arrest-LF model, when flow was 20 mL/kg/min, there was little difference between α-stat and pH-stat management. However, for LF-50, pH-stat management resulted in better cortical oxygenation during recovery and Bax, Bcl-2, pAk, and Caspase-3 changes were consistent with lesser activation of proapoptotic signaling with pH-stat than with α-stat.
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Pediatr Crit Care Me · Mar 2011
Parental presence and visiting policies in Italian pediatric intensive care units: a national survey.
To investigate parental presence and visiting policies in Italian pediatric intensive care units (PICUs). ⋯ In Italian PICUs, there is a marked tendency to apply restrictive visiting policies, not to allow parents 24-hr access at bedside, and to limit the presence of parents during procedures and cardiopulmonary resuscitation. A revision of current policies has begun, signaling a readiness for change.