Pediatr Crit Care Me
-
Pediatr Crit Care Me · May 2010
Case ReportsOmphalocele and alveolar capillary dysplasia: a new association.
First report of an infant with coexistent omphalocele and alveolar capillary dysplasia. ⋯ This is the first description of an association between omphalocele and alveolar capillary dysplasia. In newborns with omphalocele who have severe respiratory insufficiency and pulmonary hypertension, alveolar capillary dysplasia should be considered.
-
Pediatr Crit Care Me · May 2010
Case ReportsTherapeutic bilateral lung lavage in a child with pulmonary alveolar proteinosis.
Pulmonary alveolar proteinosis is a rare condition that can cause life-threatening respiratory failure attributable to excessive alveolar accumulation of surfactant proteins. The standard treatment for removing these secretions is through therapeutic bilateral lung lavage. Descriptions of procedures for performing therapeutic bilateral lung lavage and methods used to evaluate the overall effectiveness of this invasive procedure in children with pulmonary alveolar proteinosis have not been adequately described in the medical literature. We successfully and safely performed therapeutic bilateral lung lavage and obtained lung mechanics measurements in a child with pulmonary alveolar proteinosis. ⋯ This case report demonstrates that therapeutic bilateral lung lavage can be performed safely and effectively in a pediatric patient with pulmonary alveolar proteinosis by isolating individual lungs using a dual-lumen endotracheal tube. In this patient, therapeutic bilateral lung lavage was found to have a significant impact on lung function and mechanics after this procedure.
-
Pediatr Crit Care Me · May 2010
Reducing the incidence of necrotizing enterocolitis in neonates with hypoplastic left heart syndrome with the introduction of an enteral feed protocol.
Neonates with hypoplastic left heart syndrome are prone to gastrointestinal complications, including necrotizing enterocolitis, during initiation or advancement of enteral feeds. A feeding protocol was developed to standardize practice across a multidisciplinary team. The purpose of this study was to examine the impact of a standardized feeding protocol on the incidence of necrotizing enterocolitis and overall postoperative gastrointestinal morbidity. ⋯ Measures directed at reducing the incidence of necrotizing enterocolitis may reduce morbidity in neonates with hypoplastic left heart syndrome and reduce cost by decreasing hospital length of stay. A standardized feeding protocol instituted to address these problems likely contributed to reducing the incidence of necrotizing enterocolitis in this high-risk population.
-
Pediatr Crit Care Me · May 2010
Critical appraisal of: triaging pediatric critical care resources during a pandemic: ethical and medical considerations.
To identify the ethical norms that should govern the allocation of pediatric critical care resources during a pandemic. ⋯ Although research to develop such scoring systems is ongoing, clinicians will need to rely more heavily on individual diagnoses of acute illnesses with high mortality rates and underlying conditions with short life expectancies and on random allocation methods.
-
Pediatr Crit Care Me · May 2010
The motor response to stimulation predicts outcome as well as the full Glasgow Coma Scale in children with severe head injury.
To evaluate how well the full Glasgow Coma Scale and the motor response, which is a subscore of the Glasgow Coma Scale, predict the outcome in children who have sustained a traumatic brain injury. The best scores in the first 24 hrs were used. ⋯ Both the full Glasgow Coma Scale score and the motor response provide a useful indication of long-term outcome, although neither score is sufficiently accurate to be used to limit treatment. The full Glasgow Coma Scale does not have a linear relationship with mortality, and there is poor interobserver agreement. The motor response should be used in children in preference to the full Glasgow Coma Scale; the predictive power is equivalent to the full Glasgow Coma Scale, there is a linear relationship to mortality, and it is easier to collect accurately.