Pediatr Crit Care Me
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Pediatr Crit Care Me · May 2010
Emergent endotracheal intubations in children: be careful if it's late when you intubate.
Emergent endotracheal intubations carry a high risk of morbidity and mortality in critically ill adults. Although children may be at higher risk during this procedure as a result of age-related differences in anatomy and physiology, this has not been previously examined. The purpose of this study was to delineate the risks of emergent endotracheal intubations in children. ⋯ Emergent endotracheal intubations are commonly performed in children, are two times more likely to occur off-hours, and are associated with three times the risk of complications as nonemergent intubations.
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Pediatr Crit Care Me · May 2010
The effect of blood transfusion on brain oxygenation in children with severe traumatic brain injury.
The indications for blood transfusion in traumatic brain injury are controversial. In particular, little is known about the effect of blood transfusion in childhood traumatic brain injury. This study aimed to examine the influence of blood transfusion on brain tissue oxygen tension in children with severe traumatic brain injury. ⋯ Brain tissue oxygen tension increased transiently in 79% of blood transfusion in pediatric traumatic brain injury patients, and decreased transiently in 21%. Brain tissue oxygen tension returned to baseline within 24 hrs. Reliable predictors of this brain tissue oxygen tension response to blood transfusion, however, remain elusive.
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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.
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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.
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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.