Pediatr Crit Care Me
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Pediatr Crit Care Me · Mar 2010
ReviewPreoperative pulmonary hemodynamics and assessment of operability: is there a pulmonary vascular resistance that precludes cardiac operation?
Preoperative pulmonary vascular disease remains an important risk factor for death or right-heart failure in selected children undergoing two-ventricle repair, single-ventricle palliation, or heart transplantation. Preoperative criteria for poor outcome after operation remain unclear. The purpose of this review is to critically assess both the historic and current data and make recommendations where appropriate. ⋯ In children awaiting cardiac transplantation with elevated pulmonary vascular disease of >6 U.m and/or transpulmonary gradient of >15 mm Hg, heart transplantation is deemed feasible in most transplant centers if the administration of inotropes or vasodilators can decrease the pulmonary vascular disease to <6 U.m or transpulmonary gradient to <15 mm Hg. In patients with preoperative pulmonary vascular disease, there may be contributing factors to the pulmonary vascular disease, such as the specifics of the cardiac lesion (atrioventricular valve regurgitation, low cardiac output), parenchymal and/or airway issues, and/or individual genetic predisposition. Amelioration of any reversible factors before operation and optimization of their management in the preoperative and postoperative period are recommended.
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Lung and heart-lung transplantation are accepted treatments for children with end-stage pulmonary vascular disease. This is a review of the current literature and our own experience with lung and heart-lung transplantation for children with pulmonary hypertension of a variety of causes. I reviewed the pertinent literature and our lung transplant database to acquire information and data regarding this subject. ⋯ The major operative complications include those related to the surgical procedure itself (vascular and airway anastomotic stenoses) and those related to graft dysfunction. The 3- and 5-yr survival is approximately 60% and 50%, respectively, for children undergoing lung transplantation for pulmonary hypertension. Although these survival statistics are somewhat poor, transplantation remains the only viable alternative for children with end-stage pulmonary vascular disease failing to respond to medical therapy.
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Pediatr Crit Care Me · Mar 2010
Comparative StudyImpact of hypothermia in the rural, pediatric trauma patient.
Hypothermia is an independent predictor of mortality in adult trauma studies. However, the impact of hypothermia on the pediatric trauma population has not been described. The purpose of this study is to evaluate hypothermia as a cofactor to mortality, complications, and among survivors, hospital length of stay parameters in the pediatric trauma population. ⋯ Hypothermia is a common problem at admission among pediatric trauma patients. Hypothermia is associated with an increase in the odds of death and the development of a bleeding diathesis, while having decreased odds for developing pneumonia. While the length of stay indicators were longer in the hypothermic cohort among survivors, no significant association was noted with hypothermia for hospital, ICU, or ventilator days after controlling for confounders.
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Pediatr Crit Care Me · Mar 2010
ReviewDevelopmental neurotoxicity of sedatives and anesthetics: a concern for neonatal and pediatric critical care medicine?
To evaluate the currently available evidence for the deleterious effects of sedatives and anesthetics on developing brain structure and neurocognitive function. ⋯ Neuronal cell death after neonatal exposure to sedatives and anesthetics has been clearly demonstrated in developing animal models. Although the relevance for human medicine remains speculative, the phenomenon's serious implications for public health necessitate further preclinical and clinical studies. Intensivists using sedatives and anesthetics in neonates and infants need to stay informed about this rapidly emerging field of research.
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Pediatr Crit Care Me · Mar 2010
Comparative StudyConnecting multiple low-flow intravenous infusions in the newborn: problems and possible solutions.
To compare the efficiency of a stopcock system and a newly designed device to titrate low-flow infusions to critically ill infants. ⋯ When using the conventional stopcock array to titrate low-rate infusions, significant delays were observed. A device designed specifically for infusions in infants may substantially improve this system.