Pediatr Crit Care Me
-
Pediatr Crit Care Me · Sep 2009
Pediatric critical care telemedicine in rural underserved emergency departments.
A disparity in access to health care exists between rural and urban areas. Although 21% of children in the United States live in rural areas, only 3% of pediatric intensivists practice in rural areas. In an attempt to address this issue, we implemented a program of pediatric critical care telemedicine consultations in rural emergency departments (EDs) and report our results. ⋯ With telemedicine, it is feasible to provide urgent subspecialty critical care for children in underserved rural EDs, improve patient care, and provide a high degree of provider satisfaction. Pediatric critical care telemedicine may help to address the disparities in the access to and the outcome of medical care between rural and urban areas.
-
Pediatr Crit Care Me · Sep 2009
The effect of syringe size on reliability and safety of low-flow infusions.
To determine the effect of syringe size on safety and reliability of low-flow infusions at rates relevant to hemodynamically unstable infants. ⋯ Syringe size is related to time to reach steady-state flow, time to alarm occlusion, and variability of low-flow infusions.
-
Pediatr Crit Care Me · Sep 2009
A tale of two bridges: effect of the bloodless bridge on renal function and blood pressure in neonates managed with venoarterial extracorporeal membrane oxygenation.
To investigate if a change in bridge design of the extracorporeal membrane oxygenation (ECMO) circuit had an impact on renal function and blood pressure in neonates requiring venoarterial ECMO support. ⋯ Patients managed on venoarterial ECMO after the transition to the "bloodless" bridge had less hypertension compared with those managed before the bridge change. This may reflect improved maintenance of renal perfusion associated with transition to an ECMO bridge design that does not require intermittent circulation with associated arterial-venous shunting.
-
Pediatr Crit Care Me · Sep 2009
Airway exchange catheters use in the airway management of neonates and infants undergoing surgical treatment of laryngeal stenosis.
Congenital and acquired upper airway obstruction in infants commonly manifests as an acute, potentially life-threatening condition or a slow and gradual deterioration and can be a challenge to the pediatric anesthesiologist. This case series reports the nonconventional use of pediatric airway exchange catheters emergent and short-term airway management and lung ventilation in neonates and infants with severe laryngotracheal stenosis. ⋯ Airway exchange catheters represent a useful additional tool for short-term advanced airway management for both oxygenation and ventilation in neonates and infants presenting with severe laryngotracheal stenosis.
-
Pediatr Crit Care Me · Sep 2009
Effect of injury severity on the incidence and utilization-related outcomes of venous thromboembolism in pediatric trauma inpatients.
The objective of this study was to generate national estimates of the effect of injury severity on the occurrence rate and associated resource utilization-related outcomes of venous thromboembolism (VTE) between pediatric and adolescent trauma inpatients in the United States. ⋯ VTE increases both the length of stay and hospitalization costs independent of injury severity, demonstrating the need to consider thromboprophylaxis in the critically injured population. However, the low overall occurrence rate of VTE in young trauma patients, even in the intensive care unit, highlights the need for additional studies of risk factors and the potential risks of prophylactic anticoagulation, so that thromboprophylaxis can be more directly targeted to the children at highest risk.