Pediatr Crit Care Me
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To canvass the current opinion of pediatric intensivists in the United Kingdom regarding the importance of hyperglycemia,their approach to management, and their views in relation to a potential intervention trial of tight glycemic control. ⋯ This survey suggests significant variation in the management of hyperglycemia across the UK Practice varies even among intensivists from the same unit, reflecting the fact that few units have 'an agreed written guidance in place.' The majority of intensivists would be prepared to participate in a trial of tight glycemic control.
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Pediatr Crit Care Me · May 2009
Secondary hemophagocytic lymphohistiocytosis and severe sepsis/ systemic inflammatory response syndrome/multiorgan dysfunction syndrome/macrophage activation syndrome share common intermediate phenotypes on a spectrum of inflammation.
In an effort to attain earlier diagnoses in children with hemophagocytic lymphohistiocytosis (HLH), the International Histiocyte Society has now broadened their diagnostic criteria to no longer differentiate primary (HLH) and secondary hemophagocytic lymphohistiocytosis (SHLH). Five of the following eight diagnostic criteria needed to be met: 1) fever, 2) cytopenia of two lines, 3) hypertriglyceridemia and/or hypofibrinogenemia, 4) hyperferritinemia (>500 microg/L), 5) hemophagocytosis, 6) elevated soluble interleukin-2 receptor (CD25), 7) decreased natural killer-cell activity, and 8) splenomegaly can also commonly be found in patients with sepsis, systemic inflammatory response syndrome (SIRS), multiorgan dysfunction syndrome (MODS), and macrophage activation syndrome (MAS). Nevertheless, the therapeutic options for these are radically different. ⋯ MAS has a mortality rate between 8% and 22%. Because SHLH and severe sepsis/SIRS/MODS/MAS share clinical and laboratory inflammatory phenotypes, we recommend extreme caution when considering applying HLH therapies to children with sepsis/SIRS/MODS/MAS. HLH therapies are clearly warranted for children with HLH; however, a quantitative functional estimate of cytotoxic lymphocyte function may be a more precise approach to define the overlap of these conditions, better identify these processes, and develop novel therapeutic protocols that may lead to improved treatments and outcomes.
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Pediatr Crit Care Me · May 2009
An unusual cause of multiple organ dysfunction syndrome in the pediatric intensive care unit: hemophagocytic lymphohistiocytosis.
To report our experience in children with primary or secondary hemophagocytic lymphohistiocytosis (HLH) presented with multiple organ dysfunction syndrome (MODS) in pediatric intensive care unit (PICU). ⋯ HLH is a frequently lethal disease and with a clinical presentation similar to severe sepsis, MODS, disseminated intravascular coagulation, or septic shock, which are frequent diagnoses in the PICU. In the PICU, HLH should be considered in the case of prolonged fever, splenomegaly, cytopenia, and MODS. It is important for pediatricians and particularly pediatric intensivists to know the diagnostic criteria and possible clinical presentations of HLH so treatment is initiated promptly.
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Pediatr Crit Care Me · May 2009
National survey of pediatric critical care medicine fellowship clinical and research time allocation.
Pediatric critical care medicine (PCCM) fellowship programs vary in the number of fellows per program and experiences offered. We evaluated whether program size and rotation distribution affect clinical and research time allocation. ⋯ Data on clinical and research time allocation of U.S. PCCM fellowships can help program directors benchmark their program training time and content. Fellowship size and unit structure do not influence overall allocation of clinical and research time or night call, but impact the number of non-ICU rotations and elective exposures.
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Pediatr Crit Care Me · May 2009
Profile and consequences of children requiring prolonged mechanical ventilation in three Brazilian pediatric intensive care units.
To describe the characteristics of children submitted to prolonged mechanical ventilation (MV), and evaluate their mortality, and associated factors as well as the potential impact at admissions to the pediatric intensive care unit (PICU). ⋯ A small group of children admitted to the PICU requires prolonged MV. The elevated mortality rate is associated with higher ventilatory parameters and vasoactive drug support on the 21st day of MV. Stable children requiring prolonged MV in the PICU potentially prevent additional admissions of a large number of acute and unstable patients.