Pediatr Crit Care Me
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Pediatr Crit Care Me · Mar 2009
Derivation and validation of an equation for adjustment of neuron-specific enolase concentrations in hemolyzed serum.
To derive and validate a formula to allow for adjustment of serum neuron-specific enolase (NSE) concentrations based on the amount of hemolysis in the sample. To compare the accuracy of qualitative and quantitative assessment of hemolysis. ⋯ We retrospectively derived and prospectively validated an equation for adjusting serum NSE concentrations based on the amount of hemolysis in the sample. Use of this formula will allow for accurate measurement of NSE even in hemolyzed sample and may improve its usefulness as a marker of brain injury in children. Qualitative assessment of the degree of hemolysis is not accurate and should not be used.
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Pediatr Crit Care Me · Mar 2009
Simulation at the point of care: reduced-cost, in situ training via a mobile cart.
The rapid growth of simulation in health care has challenged traditional paradigms of hospital-based education and training. Simulation addresses patient safety through deliberative practice of high-risk low-frequency events within a safe, structured environment. Despite its inherent appeal, widespread adoption of simulation is prohibited by high cost, limited space, interruptions to clinical duties, and the inability to replicate important nuances of clinical environments. We therefore sought to develop a reduced-cost low-space mobile cart to provide realistic simulation experiences to a range of providers within the clinical environment and to serve as a model for transportable, cost-effective, widespread simulation-based training of bona-fide workplace teams. ⋯ By bringing all pedagogical elements to the actual clinical environment, a mobile cart can provide simulation to hospital teams that might not otherwise benefit from the educational tool. By reducing the setup cost and the need for dedicated space, the mobile approach provides a mechanism to increase the number of institutions capable of harnessing the power of simulation-based education internationally.
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Pediatr Crit Care Me · Mar 2009
Case ReportsThromboelastography to direct the administration of recombinant activated factor VII in a child with traumatic injury requiring massive transfusion.
To describe the use of thromboelastography (TEG) to direct hemostatic resuscitation in a child with traumatic injury requiring massive transfusion. ⋯ Our clinical and TEG laboratory results postresuscitation support the potential use of TEG as a tool to direct hemostatic resuscitation in patients with severe trauma requiring massive transfusion. TEG is a quick and focused method of qualitatively assessing the entire coagulation cascade, from clot formation to fibrinolysis that permits a targeted transfusion approach to the treatment of coagulopathy. TEG has the potential to rapidly and effectively direct hemostatic resuscitation in patients with the coagulopathy of trauma.
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Pediatr Crit Care Me · Mar 2009
Procalcitonin versus C-reactive protein and immature-to-total neutrophil ratio as markers of infection after cardiopulmonary bypass in children.
To document concentrations of procalcitonin (PCT), C-reactive protein (CRP), and immature-to-total neutrophil ratio (ITR), postcardiopulmonary bypass (CPB), and to test the hypothesis that PCT is a more reliable marker of infection than CRP or ITR in the post-CPB child. ⋯ CRP was a poor marker of sepsis in this study. Children with a PCT <2.2 ng/mL or ITR <0.08 were unlikely to have definite or probable sepsis. However, only a third of children with high values of PCT and ITR had definite or probable sepsis.
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Pediatr Crit Care Me · Mar 2009
Case ReportsMonitoring biochemical parameters as an early sign of propofol infusion syndrome: false feeling of security.
The aim of this report is to describe a fatal case of propofol infusion syndrome (PRIS), despite regular screening for this syndrome and immediate discontinuation of the infusion after the first signs of biochemical derangement. ⋯ This case report demonstrates that frequent monitoring of biochemical parameters, as suggested in literature, cannot always prevent death due to PRIS.