Pediatr Crit Care Me
-
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.
-
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.
-
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.
-
Pediatr Crit Care Me · May 2009
Pediatricians' attitudes toward resuscitation in children with chronic illnesses.
Do not attempt resuscitation (DNAR) orders are becoming more common in children with chronic illnesses. In this study, we compare pediatricians' attitudes about DNAR orders in four venues. Our hypotheses are: 1) venue matters: acceptance of DNAR varies by where the arrest occurs; 2) specialty affiliation matters: acceptance of DNAR varies by pediatric specialization; and 3) the personal influences the professional: pediatricians are more likely to respect and recommend a DNAR if they would choose DNAR for their own child. ⋯ DNAR decisions have become well accepted in the pediatric community for both end-of-life and poor quality of life cases.
-
Pediatr Crit Care Me · May 2009
Case ReportsA novel use of etomidate for intentional adrenal suppression to control severe hypercortisolemia in childhood.
To describe a novel use for etomidate in critically ill children. Etomidate induction of anesthesia in children is controversial due to adrenal suppression; we review this controversy and describe a therapeutic application of this "side effect" using a continuous etomidate infusion in pediatric intensive care to deliberately suppress critically elevated endogenous cortisol. ⋯ The adrenal suppression caused by etomidate, so controversial in the care of the critically ill at present, can be therapeutically used for short-term control of severe hypercortisolemia in children.