Pediatr Crit Care Me
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Pediatr Crit Care Me · Jan 2009
ReviewClinical decision support systems in the pediatric intensive care unit.
To review the use of clinical decision support systems (CDSS) available in the pediatric intensive care unit (PICU). ⋯ CDSS have the potential to improve clinical practice in PICU settings. Care should be taken when selecting and implementing such systems to achieve the goal of improved clinical practice while avoiding potential adverse impacts sometimes associated with the implementation of new technologies in complex healthcare settings.
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The aims of this review were to summarize a) the consensus definitions of normal and pathologic intra-abdominal pressure (IAP); b) the techniques to measure IAP; c) the risk factors for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS); d) the pathophysiology of ACS; and e) the current recommendations for management and prevention of ACS. ⋯ A widespread awareness of the recognition and current approach to management and prevention of IAH and ACS is needed among pediatric intensivists, so outcome of these life-threatening disease processes might be improved.
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Pediatr Crit Care Me · Jan 2009
Multicenter StudyHigh-alert medications in the pediatric intensive care unit.
To identify pediatric intensive care unit (PICU) clinicians' perceptions of high-alert medications and to develop a PICU-specific, high-alert medications list. We hypothesize that a PICU-specific list will include medications not identified on the Institute for Safe Medications Practices list and that the high-alert medications identified will differ by PICU clinician type (physicians, nurses, pharmacists). ⋯ PICU clinicians identified high-alert medications not identified on the Institute for Safe Medications Practices list. Risks of the identified high-alert medications were attributed to a wide range of different stages in the medication process as well as clinicians' varying experiences in the medication process.
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Pediatr Crit Care Me · Jan 2009
Comparative StudyMeropenem use and colonization by antibiotic-resistant Gram-negative bacilli in a pediatric intensive care unit.
The carbapenems are broad-spectrum beta-lactam antibiotics with activity against most organisms encountered in the pediatric intensive care unit (PICU). In anticipation of their increased use in critically ill children, we measured the effect of sustained meropenem use on the pattern of Gram-negative bacillus colonization in patients admitted to a tertiary care PICU. ⋯ There was no statistically detectable effect on the prevalence of colonization by Gram-negative organisms resistant to one or more classes of broad-spectrum parenteral antibiotics, or to colonization by organisms resistant specifically to meropenem, when meropenem was the preferred antibiotic in a PICU.
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To review the epidemiology of pediatric multiple organ dysfunction syndrome (MODS) and summarize current concepts regarding the pathophysiology of shock, organ dysfunction, and nosocomial infections in this population. ⋯ Over the last 20 yrs, there has been an increasing knowledge on the epidemiology of pediatric MODS and on the physiologic mechanisms involved in the genesis of organ dysfunction. Nevertheless, further studies are needed to more clearly evaluate what is the long-term outcome of pediatric MODS.