Pediatr Crit Care Me
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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.
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Pediatr Crit Care Me · Jan 2009
Comparative StudySerial lactate measurements using microdialysis of interstitial fluid do not correlate with plasma lactate in children after cardiac surgery.
Serial postoperative blood lactate (BL) concentrations have been shown to predict outcome of children after congenital heart surgery (CHS), and interventions aimed at lowering lactate can improve the outcome of these children. The cumulative blood loss for diagnostic purposes, such as repetitive arterial blood sampling in the intensive care unit, contributes, especially in small children, to anemia. Techniques to limit blood loss can therefore be of use. Microdialysis is a technique to monitor tissue chemistry in various clinical settings, and we hypothesized that it may be a valuable alternative for frequent blood sampling to monitor lactate in children after CHS. ⋯ Serial lactate measurements in microdialysis fluid of subcutaneous adipose tissue are feasible, but cannot be used as a reliable interchangeable method for plasma lactate analysis in children after CHS at this time. Whether this technique has its own place in the assessment of the overall hemodynamic status and tissue perfusion in children after CHS needs to be addressed in future studies.
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Pediatr Crit Care Me · Jan 2009
Randomized Controlled TrialLow-dose hydrocortisone in pediatric septic shock: an exploratory study in a third world setting.
To study the efficacy of low-dose intravenous hydrocortisone therapy in the management of pediatric septic shock with respect to the time taken for shock reversal and requirement of inotropes. ⋯ Our data, although, inconclusive favor the need for a study with a larger sample size to clearly define role of low-dose hydrocortisone in pediatric septic shock in developing countries, while taking in consideration effect of malnutrition, delayed presentations, and their interactions with the hypothalamic-pituitary-adrenocortical axis.
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Pediatr Crit Care Me · Jan 2009
Comparative StudyMilrinone enhances relaxation to prostacyclin and iloprost in pulmonary arteries isolated from lambs with persistent pulmonary hypertension of the newborn.
Prostacyclin is a pulmonary vasodilator and is produced by prostacyclin synthase and stimulates adenylate cyclase (AC) via the prostacyclin receptor (IP) to produce cAMP. Forskolin is a direct stimulant of AC. Phosphodiesterase 3 hydrolyzes cAMP and is inhibited by milrinone. ⋯ Prostacyclin and iloprost are dilators of PAs from PPHN lambs and their effect is enhanced by milrinone. This combination therapy may be an effective strategy in the management of patients with PPHN.
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Pediatr Crit Care Me · Jan 2009
Adequate agreement between venous oxygen saturation in right atrium and pulmonary artery in critically ill children.
To determine the agreement between venous oxygen saturation in right atrium (Srao2) and pulmonary artery (Svo2) in critically ill pediatric patients. ⋯ The concordance analysis performed allows to conclude that there is an appropriate agreement between Svo2 and Srao2. This finding may become clinically relevant considering the difficulties associated to the use of PAC in children.