Pediatr Crit Care Me
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Pediatr Crit Care Me · May 2009
Reduction of hospital mortality and of preventable cardiac arrest and death on introduction of a pediatric medical emergency team.
To determine the effect of a medical emergency team (MET) on the incidence of unexpected cardiac arrest and death. ⋯ Introduction of a MET was associated with reduction of total hospital death and reduction of preventable cardiac arrest and death with increased survival in wards of a pediatric hospital. MET calling criteria identified some but not all children at risk of unexpected cardiac arrest and death.
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Pediatr Crit Care Me · May 2009
CommentA critical appraisal of "transfusion strategies for patients in pediatric intensive care units" by Lacroix J, Hebert PC, Hutchison, et al (N Engl J Med 2007; 356:1609-1619).
To review the findings and discuss the implications of transfusion strategies in stable critically ill children. ⋯ Using a restrictive transfusion protocol with a transfusion threshold of 7 g/dL in stable critically ill children is as safe as using a liberal protocol and can decrease the number of patients exposed to RBC transfusions.
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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
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.
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Pediatr Crit Care Me · May 2009
Randomized Controlled TrialEffect of alternative chest compression techniques in infant and child on rescuer performance.
Current chest compression (CC) guidelines for an infant recommend a two-finger (TF) technique with lone rescuer and a two- thumb (TT) technique with two rescuers, and for a child either an one hand (OH) or a two hand (TH) technique with one or two rescuers. The effect of a 30:2 compression:ventilation ratio using these techniques on CC quality and rescuer fatigue is unknown. We hypothesized that during lone rescuer CC, TT technique, in infant and TH in child achieve better compression depth (CD) without additional rescuer fatigue compared with TF and OH, respectively. ⋯ Two-thumb compression provides higher CD and CP compared with TF without any evidence of decay in quality and additional rescuer fatigue over 5 minutes. There was no significant difference in child CC quality or rescuer fatigue between OH and TH. Two-thumb technique is preferred for infant CC and our data support the current guidelines for child CC.