Pediatr Crit Care Me
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Pediatr Crit Care Me · Nov 2008
Intercontinental differences in end-of-life attitudes in the pediatric intensive care unit: results of a worldwide survey.
To examine intercontinental differences in end-of-life practices in pediatric intensive care units. ⋯ This study confirms that important intercontinental differences exist toward end-of-life issues in pediatric intensive care. Although the legal and ethical situation is rapidly evolving, a certain degree of paternalism seems to persist among European and South-American caregivers. This study suggests that ethical principles depend on the cultural roots of countries or continents, emphasizing the need to foster dialogue on end-of-life issues around the world to learn from each other and improve end-of-life care in pediatric intensive care units.
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Pediatr Crit Care Me · Nov 2008
Hyperglycemia is associated with morbidity in critically ill children with meningococcal sepsis.
To determine the association between hyperglycemia and outcome in children ventilated for meningococcal sepsis. ⋯ There was a significant association between hyperglycemia and outcome. Our results support a trial of tight glycemic control in this group of critically ill children.
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Pediatr Crit Care Me · Nov 2008
Dexmedetomidine as the primary sedative during invasive procedures in infants and toddlers with congenital heart disease.
In this report, we describe the use of dexmedetomidine as the primary sedative agent while performing invasive procedures in infants and toddlers with congenital heart disease who are breathing spontaneously. ⋯ Our experience suggests that invasive procedures can be successfully performed in spontaneously breathing infants and toddlers with congenital heart disease using dexmedetomidine alone or in combination with low dose ketamine.
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Pediatr Crit Care Me · Nov 2008
A protocolized approach to identify and manage hyperglycemia in a pediatric critical care unit.
Hyperglycemia is a risk factor for poor outcome in critically ill patients, and glycemic control may decrease morbidity and mortality in adults. There is limited information regarding hyperglycemia and its control in pediatric intensive care. ⋯ Hyperglycemia is prevalent in pediatric intensive care units and may be effectively identified and managed using a protocolized approach.
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Pediatr Crit Care Me · Nov 2008
Case ReportsTransient ventricular dysfunction after an asphyxiation event: stress or hypoxia?
This report of a pediatric patient with acute upper airway obstruction causing asphyxiation emphasizes the need to maintain clinical suspicion for acquired myocardial dysfunction, despite the presumed role of noncardiogenic causes for pulmonary edema after an acute upper airway obstruction. ⋯ Myocardial dysfunction is rarely documented in children after an acute upper airway obstruction or an asphyxiation event. Pediatric intensivists and hospitalists should maintain a high degree of clinical suspicion and screen for possible myocardial dysfunction in the pediatric patient with an acute severe hypoxic event especially when accompanied by pulmonary edema. Prompt evaluation ensures appropriate support. Additionally, some role may exist for early adrenergic receptor blockade.