Pediatr Crit Care Me
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To develop a reliable predictor of major adverse events after pediatric cardiac surgery, with the aim of reducing mortality of cardiac extracorporeal life support through earlier, more accurate patient selection. ⋯ Lactate and Scvo2 are the only postoperative measurements with predictive power for major adverse events. Forming a ratio of the two (Scvo2/lactate), seems to improve predictive power, presumably by combining their individual predictive strengths. Both measures have excellent specificities but lower sensitivities. Predictive power of single measures is only fair but can be improved, in high risk patients, by monitoring repeated measures over time.
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Pediatr Crit Care Me · Nov 2008
Experience with intravenous enoxaparin in critically ill infants and children.
Subcutaneous administration of enoxaparin is often difficult in special populations, such as premature infants and critically ill children with severe edema. The difficulty achieving adequate anticoagulation in these patients has led to the employment of intravenous enoxaparin in some cases. However, little pharmacodynamic data are available for determining the appropriate dosing and monitoring (by anti-Factor Xa levels) of intravenous enoxaparin. The objective of this study is to report our experience with the use of intravenous enoxaparin in pediatric patients in the intensive care unit. ⋯ Our data show that the pharmacodynamics of intravenous administration is different from subcutaneous administration and deserves further study.
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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.