Pediatr Crit Care Me
-
Pediatr Crit Care Me · Jul 2008
Theory and in vitro validation of a new extracorporeal arteriovenous loop approach for hemodynamic assessment in pediatric and neonatal intensive care unit patients.
No simple method exists for repeatedly measuring cardiac output in intensive care pediatric and neonatal patients. The purpose of this study is to present the theory and examine the in vitro accuracy of a new ultrasound dilution cardiac output measurement technology in which an extracorporeal arteriovenous tubing loop is inserted between existing arterial and venous catheters. ⋯ In vitro validation confirmed the ability of the ultrasound dilution technology to accurately measure small flows and volumes required for hemodynamic assessments in small pediatric and neonatal patients. Clinical studies are in progress to assess the reliability of this technology under different clinical situations.
-
To identify risk factors for pneumothorax in very low birth weight infants. ⋯ Pneumothorax is associated with factors present on day of pneumothorax and not with initial ventilation variables or initial severity of lung disease. Decreasing the risk of pneumothorax requires rigorous control of ventilation, including optimizing positive end-expiratory pressure and minimizing peak inspiratory pressure.
-
Pediatr Crit Care Me · Jul 2008
Renal effects of fenoldopam in critically ill pediatric patients: A retrospective review.
Published data describe the use of fenoldopam in adults for treatment of oliguria/anuria and for renal perfusion and protection, but pediatric data are scant. We assessed the effects of fenoldopam on urine output and potential deleterious changes in hemodynamics or serum creatinine in children. ⋯ Fenoldopam increases urine output in select critically ill pediatric patients without requiring escalation of inotropic support. There were no adverse hemodynamic effects or alterations in serum creatinine. Further prospective pediatric studies to define the role of fenoldopam in children are warranted.
-
To examine the prevalence of and risk factors associated with arterial catheterization complications in a large pediatric patient population in an effort to generate hypotheses for future prospective study of arterial catheter placement. ⋯ Complications associated with arterial catheterization are common in critically ill children. Significantly, we were unable to account for the potential confounding effect of central venous catheterization in this study secondary to limitations of ICD-9 coding. This study serves as a hypothesis-generating report of a large pediatric sample and suggests the need to carefully assess arterial catheter-associated complications in a prospective study independent of central venous catheters.
-
Pediatr Crit Care Me · Jul 2008
A multidisciplinary survey on capillary refill time: Inconsistent performance and interpretation of a common clinical test.
Capillary refill time is a common clinical test used in pediatric critical care and emergency medicine. Despite this, we hypothesize that capillary refill time is performed inconsistently and its interpretation by healthcare providers in the acute care setting is variable. ⋯ The results of this single-institution survey show that while most nurses and pediatric trainees reported using capillary refill time on every patient as a test for perfusion, only a few staff physicians reported using capillary refill time on every patient. In addition, although this study shows that the majority of survey responders stated that they used capillary refill time frequently, we observed no consistent response in how they performed and interpreted capillary refill time. Given that the use of this simple, noninvasive clinical test is supported by many pediatric organizations and pediatricians, the results of this study emphasize the need to examine why this test is inconsistently performed by healthcare providers so as to ensure its reliable performance in the future.