Pediatr Crit Care Me
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Pediatr Crit Care Me · Jul 2007
Multicenter StudyAcute lung injury in pediatric intensive care in Australia and New Zealand: a prospective, multicenter, observational study.
Acute lung injury (ALI) is poorly defined in children. The objective of this prospective study was to clarify the incidence, demographics, management strategies, outcome, and mortality predictors of ALI in children in Australia and New Zealand. ⋯ ALI in children is uncommon but has a high mortality rate. Risk factors for mortality are easily identified. Ventilatory variables and indexes of lung severity were significantly associated with mortality.
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Pediatr Crit Care Me · Jul 2007
Relationship between physiologic deadspace/tidal volume ratio and gas exchange in infants with acute bronchiolitis on invasive mechanical ventilation.
To evaluate the association between deadspace/tidal volume ratio (Vd/Vt) and gas exchange variables: Pao2, Paco2, Pao2/Fio2, arterial/alveolar oxygen tension ratio (Pao2/PAo2), alveolar-arterial oxygen tension difference/arterial oxygen tension ratio (P(A-a)o2/Pao2), carbon dioxide production (Vco2), ventilation index ([Paco2 x peak inspiratory pressure x mechanical respiratory rate]/1000), and oxygenation index ([mean airway pressure x Fio2 x 100]/Pao2), all measured at an early stage in children with obstructive acute respiratory failure. ⋯ In the study population, Vd/Vt not only reflected ventilatory disorders, as is well recognized, but also was associated with disturbances of oxygenation. These results warrant further evaluation of the usefulness of serial measurement of Vd/Vt as a marker of disease severity in severe acute bronchiolitis and other causes of respiratory failure.
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Pediatr Crit Care Me · Jul 2007
The use of repeated head computed tomography in pediatric blunt head trauma: factors predicting new and worsening brain injury.
Opinion is divided on the value of repeat head computed tomography for guiding clinical management of pediatric patients with blunt head trauma. This study describes the prevalence of worsening brain injury on repeat computed tomography, predictors of worsening computed tomography findings, and the frequency of neurosurgical intervention after the repeat computed tomography. ⋯ Repeat head computed tomography imaging is frequently used. About 30% of repeated computed tomographies showed new or worsening brain injury. However, worsening brain injury on repeat computed tomography rarely resulted in neurosurgical intervention. Patients with moderate or severe head injury and intraparenchymal injuries were more likely to show worsening brain injury and undergo neurosurgical intervention.
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Pediatr Crit Care Me · Jul 2007
Have changes in ventilation practice improved outcome in children with acute lung injury?
To describe the changes that have occurred in mechanical ventilation in children with acute lung injury in our institution over the last 10-15 yrs and to examine the impact of these changes, in particular of the delivered tidal volume on mortality. ⋯ The changes in the clinical practice of mechanical ventilation in children in our institution reflect those reported for adults. In our experience, mortality among children with acute lung injury was reduced by 40%, and tidal volume was independently associated with reduced mortality and an increase in ventilation-free days.
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Pediatr Crit Care Me · Jul 2007
Case ReportsFatal acute fibrinous and organizing pneumonia in an infant: The histopathologic variability of acute respiratory distress syndrome.
The histopathologic pattern of acute fibrinous and organizing pneumonia (AFOP) has been described recently in cases of acute respiratory distress syndrome (ARDS) in adults and differs from the well-recognized pattern of classic diffuse alveolar damage (DAD). The objective of this study was to determine whether similar appearances can be seen in infant ARDS. ⋯ The histopathologic features of AFOP may be seen in some cases of infant ARDS. The variability in the histopathology of ARDS raises questions as to the pathogenesis and clinical correlates of these different patterns.