Pediatr Crit Care Me
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Pediatr Crit Care Me · May 2007
Case ReportsIncreasing use of extracorporeal life support in methicillin-resistant Staphylococcus aureus sepsis in children.
Pediatric cases of fulminant community-associated methicillin-resistant Staphylococcus aureus (MRSA) infections requiring extracorporeal life support (ECLS) have been reported, but the frequency of ECLS use for severe presentations of staphylococcal disease is unknown. ⋯ The use of ECLS for MRSA infection seems to be increasing both locally and internationally. High mortality rates, particularly in older patients, are concerning and highlight the increasing problem with this pathogen.
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Pediatr Crit Care Me · May 2007
Implementation of a medical emergency team in a large pediatric teaching hospital prevents respiratory and cardiopulmonary arrests outside the intensive care unit.
We implemented a medical emergency team (MET) in our free-standing children's hospital. The specific aim was to reduce the rate of codes (respiratory and cardiopulmonary arrests) outside the intensive care units by 50% for >6 months following MET implementation. ⋯ Implementation of a MET is associated with a reduction in the risk of respiratory and cardiopulmonary arrest outside of critical care areas in a large tertiary children's hospital.
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Pediatr Crit Care Me · May 2007
Case ReportsInstitutional policies on determination of medically inappropriate interventions: use in five pediatric patients.
To describe recent experience using the Texas Advance Directives Act to facilitate care of terminally ill children managed in the two tertiary pediatric hospitals of the Texas Medical Center, Houston, TX. ⋯ Use of institutional policies in accordance with the Texas Advance Directives Act may assist in the care of terminally ill children and their families.
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Pediatr Crit Care Me · May 2007
Mortality before and after initiation of a computerized physician order entry system in a critically ill pediatric population.
A worrisome increase in mortality has been reported recently following the initiation of a computerized physician order entry (CPOE) system in a critically ill pediatric transport population. We tested the hypothesis that such a mortality increase did not occur after the initiation of CPOE in a pediatric population that was directly admitted to the neonatal and pediatric intensive care units at Montefiore Medical Center during two 6-month periods before CPOE and one 6-month period immediately after CPOE was initiated. Mortality in the pre- and post-CPOE time periods was compared, and adjustment for potentially confounding covariates was performed. ⋯ Mortality did not increase during CPOE initiation.
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Pediatr Crit Care Me · May 2007
Pertussis: severe clinical presentation in pediatric intensive care and its relation to outcome.
To describe our institutional experience in the management of infants and children with pertussis admitted during a 20-yr period (January 1985 through December 2004) and also to study the relation between method of presentation and outcome. ⋯ Patients with pertussis, presenting as apnea (with or without cough paroxysms), treated in the pediatric intensive care unit had 100% survival. However, pneumonia as the main reason for admission and the need for circulatory support is associated with a very poor outcome. A deeper understanding of the molecular basis of Bordetella pertussis and its relation to the human host might offer means for future therapies.