Pediatr Crit Care Me
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Pediatr Crit Care Me · May 2007
Case ReportsSuccessful use of extracorporeal membrane oxygenation in severe necrotizing pneumonia caused by Staphylococcus aureus.
To report the successful use of extracorporeal membrane oxygenation (ECMO) as rescue therapy for severe necrotizing pneumonia secondary to infection by the Staphylococcus aureus species. ⋯ ECMO as rescue support should be considered in a timely fashion for refractory hypoxemic respiratory failure resulting from S. aureus pneumonia, including patients with necrotizing pneumonia. Use of ECMO support in such cases, coupled with aggressive measures aimed at minimizing bleeding, such as the use of activated factor VII, may result in excellent short- and long-term outcomes for such patients.
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Pediatr Crit Care Me · May 2007
Transhepatic Broviac catheter placement for long-term central venous access in critically ill children with complex congenital heart disease.
Critically ill children with cardiac disease often require prolonged central venous access. Thrombosis of systemic veins or the need to preserve vessels for future cardiac procedures limits sites for placement of central venous catheters in these patients. This study evaluates the use of Broviac placement via the transhepatic approach for this patient population. ⋯ Transhepatic Broviac catheters can be used safely in critically ill children with cardiac disease and remain indwelling for adequate periods of time. This modality of prolonged vascular access should be considered for children whose veins are occluded or need to be preserved for future procedures.
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Pediatr Crit Care Me · May 2007
Identification of adrenal insufficiency in pediatric critical illness.
To determine physicians' beliefs and practices regarding adrenal dysfunction in pediatric critical illness. ⋯ There is no consensus among pediatric intensivists or endocrinologists as to how often adrenal insufficiency occurs in pediatric critical illness or how to diagnose this condition. Despite this lack of consensus, however, many pediatric intensivists would empirically treat hypotensive patients who they suspect may have adrenal insufficiency. Prospective studies are required to determine the definition, frequency, and appropriate treatment of adrenal insufficiency in critically ill pediatric patients.
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Pediatr Crit Care Me · May 2007
Editorial CommentComputerized physician order entry: friend or foe?