Pediatr Crit Care Me
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Pediatr Crit Care Me · May 2006
Multicenter StudyENHANCE: results of a global open-label trial of drotrecogin alfa (activated) in children with severe sepsis.
To gather additional 28-day all-cause mortality data and safety information for pediatric patients with severe sepsis who received drotrecogin alfa (activated) (DrotAA). ⋯ Without a placebo control, no efficacy conclusions are possible. Subgroups at higher risk of death were identified, and the change in protein C level from baseline was predictive of survival. The most significant complication observed was bleeding. Risk factors for serious bleeding appear to be multiple organ failure, thrombocytopenia, and coagulopathy.
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Pediatr Crit Care Me · May 2006
Serial circulating vasopressin levels in children with septic shock.
Septic shock is an important cause of death in pediatric intensive care units. Initial evaluations have shown that vasopressin may have a role in catecholamine refractory shock in adults. It is important to determine whether children with septic shock have deficiency of vasopressin. This will help in defining the role of vasopressin in septic shock. ⋯ The results of our study suggest that vasopressin levels are elevated in children with septic shock and that serial values up to 96 hrs do not show any decline.
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Pediatr Crit Care Me · May 2006
Case ReportsFatal cerebral edema from late-onset ornithine transcarbamylase deficiency in a juvenile male patient receiving valproic acid.
The aims of this report are to 1) present a rare case of fatal cerebral edema associated with late-onset ornithine transcarbamylase (OTC) deficiency in a juvenile male patient receiving valproic acid and 2) review the neuropathologic changes associated with the hyperammonemia. ⋯ OTC deficiency is the most common urea cycle defect causing hyperammonemia. Late-onset presentations of OTC are infrequent, primarily affecting female patients. We present a rare case of a late-onset OTC deficiency in a juvenile male patient receiving valproic acid therapy who developed fatal cerebral edema. Valproic acid exacerbates acute elevations in ammonia and may contribute synergistically with ammonia to cerebral mitochondrial dysfunction.
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Pediatr Crit Care Me · May 2006
Evaluation of a noninvasive cardiac output monitor in mechanically ventilated children.
To compare measurements of cardiac output (CO) and cardiac index (CI) obtained by a recently developed noninvasive continuous cardiac output system, NICO (CONICO), and transthoracic Doppler echocardiography (COTTE) in mechanically ventilated children. ⋯ The NICO system is a new device that measures CO easily and automatically in mechanically ventilated children weighing >15 kg. CO values obtained with this technique were in agreement with those obtained with Doppler echocardiography in children in respiratory and hemodynamic stable condition. The NICO system needs further investigation in children in unstable respiratory and hemodynamic condition.
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Pediatr Crit Care Me · May 2006
Case ReportsHeparin-induced thrombocytopenia in a pediatric patient receiving extracorporeal support and treated with argatroban.
Heparin-induced thrombocytopenia (HIT) is rare in the pediatric population, with a majority occurring in the pediatric intensive care unit setting. All reported cases have been associated with the use of unfractionated heparin. Because unfractionated heparin is the anticoagulant of choice for extracorporeal life support, the development of HIT in these patients can be devastating. We report a case of HIT with evidence of small-vessel arterial thromboembolism in a 17-month-old child receiving extracorporeal membrane oxygenation and continuous renal replacement therapy successfully treated with argatroban. ⋯ This report documents a pediatric case of HIT successfully treated with argatroban, allowing continuation of the venovenous extracorporeal membrane oxygenation and continuous renal replacement therapy, with resolution of the thromboembolic ischemia and thrombocytopenia.