Pediatr Crit Care Me
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Pediatr Crit Care Me · Nov 2005
CommentCorrelation of the Bispectral Index Monitor with the COMFORT scale in the pediatric intensive care unit.
The COMFORT scale is a commonly used observational scoring system to assess the level of sedation in ventilated children in pediatric intensive care units (PICUs). The bispectral index (BIS) monitor is a processed electroencephalographic parameter that noninvasively measures the hypnotic effect of anesthetic and sedative drugs on the brain. The objective of this study was to assess the degree of correlation between the COMFORT scale and the BIS monitor. ⋯ The BIS monitor may be a valid and useful monitor of the level of sedation of children in the PICU. We cannot expect perfect correlation between BIS values and observational scales because they measure different variables. The BIS monitor may be the best objective monitor currently available for children receiving neuromuscular blockade because it does not rely on subjective measures such as those used in the COMFORT scale. The ability of the BIS monitor to distinguish between very deep levels of sedation may be useful to prevent over-sedation of children in PICUs and to help clarify the appropriate target level of sedation for each child.
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Pediatr Crit Care Me · Nov 2005
Evaluation of tissue saturation as a noninvasive measure of mixed venous saturation in children.
Mixed venous saturation (S & OV0456;o2) is an important measurement that helps guide the care of critically ill patients. Invasive S & OV0456;o2 assessment in infants and children is often avoided because of the inherent risks. A noninvasive tissue saturation (S to 2) monitor has recently been developed that uses near-infrared spectroscopy to measure oxyhemoglobin saturation in muscle. In adult and animal studies, S to 2 correlated with oxygen delivery and S & OV0456;o2. There has been no evaluation in pediatric patients. ⋯ Noninvasive tissue saturation over the deltoid does not correlate with S & OV0456;o2 in children. It is possible that more precise probe spacing, coupled with optimal muscle-mass location, could result in more accurate measures in future investigations.
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Pediatr Crit Care Me · Nov 2005
Posttransfusion equilibration of hematocrit in hemodynamically stable neonates.
To determine whether hematocrit obtained 15 mins after blood transfusion in hemodynamically stable neonates is significantly different from that obtained after 6 hrs. We hypothesized that the hematocrit stabilizes within the first 15 mins that follow a 3-hr blood transfusion in preterm infants. ⋯ The hematocrit obtained 15 mins after the end of a 3-hr blood transfusion in hemodynamically stable, anemic infants is indistinguishable from that obtained after 6 hrs in the same infants. Thus, if the increase of hematocrit is deemed insufficient at 15 mins after the transfusion, it is possible to complete the transfusion without exposing the patient to an additional donor.
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Pediatr Crit Care Me · Nov 2005
Leadership and management training of pediatric intensivists: how do we gain our skills?
Intensivists manage a diverse team of health care professionals. For decades, business literature has recognized the value of leadership and management skills, yet this is relatively unexplored in critical care. ⋯ Although leadership and management training was perceived as important to this sample of pediatric generally young intensivists, most feel inadequately prepared for critical aspects of these responsibilities, most notably, stress and conflict management. These findings provide an opportunity for specific curriculum development in leadership and management for those believing these skills should be further refined.
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Pediatr Crit Care Me · Nov 2005
Increased levels of tumor necrosis factor-alpha and decreased levels of interleukin-12 p 70 in tracheal aspirates, within 2 hrs after birth, are associated with mortality among ventilated preterm infants.
To determine the association of antibacterial interleukin (IL)-12 p 70 levels as well as the pathogen-induced proinflammatory cytokine response in tracheal aspirate (TA) to respiratory failure and mortality among ventilated preterm infants. ⋯ Pathogen-induced excessive production of the proinflammatory cytokine TNF-alpha and lack of antibacterial IL-12 p 70 response in the TA are associated with increased neonatal mortality among ventilated preterm infants.