Pediatr Crit Care Me
-
Pediatr Crit Care Me · Sep 2005
Comparative StudyHemolytic characteristics of three commercially available centrifugal blood pumps.
As compared with traditional extracorporeal roller-occlusion blood pumps, nonocclusive centrifugal pumps offer the benefits of requiring a smaller circuit surface area and, thus, a smaller prime volume. However, centrifugal blood pumps have been reported to generate unacceptable levels of hemolysis. We hypothesize that the newer generation centrifugal pumps have an incidence of hemolysis similar to the traditional roller head pumps and, thus, could be used for extracorporeal membrane oxygenation circuits. ⋯ These data are encouraging for the development of a low-prime, mobile neonatal extracorporeal membrane oxygenation circuit using centrifugal pump technology.
-
Nesiritide (synthetic B-type natriuretic peptide) has been shown to be effective in the management of acute decompensated heart failure in adults. The role of nesiritide in pediatric heart failure has not been examined. In the present study, we reviewed our initial experience with nesiritide in children with primary heart failure or low cardiac output after heart surgery. ⋯ Nesiritide is well tolerated in children with heart failure and is associated with improved diuresis. Further prospective studies will be needed to compare nesiritide with other vasoactive agents and examine the cost-efficacy of this therapy.
-
Pediatr Crit Care Me · Sep 2005
Comparative Study Controlled Clinical TrialComparison of temporal artery thermometer to standard temperature measurements in pediatric intensive care unit patients.
To determine the accuracy of noninvasive infrared temporal artery thermometry compared with rectal, axillary, and pulmonary artery catheter measurements in pediatric intensive care patients, and to determine whether temporal artery temperatures are affected by circulatory shock or by vasopressor use. We hypothesized that temporal artery temperatures do not differ from axillary and rectal temperatures in critically ill children, but temporal artery accuracy is decreased by shock or vasopressor use. ⋯ Temporal artery and axillary temperature measurements showed variability to rectal temperatures but had marked variability in febrile children. Neither was sufficiently accurate to recommend replacing rectal or other invasive methods. As temporal artery and axillary provide similar accuracy, temporal artery thermometers may serve as a suitable alternative for patients in whom invasive thermometry is contraindicated.
-
To describe survival to intensive care unit (ICU) discharge and 6-month survival in a large cohort of pediatric oncology patients with severe sepsis. ⋯ In a large series of pediatric oncology patients with severe sepsis, ICU mortality was only 17% overall, although mortality remained quite high in the higher acuity patients. Mortality among the higher acuity patients was significantly associated with only a small number of variables. The number of patients alive at 6 months and the encouraging ICU survival rate further justifies the use of aggressive ICU interventions in this population.
-
Pediatr Crit Care Me · Sep 2005
ReviewLiver support for fulminant hepatic failure: is it time to use the molecular adsorbents recycling system in children?
To describe the main liver support devices used for fulminant hepatic failure (FHF) and to review data on the Molecular Adsorbents Recycling System (MARS) and assess its efficiency in children. ⋯ Although promising preliminary results suggest that MARS may have a significant position in the therapeutic arsenal for FHF, no sufficient data exist to justify its use in children. For as long as the results of the ongoing adult trial are not available, the indications of this expensive technique in children with FHF are limited.