Pediatr Crit Care Me
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Pediatr Crit Care Me · Jan 2005
Short-term psychiatric adjustment of children and their parents following meningococcal disease.
To assess short-term changes in child and parent psychiatric status following meningococcal disease. ⋯ Admission of children to pediatric intensive care units for meningococcal disease is associated with an increase in and high levels of psychiatric and posttraumatic stress disorder symptoms in children and parents. Length of admission is associated with psychiatric symptoms in children and posttraumatic stress disorder symptoms in parents. Pediatric follow-up should explore psychiatric as well as physical sequelae in children and parents.
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Pediatr Crit Care Me · Jan 2005
Tracheal gas insufflation as a lung-protective strategy: physiologic, histologic, and biochemical markers.
Conventional mechanical ventilation in acute lung failure potentiates lung injury, which can be assessed by physiologic, histologic, and biochemical markers. Thus, new ventilation strategies are directed at reducing lung injury. Tracheal gas insufflation has been shown to reduce endotracheal tube prosthetic deadspace and peak inspiratory pressure during conventional mechanical ventilation. Our objective was to use physiologic, histologic, and biochemical markers to test the hypothesis that tracheal gas insufflation in acute lung injury is lung protective. ⋯ Tracheal gas insufflation resulted in lower ventilatory requirements (peak inspiratory pressure, tidal volume, and deadspace) and a more favorable histologic trend than conventional mechanical ventilation. Tracheal gas insufflation offers potential as a lung-protective strategy for acute lung injury in the developing rabbit lung and may be a useful clinical adjunct to neonatal respiratory management.
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Pediatr Crit Care Me · Jan 2005
Comparative StudyIntraosseous access in the setting of pediatric critical care transport.
To demonstrate safety and efficacy of intraosseous needle placement among health care provider groups in the setting of pediatric critical care transport. ⋯ Intraosseous placement is frequently needed in the care of critically ill pediatric patients before they reach the pediatric intensive care unit. We have demonstrated that intraosseous needles can be placed safely with similar rates of success when comparing different provider groups. Emergency medical technician-paramedics, emergency medicine physicians, and pediatric critical care transport teams should be familiar with intraosseous placement.
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Pediatr Crit Care Me · Jan 2005
Preventing adverse events in the pediatric intensive care unit: prospectively targeting factors that lead to intravenous potassium chloride order errors.
To prospectively identify and reduce proximal causes of error contributing to inappropriate intravenous potassium chloride orders and reduce adverse events subsequent to these ordering errors. ⋯ Simple, blame-free, system-wide interventions designed to reduce proximal causes of error can be an effective, proactive means of reducing the likelihood of medical morbidity.
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Pediatr Crit Care Me · Jan 2005
Case ReportsManagement of a large organized intraatrial catheter-tip thrombus in a child with acquired immunodeficiency syndrome using escalating tissue plasminogen activator infusions.
To describe the dissolution of a large organized intraatrial catheter-tip thrombus using a novel aggressive dose escalation of tissue plasminogen activator infusion. ⋯ Prolonged infusion of tissue plasminogen activator in escalating doses was safe and effective in the management of a large intracardiac catheter-tip thrombus and helped avoid open-heart surgery. In view of the potential hazards of tissue plasminogen activator, close pediatric ICU monitoring is indicated with the use of high-dose tissue plasminogen activator infusions.