Pediatr Crit Care Me
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Pediatr Crit Care Me · May 2004
The use of telemedicine to provide pediatric critical care consultations to pediatric trauma patients admitted to a remote trauma intensive care unit: a preliminary report.
Injured pediatric patients in remote communities are often cared for at trauma centers that may be underserved with respect to pediatric specialty services. The objective of this study is to describe a pilot telemedicine project that allows a remote trauma center's adult intensive care unit to obtain nontrauma, nonsurgical-related pediatric critical care consultations for acutely injured children. ⋯ Our report of a trauma intensive care unit based pediatric critical care telemedicine program demonstrates that telemedicine consultations to a remote intensive care unit are feasible and suggests a high level of satisfaction among providers and parents.
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Pediatr Crit Care Me · May 2004
Case ReportsJading in the pediatric intensive care unit: Implications for healthcare providers of medically complex children.
To discuss the phenomenon of jading within the context of the pediatric intensive care unit. ⋯ Jading describes a process of exhaustion whereby apathy, cynicism, and callousness replace the drive to be responsive, to make a difference, and to care. The issue of jading has become an increasing area of concern in the pediatric intensive care unit, due in part to recurring, prolonged admissions, combined with the perception, at times, that continued medical care is fruitless. With a better understanding of the phenomenon of jading, and by reconsidering their own responses, pediatric intensive care unit practitioners can avoid becoming jaded.
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Pediatr Crit Care Me · May 2004
A descriptive study of children dying in the pediatric intensive care unit after withdrawal of life-sustaining treatment.
To examine physiologic and therapeutic changes following withdrawal of life-sustaining treatment in children. ⋯ Forgoing life-sustaining treatment in a small cohort of children at a single institution follows a pattern: Most cases occur after prolonged intensive care unit stays, withdrawal of treatment occurs almost immediately after the decision to withdraw, most treatments are withdrawn simultaneously rather than sequentially, and most patients die within minutes of life-sustaining treatment cessation. This is the first pediatric study to report the time to death after withdrawal of life-sustaining treatment and factors associated with shorter time to death in children.
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Pediatr Crit Care Me · May 2004
Comparative StudyComparison of solute clearance in three modes of continuous renal replacement therapy.
To compare the clearances of low molecular weight molecules using three modalities of continuous renal replacement therapy (CRRT) at the low blood flow rates typically used in pediatric patients. ⋯ CVVHD was superior to predilution CVVH for clearance of urea and creatinine. Postdilution CVVH and CVVHD gave nearly equivalent clearances. At the low blood flow rates used in pediatric patients, which raise concerns about high ultrafiltration during postdilution CVVH causing excessive hemoconcentration and filter clotting, CVVHD appears to be the optimal modality for maximizing clearance of small solutes during CRRT.