Pediatric clinics of North America
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Pediatr. Clin. North Am. · Jun 2008
ReviewHypothermia therapy for cardiac arrest in pediatric patients.
Cardiac arrest is associated with high morbidity and mortality in children. Hypothermia therapy has theoretical benefits on brain preservation and has the potential to decrease morbidity and mortality in children following cardiac arrest. ⋯ Methods of inducing hypothermia include simple surface cooling techniques, intravenous boluses of cold saline, gastric lavage with ice-cold normal saline, and using the temperature control device with extracorporeal life support. We recommend further study before a strong recommendation can be made to use hypothermia therapy in children with cardiac arrest.
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This article reviews exogenous surfactant therapy and its use in mitigating acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) in infants, children, and adults. Biophysical and animal research documenting surfactant dysfunction in ALI/ARDS is described, and the scientific rationale for treatment with exogenous surfactant is discussed. ⋯ Particular advantages from surfactant therapy in direct pulmonary forms of these syndromes are described. Also discussed are additional factors affecting the efficacy of exogenous surfactants in ALI/ARDS.
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The understanding of the incidence, epidemiology, etiology, and pathophysiology of pediatric cardiac arrest has evolved greatly in the past two decades. This includes recognition that cardiopulmonary resuscitation delays in cardiac arrest are especially injurious, ventricular arrhythmias are not as uncommon in children as previously believed, and four distinct phases of cardiac arrest can be delineated. Performance of, and technologic advances in, the treatment of cardiac arrest make this an exciting time in the field.
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Diabetic ketoacidosis (DKA) is a common, life-threatening complication of diabetes mellitus in children. Central nervous system changes seen in DKA include the altered sensorium seen commonly in DKA and loosely characterized as diabetic coma and the uncommon but worrisome progressively deepening coma caused by cerebral edema, which has both a high morbidity and mortality. This article discusses the assessment and treatment of DKA in the setting of the pediatric ICU.
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Parents are important partners who collaborate with the multidisciplinary team to improve quality of care. This article discusses a framework for action toward quality improvement in pediatric intensive care by parental empowerment through parent satisfaction with care. Incorporating the concepts of family-centered care and parental needs and experiences into a parent satisfaction instrument may provide quality improvement projects based on the empowerment of parents and eventually may facilitate the implementation and evaluation of quality initiatives.