Pediatric clinics of North America
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Pediatr. Clin. North Am. · Jun 2008
ReviewForgoing life-sustaining or death-prolonging therapy in the pediatric ICU.
Most deaths in the pediatric intensive care unit occur after a decision to withhold or withdraw life-sustaining treatments. The management of children at the end of life can be divided into three steps. The first concerns the decision-making process. ⋯ The third regards the evaluation of the decision and its implementation. The mission of pediatric intensive care has expanded to provide the best possible care to dying children and their families. Improving the quality of care received by dying children remains an ongoing challenge for every pediatric intensive care unit team member.
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Pediatr. Clin. North Am. · Jun 2008
ReviewMedical errors affecting the pediatric intensive care patient: incidence, identification, and practical solutions.
The complexity of patient care and the potential for medical error make the pediatric ICU environment a key target for improvement of outcomes in hospitalized children. This article describes several event-specific errors as well as proven and potential solutions. Analysis of pediatric intensive care staffing, education, and administration systems, although a less "traditional" manner of thinking about medical error, may reveal further opportunities for improved pediatric ICU outcome.
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This article reviews selected issues of endocrine concerns in the pediatric intensive care unit, exclusive of diabetic ketoacidosis. The sympathoadrenergic arm of the neuroendocrine stress response is described, followed by discussions of two topics of particular current concern: critical illness hyperglycemia and relative adrenal insufficiency. A selected set of common scenarios encountered in the daily practice of intensive care follows.
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Pediatr. Clin. North Am. · Jun 2008
ReviewImmunoparalysis and adverse outcomes from critical illness.
Proper immunologic balance between pro- and anti-inflammatory forces is necessary for recovery from critical illness. Persistence of a marked compensatory anti-inflammatory innate immune response after an insult is termed immunoparalysis. ⋯ Evidence suggests that this may be associated with improved clinical outcomes. Immune-monitoring protocols are needed to identify patients who may benefit from immunomodulatory trials.
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This article explores the use of physician extenders in the pediatric ICU setting. The Libby Zion case is highlighted because of its impact on the use of manpower in the hospital setting. ⋯ Findings indicate a positive impact within the pediatric intensive care setting with the use of NPs and PAs. The American Academy of Pediatrics has supported the use of physician extenders in the care of hospitalized children.