Pediatric clinics of North America
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Pediatr. Clin. North Am. · Jun 2013
ReviewAdvances in recognition, resuscitation, and stabilization of the critically ill child.
Advances in early recognition, effective response, and high-quality resuscitation before, during, and after cardiac arrest have resulted in improved survival for infants and children over the past 10 years. This review addresses several key factors that can make a difference in survival outcomes, including the etiology of pediatric cardiac arrests in and out of hospital, mechanisms and techniques of circulation of blood flow during cardiopulmonary resuscitation (CPR), quality of CPR, meticulous postresuscitative care, and effective training. Monitoring and quality improvement of each element in the system of resuscitation care are increasingly recognized as key factors in saving lives.
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Telemedicine technologies involve real-time, live, interactive video and audio communication and allow pediatric critical care physicians to have a virtual presence at the bedside of any critically ill child. Telemedicine use is increasing and will be a common technology in remote emergency departments, inpatient wards, and pediatric intensive care units. There is mounting data that demonstrate that the use of telemedicine technologies can result in higher quality of care, more efficient resource use and improved cost-effectiveness, and higher satisfaction among patients, parents, and remote providers compared to current models of care.
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Pediatr. Clin. North Am. · Jun 2013
ReviewAdvances in monitoring and management of pediatric acute lung injury.
This article focuses on the respiratory management and monitoring of pediatric acute lung injury (ALI) as a specific cause for respiratory failure. Definitive, randomized, controlled trials in pediatrics to guide optimal ventilatory management are few. ⋯ Careful monitoring of the patient's respiratory status with airway graphic analysis and capnography can be helpful. Definitive data are needed in the pediatric population to assist in the care of infants, children, and adolescents with ALI to improve survival and functional outcome.
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Pediatr. Clin. North Am. · Jun 2013
ReviewFamily-centered care in the pediatric intensive care unit.
Patient-centered and family-centered care (PFCC) has been endorsed by many professional health care organizations. Although variably defined, PFCC is an approach to care that is respectful of and responsive to the preferences, needs, and values of individual patients and their families. Research regarding PFCC in the pediatric intensive care unit has focused on 4 areas including (1) family visitation; (2) family-centered rounding; (3) family presence during invasive procedures and cardiopulmonary resuscitation; and (4) family conferences. Although challenges to successful implementation exist, the growing body of evidence suggests that PFCC is beneficial to patients, families, and staff.
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Because pediatric intensive care units (PICUs) improve survival for a range of acute diseases, attention has turned toward ensuring the best possible functional outcomes after critical illness. The neurocritical care of children is of increasing interest. ⋯ This article reviews the special challenges faced by PICUs with regards to diseases, technologies, and skills and the progress that has been made in treatment, monitoring, and prognostication. Recent advances in translational research expected to modify the field in the near-term are described.