Indian journal of pediatrics
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To define sepsis and septic shock in children, to outline an approach to treatment in the emergency, critical care units and to outline a global sepsis initiative. ⋯ A collaborative approach to the diagnosis and treatment of sepsis by the Emergency Department and Pediatric Intensive Care Unit can lead to improved outcomes of children with sepsis. Treatment based on a model of escalating levels of care and organ support which takes into consideration the resources available in different settings is likely to improve sepsis outcomes globally. The World Federation Sepsis Initiative (www.wfpiccs.org) is intended to promote treatment based on this model.
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To review contemporary guidelines and therapies for pediatric cardiac arrest and discuss potential novel therapies. ⋯ With only 30% return of spontaneous circulation, 12% survival to hospital discharge and 4% intact neurologic survival, pediatric cardiac arrest remains an area of intense research for therapies to improve its outcomes. In addition to the rapid implementation of basic and advanced life support interventions, new therapies that may have value include mild hypothermia, extracorporeal support, promotion of cerebral blood flow and other more novel therapies targeting oxidative stress, excitotoxicity, neuronal death, and rehabilitation.
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The HIV pandemic has affected children throughout the developing world. This article describes the experience of the Paediatric Intensive Care Unit at the Red Cross War Memorial Children's Hospital in Cape Town, South Africa. ⋯ In the absence of anti-retroviral therapy, long term outcomes from PICU admission of HIV infected children have not improved significantly, and it is debatable whether PICU admission is justified. Once anti-retroviral therapy is available to children, there may be significant improvements in outcome and possible affected children should be admitted to the PICU if resources are available.
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Safe transport of critically ill children remains a globally important issue, particularly in the developing countries such as India and Africa where the high risk mortality and morbidity exists during the transport process that may be less than optimal due to personnel and resource limitation. This article is intended to familiarize the reader with essential components of a good ground pediatric critical care transport program with special reference to developing countries. Essential equipment, medications, training requirement and responsibilities of transport team have been discussed in detail. In addition, recommendations from American (American academy of pediatrics-Transport section) and British pediatric critical care transport systems have been included, keeping in mind the practical feasibility in the Indian scenario where resources are limited.
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Probiotics are "live microbes which when administered in adequate amounts confer a health benefit to the host" (FAO/WHO joint group). Their potential role in bio-ecological modification of pathological internal milieu of the critically ill is under evaluation. Probiotics are available as single microbial strain (e.g., Bacillus clausii, Lactobacillus) or as a mix of multiple strains of Lactobacillus (acidophilus, sporogenes, lactis, reuteri RC-14, GG, and L. plantarum 299v), Bifidobacterium (bifidum, longum, infantis), Streptococcus (thermophillus, lactis, fecalis), Saccharomyces boulardii etc. ⋯ Gap exists in our knowledge regarding mechanisms of action of different probiotics, most effective strains--single or multiple, cost effectiveness, risk-benefit potential, optimum dose, frequency and duration of treatment etc. More information is needed on safety profile of probiotics in immunocompromised state of the critically ill in view of rare reports of fungemia and sepsis and a trend toward possible increase in nosocomial infection. At present, despite theoretical potential benefits, available evidence is not conclusive to recommend probiotics for routine use in the critically ill.