Journal of pediatric intensive care
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Noninvasive ventilation has been available for many years for use in the pediatric population. Historically, continuous positive airway pressure and bilevel positive airway pressure modes were used for respiratory diseases, including neonatal apnea, bronchiolitis, asthma, and pneumonia. ⋯ Studies have shown that these therapies can decrease the need for intubation and ventilation, decrease length of intensive care days, and increase patient comfort. Additional research is needed to support optimal setting selection and recommendations for the use of noninvasive therapies for infants and children.
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J Pediatr Intensive Care · Sep 2014
ReviewEthical challenges with the advancement of hematopoietic stem cell transplant.
Advancements in medical science and pediatric intensive care have significantly improved outcomes for children undergoing hematopoietic stem cell transplantation (HSCT). Critical care management of HSCT patients requires pediatric intensivists to deal with ethical issues including aggressiveness of care and futility, limiting treatment, shared decision-making with families of critically ill children, and decision-making in the context of multi-disciplinary management of complex patients. This paper will discuss the fundamental ethical principles to enable pediatric intensivists to address questions of medical decision-making. ⋯ A framework for end of life communication with families will be provided. Finally, this paper will discuss the potential conflicts resulting from multi-disciplinary care of the HSCT patient in the pediatric intensive care unit. As medical management of the HSCT patient continues to evolve, awareness of the ethical issues surrounding their care is important for both patient and provider.
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J Pediatr Intensive Care · Mar 2014
Utility of daily routine portable chest X-ray in mechanically ventilated patients in the pediatric intensive care unit.
The utility of daily routine chest X-rays (CXRs) in mechanically ventilated patients in intensive care units is still controversial. The present study compared the diagnostic, therapeutic and outcome efficacy between daily routine and non-routine (clinically indicated) CXRs in children patients in pediatric intensive care unit (PICU). A prospective randomized study conducted in tertiary center 18-bed PICU, Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia. ⋯ Also, the percentage of CXRs with new findings that result in intervention was higher in non-routine group (78% vs. 69%; OR = 1.60; 95% CI = 0.50-5.70). The daily routine CXRs was not associated with a reduced effect on length of stay in PICU and hospital or mortality and it does not seem to add any advantages over non-routine CXRs in PICU. Large multicenter studies are needed to confirm these results.
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J Pediatr Intensive Care · Sep 2013
SpO2/FiO2 as a predictor of non-invasive ventilation failure in children with hypoxemic respiratory insufficiency.
Generally, monitoring of hypoxemia has been always based on partial pressure of arterial oxygen to fraction of inspired oxygen ratio; recently it was confirmed a good correlation between this ratio and a non-invasive alternative ratio of oxygen saturation to fraction of inspired oxygen (SF ratio = SpO2/FiO2). The SF ratio has been studied and validated, especially in the intubated patients, however studies monitoring patients treated with non-invasive ventilation (NIV) are lacking. The aim of the study was to determine if the SF ratio is a reliable predictive factor for failure of NIV in pediatric patients diagnosed with hypoxemic acute respiratory failure due to pneumonia. ⋯ Multivariable analysis revealed the SF ratio at two hours to be an independent predictor of NIV failure (odds ratio = 0.96, 95% confidence intervals 0.93-0.99; P = 0.015). Area Under Receiver Operating Characteristic curve = 0.90 (95% confidence interval = 0.79 to 1.000), optimal cut off value for SF at 2 hours ≤ 189; sensitivity = 86%, specificity = 74%. In conclusion, the SF ratio of 189 or less at 2 hours of NIV seems to be useful for predicting NIV failure in this cohort.
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J Pediatr Intensive Care · Jun 2013
Case ReportsNeurogenic pulmonary edema in an infant with ventriculoperitoneal shunt malfunction.
Neurogenic pulmonary edema (NPE) and neurogenic stunned myocardium are known complications of acute neuropathology, but these conditions have only rarely been reported with ventriculoperitoneal shunt malfunction. Furthermore, shunt malfunction presenting with NPE has not been described in a pediatric patient. A case of acute shunt malfunction and NPE followed by a complicated cardiopulmonary clinical course is reviewed.