Articles: critical-care.
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Cardiovascular monitoring in pediatrics was previously limited by inappropriate material. Following M. ⋯ These techniques allow the survey and the treatment of latent or patent hemodynamical disturbances with objective data. We describe these invasive techniques and their indications in pediatric intensive care.
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Meningeal penetration of bacteria induces an inflammatory response which affects mainly the endothelium of cerebral vessels. This inflammatory reaction is directly responsible for thrombosis and indirectly creates cerebral oedema and reduced cerebral blood flow. ⋯ Nowadays, control of cerebral oedema is the main goal of intensive care treatment of meningitis that needs invasive monitoring of intracranial pressure. We may hope that in a next future new therapeutic agents will be able to control inflammatory reaction and vascular process.
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An attempt was made to outline a program of intensive care on the basis of experience with 396 patients with hematologic diseases admitted in a critical condition (shock of various genesis, mainly bacterial, acute liver and renal insufficiency, spontaneous hemorrhage, etc.) taking into account the characteristic signs of such patients. The percentage of patients transferred to the hematology department rose from 36.2 to 47.9% as a result of 14-year experience. A conclusion was made of the appropriateness of such a department in each major inpatient hematologic clinic.
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Five years' experience of paediatric intensive care in a district general hospital were analysed retrospectively. A total of 54 infants and children required respiratory support during this time--21 on a high dependency area of the children's ward and 33 on a general intensive care unit. Forty two (78%) of the patients survived, and 33 (61%) of the patients required respiratory support within four hours of admission, thus the experience of the local paediatric and anaesthetic team was crucial to the management of these children. Good intensive care for children can be provided within a district general hospital.