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Pediatric Critical Care Medicine

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https://www.readbyqxmd.com/read/27849657/long-term-follow-up-on-health-related-quality-of-life-after-mechanical-circulatory-support-in-children
#1
Thilo P K Fleck, Georg Dangel, Felix Bächle, Christoph Benk, Jochen Grohmann, Johannes Kroll, Matthias Siepe, Rene Höhn, Janbernd Kirschner, Friedhelm Beyersdorf, Brigitte Stiller
OBJECTIVE: The objective of this study was to evaluate health-related quality of life in long-term survivors of mechanical circulatory support after acute cardiopulmonary failure. DESIGN: Prospective follow-up study. SETTING: Single-institutional in a center for congenital heart disease and pediatric cardiology. PATIENTS: Fifty patients who underwent 58 mechanical circulatory support therapies in our institution from 2001 to 2012...
November 15, 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27849656/the-use-of-nesiritide-in-children-with-congenital-heart-disease
#2
Ronald A Bronicki, Michele Domico, Paul A Checchia, Curtis E Kennedy, Ayse Akcan-Arikan
OBJECTIVE: We evaluated the use of nesiritide in children with critical congenital heart disease, pulmonary congestion, and inadequate urine output despite conventional diuretic therapy. DESIGN: We conducted a retrospective analysis of 26 consecutive patients, comprising 37 infusions occurring during separate hospitalizations. Hemodynamic variables, urine output, and serum creatinine levels were monitored prior to and throughout the duration of therapy with nesiritide...
November 15, 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27846092/pilot-mechanistic-study-of-insulin-modulation-of-somatotrophic-hormones-inflammation-and-lipid-metabolism-during-critical-illness-in-children
#3
Ricardo G Branco, Pedro Celiny R Garcia, Jefferson P Piva, Geniara S Conrado, Felipe Cabral, Cecilia Korb, Humberto Fiori, Matteo Baldisserotto, Robert C Tasker
OBJECTIVES: To evaluate the mechanism of insulin modulation on somatotrophic response, inflammation, and lipid metabolism in critically ill children. DESIGN: Open-label randomized mechanistic study. SETTING: Two-center, tertiary PICU study. PATIENTS: Thirty critically ill children between 1 month and 14 years old, requiring mechanical ventilation and with evidence of two or more organ system failures. INTERVENTIONS: Randomized physiologic design of hyperinsulinemic-euglycemic clamp using continuous insulin infusion at 0...
November 11, 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27832023/rbc-distribution-width-biomarker-for-red-cell-dysfunction-and-critical-illness-outcome
#4
Ahmed S Said, Philip C Spinella, Mary E Hartman, Katherine M Steffen, Ronald Jackups, Richard Holubkov, Mike Wallendorf, Allan Doctor
OBJECTIVES: RBC distribution width is reported to be an independent predictor of outcome in adults with a variety of conditions. We sought to determine if RBC distribution width is associated with morbidity or mortality in critically ill children. DESIGN: Retrospective observational study. SETTING: Tertiary PICU. PATIENTS: All admissions to St. Louis Children's Hospital PICU between January 1, 2005, and December 31, 2012...
November 9, 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27828898/pediatric-ventilator-associated-infections-the-ventilator-associated-infection-study
#5
Douglas F Willson, Michelle Hoot, Robinder Khemani, Christopher Carrol, Aileen Kirby, Adam Schwarz, Rainer Gedeit, Sholeen T Nett, Simon Erickson, Heidi Flori, Spencer Hays, Mark Hall
OBJECTIVE: Suspected ventilator-associated infection is the most common reason for antibiotics in the PICU. We sought to characterize the clinical variables associated with continuing antibiotics after initial evaluation for suspected ventilator-associated infection and to determine whether clinical variables or antibiotic treatment influenced outcomes. DESIGN: Prospective, observational cohort study conducted in 47 PICUs in the United States, Canada, and Australia...
November 8, 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27820718/mannose-binding-lectin-levels-in-critically-ill-children-with-severe-infections
#6
Erik C Madsen, Emily R Levy, Kate Madden, Anna A Agan, Ryan M Sullivan, Dionne A Graham, Adrienne G Randolph
OBJECTIVES: Low mannose-binding lectin levels and haplotypes associated with low mannose-binding lectin production have been associated with infection and severe sepsis. We tested the hypothesis that mannose-binding lectin levels would be associated with severe infection in a large cohort of critically ill children. DESIGN: Prospective cohort study. SETTING: Medical and Surgical PICUs, Boston Children's Hospital. PATIENTS: Children less than 21 years old admitted to the ICUs from November 2009 to November 2010...
November 3, 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27811533/spectral-electroencephalogram-analysis-for-the-evaluation-of-encephalopathy-grade-in-children-with-acute-liver-failure
#7
Craig A Press, Lindsey Morgan, Michele Mills, Cynthia V Stack, Joshua L Goldstein, Estella M Alonso, Mark S Wainwright
OBJECTIVE: Spectral electroencephalogram analysis is a method for automated analysis of electroencephalogram patterns, which can be performed at the bedside. We sought to determine the utility of spectral electroencephalogram for grading hepatic encephalopathy in children with acute liver failure. DESIGN: Retrospective cohort study. SETTING: Tertiary care pediatric hospital. PATIENTS: Patients between 0 and 18 years old who presented with acute liver failure and were admitted to the PICU...
November 1, 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27811532/identifying-children-at-risk-of-malignant-bordetella-pertussis-infection
#8
Anusha Ganeshalingham, Brent McSharry, Brian Anderson, Cameron Grant, John Beca
OBJECTIVE: To identify factors associated with malignant pertussis. DESIGN: A retrospective case notes review from January 2003 to August 2013. Area under the receiver-operator characteristic curve was used to determine how well vital sign and white cell characteristics within 48 hours of hospital presentation identified children with malignant pertussis. SETTING: The national children's hospital in Auckland, New Zealand. PATIENTS: One hundred fifty-two children with pertussis...
November 1, 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27811531/the-impact-of-chronic-health-conditions-on-length-of-stay-and-mortality-in-a-general-picu
#9
Scott O'Brien, Simon Nadel, Ofran Almossawi, David P Inwald
OBJECTIVES: Each year approximately 20,000 children are admitted to PICUs across the United Kingdom. It is highlighted in several international studies that 40-70% of children admitted to PICUs have at least one chronic health condition that leads to increased length of stay and higher mortality rates. The prevalence of chronic health conditions in children admitted to U.K. PICUs is unknown. The purpose of this study was to use existing clinical data to explore the prevalence and impact of chronic health conditions on length of stay and mortality in a tertiary U...
November 1, 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27811530/clinical-examination-does-not-predict-response-to-albuterol-in-ventilated-infants-with-bronchiolitis
#10
Craig M Schramm, Kathleen A Sala, Christopher L Carroll
OBJECTIVE: Bronchiolitis is a common respiratory infection in infants that is sometimes treated with albuterol. Response to albuterol is determined by clinical assessment, but this subjective determination is potentially unreliable. In this study, we compared providers' clinical assessment of response to albuterol with the measurement of response by pulmonary mechanics in intubated, sedated, and ventilated infants. DESIGN: Before and 20 minutes following racemic albuterol therapy, a nurse, respiratory therapist, and physician performed simultaneous examinations and assessed response to albuterol in a population of intubated infants with bronchiolitis...
November 1, 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27811529/adult-outcomes-after-newborn-respiratory-failure-treated-with-extracorporeal-membrane-oxygenation
#11
William A Engle, Karen W West, Gail A Hocutt, Eugenia K Pallotto, Barbara Haney, Rachel J Keith, Dan L Stewart, Ellen Knodel, Denise Suttner, Rachel Chapman, Alison Thomas, Beverly Schwerin, Eileen Stork, Moira Crowley, Anthony J Piazza, Micheal L Heard, Netsanet Gebregziabher, William Fadel, Robert Bartlett
OBJECTIVE: To describe the outcome of young adults treated for hypoxemic respiratory failure with extracorporeal membrane oxygenation as neonates. DESIGN: The study was designed as a multisite, cross sectional survey. SETTING: The survey was completed electronically or on paper by subjects and stored in a secure data base. SUBJECTS: Subjects were surviving neonatal extracorporeal membrane oxygenation patients from eight institutions who were18 years old or older...
November 1, 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27801709/bedside-ultrasound-for-the-diagnosis-of-abnormal-diaphragmatic-motion-in-children-after-heart-surgery
#12
Laura Gil-Juanmiquel, Margarida Gratacós, Yolanda Castilla-Fernández, Joaquim Piqueras, Tracy Baust, Nuria Raguer, Joan Balcells, Santiago Perez-Hoyos, Raul F Abella, Joan Sanchez-de-Toledo
OBJECTIVE: To assess the utility of bedside ultrasound combining B- and M-mode in the diagnosis of abnormal diaphragmatic motion in children after heart surgery. DESIGN: Prospective post hoc blinded comparison of ultrasound performed by two different intensivists and fluoroscopy results with electromyography. SETTING: Tertiary university hospital. SUBJECTS: Children with suspected abnormal diaphragmatic motion after heart surgery...
October 28, 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27801708/pediatric-critical-care-transport-as-a-conduit-to-terminal-extubation-at-home-a-case-series
#13
Corina Noje, Meghan L Bernier, Philomena M Costabile, Bruce L Klein, Sapna R Kudchadkar
OBJECTIVES: To present our single-center's experience with three palliative critical care transports home from the PICU for terminal extubation. DESIGN: We performed a retrospective chart review of patients transported between January 1, 2012, and December 31, 2014. SETTING: All cases were identified from our institutional pediatric transport database. PATIENTS: Patients were terminally ill children unable to separate from mechanical ventilation in the PICU, who were transported home for terminal extubation and end-of-life care according to their families' wishes...
October 28, 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27801707/implementation-of-a-nurse-driven-sedation-protocol-in-a-picu-decreases-daily-doses-of-midazolam
#14
Bénédicte Gaillard-Le Roux, Jean-Michel Liet, Pierre Bourgoin, Arnaud Legrand, Jean-Christophe Roze, Nicolas Joram
OBJECTIVES: To evaluate the impact of a nurse-driven sedation protocol on the length of mechanical ventilation, total daily doses of sedatives, and complications of sedation. DESIGN: A single-center prospective before and after study was conducted from October 2010 to December 2013. SETTING: Twelve-bed surgical and medical PICU of the university-affiliated hospital in Nantes, France. PATIENTS: A total of 235 patients, between 28 days and 18 years old, requiring mechanical ventilation for at least 24 hours were included in the study; data from 194 patients were analyzed...
October 28, 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27792123/acute-kidney-injury-in-patients-undergoing-the-extracardiac-fontan-operation-with-and-without-the-use-of-cardiopulmonary-bypass
#15
Claudia A Algaze, Andrew M Koth, Lisa W Faberowski, Frank L Hanley, Catherine D Krawczeski, David M Axelrod
OBJECTIVES: To describe the prevalence and risk factors for acute kidney injury in patients undergoing the extracardiac Fontan operation with and without cardiopulmonary bypass, and to determine whether acute kidney injury is associated with duration of mechanical ventilation, cardiovascular ICU and hospital postoperative length of stay, and early mortality. DESIGN: Single-center retrospective cohort study. SETTING: Pediatric cardiovascular ICU, university-affiliated children's hospital...
October 27, 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27776085/patterns-of-postoperative-delirium-in-children
#16
Jochen Meyburg, Mona-Lisa Dill, Chani Traube, Gabrielle Silver, Rebecca von Haken
OBJECTIVE: Intensive care delirium is a substantial problem in adults. Intensive care delirium is increasingly recognized in pediatrics in parallel with the development of specific scoring systems for children. However, little is known about the fluctuating course of intensive care delirium in children after surgery and possible implications on diagnostic and therapeutic strategies. DESIGN: Patients that needed treatment in the PICU following elective surgery were screened for intensive care delirium with the Cornell Assessment of Pediatric Delirium...
October 21, 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27755398/the-incidence-of-acute-kidney-injury-and-its-effect-on-neonatal-and-pediatric-extracorporeal-membrane-oxygenation-outcomes-a-multicenter-report-from-the-kidney-intervention-during-extracorporeal-membrane-oxygenation-study-group
#17
Geoffrey M Fleming, Rashmi Sahay, Michael Zappitelli, Eileen King, David J Askenazi, Brian C Bridges, Matthew L Paden, David T Selewski, David S Cooper
OBJECTIVE: In a population of neonatal and pediatric patients on extracorporeal membrane oxygenation; to describe the prevalence and timing of acute kidney injury utilizing a consensus acute kidney injury definition and investigate the association of acute kidney injury with outcomes (length of extracorporeal membrane oxygenation and mortality). DESIGN: Multicenter retrospective observational cohort study. SETTING: Six pediatric extracorporeal membrane oxygenation centers...
October 13, 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27755397/a-novel-electrocardiogram-algorithm-utilizing-st-segment-instability-for-detection-of-cardiopulmonary-arrest-in-single-ventricle-physiology-a-retrospective-study
#18
Eric L Vu, Craig G Rusin, Dan J Penny, Kathy K Kibler, Ronald Blaine Easley, Brendan Smith, Dean Andropoulos, Ken Brady
OBJECTIVE: We evaluated ST-segment monitoring to detect clinical decompensation in infants with single ventricle anatomy. We proposed a signal processing algorithm for ST-segment instability and hypothesized that instability is associated with cardiopulmonary arrests. DESIGN: Retrospective, observational study. SETTING: Tertiary children's hospital 21-bed cardiovascular ICU and 36-bed step-down unit. PATIENTS: Twenty single ventricle infants who received stage 1 palliation surgery between January 2013 and January 2014...
October 13, 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27741041/the-clinical-impact-of-heated-humidified-high-flow-nasal-cannula-on-pediatric-respiratory-distress
#19
Atsushi Kawaguchi, Yutaka Yasui, Allan deCaen, Daniel Garros
OBJECTIVES: To assess the impact on a single PICU of introducing high-flow nasal cannula as a management tool for respiratory distress. DESIGN: Retrospective cohort study, including an interrupted time series analysis with a propensity score adjustment and a matched-pair analysis. SETTING: A single university-affiliated children's hospital PICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Differences in clinical outcomes when comparing the pre-high-flow nasal cannula era (2004-2008) and the high-flow nasal cannula era (2010-2014), excluding 2009 as a washout period, and clinical impacts of high-flow nasal cannula as an exposure of interest...
October 12, 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27741040/citric-acid-cycle-metabolites-predict-the-severity-of-myocardial-stunning-and-mortality-in-newborn-pigs
#20
Janus Adler Hyldebrandt, Nicolaj Brejnholt Støttrup, Christian Alcaraz Frederiksen, Johan Heiberg, Rune Isak Dupont Birkler, Mogens Johannsen, Michael Rahbek Schmidt, Hanne Berg Ravn
OBJECTIVES: Myocardial infarction and chronic heart failure induce specific metabolic changes in the neonatal myocardium that are closely correlated to outcome. The aim of this study was to examine the metabolic responses to noninfarct heart failure and inotropic treatments in the newborn heart, which so far are undetermined. DESIGN: A total of 28 newborn pigs were instrumented with a microdialysis catheter in the right ventricle, and intercellular citric acid cycle intermediates and adenosine metabolite concentrations were determined at 20-minute intervals...
October 12, 2016: Pediatric Critical Care Medicine
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