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Pediatric Critical Care Medicine

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https://www.readbyqxmd.com/read/28212163/multiple-organ-dysfunction-in-children-mechanically-ventilated-for-acute-respiratory-failure
#1
Scott L Weiss, Lisa A Asaro, Heidi R Flori, Geoffrey L Allen, David Wypij, Martha A Q Curley
OBJECTIVES: The impact of extrapulmonary organ dysfunction, independent from sepsis and lung injury severity, on outcomes in pediatric acute respiratory failure is unclear. We sought to determine the frequency, timing, and risk factors for extrapulmonary organ dysfunction and the independent association of multiple organ dysfunction syndrome with outcomes in pediatric acute respiratory failure. DESIGN: Secondary observational analysis of the Randomized Evaluation of Sedation Titration for Respiratory Failure cluster-randomized prospective clinical trial conducted between 2009 and 2013...
February 16, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28212162/volume-and-pressure-delivery-during-pediatric-high-frequency-oscillatory-ventilation
#2
Ronald Wong, Timothy Deakers, Justin Hotz, Robinder G Khemani, Patrick A Ross, Christopher J Newth
OBJECTIVE: Identify variables independently associated with delivered tidal volume (VT) and measured mean airway pressure during high-frequency oscillatory ventilation across the range of pediatric endotracheal tube sizes. DESIGN: In vitro study. SETTING: Research laboratory. INTERVENTIONS: An in vitro bench model of the intubated pediatric respiratory system during high-frequency oscillatory ventilation was used to obtain delivered VT and mean airway pressure (in the distal lung) for various endotracheal tube sizes...
February 16, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28207571/systematic-review-of-interventions-to-reduce-psychiatric-morbidity-in-parents-and-children-after-picu-admissions
#3
Samantha C Baker, Julia A Gledhill
OBJECTIVE: To describe and evaluate interventions aimed at reducing psychiatric morbidity in parents and children discharged from PICU. DATA SOURCES: A systematic review of the literature was undertaken, searching EMBASE, PSYCHinfo, MEDLINE, and CINAHL. Experts in the field were contacted to identify unpublished studies. STUDY SELECTION: Exclusion criteria: Studies with participants above age 18 or drawn from a neonatal ICU, studies not in English, and those not measuring psychopathology...
February 15, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28207570/international-survey-of-critically-ill-children-with-acute-neurologic-insults-the-prevalence-of-acute-critical-neurological-disease-in-children-a-global-epidemiological-assessment-study
#4
Ericka L Fink, Patrick M Kochanek, Robert C Tasker, John Beca, Michael J Bell, Robert S B Clark, Jamie Hutchison, Monica S Vavilala, Anthony Fabio, Derek C Angus, R Scott Watson
OBJECTIVE: The international scope of critical neurologic insults in children is unknown. Our objective was to assess the prevalence and outcomes of children admitted to PICUs with acute neurologic insults. DESIGN: Prospective study. SETTING: Multicenter (n = 107 PICUs) and multinational (23 countries, 79% in North America and Europe). PATIENTS: Children 7 days to 17 years old admitted to the ICU with new traumatic brain injury, stroke, cardiac arrest, CNS infection or inflammation, status epilepticus, spinal cord injury, hydrocephalus, or brain mass...
February 15, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28198758/medication-reconciliation-failures-in-children-and-young-adults-with-chronic-disease-during-intensive-and-intermediate-care
#5
Danielle D DeCourcey, Melanie Silverman, Esther Chang, Al Ozonoff, Carolyn Stickney, Darla Pichoff, Alexandra Oldershaw, Jonathan A Finkelstein
OBJECTIVES: Although medication reconciliation has become standard during hospital admission, rates of unintentional medication discrepancies during intensive care of pediatric patients with chronic disease are unknown. Such discrepancies are an important cause of adverse drug events in adults with chronic illness and are associated with unintentional discontinuation of chronic medications. We sought to determine the rate, type, timing, and predictors of potentially harmful unintentional medication discrepancies in children and young adults with chronic disease...
February 14, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28198757/effect-of-temperature-on-heart-rate-variability-in-neonatal-icu-patients-with-hypoxic-ischemic-encephalopathy
#6
An N Massaro, Heather E Campbell, Marina Metzler, Tareq Al-Shargabi, Yunfei Wang, Adre du Plessis, Rathinaswamy B Govindan
OBJECTIVE: To determine whether measures of heart rate variability are related to changes in temperature during rewarming after therapeutic hypothermia for hypoxic-ischemic encephalopathy. DESIGN: Prospective observational study. SETTING: Level 4 neonatal ICU in a free-standing academic children's hospital. PATIENTS: Forty-four infants with moderate to severe hypoxic-ischemic encephalopathy treated with therapeutic hypothermia...
February 14, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28198756/utility-of-assessing-cytokine-levels-for-the-differential-diagnosis-of-pneumonia-in-a-pediatric-population
#7
Jian-Ming Zhou, Qing Ye
OBJECTIVES: Although pneumonia is easily diagnosed, determining the causative agent is difficult due to low pathogen detection rates. We performed a prospective observational study to evaluate the utility of measuring inflammatory cytokine levels to discriminate between pneumonia caused by typical bacteria, respiratory syncytial virus, or Mycoplasma pneumoniae in a pediatric population. DESIGN: Serum inflammatory cytokine levels at early stages of the disease were evaluated for pneumonia caused by the three different pathogenic microorganisms...
February 14, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28198755/career-development-support-in-pediatric-critical-care-medicine-a-national-survey-of-fellows-and-junior-faculty
#8
Christina L Cifra, Shilpa S Balikai, Tanya D Murtha, Benson Hsu, Carley L Riley
OBJECTIVES: To determine the perceptions of current pediatric critical care medicine fellows and junior faculty regarding the extent and quality of career development support received during fellowship training. DESIGN: Web-based cross-sectional survey open from September to November 2015. SETTING: Accreditation Council for Graduate Medical Education-accredited pediatric critical care medicine fellowship programs. SUBJECTS: Pediatric critical care medicine fellows (second yr or higher) and junior faculty (within 5 yr of completing a pediatric critical care medicine fellowship program)...
February 14, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28198754/relationship-between-adverse-tracheal-intubation-associated-events-and-picu-outcomes
#9
Margaret M Parker, Gabrielle Nuthall, Calvin Brown, Katherine Biagas, Natalie Napolitano, Lee A Polikoff, Dennis Simon, Michael Miksa, Eleanor Gradidge, Jan Hau Lee, Ashwin S Krishna, David Tellez, Geoffrey L Bird, Kyle J Rehder, David A Turner, Michelle Adu-Darko, Sholeen T Nett, Ashley T Derbyshire, Keith Meyer, John Giuliano, Erin B Owen, Janice E Sullivan, Keiko Tarquinio, Pradip Kamat, Ronald C Sanders, Matthew Pinto, G Kris Bysani, Guillaume Emeriaud, Yuki Nagai, Melissa A McCarthy, Karen H Walson, Paula Vanderford, Anthony Lee, Jesse Bain, Peter Skippen, Ryan Breuer, Sarah Tallent, Vinay Nadkarni, Akira Nishisaki
OBJECTIVE: Tracheal intubation in PICUs is a common procedure often associated with adverse events. The aim of this study is to evaluate the association between immediate events such as tracheal intubation associated events or desaturation and ICU outcomes: length of stay, duration of mechanical ventilation, and mortality. STUDY DESIGN: Prospective cohort study with 35 PICUs using a multicenter tracheal intubation quality improvement database (National Emergency Airway Registry for Children: NEAR4KIDS) from January 2013 to June 2015...
February 14, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28198753/mechanical-ventilation-weaning-practices-and-decision-making-in-european-picus
#10
Lyvonne N Tume, Martin C J Kneyber, Bronagh Blackwood, Louise Rose
OBJECTIVES: This survey had three key objectives: 1) To describe responsibility for key ventilation and weaning decisions in European PICUs and explore variations across Europe; 2) To describe the use of protocols, spontaneous breathing trials, noninvasive ventilation, high-flow nasal cannula use, and automated weaning systems; and 3) To describe nurse-to-patient staffing ratios and perceived nursing autonomy and influence over ventilation decision making. DESIGN: Cross-sectional electronic survey...
February 14, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28178077/glucocorticoid-receptor-polymorphisms-and-outcomes-in-pediatric-septic-shock
#11
Natalie Z Cvijanovich, Nick Anas, Geoffrey L Allen, Neal J Thomas, Michael T Bigham, Scott L Weiss, Julie Fitzgerald, Paul A Checchia, Keith Meyer, Michael Quasney, Rainer Gedeit, Robert J Freishtat, Jeffrey Nowak, Shekhar S Raj, Shira Gertz, Jocelyn R Grunwell, Amy Opoka, Hector R Wong
OBJECTIVE: Polymorphisms of the glucocorticoid receptor gene are associated with outcome and corticosteroid responsiveness among patients with inflammatory disorders. We conducted a candidate gene association study to test the hypothesis that these polymorphisms are associated with outcome and corticosteroid responsiveness among children with septic shock. DESIGN: We genotyped 482 children with septic shock for the presence of two glucocorticoid receptor polymorphisms (rs56149945 and rs41423247) associated with increased sensitivity and one glucocorticoid receptor polymorphism (rs6198) associated with decreased sensitivity to corticosteroids...
February 7, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28178076/pediatric-acute-respiratory-distress-syndrome-in-pediatric-allogeneic-hematopoietic-stem-cell-transplants-a-multicenter-study
#12
Courtney M Rowan, Lincoln S Smith, Ashley Loomis, Jennifer McArthur, Shira J Gertz, Julie C Fitzgerald, Mara E Nitu, Elizabeth A S Moser, Deyin D Hsing, Christine N Duncan, Kris M Mahadeo, Jerelyn Moffet, Mark W Hall, Emily L Pinos, Robert F Tamburro, Ira M Cheifetz
OBJECTIVE: Immunodeficiency is both a preexisting condition and a risk factor for mortality in pediatric acute respiratory distress syndrome. We describe a series of pediatric allogeneic hematopoietic stem cell transplant patients with pediatric acute respiratory distress syndrome based on the recent Pediatric Acute Lung Injury Consensus Conference guidelines with the objective to better define survival of this population. DESIGN: Secondary analysis of a retrospective database...
February 7, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28178075/factors-associated-with-mortality-in-low-risk-pediatric-critical-care-patients-in-the-netherlands
#13
Carin W Verlaat, Idse H Visser, Nina Wubben, Jan A Hazelzet, Joris Lemson, Mark van den Boogaard, Johannes van der Hoeven
OBJECTIVE: To determine differences between survivors and nonsurvivors and factors associated with mortality in pediatric intensive care patients with low risk of mortality. DESIGN: Retrospective cohort study. SETTING: Patients were selected from a national database including all admissions to the PICUs in The Netherlands between 2006 and 2012. PATIENTS: Patients less than 18 years old admitted to the PICU with a predicted mortality risk lower than 1% according to either the recalibrated Pediatric Risk of Mortality or the Pediatric Index of Mortality 2 were included...
February 7, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28125548/finding-diagnostic-errors-in-children-admitted-to-the-picu
#14
Maria Caridad Davalos, Kenya Samuels, Ashley N D Meyer, Satid Thammasitboon, Moushumi Sur, Kevin Roy, Aymer Al-Mutairi, Hardeep Singh
OBJECTIVES: To determine whether the Safer Dx Instrument, a structured tool for finding diagnostic errors in primary care, can be used to reliably detect diagnostic errors in patients admitted to a PICU. DESIGN AND SETTING: The Safer Dx Instrument consists of 11 questions to evaluate the diagnostic process and a final question to determine if diagnostic error occurred. We used the instrument to analyze four "high-risk" patient cohorts admitted to the PICU between June 2013 and December 2013...
January 25, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28125547/epidemiology-of-pediatric-critical-illness-in-a-population-based-birth-cohort-in-olmsted-county-mn
#15
Sheri S Crow, Chaitanya Undavalli, David O Warner, Slavica K Katusic, Pujan Kandel, Sinead L Murphy, Darrell R Schroeder, R Scott Watson
OBJECTIVES: Investigations of pediatric critical illness typically focus on inpatient cohorts drawn from wide referral areas and diverse healthcare systems. Cohorts amenable to investigating the full spectrum of critical illness as it develops within a community have yet to be studied in the United States. Our objective was to provide the first epidemiologic report of the incidence and presentation of pediatric critical illness within a U.S. population-based birth cohort. DESIGN: Retrospective cohort study...
January 25, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28121834/pao2-fio2-ratio-derived-from-the-spo2-fio2-ratio-to-improve-mortality-prediction-using-the-pediatric-index-of-mortality-3-score-in-transported-intensive-care-admissions
#16
Samiran Ray, Libby Rogers, Christina Pagel, Sainath Raman, Mark J Peters, Padmanabhan Ramnarayan
OBJECTIVES: To derive a relationship between the SpO2/FIO2 ratio and PaO2/FIO2 ratio across the entire range of SpO2 values (0-100%) and to evaluate whether mortality prediction using the Pediatric Index of Mortality-3 can be improved by the use of PaO2/FIO2 values derived from SpO2/FIO2. DESIGN: Retrospective analysis of prospectively collected data. SETTING: A regional PICU transport service. PATIENTS: Children transported to a PICU...
January 24, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28121833/volume-targeted-ventilation-in-the-neonate-benchmarking-ventilators-on-an-active-lung-model
#17
Tobias J Krieger, Martin Wald
OBJECTIVE: Mechanically ventilated neonates have been observed to receive substantially different ventilation after switching ventilator models, despite identical ventilator settings. This study aims at establishing the range of output variability among 10 neonatal ventilators under various breathing conditions. DESIGN: Relative benchmarking test of 10 neonatal ventilators on an active neonatal lung model. SETTING: Neonatal ICU. SUBJECTS: Ten current neonatal ventilators...
January 24, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28121832/central-venous-to-arterial-co2-difference-after-cardiac-surgery-in-infants-and-neonates
#18
Leslie A Rhodes, W Clinton Erwin, Santiago Borasino, David C Cleveland, Jeffrey A Alten
OBJECTIVES: Venous to arterial CO2 difference correlates with cardiac output in critically ill adults, but its utility in pediatric patients is unclear. We sought to correlate venous to arterial CO2 difference with other cardiac output surrogates (arteriovenous oxygen saturation difference, central venous oxygen saturation, and lactate) and investigate its capacity to predict poor outcomes associated with low cardiac output (low cardiac output syndrome) in infants after cardiac surgery with cardiopulmonary bypass...
January 24, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28114163/doppler-ultrasonography-of-the-central-retinal-vessels-in-children-with-brain-death
#19
Becky J Riggs, Joanna S Cohen, Bhavana Shivakumar, Carmelina Trimboli-Heidler, Jason T Patregnani, Marijean M Miller, Michael C Spaeder, Nathan P Dean
OBJECTIVE: The purpose of this observational study is to explore if bedside Doppler ultrasonography of the central retinal vessels has the potential to become an ancillary study to support the timely diagnosis of brain death in children. DESIGN: Seventeen-month prospective observational cohort. SETTING: Forty-four bed pediatric medical and surgical ICU in an academic teaching hospital. PATIENTS: All children 0-18 years old who were clinically evaluated for brain death at Children's National Health Systems were enrolled and followed until discharge or death...
January 20, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28114162/impact-of-viral-respiratory-pathogens-on-outcomes-after-pediatric-cardiac-surgery
#20
Katie Moynihan, Andrew Barlow, Nelson Alphonso, Ben Anderson, Janelle Johnson, Clare Nourse, SanmariƩ Schlebusch, Tom R Karl, Luregn J Schlapbach
OBJECTIVES: Viral respiratory infection is commonly considered a relative contraindication to elective cardiac surgery. We aimed to determine the frequency and outcomes of symptomatic viral respiratory infection in pediatric cardiac surgical patients. DESIGN: Retrospective cohort study of children undergoing cardiac surgery. Symptomatic children were tested using a multiplex Polymerase Chain Reaction (respiratory virus polymerase chain reaction) panel capturing nine respiratory viruses...
January 20, 2017: Pediatric Critical Care Medicine
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