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Pediatric Clinics of North America

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https://www.readbyqxmd.com/read/28941547/the-collaborative-pediatric-critical-care-research-network-recent-progress-and-future-directions
#1
EDITORIAL
Kathleen L Meert, Daniel A Notterman
No abstract text is available yet for this article.
October 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28941546/pediatric-critical-care-medicine
#2
EDITORIAL
Bonita F Stanton
No abstract text is available yet for this article.
October 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28941545/transfusion-decision-making-in-pediatric-critical-illness
#3
REVIEW
Chris Markham, Peter Hovmand, Allan Doctor
Transfusion decision making (TDM) in the critically ill requires consideration of: (1) anemia tolerance, which is linked to active pathology and to physiologic reserve, (2) differences in donor RBC physiology from that of native RBCs, and (3) relative risk from anemia-attributable oxygen delivery failure vs hazards of transfusion, itself. Current approaches to TDM (e.g. hemoglobin thresholds) do not: (1) differentiate between patients with similar anemia, but dissimilar pathology/physiology, and (2) guide transfusion timing and amount to efficacy-based goals (other than resolution of hemoglobin thresholds)...
October 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28941544/management-issues-in-critically-ill-pediatric-patients-with-trauma
#4
REVIEW
Omar Z Ahmed, Randall S Burd
The management of critically ill pediatric patients with trauma poses many challenges because of the infrequency and diversity of severe injuries and a paucity of high-level evidence to guide care for these uncommon events. This article discusses recent recommendations for early resuscitation and blood component therapy for hypovolemic pediatric patients with trauma. It also highlights the specific types of injuries that lead to severe injury in children and presents challenges related to their management.
October 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28941543/cardiopulmonary-resuscitation-in-pediatric-and-cardiac-intensive-care-units
#5
REVIEW
Robert M Sutton, Ryan W Morgan, Todd J Kilbaugh, Vinay M Nadkarni, Robert A Berg
Approximately 5000 to 10,000 children suffer an in-hospital cardiac arrest requiring cardiopulmonary resuscitation (CPR) each year in the United States. Importantly, 2% to 6% of all children admitted to pediatric intensive care units (ICUs) receive CPR, as do 4% to 6% of children admitted to pediatric cardiac ICUs. Survival from pediatric ICU cardiac arrest has improved substantially during the past 20 years presumably due to improved training methods, CPR quality, and post-resuscitation care. Extracorporeal life support CPR remains an important treatment option for both cardiac and noncardiac ICU patients...
October 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28941542/end-of-life-and-bereavement-care-in-pediatric-intensive-care-units
#6
REVIEW
Markita L Suttle, Tammara L Jenkins, Robert F Tamburro
Most childhood deaths in the United States occur in hospitals. Pediatric intensive care clinicians must anticipate and effectively treat dying children's pain and suffering and support the psychosocial and spiritual needs of families. These actions may help family members adjust to their loss, particularly bereaved parents who often experience reduced mental and physical health. Candid and compassionate communication is paramount to successful end-of-life (EOL) care as is creating an environment that fosters meaningful family interaction...
October 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28941541/morbidity-changing-the-outcome-paradigm-for-pediatric-critical-care
#7
REVIEW
Julia A Heneghan, Murray M Pollack
The focus of critical care has evolved from saving lives to preservation of function. Morbidity rates in pediatric critical care are approximately double mortality rates. Morbidity includes complications of disease and medical care. In pediatric critical care, functional status morbidity is an intermediate outcome in the progression toward death and is the result of the same factors associated with mortality, including physiologic profiles and case-mix factors. The Functional Status Scale developed by Collaborative Pediatric Critical Care Research Network is a validated, granular, age-independent measure of functional status that has proved valuable and practical even in large outcome studies...
October 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28941540/adjunctive-steroid-therapy-for-treatment-of-pediatric-septic-shock
#8
REVIEW
Jerry J Zimmerman
Septic shock remains the major cause of childhood morbidity and mortality worldwide. Although early sepsis recognition, fluid resuscitation, timely administration of antimicrobials, and vasoactive-inotropic drug infusions are all key to achieving good sepsis outcomes, therapy using various steroid drug classes remains an attractive adjunctive intervention to minimize the duration of septic shock and transition to multiple organ dysfunction syndrome. All steroid drug classes possess biological plausibility to affect a beneficial clinical effect among children with septic shock, but none has undergone rigorous, prospective assessment in a large, high-quality pediatric interventional trial...
October 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28941539/delirium-in-pediatric-critical-care
#9
REVIEW
Anita K Patel, Michael J Bell, Chani Traube
Delirium occurs frequently in the critically ill child. It is a syndrome characterized by an acute onset and fluctuating course, with behaviors that reflect a disturbance in awareness and cognition. Delirium represents global cerebral dysfunction due to the direct physiologic effects of an underlying medical illness or its treatment. Pediatric delirium is strongly associated with poor outcomes, including increased mortality, prolonged intensive care unit length of stay, longer time on mechanical ventilation, and increased cost of care...
October 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28941538/sedation-analgesia-and-neuromuscular-blockade-in-pediatric-critical-care-overview-and-current-landscape
#10
REVIEW
Athena F Zuppa, Martha A Q Curley
Sedation is a mainstay of therapy for critically ill children. Although necessary in the care of the critically ill child, sedative drugs are associated with adverse effects, such as disruption of circadian rhythm, altered sleep, delirium, potential neurotoxicity, and immunosuppression. Optimal approaches to the sedation of the critically ill child should include identification of sedation targets and sedation interruptions, allowing for a more individualized approach to sedation. Further research is needed to better understand the relationship between critical illness and sedation pharmacokinetics and pharmacodynamics, the impact of sedation on immune function, and the genetic implications on drug disposition and response...
October 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28941537/immunoparalysis-in-pediatric-critical-care
#11
REVIEW
Mark W Hall, Kristin C Greathouse, Rajan K Thakkar, Eric A Sribnick, Jennifer A Muszynski
Although many forms of critical illness are initiated by a proinflammatory stimulus, a compensatory anti-inflammatory response can occur with systemic inflammation. Immunoparalysis, an important form of acquired immunodeficiency, affects the innate and adaptive arms of the immune system. Immunoparalysis has been associated with increased risks for nosocomial infection and death in a variety of pediatric critical illnesses. Evidence suggests that immunoparalysis is reversible with immunostimulants. Highly standardized, prospective immune monitoring regimens are needed to better understand the immunologic effects of critical care treatment regimens and to enrich clinical trials with subjects most likely to benefit from immunostimulatory therapies...
October 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28941536/rationale-for-adjunctive-therapies-for-pediatric-sepsis-induced-multiple-organ-failure
#12
REVIEW
Bradley S Podd, Dennis W Simon, Santiago Lopez, Andrew Nowalk, Rajesh Aneja, Joseph A Carcillo
Adjunctive therapies have been proposed for use in at least 5 inflammation pathobiology phenotypes in pediatric sepsis-induced multiple organ failure. This article discusses host-pathogen interaction prototypes to facilitate understanding of the rationale for personalized therapy in these phenotypes. The article discusses the literature on adjunctive antiinflammatory and immune modulation therapies that, in addition to traditional organ support and infection source control, might be part of a personalized precision medicine approach to the reversal of each of these inflammatory pathobiology phenotypes...
October 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28941535/mechanical-ventilation-and-decision-support-in-pediatric-intensive-care
#13
REVIEW
Christopher John L Newth, Robinder G Khemani, Philippe A Jouvet, Katherine A Sward
Respiratory support is required in most children in the pediatric intensive care unit. Decision-support tools (paper or electronic) have been shown to improve the quality of medical care, reduce errors, and improve outcomes. Computers can assist clinicians by standardizing descriptors and procedures, consistently performing calculations, incorporating complex rules with patient data, and capturing relevant data. This article discusses computer decision-support tools to assist clinicians in making flexible but consistent, evidence-based decisions for equivalent patient states...
October 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28941534/ventilator-associated-pneumonia-in-critically-ill-children-a-new-paradigm
#14
REVIEW
Peter M Mourani, Marci K Sontag
Ventilator-associated pneumonia (VAP) is a serious complication of critical illness. Surveillance definitions have undergone revisions for more objective and consistent reporting. The 1 organism-1 disease paradigm for microbial involvement may not adequately apply to many cases of VAP, in which pathogens are introduced to a pre-existing and often complex microbial community that facilitates or hinders the potential pathogen, consequently determining whether progression to VAP occurs. As omics technology is applied to VAP, a paradigm is emerging incorporating simultaneous assessments of microbial populations and their activity, as well as the host response, to personalize prevention and treatment...
October 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28941533/pathophysiology-and-management-of-acute-respiratory-distress-syndrome-in-children
#15
REVIEW
Sabrina M Heidemann, Alison Nair, Yonca Bulut, Anil Sapru
Acute respiratory distress syndrome (ARDS) is a syndrome of noncardiogenic pulmonary edema and hypoxia that accompanies up to 30% of deaths in pediatric intensive care units. Pediatric ARDS (PARDS) is diagnosed by the presence of hypoxia, defined by oxygenation index or Pao2/Fio2 ratio cutoffs, and new chest infiltrate occurring within 7 days of a known insult. Hallmarks of ARDS include hypoxemia and decreased lung compliance, increased work of breathing, and impaired gas exchange. Mortality is often accompanied by multiple organ failure...
October 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28734522/global-infections-and-child-health
#16
EDITORIAL
James P Nataro
No abstract text is available yet for this article.
August 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28734521/global-infections-and-child-health
#17
EDITORIAL
Bonita F Stanton
No abstract text is available yet for this article.
August 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28734520/management-of-refugees-and-international-adoptees
#18
REVIEW
Linda A Waggoner-Fountain
Refugee children and international adoptees have special medical considerations that must be addressed. Providers must be aware of the immigration history, where, and under what circumstances the child lived and migrated to the United States. Federal guidelines exist regarding which infections should be screened for, and how and when and which vaccines should be administered.
August 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28734519/zika-virus-infection
#19
REVIEW
Debbie-Ann T Shirley, James P Nataro
In less than 2 years since entry into the Americas, we have witnessed the emergent spread of Zika virus into large subsets of immunologically naïve human populations and then encountered the devastating effects of microcephaly and brain anomalies that can arise from in utero infection with the virus. Diagnostic evaluation and management of affected infants continues to evolve as our understanding of Zika virus rapidly advances. The development of a safe and effective vaccine holds the potential to attenuate the spread of infection and limit the impact of congenital infection...
August 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28734518/influenza-a-global-perspective
#20
REVIEW
Elizabeth T Rotrosen, Kathleen M Neuzil
Influenza is a common respiratory illness in children and accounts for substantial morbidity and mortality on an annual basis. Inactivated and live influenza vaccines are approved for children and are safe and efficacious. The absolute effectiveness of vaccines varies by year and is influenced by several factors. The reason for recent reduced performance of live-attenuated influenza vaccines is poorly understood, and active research is ongoing. Vaccination programs are less common in tropical and subtropical countries, where unique logistical and feasibility challenges exist...
August 2017: Pediatric Clinics of North America
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