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fluid resuscitation pediatric

Karthik Narayanan Ramaswamy, Sunit Singhi, Muralidharan Jayashree, Arun Bansal, Karthi Nallasamy
OBJECTIVE: We compared efficacy of dopamine and epinephrine as first-line vasoactive therapy in achieving resolution of shock in fluid-refractory hypotensive cold septic shock. DESIGN: Double-blind, pilot, randomized controlled study. SETTING: Pediatric emergency and ICU of a tertiary care teaching hospital. PATIENTS: Consecutive children 3 months to 12 years old, with fluid-refractory hypotensive septic shock, were enrolled between July 2013 and December 2014...
September 23, 2016: Pediatric Critical Care Medicine
Valerie Plant, Poornima Vanguri, Rahul Anand, Jeffrey Haynes, Michel Aboutanos, Paula Ferrada
INTRODUCTION: Limited transthoracic echocardiogram (LTTE) has been shown to be a useful tool in guiding resuscitation in adult trauma patients. Our hypothesis is that image-guided resuscitation in pediatric trauma patients with LTTE is feasible. METHODS: A retrospective chart review was performed on highest level pediatric trauma alerts (age 18 years or younger) at our level I trauma center during a 6-month period. Patients were divided into 2 groups as follows: those who had LTTE performed (LTTE group) and those who did not have LTTE performed (non-LTTE group)...
September 9, 2016: Pediatric Emergency Care
Roni D Lane, Tomohiko Funai, Ron Reeder, Gitte Y Larsen
BACKGROUND AND OBJECTIVE: Septic shock impacts mortality, morbidity, and health care costs. A quality improvement (QI) initiative was launched to improve early recognition and timely treatment of patients with septic shock in a pediatric emergency department (PED). Our primary aim was to describe the longitudinal effectiveness of the program, iterative changes in clinical practice, and associated outcomes. METHODS: We implemented multiple interventions during our QI initiative (February 2007 to December 2014)...
September 7, 2016: Pediatrics
Nithya Kannan, Jin Wang, Richard B Mink, Mark S Wainwright, Jonathan I Groner, Michael J Bell, Christopher C Giza, Douglas F Zatzick, Richard G Ellenbogen, Linda Ng Boyle, Pamela H Mitchell, Frederick P Rivara, Ali Rowhani-Rahbar, Monica S Vavilala
OBJECTIVES: Early resuscitation may improve outcomes in pediatric traumatic brain injury (TBI). We examined the association between timely treatment of hypotension and hypoxia during early care (prehospital or emergency department locations) and discharge outcomes in children with severe TBI. METHODS: Hypotension was defined as systolic blood pressure less than 70 + 2 (age in years), and hypoxia was defined as PaO2 less than 60 mm Hg or oxygen saturation less than 90% in accordance with the 2003 Brain Trauma Foundation guidelines...
July 12, 2016: Pediatric Emergency Care
Hazim Sadideen, Federica D'Asta, Naiem Moiemen, Yvonne Wilson
Overestimation of burn size especially in children is common. It is unclear if this may cause harm. This study was designed to assess the accuracy of burn size estimation by referring non-burn clinicians and investigate whether inaccurate estimates caused any harm. Three and a half years retrospective review of pediatric resuscitation burns (ie, ≥10% TBSA) referred to a tertiary burns center from other hospitals was performed. This included basic demographics, data from referring emergency departments (initial TBSA estimations and fluid volumes prescribed), and data on arrival to the burn center (actual burn TBSA sustained, fluid volumes given prior to arrival, and actual fluid volumes required)...
June 29, 2016: Journal of Burn Care & Research: Official Publication of the American Burn Association
(no author information available yet)
No abstract text is available yet for this article.
June 2016: Annals of Intensive Care
Aymen A Alian, Gourg Atteya, Dorothy Gaal, Thomas Golembeski, Brian G Smith, Feng Dai, David G Silverman, Kirk Shelley
BACKGROUND: Scoliosis surgery is often associated with substantial blood loss, requiring fluid resuscitation and blood transfusions. In adults, dynamic preload indices have been shown to be more reliable for guiding fluid resuscitation, but these indices have not been useful in children undergoing surgery. The aim of this study was to introduce frequency-analyzed photoplethysmogram (PPG) and arterial pressure waveform variables and to study the ability of these parameters to detect early bleeding in children during surgery...
August 2016: Anesthesia and Analgesia
Antonios I Vezakis, Eirini V Pantiora, Elissaios A Kontis, Vasileios Sakellariou, Dimitrios Theodorou, Georgios Gkiokas, Andreas A Polydorou, Georgios P Fragulidis
BACKGROUND: Ingestion of caustic substances is a medical emergency in both the adult and pediatric population and is associated with high morbidity and mortality. The extent of injuries after ingestion of caustic substances depends on the nature, amount, and concentration of the agent and on the exposure time. Acutely, caustic substances may cause massive hemorrhage and gastrointestinal tract perforation; the most markedly affected cases require urgent surgical treatment. Patients surviving the initial event may present with aorto-enteric or gastrocolic fistulae, esophageal strictures, dysphagia, and increased risk of esophageal cancer as long term sequelae...
2016: American Journal of Case Reports
Alexander Levitov, Heidi L Frankel, Michael Blaivas, Andrew W Kirkpatrick, Erik Su, David Evans, Douglas T Summerfield, Anthony Slonim, Raoul Breitkreutz, Susanna Price, Matthew McLaughlin, Paul E Marik, Mahmoud Elbarbary
OBJECTIVE: To establish evidence-based guidelines for the use of bedside cardiac ultrasound, echocardiography, in the ICU and equivalent care sites. METHODS: Grading of Recommendations, Assessment, Development and Evaluation system was used to rank the "levels" of quality of evidence into high (A), moderate (B), or low (C) and to determine the "strength" of recommendations as either strong (strength class 1) or conditional/weak (strength class 2), thus generating six "grades" of recommendations (1A-1B-1C-2A-2B-2C)...
June 2016: Critical Care Medicine
C-W Lee, H Su, P-Y Chen, S-J Lin, J Shiea, S-J Shin, B-H Chen
The World Health Organization acknowledges that pesticide self-poisoning is among the most frequently used methods of suicide worldwide. It is therefore of the highest importance to promptly identify the type of pesticides ingested by self-poisoning patients because different pesticides cause intoxication through different mechanisms, requiring different therapeutic strategies, precautions against contraindicating actions, directions of clinical course monitoring and predictions of prognosis. In this perspective Special Feature, Pr...
February 2016: Journal of Mass Spectrometry: JMS
Katherine Bakes, Jason S Haukoos, Sara J Deakyne, Emily Hopkins, Josh Easter, Kim McFann, Alison Brent, Arleta Rewers
BACKGROUND: The optimal rate of fluid administration in pediatric diabetic ketoacidosis (DKA) is unknown. OBJECTIVE: Our aim was to determine whether the volume of fluid administration in children with DKA influences the rate of metabolic normalization. METHODS: We performed a randomized controlled trial conducted in a tertiary pediatric emergency department from December 2007 until June 2010. The primary outcome was time to metabolic normalization; secondary outcomes were time to bicarbonate normalization, pH normalization, overall length of hospital treatment, and adverse outcomes...
April 2016: Journal of Emergency Medicine
Tabitha Garwe, Jeremy J Johnson, Robert W Letton
OBJECTIVES: Traditionally, in both pediatric and adult trauma patients, management of hemorrhage and shock has included early rapid intravenous fluid (IVF) replacement at the scene or during transport to a definitive care facility. Because prehospital resuscitation can be considered as a lifesaving intervention, severely injured patients are more likely to receive IVF. Observational studies not adequately adjusting for this confounding by indication (indication bias) while evaluating the impact of prehospital IVF on mortality in clinically heterogeneous patient populations are likely to find an increased mortality associated with the use of prehospital IVF, an association that may be spurious even after traditional multivariable risk adjustment...
January 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Rajit K Basu, Ahmad Kaddourah, Tara Terrell, Theresa Mottes, Patricia Arnold, Judd Jacobs, Jennifer Andringa, Melissa Armor, Lauren Hayden, Stuart L Goldstein
BACKGROUND: Acute kidney injury (AKI) is associated with poor outcomes in critically ill children. Recent international consensus panels recommend standardized classification systems to improve the precision of AKI diagnosis, but there is a paucity of data to enable this refinement, particularly in pediatric critical care. METHODS/DESIGN: This is a prospective observational study. We anticipate collecting data from more than 5500 critically ill children admitted to 32 pediatric intensive care units (PICUs) across the world, during the calendar year of 2014...
2015: Journal of Clinical Trials
Shuang Liu, Xiaoxu Ren, Linying Gun, Qi Zhang, Jin Zhang, Yiming Zhu
OBJECTIVE: The mainstay of therapy in patients with septic shock is early and aggressive intravenous fluid resuscitation. However the type of intravenous fluid that would be ideal for managing septic shock has been intensely debated. In this study, the authors observed the effects of 3% hypertonic saline solution compared with normal saline solution as early fluid resuscitation in children with septic shock. METHOD: In this prospective study, 44 septic shock children seen in the intensive care unit (ICU) of the Children's Hospital Affiliated to Capital Institute of Pediatrics were enrolled from January 2012 to January 2014, of whom 33 were male and 11 were female...
August 2015: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Jamie K Overbey, Alexander A Kon
BACKGROUND: In 2007, an update was released to the pediatric and neonatal septic shock guidelines, which emphasized early use of therapies, specifically, first-hour fluid resuscitation and inotrope therapy. This has led to increased use of intraosseous (IO) access as a source of vascular access. Previously, IO access could be obtained only via a manual IO placement. New semi-automatic devices, such as EZ-IO(®) (Vidacare, Shavano Park, TX), allow for safer and quicker IO access. Data support the use of semi-automatic devices during the acute resuscitation period...
January 2016: Journal of Emergency Medicine
Daniela Nasu Monteiro Medeiros, Juliana Ferreira Ferranti, Artur Figueiredo Delgado, Werther Brunow de Carvalho
AIM: The goal of this study was to perform a systematic review of the literature assessing the use of colloids for the initial treatment of severe sepsis and septic shock in pediatric patients. DESIGN: The PICO [Patient, Intervention, Comparison, Outcome] method was used for the selection of studies, and the Cochrane Bias Tool was used to analyze the quality of the selected studies. DATA SEARCH: Relevant studies were sought using the following databases: EMBASE (1980 to March 2014), PubMed (1970 to March 2014), Cochrane (1980 to March 2014), Web of Science, and Scopus...
November 2015: Pediatric Emergency Care
Karin Reuter-Rice, Dana Patrick, Elizabeth Kantor, Cathy Nolin, Jennifer Foley
Intraosseous (IO) access is a standard of care for pediatric emergencies in the absence of conventional intravenous access. Intraosseous needles provide access for resuscitation fluids and medications and are often placed in the emergency department. However, there are no studies to date that describe the characteristics of pediatric IO needle recipients or their dispositions and outcomes. This study examined the characteristics and disposition of children following IO needle placement by prehospital and emergency room teams before being transported to a children's hospital...
October 2015: Advanced Emergency Nursing Journal
Maisam Abu-El-Haija, Joseph J Palermo, Lin Fei, Tom K Lin
OBJECTIVE: The incidence of acute pancreatitis (AP) in childhood has increased in the last 2 decades, yet management has been largely extrapolated from adult studies. We sought to determine whether there is a consensus for treatment of AP among different pediatric subspecialists. METHODS: Providers from subspecialties seeing most patients admitted for AP were surveyed on their practice patterns in managing a first attack of uncomplicated AP. RESULTS: From November 2009 to August 2013, there were 284 admissions for patients with AP to our center...
January 2016: Pancreas
Allan R de Caen, Ian K Maconochie, Richard Aickin, Dianne L Atkins, Dominique Biarent, Anne-Marie Guerguerian, Monica E Kleinman, David A Kloeck, Peter A Meaney, Vinay M Nadkarni, Kee-Chong Ng, Gabrielle Nuthall, Amelia G Reis, Naoki Shimizu, James Tibballs, Remigio Veliz Pintos
No abstract text is available yet for this article.
October 20, 2015: Circulation
W Joshua Frazier, Jennifer A Muszynski
No abstract text is available yet for this article.
October 2015: Pediatric Critical Care Medicine
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