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Respiratory therapy in critically ill child

Fernando Maria de Benedictis, Andrew Bush
Wheeze is a common symptom in young children and is usually associated with viral illnesses. It is a major source of morbidity and is responsible for a high consumption of healthcare and economic resources worldwide. A few children have a condition resembling classical asthma. Rarer specific conditions may have a wheezy component and should be considered in the differential diagnosis. Over the last half century, there have been many circular discussions about the best way of managing preschool wheeze. In general, intermittent wheezing should be treated with intermittent bronchodilator therapy, and a controller therapy should be prescribed for a young child with recurrent wheezing only if positively indicated, and only then if carefully monitored for efficacy...
October 4, 2016: Archives of Disease in Childhood
James Cook, Sejal Saglani
PURPOSE OF REVIEW: Exacerbations of asthma in children are most frequently precipitated by respiratory infections with a seasonal pattern. However, management takes little account of the underlying infective or other precipitant abnormality. RECENT FINDINGS: Interactions between environmental triggers, the airway microbiome and innate immune responses are key determinants of exacerbations. Elevated innate cytokines interleukin (IL)-33 and IL-25, and abnormal molecular responses in the interferon pathway are associated with rhinoviral infections...
January 2016: Current Opinion in Pulmonary Medicine
Jennifer E Schuster, Jenna O Miller, Rangaraj Selvarangan, Gina Weddle, Marita T Thompson, Ferdaus Hassan, Shannon L Rogers, M Steven Oberste, W Allan Nix, Mary Anne Jackson
BACKGROUND: Enterovirus 68 (EV-D68) causes acute respiratory tract illness in epidemic cycles, most recently in Fall 2014, but clinical characteristics of severe disease are not well reported. OBJECTIVES: Children with EV-D68 severe respiratory disease requiring pediatric intensive care unit (PICU) management were compared with children with severe respiratory disease from other enteroviruses/rhinoviruses. STUDY DESIGN: A retrospective review was performed of all children admitted to Children's Mercy Hospital PICU from August 1-September 15, 2014 with positive PCR testing for enterovirus/rhinovirus...
September 2015: Journal of Clinical Virology: the Official Publication of the Pan American Society for Clinical Virology
Kana R Jat, Deepak Chawla
BACKGROUND: Bronchiolitis is one of the most frequent causes of respiratory failure in infants; some infants will require intensive care and mechanical ventilation. There is lack of evidence regarding effective treatment for bronchiolitis other than supportive care. Abnormalities of surfactant quantity or quality (or both) have been observed in severe cases of bronchiolitis. Exogenous surfactant administration appears to favourably change the haemodynamics of the lungs and may be a potentially promising therapy for severe bronchiolitis...
2015: Cochrane Database of Systematic Reviews
J O Klein, S S Gellis
Effective antibiotics are now available for most of the common bacterial infections. However, with few exceptions they are limited in their spectrum of activity and some have significant toxicity. In order to provide rational therapy, the physician must have knowledge of the infecting organism. The pediatrician is at a particular disadvantage in obtaining specific etiologic information since his young patient is often unable to cooperate or volunteer materials. In the critically ill child, every effort should be made to obtain material from blood and from the focus of infection...
February 1971: Pediatric Clinics of North America
Halden F Scott, Sara J Deakyne, Jason M Woods, Lalit Bajaj
OBJECTIVES: This study sought to determine the prevalence, test characteristics, and severity of illness of pediatric patients with systemic inflammatory response syndrome (SIRS) vital signs among pediatric emergency department (ED) visits. METHODS: This was a retrospective descriptive cohort study of all visits to the ED of a tertiary academic free-standing pediatric hospital over 1 year. Visits were included if the patient was <18 years of age and did not leave before full evaluation or against medical advice...
April 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Scott L Weiss, Julie C Fitzgerald, John Pappachan, Derek Wheeler, Juan C Jaramillo-Bustamante, Asma Salloo, Sunit C Singhi, Simon Erickson, Jason A Roy, Jenny L Bush, Vinay M Nadkarni, Neal J Thomas
RATIONALE: Limited data exist about the international burden of severe sepsis in critically ill children. OBJECTIVES: To characterize the global prevalence, therapies, and outcomes of severe sepsis in pediatric intensive care units to better inform interventional trials. METHODS: A point prevalence study was conducted on 5 days throughout 2013-2014 at 128 sites in 26 countries. Patients younger than 18 years of age with severe sepsis as defined by consensus criteria were included...
May 15, 2015: American Journal of Respiratory and Critical Care Medicine
Thomas Weber, Thomas Wagner, Konrad Neumann, Engelbert Deusch
OBJECTIVE: To predict fluid responsiveness by noninvasive methods in a pediatric critical care population. DESIGN: Prospective observational clinical trial. SETTING: PICU in a tertiary care academic hospital. PATIENTS: Thirty-one pediatric patients aged from 1 day to 13 years under mechanical ventilation and on catecholamine support. INTERVENTIONS: We tested three noninvasive methods to predict fluid responsiveness: an esophageal Doppler system (CardioQ), a pulse contour analysis algorithm system (LiDCOrapid), and respiratory variations in vena cava inferior diameter...
March 2015: Pediatric Critical Care Medicine
Lynn Sinitsky, David Walls, Simon Nadel, David P Inwald
OBJECTIVE: Recent evidence suggests that fluid overload may be deleterious to critically ill children. The purpose of this study was to investigate the association of early fluid overload with respiratory morbidity and mortality in patients admitted to a general PICU. DESIGN: Retrospective cohort study. SETTING: Single, tertiary referral PICU. PATIENTS SIX HUNDRED THIRTY-SIX: patients aged 0-16 years invasively ventilated at 48 hours post admission, admitted between April 1, 2009, and March 31, 2013...
March 2015: Pediatric Critical Care Medicine
Weiyuan Yan, Lijie Wang
OBJECTIVE: To evaluate the clinical value of the pulse indicator continuous cardiac output (PiCCO) system in patients with severe acute pancreatitis (SAP) complicated with acute respiratory distress syndrome (ARDS). METHOD: Two cases of SAP with ARDS were monitored using PiCCO during comprehensive management in the Pediatric Intensive Care Unit (PICU) of Shengjing Hospital, China Medical University. To guide fluid management, the cardiac index (CI) was measured to assess cardiac function, the global end-diastolic volume index (GEDVI) was used to evaluate cardiac preload, and the extravascular lung water index (EVLWI) was used to evaluate the pulmonary edema...
September 2014: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Mark Duffett, Karen Choong, Thuva Vanniyasingam, Lehana Thabane, Deborah J Cook
OBJECTIVE: Changing clinician practice in pediatric critical care is often difficult. Tailored knowledge translation interventions may be more effective than other types of interventions. To inform the design of tailored interventions, the primary objective of this survey was to describe the importance of specific factors that influence physicians and pharmacists when they make decisions about medications in critically ill children. DESIGN: In this postal survey, respondents used 7-point scales to rate the importance of specific factors that influence their decisions in the following scenarios: corticosteroids for shock, intensive insulin therapy, stress ulcer prophylaxis, surfactant for acute respiratory distress syndrome, and sedation interruption...
January 2015: Pediatric Critical Care Medicine
Joseph A Carcillo
PURPOSE OF REVIEW: To review the past year's literature, and selected prior literature relevant to these most recent findings, regarding intravenous fluid choices in the management of critically ill children. RECENT FINDINGS: Twenty-eight publications were identified using the keywords pediatrics and intravenous fluid in the PubMed database. The subjects identified included intravenous fluid choices related to perioperative maintenance fluid management, rehydration for dehydration related to diarrhea losses, rehydration in diabetic ketoacidosis, intravenous fluid needs during mechanical ventilation, use of intravenous fluids as hyperosmolar agents in traumatic brain injury, isotonic fluid bolus resuscitation for sepsis-related capillary leak syndrome-induced hypovolemic shock, maintenance intravenous fluid and blood transfusion for malaria-associated euvolemic severe anemia shock, isotonic fluid and blood boluses for trauma-induced hemorrhagic shock, and isotonic fluid boluses and generous maintenance infusion for burn resuscitation...
August 2014: Current Opinion in Critical Care
Karen Choong, Gary Foster, Douglas D Fraser, James S Hutchison, Ari R Joffe, Philippe A Jouvet, Kusum Menon, Eleanor Pullenayegum, Roxanne E Ward
OBJECTIVE: To evaluate acute rehabilitation practices in pediatric critical care units across Canada. DESIGN: Retrospective cohort study. SETTING: Six Canadian, tertiary care pediatric critical care units. PATIENTS/SUBJECTS: Six hundred children aged under 17 years admitted to pediatric critical care unit during a winter and summer month of 2011 with a greater than 24-hour length of stay. INTERVENTIONS: None...
July 2014: Pediatric Critical Care Medicine
Sara Mayfield, Jacqueline Jauncey-Cooke, Judith L Hough, Andreas Schibler, Kristen Gibbons, Fiona Bogossian
BACKGROUND: Respiratory support is a central component of the management of critically ill children. It can be delivered invasively via an endotracheal tube or non-invasively via face mask, nasal mask, nasal cannula or oxygen hood/tent. Invasive ventilation can be damaging to the lungs, and the tendency to use non-invasive forms is growing. However, non-invasive delivery is often poorly tolerated by children. High-flow nasal cannula (HFNC) oxygen delivery is a relatively new therapy that shows the potential to reduce the need for intubation and be better tolerated by children than other non-invasive forms of support...
2014: Cochrane Database of Systematic Reviews
Snezana Rsovac, Katarina Milosevic, Branimir Nestorovic, Aleksandra Nikolic
BACKGROUND: Mechanical ventilation is a frequently applied therapy in critically ill children and can be lifesaving in many cases. Clinical use of this technique has well documented benefits, but can be associated with different complications and adverse physiologic effects. OBJECTIVES: The aim of this study was to investigate the complications and clinical outcome of mechanical ventilation in Serbian pediatric patients. MATERIAL AND METHODS: The study encompassed 42 children with respiratory insufficiency that underwent mechanical ventilation during hospitalization over a period of 12 consecutive months...
January 2014: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Surender Rajasekaran, Katherine Kruse, Karen Kovey, Alan T Davis, Nabil E Hassan, Akunne N Ndika, Sandra Zuiderveen, James Birmingham
OBJECTIVES: Secondary hemophagocytic lymphohistiocytosis, macrophage activating syndrome, and sepsis share the same inflammatory phenotype leading often to multiple organ dysfunction syndrome needing intensive care. The goal of this article is to describe our experience with anakinra (Kineret), a recombinant interleukin-1 receptor antagonist, in decreasing the systemic inflammation. DESIGN: Retrospective case series. SETTING: The PICU at the Helen DeVos Children's Hospital (Grand Rapids, MI)...
June 2014: Pediatric Critical Care Medicine
Luregn J Schlapbach, Jonas Schaefer, Ann-Maree Brady, Sara Mayfield, Andreas Schibler
PURPOSE: Optimal respiratory support for interhospital transport of critically ill children is challenging and has been scarcely investigated. High-flow nasal cannula (HFNC) therapy has emerged as a promising support mode in the paediatric intensive care unit (PICU), but no data are available on HFNC used during interhospital transport. We aimed to assess the safety of HFNC during retrievals of critically ill children and its impact on the need for invasive ventilation (IV). METHODS: This was a retrospective, single-centre study of children under 2 years old transported by a specialized paediatric retrieval team to PICU...
April 2014: Intensive Care Medicine
Carleen Zebuhr, Amit Sinha, Heather Skillman, Shannon Buckvold
Decreased intensive care unit (ICU) mortality has led to an increase in ICU morbidity. ICU-induced immobilization plays a major role in this morbidity. Recently, ICU mobility has been shown to be safe and effective in adolescent and adult patients. We report the successful rehabilitation of an 8-year-old boy with severe acute respiratory distress syndrome on extracorporeal membrane oxygenation. A child who is critically ill may safely perform active rehabilitation while on venovenous extracorporeal membrane oxygenation...
May 2014: PM & R: the Journal of Injury, Function, and Rehabilitation
Stacey Galowitz, Christopher Chang
Asthma is a heterogeneous disease with numerous clinical phenotypes. Severe asthma constitutes about 10 % of all cases of asthma. There is significant geographic and regional variation in the incidence and severity of asthma. Other important factors include gender, ethnicity, living environment, lifestyle, socioeconomic class, and pathophysiology. These factors can often be identified as either genetic or environmental influences on asthma severity. The immune system derangements in severe asthma are poorly understood...
February 2015: Clinical Reviews in Allergy & Immunology
Mette Dokken, Tone Rustøen, Audun Stubhaug
BACKGROUND: Monitoring nutrition therapy is essential in the care of critically ill children, but the risk of nutrition failure seems to remain. The aims of the present study were to examine the prevalence of underfeeding, adequate feeding, and overfeeding in mechanically ventilated children and to identify barriers to the delivery of nutrition support. MATERIALS AND METHODS: Children aged 0-14 years who fulfilled the criteria for indirect calorimetry were enrolled in this prospective, observational study and were studied for up to 5 consecutive days...
March 2015: JPEN. Journal of Parenteral and Enteral Nutrition
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