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Pediatric Intensive Care Therapy

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https://www.readbyqxmd.com/read/28444080/rhabdomyolysis-as-a-manifestation-of-a-metabolic-disease-a-case-report
#1
Marta Sousa Moniz, Maria Inês Mascarenhas, Carlos Escobar, Pedro Nunes, Clara Abadesso, Helena Loureiro, Helena Almeida
Rhabdomyolysis is a process of muscle destruction that can present with varying clinical manifestations. In pediatric patients, its main etiology is infectious diseases. We present a previously healthy adolescent who was admitted to our emergency department with a four-day history of myalgia, muscle weakness and dark urine. At presentation, she was dehydrated. Blood analysis revealed acute renal failure and increased muscular enzymes. She was transferred to our pediatric intensive care unit. Medical therapies for correction of dehydration and the ionic and metabolic consequences of renal failure were performed...
January 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28435316/subanesthetic-ketamine-for-pain-management-in-hospitalized-children-adolescents-and-young-adults-a-single-center-cohort-study
#2
Kathy A Sheehy, Caroline Lippold, Amy L Rice, Raissa Nobrega, Julia C Finkel, Zenaide Mn Quezado
BACKGROUND: Subanesthetic doses of ketamine, an N-methyl-d-aspartate receptor antagonist used as an adjuvant to opioid for the treatment of pain in adults with acute and chronic pain, have been shown, in some instances, to improve pain intensity and to decrease opioid intake. However, less is known about the role of ketamine in pain management in children, adolescents, and young adults. PURPOSE: We examined the effects of subanesthetic ketamine on pain intensity and opioid intake in children, adolescents, and young adults with acute and chronic pain syndromes treated in an inpatient setting...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28425334/remifentanil-for-sedation-of-children-with-traumatic-brain-injury
#3
James L Hungerford, Nicole O'Brien, Melissa Moore-Clingenpeel, Eric A Sribnick, Cheryl Sargel, Mark Hall, Jeffrey R Leonard, Joseph D Tobias
OBJECTIVE: To determine whether remifentanil would provide adequate sedation while allowing frequent and reproducible neurologic assessments in children admitted to the pediatric intensive care unit (PICU) with traumatic brain injury (TBI) during mechanical ventilation. DESIGN: Retrospective review. SETTING: Tertiary care PICU. PATIENTS: Thirty-eight patients over a 30-month period. MEASUREMENTS AND MAIN RESULTS: Median age was 9 years (interquartile range [IQR] 2...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28420262/impact-of-an-educational-intervention-to-improve-physician-adherence-to-bronchiolitis-clinical-practice-guidelines-a-pre-post-intervention-study
#4
Marquita C Genies, Julia M Kim, Kristina Pyclik, Suzanne Rossi, Natalie Spicyn, Janet R Serwint
Bronchiolitis is the leading cause of infant hospitalizations in the United States. Despite clinical practice guidelines discouraging the utilization of non-evidence-based therapies, there continues to be wide variation in care and resource utilization. A pre-post physician focused educational intervention was conducted with the aims to reduce the use of non-evidence-based medical therapies, including bronchodilators, among patients admitted for bronchiolitis. Among patients meeting inclusion criteria (pre: n = 45; post: n = 47), bronchodilator use decreased by 50% ( P < ...
April 1, 2017: Clinical Pediatrics
https://www.readbyqxmd.com/read/28408236/unintentional-pediatric-cocaine-exposures-result-in-worse-outcomes-than-other-unintentional-pediatric-poisonings
#5
Patil Armenian, Michelle Fleurat, George Mittendorf, Kent R Olson
BACKGROUND: Unintentional pediatric cocaine exposures are rare but concerning due to potentially serious complications such as seizures, dysrhythmias, and death. OBJECTIVES: The objectives were to assess the demographic and clinical characteristics of pediatric cocaine exposures reported to the California Poison Control System. METHODS: This is a retrospective study of all confirmed pediatric (< 6 years of age) cocaine exposures reported to the California Poison Control System from January 1, 1997-September 30, 2010...
April 10, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28407067/evaluation-of-a-second-sign-process-for-antimicrobial-prior-authorization
#6
Aimee M Dassner, Jennifer E Girotto
Background.: A second-sign prospective restriction of select broad-spectrum antimicrobials was fully implemented in January 2015 as a pediatric antimicrobial stewardship program (ASP) initiative to help ensure the most appropriate empiric use of ceftaroline, cefepime, fidaxomicin, linezolid, and vancomycin (intravenous). The objective of this evaluation is to assess the effectiveness of a forced second-sign process in the electronic medical record as a pediatric ASP strategy. We anticipated that the second-sign process for antibiotics would increase the appropriateness of empiric antibiotic use, as defined by preapproved criteria, clinical pathways, national guidelines, and pediatric-specific infectious diseases reference texts, while not causing significant delay in the initial administration of antibiotic therapy...
April 12, 2017: Journal of the Pediatric Infectious Diseases Society
https://www.readbyqxmd.com/read/28394814/percutaneous-mechanical-circulatory-support-using-impella%C3%A2-devices-for-decompensated-cardiogenic-shock-a-pediatric-heart-center-experience
#7
Dhaval Parekh, Aamir Jeewa, Sebastian C Tume, William J Dreyer, Ricardo Pignatelli, David Horne, Henri Justino, Athar M Qureshi
Cardiogenic shock remains a significant cause of mortality and morbidity in children with heart failure. Percutaneous mechanical circulatory support may be an additional tool to augment left heart support and decompression in addition to conventional therapies. This report aims to review the clinical and hemodynamic outcomes of the Impella® device at a pediatric center. A retrospective review of all implants between October 2014 and November 2016 was conducted. Clinical outcomes, device implant techniques, complications, and hemodynamic data were collected...
April 6, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28353318/high-flow-nasal-cannula-therapies-for-respiratory-management-in-pediatric-patients
#8
Gang Liu, Conghai Fan, Hongwei Wu
High flow nasal cannula (HFNC) oxygen therapy is a non-invasive form of respiratory support that is rapidly being taken up in paediatric intensive care units (PICU). For infants with bronchiolitis - who are the largest non-elective source of admissions to a PICU - there is some evidence that using HFNC therapy reduces the need for intubation and mechanical ventilation. The aim of this review article is is to explore, describe, critique and add to the evidence surrounding the use of HFNC therapy in the pediatric population for the management of respiratory distress...
March 27, 2017: Minerva Pediatrica
https://www.readbyqxmd.com/read/28349774/increasing-ketamine-use-for-refractory-status-epilepticus-in-us-pediatric-hospitals
#9
Sotirios Keros, Ersida Buraniqi, Byron Alex, Annalee Antonetty, Hugo Fialho, Baria Hafeez, Michele C Jackson, Rachel Jawahar, Stephanie Kjelleren, Elizabeth Stewart, Lindsey A Morgan, Mark S Wainwright, Yoshimi Sogawa, Anup D Patel, Tobias Loddenkemper, Zachary M Grinspan
Ketamine is an emerging therapy for pediatric refractory status epilepticus. The circumstances of its use, however, are understudied. The authors described pediatric refractory status epilepticus treated with ketamine from 2010 to 2014 at 45 centers using the Pediatric Hospital Inpatient System database. For comparison, they described children treated with pentobarbital. The authors estimated that 48 children received ketamine and pentobarbital for refractory status epilepticus, and 630 pentobarbital without ketamine...
January 1, 2017: Journal of Child Neurology
https://www.readbyqxmd.com/read/28348507/variations-of-surveillance-practice-for-patients-with-bone-sarcoma-a-survey-of-australian-sarcoma-clinicians
#10
Jeremy Lewin, Kate Thompson, Susie Bae, Jayesh Desai, Robyn Strong, Denise Caruso, Deborah Howell, Alan Herschtal, Michael Sullivan, Lisa Orme
Introduction. After treatment, bone sarcoma patients carry a high chance of relapse and late effects from multimodal therapy. We hypothesize that significant variation in surveillance practice exists between pediatric medical oncology (PO) and nonpediatric medical oncology (NP) sarcoma disciplines. Methods. Australian sarcoma clinicians were approached to do a web based survey that assessed radiologic surveillance (RS) strategies, late toxicity assessment, and posttreatment psychosocial interventions. Results...
2017: Sarcoma
https://www.readbyqxmd.com/read/28337077/antithrombin-iii-doses-rounded-to-available-vial-sizes-in-critically-ill-pediatric-patients
#11
Winifred M Stockton, Eimeira Padilla-Tolentino, Carolyn E Ragsdale
OBJECTIVES: Children have decreased levels of antithrombin III (AT III) compared to adults. These levels may be further decreased during acute illness. Administration of exogenous AT III can increase anticoagulant efficacy. The objective of this study was to evaluate AT III doses rounded to available vial sizes compared to partial vial doses in critically ill pediatric patients, including patients receiving extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT)...
January 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/28328243/factors-associated-with-bleeding-and-thrombosis-in-children-receiving-extracorporeal-membrane-oxygenation-ecmo
#12
Heidi J Dalton, Ron Reeder, Pamela Garcia-Filion, Richard Holubkov, Robert A Berg, Athena Zuppa, Frank W Moler, Thomas Shanley, Murray M Pollack, Christopher Newth, John Berger, David Wessel, Joseph Carcillo, Michael Bell, Sabrina Heidemann, Kathleen L Meert, Richard Harrison, Allan Doctor, Robert F Tamburro, J Michael Dean, Tammara Jenkins, Carol Nicholson
RATIONALE: Extracorporeal membrane oxygenation (ECMO) is employed for respiratory and cardiac failure in children but is complicated by bleeding and thrombosis. OBJECTIVES: (1) Measure the incidence of bleeding (blood loss requiring transfusion or intracranial hemorrhage) and thrombosis during ECMO support; (2) identify factors associated with these complications; and (3) determine the impact of these complications on patient outcome. METHODS: Prospective, observational cohort study in pediatric, cardiac, and neonatal intensive care units in eight hospitals from December 2012 to September 2014...
March 22, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28321321/associations-between-fluid-balance-and-outcomes-in-critically-ill-children-a-protocol-for-a-systematic-review-and-meta-analysis
#13
Rashid Alobaidi, Catherine Morgan, Rajit K Basu, Erin Stenson, Robin Featherstone, Sumit R Majumdar, Sean M Bagshaw
BACKGROUND: Fluid therapy is a mainstay during the resuscitation of critically ill children. After initial stabilization, excessive fluid accumulation may lead to complications of fluid overload, which has been independently associated with increased risk for mortality and major morbidity in critically ill children. OBJECTIVES: Perform an evidence synthesis to describe the methods used to measure fluid balance, define fluid overload, and evaluate the association between fluid balance and outcomes in critically ill children...
2017: Canadian Journal of Kidney Health and Disease
https://www.readbyqxmd.com/read/28319075/autologous-hematopoietic-stem-cell-transplantation-for-pediatric-multiple-sclerosis-a-registry-based-study-of-the-autoimmune-diseases-working-party-adwp-and-pediatric-diseases-working-party-pdwp-of-the-european-society-for-blood-and-marrow-transplantation-ebmt
#14
J Burman, K Kirgizov, K Carlson, M Badoglio, G L Mancardi, G De Luca, B Casanova, J Ouyang, R Bembeeva, J Haas, P Bader, J Snowden, D Farge
Autologous hematopoietic stem cell transplantation (aHSCT) is a promising therapy for multiple sclerosis (MS), which has mainly been used in adults. The purpose of this study was to investigate efficacy and adverse events of aHSCT in the treatment of children with MS using data from the European Society for Blood and Marrow Transplantation registry. Twenty-one patients with a median follow-up time of 2.8 years could be identified. PFS at 3 years was 100%, 16 patients improved in expanded disability status scale score and only 2 patients experienced a clinical relapse...
March 20, 2017: Bone Marrow Transplantation
https://www.readbyqxmd.com/read/28304316/perspectives-and-attitudes-of-pediatricians-concerning-post-discharge-care-practice-of-premature-infants
#15
A Gad, E Parkinson, N Khawar, A Elmeki, P Narula, D Hoang
OBJECTIVE: Survival rates of premature infants are at a historical high and increasingly more pediatricians are caring for former premature infants. The goal of this study was to describe the perspectives and attitudes of pediatricians, as well as, the challenges of rendering post-neonatal intensive care unit (NICU) discharge care for premature infants. METHODS: An anonymous 22-question web-based survey was emailed to pediatricians who are current members of the American Academy of Pediatrics (AAP) and practicing in Kings County, New York...
March 16, 2017: Journal of Neonatal-perinatal Medicine
https://www.readbyqxmd.com/read/28297684/physical-and-occupational-therapy-utilization-in-a-pediatric-intensive-care-unit
#16
Liang R Cui, Megan LaPorte, Matthew Civitello, Meg Stanger, Maxine Orringer, Frank Casey, Bradley A Kuch, Sue R Beers, Cynthia A Valenta, Patrick M Kochanek, Amy J Houtrow, Ericka L Fink
PURPOSE: To characterize the use of physical therapy (PT) and occupational therapy (OT) consultation in our pediatric intensive care unit (PICU). MATERIALS AND METHODS: We studied children aged 1week-18years admitted to a tertiary care PICU for ≥3days. Patient characteristics, details of PT and OT sessions and adverse events were collected. A multivariable logistic regression was performed to determine factors associated with receipt of PT and OT consultation with propensity analysis followed by a regression for factors associated with outcome...
March 7, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28289528/clinical-cardiac-regenerative-studies-in-children
#17
REVIEW
Imre J Pavo, Ina Michel-Behnke
Although the incidence of pediatric heart failure is low, the mortality is relatively high, with severe clinical symptoms requiring repeated hospitalization or intensive care treatment in the surviving patients. Cardiac biopsy specimens have revealed a higher number of resident human cardiac progenitor cells, with greater proliferation and differentiation capacity, in the neonatal period as compared with adults, demonstrating the regeneration potential of the young heart, with rising interest in cardiac regeneration therapy in critically ill pediatric patients...
February 26, 2017: World Journal of Cardiology
https://www.readbyqxmd.com/read/28273758/aspects-and-intensity-of-pediatric-palliative-case-management-provided-by-a-hospital-based-case-management-team
#18
Charissa T Jagt-van Kampen, Derk A Colenbrander, Diederik K Bosman, Martha A Grootenhuis, Marijke C Kars, Antoinette Yn Schouten-van Meeteren
OBJECTIVES: Anticipating case management is considered crucial in pediatric palliative care. In 2012, our children's university hospital initiated a specialized pediatric palliative care team (PPCT) to deliver inbound and outbound case management for children with life-shortening disease. The aim of this report is to gain insight in the first 9 months of this PPCT. METHODS: Aspects of care during the first 9 months of the PPCT are presented, and comparison is made between patients with malignant disease (MD) and nonmalignant disease (NMD) in a retrospective study design...
January 1, 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/28260481/incidence-and-patient-outcomes-in-renal-replacement-therapy-after-orthotopic-liver-transplant
#19
Asude Ayhan, Zeynep Ersoy, Aydin Ulas, Pinar Zeyneloglu, Arash Pirat, Mehmet Haberal
OBJECTIVES: Our objective was to evaluate the incidence of renal replacement therapy after orthotopic liver transplant and to evaluate and analyze patient outcomes. MATERIALS AND METHODS: We performed a retrospective analysis of 177 consecutive patients at a tertiary care unit who underwent orthotopic liver transplant between January 2010 and June 2016. Patients who were admitted to the intensive care unit after orthotopic liver transplant and who required renal replacement therapy were included...
February 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28260473/perioperative-venoarterial-extracorporeal-membrane-oxygenation-support-during-heart-transplant
#20
Ender Gedik, Funda Atar, Aycan Ozdemirkan, Aynur Camkiran Firat, Pinar Zeyneloglu, Atilla Sezgin, Arash Pirat
OBJECTIVES: Heart transplant is the only definitive treatment of end-stage heart failure. Venoarterial extracorporeal membrane oxygenation may be used as a bridge to heart transplant. This technique may be used after heart transplant for conditions refractory to medical treatment like primary graft failure. Previously, we reported our experience with patients who received extracorporeal support as a bridge to emergency heart transplant. In this study, we present our perioperative experience with heart transplants in which extracorporeal support was used...
February 2017: Experimental and Clinical Transplantation
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