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Pediatric Intensive Care Therapy

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https://www.readbyqxmd.com/read/27917707/management-of-pneumonia-in-the-pediatric-critical-care-unit-an-area-for-antimicrobial-stewardship
#1
Aimee M Dassner, David P Nicolau, Jennifer E Girotto
Pediatric pneumonia is one of the most common causes of childhood infection requiring hospitalization and is a substantial driver of antimicrobial use among hospitalized children. About 12-20% of pediatric patients hospitalized with community-acquired pneumonia (CAP) require critical care. Additionally, nosocomial pneumonias (i.e. hospital-acquired and ventilator-associated pneumonias) are responsible for 15-53% of hospital-associated infections and are the most common indication for empiric antibiotics in the pediatric intensive care unit...
December 4, 2016: Current Pediatric Reviews
https://www.readbyqxmd.com/read/27890486/towards-a-multidisciplinary-approach-to-understand-and-manage-obesity-and-related-diseases
#2
REVIEW
Stephan C Bischoff, Yves Boirie, Tommy Cederholm, Michael Chourdakis, Cristina Cuerda, Nathalie M Delzenne, Nicolaas E Deutz, Denis Fouque, Laurence Genton, Carmen Gil, Berthold Koletzko, Miguel Leon-Sanz, Raanan Shamir, Joelle Singer, Pierre Singer, Nanette Stroebele-Benschop, Anders Thorell, Arved Weimann, Rocco Barazzoni
Overnutrition and sedentary lifestyle result in overweight or obesity defined as abnormal or excessive fat accumulation that may impair health. According to the WHO, the worldwide prevalence of obesity nearly doubled between 1980 and 2008. In 2008, over 50% of both men and women in the WHO European Region were overweight, and approximately 23% of women and 20% of men were obese. Comprehensive diagnostic and therapeutic approaches should include nutritional treatment to favor the best metabolic and nutritional outcome, as well as to induce potential disease-specific benefits from selected nutritional regimens...
November 16, 2016: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/27882142/multicenter-study-on-the-prognosis-associated-with-respiratory-support-for-children-with-acute-hypoxic-respiratory-failure
#3
Fei Guo, Lin Hao, Qing Zhen, Min Diao, Chonglin Zhang
The objective of the present study was to explore the factors influencing the outcomes related to respiratory support of children with acute hypoxic respiratory failure (AHRF) in 30 hospitals. This was a non-controlled prospective and collaborative multicenter clinical study conducted from June, 2010 to May, 2011 (each hospital for 12 consecutive months). Children aged from 29 days to 6 years and who met the diagnostic standards of AHRF were enrolled as subjects for the study. After patients were enrolled, general parameters including disease diagnosis, treatment and prognosis were recorded...
November 2016: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/27867308/effect-of-n-methyl-d-aspartate-receptor-antagonist-dextromethorphan-on-opioid-analgesia-in-pediatric-intensive-care-unit
#4
Mohammed Naeem, Hala Al Alem, Ali Al Shehri, Majed Al-Jeraisy
Objective. Pain control is an essential goal in the management of critical children. Narcotics are the mainstay for pain control. Patients frequently need escalating doses of narcotics. In such cases an adjunctive therapy may be beneficial. Dextromethorphan (DM) is NMDA receptor antagonist and may prevent tolerance to narcotics; however, its definitive role is still unclear. We sought whether dextromethorphan addition could decrease the requirements of fentanyl to control pain in critical children. Design. Double-blind, randomized control trial (RCT)...
2016: Pain Research & Management: the Journal of the Canadian Pain Society
https://www.readbyqxmd.com/read/27862499/pain-assessment-and-management-in-paediatric-oncology-a-cross-sectional-audit
#5
Karin Plummer, Maria McCarthy, Ian McKenzie, Fiona Newall, Elizabeth Manias
AIMS AND OBJECTIVES: To describe the pain assessment and management practices documented by health professionals within a tertiary Children's Cancer Centre and to evaluate how these practices compare with international recommendations. BACKGROUND: Children with cancer are vulnerable to pain due to the intensity of antineoplastic therapy. Therefore, it is imperative to ensure that current pain management practices provided to paediatric oncology in-patients is of a high quality...
November 10, 2016: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/27843007/a-systematic-review-and-meta-analysis-of-intensive-multidisciplinary-intervention-for-pediatric-feeding-disorders-how-standard-is-the-standard-of-care
#6
William G Sharp, Valerie M Volkert, Lawrence Scahill, Courtney E McCracken, Barbara McElhanon
OBJECTIVE: To assess models of care and conduct a meta-analysis of program outcomes for children receiving intensive, multidisciplinary intervention for pediatric feeding disorders. STUDY DESIGN: We searched Medline, PsycINFO, and PubMed databases (2000-2015) in peer-reviewed journals for studies that examined the treatment of children with chronic food refusal receiving intervention at day treatment or inpatient hospital programs. Inclusion criteria required the presentation of quantitative data on food consumption, feeding behavior, and/or growth status before and after intervention...
November 8, 2016: Journal of Pediatrics
https://www.readbyqxmd.com/read/27808460/patient-reported-health-status-during-pediatric-cancer-treatment
#7
Sarah Dobrozsi, Ke Yan, Raymond Hoffmann, Julie Panepinto
BACKGROUND: Changes in patient function and factors affecting pediatric patients with cancer during treatment are largely unknown. The purpose of this study was to measure patient-reported outcomes (PROs) in children during the initial 6 months of therapy to characterize function and explore factors associated with function including type of cancer, intensity of therapy, age, and gender. PROCEDURE: We conducted a prospective cohort study of children aged 5-21 newly diagnosed with cancer...
November 3, 2016: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/27806794/-follow-up-of-survived-children-supported-by-extracorporeal-membrane-oxygenation
#8
Y Cheng, Z J Lu, X G Yan, J He, G F Yan, X D Cai, W J Shen, A L Jin, G P Lu
Objective: To summarize the follow-up of children treated with venoarterial extracorporeal membrane oxygenation (ECMO) by incision of internal carotid artery-vein. Method: This was a retrospective study, 10 children in whom the conventional therapy failed, but survived after treatment with ECMO technique through right internal jugular artery-venous incision and ligation after ECMO in pediatric intensive care unit (PICU) of Fudan University were followed up from December 2011 to December 2015. Primary disease situation, neurological development, growth and development, quality of life and personality development were included...
November 2, 2016: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
https://www.readbyqxmd.com/read/27799777/high-frequency-oscillatory-ventilation-is-an-effective-treatment-for-severe-pediatric-acute-respiratory-distress-syndrome-with-refractory-hypoxemia
#9
Yu-Xiong Guo, Zhao-Ni Wang, Ya-Ting Li, Li Pan, Li-Fen Yang, Yan Hu, Yue-Yu Sun, Liang-Ming Cai, Zhuang-Gui Chen
BACKGROUND AND PURPOSE: Early or primary application of high-frequency oscillatory ventilation (HFOV) has been recently suggested not to offer benefit to patients with acute respiratory distress syndrome (ARDS). However, the rescue effects of HFOV on severe pediatric acute respiratory distress syndrome (PARDS) with hypoxemia refractory to conventional mechanical ventilation (CMV) remain unclear. This study aimed to determine whether severe PARDS children would benefit from HFOV when oxygenation deteriorated on CMV and to identify any potential risk factors related to mortality...
2016: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/27798546/evaluation-of-early-corticosteroid-therapy-in-management-of-pediatric-septic-shock-in-pediatric-intensive-care-patients-a-randomized-clinical-study
#10
Ahmed El-Nawawy, Doaa Khater, Heba Omar, Yasser Wali
BACKGROUND: Septic shock is a major healthcare problem. Adrenal insufficiency in children with septic shock is a recognized complication, yet is controversial regarding its management and effect on mortality. According to the current guidelines, children with risk factors for adrenal insufficiency should receive a stress dose of steroids in step 3 of treatment. This study aimed to evaluate and compare early corticosteroid therapy with the traditional use of steroids among pediatric septic shock patients...
October 25, 2016: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/27798539/pediatric-minor-traumatic-brain-injury-with-intracranial-hemorrhage-identifying-low-risk-patients-who-may-not-benefit-from-icu-admission
#11
Erin Comer Burns, Beech Burns, Craig D Newgard, Amber Laurie, Rongwei Fu, Theresa Graif, Casey S Ward, Abbie Bauer, David Steinhardt, Laura M Ibsen, David M Spiro
BACKGROUND: Pediatric patients with any severity of traumatic intracranial hemorrhage (tICH) are often admitted to intensive care units (ICUs) for early detection of secondary injury. We hypothesize that there is a subset of these patients with mild injury and tICH for whom ICU care is unnecessary. OBJECTIVES: To quantify tICH frequency and describe disposition and to identify patients at low risk of inpatient critical care intervention (CCI). METHODS: We retrospectively reviewed patients aged 0 to 17 years with tICH at a single level I trauma center from 2008 to 2013...
October 28, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27794361/the-vulnerable-microcirculation-in-the-critically-ill-pediatric-patient
#12
REVIEW
J W Kuiper, D Tibboel, C Ince
In neonates, cardiovascular system development does not stop after the transition from intra-uterine to extra-uterine life and is not limited to the macrocirculation. The microcirculation (MC), which is essential for oxygen, nutrient, and drug delivery to tissues and cells, also develops. Developmental changes in the microcirculatory structure continue to occur during the initial weeks of life in healthy neonates. The physiologic hallmarks of neonates and developing children make them particularly vulnerable during critical illness; however, the cardiovascular monitoring possibilities are limited compared with critically ill adult patients...
October 30, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27790606/nutrition-a-primary-therapy-in-pediatric-acute-respiratory-distress-syndrome
#13
REVIEW
Bryan Wilson, Katri Typpo
Appropriate nutrition is an essential component of intensive care management of children with acute respiratory distress syndrome (ARDS) and is linked to patient outcomes. One out of every two children in the pediatric intensive care unit (PICU) will develop malnutrition or have worsening of baseline malnutrition and present with specific micronutrient deficiencies. Early and adequate enteral nutrition (EN) is associated with improved 60-day survival after pediatric critical illness, and, yet, despite early EN guidelines, critically ill children receive on average only 55% of goal calories by PICU day 10...
2016: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/27783743/online-training-for-health-professionals-in-three-regions-of-brazil
#14
Edna Aparecida Bussotti, Maria Teresa Meireles Leite, Adriana Cristina da Cunha Alves, Kellen Cristensen
Objective: to describe online training experience aimed at professionals working in the public health service in 27 Neonatal and Pediatric Intensive Care Units, and to reflect concerning the training process and possible improvements in this process. Method: this is an experience report study about the online training with multidisciplinary content, planned from the situational diagnosis of 27 institutions. The training target set was 10 participants per institution and per module, including the following topics: Indicators of Quality as a Management Tool, Hand Hygiene, Patient Safety, Intravenous Therapy and Patients' Chart Record...
September 2016: Revista Brasileira de Enfermagem
https://www.readbyqxmd.com/read/27753765/risk-adjustment-for-congenital-heart-surgery-score-as-a-risk-factor-for-candidemia-in-children-undergoing-congenital-heart-defect-surgery
#15
Fabio de Araujo Motta, Libera Maria Dalla-Costa, Marisol Dominguez Muro, Andrea Lenzi, Gledson Luiz Picharski, Marion Burger
BACKGROUND: Candida species are the primary cause of invasive fungal infection in hospitalized children. There are few data on risk factors for postoperative candidemia in pediatric patients with congenital heart defects. This study aimed to identify risk factors for candidemia in patients with congenital heart defects who underwent cardiac surgery. METHODS: This was a case-control study conducted in patients admitted to a pediatric cardiology intensive care unit from January 2006 to December 2013...
November 2016: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/27750191/interhospital-transfer-of-children-in-respiratory-failure-a-clinician-interview-qualitative-study
#16
Folafoluwa O Odetola, Renee R Anspach, Yong Y Han, Sarah J Clark
PURPOSE: To investigate the decision making underlying transfer of children with respiratory failure from level II to level I pediatric intensive care unit care. METHODS: Interviews with 19 eligible level II pediatric intensive care unit physicians about a hypothetical scenario of a 2-year-old girl in respiratory failure: RESULTS: At baseline, indices critical to management were as follows: OI (53%), partial pressure of oxygen in arterial blood (Pao2)/Fio2 (32%), and inflation pressure (16%)...
October 4, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27749512/2016-update-for-the-rogers-textbook-of-pediatric-intensive-care-recognition-and-initial-management-of-shock
#17
Julie C Fitzgerald, Scott L Weiss, Niranjan Kissoon
OBJECTIVE: To review important articles in the field of pediatric shock and pediatric septic shock published subsequent to the Fifth Edition of the Rogers' Textbook of Pediatric Intensive Care. DATA SOURCES: The U.S. National Library of Medicine PubMed (www.ncbi.nlm.nih.gov/pubmed) was searched for combination of the term "pediatric" and the following terms: "sepsis, septic shock, shock, antibiotics, extracorporeal membrane oxygenation, and steroid." The abstract lists generated by these searches were screened for potential inclusion...
November 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27748700/acetazolamide-therapy-for-metabolic-alkalosis-in-pediatric-intensive-care-patients
#18
Carolina López, Andrés José Alcaraz, Blanca Toledo, Lucía Cortejoso, Maite Augusta Gil-Ruiz
OBJECTIVE: Patients in PICUs frequently present hypochloremic metabolic alkalosis secondary to loop diuretic treatment, especially those undergoing cardiac surgery. This study evaluates the effectiveness of acetazolamide therapy for metabolic alkalosis in PICU patients. DESIGN: Retrospective, observational study. SETTING: A tertiary care children's hospital PICU. PATIENTS: Children receiving at least a 2-day course of enteral acetazolamide...
December 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27743745/use-of-transcranial-doppler-for-management-of-central-nervous-system-infections-in-critically-ill-children
#19
Laurence Ducharme-Crevier, Michele G Mills, Priya M Mehta, Craig M Smith, Mark S Wainwright
BACKGROUND: The primary objective of this study was to characterize changes in cerebral blood flow measured using transcranial Doppler in children with central nervous system infections. We hypothesized that children with central nervous system infections have abnormal cerebral blood flow, associated with a greater frequency of complications and poor neurological outcome. METHODS: We conducted a single-center, retrospective study of children admitted to the neonatal or pediatric intensive care unit with central nervous system infection and undergoing transcranial Doppler as part of routine care between March 2011 and July 2015...
December 2016: Pediatric Neurology
https://www.readbyqxmd.com/read/27741074/using-pleth-variability-as-a-triage-tool-for-children-with-obstructive-airway-disease-in-a-pediatric-emergency-department
#20
Ariel Brandwein, Kavita Patel, Myriam Kline, Peter Silver, Sandeep Gangadharan
OBJECTIVES: Patients with obstructive airway disease have varying degrees of pulsus paradoxus that correlate with illness severity. Pulsus paradoxus can be measured using plethysmography. We investigated whether plethysmograph (pleth) variability on admission to the pediatric emergency department (ED) could predict patient disposition. We hypothesized that patients with a larger pleth variability would have a higher likelihood of being admitted to a general pediatrics unit or the intensive care unit (ICU)...
October 6, 2016: Pediatric Emergency Care
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