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Pediatric Intensive Care Therapy

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https://www.readbyqxmd.com/read/28534144/coordination-of-care-in-survivorship-after-treatment-of-hematological-malignancies-the-journey-is-not-over-yet
#1
REVIEW
Catherine J Lee, Lori S Muffly
The number of adult survivors of hematologic malignancies is steadily growing. This population is at moderate to high risk for cancer survivorship issues including physical and psychosocial sequelae of intensive cancer therapies. Although cancer survivorship is a growing field in pediatric and solid tumor oncology, survivorship care and research has often been overlooked in the hematologic malignancies. In this review, we focus specifically on survivorship issues related to adult patients with hematologic malignancies and provide commentary on the role of cancer survivorship, proposed survivorship care models, and the economic and health policy obstacles associated with moving the cancer survivorship field forward in this very important patient population...
May 22, 2017: Current Hematologic Malignancy Reports
https://www.readbyqxmd.com/read/28525671/infection-in-critically-ill-pediatric-patients-on-continuous-renal-replacement-therapy
#2
Maria J Santiago, Jesús López-Herce, Eva Vierge, Ana Castillo, Amaya Bustinza, Jose M Bellón, Amelia Sánchez, Sarah Fernández
INTRODUCTION: Continuous renal replacement therapies (CRRT) are frequently used in critically ill children and may increase the risk of infection. However, the incidence, characteristics and prognosis of infection in critically ill children on CRRT have not been studied. METHODS: Data from a prospective, single-center register of critically ill children treated with CRRT was analyzed. RESULTS: 55 children (40% under 1 year of age) were treated with CRRT between June 2008 and January 2012; 43 patients (78...
May 18, 2017: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/28482383/-efficacy-of-continuous-blood-purification-in-treatment-of-severe-acute-pancreatitis-in-children
#3
Y Zhu, Y Cui, Y C Zhang, H J Miao, F Wang, R X Chen, Q F Rong
Objective: To explore the therapeutic role of bedside continuous blood purification(CBP) in children with severe acute pancreatitis(SAP). Method: The clinical and laboratory data of 11 children with SAP who were admitted to Pediatric Intensive Care Unit (PICU) of Shanghai Children's Hospital from June 2013 to May 2016 were analyzed, including using pediatric critical illness score (PCIS) and pediatric risk of score mortality (PRISM)-Ⅲ score to assessing the severity of the disease.For those patients with severe organ dysfunction, CBP treatment was used when conventional therapy was not efficient...
May 4, 2017: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
https://www.readbyqxmd.com/read/28460699/case-study-of-high-dose-ketamine-for-treatment-of-complex-regional-pain-syndrome-in-the-pediatric-intensive-care-unit
#4
REVIEW
Tracy Ann Pasek, Kelli Crowley, Catherine Campese, Rachel Lauer, Charles Yang
Complex regional pain syndrome (CRPS) is a life-altering and debilitating chronic pain condition. The authors are presenting a case study of a female who received high-dose ketamine for the management of her CRPS. The innovative treatment lies not only within the pharmacologic management of her pain, but also in the fact that she was the first patient to be admitted to our pediatric intensive care unit solely for pain control. The primary component of the pharmacotherapy treatment strategy plan was escalating-dose ketamine infusion via patient-controlled-analgesia approved by the pharmacy and therapeutics committee guided therapy for this patient...
June 2017: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/28460120/post-neonatal-tetanus-in-a-picu-of-a-developing-economy-intensive-care-needs-outcome-and-predictors-of-mortality
#5
Suresh Kumar Angurana, Muralidharan Jayashree, Arun Bansal, Sunit Singhi, Karthi Nallasamy
Objectives: To evaluate pediatric intensive care unit (PICU) needs, outcome and predictors of mortality in post-neonatal tetanus. Materials and methods: Review of 30 consecutive post-neonatal tetanus cases aged 1 months to 12 years admitted to a PICU in north India over a period of 10 years (January 2006 to December 2015). Results: Chronic suppurative otitis media was the commonest portal of entry. All received tetanus toxoid, human tetanus immunoglobulin (HTIG) and appropriate antibiotics; 7 (23...
April 27, 2017: Journal of Tropical Pediatrics
https://www.readbyqxmd.com/read/28459760/an-international-survey-of-corticosteroid-use-for-the-management-of-low-cardiac-output-syndrome
#6
Saul Flores, Michael R FitzGerald, Ilias Iliopoulos, Joshua A Daily, Marco Rodriguez, David P Nelson, Hector R Wong, Kusum Menon, David S Cooper
OBJECTIVE: Limited evidence exists on use of corticosteroids in low cardiac output syndrome following cardiac surgery. We sought to determine physicians' practices and beliefs with regard to corticosteroids therapy for low cardiac output syndrome. DESIGN: Multinational internet-based survey. SETTING: Pediatric Cardiac Intensive Care Society member database. SUBJECTS: Pediatric cardiac intensive care physicians. INTERVENTIONS: None...
April 27, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28456909/patients-and-parents-views-regarding-supportive-care-in-childhood-cancer
#7
L J A Tenniglo, E A H Loeffen, L C M Kremer, A Font-Gonzalez, R L Mulder, A Postma, M C Naafs-Wilstra, M A Grootenhuis, M D van de Wetering, W J E Tissing
PURPOSE: Intensive therapies in pediatric malignancies increased survival rates but also occurrence of treatment-related morbidities. Therefore, supportive care fulfills an increasingly important role. In planning development of guidelines with incorporation of shared decision making, we noticed that little is known about the needs and preferences of patients and their parents. Our goals were therefore to investigate (1) which supportive care topics patients and parents regard as most important and (2) the preferred role they wish to fulfill in decision making...
April 29, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/28449710/effects-of-colloid-pre-loading-on-thromboelastography-during-elective-intracranial-tumor-surgery-in-pediatric-patients-hydroxyethyl-starch-130-0-4-versus-5-human-albumin
#8
Yuanzhi Peng, Jianer Du, Xuan Zhao, Xueyin Shi, Yingwei Wang
BACKGROUND: Volume replacement therapy with colloid is still worth studying in major pediatric surgery with potential risk of bleeding. This study assessed the effects of 6% hydroxyethyl starch (HES) 130/0.4 and 5% Human Albumin (HA) on coagulation tested by thromboelastography (TEG) during elective intracranial tumor surgery in pediatric patients. METHODS: In this randomized controlled trial, 60 patients undergoing intracranial tumor resection under general anesthesia were assigned to HES and HA groups (n = 30), and administered preloads of 20 mL · kg(-1) HES 130/0...
April 27, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28444080/rhabdomyolysis-as-a-manifestation-of-a-metabolic-disease-a-case-report
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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