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pediatric critical care intensive care children

H X Shi, J Z Wu, G B Chen, B Z Zhu, W Y Yan, L Chen, Y J Xiao, L Y Zhang
Objective: To assess the effectiveness in optimizing resources and shortening critical children's waiting time in pediatric emergency department (PED) with five-level pediatric emergency triage system (PETS). Methods: This retrospective study was conducted in the First Affiliated Hospital of Xiamen University after PETS was applied. The data of patients who visited the pediatric emergency department from January 2015 to December 2017 were collected and analyzed, including age, sex, diseases, visiting time, triage rate and destination...
December 2, 2018: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Pedro Bichaff, Karina T Setani, Emiliana H G Motta, Artur F Delgado, Werther B Carvalho, Michele Luglio
OBJECTIVE: Opioid abstinence syndrome is common in the pediatric intensive care environment because sedation is often needed during the children's treatment. There is no specific guideline regarding the management of these patients; and lately, methadone is an important drug for the prevention of abstinence symptoms during the weaning of opioids. This study gathers the available research to establish the initial dose of methadone, the rate of taper and tools to recognize this syndrome and act promptly...
October 2018: Revista da Associação Médica Brasileira
Sushma Reddy, Angelo Polito, Sandra Staveski, Heidi Dalton
There are substantial knowledge gaps, practice variation, and paucity of controlled trials owing to the relatively small number of patients with critical heart disease. The Pediatric Cardiac Intensive Care Society has recognised this knowledge gap as an area needing a more comprehensive and evidence-based approach to the management of the critically ill child with heart disease. To address this, the Pediatric Cardiac Intensive Care Society created a scientific statements and white papers committee. Scientific statements and white papers will present the current state-of-the-art in areas where controversy exists, providing clinicians with guidance in diagnostic and therapeutic strategies, particularly where evidence-based data are lacking...
December 4, 2018: Cardiology in the Young
Jong-Seo Yoon, Won Kyoung Jhang, Yu Hyeon Choi, Bongjin Lee, Yoon Hee Kim, Hwa Jin Cho, Byung Wook Eun, Jintae Kim, Kyung Won Kim, Joongbum Cho, Hong Ju Shin, Jeong Min Ryu, Jae Hee Chung, Young Yoo, June Huh, Seong Jong Park, June Dong Park
Background: The aim of this study was to describe the structure, organization, management, and staffing of pediatric critical care (PCC) in Korea. Methods: We directed a questionnaire survey for all Upper Grade General Hospitals (n = 43) in Korea in 2015. The first questionnaire was mainly about structure, organization, and staffing and responses were obtained from 32 hospitals. The second questionnaire was mainly about patients and management. Responses to second questionnaire were obtained from 18 hospitals...
December 3, 2018: Journal of Korean Medical Science
Todd Karsies, Melissa Moore-Clingenpeel, Mark Hall
Background: Risk-based guidelines aid empiric antibiotic selection for critically ill adults with suspected infection with Gram-negative bacilli with high potential for antibiotic resistance (termed high-risk GNRs). Neither evidence-based guidelines for empiric antibiotic selection nor validated risk factors predicting high-risk GNR growth exist for critically ill children. We developed and validated a model for predicting high-risk GNR growth in critically ill children with suspected infection...
November 2018: Open Forum Infectious Diseases
Kevin J Downes, Julie C Fitzgerald, Emily Schriver, Craig L K Boge, Michael E Russo, Scott L Weiss, Fran Balamuth, Sherri E Kubis, Pam Tolomeo, Warren B Bilker, Jennifer H Han, Ebbing Lautenbach, Susan E Coffin, Jeffrey S Gerber
Background: Biomarkers can facilitate safe antibiotic discontinuation in critically ill patients without bacterial infection. Methods: We tested the ability of a biomarker-based algorithm to reduce excess antibiotic administration in patients with systemic inflammatory response syndrome (SIRS) without bacterial infections (uninfected) in our pediatric intensive care unit (PICU). The algorithm suggested that PICU clinicians stop antibiotics if (1) C-reactive protein <4 mg/dL and procalcitonin <1 ng/mL at SIRS onset and (2) no evidence of bacterial infection by exam/testing by 48 hours...
November 22, 2018: Journal of the Pediatric Infectious Diseases Society
Brenda Bursch, Natacha D Emerson, Armen C Arevian, Hilary Aralis, Lee Galuska, Jessica Bushman, Maegan Sinclair, Karen Grimley, Patricia Lester, Yonca Bulut
PURPOSE: The primary goal of this study was to test the feasibility of an educational online self-assessment of burnout, resilience, trauma, depression, anxiety, and common workplace stressors among nurses working in a pediatric intensive care unit or neonatal intensive care unit setting. The secondary, exploratory objectives were to estimate the prevalence of psychiatric symptoms in this sample and to identify those variables that most strongly predict burnout. DESIGN AND METHODS: Data from optional and anonymous online measures were analyzed for 115 nurses (67...
November 2018: Journal of Pediatric Nursing
Gillian A Colville, Christine M Pierce, Mark J Peters
OBJECTIVES: Adults report high levels of fatigue after intensive care, but little is known about pediatric survivors. This study aimed to explore rates of self-reported fatigue in children after critical illness. DESIGN: Prospective cohort study. SETTING: Tertiary children's hospital. PATIENTS: Ninety-seven children aged 7-17 years old. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Children completed the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale 3 months after discharge from PICU...
November 16, 2018: Pediatric Critical Care Medicine
Rocío Rodríguez-Rey, Jesús Alonso-Tapia
Research on parental psychological effects related to a child's critical illness has focused on studying negative outcomes, while the possibility of posttraumatic growth (PTG), defined as the perception of positive changes after a traumatic event, has been overlooked. This study explores the degree of parental PTG after a child's hospitalization in a pediatric intensive care unit (PICU) and the role of resilience, emotions, perceived severity of the child's condition and stress in predicting PTG. In the first 48 h after their child's discharge from a PICU, N = 196 parents were assessed for resilience, emotions, perceived stress, and the degree to which they perceived their child's condition as severe...
November 20, 2018: Journal of Clinical Psychology in Medical Settings
Mitchell Hamele, Katie Neumayer, Jill Sweney, W Bradley Poss
A future global pandemic is likely to occur and planning for the care of critically ill children is less robust than that for adults. This review covers the current state of federal and regional resources for pediatric care in pandemics, a strategy for pandemic preparation in pediatric intensive care units and regions focusing on stuff, space, staff and systems, considerations in developing surge capacity and triage protocols, special circumstances such as highly infectious and highly lethal pandemics, and a discussion of ethics in the setting of pediatric critical care in a pandemic...
October 2018: Translational Pediatrics
Heather A Wolfe, Elizabeth H Mack
The relatively young field of pediatric critical care has seen a shift from an approach with little consideration for the complications and adverse effects resulting from the procedures and medications to a more cautious approach with careful concern for the associated risks. Many senior pediatric intensivists recall a time when nearly every patient had a central venous line and arterial line; and hospital acquired infections, pressure injuries, unplanned extubations, and venous thromboemboli were expected costs of aggressive care...
October 2018: Translational Pediatrics
Ahmed Nabih El Shazly, Doaa Refaey Soliman, Shuzan Ali Mohammed, Rasha Mohammed Zakaria, Fatma Elzahraa Mohammed Awais
Background: Hospital acquired infection (HAI) and multiple organ dysfunctions (MODS) remain a leading cause of death in pediatric intensive care unit (PICU) despite the great efforts to control it. Objective: Our objective was to assess the mRNA of TNFα and BCL2 for prediction of HAI and/or MODS in our community. Patients and methods: Fifty children, admitted to PICU, were included in the study after exclusion of cases of end-stage renal failure, end-stage liver failure and congenital immune deficiency...
December 2018: Annals of Medicine and Surgery
Omar Z Ahmed, Richard Holubkov, J Michael Dean, Tellen D Bennett, Kathleen L Meert, Robert A Berg, Christopher J L Newth, Joseph Carcillo, Randall S Burd, Murray M Pollack
BACKGROUND: Because pediatric trauma-related mortality continue to decline, metrics assessing morbidity are needed to evaluate the impact of treatment after injury. Based of its value for assessing children with traumatic brain injuries and other critical illnesses, Functional Status Scale (FSS), a tool that measures function in six domains (communication, feeding, mental, motor, sensory and respiratory), was evaluated as an outcome measure for the overall population of injured children...
November 15, 2018: Journal of Trauma and Acute Care Surgery
Baljit Cheema, Tyson Welzel, Beyra Rossouw
OBJECTIVES: Noninvasive ventilation is increasingly used in neonatal and pediatric patients, but the intensive care transport setting is lagging in terms of availability of noninvasive ventilation for children. The objective of this systematic review of the literature was to answer the question: In children 0 days to 18 years old, who are hospitalized with acute respiratory distress and require critical care transport, is noninvasive ventilation effective and safe during transport? DATA SOURCES: MEDLINE via PubMed, EMBASE (via Scopus), Cochrane Central Register of Controlled Trials, African Index Medicus, Web of Science Citation Index, and the World Health Organization Trials Registry...
November 15, 2018: Pediatric Critical Care Medicine
Ashley M Kroon Van Diest, Scott W Powers
PURPOSE OF REVIEW: To highlight current evidence supporting the prescription of cognitive behavioral therapy (CBT) as part of first-line preventive treatment for children and adolescents with headache and discuss a research strategy aimed at: (1) understanding how and why CBT works, and (2) developing effective and efficient approaches for integrating CBT into headache specialty, neurology, and primary care settings. RECENT FINDINGS: Although preventive medications for pediatric headache and migraine are commonly prescribed, recent meta-analyses and an NIH-funded, multi-center clinical trial suggests that the effect of pill-taking therapies may be mostly due to a placebo effect...
November 16, 2018: Headache
Justin Wang, Khai Pin Lee, Shu-Ling Chong, Mervin Loi, Jan Hau Lee
Heated humidified high flow nasal cannula therapy (HHHFNCT) is emerging as a popular non-invasive mode of respiratory support in adults and children. In recent years, its use has extended beyond the intensive care unit to other clinical areas. This review aims to explore the mechanism of action, indications, safety, and effectiveness of HHHFNCT use in the Emergency Department (ED). Areas covered: The mechanism of action of HHHFNCT, as well as its use in adult and pediatric ED will be discussed in this review...
November 14, 2018: Expert Review of Medical Devices
David Greaney, John Russell, Ian Dawkins, Martina Healy
INTRODUCTION: The safety of cuffed endotracheal tubes in the neonatal and critically ill pediatric population continues to be questioned due to the theoretical risk of acquired subglottic stenosis. The incidence of acquired subglottic stenosis in the high-risk mixed surgical and medical critically ill pediatric cohort using high-volume, low-pressure cuffed endotracheal tube policy has not yet been described. The aim of our study was to describe and evaluate the use and complication rate of cuffed ETT's in our unit over a 5-year period...
October 29, 2018: Paediatric Anaesthesia
Evelyn Dhont, Tatjana Van Der Heggen, Annick De Jaeger, Johan Vande Walle, Peter De Paepe, Pieter A De Cock
Many critically ill patients display a supraphysiological renal function with enhanced renal perfusion and glomerular hyperfiltration. This phenomenon described as augmented renal clearance (ARC) may result in enhanced drug elimination through renal excretion mechanisms. Augmented renal clearance seems to be triggered by systemic inflammation and therapeutic interventions in intensive care. There is growing evidence that ARC is not restricted to the adult intensive care population, but is also prevalent in critically ill children...
October 29, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Jan Vlachy, Mingyoung Jo, Qing Li, Turgay Ayer, Pinar Keskinocak, Julie Swann, Larry Olson, Atul Vats
Objective: cEEG is an emerging technology for which there are no clear guidelines for patient selection or length of monitoring. The purpose of this study was to identify subgroups of pediatric patients with high incidence of seizures. Study Design: We conducted a retrospective study on 517 children monitored by cEEG in the intensive care unit (ICU) of a children's hospital. The children were stratified using an age threshold selection method. Using regression modeling, we analyzed significant risk factors for increased seizure risk in younger and older children...
2018: Frontiers in Pediatrics
Amna Afzal Saeed, Qalab Abbas, Sidra Ishaque, Bushra Saeed, Anwar Ul Haque
To describe the experience of thrombolysis using tissue plasminogen activator (tPA) in critically ill children admitted to the pediatric intensive care unit (PICU), retrospective review of medical records of all children (1 month-16 years), who were admitted in PICU since January 2014 to December 2017 and received systemic tPA for thrombolysis was done. Data was collected on a structured proforma and included thrombus location, tPA dose and duration, outcome (resolution, survival) and complications (bleeding)...
October 2018: Indian Journal of Hematology & Blood Transfusion
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