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https://www.readbyqxmd.com/read/30300922/influence-of-oct1-ontogeny-and-genetic-variation-on-morphine-disposition-in-critically-ill-neonates-lessons-from-pbpk-modeling-and-clinical-study
#1
David Hahn, Chie Emoto, Joshua C Euteneuer, Tomoyuki Mizuno, Alexander A Vinks, Tsuyoshi Fukuda
Morphine is commonly used for analgesia in the neonatal intensive care unit (NICU) despite having highly variable pharmacokinetics between individual patients. The pharmacogenetic effect of variants at the loci of OCT1 and UGT2B7 on age-dependent morphine clearance were evaluated in a cohort of critically ill neonatal patients using an opportunistic sampling design. Our primary results demonstrate the significant influence of OCT1 genotype (p<0.05) and gestational age (p≤0.005) on morphine pharmacokinetics...
October 9, 2018: Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/30291321/tidal-volume-monitoring-during-emergency-neonatal-transport
#2
Joanna D Costa, Sandeep Sadashiv, Jennifer Hesler, Robert G Locke, Thomas J Blackson, Amy B Mackley
OBJECTIVE: The study aim was to identify the frequency with which tidal volumes were achieved in a target range in infants requiring positive pressure ventilation on emergency transport. STUDY DESIGN: We performed a prospective observational study of infants requiring continued positive pressure ventilation during emergency transport after resuscitation and stabilization. Blindly recorded data were analyzed for percentage of breaths that were below range, in range, and above desired range of 4-6 mL/kg...
October 5, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/30284747/a-generalized-multistage-approach-to-oral-and-nasal-intubation-in-infants-with-pierre-robin-sequence-a-retrospective-review
#3
T Wesley Templeton, Eduardo J Goenaga-Díaz, Christopher M Runyan, Eleanor P Kiell, Amy J Lee, Leah B Templeton
BACKGROUND: Airway management in children with Pierre Robin sequence in the infantile period can be challenging and frequently requires specialized approaches. AIM: The aim of this study was to review our experience with a multistage approach to oral and nasal intubation in young infants with Pierre Robin sequence. METHODS: After IRB approval, we reviewed 13 infants with Pierre Robin sequence who underwent a multistage approach to intubation in the operating room for mandibular distractor or gastrostomy tube placement...
October 4, 2018: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/30281884/consensus-based-criterion-standard-for-the-identification-of-pediatric-patients-who-need-ems-transport-to-a-hospital-with-higher-level-pediatric-resources
#4
Jonathan R Studnek, E Brooke Lerner, Manish I Shah, Lorin R Browne, David C Brousseau, Jeremy T Cushman, Peter S Dayan, Patrick C Drayna, Amy L Drendel, Matthew P Gray, Christopher A Kahn, Michael T Meyer, Manish N Shah, Rachel M Stanley
BACKGROUND: Emergency Medical Services (EMS) providers must be able to identify the most appropriate destination facility when treating children with potentially severe medical illnesses. Currently, no validated tool exists to assist EMS providers in identifying children who need transport to a hospital with higher-level pediatric care. In order for such a tool to be developed, a criterion standard needs to be defined that identifies children who received higher-level pediatric medical care...
October 3, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/30255218/prevalence-and-predictors-of-back-transport-closer-to-maternal-residence-after-acute-neonatal-care-in-a-regional-nicu
#5
Stephanie L Bourque, Claire Levek, Diane L Melara, Theresa R Grover, Sunah S Hwang
Objectives To describe the demographics, clinical characteristics and referral patterns of premature infants to a regional level IV neonatal intensive care unit (NICU); to determine the prevalence and predictors of back-transport of infants ≤ 32 weeks gestational age in a level IV NICU; for infants not back-transported closer to maternal residence, determine the length of stay beyond attainment of clinical stability. Methods Data (2010-2014) from the Children's Hospital Neonatal Database and individual chart review for infants ≤ 32 weeks admitted to a level IV NICU whose maternal residence was outside the metro area were included...
September 25, 2018: Maternal and Child Health Journal
https://www.readbyqxmd.com/read/30234741/correlation-of-bedside-pediatric-early-warning-system-score-to-interventions-during-peritransport-period
#6
Christopher K Page-Goertz, Mahua Dasgupta, Raymond G Hoffmann, Christopher Parshuram, Michael L Forbes, Michael T Meyer
BACKGROUND: The Bedside Pediatric Early Warning System score is a validated measure of severity of illness in acute care inpatient settings. Its potential as a remote assessment tool for interfacility transport has not been evaluated. We hypothesized that the Bedside Pediatric Early Warning System score was associated with need for intervention during the peritransport period and patient disposition. METHODS: We retrospectively evaluated children transported by a regional pediatric team during a 6-month period...
September 18, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/30233492/the-retinol-circulating-complex-releases-hormonal-ligands-during-acute-stress-disorders
#7
REVIEW
Yves Ingenbleek
Intensive care workers actively participate in very hot debates aiming at defining the true metabolic, hormonal and nutritional requirements of critically ill patients, the contributory roles played by thyroid and retinoid ligands being largely underestimated. The present article makes up for redressing the balance on behalf of these last hormonal compounds. The retinol circulating complex is transported in the bloodstream in the form of a trimolecular edifice made up of transthyretin (TTR), retinol-binding protein (RBP) and its retinol ligand...
2018: Frontiers in Endocrinology
https://www.readbyqxmd.com/read/30225555/resource-use-and-clinical-outcomes-in-blunt-thoracic-injury-a-10-year-trauma-registry-comparison-between-southern-finland-and-germany
#8
Mikko Heinänen, Tuomas Brinck, Rolf Lefering, Lauri Handolin, Tim Söderlund
PURPOSE: Serious thoracic injuries are associated with high mortality, morbidity, and costs. We compared patient populations, treatment, and survival of serious thoracic injuries in southern Finland and Germany. METHODS: Mortality, patient characteristics and treatment modalities were compared over time (2006-2015) in all patients with Abbreviated Injury Scale (AIS) thorax ≥ 3, Injury Severity Score (ISS) > 15, age > 15 years, blunt trauma mechanism, and treatment in Intensive Care Unit (ICU) in Level 1 hospitals included in the Helsinki Trauma Registry (HTR) and the TraumaRegister DGU® (TR-DGU)...
September 17, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/30217366/a-mixed-method-approach-to-understanding-the-factors-surrounding-delayed-diagnosis-of-type-one-diabetes
#9
TeriSue Smith-Jackson, Mary V Brown, Matthew Flint, Merilee Larsen
AIMS: This study examined delayed type one diabetes (T1D) diagnosis, along with the associated severity markers, in the United States. Qualitative reflection was explored to add depth of understanding. METHODS: 975 parents of a minor child with T1D were recruited through snowball, social media requests to complete a 55-question online survey on the experience of diagnosis. RESULTS: 34% of children with T1D had a delayed diagnosis. When compared to those without a delayed diagnosis, these children were more likely to have an Emergency Room diagnosis (39...
November 2018: Journal of Diabetes and its Complications
https://www.readbyqxmd.com/read/30189782/effects-of-medical-transport-on-outcomes-in-children-requiring-intensive-care
#10
Atsushi Kawaguchi, L Duncan Saunders, Yutaka Yasui, Allan DeCaen
BACKGROUND AND OBJECTIVES: The need to centralize patients for specialty care in the setting of regionalization may delay access to specialist services and compromise outcomes, particularly in a large geographic area. The aim of this study was to explore the effects of interhospital transferring of children requiring intensive care in a Canadian regionalization model. METHODS: A retrospective cohort design with a matched pair analysis was adopted to compare the outcomes in children younger than 17 years admitted to a pediatric intensive care unit (PICU) of a Canadian children's hospital by a specialized transport team (pediatric critical care transported [PCCT] group) and those children admitted directly to PICU from its pediatric emergency department (PED group)...
September 6, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/30186507/neonatology-paediatrics-and-paediatric-virology-on-a-british-island-an-interview-with-neonatologist-dr-prakash-thiagarajan-isle-of-man
#11
Ioannis N Mammas, Demetrios A Spandidos
Dr Prakash Thiagarajan, consultant neonatologist and clinical director at Women's and Children's Division at Noble's Hospital on the Isle of Man, is one of the most talented neonatologists in the UK with a great experience in newer modes of infant ventilation and the application of technology in neonatal medicine and paediatrics. Under his leadership, the new neonatal intensive care unit (NICU) at Noble's Hospital is a state-of-the-art neonatal unit offering the very highest standards of care for critically ill babies on the island...
September 2018: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/30178356/hyperbaric-oxygen-therapy-in-necrotizing-soft-tissue-infections-a-retrospective-study
#12
Tina Steiner, Annett Seiffart, Julia Schumann, Michael Bucher
Necrotizing soft tissue infection is a severe life-threatening disease correlated with high mortality. Until now, therapeutic concepts include antimicrobial, intensive care and surgical interventions, as well as the application of hyperbaric oxygenation (HBO), which still has a controversial status. Evidence of the therapeutic concept of HBO is, so far, limited to positive experiences in case studies and physiological benefits in animal studies. That is why the HBO therapy method is not yet fully established...
2018: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/30175402/treatment-gap-for-convulsive-status-epilepticus-in-resource-poor-countries
#13
Byungin Lee
The magnitude of the treatment gap (TG) for convulsive status epilepticus (CSE) in resource-poor countries is unknown. Hospital-based cohort studies from developing countries revealed that the management of CSE was usually suboptimal due to lack of advanced diagnostic and treatment facilities, significant delay in patient's presentation at hospital, and shortages of essential antiepileptic drugs (AEDs). However, there were no significant differences in the proportion of refractory status epilepticus, short-term mortalities, and morbidities of CSE between the developed and the developing countries...
October 2018: Epilepsia
https://www.readbyqxmd.com/read/30171974/surviving-refractory-out-of-hospital-ventricular-fibrillation-cardiac-arrest-critical-care-and-extracorporeal-membrane-oxygenation-management
#14
Jason A Bartos, Kathleen Carlson, Claire Carlson, Ganesh Raveendran, Ranjit John, Tom P Aufderheide, Demetris Yannopoulos
BACKGROUND: Resuscitation of refractory out-of-hospital ventricular fibrillation/ventricular tachycardia (VF/VT) cardiac arrest using extracorporeal membrane oxygenation (ECMO) establishes a complex patient population. We aimed to describe the critical care strategies and outcomes in this population. METHODS: Between December 1, 2015 and January 1, 2018, 100 consecutive adult patients with refractory VF/VT out-of-hospital cardiac arrest and ongoing CPR were transported to the cardiac catheterization laboratory...
November 2018: Resuscitation
https://www.readbyqxmd.com/read/30160799/total-and-high-affinity-corticosteroid-binding-globulin-depletion-in-septic-shock-is-associated-with-mortality
#15
Emily J Meyer, Marni A Nenke, Wayne Rankin, John G Lewis, Elisabeth Konings, Maarten Slager, Tim C Jansen, Jan Bakker, Johannes Hofland, Richard A Feelders, David J Torpy
CONTEXT: Corticosteroid-binding globulin (CBG) and albumin transport circulating cortisol. Cleavage of high-affinity CBG (haCBG) by neutrophil elastase at inflammatory sites causes cortisol release into tissues, facilitating immunomodulatory effects. OBJECTIVE: To determine whether depletion of haCBG is related to mortality in septic shock. DESIGN: A single-center prospective observational cohort study of patients recruited with critical illness or septic shock, using serum samples collected at 0, 8, 24, 48 and 72 hours...
August 30, 2018: Clinical Endocrinology
https://www.readbyqxmd.com/read/30157756/the-mission-characteristics-of-a-newly-implemented-rural-helicopter-emergency-medical-service
#16
Daniel Kornhall, Robert Näslund, Cecilia Klingberg, Regina Schiborr, Mikael Gellerfors
BACKGROUND: Physician-staffed helicopter emergency services (HEMS) can provide benefit through the delivery of specialist competence and equipment to the prehospital scene and through expedient transport of critically ill patients to specialist care. This paper describes the integration of such a system in a rural Swedish county. METHODS: This is a retrospective database study recording the outcomes of every emergency call centre dispatch request as well as the clinical and operational data from all completed missions during this service's first year in operation...
August 29, 2018: BMC Emergency Medicine
https://www.readbyqxmd.com/read/30153186/transport-of-critically-ill-cardiovascular-patients
#17
Yelena Ignatyeva, Albert Phan Nguyen, Ulrich Schmidt, Ron Barak, Ravi Agarwal, Judy E Davidson
Intra-hospital transport (IHT) of intensive care unit (ICU) patients is associated with a 30% to 60% incidence of adverse events (AEs). This prospective observational study collected data from 200 patient transports from a 24-bed cardiovascular intensive care unit (ICU) between July 2017 and December 2017. Phase 1 of the study focused on identifying and correcting deficiencies in nurses' knowledge regarding IHT. Phase 2 observed the occurrence and type of AEs during the IHT of ICU patients with and without physician accompaniment...
October 2018: Critical Care Nursing Quarterly
https://www.readbyqxmd.com/read/30126377/delayed-access-to-emergency-obstetrical-care-among-preeclamptic-and-non-preeclamptic-women-in-port-au-prince-haiti
#18
Katharine Hutchinson, Malcolm Bryant, Mary Bachman DeSilva, Deborah Price, Lora Sabin, Lindsay Bryson, Roger Jean Charles, Eugene Declercq
BACKGROUND: The primary objective of this comparative, cross-sectional study was to identify factors affecting delays in accessing emergency obstetric care and clinical consequences of delays among preeclamptic and non-preeclamptic women in Port-au-Prince, Haiti. METHODS: We administered 524 surveys to women admitted to the Médecins Sans Frontières Centre de Référence en Urgences Obstétricales (CRUO) obstetric emergency hospital. Survey questions addressed first (at home), second (transport) and third (health facility) delays; demographic, clinical, and behavioral risk factors for delay; and clinical outcomes for women and infants...
August 20, 2018: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/30121790/interhospital-transport-of-ards-patients-on-extracorporeal-membrane-oxygenation
#19
Jan Florian Heuer, Moritz Mirschel, Annalen Bleckmann, Michael Quintel, Onnen Moerer
Veno-venous extracorporeal membrane oxygenation (ECMO) can be a lifesaving therapy for patients with severe acute respiratory distress syndrome (ARDS). ECMO is a technically complex and challenging procedure and should therefore only be performed in specialized centers. Transporting ARDS patients to ECMO centers for treatment can be dangerous because of the risk of hypoxemia during transport. This raises the question if ECMO should not be already initiated in the transferring hospital before transport. Over a 5-year period, we studied ARDS patients who had been transported to our department by our mobile ECMO team for further treatment after ECMO had already been initiated at the referring hospital...
August 18, 2018: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
https://www.readbyqxmd.com/read/30118376/utilizing-pediatric-scoring-systems-to-predict-disposition-during-interfacility-transport
#20
Tanya Holt, Michael Prodanuk, Gregory Hansen
OBJECTIVE: Determining care disposition for pediatric patients during interfacility transport is often challenging. Severity of illness scoring can assist with this process. The purpose of this retrospective study was to compare currently utilized scoring systems and their ability to reliably match pediatric transport patients' severity of illness with the level of care necessary. METHODS: The retrospective transport registry review for our region included 209 patients <18 years, transported between 2015 and 2016 and admitted to tertiary care...
August 17, 2018: Prehospital Emergency Care
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