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Pediatric Cardiac icu

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https://www.readbyqxmd.com/read/29777740/rapid-response-systems
#1
REVIEW
Patrick G Lyons, Dana P Edelson, Matthew M Churpek
INTRODUCTION: Rapid response systems are commonly employed by hospitals to identify and respond to deteriorating patients outside of the intensive care unit. Controversy exists about the benefits of rapid response systems. AIMS: We aimed to review the current state of the rapid response literature, including evolving aspects of afferent (risk detection) and efferent (intervention) arms, outcome measurement, process improvement, and implementation. DATA SOURCES: Articles written in English and published in PubMed...
May 16, 2018: Resuscitation
https://www.readbyqxmd.com/read/29770293/current-monitoring-and-innovative-predictive-modeling-to-improve-care-in-the-pediatric-cardiac-intensive-care-unit
#2
REVIEW
Mary K Olive, Gabe E Owens
The objectives of this review are (I) to describe the challenges associated with monitoring patients in the pediatric cardiac intensive care unit (PCICU) and (II) to discuss the use of innovative statistical and artificial intelligence (AI) software programs to attempt to predict significant clinical events. Patients cared for in the PCICU are clinically fragile and at risk for fatal decompensation. Current monitoring modalities are often ineffective, sometimes inaccurate, and fail to detect a deteriorating clinical status in a timely manner...
April 2018: Translational Pediatrics
https://www.readbyqxmd.com/read/29753821/thromboelastography-is-associated-with-surrogates-for-bleeding-after-pediatric-cardiac-surgery
#3
Sirisha Emani, Lynn A Sleeper, David Faraoni, Michelle Mulone, Fatoumata Diallo, James A DiNardo, Juan Ibla, Sitaram M Emani
BACKGROUND: Perioperative bleeding is a common complication in pediatric patients undergoing cardiac surgery. Although thromboelastography (TEG) has been utilized in patients undergoing adult cardiac surgery, limited data are available in pediatric patients. We hypothesize that TEG parameters may be associated with surrogate endpoints for postoperative bleeding in pediatric patients undergoing complex cardiac surgery. METHODS: In a retrospective study, TEG was obtained after protamine administration and upon intensive care unit (ICU) admission in pediatric patients (≤ 18yrs) undergoing cardiac surgery requiring cardiopulmonary bypass...
May 10, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29746361/prolonged-qrs-widening-after-aripiprazole-overdose
#4
Maryann Mazer-Amirshahi, Robert Porter, Kayla Dewey
BACKGROUND: Aripiprazole is an atypical antipsychotic with a long half-life. Overdose can result in protracted somnolence and cardiac disturbances, particularly QT interval prolongation. METHODS: This is a single case report of a 14-year-old boy who took an overdose of aripiprazole and developed QRS widening. CASE: A 14-year-old boy intentionally ingested 20 tablets of aripiprazole (5 mg). He was brought to the emergency department when his ingestion was discovered...
May 5, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29732182/drugs-pharmacokinetics-during-veno-venous-extracorporeal-membrane-oxygenation-in-pediatrics
#5
REVIEW
Matteo Di Nardo, Enno Diederick Wildschut
Data evaluating pharmacokinetic/pharmacodynamic (PK/PD) aspect in the pediatric population are scarce especially regarding the pediatric intensive care unit. Dosing of frequently used drugs (sedatives, analgesics, antibiotics and cardiovascular drugs) are mainly based on non "pediatric intensive care unit (PICU)" patients, and sometimes are translated from adult patients. Among PICU patients, the most complex patients are the ones who are critically ill and are receiving mechanical circulatory/respiratory support for cardiac and/or respiratory failure...
March 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29730898/avoidance-of-overt-precipitation-and-patient-harm-following-errant-y-site-administration-of-calcium-chloride-and-parenteral-nutrition-compounded-with-sodium-glycerophosphate
#6
Collin Anderson, Chanelle Stidham, Sabrina Boehme, Jared Cash
Calcium phosphate precipitates present 1 of many challenges associated with parenteral nutrition (PN) compounding. Extensive research has led to the establishment of solubility curves to guide practitioners in the prescription and preparation of stable PN. Concurrent dosing of intravenous products via y-site administration with PN can alter the chemical balance of the solution and modify solubility. Medications containing calcium or phosphate should not be administered in the same line as PN, due to the high potential for precipitation...
December 14, 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/29716905/mobilization-therapy-in-the-pediatric-intensive-care-unit-a-multidisciplinary-quality-improvement-initiative
#7
Blair R L Colwell, Cydni N Williams, Serena P Kelly, Laura M Ibsen
BACKGROUND: Mobilization is safe and associated with improved outcomes in critically ill adults, but little is known about mobilization of critically ill children. OBJECTIVE: To implement a standardized mobilization therapy protocol in a pediatric intensive care unit and improve mobilization of patients. METHODS: A goal-directed mobilization protocol was instituted as a quality improvement project in a 20-bed cardiac and medical-surgical pediatric intensive care unit within an academic tertiary care center...
May 2018: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/29707528/changes-in-near-infrared-spectroscopy-after-congenital-cyanotic-heart-surgery
#8
Judith Ju-Ming Wong, Ching Kit Chen, Rajesh Babu Moorakonda, Olivia Wijeweera, Tracy Yi Shuen Tan, Masakazu Nakao, John Carson Allen, Tsee Foong Loh, Jan Hau Lee
Background: Since oxygen saturation from pulse oximetry (SpO2 ) and partial pressure of arterial oxygen (PaO2 ) are observed to improve immediately after surgical correction of cyanotic congenital heart disease (CHD), we postulate that cerebral (CrO2 ) and somatic (SrO2 ) oximetry also improves immediately post-correction. We aim to prospectively examine CrO2 and SrO2 , before, during, and after surgical correction as well as on hospital discharge in children with cyanotic CHD to determine if and when these variables increase...
2018: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29698662/liberal-use-of-delayed-sternal-closure-in-children-is-not-associated-with-increased-morbidity
#9
S Ram Kumar, Nigel Scott, Winfield J Wells, Vaughn A Starnes
BACKGROUND: Delayed sternal closure (DSC) is often employed to optimize hemodynamics following pediatric cardiac surgery. Prior reports have suggested that DSC may be associated with increased morbidity. We sought to analyze the impact of a liberal policy of DSC on surgical outcomes at our center. METHODS: We retrospectively evaluated the clinical course of 1,000 consecutive patients between July 2005 and June 2015 whose sternum was electively left open following pediatric cardiac surgery...
April 23, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29692230/nutrition-considerations-in-the-pediatric-cardiac-intensive-care-unit-patient
#10
Lindsey Justice, Jason R Buckley, Alejandro Floh, Megan Horsley, Jeffrey Alten, Vijay Anand, Steven M Schwartz
Adequate caloric intake plays a vital role in the course of illness and the recovery of critically ill patients. Nutritional status and nutrient delivery during critical illness have been linked to clinical outcomes such as mortality, incidence of infection, and length of stay. However, feeding practices with critically ill pediatric patients after cardiac surgery are variable. The Pediatric Cardiac Intensive Care Society sought to provide an expert review on provision of nutrition to pediatric cardiac intensive care patients, including caloric requirements, practical considerations for providing nutrition, safety of enteral nutrition in controversial populations, feeding considerations with chylothorax, and the benefits of feeding beyond nutrition...
May 2018: World Journal for Pediatric & Congenital Heart Surgery
https://www.readbyqxmd.com/read/29685473/acute-pediatric-colchicine-toxicity-is-associated-with-marked-bradydysrhythmias
#11
Lamya Mubayed, Brie-Ann A Muller, Jessica L Jacobson, Howard A Hast, Hoang H Nguyen
BACKGROUND: Colchicine ingestion is rare but highly lethal. Patients usually die of multiorgan failure and cardiogenic shock. Colchicine is not only associated with depressed myocardial function but also with fatal heart rhythm disturbances, such as complete heart block, ventricular tachycardia, and asystole. While histologic changes of myocytes are well known, the mechanism by which colchicine affects cardiac impulse generation and conduction is not fully understood. CASE REPORT: We present a case of colchicine ingestion with sinus bradycardia, marked sinus arrhythmia, and first- and second-degree heart block...
April 20, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29677008/evolution-of-acute-kidney-injury-and-its-association-with-systemic-hemodynamics-in-children-with-fluid-refractory-septic-shock
#12
Akash Deep, Hiremath Sagar, Chulananda Goonasekera, Palaniswamy Karthikeyan, Joe Brierley, Abdel Douiri
OBJECTIVES: There are no studies in pediatrics evaluating the progression of acute kidney injury in septic shock. We investigated the evolution of sepsis-associated acute kidney injury and its association with systemic hemodynamics in children with fluid-refractory septic shock. DESIGN: Prospective cohort study. SETTING: PICU of a tertiary care hospital. PATIENTS: All patients with fluid-refractory septic shock (n = 61) between September 2010 and February 2014...
April 19, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29667902/myocardial-protection-following-del-nido-cardioplegia-in-pediatric-cardiac-surgery
#13
Debasish Panigrahi, Saibal Roychowdhury, Rahul Guhabiswas, Emmanuel Rupert, Mrinalendu Das, Pradeep Narayan
Background This study was designed to compare myocardial protection with del Nido cardioplegia and conventional blood cardioplegia in children undergoing cardiac surgery in Risk Adjustment for Congenital Heart Surgery categories 1 and 2. Methods Sixty patients were randomized into 2 groups receiving del Nido cardioplegia solution or conventional blood cardioplegia. Myocardial injury was assessed using biochemical markers (troponin I and creatine kinase-MB). Vasoactive-inotropic scores were calculated to compare inotropic requirements...
January 1, 2018: Asian Cardiovascular & Thoracic Annals
https://www.readbyqxmd.com/read/29664502/hospital-acquired-hyponatremia-does-the-type-of-fluid-therapy-affect-children-admitted-to-intensive-care
#14
Pilar Velasco, Andrés J Alcaraz, Niki Oikonomopoulou, Marina Benito, Raquel Moya, Álvaro Sánchez
INTRODUCTION: The objective of this study was to evaluate the association between the type of initial fluid therapy used (isotonic or hypotonic solutions) and the development of hyponatremia, the plas ma chlorine values and the tolerance of venous access. PATIENTS AND METHOD: Retrospective cohort study in a Pediatric Intensive Care Unit (PICU) of a high complexity hospital. There were included children younger than 15 years old hospitalized during the first semester of 2010 and 2013 who recei ved intravenous maintenance fluid therapy, excluding patients undergoing cardiac surgery, kidney transplant and admissions that lasted less than 24 hours...
February 2018: Revista Chilena de Pediatría
https://www.readbyqxmd.com/read/29659415/functional-status-change-among-children-with-extracorporeal-membrane-oxygenation-to-support-cardiopulmonary-resuscitation-in-a-pediatric-cardiac-icu-a-single-institution-report
#15
Asaad G Beshish, Mathew R Baginski, Thomas J Johnson, Barry K Deatrick, Ryan P Barbaro, Gabe E Owens
OBJECTIVES: The purpose of this study is to describe the functional status of survivors from extracorporeal cardiopulmonary resuscitation instituted during in-hospital cardiac arrest using the Functional Status Scale. We aimed to determine risk factors leading to the development of new morbidity and unfavorable functional outcomes. DESIGN: This was a single-center retrospective chart review abstracting patient characteristics/demographic data, duration of cardiopulmonary resuscitation, duration of extracorporeal membrane oxygenation support, as well as maximum lactate levels within 2 hours before and after extracorporeal cardiopulmonary resuscitation...
April 13, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29652752/practice-change-from-intermittent-medication-boluses-to-bolusing-from-a-continuous-infusion-in-pediatric-critical-care-a-quality-improvement-project
#16
Jessica L Hochstetler, A Jill Thompson, Natalie M Ball, Melissa C Evans, Shaun C Frame, A Lauren Haney, Amelia K Little, Jaime L O'Donnell, Bryna M Rickett, Elizabeth H Mack
OBJECTIVES: To determine whether implementing a guideline to bolus medications from continuous infusions in PICUs affects nursing satisfaction, patient safety, central line entries, medication utilization, or cost. DESIGN: This is a pre- and postimplementation quality improvement study. SETTING: An 11-bed ICU and 14-bed cardiac ICU in a university-affiliated children's hospital. PATIENTS: Patients less than 18 years old admitted to the PICU or pediatric cardiac ICU receiving a continuous infusion of dexmedetomidine, midazolam, fentanyl, morphine, vecuronium, or cisatracurium from May 2015 to May 2016, excluding November 2015 (washout period), were eligible for inclusion...
April 12, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29652273/assessment-of-the-effect-of-two-regimens-of-milrinone-infusion-in-pediatric-patients-undergoing-fontan-procedure-a-randomized-study
#17
Rabie Soliman, Adel Ragheb
Objective: The aim of the study was to compare the effect of two different regimens of milrinone on hemodynamics and oxygen saturation in pediatric patients undergoing Fontan procedure. Design: This was a randomized study. Setting: Cardiac centers. Patients: This study included 116 patients undergoing Fontan procedure. Material and Methods: Group E: Milrinone was started as infusion 0.5 μg/kg/min without a loading dose at the beginning of cardiopulmonary bypass (CPB) followed by infusion 0...
April 2018: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/29623729/pharmacokinetic-considerations-for-pediatric-patients-receiving-analgesia-in-the-intensive-care-unit-targeting-postoperative-ecmo-and-hypothermia-patients
#18
Gerdien A Zeilmaker, Paula Pokorna, Paola Mian, Enno D Wildschut, Catherijne A J Knibbe, Elke H J Krekels, Karel Allegaert, Dick Tibboel
Adequate postoperative analgesia in pediatric patients in the intensive care unit (ICU) matters, since untreated pain is associated with negative outcomes. Compared to routine postoperative patients, children undergoing hypothermia (HT) or extracorporeal membrane oxygenation (ECMO), or recovering after cardiac surgery likely display non-maturational differences in pharmacokinetics (PK) and pharmacodynamics (PD). These differences warrant additional dosing recommendations to optimize pain treatment. Areas covered: Specific populations within the ICU will be discussed with respect to expected variations in PK and PD for various analgesics...
April 2018: Expert Opinion on Drug Metabolism & Toxicology
https://www.readbyqxmd.com/read/29620706/furosemide-response-predicts-acute-kidney-injury-after-cardiac-surgery-in-infants-and-neonates
#19
Santiago Borasino, Kevin M Wall, Jack H Crawford, Kristal M Hock, David C Cleveland, Fazlur Rahman, Kimberly D Martin, Jeffrey A Alten
OBJECTIVE: Cardiac surgery-induced acute kidney injury occurs frequently in neonates and infants and is associated with postoperative morbidity/mortality; early identification of cardiac surgery-induced acute kidney injury may be crucial to mitigate postoperative morbidity. We sought to determine if hourly or 6-hour cumulative urine output after furosemide in the first 24 hours after cardiopulmonary bypass could predict development of cardiac surgery-induced acute kidney injury and other deleterious outcomes...
April 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29615134/improving-outcomes-after-pediatric-cardiac-arrest-the-icu-resuscitation-project-study-protocol-for-a-randomized-controlled-trial
#20
Ron W Reeder, Alan Girling, Heather Wolfe, Richard Holubkov, Robert A Berg, Maryam Y Naim, Kathleen L Meert, Bradley Tilford, Joseph A Carcillo, Melinda Hamilton, Matthew Bochkoris, Mark Hall, Tensing Maa, Andrew R Yates, Anil Sapru, Robert Kelly, Myke Federman, J Michael Dean, Patrick S McQuillen, Deborah Franzon, Murray M Pollack, Ashley Siems, John Diddle, David L Wessel, Peter M Mourani, Carleen Zebuhr, Robert Bishop, Stuart Friess, Candice Burns, Shirley Viteri, David A Hehir, R Whitney Coleman, Tammara L Jenkins, Daniel A Notterman, Robert F Tamburro, Robert M Sutton
BACKGROUND: Quality of cardiopulmonary resuscitation (CPR) is associated with survival, but recommended guidelines are often not met, and less than half the children with an in-hospital arrest will survive to discharge. A single-center before-and-after study demonstrated that outcomes may be improved with a novel training program in which all pediatric intensive care unit staff are encouraged to participate in frequent CPR refresher training and regular, structured resuscitation debriefings focused on patient-centric physiology...
April 3, 2018: Trials
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