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Pediatric Cardiac icu

Benjamin H Goot, Jon Kaufman, Zhaoxing Pan, David W A Bourne, Francis Hickey, Mark Twite, Jeffrey Galinkin, Uwe Christians, Jeannie Zuk, Eduardo M da Cruz
OBJECTIVES: To assess if morphine pharmacokinetics are different in children with Down syndrome when compared with children without Down syndrome. DESIGN: Prospective single-center study including subjects with Down syndrome undergoing cardiac surgery (neonate to 18 yr old) matched by age and cardiac lesion with non-Down syndrome controls. Subjects were placed on a postoperative morphine infusion that was adjusted as clinically necessary, and blood was sampled to measure morphine and its metabolites concentrations...
March 15, 2018: Pediatric Critical Care Medicine
Laura J Olivieri, David Zurakowski, Karthik Ramakrishnan, Lillian Su, Fahad A Alfares, Matthew R Irwin, Jenna Heichel, Axel Krieger, Dilip S Nath
BACKGROUND: Postoperative care delivered in the pediatric cardiac intensive care unit (CICU) relies on providers' understanding of patients' congenital heart defects (CHDs) and procedure performed. Novel, bedside use of virtual, three-dimensional (3D) heart models creates access to patients' CHD to improve understanding. This study evaluates the impact of patient-specific virtual 3D heart models on CICU provider attitudes and care delivery. METHODS: Virtual 3D heart models were created from standard preoperative cardiac imaging of ten patients with CHD undergoing repair and displayed on a bedside tablet in the CICU...
March 2018: World Journal for Pediatric & Congenital Heart Surgery
Anna Cavigelli-Brunner, Maja I Hug, Hitendu Dave, Oskar Baenziger, Christoph Buerki, Dominique Bettex, Vincenzo Cannizzaro, Christian Balmer
OBJECTIVES: Dobutamine and milrinone are commonly used after open-heart surgery to prevent or treat low cardiac output syndrome. We sought to compare efficacy and safety of these drugs in pediatric patients. DESIGN: Prospective, single-center, double-blinded, randomized clinical pilot study. SETTING: Tertiary-care university children's hospital postoperative pediatric cardiac ICU. PATIENTS: After written consent, 50 consecutive patients (age, 0...
March 13, 2018: Pediatric Critical Care Medicine
Catherine E Ross, Lisa A Asaro, David Wypij, Conor C Holland, Michael W Donnino, Monica E Kleinman
AIM: To quantify the physiologic effects of pre-arrest bolus dilute epinephrine in the pediatric intensive care unit. METHODS: Patients <18 years old and ≥37 weeks gestation who received an intravenous bolus of dilute epinephrine (10 mcg/mL) in the pediatric intensive care units at our institution from January 2011 to March 2017 were retrospectively identified. Patients were excluded if doses exceeded 20 mcg/kg, or under the following circumstances: orders limiting resuscitation, extracorporeal membrane oxygenation, active chest compressions, simultaneous administration of other blood pressure-altering interventions or documented normotension prior to epinephrine...
March 8, 2018: Resuscitation
Christopher S Parshuram, Karen Dryden-Palmer, Catherine Farrell, Ronald Gottesman, Martin Gray, James S Hutchison, Mark Helfaer, Elizabeth A Hunt, Ari R Joffe, Jacques Lacroix, Michael Alice Moga, Vinay Nadkarni, Nelly Ninis, Patricia C Parkin, David Wensley, Andrew R Willan, George A Tomlinson
Importance: There is limited evidence that the use of severity of illness scores in pediatric patients can facilitate timely admission to the intensive care unit or improve patient outcomes. Objective: To determine the effect of the Bedside Paediatric Early Warning System (BedsidePEWS) on all-cause hospital mortality and late admission to the intensive care unit (ICU), cardiac arrest, and ICU resource use. Design, Setting, and Participants: A multicenter cluster randomized trial of 21 hospitals located in 7 countries (Belgium, Canada, England, Ireland, Italy, New Zealand, and the Netherlands) that provided inpatient pediatric care for infants (gestational age ≥37 weeks) to teenagers (aged ≤18 years)...
February 27, 2018: JAMA: the Journal of the American Medical Association
Jameela Abdulaziz Kari, Mohamed Ahmed Shalaby, Kholoud Sofyani, Ahmad Saleh Sanad, Albaraa Fuad Ossra, Rayan Smeer Halabi, Maha Hassan Aljuhani, Wael Mohammad Toffaha, Feras Aymen Moria, Samar Sabry, Hanan AbdelAziz Ahmed, Khalid Abdulaziz Alhasan, Sara Sharief, Osama Safdar
BACKGROUND: Acute kidney injury (AKI) is common in critically ill children with significant mortality and morbidity. Serum creatinine is an insensitive and late biomarker compared to newly proposed AKI biomarkers. METHODS: Prospective study in pediatric intensive care unit (PICU) over three months to compare between serum cystatin-C (s-Cys-C) and urinary neutrophil gelatinase-associated lipocalin (uNGAL) as AKI biomarkers at multiple time points with pediatric risk, injury, failure, loss, end-stage renal disease (pRIFLE) classification in diagnosing AKI...
February 20, 2018: World Journal of Pediatrics: WJP
Priya Bhaskar, Mallikarjuna Rettiganti, Jeffrey M Gossett, Punkaj Gupta
Background: The existing training pathways to become a pediatric cardiac intensivist are very variable with physicians coming from varied training backgrounds of pediatric critical care, pediatric cardiology, neonatology, or pediatric anesthesia. Aim: To evaluate the impact of cardiac Intensive Care Unit (ICU) attending physician training background on outcomes in children undergoing heart operations. Setting and Design: Patients in the age group from 1 day to 18 years undergoing heart operation at a Pediatric Health Information System database participating hospital were included (2010-2015)...
January 2018: Annals of Pediatric Cardiology
Maziar Khorsandi, Mark Davidson, Omar Bouamra, Andrew McLean, Kenneth MacArthur, Ida Torrance, Gillian Wylie, Ed Peng, Mark Danton
Introduction: Around 3.2%-8.4% of patients receive venoarterial (VA) extracorporeal membrane oxygenation (ECMO) support after pediatric cardiac surgery. The desired outcome is "bridge-to-recovery" in most cases. There is no universally agreed protocol, and given the associated costs and complications rates, the decisions as of when and when not to institute VA ECMO are largely empirical. Methods: A retrospective review of the ECMO database at the Scottish Pediatric Cardiac Services (SPCS) was undertaken...
January 2018: Annals of Pediatric Cardiology
Mark S Wainwright
PURPOSE OF REVIEW: All critical care is directed at maintaining brain health, but recognizing neurologic complications of critical illness in children is difficult, and limited data exist to guide practice. This article discusses an approach to the recognition and management of seizures, stroke, and cardiac arrest as complications of other critical illnesses in the pediatric intensive care unit. RECENT FINDINGS: Convulsive and nonconvulsive seizures occur frequently in children after cardiac arrest or traumatic brain injury and during extracorporeal membrane oxygenation...
February 2018: Continuum: Lifelong Learning in Neurology
Wail Ali, Beth A Bubolz, Linh Nguyen, Danny Castro, Jorge Coss-Bu, Michael M Quach, Curtis E Kennedy, Anne E Anderson, Yi-Chen Lai
Objective: Convulsive status epilepticus can exert profound cardiovascular effects in adults including ventricular depolarization-repolarization abnormalities. Whether status epilepticus adversely affects ventricular electrical properties in children is less understood. Therefore, we sought to characterize ventricular alterations and the associated clinical factors in children following convulsive status epilepticus. Methods: We conducted a 2-year retrospective, case-control study...
December 2017: Epilepsia Open
Julianna Boydston
OBJECTIVES: This project aimed to improve thoroughness and continuity of care of patients in a pediatric cardiac intensive care unit. Specific objectives were to increase support of clinical nurse and family participation in multidisciplinary rounds (MDR), as well as full use of a multi-component Complex Care Checklist (CCC) by all nurses in this unit. INTRODUCTION: Communication and collaboration are paramount for safe care and positive outcomes of critically ill patients hospitalized in intensive care units...
February 2018: JBI Database of Systematic Reviews and Implementation Reports
Neta Cohen, Dennis Scolnik, Ayelet Rimon, Uri Balla, Miguel Glatstein
OBJECTIVE: Drowning is a leading cause of death among infants and toddlers. Unique physiological and behavioral factors contribute to high mortality rates. Drowning incidents predominantly occur during warmer months and holidays. The aim of this study was to describe the characteristics of pediatric drowning victims who attended 2 different emergency departments (EDs), 1 near and 1 distant from the sea coast, to recognize risk factors, complications, causes of death, and the educational needs of families and caregivers...
February 5, 2018: Pediatric Emergency Care
I Goyer, D Brossier, B Toledano
Decompensated heart failure in children requires rapid and aggressive support. In refractory cases, invasive supportive care is essential to ensure cardiac output. This results in lengthy pediatric intensive care unit (PICU) stays, secondary morbidity, and high cost. Levosimendan may help palliate the pitfalls encountered with the usual treatment. It has been shown to improve hemodynamics and decrease morbidity and mortality from heart failure in adult trials and pediatric cohorts. We report the case of a 15-year-old boy with dilated cardiomyopathy and refractory ventricular dysfunction who was weaned from continuous inotropes and discharged from the PICU with levosimendan while waiting for heart transplantation...
February 2018: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
Rita V Alvarez, Claire Palmer, Angela S Czaja, Chris Peyton, Gabrielle Silver, Chani Traube, Peter M Mourani, Jon Kaufman
OBJECTIVE: To determine incidence, associated risk factors, and characteristics of delirium in a pediatric cardiac intensive care unit (CICU). Delirium is a frequent and serious complication in adults after cardiac surgery, but there is limited understanding of its impact in children with critical cardiac disease. STUDY DESIGN: Single-center prospective observational study of CICU patients ≤21 years old. All were screened for delirium using the Cornell Assessment for Pediatric Delirium each 12-hour shift...
January 29, 2018: Journal of Pediatrics
Sura Lee
BACKGROUND: Tracheoesophageal fistula (TEF) and esophageal atresia (EA) are rare anomalies in neonates. Up to 50% of neonates with TEF/EA will have Vertebral anomalies (V), Anal atresia (A), Cardiac anomalies (C), Tracheoesophageal fistula (T), Esophageal atresia (E), Renal anomalies (R), and Limb anomalies (L) (VACTERL) association, which has the potential to cause serious morbidity. PURPOSE: Timely management of the neonate can greatly impact the infant's overall outcome...
February 2018: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
Tarek Ahmed Abdel Gawad, Waleed Mohamed Elguindy, Omneya Ibrahim Youssef, Tamer Ashraf Abosalem
AIM: This study aimed to assess the prevalence of early postoperative arrhythmias after cardiac operation in the pediatric population, and to analyse possible risk factors. MATERIAL AND METHODS: Cross-sectional study included 30 postoperative patients, with age range four up to 144 months. They were selected from those admitted to the Cardiology Unit in the Pediatric department of Ain Shams University hospitals, after undergoing cardiopulmonary bypass (CPB) surgery for correction of congenital cardiac defects...
December 15, 2017: Open Access Macedonian Journal of Medical Sciences
Rambod Amirnovin, Phuong Lieu, Flerida Imperial-Perez, Carol Taketomo, Barry P Markovitz, David Y Moromisato
OBJECTIVE: Hypokalemia in children following cardiac surgery occurs frequently, placing them at risk of life-threatening arrhythmias. However, renal insufficiency after cardiopulmonary bypass warrants careful administration of potassium (K+). Two different nurse-driven protocols (high dose and tiered dosing) were implemented to identify an optimal K+ replacement regimen, compared to an historical low-dose protocol. Our objective was to evaluate the safety, efficacy, and timeliness of these protocols...
January 1, 2018: Journal of Intensive Care Medicine
Renee L Devor, Paul Kang, Chasity Wellnitz, John J Nigro, Daniel A Velez, Brigham C Willis
OBJECTIVES: 1) Determine the correlation between pulmonary dead space fraction and extubation success in postoperative pediatric cardiac patients; and 2) document the natural history of pulmonary dead space fractions, dynamic compliance, and airway resistance during the first 72 hours postoperatively in postoperative pediatric cardiac patients. DESIGN: A retrospective chart review. SETTING: Cardiac ICU in a quaternary care free-standing children's hospital...
January 16, 2018: Pediatric Critical Care Medicine
Philippe Gaudard, Claudio Barbanti, Bertrand Rozec, Philippe Mauriat, Mimoun M'rini, Gilles Cambonie, Jean Michel Liet, Claude Girard, Pierre Louis Leger, Ziad Assaf, Pierre Damas, Gauthier Loron, Laurent Lecourt, Julien Amour, Philippe Pouard
BACKGROUND: Nitric oxide (NO) has a well-known efficacy in pulmonary hypertension (PH), with wide use for 20 years in many countries. The objective of this study was to describe the current use of NO in real life and the gap with the guidelines. METHODS: This is a multicenter, prospective, observational study on inhaled NO administered through an integrated delivery and monitoring device and indicated for PH according to the market authorizations. The characteristics of NO therapy and ventilation modes were observed...
January 16, 2018: Anesthesia and Analgesia
C McKee, D Tumin, B R Alevriadou, K K Nicol, A R Yates, D Hayes, J D Tobias
Avoidance of red blood cell (RBC) transfusions in patients awaiting heart transplantation (HTx) has been suggested to minimize the risk of allosensitization. Although recent studies have suggested that an immature immune system in younger HTx recipients may reduce risks associated with RBC transfusion, the role of age in moderating the influence of transfusion on HTx outcomes remains unclear. We used available data from a national transplant registry to explore whether the association between pre-transplant transfusions and outcomes of pediatric HTx varies by patient age...
January 16, 2018: Pediatric Cardiology
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