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https://www.readbyqxmd.com/read/28924282/overcrowding-and-possible-solutions-for-a-busy-paediatric-emergency-department
#1
Muhammad Irfan Habib, Khalid Mehmood Khan
OBJECTIVE: To quantify the extent of emergency department overcrowding in a tertiary care hospital and to identify possible solutions. METHODS: This retrospective study was conducted at the National Institute of Child Health, Karachi, and comprised data of all patients presenting to the emergency department from November 2014 to January 2015. Data was collected through the health management information system which generates daily report of patients. Patients who stayed at the emergency department for 4 or more hours were included...
September 2017: JPMA. the Journal of the Pakistan Medical Association
https://www.readbyqxmd.com/read/28921175/routine-gastric-residual-volume-measurement-and-energy-target-achievement-in-the-picu-a-comparison-study
#2
Lyvonne N Tume, Anna Bickerdike, Lynne Latten, Simon Davies, Madeleine H Lefèvre, Gaëlle W Nicolas, Frédéric V Valla
Critically ill children frequently fail to achieve adequate energy intake, and some care practices, such as the measurement of gastric residual volume (GRV), may contribute to this problem. We compared outcomes in two similar European Paediatric Intensive Care Units (PICUs): one which routinely measures GRV (PICU-GRV) to one unit that does not (PICU-noGRV). An observational pilot comparison study was undertaken. Eighty-seven children were included in the study, 42 (PICU-GRV) and 45 (PICU-noGRV). There were no significant differences in the percentage of energy targets achieved in the first 4 days of PICU admission although PICU-noGRV showed more consistent delivery of median (and IQR) energy targets and less under and over feeding for PICU-GRV and PICU-noGRV: day 1 37 (14-72) vs 44 (0-100), day 2 97 (53-126) vs 100 (100-100), day 3 84 (45-112) vs 100 (100-100) and day 4 101 (63-124) vs 100 (100-100)...
September 18, 2017: European Journal of Pediatrics
https://www.readbyqxmd.com/read/28905374/heat-and-moisture-exchangers-versus-heated-humidifiers-for-mechanically-ventilated-adults-and-children
#3
REVIEW
Donna Gillies, David A Todd, Jann P Foster, Bisanth T Batuwitage
BACKGROUND: Invasive ventilation is used to assist or replace breathing when a person is unable to breathe adequately on their own. Because the upper airway is bypassed during mechanical ventilation, the respiratory system is no longer able to warm and moisten inhaled gases, potentially causing additional breathing problems in people who already require assisted breathing. To prevent these problems, gases are artificially warmed and humidified. There are two main forms of humidification, heat and moisture exchangers (HME) or heated humidifiers (HH)...
September 14, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28886496/convulsive-status-epilepticus-in-a-quaternary-hospital-paediatric-intensive-care-unit-picu-in-south-africa-an-8-year-review
#4
Yavini Reddy, Yusentha Balakrishna, Lawrence Mubaiwa
PURPOSE: Convulsive status epilepticus (CSE) is associated with a high morbidity and mortality. This study aimed to describe the clinical profile, aetiology, neuroimaging and EEG findings as well as outcome of children with CSE in Sub-Saharan Africa. METHODS: This was a retrospective analysis of electronic records of children with CSE admitted to the Paediatric Intensive Care Unit (PICU) over an 8-year period from January 2007 to December 2014. RESULTS: Seventy six patients were admitted to the PICU with CSE and 55(72%) had refractory status epilepticus...
August 2, 2017: Seizure: the Journal of the British Epilepsy Association
https://www.readbyqxmd.com/read/28879605/in-vitro-evaluation-of-limitations-and-possibilities-for-the-future-use-of-intracorporeal-gas-exchangers-placed-in-the-upper-lobe-position
#5
Erin Schumer, Klaus Höffler, Christian Kuehn, Mark Slaughter, Axel Haverich, Bettina Wiegmann
The lack of donor organs has led to the development of alternative "destination therapies", such as a bio-artificial lung (BA) for end-stage lung disease. Ultimately aiming at a fully implantable BA, general capabilities and limitations of different oxygenators were tested based on the model of BA positioning at the right upper lobe. Three different-sized oxygenators (neonatal, paediatric, and adult) were tested in a mock circulation loop regarding oxygenation and decarboxylation capacities for three respiratory pathologies...
September 6, 2017: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
https://www.readbyqxmd.com/read/28876668/accidental-and-non-accidental-injury-related-admissions-to-the-paediatric-intensive-care-unit-at-chris-hani-baragwanath-academic-hospital-johannesburg
#6
N Patel, I Khofi-Phiri, R Mathiva, A Grieve, J Loveland, G Nethathe
BACKGROUND: Paediatric trauma is a major cause of morbidity and mortality in low and middle income countries. Data from these regions describing the extent and severity of this problem is scant. Local data is vital to understanding and responding to the problem of childhood injury. METHOD: A retrospective record review of all trauma cases admitted to the PICU at CHBAH from 1 January 2011 to 31 December 2013 was performed. Descriptive statistics were generated using MS Excel...
June 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28876667/evaluation-of-thoracoscopy-in-the-diagnosis-of-diaphragmatic-injuries-in-penetrating-thoracoabdominal-trauma-without-lung-deflation-at-dr-george-mukhari-academic-hospital
#7
L Nsakala
BACKGROUND: With a mortality estimated at 25% when missed, diaphragmatic injuries due to penetrating thoracoabdominal trauma present a diagnostic challenge for both the radiologist and the surgeon. In the current literature, chest x-ray has a sensitivity of 27-60% for left-sided injuries and only 17% for right-sided injuries while, CT scan has a sensitivity of 14-61% and a specificity of 76-99%. Thoracoscopy using a single lung ventilation is one of the modalities of choice for the diagnosis of these injuries with a specificity of 100% and a sensitivity of 87...
June 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28871575/inert-gas-washout-background-and-application-in-various-lung-diseases
#8
Jakob Usemann, Sophie Yammine, Florian Singer, Philipp Latzin
Multiple breath inert gas washout (MBW) is a lung function technique to measure ventilation inhomogeneity. The technique was developed more than 60 years ago, but not much used for many decades. Technical improvements, easy protocols and higher sensitivity compared with standard lung function tests in some disease groups have led to a recent renaissance of MBW. The lung clearance index (LCI) is a common measure derived from MBW tests, and offers information on lung pathology complementary to that from conventional lung function tests such as spirometry...
September 5, 2017: Swiss Medical Weekly
https://www.readbyqxmd.com/read/28870163/comparison-of-the-supreme%C3%A2-and-proseal%C3%A2-laryngeal-mask-airways-in-infants-a-prospective-randomised-clinical-study
#9
Sibel Oba, Hacer Sebnem Turk, Canan Tulay Isil, Huseyin Erdogan, Pinar Sayin, Ali Ihsan Dokucu
BACKGROUND: The Supreme™ and ProSeal™ laryngeal mask airways (LMAs) are widely used in paediatric anaesthesia; however, LMA use in infants is limited because many anaesthesiologists prefer to use tracheal intubation in infants. In this study, we compared the Supreme and ProSeal LMAs in infants by measuring their performance characteristics, including insertion features, ventilation parameters, induced changes in haemodynamics and rates of postoperative complications. METHODS: Infants of ASA physical status I scheduled for elective, minor, lower abdominal surgery were divided into two groups: the Supreme LMA group and the ProSeal LMA group...
September 5, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28771680/safety-and-efficacy-of-rescue-flexible-bronchoscopic-intubation-using-the-bentson-floppy-tip-guidewire-via-a-supraglottic-airway-in-critically-ill-children
#10
D Cross, A Nyman, P James, A Durward
Difficulty in tracheal intubation in paediatric intensive care patients is associated with increased morbidity and mortality. Delays to intubation and interruption to oxygenation and ventilation are poorly tolerated. We developed a safe and atraumatic tracheal intubation technique. A floppy-tipped guidewire and airway exchange catheter were placed to a pre-determined length under bronchoscopic guidance while oxygenation and ventilation was maintained via a supraglottic airway device (SAD). We performed a retrospective review of this technique on patients who were either known to have or who had an unexpected difficultly in intubation...
August 3, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28770972/prophylactic-levosimendan-for-the-prevention-of-low-cardiac-output-syndrome-and-mortality-in-paediatric-patients-undergoing-surgery-for-congenital-heart-disease
#11
REVIEW
Johanna Hummel, Gerta Rücker, Brigitte Stiller
BACKGROUND: Low cardiac output syndrome remains a serious complication, and accounts for substantial morbidity and mortality in the postoperative course of paediatric patients undergoing surgery for congenital heart disease. Standard prophylactic and therapeutic strategies for low cardiac output syndrome are based mainly on catecholamines, which are effective drugs, but have considerable side effects. Levosimendan, a calcium sensitiser, enhances the myocardial function by generating more energy-efficient myocardial contractility than achieved via adrenergic stimulation with catecholamines...
August 2, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28761700/a-novel-treadmill-protocol-for-exercise-testing-in-children-the-british-columbia-children-s-hospital-protocol
#12
D Kathryn Duff, Astrid M De Souza, Derek G Human, James E Potts, Kevin C Harris
BACKGROUND: Exercise testing in children is widely recommended for a number of clinical and prescriptive reasons. Many institutions continue to use the Bruce protocol for treadmill testing; however, with its incremental changes in speed and grade, it has challenges for practical application in children. We have developed a novel institutional protocol (British Columbia Children's Hospital (BCCH)), which may have better utility in paediatric populations. AIM: To determine if our institutional protocol yields similar peak responses in minute ventilation (VE), oxygen consumption (VO2), carbon dioxide production (VCO2), respiratory exchange ratio (RER), metabolic equivalents (METS) and heart rate (HR) when compared with the traditional Bruce protocol...
2017: BMJ Open Sport & Exercise Medicine
https://www.readbyqxmd.com/read/28727606/the-clinical-utility-of-respiratory-variation-in-inferior-vena-cava-diameter-for-predicting-fluid-responsiveness-in-spontaneously-ventilating-patients
#13
Elliot Long, Ed Oakley, Trevor Duke, Franz E Babl
No abstract text is available yet for this article.
July 19, 2017: Shock
https://www.readbyqxmd.com/read/28684015/bioimpedance-spectroscopy-measurements-of-phase-angle-and-height-for-age-are-predictive-of-outcome-in-children-following-surgery-for-congenital-heart-disease
#14
L V Marino, R Meyer, M Johnson, C Newell, C Johnstone, A Magee, K Sykes, S A Wootton, J V Pappachan
OBJECTIVE: Children with congenital heart disease (CHD) are often growth restricted (low weight- and/or height-for-age) which may increase risk of poor post operative resilience. Bioelectrical impedance spectroscopy (BIS) has been used to determine body composition in different clinical settings and has been shown to mark differences in nutritional state and clinical outcome. In disease conditions were fluid is not normally distributed it is proposed that raw impedance values and BIS derived phase-angle may serve as prognostic indicators of clinical outcome...
June 28, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28668993/trauma-related-admissions-to-the-picu-at-chris-hani-baragwanath-academic-hospital-johannesburg
#15
Nirav Patel, I Khofi-Phiri, L R Mathiva, A Grieve, J Loveland, G D Nethathe
BACKGROUND: Paediatric trauma is a major cause of morbidity and mortality in low and middle income countries. Data from these regions are scant. We aimed to describe the demographic and injury profile, treatment modality and outcome of trauma admissions to the paediatric intensive care unit at Chris Hani Baragwanath Academic Hospital (CHBAH). METHODS: A retrospective record review of trauma cases admitted to the PICU at CHBAH from 2011 to 2013 was performed. RESULTS: One-fifth of admissions were due to trauma...
July 1, 2017: Pediatric Surgery International
https://www.readbyqxmd.com/read/28653270/revision-adenoidectomy-in-children-a-population-based-cohort-study-in-taiwan
#16
Chia-Hsuan Lee, Wei-Hsiu Chang, Jenq-Yuh Ko, Te-Huei Yeh, Wei-Chung Hsu, Kun-Tai Kang
There is a lack of population-level analysis of revision adenoidectomy in children. This study reveals the revision rates and factors associated with paediatric revision adenoidectomy in Taiwan. From the Taiwan National Health Insurance Research Database, we identified all in-hospital children (age <18 years) who underwent adenoidectomy between 2000 and 2007. All children had received at least 5 years of follow-up from the index date, and the clinical records until 2012 were examined. Factors affecting the paediatric revision adenoidectomy were analysed using the multivariable Cox proportional hazards model...
June 26, 2017: European Archives of Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28637741/the-closed-trial-clonidine-compared-with-midazolam-for-sedation-of-paediatric-patients-in-the-intensive-care-unit-study-protocol-for-a-multicentre-randomised-controlled-trial
#17
Antje Neubert, Manuel Alberto Baarslag, Monique van Dijk, Joost van Rosmalen, Joseph F Standing, Yucheng Sheng, Wolfgang Rascher, Deborah Roberts, Jackie Winslade, Louise Rawcliffe, Sara M Hanning, Tuuli Metsvaht, Viviana Giannuzzi, Peter Larsson, Pavla Pokorná, Alessandra Simonetti, Dick Tibboel
INTRODUCTION: Sedation is an essential part of paediatric critical care. Midazolam, often in combination with opioids, is the current gold standard drug. However, as it is a far-from-ideal agent, clonidine is increasingly being used in children. This drug is prescribed off-label for this indication, as many drugs in paediatrics are. Therefore, the CLOSED trial aims to provide data on the pharmacokinetics, safety and efficacy of clonidine for the sedation of mechanically ventilated patients in order to obtain a paediatric-use marketing authorisation...
June 21, 2017: BMJ Open
https://www.readbyqxmd.com/read/28625194/preoperative-malnutrition-is-associated-with-increased-mortality-and-adverse-outcomes-after-paediatric-cardiac-surgery
#18
Faith Ross, Gregory Latham, Denise Joffe, Michael Richards, Jeremy Geiduschek, Michael Eisses, Douglas Thompson, Monique Radman
BACKGROUND: Malnutrition is common in children with CHD and is likely to place them at an increased risk for adverse surgical outcomes. We sought to evaluate the impact of preoperative malnutrition on outcomes after paediatric cardiac surgery. METHODS: We conducted a retrospective analysis of patients from age 0 to 5 years undergoing cardiac surgery at Seattle Children's Hospital from 2006 to 2015. We used regression modelling to examine the impact of malnutrition on surgical outcomes...
June 19, 2017: Cardiology in the Young
https://www.readbyqxmd.com/read/28604209/a-literature-review-exploring-role-transitions-in-caring-for-a-child-requiring-long-term-ventilationin-recent-years-the-uk-and-other-high-income-countries-have-seen-an-increase-in-the-use-of-long-term-ventilation-ltv-in-paediatric-intensive-care-neupane-et
#19
REVIEW
Emily Goss
Government policies advocate that children should be cared for at home ( Noyes et al 2006 ), although medically stable LTV children often stay in hospital months longer than is necessary ( NHS England 2015 ). Research shows that parents of these children develop a dual role as parents and nurses, which leads to role conflict and ambiguity ( Hewitt-Taylor 2011 ).
June 12, 2017: Nursing Children and Young People
https://www.readbyqxmd.com/read/28586587/laser-myringotomy-versus-ventilation-tubes-in-otitis-media-with-effusion
#20
Mohammad Yousaf, Suhail Ahmad Malik, Tahir Haroon
BACKGROUND: Otitis media with effusion (OME) is a leading cause of difficulty in hearing in paediatric population. Otitis media with effusion must be detected and managed early to prevent conductive hearing loss in children. It was aimed to compare results of laser myringotomy and ventilation tube insertion, in terms of hearing improvement and recurrence of Middle ear effusion (MEE). METHODS: This randomized controlled trial was conducted from February 2012 to January 2015...
October 2016: Journal of Ayub Medical College, Abbottabad: JAMC
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