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Ventilator strategies in Children

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https://www.readbyqxmd.com/read/28406862/a-randomized-controlled-trial-of-corticosteroids-in-pediatric-septic-shock-a-pilot-feasibility-study
#1
Kusum Menon, Dayre McNally, Katharine O'Hearn, Anand Acharya, Hector R Wong, Margaret Lawson, Tim Ramsay, Lauralyn McIntyre, Elaine Gilfoyle, Marisa Tucci, David Wensley, Ronald Gottesman, Gavin Morrison, Karen Choong
OBJECTIVE: To determine the feasibility of conducting a randomized controlled trial of corticosteroids in pediatric septic shock. DESIGN: Randomized, double-blind, placebo controlled trial. SETTING: Seven tertiary level PICUs in Canada. PATIENTS: Children newborn to 17 years old inclusive with suspected septic shock. INTERVENTION: Administration of IV hydrocortisone versus placebo until hemodynamic stability is achieved or for a maximum of 7 days...
April 12, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28338487/the-evolution-of-disease-chronic-lung-disease-of-infancy-and-pulmonary-hypertension
#2
Michael C Tracy, David N Cornfield
PURPOSE OF REVIEW: Bronchopulmonary dysplasia (BPD) or chronic lung disease of infancy BPD was originally described 50 years ago, in 1967 by Northway et al. This article possesses two fundamental objectives to provide: a brief historical perspective on BPD; and an update relative to current notions of epidemiology, pathophysiology, evaluation, and clinical management of BPD complicated by vascular disease. The review highlights areas of consensus and ongoing uncertainty. RECENT FINDINGS: The clinical cause and presentation of infants with BPD has evolved over the past several decades...
March 23, 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28306631/thermoregulate-autoregulate-and-ventilate-brain-directed-critical-care-for-pediatric-cardiac-arrest
#3
Jonathan E Kurz, Craig M Smith, Mark S Wainwright
PURPOSE OF REVIEW: Cardiac arrest in childhood is associated with a high risk for mortality and poor long-term functional outcome. This review discusses the current evidence for neuroprotective therapies and goals for postarrest care in the context of the pathophysiology of hypoxic-ischemic injury, modalities for neurologic prognostication in these children and potential future monitoring paradigms for maximizing cerebral perfusion in the postarrest period. RECENT FINDINGS: The recent publication of the in-hospital and out-of-hospital Therapeutic Hypothermia After Cardiac Arrest trials demonstrated a lack of statistically significant benefit for the use of postarrest therapeutic hypothermia...
March 16, 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28262914/prophylactic-levosimendan-for-the-prevention-of-low-cardiac-output-syndrome-and-mortality-in-paediatric-patients-undergoing-surgery-for-congenital-heart-disease
#4
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...
March 6, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28248714/nebulization-of-antiinfective-agents-in-invasively-mechanically-ventilated-adults-a-systematic-review-and-meta-analysis
#5
Candela Solé-Lleonart, Jean-Jacques Rouby, Stijn Blot, Garyfallia Poulakou, Jean Chastre, Lucy B Palmer, Matteo Bassetti, Charles-Edouard Luyt, Jose M Pereira, Jordi Riera, Tim Felton, Jayesh Dhanani, Tobias Welte, Jose M Garcia-Alamino, Jason A Roberts, Jordi Rello
BACKGROUND: Nebulization of antiinfective agents is a common but unstandardized practice in critically ill patients. METHODS: A systematic review of 1,435 studies was performed in adults receiving invasive mechanical ventilation. Two different administration strategies (adjunctive and substitute) were considered clinically relevant. Inclusion was restricted to studies using jet, ultrasonic, and vibrating-mesh nebulizers. Studies involving children, colonized-but-not-infected adults, and cystic fibrosis patients were excluded...
May 2017: Anesthesiology
https://www.readbyqxmd.com/read/28157809/withdrawal-assessment-tool-1-monitoring-in-picu-a-multicenter-study-on-iatrogenic-withdrawal-syndrome
#6
Angela Amigoni, Maria Cristina Mondardini, Ilaria Vittadello, Federico Zaglia, Emanuele Rossetti, Francesca Vitale, Stefania Ferrario, Fabio Savron, Giancarlo Coffaro, Luca Brugnaro, Roberta Amato, Andrea Wolfler, Linda S Franck
OBJECTIVES: Withdrawal syndrome is an adverse reaction of analgesic and sedative therapy, with a reported occurrence rate between 17% and 57% in critically ill children. Although some factors related to the development of withdrawal syndrome have been identified, there is weak evidence for the effectiveness of preventive and therapeutic strategies. The main aim of this study was to evaluate the frequency of withdrawal syndrome in Italian PICUs, using a validated instrument. We also analyzed differences in patient characteristics, analgesic and sedative treatment, and patients' outcome between patients with and without withdrawal syndrome...
February 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28146296/nasal-intermittent-positive-pressure-ventilation-nippv-versus-nasal-continuous-positive-airway-pressure-ncpap-for-preterm-neonates-after-extubation
#7
REVIEW
Brigitte Lemyre, Peter G Davis, Antonio G De Paoli, Haresh Kirpalani
BACKGROUND: Previous randomised trials and meta-analyses have shown that nasal continuous positive airway pressure (NCPAP) is a useful method for providing respiratory support after extubation. However, this treatment sometimes 'fails' in infants, and they may require endotracheal re-intubation with its attendant risks and expense. Nasal intermittent positive pressure ventilation (NIPPV) can augment NCPAP by delivering ventilator breaths via nasal prongs. Older children and adults with chronic respiratory failure benefit from NIPPV, and the technique has been applied to neonates...
February 1, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27958617/results-of-the-fontan-operation-with-no-early-mortality-in-248-consecutive-patients
#8
Edward Malec, Christoph Schmidt, Anja Lehner, Katarzyna Januszewska
BACKGROUND: Fontan operation has undergone several modifications and today is the primary way to treat a broad spectrum of congenital heart defects AIM: The purpose of this study is to present the results of treatment of children with a single ventricle operated by the same surgical team and managed according to a uniform strategy. METHODS: In the years 2007-2015, in 248 children aged 3.7 ± 2.6 years and weigh of 14.6 ± 6.1 kg with a single ventricle the Fontan surgery was performed...
December 13, 2016: Kardiologia Polska
https://www.readbyqxmd.com/read/27918382/conventional-versus-prolonged-infusion-of-meropenem-in-neonates-with-gram-negative-late-onset-sepsis-a-randomized-controlled-trial
#9
Abd Elazeez Shabaan, Islam Nour, Heba Elsayed Eldegla, Nehad Nasef, Basma Shouman, Hesham Abdel-Hady
BACKGROUND: Gram-negative bacteria are associated with significant morbidity and mortality in preterm and term newborns. Meropenem has widespread efficacy and often allows for monotherapy in this group. Prolonged infusion instead of infusion over 30 minutes has been suggested to result in higher microbiologic efficacy. OBJECTIVE: To compare the clinical and microbiologic efficacy and safety of prolonged infusions versus conventional dosing of meropenem in neonates with Gram-negative late-onset sepsis (GN-LOS)...
April 2017: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/27871584/a-comparison-of-3-ventilation-strategies-in-children-younger-than-1-year-using-a-proseal-laryngeal-mask-airway-a-randomized-controlled-trial
#10
T Wesley Templeton, Lauren K Hoke, Leah B Templeton, Douglas G Ririe, Danielle M Rose, Yvon F Bryan
STUDY OBJECTIVE: To determine quantitative differences in several routinely measured ventilation parameters using a standardized anesthetic technique and 3 different ventilation modalities in patients younger than 1 year with a ProSeal laryngeal mask airway (PLMA). DESIGN: Randomized prospective study. SETTING: Tertiary care pediatric hospital. PATIENTS: Thirty-nine American Society Anesthesiologists classifications 1 to 2, pediatric patients younger than 1 year...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27854381/interventions-for-children-with-ear-discharge-occurring-at-least-two-weeks-following-grommet-ventilation-tube-insertion
#11
REVIEW
Roderick P Venekamp, Faisal Javed, Thijs Ma van Dongen, Angus Waddell, Anne Gm Schilder
BACKGROUND: Ear discharge (otorrhoea) is common in children with grommets (ventilation/tympanostomy tubes); the proportion of children developing discharge ranges from 25% to 75%. The most common treatment strategies include oral broad-spectrum antibiotics, antibiotic eardrops or those containing a combination of antibiotic(s) and a corticosteroid, and initial observation. Important drivers for one strategy over the other are concerns over the side effects of oral antibiotics and the potential ototoxicity of antibiotic eardrops...
November 17, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27790606/nutrition-a-primary-therapy-in-pediatric-acute-respiratory-distress-syndrome
#12
REVIEW
Bryan Wilson, Katri Typpo
Appropriate nutrition is an essential component of intensive care management of children with acute respiratory distress syndrome (ARDS) and is linked to patient outcomes. One out of every two children in the pediatric intensive care unit (PICU) will develop malnutrition or have worsening of baseline malnutrition and present with specific micronutrient deficiencies. Early and adequate enteral nutrition (EN) is associated with improved 60-day survival after pediatric critical illness, and, yet, despite early EN guidelines, critically ill children receive on average only 55% of goal calories by PICU day 10...
2016: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/27787571/-anesthesia-for-medical-students-a-brief-guide-to-practical-anesthesia-in-adults-with-a-web-based-video-illustration
#13
REVIEW
S Mathis, O Schlafer, J Abram, J Kreutziger, P Paal, V Wenzel
In Germany, Austria and Switzerland, anesthesiologists are the second largest group of physicians in hospitals, but this does not correspond to the amount of anesthesiology teaching that medical students receive in medical schools. Accordingly, the chances of medical students recognizing anesthesiology as a promising personal professional career are smaller than in other disciplines with large teaching components. Subsequent difficulties to recruit anesthesiology residents are likely, although many reasons support anesthesiology as a professional career...
December 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27734109/conservative-fluid-management-or-deresuscitation-for-patients-with-sepsis-or-acute-respiratory-distress-syndrome-following-the-resuscitation-phase-of-critical-illness-a-systematic-review-and-meta-analysis
#14
REVIEW
Jonathan A Silversides, Emmet Major, Andrew J Ferguson, Emma E Mann, Daniel F McAuley, John C Marshall, Bronagh Blackwood, Eddy Fan
BACKGROUND: It is unknown whether a conservative approach to fluid administration or deresuscitation (active removal of fluid using diuretics or renal replacement therapy) is beneficial following haemodynamic stabilisation of critically ill patients. PURPOSE: To evaluate the efficacy and safety of conservative or deresuscitative fluid strategies in adults and children with acute respiratory distress syndrome (ARDS), sepsis or systemic inflammatory response syndrome (SIRS) in the post-resuscitation phase of critical illness...
February 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/27716596/assessment-of-mastoid-function-with-magnetic-resonance-imaging-after-canal-wall-up-cholesteatoma-surgery
#15
William J Parkes, Sharon L Cushing, Blake C Papsin, Susan I Blaser, Adrian L James
OBJECTIVE: To use magnetic resonance imaging (MRI) to assess the extent of mastoid opacification after canal wall up (CWU) cholesteatoma surgery. MATERIALS AND METHODS: Thirty-five children in whom post-operative MRI had been obtained after CWU surgery. Cholesteatoma confined to the meso- and/or epi-tympanum was removed using a transcanal approach (n=18). More extensive disease required a combined approach tympanomastoidectomy (CAT, n=17). Mastoid opacification was assessed in both ears by a neuroradiologist blind to surgical details using an ordinal scale from 0 (no opacification) to 6 (completely opacified)...
August 2016: Journal of International Advanced Otology
https://www.readbyqxmd.com/read/27687391/comparing-3-ventilation-modalities-by-measuring-several-respiratory-parameters-using-the-proseal-laryngeal-mask-airway-in-children
#16
T Wesley Templeton, Lauren K Hoke, Jill Yaung, Carol A Aschenbrenner, Danielle M Rose, Leah B Templeton, Yvon F Bryan
STUDY OBJECTIVE: To determine quantitative differences in several routinely measured ventilation parameters using a standardized anesthetic technique and 3 different ventilation modalities in pediatric patients with a ProSeal laryngeal mask airway (PLMA). DESIGN: Randomized prospective study. SETTING: Pediatric hospital of a tertiary care academic medical center. PATIENTS: Thirty-three, American Society of Anesthesiologists classification 1-2, pediatric patients (12 months to 5 years)...
November 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27679965/pediatric-out-of-hospital-cardiac-arrest-characteristics-and-their-association-with-survival-and-neurobehavioral-outcome
#17
Kathleen L Meert, Russell Telford, Richard Holubkov, Beth S Slomine, James R Christensen, J Michael Dean, Frank W Moler
OBJECTIVE: To investigate relationships between cardiac arrest characteristics and survival and neurobehavioral outcome among children recruited to the Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital trial. DESIGN: Secondary analysis of Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital trial data. SETTING: Thirty-six PICUs in the United States and Canada. PATIENTS: All children (n = 295) had chest compressions for greater than or equal to 2 minutes, were comatose, and required mechanical ventilation after return of circulation...
December 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27606309/sedation-in-critically-ill-children-with-respiratory-failure
#18
REVIEW
Nienke J Vet, Niina Kleiber, Erwin Ista, Matthijs de Hoog, Saskia N de Wildt
This article discusses the rationale of sedation in respiratory failure, sedation goals, how to assess the need for sedation as well as effectiveness of interventions in critically ill children, with validated observational sedation scales. The drugs and non-pharmacological approaches used for optimal sedation in ventilated children are reviewed, and specifically the rationale for drug selection, including short- and long-term efficacy and safety aspects of the selected drugs. The specific pharmacokinetic and pharmacodynamic aspects of sedative drugs in the critically ill child and consequences for dosing are presented...
2016: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/27590561/asplenic-patients-and-invasive-pneumococcal-disease-how-bad-is-it-these-days
#19
Thomas J Marrie, Gregory J Tyrrell, Sumit R Majumdar, Dean T Eurich
OBJECTIVES: Most are aware of pneumococcal infection as a complication of splenectomy and the increased risk of severe invasive pneumococcal disease (IPD) in asplenic patients. However little is known of the current status of this entity in a population with an active pneumococcal conjugate vaccine program for children. METHODS: All IPD cases reported from 2000 to 2014 in Northern Alberta, Canada were collected prospectively. Socio-demographic variables, clinical characteristics, and IPD-related outcomes were compared between patients with and without a spleen using the Student t-test, Chi-square test, or Fisher's exact test, as appropriate...
October 2016: International Journal of Infectious Diseases: IJID
https://www.readbyqxmd.com/read/27589216/congestive-heart-failure-in-children-with-pneumonia-and-respiratory-failure
#20
Kachaporn Nimdet, Win Techakehakij
BACKGROUND: Congestive heart failure (CHF) is one of the most common cardiac complications of pneumonia in adulthood that leads to increased risk of morbidity and mortality. However, little is known of CHF and pneumonia in children. This study aims to explore the characteristics and factors associated with the presence of CHF in under-5 children with pneumonia and respiratory failure. METHODS: A retrospective cohort was conducted in hospitalized patients aged 2-59 months with community-acquired pneumonia and respiratory failure from June 2011 to June 2014 at Suratthani Hospital, Thailand...
September 2, 2016: Pediatrics International: Official Journal of the Japan Pediatric Society
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