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32 papers 25 to 100 followers
By Neil Fernandes Pediatric resident currently pediatric critical care fellow next!
https://www.readbyqxmd.com/read/29727354/applying-machine-learning-to-pediatric-critical-care-data
#1
Jon B Williams, Debjit Ghosh, Randall C Wetzel
OBJECTIVES: To explore whether machine learning applied to pediatric critical care data could discover medically pertinent information, we analyzed clinically collected electronic medical record data, after data extraction and preparation, using k-means clustering. DESIGN: Retrospective analysis of electronic medical record ICU data. SETTING: Tertiary Children's Hospital PICU. PATIENTS: Anonymized electronic medical record data from PICU admissions over 10 years...
April 30, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29700200/external-validation-of-the-pedibirn-clinical-prediction-rule-for-abusive-head-trauma
#2
Helena Pfeiffer, Anne Smith, Alison Mary Kemp, Laura Elizabeth Cowley, John A Cheek, Stuart R Dalziel, Meredith L Borland, Sharon O'Brien, Megan Bonisch, Jocelyn Neutze, Ed Oakley, Louise Crowe, Stephen J C Hearps, Mark D Lyttle, Silvia Bressan, Franz E Babl
BACKGROUND AND OBJECTIVES: A 4-variable abusive head trauma (AHT) clinical prediction rule (CPR) for use in the PICU was derived and validated for children <3 years of age by the Pediatric Brain Injury Research Network (PediBIRN). We aimed to externally validate PediBIRN as designed (PICU only) as well as using broader inclusion criteria (admitted children with head injuries). METHODS: This was a secondary analysis of a prospective multicenter study of pediatric head injuries at 5 Australian and New Zealand tertiary pediatric centers...
April 26, 2018: Pediatrics
https://www.readbyqxmd.com/read/29727363/benzodiazepines-and-development-of-delirium-in-critically-ill-children-estimating-the-causal-effect
#3
Kalgi Mody, Savneet Kaur, Elizabeth A Mauer, Linda M Gerber, Bruce M Greenwald, Gabrielle Silver, Chani Traube
OBJECTIVES: Benzodiazepine use may be associated with delirium in critically ill children. However, benzodiazepines remain the first-line sedative choice in PICUs. Objectives were to determine the temporal relationship between administration of benzodiazepines and delirium development, control for time-varying covariates such as mechanical ventilation and opiates, and evaluate the association between dosage of benzodiazepines and subsequent delirium. DESIGN: Retrospective observational study...
May 4, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29531957/an-algorithmic-approach-for-the-treatment-of-severe-uncontrolled-asthma
#4
REVIEW
Eleftherios Zervas, Konstantinos Samitas, Andriana I Papaioannou, Petros Bakakos, Stelios Loukides, Mina Gaga
A small subgroup of patients with asthma suffers from severe disease that is either partially controlled or uncontrolled despite intensive, guideline-based treatment. These patients have significantly impaired quality of life and although they constitute <5% of all asthma patients, they are responsible for more than half of asthma-related healthcare costs. Here, we review a definition for severe asthma and present all therapeutic options currently available for these severe asthma patients. Moreover, we suggest a specific algorithmic treatment approach for the management of severe, difficult-to-treat asthma based on specific phenotype characteristics and biomarkers...
January 2018: ERJ Open Research
https://www.readbyqxmd.com/read/29532559/epidemiology-of-general-anesthesia-prior-to-age-3-in-a-population-based-birth-cohort
#5
Yu Shi, Danqing Hu, Erin L Rodgers, Slavica K Katusic, Stephen J Gleich, Andrew C Hanson, Darrell R Schroeder, Randall P Flick, David O Warner
BACKGROUND: Utilization of general anesthesia in children has important policy, economic, and healthcare delivery implications, yet there is little information regarding the epidemiology of these procedures in the United States. AIMS: The primary objective of this study was to describe in a geographically defined population the incidence of procedures requiring general anesthesia up to the child's third birthday, and the patient characteristics associated with receiving these procedures...
March 13, 2018: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29394222/hyperchloremia-is-associated-with-complicated-course-and-mortality-in-pediatric-patients-with-septic-shock
#6
Erin K Stenson, Natalie Z Cvijanovich, Nick Anas, Geoffrey L Allen, Neal J Thomas, Michael T Bigham, Scott L Weiss, Julie C Fitzgerald, Paul A Checchia, Keith Meyer, Michael Quasney, Mark Hall, Rainer Gedeit, Robert J Freishtat, Jeffrey Nowak, Shekhar S Raj, Shira Gertz, Jocelyn R Grunwell, Hector R Wong
OBJECTIVE: Hyperchloremia is associated with poor outcome among critically ill adults, but it is unknown if a similar association exists among critically ill children. We determined if hyperchloremia is associated with poor outcomes in children with septic shock. DESIGN: Retrospective analysis of a pediatric septic shock database. SETTING: Twenty-nine PICUs in the United States. PATIENTS: Eight hundred ninety children 10 years and younger with septic shock...
February 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29168046/procalcitonin-guided-antibiotic-therapy-in-intensive-care-unit-patients-a-systematic-review-and-meta-analysis
#7
Hui-Bin Huang, Jin-Min Peng, Li Weng, Chun-Yao Wang, Wei Jiang, Bin Du
BACKGROUND: Serum procalcitonin (PCT) concentration is used to guide antibiotic decisions in choice, timing, and duration of anti-infection therapy to avoid antibiotic overuse. Thus, we performed a systematic review and meta-analysis to seek evidence of different PCT-guided antimicrobial strategies for critically ill patients in terms of predefined clinical outcomes. METHODS: We searched for relevant studies in PubMed, Embase, Web of Knowledge, and the Cochrane Library up to 25 February 2017...
November 22, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/29373157/new-onset-status-epilepticus-in-pediatric-patients-causes-characteristics-and-outcomes
#8
Saba Jafarpour, Ryan M Hodgeman, Carolina De Marchi Capeletto, Mateus Torres Avelar de Lima, Kush Kapur, Robert C Tasker, Tobias Loddenkemper
BACKGROUND: Many pediatric patients presenting with status epilepticus have no history of seizures. METHODS: We retrospectively analyzed the clinical characteristics of patients aged one month to 21 years who presented during six consecutive years with convulsive status epilepticus and without a history of seizures. New-onset refractory status epilepticus was defined as status epilepticus refractory to two lines of treatment, without an identified cause in the first 48 hours...
March 2018: Pediatric Neurology
https://www.readbyqxmd.com/read/28870355/mechanical-ventilation-state-of-the-art
#9
REVIEW
Tài Pham, Laurent J Brochard, Arthur S Slutsky
Mechanical ventilation is the most used short-term life support technique worldwide and is applied daily for a diverse spectrum of indications, from scheduled surgical procedures to acute organ failure. This state-of-the-art review provides an update on the basic physiology of respiratory mechanics, the working principles, and the main ventilatory settings, as well as the potential complications of mechanical ventilation. Specific ventilatory approaches in particular situations such as acute respiratory distress syndrome and chronic obstructive pulmonary disease are detailed along with protective ventilation in patients with normal lungs...
September 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28600630/arterial-versus-venous-lactate-a-measure-of-sepsis-in-children
#10
Sahan Asela Samaraweera, Berwyck Gibbons, Anami Gour, Philip Sedgwick
This study assessed the agreement between arterial and venous blood lactate and pH levels in children with sepsis. This retrospective, three-year study involved 60 PICU patients, with data collected from electronic or paper patient records. The inclusion criteria comprised of children (≤17 years old) with sepsis and those who had a venous blood gas taken first with an arterial blood gas taken after within one hour. The lactate and pH values measured through each method were analysed. There is close agreement between venous and arterial lactate up to 2 mmol/L...
August 2017: European Journal of Pediatrics
https://www.readbyqxmd.com/read/28658197/hydrocortisone-therapy-in-catecholamine-resistant-pediatric-septic-shock-a-pragmatic-analysis-of-clinician-practice-and-association-with-outcomes
#11
Blake Nichols, Sherri Kubis, Jennifer Hewlett, Nadir Yehya, Vijay Srinivasan
OBJECTIVES: The 2012 Surviving Sepsis Campaign pediatric guidelines recommend stress dose hydrocortisone in children experiencing catecholamine-dependent septic shock with suspected or proven absolute adrenal insufficiency. We evaluated whether stress dose hydrocortisone therapy in children with catecholamine dependent septic shock correlated with random serum total cortisol levels and was associated with improved outcomes. DESIGN: Retrospective cohort study. SETTING: Non-cardiac PICU...
September 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/25635367/sedation-drugs-used-in-intensive-care-sedation
#12
REVIEW
Valerie J Page, Daniel F McAuley
PURPOSE OF REVIEW: There is recognition that the use of sedative drugs in critically ill patients is potentially harmful, particularly in relation to ICU delirium and clinical outcomes. In that context, there is an increasing interest in maintaining light sedation, the use of non-gamma-aminobutyric acid agonist agents and antipsychotics. RECENT FINDINGS: The sedative drugs currently available have limitations relating to duration of action, cost or variability in response...
April 2015: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27798546/evaluation-of-early-corticosteroid-therapy-in-management-of-pediatric-septic-shock-in-pediatric-intensive-care-patients-a-randomized-clinical-study
#13
RANDOMIZED CONTROLLED TRIAL
Ahmed El-Nawawy, Doaa Khater, Heba Omar, Yasser Wali
BACKGROUND: Septic shock is a major healthcare problem. Adrenal insufficiency (AI) in children with septic shock is a recognized complication, yet is controversial regarding its management and effect on mortality. According to the current guidelines, children with risk factors for AI should receive a stress dose of steroids in step 3 of treatment. This study aimed to evaluate and compare early corticosteroid therapy with the traditional use of steroids among pediatric septic shock patients...
February 2017: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/28302612/difficult-lumbar-puncture-pitfalls-and-tips-from-the-trenches
#14
REVIEW
P A Hudgins, A J Fountain, P R Chapman, L M Shah
Lumbar puncture has, for many years, been the responsibility of the internal medicine physician or the neurologist. As more patients have undergone spine surgery and with the current increase in body mass index of the general population, the radiologist has been consulted with increasing frequency to perform lumbar puncture with fluoroscopic guidance. Radiology, in fact, is now the dominant overall provider of lumbar puncture procedures. The procedure is more difficult when the needle length increases, and if fluoroscopy is used, landmarks are more difficult to visualize with increasing subcutaneous fat...
July 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28398938/pediatric-anaphylaxis-in-the-emergency-department-clinical-presentation-quality-of-care-and-reliability-of-consensus-criteria
#15
Viginia L Goetz, Kelly Kim, Antonia S Stang
OBJECTIVES: The objective of this study was to describe the quality of emergency department (ED) care for pediatric patients with anaphylaxis. The secondary objectives were to describe (1) the clinical presentation of pediatric patients with anaphylaxis including the proportion of patients meeting each of the National Institute of Allergy and Infectious Diseases (NIAID) consensus criteria and subcriteria and (2) the Interrater reliability (IRR) for applying the NIAID criteria. METHODS: We conducted a retrospective cross-sectional chart review of patients seen in a pediatric ED during a 2-year period...
April 11, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27095241/paediatric-difficult-airway-management-what-every-anaesthetist-should-know
#16
EDITORIAL
N Jagannathan, L Sohn, J E Fiadjoe
No abstract text is available yet for this article.
September 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27654000/guidelines-for-the-management-of-severe-traumatic-brain-injury-fourth-edition
#17
Nancy Carney, Annette M Totten, Cindy O'Reilly, Jamie S Ullman, Gregory W J Hawryluk, Michael J Bell, Susan L Bratton, Randall Chesnut, Odette A Harris, Niranjan Kissoon, Andres M Rubiano, Lori Shutter, Robert C Tasker, Monica S Vavilala, Jack Wilberger, David W Wright, Jamshid Ghajar
The scope and purpose of this work is 2-fold: to synthesize the available evidence and to translate it into recommendations. This document provides recommendations only when there is evidence to support them. As such, they do not constitute a complete protocol for clinical use. Our intention is that these recommendations be used by others to develop treatment protocols, which necessarily need to incorporate consensus and clinical judgment in areas where current evidence is lacking or insufficient. We think it is important to have evidence-based recommendations to clarify what aspects of practice currently can and cannot be supported by evidence, to encourage use of evidence-based treatments that exist, and to encourage creativity in treatment and research in areas where evidence does not exist...
January 1, 2017: Neurosurgery
https://www.readbyqxmd.com/read/27203509/clinical-challenges-in-mechanical-ventilation
#18
REVIEW
Ewan C Goligher, Niall D Ferguson, Laurent J Brochard
Mechanical ventilation supports gas exchange and alleviates the work of breathing when the respiratory muscles are overwhelmed by an acute pulmonary or systemic insult. Although mechanical ventilation is not generally considered a treatment for acute respiratory failure per se, ventilator management warrants close attention because inappropriate ventilation can result in injury to the lungs or respiratory muscles and worsen morbidity and mortality. Key clinical challenges include averting intubation in patients with respiratory failure with non-invasive techniques for respiratory support; delivering lung-protective ventilation to prevent ventilator-induced lung injury; maintaining adequate gas exchange in severely hypoxaemic patients; avoiding the development of ventilator-induced diaphragm dysfunction; and diagnosing and treating the many pathophysiological mechanisms that impair liberation from mechanical ventilation...
April 30, 2016: Lancet
https://www.readbyqxmd.com/read/28029394/non-anion-gap-metabolic-acidosis-a-clinical-approach-to-evaluation
#19
Mandana Rastegar, Glenn T Nagami
Acid-base disturbances can result from kidney or nonkidney disorders. We present a case of high-volume ileostomy output causing large bicarbonate losses and resulting in a non-anion gap metabolic acidosis. Non-anion gap metabolic acidosis can present as a form of either acute or chronic metabolic acidosis. A complete clinical history and physical examination are critical initial steps to begin the evaluation process, followed by measuring serum electrolytes with a focus on potassium level, blood gas, urine pH, and either direct or indirect urine ammonium concentration...
February 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/26977974/what-is-ecmo
#20
REVIEW
Alexander White, Eddy Fan
No abstract text is available yet for this article.
March 15, 2016: American Journal of Respiratory and Critical Care Medicine
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