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By Neil Fernandes Pediatric resident currently pediatric critical care fellow next!
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
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
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...
December 1, 2017: Pediatric Neurology
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
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
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
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
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
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
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
N Jagannathan, L Sohn, J E Fiadjoe
No abstract text is available yet for this article.
September 2016: British Journal of Anaesthesia
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
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
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
(no author information available yet)
No abstract text is available yet for this article.
March 15, 2016: American Journal of Respiratory and Critical Care Medicine
Takashi Asai
No abstract text is available yet for this article.
August 2017: Journal of Anesthesia
Rinaldo Bellomo, John A Kellum, Claudio Ronco, Ron Wald, Johan Martensson, Matthew Maiden, Sean M Bagshaw, Neil J Glassford, Yugeesh Lankadeva, Suvi T Vaara, Antoine Schneider
Acute kidney injury (AKI) and sepsis carry consensus definitions. The simultaneous presence of both identifies septic AKI. Septic AKI is the most common AKI syndrome in ICU and accounts for approximately half of all such AKI. Its pathophysiology remains poorly understood, but animal models and lack of histological changes suggest that, at least initially, septic AKI may be a functional phenomenon with combined microvascular shunting and tubular cell stress. The diagnosis remains based on clinical assessment and measurement of urinary output and serum creatinine...
June 2017: Intensive Care Medicine
R Phillip Dellinger, Christa A Schorr, Mitchell M Levy
No abstract text is available yet for this article.
March 2017: Critical Care Medicine
Leslie A Dervan, Beryl Yaghmai, Robert Scott Watson, Fredric M Wolf
BACKGROUND: Continuous opioid infusion therapy is commonly utilized in the pediatric intensive care setting to treat pain and facilitate tolerance of invasive therapies. Transitioning to methadone is one common strategy for weaning from continuous opioid infusions, but in practice this transition can be challenging, and many children still experience iatrogenic withdrawal. AIM: We reviewed the literature to evaluate the best available evidence to guide methadone therapy in this setting, and to summarize associated adverse events...
March 2017: Paediatric Anaesthesia
Pradip P Chaudhari, Michael C Monuteaux, Richard G Bachur
BACKGROUND: Varying urine white blood cell (WBC) thresholds have been recommended for the presumptive diagnosis of urinary tract infection (UTI) among young infants. These thresholds have not been studied with newer automated urinalysis systems that analyze uncentrifuged urine that might be influenced by urine concentration. Our objective was to determine the optimal urine WBC threshold for UTI in young infants by using an automated urinalysis system, stratified by urine concentration...
November 2016: Pediatrics
2017-02-02 19:48:44
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