Critical care clinics
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Critical care clinics · Apr 2013
ReviewQuality: performance improvement, teamwork, information technology and protocols.
Using the Institute of Medicine framework that outlines the domains of quality, this article considers four key aspects of health care delivery which have the potential to significantly affect the quality of health care within the pediatric intensive care unit. The discussion covers: performance improvement and how existing methods for reporting, review, and analysis of medical error relate to patient care; team composition and workflow; and the impact of information technologies on clinical practice. Also considered is how protocol-driven and standardized practice affects both patients and the fiscal interests of the health care system.
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Acute respiratory failure is common in critically ill children, who are at increased risk of respiratory embarrassment because of the developmental variations in the respiratory system. Although multiple etiologies exist, pneumonia and bronchiolitis are most common. Respiratory system monitoring has evolved, with the clinical examination remaining paramount. ⋯ Children with ALI/ARDS have better overall outcomes than adults, although data regarding specific therapies are still lacking. Most children will have some degree of long-term physiologic respiratory compromise after recovery from ALI/ARDS. The physiologic basis for respiratory failure and its therapeutic options are reviewed here.
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Critical care clinics · Apr 2013
ReviewRenal complications and therapy in the PICU: hypertension, CKD, AKI, and RRT.
This article provides the bedside clinician an overview of the unique renal complications that are seen commonly in the pediatric intensive care unit. These sections are purposely succinct to give a quick guide to the clinician for the care of these children. We have identified four major areas that should result in discussion and cooperative care between intensive care physicians and nephrologists for the care of these children: (1) hypertension, (2) chronic kidney failure, (3) acute kidney injury, and (4) renal replacement therapy.