Bmc Pediatr
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Observational Study
Assessment of atropine-sufentanil-atracurium anaesthesia for endotracheal intubation: an observational study in very premature infants.
Premedication before neonatal intubation is heterogeneous and contentious. The combination of a short acting, rapid onset opioid with a muscle relaxant is considered suitable by many experts. The purpose of this study was to describe the tolerance and conditions of intubation following anaesthesia with atropine, sufentanil and atracurium in very premature infants. ⋯ This drug combination offers satisfactory success rate for first attempt and intubation conditions for the operator without any significant change in heart rate and blood pressure for the patient. However it is associated with frequent desaturations and a possible persistent hypercapnia. SpO2 and PCO2 can be significantly modified during neonatal intubation and should be cautiously followed in this high-risk population.
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Hyperlactatemia upon admission is a documented risk factor for mortality in critically ill adult patients. However, the predictive significance of a single lactate measurement at admission for mortality in the general population of critically ill children remains uncertain. This study evaluated the predictive value of blood lactate levels at admission and determined the cut-off values for predicting in-hospital mortality in the critically ill pediatric population. ⋯ A high blood lactate level at admission is independently associated with and predictive of in-hospital mortality in the general population of critically ill children.
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Mortality in severely injured children: experiences of a German level 1 trauma center (2002 - 2011).
Trauma in pediatric patients is a major cause of death. This study investigated differences between decedents and survivors. Furthermore, an analysis of preventable and potential preventable trauma deaths was conducted and errors in the acute trauma care were investigated. ⋯ Head trauma is the determinant factor for mortality in severely injured pediatric patients. Death occurred shortly after arrival and long term intensive care stays might be an exception. In treatment of severely injured children volume management, hemorrhage and coagulopathy management, rescue time, and total surgery time should receive more attention.
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Provision of optimal nutrition in children in critical care is often challenging. This study evaluated exclusive enteral nutrition (EN) provision practices and explored predictors of energy intake and delay of EN advancement in critically ill children. ⋯ Provision of optimal EN support remains challenging and varies during hospitalisation and among patients. Delivery of EN should be prioritized over other "non-nutritional" fluids whenever this is possible.