Pediatr Crit Care Me
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Pediatr Crit Care Me · Jan 2003
Nosocomial urinary tract infections in children in a pediatric intensive care unit: a follow-up after 10 years.
To define nosocomial urinary tract infection (NUTI) rates in a pediatric intensive care unit, and determine whether practice recommendations have been sustained after 10 yrs. ⋯ NUTIs in children in our pediatric intensive care unit were associated with previous cardiovascular surgery and with urinary tract catheterization of at least 3 days. The need for careful fluid monitoring by catheterization must be balanced against the increased risk of catheter-related urinary tract infection. Removal of urinary catheters at the earliest opportunity will prevent many infections. Ongoing education or innovative strategies will be required to sustain optimal practice.
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Pediatr Crit Care Me · Jan 2003
Randomized Controlled Trial Comparative Study Clinical TrialComparison of loss in lung volume with open versus in-line catheter endotracheal suctioning.
Disconnecting the endotracheal tube from the ventilator causes significant loss in lung volume, which is further exacerbated by suctioning. In-line catheter suction systems have putative benefits over open catheter suction by maintaining positive pressure, thereby minimizing hypoxemia and hemodynamic instability. However, there is a theoretical risk of generating large negative airway pressures and auto-cycling of the ventilator with in-line catheter suction systems. We studied the effects on lung volume with both these techniques. ⋯ The most significant loss in lung volume during suctioning occurs primarily during ventilator disconnection. Hence, open catheter suction results in greater lung volume loss when compared with in-line catheter suction. We suggest that in-line catheter suction is preferable, especially in patients with significant lung disease and who require high positive end-expiratory pressures, to avoid alveolar derecruitment and exacerbating hypoxemia during endotracheal tube suctioning.
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Pediatr Crit Care Me · Jan 2003
Randomized Controlled Trial Clinical TrialSerum creatinine and estimated creatinine clearance do not predict perioperatively measured creatinine clearance in neonates undergoing congenital heart surgery.
To describe changes in creatinine clearance (CrCl) in a small group of neonates who underwent surgery for repair of transposition of the great arteries or palliation of hypoplastic left heart syndrome. To determine whether serum creatinine, urine output, or the Schwartz formula accurately predict measured CrCl in these patients. ⋯ Perioperative CrCl is unpredictable in neonates with transposition of the great arteries and hypoplastic left heart syndrome. Serum creatinine, urine output, and the Schwartz formula do not accurately predict CrCl. Reliance on estimates of CrCl could result in toxic concentrations of drugs eliminated by the kidneys.
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Pediatr Crit Care Me · Jan 2003
Randomized Controlled Trial Clinical TrialErythropoietin therapy in children with bronchiolitis and anemia.
Critically ill children with bronchiolitis often require red blood cell transfusions. Anemia normally results in increased circulating erythropoietin concentrations; however, critical illness has been associated with a blunted erythropoietin response. Treatment with erythropoietin decreases the need for red blood cell transfusion in several disease states. We hypothesized that critically ill children with bronchiolitis and anemia would have a circulating erythropoietin deficiency and that treatment with exogenous erythropoietin would increase reticulocyte count and hematocrit and reduce red blood cell transfusion requirements. ⋯ Despite a favorable reticulocyte and circulating erythropoietin response, red blood cell transfusion requirements were not significantly diminished by erythropoietin treatment in children with bronchiolitis and respiratory failure. Erythropoietin cannot be routinely recommended for this patient population.
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Pediatr Crit Care Me · Jan 2003
Randomized Controlled Trial Comparative Study Clinical TrialInterpretation of digital radiographs by pediatric critical care physicians using Web-based bedside personal computers versus diagnostic workstations.
To determine whether the interpretations of digital radiographs by pediatric critical care physicians displayed on the bedside personal computer differ from the interpretations of images displayed on the diagnostic workstation. ⋯ With the exception of diffuse chest abnormalities, pediatric critical care physicians can use the Web-based bedside personal computer for clinical decision-making with the confidence that the decisions will be similar to those made on the diagnostic workstation.