Pediatr Crit Care Me
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Pediatr Crit Care Me · Jan 2005
Comparative StudyAssessment of sedation levels in pediatric intensive care patients can be improved by using the COMFORT "behavior" scale.
The original COMFORT scale, including both observational and physiologic items, has been validated for measuring distress in children admitted to a pediatric intensive care unit. However, physiologic variables are influenced by drugs given in the pediatric intensive care unit setting. The objectives of this study were to assess the usefulness of physiologic variables in judgment of sedation and to determine new cutoff points for the COMFORT "behavioral" scale (COMFORT-B), using only observational items. ⋯ The COMFORT-B scale is a reliable alternative to the original COMFORT scale. The cutoff points of the COMFORT-B scale in conjunction with the Nurse Interpretation Score of Sedation facilitate the use of sedation algorithms on the pediatric intensive care unit.
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Pediatr Crit Care Me · Jan 2005
Tracheal gas insufflation as a lung-protective strategy: physiologic, histologic, and biochemical markers.
Conventional mechanical ventilation in acute lung failure potentiates lung injury, which can be assessed by physiologic, histologic, and biochemical markers. Thus, new ventilation strategies are directed at reducing lung injury. Tracheal gas insufflation has been shown to reduce endotracheal tube prosthetic deadspace and peak inspiratory pressure during conventional mechanical ventilation. Our objective was to use physiologic, histologic, and biochemical markers to test the hypothesis that tracheal gas insufflation in acute lung injury is lung protective. ⋯ Tracheal gas insufflation resulted in lower ventilatory requirements (peak inspiratory pressure, tidal volume, and deadspace) and a more favorable histologic trend than conventional mechanical ventilation. Tracheal gas insufflation offers potential as a lung-protective strategy for acute lung injury in the developing rabbit lung and may be a useful clinical adjunct to neonatal respiratory management.
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Pediatr Crit Care Me · Jan 2005
Comparative StudyIntraosseous access in the setting of pediatric critical care transport.
To demonstrate safety and efficacy of intraosseous needle placement among health care provider groups in the setting of pediatric critical care transport. ⋯ Intraosseous placement is frequently needed in the care of critically ill pediatric patients before they reach the pediatric intensive care unit. We have demonstrated that intraosseous needles can be placed safely with similar rates of success when comparing different provider groups. Emergency medical technician-paramedics, emergency medicine physicians, and pediatric critical care transport teams should be familiar with intraosseous placement.
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Pediatr Crit Care Me · Jan 2005
Preventing adverse events in the pediatric intensive care unit: prospectively targeting factors that lead to intravenous potassium chloride order errors.
To prospectively identify and reduce proximal causes of error contributing to inappropriate intravenous potassium chloride orders and reduce adverse events subsequent to these ordering errors. ⋯ Simple, blame-free, system-wide interventions designed to reduce proximal causes of error can be an effective, proactive means of reducing the likelihood of medical morbidity.
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Pediatr Crit Care Me · Jan 2005
Case ReportsManagement of a large organized intraatrial catheter-tip thrombus in a child with acquired immunodeficiency syndrome using escalating tissue plasminogen activator infusions.
To describe the dissolution of a large organized intraatrial catheter-tip thrombus using a novel aggressive dose escalation of tissue plasminogen activator infusion. ⋯ Prolonged infusion of tissue plasminogen activator in escalating doses was safe and effective in the management of a large intracardiac catheter-tip thrombus and helped avoid open-heart surgery. In view of the potential hazards of tissue plasminogen activator, close pediatric ICU monitoring is indicated with the use of high-dose tissue plasminogen activator infusions.