Pediatr Crit Care Me
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To develop definitions of bloodstream infections in the newborn that would enable clinicians to identify infection early, so patients can be enrolled in clinical trials. The definitions should be useful for surveillance and epidemiologic purposes. ⋯ Current definitions of neonatal infection (and associated categories) used by neonatal clinicians and researchers have been either adapted/modified from definitions developed for adults or generated by individuals to suit their local needs or the needs of a particular study. It is clear that definitions generated for adults are not applicable to children or to newborn infants. In addition, developing and using unique definitions to suit individual or local needs make comparisons of outcome data and result of studies very difficult. This article proposes a set of definitions that are based as much as possible on current evidence. These definitions may be applicable widely for daily management of an infant with an infection and for research and epidemiologic studies.
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Pediatr Crit Care Me · May 2005
Review Comparative StudyCentral venous catheter use in the pediatric patient: mechanical and infectious complications.
Following the introduction and widespread use of central venous catheters (CVCs) in adults, these devices are being used with increasing frequency in the pediatric population. This review will focus on differences between adults and children regarding CVC use and its potential complications. Both mechanical and infectious complications will be discussed. ⋯ CVC-related complications in pediatric patients are closely linked to age, body size, and age-related immune status. In older children, many complications are similar to those encountered in adult patients. Because of ongoing growth and body changes, a cutoff point beyond which children can be regarded as "young adults" is difficult to define; many of our recommendations are therefore age-related. More frequently than in adults, an implanted port may be the first choice in pediatric patients when long indwelling times are expected. The optimal site of insertion also depends on factors such as the patients' age as well as the need for sedation and analgesia during the insertion procedure. In contrast to guidelines in adult patients, we recommend that a radiograph always be made following CVC insertion to check the position of the catheter. Regarding prevention of infectious complications, we recommend full sterile barrier precautions during CVC insertion and strict protocols for catheter care. CVCs should be removed as soon as possible when they are no longer needed, but there is no place for elective CVC replacement on a routine basis. New developments such as the use of impregnated catheters might help reduce infection rates; however, additional research will be required to provide more evidence of benefit in the pediatric population.
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Pediatr Crit Care Me · May 2005
Nurse staffing and unplanned extubation in the pediatric intensive care unit.
To determine the association between unplanned extubations and years of nurse experience and nurse-to-patient ratio in the pediatric intensive care unit (PICU). ⋯ Pediatric patients are more likely to experience an unplanned extubation when being cared for by a nurse assigned to two patients compared with a nurse caring for one patient. To provide safe patient care, health care policymakers and hospital administrators should consider the nurse-to-patient ratio and its potential association with adverse events in hospitalized children.
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Pediatr Crit Care Me · May 2005
Reproducibility of cerebral oxygenation measurement in neonates and infants in the clinical setting using the NIRO 300 oximeter.
To study reproducibility of cerebral tissue oxygenation index (cTOI) values in neonates and infants in a clinical setting using the NIRO 300 oximeter (Hamamatsu Photonics, Hamamatsu City, Japan). ⋯ The present study shows that cTOI measurements using the NIRO 300 oximeter at the lateral forehead of neonates and infants are not well reproducible under clinical conditions. This raises the question whether generally valid normal values can be defined with the used approach and makes it difficult to determine a normal range of cerebral oxygenation.
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Pediatr Crit Care Me · May 2005
Case ReportsPosttraumatic cholothorax in a child: case report and review of the literature.
Thoracobiliary fistula, subsequent to a combined thoracic and hepatic blunt trauma, is a rare complication, which calls for a high index of suspicion during diagnostic workup. Due to its uncommon nature, especially in children, and hence the paucity of reports in literature, no consensus has been reached on its optimal management. ⋯ The recent tendency to observe rather than explore abdominal trauma and the absence of a definitive diagnostic test for diaphragmatic injury may contribute to a delayed diagnosis of the components that may result in the development of a fistula. Literature review substantiates endoscopic retrograde cholangiopancreatography as the imaging modality of choice, because it has the potential of therapeutic intervention by sphincterotomy or stent placement. A nonoperative approach was successful in this case.