Pediatr Crit Care Me
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Pediatr Crit Care Me · May 2005
ReviewPhysicians' ability to diagnose sepsis in newborns and critically ill children.
To elucidate physicians' ability to correctly diagnose infection in critically ill children in three different situations: 1) post hoc adjudication (e.g., ward rounds, outcome determination in surveillance studies or controlled trials), 2) when decisions must be made (e.g., sepsis workup in suspected infection), c) and applying suggested adult consensus conference definitions in children. ⋯ Misclassification is a serious threat in post hoc adjudication of episodes or when consensus definitions rely on the application of criteria with imperfect sensitivity (e.g., the positivity of blood cultures in premature infants or children). This underscores the need to use probability-based categorizations such as probable and possible infection.
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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
A retrospective cohort study of prognostic factors associated with outcome in pediatric severe sepsis: what is the role of steroids?
Systemic corticosteroids remain controversial in the treatment of pediatric patients with severe sepsis. Recent studies in septic adults have shown decreased mortality with the use of hydrocortisone in patients with relative adrenal insufficiency. We conducted this large retrospective cohort study to further characterize severe sepsis in infants and children and correlates of outcome, including the use of steroids. ⋯ From this administrative database analysis, there is no evidence that steroids are associated with improved outcome in critically ill infants and children with sepsis. Although steroids may be given preferentially to more severely ill children, their use was associated with increased mortality. Clinicians should maintain equipoise on this topic pending prospective randomized clinical trials.
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Pediatr Crit Care Me · May 2005
The strong ion gap predicts mortality in children following cardiopulmonary bypass surgery.
Stewart's strong ion theory quantifies unmeasured tissue acids produced following hypoxia or hypoperfusion, by calculation of the strong ion gap. Our study objectives were as follows: a) to determine the 24-hr profile of the strong ion gap following cardiopulmonary bypass surgery; and b) to compare the prognostic value in terms of intensive care unit mortality of this variable with blood lactate. ⋯ An elevated strong ion gap occurs commonly following bypass surgery and appears to be superior to lactate as a mortality predictor.
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Pediatr Crit Care Me · May 2005
Integrating the Institute of Medicine's six quality aims into pediatric critical care: relevance and applications.
The Institute of Medicine's report Crossing the Quality Chasm recommends "six aims for improvement." The aims are safety, effectiveness, equity, timeliness, patient-centeredness, and efficiency. This review focuses on the quality of care information relevant to the Institute of Medicine's six aims to assess their relevance, potential impact, and affect on pediatric critical care practice. It is concluded that if the care for pediatric intensive care patients is to be fundamentally improved, an understanding of the current care environment, the existing evidence base, the opportunities for improvement, and the documentation of the improvements needs to be realized. The Institute of Medicine's six aims provide a useful framework to advance the quality of care in this pediatric subspecialty and perhaps others.