Pediatr Crit Care Me
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Pediatr Crit Care Me · May 2005
ReviewWhat have we learned from observational studies on neonatal sepsis?
To assess how observational studies on neonatal sepsis can help define the knowledge base required for neonatal randomized, clinical trials. ⋯ Future observational studies must address three key issues. They should begin with a clear analytic and sampling plan that pays careful attention to the proper use and reporting of multivariate analyses. Second, they must explicitly address two subpopulations: critically ill newborns with negative cultures and asymptomatic newborns with positive cultures. Finally, they should be theory driven and provide empirical physiologic data that permit situating their results in the context of the evolving systemic inflammatory response syndrome and PIRO (predisposition, infection, host response, organ dysfunction) models.
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Pediatr Crit Care Me · May 2005
Multicenter StudyExtubation failure in pediatric intensive care incidence and outcomes.
To evaluate the hypotheses that children requiring reintubation are at an increased risk of prolonged hospitalizations, congenital heart disease, and death compared with age- and disease-severity-matched control patients. ⋯ In the present trial, 4.1% of mechanically ventilated children failed extubation. Pediatric intensive care unit patients with failed extubation have longer hospital, pediatric intensive care unit, and ventilator courses but are not at increased risk of death relative to nonfailed extubation patients.
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Pediatr Crit Care Me · May 2005
ReviewSepsis predisposition in children with human immunodeficiency virus.
To review predisposition to sepsis in children infected with human immunodeficiency virus (HIV) in the era of highly active antiretroviral therapy (HAART). ⋯ Pediatric HIV infection is not a homogeneous condition in the era of HAART. Susceptibility to sepsis, morbidity, and mortality differ according to stage of disease, access to HAART, and virologic and immunologic response to treatment. These issues should be considered if HIV-infected children are to be enrolled and stratified in clinical trials.
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Pediatr Crit Care Me · May 2005
ReviewReducing the global burden of sepsis in infants and children: a clinical practice research agenda.
Sepsis remains a predominant cause of mortality and morbidity in children in the developing and industrialized world. This review discusses a clinical practice research agenda to reduce this global burden. ⋯ The global burden of sepsis can be reduced by 1) prevention with improved heterologous or specific vaccines and vitamin or mineral supplement programs; 2) early recognition and treatment with appropriate antibiotics, intravenous fluid resuscitation, and inotropic support in organized healthcare-delivery systems; and 3) development of new diagnostics and therapeutics that reduce systemic thrombosis, improve immune function, and kill resistant organisms.
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Pediatr Crit Care Me · May 2005
Comparative Study Clinical TrialPressure support ventilation combined with volume guarantee versus synchronized intermittent mandatory ventilation: a pilot crossover trial in premature infants in their weaning phase.
To compare pressure support ventilation combined with volume guarantee (PSV-VG) to synchronized intermittent mandatory ventilation (SIMV) regarding safety, course of blood gases, and infant-ventilator interaction in premature infants. ⋯ The potentials of PSV-VG to improve infant-ventilator synchrony and to decrease pressure needed to ventilate premature lungs are promising, even though the changes were small. However, its benefits during acute illness and on the final outcome remain to be proven.