Pediatr Crit Care Me
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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.
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Pediatr Crit Care Me · May 2005
Case ReportsUse of recombinant factor VIIa for refractory hemorrhage during extracorporeal membrane oxygenation.
To describe the outcome and treatment of two patients with recombinant factor VIIa (rFVIIa) for severe hemorrhage associated with extracorporeal membrane oxygenation (ECMO). ⋯ The efficacy of rFVIIa in reducing intractable bleeding postcardiac surgery and in other coagulopathic states is being investigated. Despite theoretical concerns of thrombosis, these cases illustrate that there may be a role for the cautious use of rFVIIa in treating severe and intractable hemorrhage associated with ECMO.
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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.
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Pediatr Crit Care Me · May 2005
Routine enteral nutrition in neonates on extracorporeal membrane oxygenation.
To evaluate over a 5-yr period the feasibility and tolerance of a protocol of routine enteral nutrition in neonates requiring extracorporeal membrane oxygenation (ECMO). ⋯ Neonates on ECMO in this series tolerated enteral feeding well and did not show serious adverse effects. Overall, it is our experience that routine use of enteral feeding in critically ill neonates on VA-ECMO is feasible.
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Pediatr Crit Care Me · May 2005
Effect of one-rescuer compression/ventilation ratios on cardiopulmonary resuscitation in infant, pediatric, and adult manikins.
Optimal chest compression to ventilation ratio (C:V) for one-rescuer cardiopulmonary resuscitation (CPR) is not known, with current American Heart Association recommendations 3:1 for newborns, 5:1 for children, and 15:2 for adults. C:V ratios influence effectiveness of CPR, but memorizing different ratios is educationally cumbersome. We hypothesized that a 10:2 ratio might provide adequate universal application for all age arrest victims. ⋯ C:V ratio and manikin size have a significant influence on the number of effective compressions and ventilations delivered during ideal, metronome-paced, one-rescuer CPR. Low ratios of 3:1, 5:1, and 10:2 favor ventilation, and high ratios of 15:2 favor compression, especially in adult manikins. Rescuers subjectively preferred C:V ratios of 10:2 and 15:2 over 3:1 or 5:1. Infant CPR caused less exertion and subjective fatigue than pediatric or adult CPR technique, without significant difference by C:V ratio. We speculate that a universal 10:2 C:V ratio for one-rescuer layperson CPR is physiologically reasonable but warrants further study with particular attention to educational value and technique retention.