Pediatr Crit Care Me
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Pediatr Crit Care Me · May 2005
ReviewConcept of PIRO as a new conceptual framework to understand sepsis.
To define and introduce the PIRO model for categorizing sepsis in infants and children. ⋯ The PIRO model is a conceptual framework for understanding sepsis that has many favorable attributes. The PIRO model should be directly tested in both the research laboratory and in clinical trial designs to determine the practical value and clinical relevance of this new classification scheme for sepsis.
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To define pneumonia in critically ill children in the intensive care unit setting for surveillance of infection and for the design, conduct, and evaluation of clinical trials in the prevention and therapy of lower respiratory tract infections in this population. ⋯ Although pneumonia is one of the most common diagnoses in critically ill children, there have been few studies validating diagnostic criteria. Definitions for definite, probable, and possible community-acquired pneumonia and nosocomial pneumonia were achieved by consensus of experts based on guidelines from governmental agencies, professional organizations, and published literature. Future research should determine the utility of these definitions in the critically ill child and adapt them accordingly.
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Pediatr Crit Care Me · May 2005
ReviewSeverity of illness and organ dysfunction scoring in children.
To describe predictive and descriptive general scores that can be used to estimate the severity of illness in critically ill children. ⋯ Pediatric Risk of Mortality III, Pediatric Index of Mortality 2, and Pediatric Logistic Organ Dysfunction scores are the best available tools to estimate the severity of illness in critically ill children.
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To summarize the scope and epidemiology of pediatric sepsis. ⋯ Sepsis is a major health problem among children in both developing and industrialized countries. However, sepsis is both preventable and treatable. Improved prevention and treatment of sepsis could have a substantial effect on survival and quality of life of all children, both those who are otherwise healthy and those who are chronically ill. The variations in the epidemiology of pediatric sepsis underscore the need for a multidisciplinary approach and consistently applied definitions.
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Pediatr Crit Care Me · May 2005
ReviewIdentification of central venous catheter-related infections in infants and children.
To define central venous catheter-related infections in infants and children for the purpose of enrolling children in sepsis studies, for epidemiology and surveillance studies, and for clinical management. ⋯ For the purposes of enrolling patients with sepsis in clinical trials, only patients who meet criteria for definite catheter-related bloodstream infection should be categorized as having the catheter as the infection source. Because many patients suspected of having catheter-related bloodstream infection do not have positive blood culture results, which makes the confirmation of infection difficult, we recommend that these patients not be enrolled in sepsis trials. Because catheter tips are often not obtained for culture in children, the epidemiology of catheter-associated bloodstream infection (bloodstream infection in a patient who has a central venous catheter and no other obvious source of infection) is better understood than the epidemiology of confirmed catheter-related bloodstream infection in infants and children. Definitions for catheter-related bloodstream infection that compare the through-catheter and peripheral culture for time to positivity or for quantitative growth are unlikely to be falsely positive, but sensitivity requires further validation.