Pediatr Crit Care Me
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Pediatr Crit Care Me · Nov 2006
ReviewOctreotide therapy for chylothorax in infants and children: A brief review.
We review physiology and pharmacology relating to the use of octreotide for chylothorax in infants and children. We review the published experience of octreotide dosing in this context. ⋯ Octreotide has been used as a successful therapeutic adjunct in a small number of neonatal cases and a larger number of pediatric cases. No consensus has been reached as to the optimal route of administration, dose, duration of therapy, or strategy for discontinuation of therapy. We suggest using higher doses (80-100 microg/kg/day) and initiating therapy early rather than using a low initial dose with upward titration. Duration of therapy required to elicit a significant response may vary between patients.
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Pediatr Crit Care Me · Nov 2006
Is there a "right" way to wean my patient from the ventilator? A critical appraisal of Randolph et al: Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children: A randomized controlled trial (JAMA 2002; 288:2561-2568).
To review the findings and discuss the implications of mechanical ventilator weaning protocols in children. ⋯ The majority of children are weaned from mechanical ventilation over a short period of time. Weaning protocols may not shorten this brief duration of weaning but may have other advantages such as improved collaboration between healthcare team members. Future research into the effects of sedation on weaning from mechanical ventilation is needed in children.
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Pediatr Crit Care Me · Nov 2006
Is a prophylactic treatment by erythropoietin relevant to reduce red blood cell transfusion in the pediatric intensive care unit?
An adult trial reported the efficacy of recombinant human erythropoietin in critically ill patients with a 19% decrease in red blood cell transfusion. Our aim was to evaluate the relevance of this prophylactic treatment in children hospitalized in a pediatric intensive care unit (PICU). ⋯ If we applied the results of the adult trial to our PICU, we would have to treat 31% of the children with prophylactic erythropoietin and thereby expect a reduction of one red blood cell transfusion for every 17 treated patients.
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Pediatr Crit Care Me · Nov 2006
Characteristics and outcomes of interhospital transfers from level II to level I pediatric intensive care units.
To examine the characteristics, resource utilization, and outcomes for transfer admissions from level II to level I pediatric intensive care units (PICUs). ⋯ This study highlights significant differences in patient characteristics, resource utilization, and outcomes across mortality risk-stratified groups of critically ill and injured children transferred from level II to level I PICU care. Further studies are warranted to investigate decision making that prompt inter-PICU transfers.
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Pediatr Crit Care Me · Nov 2006
Case ReportsUse of fenoldopam to increase urine output in a patient with renal insufficiency secondary to septic shock: A case report.
We describe the use of fenoldopam to increase urine output in a pediatric patient with sepsis, heart failure, oliguria, and volume overload. ⋯ Fenoldopam increased urine output in a pediatric patient who was in septic shock and oliguria. The mechanism for this effect is unclear, and further trials are necessary to determine the role of fenoldopam in this patient population.