Pediatr Crit Care Me
-
Pediatr Crit Care Me · Jan 2006
Pediatric critical care community survey of knowledge and attitudes toward therapeutic hypothermia in comatose children after cardiac arrest.
Therapeutic hypothermia improves neurologic outcome and survival after adult out-of-hospital cardiac arrest. To help us design a prospective hypothermia trial in children, we developed a survey to assess current knowledge and attitude of pediatric critical care providers regarding therapeutic hypothermia and potential impediments to implementing a prospective study. ⋯ Despite widespread awareness of therapeutic hypothermia's beneficial effects after arrest, it is not widely used by pediatric critical care clinicians sampled in our survey. Among those using hypothermia, there is wide variation in methodology and end points of therapy. This seems to result from a lack of evidence, difficulty with the technique, and unavailability of explicit protocols. Pediatric studies are needed to assess the safety, feasibility, and effectiveness of therapeutic hypothermia after cardiac arrest and other causes of brain injury.
-
Pediatr Crit Care Me · Jan 2006
Matrix metalloproteinase and tissue inhibitor of matrix metalloproteinase expression profiles in tracheal aspirates do not adequately reflect tracheal or lung tissue profiles in neonatal respiratory distress: observations from an animal model.
Matrix metalloproteinase (MMP)/tissue inhibitor of matrix metalloproteinase (TIMP) expression in tracheal aspirates (TA) is commonly assayed to represent the protein profile in the lung. This study tests the hypothesis that the profile of MMPs 2, 7, and 9 and the profile of TIMPs 1 and 2 will be different in TA, tracheal tissue, and lung tissue in neonatal respiratory distress. ⋯ The MMP/TIMP profiles in TA do not adequately represent the profiles in either trachea or lung. Thus, MMP/TIMP profiles from TA are limited and should be interpreted for trends rather than actual tissue levels.
-
Pediatr Crit Care Me · Jan 2006
Growth, development, and failure to thrive: factors that underlie the availability of pediatric critical care facilities in the United States.
Pediatric intensive care units (PICUs) have grown in number and size over time in aggregate across the United States, but the factors promoting such changes have not been well characterized. This study was conducted to explore the establishment, expansion, and closure of PICUs. ⋯ This study provides new insight into decision-making that influences the availability of critical care services for children. The establishment, expansion, and closure of PICUs are driven predominantly by local demand for pediatric critical care services, whereas availability of subspecialists as well as competition between PICUs within the same market affect the long-term sustainability of such services.