Pediatr Crit Care Me
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Pediatr Crit Care Me · Jul 2006
Noninvasive positive pressure ventilation: five years of experience in a pediatric intensive care unit.
To evaluate the feasibility and outcome of noninvasive positive pressure ventilation (NPPV) in daily clinical practice. ⋯ This study demonstrates the feasibility and efficacy of NPPV in the daily practice of a pediatric intensive care unit. This ventilatory support could be proposed as a first-line treatment in children with acute respiratory distress, except in those with a diagnosis of acute respiratory distress syndrome.
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Pediatr Crit Care Me · Jul 2006
Comparative StudyPerformance of Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality (PIM), and PIM2 in a pediatric intensive care unit in a developing country.
To determine the discriminative ability and calibration of existing scoring systems in predicting the outcome (mortality) in children admitted to an Indian pediatric intensive care unit (PICU). ⋯ The area under the receiver operating characteristic curve for all the models evaluated was >0.8. However, all the models underpredicted mortality. The likely reasons for this could be differences in the patient profile and greater load of severity of illness being managed with lesser resources--both physical and human--and differences in the quality of care.
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Pediatr Crit Care Me · Jul 2006
Comparative Study Controlled Clinical TrialChanges in cerebral saturation profile in response to mechanical ventilation alterations in infants with bidirectional superior cavopulmonary connection.
To document cerebral saturation in response to alterations in mechanical ventilation in infants with bidirectional superior cavopulmonary connection. ⋯ Hyperventilation can potentially cause a decrease in cerebral oxygenation and should be avoided in children with bidirectional superior cavopulmonary connection. Normoventilation and mild respiratory acidosis, however, preserve cerebral oxygenation in these patients.
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Pediatr Crit Care Me · Jul 2006
Altered cerebrovascular responses after exposure to venoarterial extracorporeal membrane oxygenation: role of the nitric oxide pathway.
Previous studies in our laboratory on newborn lambs have shown cerebral autoregulation impairment after exposure to venoarterial extracorporeal membrane oxygenation (VA ECMO), with additional studies showing an altered cerebrovascular response to NG-nitro-L-arginine methyl ester in lamb cerebral vessels in this same model. ⋯ Cerebral arteries exposed to VA ECMO had impaired myogenic responses combined with altered endothelial function. The endothelial alteration seems to be mediated through the nitric oxide pathway, with recovery noted after addition of a nitric oxide donor. It can be postulated that these changes may reflect the mechanisms for the impairment of cerebral autoregulation previously reported in this lamb model.
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Pediatr Crit Care Me · Jul 2006
Clinical TrialSpontaneous breathing trial predicts successful extubation in infants and children.
To assess the value of a spontaneous breathing trial (SBT) using a flow-inflating bag in predicting extubation success. Secondary goals were to evaluate the positive and negative predictive accuracy of a 15-min SBT. ⋯ A 15-min flow-inflating bag SBT represents a practical, reliable bedside test that has 95% sensitivity for predicting extubation success in pediatric ICU patients. A trial failure is associated with but does not accurately predict extubation failure.