Pediatr Crit Care Me
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To assess the measured resting energy expenditure pattern over time in a group of critically ill children who were admitted to a pediatric intensive care unit and to determine whether a hypermetabolic response, i.e., >10% above predicted, occurred in a pattern similar to that observed in adults. A secondary aim was to compare the accuracy of a newly derived prediction equation specific to the pediatric intensive care unit and the measured resting energy expenditure. ⋯ The hypermetabolic response apparent in adults was not evident in these critically ill children. Currently available prediction equations cannot substitute for indirect calorimetry measurement of energy expenditure in guiding nutritional support in pediatric intensive care units.
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Pediatr Crit Care Me · May 2007
Case ReportsInstitutional policies on determination of medically inappropriate interventions: use in five pediatric patients.
To describe recent experience using the Texas Advance Directives Act to facilitate care of terminally ill children managed in the two tertiary pediatric hospitals of the Texas Medical Center, Houston, TX. ⋯ Use of institutional policies in accordance with the Texas Advance Directives Act may assist in the care of terminally ill children and their families.
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Pediatr Crit Care Me · May 2007
Assessment of parental presence during bedside pediatric intensive care unit rounds: effect on duration, teaching, and privacy.
There is a paucity of literature evaluating the effects of family member presence during bedside medical rounds in the pediatric intensive care unit. We hypothesized that, when compared with rounds without family members, parental presence during morning medical rounds would increase time spent on rounds, decrease medical team teaching/education, increase staff dissatisfaction, create more stress in family members, and violate patient privacy in our open unit. ⋯ Parental presence on rounds does not seem to interfere with the educational and communication process. Parents report satisfaction with participation in rounds, and privacy violations do not seem to be a concern from their perspective.
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Pediatr Crit Care Me · May 2007
Mortality before and after initiation of a computerized physician order entry system in a critically ill pediatric population.
A worrisome increase in mortality has been reported recently following the initiation of a computerized physician order entry (CPOE) system in a critically ill pediatric transport population. We tested the hypothesis that such a mortality increase did not occur after the initiation of CPOE in a pediatric population that was directly admitted to the neonatal and pediatric intensive care units at Montefiore Medical Center during two 6-month periods before CPOE and one 6-month period immediately after CPOE was initiated. Mortality in the pre- and post-CPOE time periods was compared, and adjustment for potentially confounding covariates was performed. ⋯ Mortality did not increase during CPOE initiation.
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Pediatr Crit Care Me · May 2007
Pertussis: severe clinical presentation in pediatric intensive care and its relation to outcome.
To describe our institutional experience in the management of infants and children with pertussis admitted during a 20-yr period (January 1985 through December 2004) and also to study the relation between method of presentation and outcome. ⋯ Patients with pertussis, presenting as apnea (with or without cough paroxysms), treated in the pediatric intensive care unit had 100% survival. However, pneumonia as the main reason for admission and the need for circulatory support is associated with a very poor outcome. A deeper understanding of the molecular basis of Bordetella pertussis and its relation to the human host might offer means for future therapies.