Pediatr Crit Care Me
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To develop a reliable predictor of major adverse events after pediatric cardiac surgery, with the aim of reducing mortality of cardiac extracorporeal life support through earlier, more accurate patient selection. ⋯ Lactate and Scvo2 are the only postoperative measurements with predictive power for major adverse events. Forming a ratio of the two (Scvo2/lactate), seems to improve predictive power, presumably by combining their individual predictive strengths. Both measures have excellent specificities but lower sensitivities. Predictive power of single measures is only fair but can be improved, in high risk patients, by monitoring repeated measures over time.
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Pediatr Crit Care Me · Nov 2008
Interleukin-1 receptor antagonist intron 2 variable number of tandem repeats polymorphism and respiratory failure in children with community-acquired pneumonia.
To determine whether the variable nucleotide tandem repeat polymorphism in intron 2 of the interleukin-1 receptor antagonist gene is associated with lung injury in children with community-acquired pneumonia. ⋯ In children with community-acquired pneumonia, absence of the A1 allele at the interleukin-1 receptor antagonist intron 2 polymorphic site is associated with increased risk for more severe lung injury, as measured by the need for positive pressure ventilation or the development of acute lung injury or acute respiratory distress syndrome. Conversely, presence of the A1 allele is associated with decreased risk for more severe lung injury in this patient population.
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Pediatr Crit Care Me · Nov 2008
Experience with intravenous enoxaparin in critically ill infants and children.
Subcutaneous administration of enoxaparin is often difficult in special populations, such as premature infants and critically ill children with severe edema. The difficulty achieving adequate anticoagulation in these patients has led to the employment of intravenous enoxaparin in some cases. However, little pharmacodynamic data are available for determining the appropriate dosing and monitoring (by anti-Factor Xa levels) of intravenous enoxaparin. The objective of this study is to report our experience with the use of intravenous enoxaparin in pediatric patients in the intensive care unit. ⋯ Our data show that the pharmacodynamics of intravenous administration is different from subcutaneous administration and deserves further study.
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Pediatr Crit Care Me · Nov 2008
Intercontinental differences in end-of-life attitudes in the pediatric intensive care unit: results of a worldwide survey.
To examine intercontinental differences in end-of-life practices in pediatric intensive care units. ⋯ This study confirms that important intercontinental differences exist toward end-of-life issues in pediatric intensive care. Although the legal and ethical situation is rapidly evolving, a certain degree of paternalism seems to persist among European and South-American caregivers. This study suggests that ethical principles depend on the cultural roots of countries or continents, emphasizing the need to foster dialogue on end-of-life issues around the world to learn from each other and improve end-of-life care in pediatric intensive care units.
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Pediatr Crit Care Me · Nov 2008
A protocolized approach to identify and manage hyperglycemia in a pediatric critical care unit.
Hyperglycemia is a risk factor for poor outcome in critically ill patients, and glycemic control may decrease morbidity and mortality in adults. There is limited information regarding hyperglycemia and its control in pediatric intensive care. ⋯ Hyperglycemia is prevalent in pediatric intensive care units and may be effectively identified and managed using a protocolized approach.