Pediatr Crit Care Me
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Pediatr Crit Care Me · Jan 2008
Multicenter StudyPediatric interhospital transport: diagnostic discordance and hospital mortality.
Determine the rate of discordance between the reason for transport (determined by referring institution) and the final diagnosis (determined by accepting institution), identify factors associated with diagnostic discordance, and determine whether diagnostic discordance is associated with mortality and morbidity. ⋯ Discordance between primary reason for transport and diagnosis category is common in the pediatric interhospital transport population. Although discordance does not appear to lead to increased mortality, further study is needed to determine the impact of diagnostic discordance on other patient outcomes.
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Pediatr Crit Care Me · Jan 2008
Energy expenditure and caloric and protein intake in infants following the Norwood procedure.
Cardiopulmonary bypass in infants results in a hypermetabolic response. Energy requirements of these patients have not been well studied. We assessed energy expenditure and caloric and protein intake during the first 3 days following the Norwood procedure. ⋯ Infants exhibit a hypermetabolic response immediately following the Norwood procedure. Caloric and protein intake was inadequate to meet energy expenditure during the first 2 days after surgery. Further studies are warranted to examine the effects of caloric and protein supplementation on postoperative outcomes in infants after cardiopulmonary bypass.
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Pediatr Crit Care Me · Jan 2008
Prediction of raised intracranial pressure complicating severe traumatic brain injury in children: implications for trial design.
To describe current patterns of management of raised intracranial pressure (ICP) in traumatic brain injury relevant to clinician buy-in to possible randomized controlled trials of treatments of raised ICP. To examine the feasibility of early identification of children at sufficient risk of developing raised ICP to permit a uniform approach between centers to the initiation of ICP monitoring. This would permit quantification of ICP elevation and enrollment as appropriate to randomized controlled trials of raised ICP interventions. ⋯ Simple models based on early clinical data may predict the development of raised ICP sufficiently well to encourage a consistent approach between centers to initiation of ICP monitoring. We estimate studies designed to detect reductions in ICU mortality will require >320 children per arm, although this figure may be higher if more conservative assumptions are made.
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Pediatr Crit Care Me · Jan 2008
Intensive care unit variables and outcome after pediatric traumatic brain injury: a retrospective study of survivors.
Traumatic brain injury is a leading cause of death and disability in children. Hypotension has been associated with poor survival and outcome in children after traumatic brain injury, but the effect of acute hypertension is less certain. The objective was to obtain acute physiologic variables during the early hospitalization period in a cohort of children prospectively enrolled in another study. ⋯ This study suggests that early markers of secondary injury after moderate to severe traumatic brain injury in children may be predictive of long-term outcome. This study reinforces the need for longer term, systematic, and more precise measurements of outcomes in children with traumatic brain injury and prospective studies to examine the predictive value of acute management variables on multiple types of outcomes after traumatic brain injury in children.