Pediatr Crit Care Me
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Pediatr Crit Care Me · Sep 2008
Randomized Controlled TrialThe umbilical arterial catheter: a formula for improved positioning in the very low birth weight infant.
: An umbilical arterial catheter is often used to monitor blood pressure and take frequent blood samples in the very low birth weight newborn infant requiring neonatal intensive care. Incorrect placement of the umbilical arterial catheter increases catheter complications, and adjustment of catheter position after radiograph increases infant handling and infection risk. Current methods overestimate insertion length in very low birth weight babies. We suggest a new formula for calculating insertion length that is more appropriate for today's neonatal intensive care population. The Umbilical Arterial Catheter Calculation Study, Australian Perinatal Trials Register PT0398, was set up to investigate this technical change. Our hypothesis was that the new formula would improve the siting of umbilical arterial catheters in very low birth weight infants. ⋯ : The use of the new formula results in better overall placement and in significantly less overinsertion of umbilical artery catheters in very low birth weight infants.
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Pediatr Crit Care Me · Sep 2008
The endotracheal tube air leak test does not predict extubation outcome in critically ill pediatric patients.
Endotracheal tube air leak pressures are used to predict postextubation upper airway compromise such as stridor, upper airway obstruction, or risk of reintubation. To determine whether the absence of an endotracheal tube air leak (air leak test >/=30 cm H2O) measured during the course of mechanical ventilation predicts extubation failure in infants and children. ⋯ An endotracheal tube air leak pressure >/=30 cm H2O measured in the nonparalyzed patient before extubation or for the duration of mechanical ventilation was common and did not predict an increased risk for extubation failure. Pediatric patients who are clinically identified as candidates for an extubation trial but do not have an endotracheal tube air leak may successfully tolerate removal of the endotracheal tube.
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Pediatr Crit Care Me · Sep 2008
Randomized Controlled Trial Multicenter StudyPost hoc analysis of calfactant use in immunocompromised children with acute lung injury: Impact and feasibility of further clinical trials.
To assess the impact of calfactant (a modified natural bovine lung surfactant) in immunocompromised children with acute lung injury and to determine the number of patients required for a definitive clinical trial of calfactant in this population. ⋯ These preliminary data suggest a potential benefit of calfactant in this high-risk population. A clinical trial powered to appropriately assess these findings seems warranted and feasible.
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Pediatr Crit Care Me · Sep 2008
ReviewA comprehensive review of pediatric endotracheal suctioning: Effects, indications, and clinical practice.
To provide a comprehensive, evidence-based review of pediatric endotracheal suctioning: effects, indications, and clinical practice. ⋯ Endotracheal suctioning is a procedure used regularly in the pediatric intensive care unit. Despite this, good evidence supporting its practice is limited. Further, controlled clinical studies are needed to develop evidence-based protocols for endotracheal suctioning of infants and children, and to examine the impact of different suctioning techniques on the duration of ventilatory support, incidence of nosocomial infection, and length of pediatric intensive care unit and hospital stay.