Pediatr Crit Care Me
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Pediatr Crit Care Me · Jan 2009
Case ReportsNear infrared spectroscopy changes with pericardial tamponade.
Report on the use of near infrared spectroscopy (NIRS) for the recognition of pericardial tamponade after neonatal congenital heart surgery. ⋯ Pericardial tamponade is a well-known complication of open heart surgery in children, and early recognition of this can be difficult. This case report demonstrated cerebral saturation to be decreased as impending pericardial tamponade developed. Along with the commonly used markers of tamponade, near infrared spectroscopy measurement of cerebral saturation may also be of benefit in recognizing this life-threatening condition.
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We explored the hypothesis that marked decline in plasma zinc concentrations among critically ill children is related to shifts in metallothionein expression and inflammation. ⋯ Plasma zinc concentrations are low in critically ill children. Plasma zinc correlated with measures of inflammation (C-reactive protein and interleukin-6) on day 3; low plasma zinc concentrations were associated with the degree of organ failure on day 3. These data serve as the basis for a larger study of shifts in plasma zinc concentrations in critically children to potentially identify patients who might benefit from zinc supplementation.
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Pediatr Crit Care Me · Jan 2009
Feasibility of weaning and direct extubation from open lung high-frequency ventilation in preterm infants.
High-frequency ventilation (HFV) is increasingly used in preterm infants, but data on weaning and extubation are limited. We aimed to establish if weaning the continuous distending pressure (CDP) below 8 cm H2O and the Fio2 below 0.30 is feasible in preterm infants on open lung HFV and if these settings result in successful extubation. ⋯ This study shows that weaning the CDP below 8 cm H2O with an Fio2 below 0.30 is feasible during open lung HFV and extubation at these settings can be successful in preterm infants. In our series, a 90% success rate was observed. The value of this approach should be prospectively compared with conventional weaning and extubation strategies.
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Pediatr Crit Care Me · Jan 2009
Incidence and risk factors of upper gastrointestinal bleeding in mechanically ventilated children.
To identify the incidence and factors related to upper gastrointestinal (UGI) bleeding in children requiring mechanical ventilation for longer than 48 hrs. ⋯ The incidence of UGI bleeding is high in children requiring mechanical ventilation. Organ failure and high pressure ventilator setting are significant risk factors for UGI bleeding.
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Pediatr Crit Care Me · Jan 2009
Survey of pediatric resident experiences with resuscitation training and attendance at actual cardiopulmonary arrests.
The literature suggests pediatric residents are inadequately prepared to perform resuscitation maneuvers when a child suffers a cardiopulmonary arrest (CPA). Our objective was to characterize the resuscitation training and CPA resuscitation experience of residents, including hands on experience with discharging a defibrillator. ⋯ Almost every pediatric resident was involved in attempting to resuscitate a child suffering a CPA, yet many were inadequately trained to respond. Formal mechanisms are needed to guarantee adequate resuscitation training for pediatric residents, especially regarding participation in basic life support and hands on defibrillator training.