Pediatr Crit Care Me
-
Pediatr Crit Care Me · Nov 2010
Outcomes of hematopoietic stem cell transplant patients who received continuous renal replacement therapy in a pediatric oncology intensive care unit.
To assess the long-term benefits of continuous renal replacement therapy (CRRT) in this patient population and to analyze factors associated with survival. Hematopoietic stem cell transplantation is being utilized as curative therapy for a variety of disorders. However, organ dysfunction is commonly associated with this therapy. Continuous renal replacement therapy (CRRT) is increasingly being used in the treatment of this multiorgan dysfunction. ⋯ In this single-center study, CRRT was not associated with long-term survival in pediatric allogeneic hematopoietic stem cell transplantation patients. Clinical data exist, both before and during CRRT, that may be associated with length of survival. Lower C-reactive protein levels at CRRT end were associated with longer survival, suggesting that the ability to attenuate inflammation during CRRT may afford a survival advantage. These findings require confirmation in a prospective study.
-
Pediatr Crit Care Me · Nov 2010
Comment Multicenter Study Comparative StudyComparison of the effectiveness and safety of two insulin infusion protocols in the management of hyperglycemia in critically ill children.
To compare the effectiveness and safety of a paper-based and a computerized algorithm used for tight glycemic control. ⋯ YIIP is less effective but is as safe as ePi in achieving tight glycemic control. We are awaiting the results of two multicenter trials designed to determine the survival benefit of tight glycemic control in children. Further studies are needed to determine the clinical significance of the different glucose metrics in critically ill patients.
-
Pediatr Crit Care Me · Nov 2010
Comment Multicenter StudyTemperature patterns in the early postresuscitation period after pediatric inhospital cardiac arrest.
To describe the prevalence of postarrest hyperthermia among children during the first 24 hrs after inhospital cardiac arrest and to determine the association of persistent postarrest hyperthermia with neurologic outcome and death before hospital discharge. ⋯ Despite current guidelines to avoid postarrest hyperthermia, a temperature of ≥38°C occurred commonly among children in the first 24 hrs postarrest. Persistent postarrest hyperthermia was associated with unfavorable neurologic outcomes, even after controlling for potential confounding factors.
-
Pediatr Crit Care Me · Nov 2010
Acute lung injury in children: therapeutic practice and feasibility of international clinical trials.
To describe mechanical ventilation strategies in acute lung injury and to estimate the number of eligible patients for clinical trials on mechanical ventilation management. In contrast to adult medicine, there are few clinical trials to guide mechanical ventilation management in children with acute lung injury. ⋯ Our study reveals inconsistent mechanical ventilation practice and use of adjunctive therapies in children with acute lung injury. Pediatric clinical trials assessing mechanical ventilation management are needed to generate evidence to optimize outcomes. We estimate that a large number of centers (∼60) are needed to conduct such trials; it is imperative, therefore, to bring about international collaboration.