Pediatr Crit Care Me
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Pediatr Crit Care Me · Jan 2010
ReviewPediatric infectious diseases: 2009 update for the Rogers' Textbook of Pediatric Intensive Care.
To review important articles in the field of infectious diseases that pertain to the care of children in pediatric critical care units, published subsequent to the fourth edition of the Rogers' Textbook of Pediatric Intensive Care. ⋯ Significant advances continue to be made in our understanding of specific diseases as well as the approach to treatment. There are significant variations in outcome from specific infectious diseases in developing countries compared with the developed world. The looming problem of antimicrobial resistance and relative lack of new anti-infective agents in development is an issue that will be faced by pediatric intensive care units throughout the world in the near future. Updated evidence-based guidelines have appeared for early treatment of septic shock in children, and on prevention and treatment of opportunistic infections in adults and adolescents with human immunodeficiency virus. In patients with measles, use of oral co-trimoxazole or amoxicillin reduces the risk of secondary bacterial infections of respiratory tract; however, the same may not be true for other systemic viral infections, such as influenza. In patients with acute bacterial meningitis, maintenance fluids-instead of restricted fluids-and use of glycerol may improve the outcomes; however, the role of dexamethasone in prevention of adverse outcome needs reevaluation. Intravenous use of botulism immune globulin decreases the length of hospital stay and mechanical ventilation. Pediatric patients with aspergillosis have radiologic findings distinct from those of adults and present more often with nodules, and only rarely with cavitation; early focal surgical resection may improve the survival of these patients.
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Pediatr Crit Care Me · Jan 2010
ReviewStress ulcer, gastritis, and gastrointestinal bleeding prophylaxis in critically ill pediatric patients: a systematic review.
To identify and evaluate the quality of evidence supporting prophylactic use of treatments for stress ulcers and upper gastrointestinal bleeding. Stress ulcers, erosions of the stomach and duodenum, and upper gastrointestinal bleeding are well-known complications of critical illness in children admitted to the pediatric intensive care unit. ⋯ Although pooled data of two studies suggested that critically ill pediatric patients may benefit from receiving prophylactic treatment to prevent upper gastrointestinal bleeding, we found that high-quality evidence to guide clinical practice is still limited.