Pediatr Crit Care Me
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Pediatr Crit Care Me · Mar 2010
ReviewPathophysiology of right ventricular failure in pulmonary hypertension.
This review focuses on right ventricular anatomy and function and the significance of ventricular interdependence in the response of the right ventricle to an increase in afterload. This is followed by a discussion of the pathophysiology of right ventricular failure in pulmonary arterial hypertension as well as in other clinical syndromes of pulmonary hypertension. ⋯ Regardless of the etiology, an increase in right ventricular afterload leads to a number of compensatory changes in cardiovascular physiology. These changes are not altogether intuitive and require an understanding of right ventricular physiology and ventricular interdependence to optimize the care of these patients.
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Lung and heart-lung transplantation are accepted treatments for children with end-stage pulmonary vascular disease. This is a review of the current literature and our own experience with lung and heart-lung transplantation for children with pulmonary hypertension of a variety of causes. I reviewed the pertinent literature and our lung transplant database to acquire information and data regarding this subject. ⋯ The major operative complications include those related to the surgical procedure itself (vascular and airway anastomotic stenoses) and those related to graft dysfunction. The 3- and 5-yr survival is approximately 60% and 50%, respectively, for children undergoing lung transplantation for pulmonary hypertension. Although these survival statistics are somewhat poor, transplantation remains the only viable alternative for children with end-stage pulmonary vascular disease failing to respond to medical therapy.
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Pediatr Crit Care Me · Mar 2010
Comparative StudyDiagnosis of ventilator-associated pneumonia in children in resource-limited setting: a comparative study of bronchoscopic and nonbronchoscopic methods.
To compare the available methods for the diagnosis of ventilator-associated pneumonia in intubated pediatric patients and to suggest less costly diagnostic method for developing countries. ⋯ Blind bronchoalveolar lavage was the most reliable method followed closely by blind bronchial sampling for the diagnosis of ventilator-associated pneumonia. Considering the difference of the cost in the two procedures, blind bronchial sampling may be the preferred method in the pediatric intensive care unit of a developing country.
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Pediatr Crit Care Me · Mar 2010
ReviewDevelopmental neurotoxicity of sedatives and anesthetics: a concern for neonatal and pediatric critical care medicine?
To evaluate the currently available evidence for the deleterious effects of sedatives and anesthetics on developing brain structure and neurocognitive function. ⋯ Neuronal cell death after neonatal exposure to sedatives and anesthetics has been clearly demonstrated in developing animal models. Although the relevance for human medicine remains speculative, the phenomenon's serious implications for public health necessitate further preclinical and clinical studies. Intensivists using sedatives and anesthetics in neonates and infants need to stay informed about this rapidly emerging field of research.
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Pediatr Crit Care Me · Mar 2010
Intrahospital transport of children on extracorporeal membrane oxygenation: indications, process, interventions, and effectiveness.
To evaluate indications, process, interventions, and effectiveness of patients undergoing intrahospital transport. Critically ill patients supported with extracorporeal membrane oxygenation are transported within the hospital to the radiology suite, cardiac catheterization suite, operating room, and from one intensive care unit to another. No studies to date have systematically evaluated intrahospital transport for patients on extracorporeal membrane oxygenation. ⋯ Although transporting patients on extracorporeal membrane oxygenation is labor intensive and requires extensive logistic support, it can be carried out safely in experienced hands and it can result in important therapeutic and diagnostic yields. To our knowledge, this is the first study designed to evaluate safety and efficacy of intrahospital transport for patients receiving extracorporeal membrane oxygenation support.