Pediatr Crit Care Me
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Pediatr Crit Care Me · Nov 2011
Lung aeration during ventilation after recruitment guided by tidal elimination of carbon dioxide and dynamic compliance was better than after end-tidal carbon dioxide targeted ventilation: a computed tomography study in surfactant-depleted piglets.
To test the hypothesis that tidal elimination of carbon dioxide and dynamic compliance guided lung recruitment and positive end-expiratory pressure titration in surfactant-depleted piglets result in improved aeration (repeated computed tomography scans) and reduced ventilation pressures compared to those of a control group with conventional end-tidal carbon dioxide targeted ventilation. ⋯ Aeration was significantly better after recruitment and positive end-expiratory pressure titration than in a control group managed by "conventional" end-tidal carbon dioxide targeted ventilation. An increase of the end-inspiratory pressure above the tidal elimination of carbon dioxide peak/plateau did not result in an increased amount of normally aerated lung. A recruitment maneuver resulted in a lower ventilatory amplitude for achieving a target tidal volume and better dynamic compliance at the end of the study period compared to those of the control group.
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Pediatr Crit Care Me · Nov 2011
Deep nasopharyngeal aspiration as a treatment option for conversion of supraventricular paroxysmal tachycardia in infants: First experiences.
Supraventricular paroxysmal tachycardias are the most common paroxysmal rhythm disorders in childhood. Atypical clinical presentations as well as their ability to induce hemodynamic deterioration imply necessity for arrhythmia rapid termination during the first months of life. The objective of this article was to evaluate the efficiency of deep nasopharyngeal aspiration as a potential vagal maneuver for supraventricular paroxysmal tachycardias termination. ⋯ Deep nasopharyngeal aspiration could be an alternative vagal maneuver for infants with supraventricular paroxysmal tachycardia.
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Pediatr Crit Care Me · Nov 2011
Case ReportsNeurogenic stunned myocardium presenting as left ventricular hypertrabeculation in childhood: a variant of Takotsubo cardiomyopathy?
To report the first case of neurogenic stunned myocardium presenting with heart left ventricle noncompaction requiring intensive care in the perioperative period of tension tumor-induced hydrocephalus. ⋯ This report describes a unique presentation of myocardial stunning in association with an intracranial illness, namely, a hypertensive hydrocephalus complicating an intracranial neoplasm.
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Pediatr Crit Care Me · Nov 2011
Case ReportsProlonged venovenous extracorporeal membrane oxygenation in a child with leukemia and persistent bacteremia.
In patients who require extracorporeal membrane oxygenation for prolonged periods, it is uncertain whether nosocomial bacteremia that persists throughout an entire extracorporeal membrane oxygenation run can be associated with good outcomes. ⋯ Sustained bacteremia during an extracorporeal membrane oxygenation run should not be regarded as a reason to withdraw extracorporeal support, although efforts are clearly warranted to identify possible sources of sepsis and wean off extracorporeal membrane oxygenation at the earliest opportunity.
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Pediatr Crit Care Me · Nov 2011
Neonatal and pediatric regionalized systems in pediatric emergency mass critical care.
Improved health outcomes are associated with neonatal and pediatric critical care in well-organized, cohesive, regionalized systems that are prepared to support and rehabilitate critically ill victims of a mass casualty event. However, present systems lack adequate surge capacity for neonatal and pediatric mass critical care. In this document, we outline the present reality and suggest alternative approaches. ⋯ States and regions (facilitated by federal partners) should review current emergency operations and devise appropriate plans to address the population-based needs of infants and children in large-scale disasters. Action at the state, regional, and federal levels should address legal, operational, and information systems to provide effective pediatric mass critical care through: 1) predisaster/mass casualty planning, management, and assessment with input from child health professionals; 2) close cooperation, agreements, public-private partnerships, and unique delivery systems; and 3) use of existing public health data to assess pediatric populations at risk and to model graded response plans based on increasing patient volume and acuity.