Pediatr Crit Care Me
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Pediatr Crit Care Me · Jan 2011
Multicenter StudyAcute kidney injury and renal replacement therapy independently predict mortality in neonatal and pediatric noncardiac patients on extracorporeal membrane oxygenation.
To determine the independent impact of acute kidney injury (AKI) and renal replacement therapy (RRT) in infants and children who receive extracorporeal membrane oxygenation. Despite continued expertise/technological advancement, patients who receive extracorporeal membrane oxygenation have high mortality. AKI and RRT portend poor outcomes independent of comorbidities and illness severity in several critically ill populations. ⋯ After adjusting for known predictors of mortality, AKI and RRT independently predict mortality in neonates and children, who receive extracorporeal membrane oxygenation. Ascertainment of AKI risk factors, testing novel therapies, and optimizing the timing/delivery of RRT may positively impact survival.
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Pediatr Crit Care Me · Jan 2011
Safety and efficacy of intravenous labetalol for hypertensive crisis in infants and small children.
To determine the efficacy and safety of labetalol for hypertensive crisis in children ≤ 24 months of age. ⋯ Continuous intravenous labetalol infusion is efficacious for treatment of hypertensive crisis in children ≤ 24 months of age. Aside from patients presenting with ischemic or traumatic brain injury, labetalol was safe to use in this population for hypertensive emergencies and had a satisfactory adverse effect profile. Labetalol may reach dose saturation at a much lower dose in young children in comparison to adults. Clinicians should use caution when initiating labetalol infusions in young patients with brain injury.
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Pediatr Crit Care Me · Jan 2011
Simulation-based mock codes significantly correlate with improved pediatric patient cardiopulmonary arrest survival rates.
To evaluate the viability and effectiveness of a simulation-based pediatric mock code program on patient outcomes, as well as residents' confidence in performing resuscitations. A resident's leadership ability is integral to accurate and efficient clinical response in the successful management of cardiopulmonary arrest (CPA). Direct experience is a contributing factor to a resident's code team leadership ability; however, opportunities to gain experience are limited by relative infrequency of pediatric arrests and code occurrences when residents are on service. ⋯ This study suggests that a simulation-based mock code program may significantly benefit pediatric patient CPA outcomes-applied clinical outcomes-not simply learner perceived value, increased confidence, or simulation-based outcomes. The use of mock codes as an integral part of residency programs could provide residents with the resuscitation training they require to become proficient in their practice. Future programs that incorporate transport scenarios, ambulatory care, and other outpatient settings could further benefit pediatric patients in prehospital contexts.
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Pediatr Crit Care Me · Jan 2011
Noninvasive ventilation in a tertiary pediatric intensive care unit in a middle-income country.
To determine the factors that predict outcome of noninvasive ventilation (NIV) in critically ill children. ⋯ NIV was a feasible strategy of respiratory support to avoid intubation in > 75% of children in this study. A higher Pediatric Risk of Mortality II score, sepsis at initiation of NIV, an abnormal respiratory rate, and a higher requirement of Fio2 may be predictive factors of NIV failure.
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Pediatr Crit Care Me · Jan 2011
Effects of flow rate and airleak at the nares and mouth opening on positive distending pressure delivery using commercially available high-flow nasal cannula systems: a lung model study.
Use of high-flow humidified nasal cannulas to deliver continuous positive airway pressure in children is increasing. Data on the relationship between the flow values and the corresponding pressures are limited. The purpose of this experiment was to evaluate the relationship between the device, intraprong, and proximal airway pressures and the flow values in a neonatal/pediatric test lung model, using the Vapotherm 2000i and Fisher-Paykel humidified nasal cannulas devices. ⋯ High flow humidified nasal cannulas systems may deliver uncontrolled continuous positive airway pressure to infants. This, along with the potentially large nares and mouth leak effects on any form of continuous positive airway pressure, renders the effective humidified nasal cannulas delivered continuous positive airway pressure particularly unpredictable.