Pediatr Crit Care Me
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Pediatr Crit Care Me · May 2011
ReviewThe diagnostic dilemma of ventilator-associated pneumonia in critically ill children.
A review of the existing literature on ventilator-associated pneumonia in children with emphasis on problems in diagnosis. ⋯ Ventilator-associated pneumonia is an important nosocomial infection in the pediatric intensive care unit. Conclusions regarding epidemiology, treatment, and outcomes are greatly hampered by the inadequacies of current diagnostic methods. We recommend a more rigorous approach to diagnosis by using the Centers for Disease Control and Prevention algorithm. Given that ventilator-associated pneumonia is the most common reason for antibiotic use in the pediatric intensive care unit, more systematic studies are sorely needed.
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Pediatr Crit Care Me · May 2011
Randomized Controlled TrialSevere traumatic brain injury in children elevates glial fibrillary acidic protein in cerebrospinal fluid and serum.
1) To determine the levels of glial fibrillary acidic protein (GFAP) in both cerebrospinal fluid and serum; 2) to determine whether serum GFAP levels correlate with functional outcome; and 3) to determine whether therapeutic hypothermia, as compared with normothermia, alters serum GFAP levels in children with severe traumatic brain injury (TBI). ⋯ GFAP was markedly elevated in cerebrospinal fluid and serum in children after severe TBI and serum GFAP measured on pediatric intensive care unit day 1 correlated with functional outcome at 6 months. Hypothermia therapy did not alter serum GFAP levels compared with normothermia after severe TBI in children. Serum GFAP concentration, together with other biomarkers, may have prognostic value after TBI in children.
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Pediatr Crit Care Me · May 2011
Impact of a computerized note template/checklist on documented adherence to institutional criteria for determination of neurologic death in a pediatric intensive care unit.
Variability exists in the documentation of death by neurologic criteria in children. We hypothesized that the use of a note template/checklist, which included directive (educational) prompts based on institutional neurologic determination of death criteria, improved thoroughness of documentation within our institutional guidelines for the neurologic determination of death. ⋯ Use of a note template/checklist to guide and document neurologic determination of death improved adherence to institutional criteria for assessment of cessation of neurologic function.
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Pediatr Crit Care Me · May 2011
Infections acquired during extracorporeal membrane oxygenation in neonates, children, and adults.
To determine current rates, risk factors, and causal organisms related to infections acquired during extracorporeal membrane oxygenation (ECMO). ⋯ Infections acquired during ECMO are common and can have significant associated consequences. Knowledge of high-risk patients and common causal organisms may improve strategies for treatment and prevention, but further work to develop strategies and guidelines for prevention of these infections is urgently needed.
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Pediatr Crit Care Me · May 2011
Opportunities for antibiotic reduction in mechanically ventilated children.
To identify opportunities to safely reduce antibiotic use in critically ill children with moderately severe respiratory failure. ⋯ Eleven of 20 mechanically ventilated children treated with antibiotics for presumed infectious pneumonia had undetectable concentrations of bacteria in their lower respiratory tract, and three others had organisms present at low concentrations, suggesting that opportunities exist to reduce antibiotic exposure in this population.