Pediatr Crit Care Me
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Pediatr Crit Care Me · May 2011
ReviewPediatric respiratory diseases: 2011 update for the Rogers' Textbook of Pediatric Intensive Care.
To review articles relevant to the field of pediatric respiratory disease that were published after the 2008 Rogers' Textbook of Pediatric Intensive Care. ⋯ There have been important new developments relevant to the pathogenesis and management of pediatric respiratory diseases. In particular, new insights into the causal pathways of respiratory syncytial virus-induced airways disease can potentially lead to novel therapies. Computed tomography imaging of the injured lung during mechanical ventilation has opened new avenues for future research directed at testing new treatments in acute lung injury subpopulations defined according to lung mechanics. Promising new monitoring techniques may play a supporting role in the conduct of these studies. Finally, evidence from the neonatal literature recently has shown how the course and future consequences of respiratory failure in this population may be modified through more widespread use of noninvasive support.
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Pediatr Crit Care Me · May 2011
Randomized Controlled TrialPediatric residents experience a significant decline in their response capabilities to simulated life-threatening events as their training frequency in cardiopulmonary resuscitation decreases.
To determine the frequency of cardiopulmonary resuscitation education using high-fidelity patient simulators during pediatric residency training. ⋯ Pediatric residents show a significantly slower response time to effectively manage episodes of apnea and cardiac arrest 8 months after their initial resuscitation training, when compared to 4 months after training. These results may indicate that residents require more frequent training than currently recommended.
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Pediatr Crit Care Me · May 2011
Induction and maintenance of therapeutic hypothermia after pediatric cardiac arrest: efficacy of a surface cooling protocol.
To assess the feasibility, effectiveness, side effects, and adverse events associated with a standardized surface cooling protocol. Induced therapeutic hypothermia after pediatric cardiac arrest is an important intervention. ⋯ A standard surface cooling protocol achieved rapid induction of hypothermia after pediatric cardiac arrest. During maintenance of hypothermia, 78% of measures were within target T 32°C-34°C. Commonly employed temperature sites (esophageal, rectal, and bladder) were similar. Overshoot hypothermia and associated side effects were common, but there were no serious adverse events attributable to induced therapeutic hypothermia in this case series. Surface cooling protocols to induce and maintain therapeutic hypothermia after pediatric cardiac arrest are potentially feasible.
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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.
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Pediatr Crit Care Me · May 2011
Prospective operationalization and feasibility of a glycemic control protocol in critically ill children.
To evaluate the feasibility and safe operationalization of a pediatric glycemic control protocol in the setting of a general pediatric intensive care unit in a developing country. ⋯ Hyperglycemia is frequent in critically ill children managed in a pediatric intensive care unit in a developing country. Using a glycemic control protocol, one-third of these children required insulin, but attendants should be aware of a significant risk of hypoglycemia in this setting. Based on these data, a trial to detect a 20% relative reduction in mortality (power 90%, p = .05) associated with insulin in a similar population would need to screen >10,000 patients.