Pediatr Crit Care Me
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Pediatr Crit Care Me · Jul 2011
ReviewNear-infrared spectroscopy as a hemodynamic monitor in critical illness.
Near-infrared spectroscopy has moved from a research tool to a widely used clinical monitor in the critically ill pediatric patient over the last decade. The physiological and clinical evidence supporting this technology in practice is reviewed here. ⋯ Class II, level B evidence supports the conclusion that near-infrared spectroscopy offers a favorable risk-benefit profile and can be effective and beneficial as a hemodynamic monitor for the care of critically patients.
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Pediatr Crit Care Me · Jul 2011
ReviewLactate and acid base as a hemodynamic monitor and markers of cellular perfusion.
: The intra- and postoperative monitoring of lactate and acid-base has been advocated in pediatric cardiac critical care as surrogate markers of cardiac output, oxygen delivery, and cellular perfusion. Many clinicians use lactate and base excess routinely as markers of tissue perfusion and to assess the effectiveness of their intervention. This review discusses the strengths and weaknesses of using these measurements in pediatric cardiac critical care. ⋯ : Many factors other than tissue hypoxia may contribute to hyperlactemia in critical illness. Although the presence of hyperlactemia on admission appears to be associated with intensive care unit mortality and morbidity in some retrospective analyses, significant overlap between survivors and nonsurvivors means that nonsurvivors cannot be predicted from admission lactate measurement. Persistently elevated postoperative lactate is associated with increased morbidity and mortality in the pediatric cardiac population. To date there is no randomized control trial of goal-directed therapy in adult or pediatric cardiac care that includes normalization of lactate as a target. Overall equivalent time measurements of base excess, anion gap, and pH have a low predictive value for morbidity and mortality in children after cardiac surgery. Lactate is one of a cluster of markers of cellular perfusion and oxygen delivery. Alone, as a single measurement, it has minimal predictive value and is nondiscriminatory for survival.
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Pediatr Crit Care Me · Jul 2011
ReviewBiomonitors of cardiac injury and performance: B-type natriuretic peptide and troponin as monitors of hemodynamics and oxygen transport balance.
Serum biomarkers, such as B-type natriuretic peptide and troponin, are frequently measured in the cardiac intensive care unit. A review of the evidence supporting monitoring of these biomarkers is presented.
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Pediatr Crit Care Me · Jul 2011
ReviewHemodynamic monitoring by transpulmonary thermodilution and pulse contour analysis in critically ill children.
To summarize the physiologic principles underlying the hemodynamic monitoring using the PiCCO device (Pulsion, Munich, Germany) incorporating the transpulmonary thermodilution technique, the pulse contour cardiac output, and estimation of the arterial pressure variation method. Analysis and review of the current literature. ⋯ The PiCCO device may be a useful adjunct for hemodynamic monitoring in critically ill children. Further studies are needed to clarify the reliability and clinical value of pulse contour method and extravascular lung water measurement.
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Pediatr Crit Care Me · Jul 2011
Assessment of the Pediatric Index of Mortality 2 with the Pao₂/Fio₂ ratio derived from the Spo₂/Fio₂ ratio: a prospective pilot study in a French pediatric intensive care unit.
The Pediatric Index of Mortality 2 is a mortality prediction tool used in pediatric intensive care units. Arterial blood gas sampling that is required to calculate the Pao₂/Fio₂ ratio is often unavailable. Several authors have proposed mathematical relations between the Pao₂/Fio₂ and Spo₂/Fio₂ ratios. The main objective of this study was to assess the validity of the Pediatric Index of Mortality 2 score and three modified Pediatric Index of Mortality 2 scores with the Pao2/Fio2 ratio calculated from the Spo₂/Fio₂ ratio. ⋯ This study suggests that the Spo₂/Fio₂ ratio could be used in place of Pao₂/Fio₂ for calculating Pediatric Index of Mortality 2. This must nonetheless be confirmed by a larger prospective multicenter study.