Pediatr Crit Care Me
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Pediatr Crit Care Me · Jul 2011
Utility of bedside angiography in the evaluation of vascular obstruction in the pediatric intensive care patient.
To review our experience with bedside angiography in order to demonstrate the utility of this technique for evaluation of blood vessels in the critically ill patient. ⋯ Bedside angiography is a rapid, safe, and useful tool for the evaluation of complex vascular anatomy in critically ill patients. In cases where vascular ultrasound is unable to provide detailed anatomy or identify collateral flow, this technique may be useful in providing safe and accurate assessment of blood vessels associated with vascular access devices.
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Pediatr Crit Care Me · Jul 2011
Energy imbalance and the risk of overfeeding in critically ill children.
To examine the role of targeted indirect calorimetry in detecting the adequacy of energy intake and the risk of cumulative energy imbalance in a subgroup of critically ill children suspected to have alterations in resting energy expenditure. We examined the accuracy of standard equations used for estimating resting energy expenditure in relation to measured resting energy expenditure in relation to measured resting energy expenditure and cumulative energy balance over 1 week in this cohort. ⋯ We detected a high incidence of overfeeding in a subgroup of critically ill children using targeted indirect calorimetry The predominance of hypometabolism, failure of physicians to correctly predict metabolic state, use of stress factors, and inaccuracy of standard equations all contributed to overfeeding in this cohort. Critically ill children, especially those with a longer stay in the PICU, are at a risk of unintended overfeeding with cumulative energy excess.
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Pediatr Crit Care Me · Jul 2011
Active surveillance culturing impacts methicillin-resistant Staphylococcus aureus acquisition in a pediatric intensive care unit.
To determine whether active surveillance culturing for methicillin-resistant Staphylococcus aureus (MRSA) decreases nosocomial MRSA acquisition in the pediatric intensive care unit. ⋯ Active surveillance culturing resulted in significantly decreased nosocomial acquisition of MRSA in a pediatric intensive care unit setting. Admission and weekly active surveillance culturing appears to be an effective tool to decrease the spread of MRSA in the pediatric intensive care unit, independent of improvement in hand hygiene compliance. The impact on hospital-acquired MRSA infections and the cost benefit of active surveillance culturing require further study.
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Pediatr Crit Care Me · Jul 2011
Development of a collaborative program to provide extracorporeal membrane oxygenation for adults with refractory hypoxemia within the framework of a pandemic.
We report the process used to rapidly develop a collaborative adult respiratory extracorporeal membrane oxygenation program as a response to caring for young adult patients with refractory hypoxemia in the setting of the pH1N1 pandemic. ⋯ In the setting of the pH1N1 influenza pandemic, an adult respiratory extracorporeal membrane oxygenation program was successfully developed to complement an established neonatal-pediatric program. This program expansion integrated all of the necessary components involved in the development process from start to finish and confirms that a healthcare system can respond very quickly and successfully to an urgent healthcare need.
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Pediatr Crit Care Me · Jul 2011
EditorialThe PICU perspective on monitoring hemodynamics and oxygen transport.
Alterations of hemodynamics and oxygen transport balance are very common scenarios in the pediatric intensive care unit (PICU), and these alterations are as heterogeneous and diverse in nature as are the patient populations that typically exist in the PICU. Accordingly, the PICU perspective on monitoring of hemodynamics and oxygen transport balance in critically ill children must be understood in this context of heterogeneity and diversity. We provide an interpretation of the evidence supporting various monitoring strategies as presented in the The Pediatric Cardiac Intensive Care Society Evidence Based Review and Consensus Statement on Monitoring of Hemodynamics and Oxygen Transport Balance from a Pediatric Intensive Care perspective.