Pediatr Crit Care Me
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Pediatr Crit Care Me · Jul 2011
ReviewVenous oximetry and the assessment of oxygen transport balance.
To review the principles of venous oximetry; the physiology of oxygen transport balance; clinical studies on venous oximetry; and the assignment of a classification of recommendation and level of evidence. ⋯ One of the tenets of critical care medicine is to provide a timely and accurate assessment of tissue oxygenation. In conjunction with other monitoring modalities, the routine deployment of central venous catheters readily enables the clinician to complete this task.
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Pediatr Crit Care Me · Jul 2011
ReviewThe Collaborative Pediatric Critical Care Research Network Critical Pertussis Study: collaborative research in pediatric critical care medicine.
To provide an updated overview of critical pertussis to the pediatric critical care community and describe a study of critical pertussis recently undertaken. ⋯ Research is urgently needed to provide an evidence base that might optimize management for critical pertussis, a serious, disabling, and too often fatal illness for U.S. children and those in the developing world.
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Pediatr Crit Care Me · Jul 2011
ReviewEchocardiography as a hemodynamic monitor in critically ill children.
Echocardiography is a widely used modality to assess myocardial structure and function in pediatric intensive care settings. While the use of echocardiography for diagnostic purposes remains important, its use as a hemodynamic monitoring tool has not been well established. ⋯ To date, the literature on echocardiography in pediatric critical care is limited. The purpose of this review is to examine the scientific evidence for the usefulness of echocardiography as a hemodynamic monitoring tool in pediatric critical care.
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Pediatr Crit Care Me · Jul 2011
ReviewMonitoring of standard hemodynamic parameters: heart rate, systemic blood pressure, atrial pressure, pulse oximetry, and end-tidal CO2.
Continuous monitoring of various clinical parameters of hemodynamic and respiratory status in pediatric critical care medicine has become routine. The evidence supporting these practices is examined in this review. ⋯ Use of heart rate, electrocardiography, noninvasive and arterial blood pressure, atrial pressure, pulse oximetry, and end-tidal carbon dioxide monitoring in the pediatric critical care unit is commonplace; this practice, however, is not supported by well-controlled clinical trials. Despite the majority of literature being case series, expert opinion would suggest that use of routine pulse oximetry and end-tidal carbon dioxide is the current standard of care. In addition, literature would suggest that invasive arterial monitoring is the current standard for monitoring in the setting of shock. The use of heart rate, electrocardiography. and atrial pressure monitoring is advantageous in specific clinical scenarios (postoperative cardiac surgery); however, the evidence for this is based on numerous case series only.
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Hemodynamic monitoring in critically ill patients has been considered part of the standard of care in managing patients with shock and/or acute lung injury, but outcome benefit, particularly in pediatric patients, has been questioned. There is difficulty in validating the reliability of monitoring devices, especially since this validation requires comparison to the pulmonary artery catheter, which has its own problems as a measurement tool. Interpretation of the available evidence reveals advantages and disadvantages of the available hemodynamic monitoring devices.