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
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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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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After its introduction in 1970, the use of the pulmonary artery catheter became a central part of the management of critically ill patients in adult and pediatric intensive care units. However, because it was introduced as a class II device, efficacy for its safety and clinical benefit did not exist during the early years of use. This review describes the pulmonary artery catheter and reviews the literature supporting its use. ⋯ The evidence supporting the use of the pulmonary artery catheter is mostly limited to level IV (nonrandomized, historical controls, and expert opinion) and level V (case series, uncontrolled studies, and expert opinion). A higher level of evidence supports the use of the pulmonary artery catheter in selected pediatric patients, especially those with pulmonary arterial hypertension and shock refractory to standard fluid resuscitation and vasoactive agents. There are no data to suggest that use of the pulmonary artery catheter increases mortality in children.