Pediatr Crit Care Me
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Pediatr Crit Care Me · Jan 2012
Comparative Study Controlled Clinical TrialInvestigation into the effect of closed-system suctioning on the frequency of pediatric ventilator-associated pneumonia in a developing country.
To investigate the effect of closed-system vs. open endotracheal suctioning on the frequency of ventilator-associated pneumonia and outcome in a pediatric intensive care unit in a developing country. ⋯ Closed-system suctioning did not affect the frequency of ventilator-associated pneumonia or patient outcome in this setting.
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Previous simulation studies suggest that temporary pediatric mass critical care approaches would accommodate plausible hypothetical sudden-impact public health emergencies. However, the utility of sustained pediatric mass critical care responses in prolonged pandemics has not been evaluated. The objective of this study was to compare the ability of a typical region to serve pediatric intensive care unit needs in hypothetical pandemics, with and without mass critical care responses sufficient to triple usual pediatric intensive care unit capacity. DESIGN, SETTING, PATIENTS, AND INTERVENTIONS: The Monte Carlo simulation method was used to model responses to hypothetical pandemics on the basis of national historical evidence regarding pediatric intensive care unit admission and length of stay in pandemic and nonpandemic circumstances. Assuming all ages are affected equally, federal guidelines call for plans to serve moderate and severe pandemics requiring pediatric intensive care unit care for 457 and 5,277 infants and children per million of the population, respectively. ⋯ Mass critical care approaches would be essential to extend care to the majority of infants and children in a severe pandemic. However, some patients needing critical care still could not be accommodated, requiring consideration of rationing.
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Pediatr Crit Care Me · Jan 2012
Comparative StudyNutrition support and deficiencies in children with severe traumatic brain injury.
Adequate nutrition support is considered important to recovery after pediatric traumatic brain injury. The 2003 Pediatric Guidelines recommend initiation of nutrition within 72 hrs after traumatic brain injury. We examined our local experience with nutritional support in severe pediatric traumatic brain injury patients (cases) and non-traumatic brain injury patients (controls). ⋯ Nutritional support was initiated in most patients within 72 hrs of pediatric intensive care unit admission. Although daily caloric and protein goals were not achieved in the first 2 wks of pediatric intensive care unit stay and nutritional deficiencies were common, earlier start of nutritional support was associated with involvement of a nutritionist and with meeting both caloric and protein goals by pediatric intensive care unit day 7.
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Pediatr Crit Care Me · Jan 2012
Comparative StudyThe association between the end tidal alveolar dead space fraction and mortality in pediatric acute hypoxemic respiratory failure.
To investigate the relationship of markers of oxygenation, PaO2/FIO2 ratio, SpO2/FIO2 ratio, oxygenation index, oxygen saturation index, and dead space (end tidal alveolar dead space fraction) with mortality in children with acute hypoxemic respiratory failure. ⋯ In pediatric acute hypoxemic respiratory failure, easily obtainable pulmonary specific markers of disease severity (SpO2/FIO2 ratio, oxygen saturation index, and the end tidal alveolar dead space fraction) may be useful for the early identification of children at high risk of death. Furthermore, the end tidal alveolar dead space fraction should be considered for risk stratification of children with acute hypoxemic respiratory failure, given that it was independently associated with mortality.