Pediatr Crit Care Me
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Pediatr Crit Care Me · Mar 2012
The COMFORT behavior scale: is a shorter observation period feasible?.
The COMFORT behavior scale has been validated for postoperative pain in 0- to 3-yr-old children. Scoring is preceded by a 2-min observation period, which nurses may consider too long. The objective of this study was to test the reliability of a 30-sec observation period. ⋯ A 30-sec COMFORT behavior scale observation increases the risk of underscoring pain. Therefore, the 2-min observation period should be adhered to in the interest of the patients.
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Pediatr Crit Care Me · Mar 2012
The unique contribution of manual chest compression-vibrations to airflow during physiotherapy in sedated, fully ventilated children.
This study aimed to quantify the specific effects of manual lung inflations with chest compression-vibrations, commonly used to assist airway clearance in ventilated patients. The hypothesis was that force applied during the compressions made a significant additional contribution to increases in peak expiratory flow and expiratory to inspiratory flow ratio over and above that resulting from accompanying increases in inflation volume. ⋯ These results provide evidence of the unique contribution of compression forces in increasing peak expiratory flow and peak expiratory to inspiratory flow ratio bias over and above that related to accompanying changes from manual hyperinflations. Force generated during compression-vibrations was the single significant factor in multivariable analysis to explain the increases in expiratory flow bias. Such increases in the expiratory bias provide theoretically optimal physiological conditions for cephalad mucus movement in fully ventilated children.
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Pediatr Crit Care Me · Mar 2012
Measured degree of dehydration in children and adolescents with type 1 diabetic ketoacidosis.
Successful management of diabetic ketoacidosis depends on adequate rehydration while avoiding cerebral edema. Our objectives are to 1) measure the degree of dehydration in children with type 1 diabetes mellitus and diabetic ketoacidosis based on change in body weight; and 2) investigate the relationships between measured degree of dehydration and clinically assessed degree of dehydration, severity of diabetic ketoacidosis, and routine serum laboratory values. ⋯ Hydration status in children with diabetic ketoacidosis cannot be accurately assessed by physical examination or blood gas values. Fluid therapy based on maintenance plus 6% deficit replacement is reasonable for most patients.
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Pediatr Crit Care Me · Mar 2012
Bias flow does not affect ventilation during high-frequency oscillatory ventilation in a pediatric animal model of acute lung injury.
During high-frequency oscillatory ventilation, bias flow is the continuous flow of gas responsible for replenishing oxygen and removing CO(2) from the patient circuit. Bias flow is usually set at 20 L/min, but many patients require neuromuscular blockade at this flow rate. The need for neuromuscular blockade may be eliminated by increasing the bias flow rate, but CO(2) retention is a potential concern. We hypothesize that in a swine model of acute lung injury, increased bias flow rates will not affect CO(2) elimination. ⋯ Changes in bias flow during high-frequency oscillatory ventilation did not affect ventilation. Further clinical investigation is ongoing in infants and children with acute lung injury being managed with high-frequency oscillatory ventilation to assess the impact of alterations of bias flow on gas exchange, cardiopulmonary parameters, sedation requirements, and other clinical outcomes.