Pediatr Crit Care Me
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Pediatr Crit Care Me · Mar 2012
Randomized Controlled TrialRandomized controlled trial of interrupted versus continuous sedative infusions in ventilated children.
To compare daily interruption vs. continuous sedative infusions in mechanically ventilated children with respect to lengths of mechanical ventilation and intensive care unit stay. ⋯ The length of mechanical ventilation, duration of intensive care unit stay, total dose of midazolam, and average calculated cost of the therapy were significantly reduced in the interrupted as compared to the continuous group of sedation.
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Pediatr Crit Care Me · Mar 2012
ReviewCritically ill children: to transfuse or not to transfuse packed red blood cells, that is the question.
This article summarizes the current data on packed red blood cell transfusion in the pediatric intensive care unit setting to help providers make evidence-based decisions regarding packed red blood cell transfusions. ⋯ The use of packed red blood cell transfusions is common in the pediatric intensive care unit setting. However, until recently there have been little data to guide providers in this practice. Studies in adult intensive care units have shown less favorable outcomes in patients who received packed red blood cell transfusions. This has led to renewed questioning of the practice of packed red blood cell transfusion in critically ill pediatric patients. New data indicate that using a hemoglobin transfusion threshold of >7 g/dL does not yield improved outcomes. Furthermore, smaller studies have suggested that pediatric intensive care unit patients may be at an increased risk for morbidity and mortality when undergoing transfusion.
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Pediatr Crit Care Me · Mar 2012
Capillary refill time and cardiac output in children undergoing cardiac catheterization.
Many pediatric healthcare providers believe that capillary refill time is a measure of perfusion and cardiac output in children. Despite its widespread use, there are no studies examining the relationship of capillary refill time to cardiac output in noncritically ill children. This study examined the inter-rater reliability of capillary refill time and its relationship to hemoglobin and with cardiac output in pediatric patients undergoing cardiac catheterization. ⋯ We found that the inter-rater reliability of capillary refill time was poor and variable under controlled conditions and capillary refill time was not correlated with cardiac output in anesthetized nonacutely ill pediatric patients undergoing cardiac catheterization. Caution should be used in inferring cardiac output from capillary refill time measurements alone.
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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
Risk factors associated with increased length of mechanical ventilation in children.
Invasive mechanical ventilation, if prolonged, may lead to high morbidity and mortality. ⋯ Among the risk factors identified, the use of noninvasive ventilation and continuous intravenous sedation on the first day of ventilation are the only two interventions that were associated with prolonged acute invasive mechanical ventilation. Further research is needed to study the impact of sedation protocols on the duration of mechanical ventilation in children.