Pediatr Crit Care Me
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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
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
Comparative StudyComparison of seven infant continuous positive airway pressure systems using simulated neonatal breathing.
Continuous positive airway pressure is an established treatment for respiratory distress in neonates. Continuous positive airway pressure has been applied to infants using an array of devices. The aim of this experimental study was to investigate the characteristics of seven continuous positive airway pressure systems using simulated breath profiles from newborns. ⋯ The seven tested continuous positive airway pressure systems showed large variations in pressure stability and imposed work of breathing. They also showed large differences in how well they maintain continuous positive airway pressure when exposed to leak. For most systems, imposed work of breathing increased with increasing continuous positive airway pressure level. The clinical importance of the difference in pressure stability is uncertain. Our results may facilitate the design of clinical studies examining the effect of pressure stability on outcome.
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Considering the potential immunomodulatory role of melatonin and its direct antioxidant activity, disturbances of the melatonin secretion pattern in the septic conditions could be particularly unfavorable. The aim of this study was to evaluate the nocturnal melatonin concentration and total 24-hr excretion of 6-sulfatoxymelatoninsulfate, melatonin's major urinary metabolite, in children with sepsis in the pediatric intensive care unit. ⋯ The present study shows that, in contradiction to results in adult patients, the nocturnal melatonin concentrations are not decreased in septic pediatric intensive care unit patients despite severe disease. Further investigations are needed to identify whether treatment with melatonin may have beneficial effects in pediatric intensive care unit patients with sepsis/septic shock.