Pediatr Crit Care Me
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Pediatr Crit Care Me · Jul 2012
ReviewDexmedetomidine and ketamine: an effective alternative for procedural sedation?
Although generally effective for sedation during noninvasive procedures, dexmedetomidine as the sole agent has not been uniformly successful for invasive procedures. To overcome some of the pitfalls with dexmedetomidine as the sole agent, there are an increasing number of reports regarding its combination with ketamine. This article provides a descriptive account of the reports from the literature regarding the use of a combination of dexmedetomidine and ketamine for procedural sedation. ⋯ The available literature except for one trial is favorable regarding the utility of a combination of ketamine and dexmedetomidine for procedural sedation. Future studies with direct comparisons to other regimens appear warranted for both invasive and noninvasive procedures.
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Pediatr Crit Care Me · Jul 2012
Predictive power of serum cystatin C to detect acute kidney injury and pediatric-modified RIFLE class in children undergoing cardiac surgery.
Acute kidney injury is a frequent and serious complication of cardiopulmonary bypass. In current clinical practice, serum creatinine is used to detect acute kidney injury. Cystatin C is a novel biomarker for kidney function that has been shown to be superior to serum creatinine in predicting acute kidney injury in adults after cardiopulmonary bypass. The aim of this study was to determine whether early cystatin C levels predict acute kidney injury associated with cardiopulmonary bypass in pediatric patients undergoing cardiac surgery and if cystatin C could predict pediatric-modified RIFLE (Risk, Injury, Failure, Loss, End-stage kidney disease) class and renal injury as determined by estimated glomerular filtration rate. We also investigated whether ultrafiltration during cardiopulmonary bypass affects cystatin C levels. ⋯ Cystatin C is an early predictor of acute kidney injury in children after cardiopulmonary bypass. Cystatin C is a good predictor of pediatric RIFLE classification and of decreased estimated glomerular filtration rate after cardiopulmonary bypass. Serum cystatin C may be cleared by ultrafiltration.
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Pediatr Crit Care Me · Jul 2012
ReviewInhaled iloprost for the control of acute pulmonary hypertension in children: a systematic review.
Inhaled iloprost is attracting growing interest as a potential alternative and/or adjuvant to inhaled nitric oxide in the management of pediatric pulmonary hypertension in the acute and intensive care settings. However, there are currently no formal evidence-based guidelines regarding the use of inhaled iloprost in children with pulmonary hypertension. The aim of this systematic review is to assess the literature concerning the use of inhaled iloprost in children with pulmonary hypertension in the acute setting. ⋯ Inhaled iloprost may be useful in the acute treatment of children and neonates with pulmonary hypertension, but clinical data are scarce, and the appropriate dosing of iloprost in different scenarios is uncertain. Well-designed prospective clinical trials are needed.
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Pediatr Crit Care Me · Jul 2012
ReviewExtracorporeal life support: an update of Rogers' Textbook of Pediatric Intensive Care.
The field of extracorporeal life support, which has focused predominantly on extracorporeal membrane oxygenation in the past, is undergoing rapid expansion following years of stagnation as newer devices and improved technology have become available. Additionally, new cannulae and cannulation techniques have allowed extracorporeal life support to be expanded to many groups who would have been excluded from support in the past. ⋯ Continued examination of the criteria and circumstances where extracorporeal life support is applied as well as outcomes which include morbidity, cost effectiveness, and quality of life are needed areas of continued research. Increasing collaborations between all centers performing extracorporeal life support throughout the world should remain a priority to further research and understanding of this complex field.