Pediatr Crit Care Me
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Pediatr Crit Care Me · Sep 2012
Mechanically ventilated children with 2009 pandemic influenza A/H1N1: results from the National Pediatric Intensive Care Registry in Japan.
To outline the characteristics, clinical course, and outcome of pediatric patients requiring mechanical ventilation with influenza A/H1N1 infection in Japan. ⋯ The clinical presentations of pediatric patients requiring mechanical ventilation for A/H1N1 in Japan were diverse. In-hospital mortality of this population was remarkably low. Rapid access to medical facilities in combination with early administration of antiviral agents may have contributed to the low mortality in this population.
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Pediatr Crit Care Me · Sep 2012
Long-stay children in intensive care: long-term functional outcome and quality of life from a 20-yr institutional study.
Long-stay patients (≥28 days) in pediatric intensive care units consume a disproportionate amount of resources, and very few studies have reported their outcome. We determined the long-term outcome of these children admitted to intensive care over a 20-yr period (January 1, 1989 to December 31, 2008). ⋯ More than two-thirds of children who stay in intensive care for ≥28 days have an unfavorable outcome (moderate disability, severe disability, or death). Long-stay patients in pediatric intensive care utilized a large proportion of resources and this utilization has considerably increased with time. Service provision and policy making should expect worsening of these trends in the future; its effects on critical care bed availability and overall activity levels could be substantial.
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Pediatr Crit Care Me · Sep 2012
Role of immunoglobulin supplementation for secondary immunodeficiency associated with chylothorax after pediatric cardiothoracic surgery.
To evaluate whether intravenous immunoglobulin was linked to a reduction in sepsis in patients with prolonged chylothoraces postpediatric cardiothoracic surgery. ⋯ Patients with prolonged, large-volume chyle loss had greater secondary immunodeficiency. Although the sample size was small and therefore able to detect only a large treatment effect from intravenous immunoglobulin, infectious outcomes were equal between the two groups.
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Pediatr Crit Care Me · Sep 2012
Personnel and unit factors impacting outcome after cardiac arrest in a dedicated pediatric cardiac intensive care unit.
To assess the impact of personnel and unit factors on outcome from cardiac arrest in a dedicated pediatric cardiac intensive care unit. ⋯ Our data suggest that personnel and unit factors may impact outcome after cardiac arrest in a pediatric cardiac intensive care unit. Weekend arrests and less experience of the primary nurse were risk factors for unsuccessful resuscitation. Neither presence at arrest onset nor experience of the attending cardiac intensivist was associated with outcome.
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Pediatr Crit Care Me · Sep 2012
Futility: unilateral decision making is not the default for pediatric intensivists.
Many hospitals have established medical futility policies allowing a physician to withdraw or withhold treatment considered futile against families' wishes, although little is known on how these policies are used. The goal of our study was to elucidate the perspective of pediatric critical care physicians on futility. ⋯ The majority of pediatric intensivists are not in support of unilateral do-not-attempt resuscitation or withholding care against families' wishes for a variety of reasons. Given this understandable reluctance on the part of the physicians for enforcing decisions, providing unqualified support to families at this difficult time is imperative. Further research is needed to facilitate decision making that respects the moral integrity of families and physicians.