Pediatr Crit Care Me
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Pediatr Crit Care Me · Mar 2013
Multicenter StudyA multicenter outcomes analysis of children with severe viral respiratory infection due to human metapneumovirus.
To investigate the impact of human metapneumovirus on morbidity and mortality outcomes in children with severe viral respiratory infection. ⋯ Analysis of our results suggests that there is substantial morbidity and mortality associated with severe viral respiratory infection due to human metapneumovirus in children. Female gender, hospital acquisition of human metapneumovirus infection, and presence of chronic medical conditions each independently increases mortality. The burden of illness from human metapneumovirus on the ICU in terms of resource utilization may be considerable.
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Pediatr Crit Care Me · Mar 2013
Randomized Controlled TrialPretreatment with midazolam blunts the rise in intracranial pressure associated with ketamine sedation for lumbar puncture in children.
Ketamine has a long history of use during pediatric procedural sedation. Concerns about raising intracranial pressure may limit use in certain situations. Whereas some data suggest that benzodiazepine coadministration may blunt this response, pediatric data during procedural sedation do not exist. We evaluated the effects of midazolam pretreatment on intracranial pressure during ketamine sedation in children. ⋯ While pretreatment with midazolam is associated with a reduction in intracranial pressure compared with sedation with ketamine alone, ketamine-containing regimens are associated with higher opening pressures than non-ketamine-containing regimens.
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Pediatr Crit Care Me · Mar 2013
ReviewMinimizing complications associated with percutaneous central venous catheter placement in children: recent advances.
To summarize existing knowledge regarding the prevalence of complications associated with temporary percutaneous central venous catheters placed in critically ill children, and to review evolving strategies to minimize the prevalence of these complications. ⋯ Complications during percutaneous central venous catheter placement in children are not rare and may be in part attributable to abnormalities in vascular anatomy. Thromboses in children with central venous catheters are increasingly recognized as an important problem for which evidence-based preventive measures are lacking. Catheter-associated bloodstream infection rates in critically ill children have markedly decreased over the last decade, associated with an increased emphasis on staff education and the use of insertion and maintenance bundles. Available evidence tends to support the use of two-dimensional ultrasound to augment the landmark technique for catheter placement, but more studies are needed.
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Pediatr Crit Care Me · Mar 2013
Clinical TrialCoagulation assessment in children with diabetic ketoacidosis.
To assess potential hypercoagulability during diabetic ketoacidosis in children. ⋯ Thromboelastographic assay results do not reflect a hypercoagulable state in this group of children with diabetic ketoacidosis. Further investigation is required to examine the potential role of injured endothelium in the suspected hypercoagulability during diabetic ketoacidosis.
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Pediatr Crit Care Me · Mar 2013
ReviewMeasuring cystatin C to determine renal function in neonates.
The incidence of acute kidney injury in neonates is high and associated with up to a 50% mortality rate. The purpose of this review was to determine the feasibility of using serum cystatin C measurements to assist clinicians in making early and accurate diagnoses of acute kidney injury in neonates. ⋯ Cystatin C has all of the theoretical properties needed to be an ideal marker of renal function. It can be used to determine baseline renal function on day 1 and is increasingly being used to determine renal function in sick neonates. In the majority of studies, the day 1 cystatin C level ranged between 1 and 2 mg/L, which gradually declined in the first year of life. However, the number of available studies evaluating cystatin C in sick neonates is currently limited, and there are also no studies linking cystatin C levels in sick babies with short-term and long-term outcomes.