Pediatr Crit Care Me
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Pediatr Crit Care Me · Jul 2013
Observational StudyThe use of near-infrared spectroscopy during an extubation readiness trial as a predictor of extubation outcome.
To determine whether the measurement of cerebral and somatic regional oxygen saturation during an extubation readiness trial predicts extubation failure in postoperative cardiac patients. ⋯ A 12% decline in somatic regional oxygen saturation during an extubation readiness trial is associated with an increased risk of extubation failure following a successful extubation readiness trial. The addition of somatic regional oxygen saturation measurements to an extubation readiness trial may improve our ability to predict extubation outcome.
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Pediatr Crit Care Me · Jul 2013
ReviewMechanisms of acute respiratory distress syndrome in children and adults: a review and suggestions for future research.
To provide a current overview of the epidemiology and pathophysiology of acute respiratory distress syndrome in adults and children, and to identify research questions that will address the differences between adults and children with acute respiratory distress syndrome. ⋯ There are significant obstacles to performing research on children with acute respiratory distress syndrome. However, epidemiologic, clinical, and animal studies suggest age-dependent differences in the pathophysiology of acute respiratory distress syndrome. In order to reduce the prevalence and improve the outcome of patients with acute respiratory distress syndrome, translational studies of inflammatory, apoptotic, alveolar fluid clearance, and repair mechanisms are needed. Understanding the differences in pathophysiologic mechanisms in acute respiratory distress syndrome between children and adults should facilitate identification of novel therapeutic interventions to prevent or modulate lung injury and improve lung repair.
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Pediatr Crit Care Me · Jul 2013
Observational StudyThe effect of atropine on rhythm and conduction disturbances during 322 critical care intubations.
Our objectives were to describe the prevalence of arrhythmia and conduction abnormalities before critical care intubation and to test the hypothesis that atropine had no effect on their prevalence during intubation. ⋯ Atropine significantly reduced the prevalence of new arrhythmias during intubation particularly for children over 1 month of age, did not convert sinus tachycardia to ventricular tachycardia or fibrillation, and may contribute to the safety of intubation.
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Pediatr Crit Care Me · Jul 2013
Clinical TrialRisk of extracorporeal life support circuit-related hyperkalemia is reduced by prebypass ultrafiltration.
Pediatric patients who receive large volume blood transfusions are at risk for experiencing transfusion-related hyperkalemic cardiac arrest. Prebypass ultrafiltration of blood used to prime cardiopulmonary bypass circuits is commonly used in pediatric cardiac surgery to create a more physiologic and electrolyte balanced priming solution prior to initiation of cardiopulmonary bypass. This study was undertaken to determine the efficacy of prebypass ultrafiltration in normalizing extracorporeal life support circuit priming solution before initiating extracorporeal life support. ⋯ Prebypass ultrafiltration normalizes the electrolyte balance of blood-primed extracorporeal life support circuits. Prebypass ultrafiltration processing may reduce the risk of transfusion-related hyperkalemic cardiac arrest in small children who require venovenous extracorporeal life support.