Pediatr Crit Care Me
-
Pediatr Crit Care Me · Jul 2013
Nonconvulsive seizures are common in children treated with extracorporeal cardiac life support.
The prevalence of electrographic seizures or nonconvulsive status epilepticus and the effect of such seizures in children treated with extracorporeal cardiac life support are not known. We investigated the occurrence of electrographic abnormalities, including asymmetries in amplitude or frequency of the background rhythm and interictal activity in children undergoing extracorporeal cardiac life support and their association with seizures. We compared mortality and radiologic evidence of neurologic injury between patients with seizures and those without seizures. ⋯ Seizures are common in children during extracorporeal cardiac life support, and most seizures are nonconvulsive. In patients undergoing extracorporeal cardiac life support, clinical features are unreliable indicators of the presence of seizures. The presence of seizures is suggestive of CNS injury. This study is limited by the exclusion of neonates, a feature of the clinical use of electroencephalography at our institution. Although seizures were not associated with increased mortality, further prospective studies in larger populations are needed to assess the long-term morbidity associated with seizures during extracorporeal cardiac life support.
-
Pediatr Crit Care Me · Jul 2013
Point prevalence survey of antimicrobial utilization in the cardiac and pediatric critical care unit.
To determine the rate of documented infections and prevalence of antimicrobial use among pediatric patients admitted to the PICU. To assess the appropriateness of antimicrobial prescribing according to clinical and microbiological findings, Infectious Disease Consult recommendations, and formulary guidelines. ⋯ There was a high prevalence of antimicrobial use in CCCU-PICU patients. Because a significant proportion of antimicrobial use was deemed inappropriate, interventions are required to optimize antimicrobial use in critically ill children.
-
Pediatr Crit Care Me · Jul 2013
Multicenter StudyUnscheduled readmissions to the PICU: epidemiology, risk factors, and variation among centers.
To determine the rate of, and potential risk factors for, unscheduled PICU readmission and assess for variability among PICUs within the United States. ⋯ The rate of unscheduled PICU readmission was low but associated with worse outcomes. Patient and admission/discharge characteristics associated with increased risk of readmissions could be used to target high-risk populations or modifiable factors to improve outcome. Variation of risk among centers suggests room for improvement.
-
Pediatr Crit Care Me · Jul 2013
Clinical TrialSildenafil exposure and hemodynamic effect after stage II single-ventricle surgery.
To determine sildenafil exposure and hemodynamic effect in children after stage II single-ventricle surgery. ⋯ Sildenafil demonstrated nonlinear exposure with high interindividual variability but was well tolerated and effectively lowered pulmonary vascular resistance index in all subjects. Sildenafil did not acutely improve myocardial performance or increase cardiac index.
-
Pediatr Crit Care Me · Jul 2013
Comparative Study Clinical TrialCord blood proteins and multichannel-electroencephalography in hypoxic-ischemic encephalopathy.
To explore the association between multiple umbilical cord blood proteins and severity of hypoxic-ischemic encephalopathy as defined by continuous multichannel electroencephalography. ⋯ Cord blood interleukin-6 and interleukin-16 were associated with electrographic grade of hypoxic-ischemic encephalopathy. To predict an abnormal electroencephalography, interleukin-16 and 10-minute Apgar used in combination performed better than current markers.