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
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.
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Pediatr Crit Care Me · Jul 2013
Complications associated with prolonged hypertonic saline therapy in children with elevated intracranial pressure.
Safe upper limits for therapeutic hypernatremia in the treatment of intracranial hypertension have not been well established. We investigated complications associated with hypernatremia in children who were treated with prolonged infusions of hypertonic saline. ⋯ Children treated by continuous hypertonic saline infusion for intracranial hypertension whose serum sodium levels exceeded certain thresholds experienced significantly more events of acute renal failure, thrombocytopenia, neutropenia, anemia, and acute respiratory distress syndrome than those whose sodium level was maintained below these thresholds.
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Pediatr Crit Care Me · Jul 2013
Intravenous colistin for multidrug-resistant gram-negative infections in critically ill pediatric patients.
Nosocomial infection due to multidrug-resistant Gram-negative pathogens in ICUs is a challenge for clinicians and microbiologists and has led to the resurgence of IV colistin use in the last decade. The aim of this study was to assess the efficacy of IV colistin in the treatment of critically ill children with multidrug-resistant Gram-negative infections. ⋯ Our study suggests that IV colistin may have a role in the treatment of infections caused by multidrug-resistant Gram-negative bacteria in critically ill children, but further prospective and randomized control trials are needed to confirm its efficacy and safety in children.
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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.