Pediatr Crit Care Me
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Pediatr Crit Care Me · Sep 2013
Randomized Controlled TrialOptimizing Patient-Ventilator Synchrony During Invasive Ventilator Assist in Children and Infants Remains a Difficult Task.
To document and compare the prevalence of asynchrony events during invasive-assisted mechanical ventilation in pressure support mode and in neurally adjusted ventilatory assist in children. ⋯ Asynchrony events are frequent during pressure support in children despite adjusting the cycling off criteria. Neurally adjusted ventilatory assist allowed for an almost ten-fold reduction in asynchrony events. Further studies should determine the clinical impact of these findings.
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Pediatr Crit Care Me · Sep 2013
Decreased Expression of Serum and Microvascular Vascular Endothelial Growth Factor Receptor-2 in Meningococcal Sepsis.
To determine the skin microvessel expression of vascular endothelial growth factor receptor 2 and serum-soluble vascular endothelial growth factor receptor 2 levels in children with meningococcal sepsis. ⋯ Microvascular expression of vascular endothelial growth factor receptor 2 and serum-soluble vascular endothelial growth factor receptor 2 levels are decreased in children with sepsis. Serum-soluble vascular endothelial growth factor receptor 2 levels are inversely correlated with disease severity indicated by Pediatric Risk of Mortality III score and survival. Decreased vascular endothelial growth factor receptor 2 expression may hinder natural recovery from sepsis-associated microvascular injury and the effectiveness of therapeutic strategies targeting vascular endothelial growth factor-vascular endothelial growth factor receptor 2 signaling in sepsis patients.
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In the past decade, guidelines have been developed for the early detection and management of severe sepsis in children and neonates. However, severe sepsis continues to be a significant U.S. healthcare problem, accounting for over 720,000 annual hospitalizations. Large-scale epidemiologic studies of severe sepsis continue to be limited, particularly in children. We present data from 1995, 2000, and 2005 in seven U.S. states, examining how case mix, outcome, and resource use for pediatric severe sepsis have changed over time. ⋯ Between 1995 and 2005, the prevalence of severe sepsis in U.S. children steadily rose, due to a significant increase in the prevalence of severe sepsis in newborns.
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Pediatr Crit Care Me · Sep 2013
Mechanical Ventilation Strategies in Children With Acute Lung Injury: A Survey on Stated Practice Pattern.
The aim of this survey was to determine North American and European pediatric intensivists' knowledge and stated practice in the management of children with acute respiratory distress syndrome with regard to mechanical ventilation settings; blood gas and SO2 targets; and use of adjunctive treatments at sites where actual practice had just been assessed. ⋯ Although in theory, many pediatric intensivists agreed with adult recommendations to ventilate with lower tidal volumes and pressure limits, the Pediatric Acute Lung Injury Mechanical Ventilation data revealed that over 25% of pediatric patients with acute lung injury/acute respiratory distress syndrome at many of these practice sites were ventilated with tidal volumes above 10 mL/kg and that high positive inspiratory pressure levels (> 35 mm Hg) were often tolerated.
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Pediatr Crit Care Me · Sep 2013
Nonconvulsive Electrographic Seizures Are Common in Children With Abusive Head Trauma.
To determine the prevalence of nonconvulsive seizures in children with abusive head trauma. ⋯ Electrographic seizures and electrographic status epilepticus are common in children with abusive head trauma. Most seizures have no clinical correlate. Further study is needed to determine whether seizure identification and management improves outcome.