Pediatr Crit Care Me
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Pediatr Crit Care Me · Oct 2014
Fatalities Above 30,000 Feet: Characterizing Pediatric Deaths on Commercial Airline Flights Worldwide.
We conducted this study to characterize in-flight pediatric fatalities onboard commercial airline flights worldwide and identify patterns that would have been unnoticed through single case analysis of these relative rare events. ⋯ Pediatric in-flight fatalities are rare, but death occurs most commonly in infants and in subjects with a preexisting medical condition. The number of fatalities involving seemingly previously healthy children under the age of 2 years (lap infants) is intriguing and could indicate a vulnerable population at increased risk of death related to in-flight environmental factors, sleeping arrangements, or yet another unrecognized factor.
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Pediatr Crit Care Me · Oct 2014
Respiratory Secretion Analyses in the Evaluation of Ventilator-Associated Pneumonia: A Survey of Current Practice in Pediatric Critical Care.
Ventilator-associated pneumonia is among the most common nosocomial infections in the PICU. Respiratory secretion cultures and Gram stains are frequently obtained for diagnosis and to guide therapy, but their specificity is questionable. We conducted a scenario-based survey of pediatric intensivists to assess their antibiotic use in response to hypothetical tracheal aspirate culture and Gram stain results. ⋯ The majority of pediatric intensivists would obtain respiratory secretion cultures and Gram stains in the evaluation of an intubated child with fever and leukocytosis and initiate antibiotics guided by the results. The specificity of respiratory secretion cultures and Gram stains for the diagnosis of ventilator-associated pneumonia requires critical evaluation as this diagnosis is responsible for more than half of antibiotic use in the PICU.
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Pediatr Crit Care Me · Oct 2014
ReviewIntegrating Palliative Care Into the PICU: A Report From the Improving Palliative Care in the ICU Advisory Board.
This review highlights benefits that patients, families and clinicians can expect to realize when palliative care is intentionally incorporated into the PICU. ⋯ Palliative care should begin at the time of a potentially life-limiting diagnosis and continue throughout the disease trajectory, regardless of the expected outcome. Although the PICU is often used for short term postoperative stabilization, PICU clinicians also care for many chronically ill children with complex underlying conditions and others receiving intensive care for prolonged periods. Integrating palliative care delivery into the PICU is rapidly becoming the standard for high quality care of critically ill children. Interdisciplinary ICU staff can take advantage of the growing resources for continuing education in pediatric palliative care principles and interventions.