Pediatr Crit Care Me
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Pediatr Crit Care Me · Nov 2014
ReviewSedation Guidelines, Protocols, and Algorithms in PICUs: A Systematic Review.
To evaluate the impact of sedation guidelines, protocols, and algorithms on clinical outcomes in PICUs. ⋯ Despite widespread recommendation for the use of sedation guidelines, protocols, and algorithms in critically ill children, our systematic review revealed a paucity of high-quality evidence to guide this practice. More robust studies are urgently needed for this important aspect of PICU care.
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Pediatr Crit Care Me · Nov 2014
Pediatric Perioperative Cardiac Arrest and Mortality: A Study From a Tertiary Teaching Hospital.
A previous survey performed in our institution demonstrated perioperative pediatric cardiac arrest and mortality rates of 22.9 and 9.8 per 10,000 anesthetics, respectively, and an anesthesia-related cardiac arrest rate of 4.58 per 10,000 anesthetics. Changes in pediatric practices (i.e., safer anesthesia techniques and change in population) may have altered cardiac arrest rates. The aim of this investigation was to reexamine the perioperative and anesthesia-related cardiac arrest rates, causes, and outcomes in a Brazilian institution. ⋯ Despite the improvements achieved in the pediatric anesthesia safety in our institution, the perioperative cardiac arrest rates are still high and similar to the developing countries rates, with the child's disease or condition being the most important trigger for cardiac arrest. Airway management continues to be the greatest cause of anesthesia-related cardiac arrest.
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Pediatr Crit Care Me · Nov 2014
Comparative StudyComparative Effectiveness of Digoxin and Propranolol for Supraventricular Tachycardia in Infants.
Supraventricular tachycardia is the most common arrhythmia in infants, and antiarrhythmic medications are frequently used for prophylaxis. The optimal prophylactic antiarrhythmic medication is unknown, and prior randomized trials have been underpowered. We used data from a large clinical registry to compare efficacy and safety of digoxin and propranolol for infant supraventricular tachycardia prophylaxis. We hypothesized that supraventricular tachycardia recurrence is less common on digoxin when compared with propranolol. ⋯ Digoxin was associated with fewer episodes of supraventricular tachycardia recurrence but more frequent hypotension in hospitalized infants relative to propranolol.
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To compare the prevalence, resource utilization, and mortality for pediatric severe sepsis identified using two established identification strategies. ⋯ Prevalence of pediatric severe sepsis increased in the studied U.S. children's hospitals over the past 9 years, whereas resource utilization and mortality decreased. Epidemiologic estimates of pediatric severe sepsis varied up to seven-fold depending on the strategy used for case ascertainment.