Pediatr Crit Care Me
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Pediatr Crit Care Me · Jul 2014
Multicenter StudyVasoactive-Inotropic Score Is Associated With Outcome After Infant Cardiac Surgery: An Analysis From the Pediatric Cardiac Critical Care Consortium and Virtual PICU System Registries.
To empirically derive the optimal measure of pharmacologic cardiovascular support in infants undergoing cardiac surgery with bypass and to assess the association between this score and clinical outcomes in a multi-institutional cohort. ⋯ Maximum vasoactive-inotropic score calculated in the first 24 hours after cardiac ICU admission was strongly and significantly associated with morbidity and mortality in this multi-institutional cohort of infants undergoing cardiac surgery. Maximum vasoactive-inotropic score more than or equal to 20 predicts an increased likelihood of a poor composite clinical outcome. The findings were consistent in stratified analyses by age and surgical complexity.
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Pediatr Crit Care Me · Jul 2014
ReviewTime for a Neonatal-Specific Consensus Definition for Sepsis.
To review the accuracy of the pediatric consensus definition of sepsis in term neonates and to determine the definition of neonatal sepsis used. ⋯ Neonatal sepsis is variably defined based on a number of clinical and laboratory criteria that make the study of this common and devastating condition very difficult. Diagnostic challenges and uncertain disease epidemiology necessarily result from a variable definition of disease. In 2005, intensivists caring for children recognized that as new drugs became available, children would be increasingly studied and thus, pediatric-specific consensus definitions were needed. Pediatric sepsis criteria are not accurate for term neonates and have not been examined in preterm neonates for whom the developmental stage influences aberrations associated with host immune response. Thus, specific consensus definitions for both term and preterm neonates are needed. Such definitions are critical for the interpretation of observational studies, future training of scientists and practitioners, and implementation of clinical trials in neonates.
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Pediatr Crit Care Me · Jul 2014
Editorial CommentA New Era of Personalized Rehabilitation in the PICU*.
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Pediatr Crit Care Me · Jul 2014
Randomized Controlled Trial Multicenter StudyContinuous Infusion of Clonidine in Ventilated Newborns and Infants: A Randomized Controlled Trial.
To assess the influence of an infusion of clonidine 1 μg/kg/hr on fentanyl and midazolam requirement in ventilated newborns and infants. ⋯ Clonidine 1 μg/kg/hr in ventilated newborns reduced fentanyl and midazolam demand with deeper levels of analgesia and sedation without substantial side effects. This was not demonstrated in older infants, possibly due to lower clonidine serum levels.
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Pediatr Crit Care Me · Jul 2014
Multicenter StudyAcute Rehabilitation Practices in Critically Ill Children: A Multicenter Study.
To evaluate acute rehabilitation practices in pediatric critical care units across Canada. ⋯ Only half of the children receive rehabilitation while in the pediatric critical care unit, and when it occurs, therapy is primarily focused on respiratory function. Mobilization appears to be reserved for at-risk children who were muscle relaxed and sedated; however, its implementation in these patients is delayed. Future pediatric-specific research is essential to identify patients at risk and to understand treatment priorities and rehabilitation strategies to improve functional recovery in critically ill children.