Pediatr Crit Care Me
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Pediatr Crit Care Me · Jan 2015
Multicenter Study Clinical TrialEfficacy Outcome Selection in the Therapeutic Hypothermia After Pediatric Cardiac Arrest Trials.
The Therapeutic Hypothermia After Pediatric Cardiac Arrest trials will determine whether therapeutic hypothermia improves survival with good neurobehavioral outcome, as assessed by the Vineland Adaptive Behavior Scales Second Edition, in children resuscitated after cardiac arrest in the in-hospital and out-of-hospital settings. We describe the innovative efficacy outcome selection process during Therapeutic Hypothermia After Pediatric Cardiac Arrest protocol development. ⋯ Extensive discussion of optimal efficacy assessment timing, and of the advantages versus drawbacks of incorporating prearrest status and using quasicontinuous versus simpler outcomes, was highly beneficial to the final Therapeutic Hypothermia After Pediatric Cardiac Arrest design. A relatively simple, binary primary outcome evaluated at 12 months was selected, with two secondary outcomes that address the potential disadvantages of primary outcome.
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Pediatr Crit Care Me · Jan 2015
The Use of an Extracorporeal Membrane Oxygenation Anticoagulation Laboratory Protocol Is Associated With Decreased Blood Product Use, Decreased Hemorrhagic Complications, and Increased Circuit Life.
To determine if a comprehensive extracorporeal membrane oxygenation anticoagulation monitoring protocol results in fewer hemorrhagic complications, reduced blood product usage, and increased circuit life. ⋯ We demonstrate an association between an extracorporeal membrane oxygenation anticoagulation laboratory protocol using anti-factor Xa assays, thromboelastography, and antithrombin measurements and a decrease in blood product transfusion, a decrease in hemorrhagic complications, and an increase in circuit life. To our knowledge, this is the first study to demonstrate clinical benefit associated with the use of these laboratory values for patients on extracorporeal membrane oxygenation.
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Pediatr Crit Care Me · Jan 2015
Making Decisions About Medications in Critically Ill Children: A Survey of Canadian Pediatric Critical Care Clinicians.
Changing clinician practice in pediatric critical care is often difficult. Tailored knowledge translation interventions may be more effective than other types of interventions. To inform the design of tailored interventions, the primary objective of this survey was to describe the importance of specific factors that influence physicians and pharmacists when they make decisions about medications in critically ill children. ⋯ The relative importance of many factors that clinicians consider when making decisions about medications varies by demographics, and depends on the clinical problem. This variability should be considered in quality improvement and knowledge translation interventions in this setting.
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To assess neonatologists' practices, knowledge, and opinions regarding the prevention of endobronchial intubation. ⋯ Neonatologists perceive endobronchial intubation as a consequential but underreported complication. Most are uncertain about the use of common vocal cord markings on endotracheal tubes, and few have seen specific instructions on this feature. We suggest that standardizing endotracheal tube safety features and making clear directions available to users may decrease the risk of endobronchial intubation in neonates.