Pediatr Crit Care Me
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Pediatr Crit Care Me · Feb 2015
Clinical TrialBacteremia and Pneumonia in a Tertiary PICU: An 11-Year Study.
To describe trends in aetiology and resistance patterns and patient outcomes of bacteraemia and pneumonia in a PICU over an 11-year period. We also describe interventions aimed at reducing multi-resistant infections and other serious bacterial infections in the PICU. ⋯ Multiresistant bacterial sepsis and persistent or recurrent sepsis are major threats in pediatric intensive care and are associated with disproportionally high death rates. Our study describes a model for monitoring these serious infections and the effects of infection control interventions in the PICU.
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Pediatr Crit Care Me · Feb 2015
Acetazolamide therapy for metabolic alkalosis in critically ill pediatric patients.
Despite a paucity of supporting literature, acetazolamide is commonly used in critically ill children with metabolic alkalosis (elevated plasma bicarbonate [pHco-3] and pH). The objective of this study was to assess the change in 18 hours after initiation of acetazolamide therapy. ⋯ Acetazolamide reduces pHco-3 concentration in critically ill, mechanically ventilated children overall, but it did not do so in cardiac patients in our cohort, even in comparison with noncardiac patients of a similar age. These findings do not support the current use of acetazolamide for metabolic alkalosis in critically ill children with congenital heart disease. Further study is required to determine why these cardiac patients respond differently to acetazolamide than noncardiac patients and whether this response impacts important clinical outcomes, for example, weaning mechanical ventilation.
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Pediatr Crit Care Me · Feb 2015
Unplanned admissions to a pediatric cardiac critical care unit: a review of 2 years' experience.
Unplanned admissions to the pediatric cardiac ICU may be a large and high-risk group. Our study describes the frequency of unplanned pediatric cardiac ICU admissions, their admission data, and outcomes. ⋯ Unplanned admissions accounted for over one third of all admissions and had a high mortality rate. The majority of these occur at night, which may affect staffing models. Acute deterioration leading to unplanned admission, rather than readmission status, may be the driving factor in increased mortality. However, the risk of readmission, lower renal function, or other indices may identify patients at higher risk of an unplanned admission. Continued efforts to identify patients at risk for unplanned admissions are warranted given the outcomes in this cohort.
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Pediatr Crit Care Me · Feb 2015
Bumetanide Continuous Infusions in Critically Ill Pediatric Patients.
Limited data exist for the use of bumetanide continuous infusions in children. The purpose of this study was to evaluate the use of bumetanide continuous infusions in critically ill pediatric patients. ⋯ This study showed that a bumetanide dose of 5.7 μg/kg/hr was effective in achieving negative fluid balance in the majority of critically ill pediatric patients. Additionally, bumetanide appears to be a safe loop diuretic for use as a continuous infusion at the doses described in critically ill pediatric patients.
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Pediatr Crit Care Me · Feb 2015
Hemofiltration Is Not Associated With Increased Mortality in Children Receiving Extracorporeal Membrane Oxygenation.
To investigate whether the use of continuous renal replacement therapy is independently associated with increased in-hospital mortality in children on extracorporeal membrane oxygenation. ⋯ In-hospital mortality was similar between children on extracorporeal membrane oxygenation with and without hemofiltration although hemofiltration appeared to be associated with a slight increase in the duration of extracorporeal membrane oxygenation and more liberal platelet transfusions.