Pediatr Crit Care Me
-
Pediatr Crit Care Me · Mar 2015
Autologous Bone Marrow Mononuclear Cells Reduce Therapeutic Intensity for Severe Traumatic Brain Injury in Children.
The devastating effect of traumatic brain injury is exacerbated by an acute secondary neuroinflammatory response, clinically manifest as elevated intracranial pressure due to cerebral edema. The treatment effect of cell-based therapies in the acute post-traumatic brain injury period has not been clinically studied although preclinical data demonstrate that bone marrow-derived mononuclear cell infusion down-regulates the inflammatory response. Our study evaluates whether pediatric traumatic brain injury patients receiving IV autologous bone marrow-derived mononuclear cells within 48 hours of injury experienced a reduction in therapeutic intensity directed toward managing elevated intracranial pressure relative to matched controls. ⋯ IV autologous bone marrow-derived mononuclear cell therapy is associated with lower treatment intensity required to manage intracranial pressure, associated severity of organ injury, and duration of neurointensive care following severe traumatic brain injury. This may corroborate preclinical data that autologous bone marrow-derived mononuclear cell therapy attenuates the effects of inflammation in the early post-traumatic brain injury period.
-
Pediatr Crit Care Me · Mar 2015
A Multicentered Prospective Analysis of Diagnosis, Risk Factors, and Outcomes Associated With Pediatric Ventilator-Associated Pneumonia.
To assess risk factors and outcomes associated with pediatric ventilator-associated pneumonia. ⋯ Pediatric ventilator-associated pneumonia is common in mechanically ventilated pediatric patients. These patients have longer length of stay, longer duration of mechanical ventilation, and increased risk for mortality.
-
Pediatr Crit Care Me · Mar 2015
Hemorrhagic Complications in Pediatric Cardiac Patients on Extracorporeal Membrane Oxygenation: An Analysis of the Extracorporeal Life Support Organization Registry.
To determine the prevalence of and risk factors for hemorrhagic complications in children with cardiac disease requiring extracorporeal membrane oxygenation. ⋯ In this large, multicenter analysis, hemorrhagic complications occurred in nearly half of children with heart disease on extracorporeal membrane oxygenation and were associated with a significant mortality risk. Several factors were associated with hemorrhagic complications in cardiac surgical patients including pre-extracorporeal membrane oxygenation mediastinal exploration, greater surgical complexity, early postoperative cannulation, and longer bypass times. Whether these risks can be mitigated by modifying or delaying systemic anticoagulation requires further investigation.
-
Pediatr Crit Care Me · Mar 2015
Fluid Overload at 48 Hours Is Associated With Respiratory Morbidity but Not Mortality in a General PICU: Retrospective Cohort Study.
Recent evidence suggests that fluid overload may be deleterious to critically ill children. The purpose of this study was to investigate the association of early fluid overload with respiratory morbidity and mortality in patients admitted to a general PICU. ⋯ Fluid overload at 48 hours was associated with oxygenation index at 48 hours and invasive ventilation days in survivors in a general PICU population. There was no association of fluid overload at 48 hours with mortality.
-
Pediatr Crit Care Me · Mar 2015
Antithrombin Concentrates Use in Children on Extracorporeal Membrane Oxygenation: A Retrospective Cohort Study.
To investigate whether receipt of any antithrombin concentrate improves laboratory and clinical outcomes in children undergoing extracorporeal membrane oxygenation for respiratory failure during their hospitalization compared with those who did not receive antithrombin. ⋯ Intermittent, on-demand dosing of antithrombin concentrate in pediatric patients on extracorporeal membrane oxygenation for respiratory failure increased antithrombin levels, but not typically to the targeted level. Patients who received antithrombin concentrate also had decreased heparin requirements for at least 12 hours after dosing. However, no differences were noted in the measured clinical endpoints. A prospective, randomized study of this intervention may require different dosing strategies; such a study is warranted given the unproven efficacy of this costly product.