Pediatr Crit Care Me
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Pediatr Crit Care Me · Mar 2016
Exploring the Role of Polycythemia in Patients With Cyanosis After Palliative Congenital Heart Surgery.
To understand the relationship between polycythemia and clinical outcome in patients with hypoplastic left heart syndrome following the Norwood operation. ⋯ Early polycythemia following the Norwood operation is associated with longer length of hospitalization even after controlling for blood cell transfusion practices. We hypothesize that polycythemia may be caused by hemoconcentration and used as an early marker of capillary leak syndrome.
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Pediatr Crit Care Me · Mar 2016
Higher Tinzaparin Dosing Is Needed to Achieve Target Anti-Xa Levels in Pediatric Cardiac Intensive Care Patients.
This study was conducted to evaluate tinzaparin dosing and therapeutic drug monitoring. ⋯ Target anti-Xa levels were reached with tinzaparin dosing in PICU patients after more than 8 doses, warranting further dose-effect research. Especially in the younger age group, substantially higher dose requirements than proposed in the internationally used guidelines are required. With the results of our study, we suggest a different therapeutic drug monitoring approach than that currently used.
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Pediatr Crit Care Me · Mar 2016
Predictors of Repeat Exchange Transfusion for Severe Neonatal Hyperbilirubinemia.
To identify the predictors of repeat exchange transfusion among infants with severe hyperbilirubinemia. ⋯ Acute bilirubin encephalopathy and excessive total serum bilirubin levels at least 30 mg/dL are predictive of repeat exchange transfusion. A risk assessment framework that combines total serum bilirubin levels, acute bilirubin encephalopathy status, and risk factors of neurotoxicity should be considered for the timely detection and monitoring of infants at risk of repeat exchange transfusion.
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Pediatr Crit Care Me · Mar 2016
Pediatric Hematopoietic Stem Cell Transplant and Intensive Care: Have Things Changed?
Mortality for pediatric patients who require intensive care posthematopoietic stem cell transplant still remains high. Previously at our institution, survival rates were 44% for patients who required mechanical ventilation posthematopoietic stem cell transplant. We conducted a review of patients to identify whether there has been any improvement in survival over the past 12 years and to identify any risk factors that contribute to mortality. ⋯ This is the largest single-center series for pediatric patients who require intensive care posthematopoietic stem cell transplant and demonstrates that this group of patients still faces high mortality. There has been an improvement in survival for those patients who require renal replacement therapy and also for patients who require mechanical ventilation more than once; however, the need for mechanical ventilation still remains a significant predictor of mortality.
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Pediatr Crit Care Me · Mar 2016
Review Practice GuidelinePediatric Cardiac Intensive Care Society 2014 Consensus Statement: Pharmacotherapies in Cardiac Critical Care: Sedation, Analgesia and Muscle Relaxant.
This article reviews pharmacotherapies currently available to manage sedation, analgesia, and neuromuscular blockade for pediatric cardiac critical patients. ⋯ In the cardiac ICU, management of the cardiac patient requires an individualized sedative and analgesic strategy that maintains hemodynamic stability. Multiple pharmacological therapies exist to achieve these goals and should be selected based on the patient's underlying physiology, hemodynamic vulnerabilities, desired level of sedation and analgesia, and the projected short- or long-term recovery trajectory.