Pediatr Crit Care Me
-
Pediatr Crit Care Me · Jun 2017
ReviewDifferentiating Delirium From Sedative/Hypnotic-Related Iatrogenic Withdrawal Syndrome Lack of Specificity in Pediatric Critical Care Assessment Tools.
To identify available assessment tools for sedative/hypnotic iatrogenic withdrawal syndrome and delirium in PICU patients, the evidence supporting their use, and describe areas of overlap between the components of these tools and the symptoms of anticholinergic burden in children. ⋯ Although important studies have demonstrated apparent high prevalence of iatrogenic withdrawal syndrome and delirium in the PICU population, the overlap in these scoring systems presents potential difficulty in distinguishing syndromes, both clinically and for research purposes.
-
Pediatr Crit Care Me · Jun 2017
Multicenter Study Observational StudyRelationship of Hospital Costs With Mortality in Pediatric Critical Care: A Multi-Institutional Analysis.
With increasing emphasis on high "value" care, we designed this study to evaluate the relationship between hospital costs and patient outcomes in pediatric critical care. ⋯ This large observational study did not demonstrate any relationship between hospital costs and patient outcomes in children with critical illness. Further efforts are needed to evaluate quality-cost relationship and high value care in critically ill children across centers of varying volume by linking data from clinical and administrative databases.
-
Pediatr Crit Care Me · Jun 2017
Comparative StudyInhaled Treprostinil Drug Delivery During Mechanical Ventilation and Spontaneous Breathing Using Two Different Nebulizers.
To determine the feasibility of delivering inhaled treprostinil during mechanical ventilation and spontaneous unassisted ventilation using the Tyvaso Inhalation System and the vibrating mesh nebulizer. We sought to compare differences in fine particle fraction, and absolute inhaled treprostinil mass delivered to neonatal, pediatric, and adult models affixed with a face mask, conventional, and high-frequency ventilation between Tyvaso Inhalation System and with different nebulizer locations between Tyvaso Inhalation System and vibrating mesh nebulizer. ⋯ The vibrating mesh nebulizer is a suitable alternative to the Tyvaso Inhalation System for inhaled treprostinil delivery. Fine particle fraction is similar between devices, and vibrating mesh nebulizer delivery meets or exceeds delivery of the Tyvaso Inhalation System. Delivery for infants and children during high-frequency oscillator ventilator with the vibrating mesh nebulizer may result in higher than expected dosages.
-
Pediatr Crit Care Me · Jun 2017
Observational StudyImplementation of an ICU Bundle: An Interprofessional Quality Improvement Project to Enhance Delirium Management and Monitor Delirium Prevalence in a Single PICU.
To examine the impact of an ICU bundle on delirium screening and prevalence and describe characteristics of delirium cases. ⋯ Implementation of an ICU bundle along with staff education and case conferences is effective for improving delirium screening, detection, and treatment and is associated with decreased delirium prevalence.
-
Pediatr Crit Care Me · Jun 2017
Three Hypothetical Inflammation Pathobiology Phenotypes and Pediatric Sepsis-Induced Multiple Organ Failure Outcome.
We hypothesize that three inflammation pathobiology phenotypes are associated with increased inflammation, proclivity to develop features of macrophage activation syndrome, and multiple organ failure-related death in pediatric severe sepsis. ⋯ Our approach to phenotype categorization remains hypothetical, and the phenotypes identified need to be confirmed in multicenter studies of pediatric multiple organ dysfunction syndrome.