Pediatr Crit Care Me
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Pediatr Crit Care Me · Dec 2018
Multicenter Study Observational StudySafety of Tranexamic Acid During Pediatric Trauma: A Nationwide Database Study.
The present study aimed to examine the association between tranexamic acid use and adverse effects (seizures, thromboembolism, and renal dysfunction) in a pediatric trauma population using a national inpatient database in Japan. We also assessed the association between tranexamic acid use and in-hospital mortality. ⋯ Tranexamic acid use is associated with a significantly increased risk of seizures. However, no difference exists among any other outcomes between the tranexamic acid and nontranexamic acid groups.
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Pediatr Crit Care Me · Dec 2018
Randomized Controlled Trial Multicenter StudyPrevalence and Prognostic Value of Abnormal Liver Test Results in Critically Ill Children and the Impact of Delaying Parenteral Nutrition.
In the Early versus Late Parenteral Nutrition in the Pediatric ICU randomized controlled trial, delaying parenteral nutrition to beyond day 7 (late parenteral nutrition) was clinically superior to supplemental parenteral nutrition initiated within 24 hours (early parenteral nutrition), but resulted in a higher rise in bilirubin. We aimed to document prevalence and prognostic value of abnormal liver tests in the PICU and the impact hereon of withholding early parenteral nutrition. ⋯ Overt cholestasis and hypoxic hepatitis were rare and unrelated to the nutritional strategy. However, withholding parenteral nutrition up to 1 week in PICU increased plasma bilirubin. A mild elevation of bilirubin on the first PICU day was associated with lower risk of death and may reflect a stress response, rather than true cholestasis.
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Pediatr Crit Care Me · Dec 2018
Multicenter Study Comparative Study Observational StudyVariability in Pediatric Ideal Body Weight Calculation: Implications for Lung-Protective Mechanical Ventilation Strategies in Pediatric Acute Respiratory Distress Syndrome.
No gold standard for ideal body weight determination in children exists. We aimed to compare four methods of ideal body weight calculation and determine level of agreement between methods and impact of measurement variance on tidal volumes prescribed in mechanically ventilated pediatric acute respiratory distress syndrome. ⋯ There is substantial variation in calculated ideal body weight among four commonly used methods, particularly in adolescents. Since varying ideal body weight may lead to discrepancies in pediatric acute respiratory distress syndrome care, a standard approach to ideal body weight measurement is needed. We recommend the McLaren method to calculate ideal body weight in children with pediatric acute respiratory distress syndrome until a gold standard method is validated.
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Pediatr Crit Care Me · Dec 2018
Multicenter Study Observational StudyPerformance of the Pediatric Index of Mortality 3 Score in PICUs in Argentina: A Prospective, National Multicenter Study.
To assess the performance of the Pediatric Index of Mortality 3 score in a population of children admitted to PICUs in Argentina. ⋯ The Pediatric Index of Mortality 3 score adequately discriminated patients who died from those who survived in our population. However, the observed mortality was higher than predicted by the score. The use of an updated instrument such as Pediatric Index of Mortality 3 will allow an actual comparison between pediatric intensive care provided in the country and care provided internationally. This might also allow future planning of pediatric intensive care services in Argentina.
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Pediatr Crit Care Me · Dec 2018
Multicenter StudyPediatric Ventilator-Associated Events: Analysis of the Pediatric Ventilator-Associated Infection Data.
To compare the prevalence of infection applying the proposed pediatric ventilator-associated events criteria versus clinician-diagnosed ventilator-associated infection to subjects in the pediatric ventilator-associated infection study. ⋯ The ventilator-associated event criteria appear to be insensitive to the clinical diagnosis of ventilator-associated infection. Differentiation between ventilator-associated condition and infection-related ventilator-associated complication was primarily determined by the clinician decision to treat with antibiotics rather than clinical signs and symptoms. The utility of the proposed pediatric ventilator-associated event criteria as a surrogate for ventilator-associated infection criteria is unclear.