Pediatr Crit Care Me
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Pediatr Crit Care Me · Apr 2018
Creating a High-Frequency Electronic Database in the PICU: The Perpetual Patient.
Our objective was to construct a prospective high-quality and high-frequency database combining patient therapeutics and clinical variables in real time, automatically fed by the information system and network architecture available through fully electronic charting in our PICU. The purpose of this article is to describe the data acquisition process from bedside to the research electronic database. ⋯ Using the existing bedside information system and network architecture of our PICU, we implemented an ongoing high-fidelity prospectively collected electronic database, preventing the continuous loss of scientific information. This offers the opportunity to develop research on clinical decision support systems and computational models of cardiorespiratory physiology for example.
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Pediatr Crit Care Me · Apr 2018
Repeat Rapid Response Events in Children: Characteristics and Outcomes.
We describe the characteristics and outcomes of pediatric repeat rapid response events within a single hospitalization. We hypothesized that triggers for repeat rapid response and initial rapid response events are similar, and repeat rapid response events are associated with high prevalence of medical complexity and worse outcomes. ⋯ Prevalence of medical complexity was high in patients with repeat rapid response compared with that reported for pediatric hospitalizations. Triggers between initial and repeat rapid response events correlated. Transfer to ICU was more likely after repeat rapid response and among repeat rapid response, events with ICU readmissions had a longer length of ICU and hospital stay. Mortality for the repeat rapid response cohort was higher than that for overall rapid responses in our center and per published reports from other centers.
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Pediatr Crit Care Me · Apr 2018
Randomized Controlled Trial Multicenter StudyInitiating Nutritional Support Before 72 Hours Is Associated With Favorable Outcome After Severe Traumatic Brain Injury in Children: A Secondary Analysis of a Randomized, Controlled Trial of Therapeutic Hypothermia.
To understand the relationship between the timing of initiation of nutritional support in children with severe traumatic brain injury and outcomes. ⋯ Initiation of nutritional support before 72 hours after traumatic brain injury was associated with decreased mortality and favorable outcome in this secondary analysis. Although this provides a rationale to initiate nutritional support early after traumatic brain injury, definitive studies that control for important covariates (severity of injury, clinical site, calories delivered, parenteral/enteral routes, and other factors) are needed to provide definitive evidence on the optimization of the timing of nutritional support after severe traumatic brain injury in children.
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Pediatr Crit Care Me · Apr 2018
ReviewIs There an Optimum Duration of Fluid Bolus in Pediatric Septic Shock? A Critical Appraisal of "Fluid Bolus Over 15-20 Versus 5-10 Minutes Each in the First Hour of Resuscitation in Children With Septic Shock: A Randomized Controlled Trial" by Sankar et al (Pediatr Crit Care Med 2017; 18:e435-e445).
To review the findings and discuss the implications of a longer duration for fluid boluses in the resuscitation of children with septic shock. ⋯ The article reviewed does not support a change in practice to a longer duration of fluid bolus. The "push" technique for titration of fluid boluses in pediatric septic shock should continue to be the method of choice. Critical Care trials using binary outcomes as endpoints should publish Fragility Index results to aid interpretation and generate stronger conclusions.
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Pediatr Crit Care Me · Apr 2018
Observational StudyCerebral Oxygen Metabolism Before and After RBC Transfusion in Infants Following Major Surgical Procedures.
Although infants following major surgery frequently require RBC transfusions, there is still controversy concerning the best definition for requirement of transfusion in the individual patient. The aim of this study was to determine the impact of RBC transfusion on cerebral oxygen metabolism in noncardiac and cardiac postsurgical infants. ⋯ Following RBC transfusion, cerebral oxygen saturation increases and cerebral fractional tissue oxygen extraction decreases. The data suggest that cerebral oxygenation in postoperative infants with cerebral fractional tissue oxygen extraction greater than or equal to 0.4 may be at risk in instable hemodynamic or respiratory situations.