Pediatr Crit Care Me
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Pediatr Crit Care Me · Apr 2018
Furosemide Response Predicts Acute Kidney Injury After Cardiac Surgery in Infants and Neonates.
Cardiac surgery-induced acute kidney injury occurs frequently in neonates and infants and is associated with postoperative morbidity/mortality; early identification of cardiac surgery-induced acute kidney injury may be crucial to mitigate postoperative morbidity. We sought to determine if hourly or 6-hour cumulative urine output after furosemide in the first 24 hours after cardiopulmonary bypass could predict development of cardiac surgery-induced acute kidney injury and other deleterious outcomes. ⋯ Urine output response to furosemide within 24 hours of cardiopulmonary bypass predicts cardiac surgery-induced acute kidney injury development and other important morbidity in children younger than 90 days old; prospective validation is warranted.
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Pediatr Crit Care Me · Apr 2018
Dexmedetomidine as Single Continuous Sedative During Noninvasive Ventilation: Typical Usage, Hemodynamic Effects, and Withdrawal.
Dexmedetomidine use in pediatric critical care is increasing. Its prolonged effects as a single continuous agent for sedation are not well described. The aim of the current study was to describe prolonged dexmedetomidine therapy without other continuous sedation, specifically the hemodynamic effects, discontinuation strategies, and risk factors for withdrawal. ⋯ Dexmedetomidine use for noninvasive positive pressure ventilation sedation in pediatric critical care has predictable hemodynamic effects including bradycardia and hypertension. Although withdrawal was associated with higher cumulative dose, these symptoms were effectively managed with short-term enteral clonidine.
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Pediatr Crit Care Me · Apr 2018
Observational StudyReorganizing Care With the Implementation of Electronic Medical Records: A Time-Motion Study in the PICU.
To assess caregivers' patient care time before and after the implementation of a reorganization of care plan with electronic medical records. ⋯ The reorganization of care with the implementation of an ICU-specific electronic medical record in the PICU did not change total patient care provided but improved nursing productivity, resulting in improved efficiency. Documentation time was significantly increased, and concern over reduced oral communication arose, which should be a focus for future electronic improvement strategies.
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To describe the use of low-dose bolus epinephrine in critically ill children during an acute hypotensive episode or prearrest condition. ⋯ Provision of low-dose bolus epinephrine during periods of acute hypotension can result in a significant increase in mean arterial blood pressure and heart rate. This dosing strategy may provide temporary stabilization while other therapies are added or adjusted, but further research is needed.
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Pediatr Crit Care Me · Apr 2018
Optimal Insertion Depth for Endotracheal Tubes in Extremely Low-Birth-Weight Infants.
To determine the optimal endotracheal tube insertion depth in extremely low-birth-weight infants based on the association between endotracheal tube depth and gestational age, body weight, body length, and head and chest circumferences at birth. ⋯ In extremely low-birth-weight infants, a linear association exists between endotracheal tube insertion depth and gestational age, body weight, body length, chest, and head circumferences at birth. Although body weight is the most accurate method for predicting endotracheal tube insertion depth, body length is also appropriate and is more favorable than body weight in delivery room resuscitation. Although no substitute for radiologic confirmation exists, a tape measure that can convert body length to endotracheal tube depth may be helpful.