Pediatr Crit Care Me
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Pediatr Crit Care Me · Jul 2018
Effects of a PICU Status Asthmaticus De-Escalation Pathway on Length of Stay and Albuterol Use.
Evaluate the effects of an asthma de-escalation clinical pathway on selected outcomes for patients admitted to a PICU with status asthmaticus. ⋯ Implementation of a PICU asthma de-escalation pathway demonstrated statistical decrease in the reported measures for children with status asthmaticus. Although the clinical significance of these changes may be debatable, the results demonstrate that efforts to standardize asthma care in the PICU setting is an area in need of further study.
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Pediatr Crit Care Me · Jul 2018
Mothers and Fathers Experience Stress of Congenital Heart Disease Differently: Recommendations for Pediatric Critical Care.
To inform pediatric critical care practice by examining how mothers and fathers experience the stress of caring for a young child with congenital heart disease and use hospital and community supports. ⋯ This study highlights the importance of understanding the paternal experience and tailoring interventions to the unique needs of both mothers and fathers. Opportunities for critical care practice change to promote the mental health of mothers and fathers following a diagnosis of congenital heart disease are discussed.
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Pediatr Crit Care Me · Jul 2018
EditorialApplying Machine Learning to Pediatric Critical Care Data.
To explore whether machine learning applied to pediatric critical care data could discover medically pertinent information, we analyzed clinically collected electronic medical record data, after data extraction and preparation, using k-means clustering. ⋯ A standard machine learning methodology was able to determine significant medically relevant information from PICU electronic medical record data which included prognosis, diagnosis, and therapy in an unsupervised approach. Further development and application of machine learning to critical care data may provide insights into how critical illness happens to children.
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Pediatr Crit Care Me · Jul 2018
Observational StudyHybrid Extracorporeal Therapies as a Bridge to Pediatric Liver Transplantation.
Standard intensive care treatment is inadequate to keep children with liver failure alive without catastrophic complications to ensure successful transplant, as accumulation of endogenous protein-bound toxins often lead to hepatic encephalopathy, hepatorenal syndrome, cardiovascular instability, and multiple organ failure. Given paucity of proven treatment modalities for liver failure, blood purification using different extracorporeal treatments as a bridge to transplantation is used, but studies evaluating the safety and efficacy of combination of these therapies, especially in pediatric liver failure, are lacking. We describe our experience at a major tertiary children's hospital, where a unique hybrid extracorporeal treatment protocol has been instituted and followed for acute liver failure or acute-on-chronic liver failure as a bridge to transplantation. This protocol combines high-flux continuous renal replacement therapy for hyperammonemia, therapeutic plasma exchange for coagulopathy, and albumin-assisted dialysis (molecular adsorbent recirculating system) for hepatic encephalopathy. ⋯ Hybrid extracorporeal therapies can be effectively implemented in pediatric liver failure as a bridge to transplantation. Overall complexity and heavy resource utilization need to be carefully considered in instituting these therapies in suitable candidates.