Pediatr Crit Care Me
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Pediatr Crit Care Me · Jan 2019
ReviewPain and Sedation Management: 2018 Update for the Rogers' Textbook of Pediatric Intensive Care.
To review important articles on pain, sedation, sleep, and delirium in the field of pediatric critical care published subsequent to the fifth edition of the Rogers' Textbook of Pediatric Critical Care. ⋯ Recent research into pediatric pain and sedation management has focused on optimizing the choice of sedative medications, in particular by increasing the use and understanding of nonopioid and nonbenzodiazepine options such as ketamine and alpha-2 agonists. Delirium has emerged as a significant morbidity in the critically ill pediatric patient, and recent articles have concentrated on the use of validated screening tools to determine the epidemiology and risk factors in specific populations, including patients with cardiac disease and those receiving extracorporeal membrane oxygenation. A consistent theme in the most recent literature is the role of titrated but effective sedation, quality improvement to increase delirium recognition, and optimizing the pediatric intensive care environment to promote sleep.
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Pediatr Crit Care Me · Jan 2019
Noninvasive Ventilation During Pediatric and Neonatal Critical Care Transport: A Systematic Review.
Noninvasive ventilation is increasingly used in neonatal and pediatric patients, but the intensive care transport setting is lagging in terms of availability of noninvasive ventilation for children. The objective of this systematic review of the literature was to answer the question: In children 0 days to 18 years old, who are hospitalized with acute respiratory distress and require critical care transport, is noninvasive ventilation effective and safe during transport? ⋯ This review found observational study evidence of a rate of intubation or escalation of 0.4% during noninvasive ventilation transport of children 0-18 years old, with an in-transport adverse event rate of 1-4%. Further studies are required. If randomized trials are not possible, it is suggested that well-conducted observational studies are reported in a more standardized manner.