Pediatr Crit Care Me
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Pediatr Crit Care Me · Nov 2020
Observational StudyParental Mental Health Care After Their Child's Pediatric Intensive Care Hospitalization.
Post-traumatic stress disorder, depression, and anxiety have all been found in parents of PICU survivors. How these research findings translate to actual use of mental health services by parents remains unknown. ⋯ After their child's PICU hospitalization, the proportion of parents with a new mental health diagnosis nearly doubled. Mothers were at nearly twice the risk of receiving a new mental health diagnosis and receiving a new mental health medication compared with fathers. The proportion of parents receiving mental healthcare is much lower than the proportion reporting mental health symptoms in long-term outcomes studies. Whether this indicates a gap in healthcare delivery for parents with mental health symptoms remains unknown.
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Pediatr Crit Care Me · Nov 2020
Observational StudyComprehensive Detection of Candidate Pathogens in the Lower Respiratory Tract of Pediatric Patients With Unexpected Cardiopulmonary Deterioration Using Next-Generation Sequencing.
Next-generation sequencing has been applied to the investigation of microorganisms in several clinical settings. We investigated the infectious etiologies in respiratory specimens from pediatric patients with unexpected cardiopulmonary deterioration using next-generation sequencing. ⋯ Our results suggest that viral and bacterial infections are common triggers in unexpected cardiopulmonary deterioration in pediatric patients. Next-generation sequencing has the potential to contribute to clarification of the etiology of pediatric critical illness.
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Mechanical ventilation of patients with acute respiratory distress syndrome should balance lung and diaphragm protective principles, which may be difficult to achieve in routine clinical practice. Through a Phase I clinical trial, we sought to determine whether a computerized decision support-based protocol (real-time effort-driven ventilator management) is feasible to implement, results in improved acceptance for lung and diaphragm protective ventilation, and improves clinical outcomes over historical controls. ⋯ A computerized decision support-based protocol prioritizing lung-protective ventilation balanced with reduction of controlled ventilation to maintain physiologic levels of patient effort can be implemented and may be associated with shorter duration of ventilation.
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Pediatr Crit Care Me · Nov 2020
Clinical Characteristics and Outcomes for Neonates, Infants, and Children Referred to a Regional Pediatric Intensive Care Transport Service for Extracorporeal Membrane Oxygenation.
To describe the clinical characteristics and outcomes of referrals for extracorporeal membrane oxygenation to a regional pediatric intensive care transport service, and identify clinical features at initial referral that predict the eventual need for extracorporeal membrane oxygenation. ⋯ In this large cohort of neonatal and pediatric extracorporeal membrane oxygenation referrals to a pediatric intensive care transport service, a considerable portion of extracorporeal membrane oxygenation referrals (59.6%) continued on conventional management; however, 8.8% of the referrals died before extracorporeal membrane oxygenation could be provided. Earlier referral for extracorporeal membrane oxygenation; targeted referral triage using primary diagnosis, oxygenation index, and Vasoactive-Inotropic Score; and access to mobile extracorporeal membrane oxygenation services and faster mobilization of transport teams are important factors that could improve outcomes.