Pediatr Crit Care Me
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Pediatr Crit Care Me · May 2022
Multicenter StudyReal-Time Ultrasound Guidance for Umbilical Venous Cannulation in Neonates With Congenital Heart Disease.
Umbilical venous cannulation is the favored approach to perinatal central access worldwide but has a failure rate of 25-50% and the insertion technique has not evolved in decades. Improving the success of this procedure would have broad implications, particularly where peripherally inserted central catheters are not easily obtained and in neonates with congenital heart disease, in whom umbilical access facilitates administration of inotropes and blood products while sparing vessels essential for later cardiac interventions. We sought to use real-time, point-of-care ultrasound to achieve central umbilical venous access in patients for whom conventional, blind placement techniques had failed. ⋯ Ultrasound guidance has become standard of care for percutaneous central venous access but is a new and emerging technique for umbilical vessel catheterization. In this early experience, we report that point-of-care ultrasound, together with liver pressure, can be used to markedly improve success of placement. This represents a significant advance in this core neonatal procedure.
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Pediatr Crit Care Me · Apr 2022
Multicenter Study Observational StudyTransfusion Ratios and Deficits in Injured Children With Life-Threatening Bleeding.
To assess the impact of plasma and platelet ratios and deficits in injured children with life-threatening bleeding. ⋯ In injured children, balanced resuscitation may improve early survival according to this hypothesis generating study. Multicenter clinical trials are needed to assess whether clinicians should target ratios and deficits as optimal pediatric hemostatic resuscitation practice.
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Pediatr Crit Care Me · Apr 2022
Multicenter StudyCritical Care Unit Organizational and Personnel Factors Impact Cardiac Arrest Prevention and Rescue in the Pediatric Cardiac Population.
Patient-level factors related to cardiac arrest in the pediatric cardiac population are well understood but may be unmodifiable. The impact of cardiac ICU organizational and personnel factors on cardiac arrest rates and outcomes remains unknown. We sought to better understand the association between these potentially modifiable organizational and personnel factors on cardiac arrest prevention and rescue. ⋯ Our multi-institutional analysis identified cardiac ICU bed occupancy, registered nurse experience, and physician staffing as potentially important factors associated with cardiac arrest prevention and rescue. Recognizing the limitations of measuring these variables cross-sectionally, additional studies are needed to further investigate these organizational and personnel factors, their interrelationships, and how hospitals can modify structure to improve cardiac arrest outcomes.
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Pediatr Crit Care Me · Mar 2022
Multicenter StudyDevelopmental Care Practice and Documentation Variability in the Cardiac ICU.
Describe variability in developmental care practices, as documented in the electronic health record, for infants undergoing congenital heart surgery. ⋯ There are significant, quantifiable variations in documented developmental care practices at both the individual and site level. More reliable documentation of developmental care practices is required to associate these variables with later outcomes and investigate disparities in individualized developmental care practices.
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Pediatr Crit Care Me · Mar 2022
Multicenter StudyHospital Charges Associated With Critical Bronchiolitis From 2009 to 2019.
To evaluate the contribution of PICU care to increasing hospital charges for patients with bronchiolitis over a 10-year study period. ⋯ In a multicenter cohort study of children hospitalized with bronchiolitis, PICU patients, especially low-risk children without the need for IMV, were the highest driver of increased hospital charges over a 10-year study period.