Pediatr Crit Care Me
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Pediatr Crit Care Me · May 2006
Multicenter StudyENHANCE: results of a global open-label trial of drotrecogin alfa (activated) in children with severe sepsis.
To gather additional 28-day all-cause mortality data and safety information for pediatric patients with severe sepsis who received drotrecogin alfa (activated) (DrotAA). ⋯ Without a placebo control, no efficacy conclusions are possible. Subgroups at higher risk of death were identified, and the change in protein C level from baseline was predictive of survival. The most significant complication observed was bleeding. Risk factors for serious bleeding appear to be multiple organ failure, thrombocytopenia, and coagulopathy.
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Pediatr Crit Care Me · Jan 2006
Multicenter StudyCapturing postoperative pain responses in critically ill infants aged 0 to 9 months.
The purpose of this study was to describe physiologic and behavioral pain behaviors in postoperative critically ill infants. A secondary aim was to identify how these pain responses vary over time. ⋯ Findings support the ability to capture different intensities of postoperative pain in critically ill infants beyond neonatal age. These pain indicators can be used for the development of a pain assessment tool for this group of infants.
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Pediatr Crit Care Me · Jan 2006
Multicenter StudyVariation in pediatric intensive care therapies and outcomes by race, gender, and insurance status.
The differential allocation of medical resources to adult patients according to characteristics such as race, gender, and insurance status raises the serious concern that such issues apply to critically ill children as well. ⋯ Risk-adjusted mortality and resource use for critically ill children did not differ according to race, gender, or insurance status. Policies to expand health insurance to children appear more likely to affect physiologic derangement on admission rather than technical quality of care in the pediatric intensive care unit setting.
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Pediatr Crit Care Me · Jul 2005
Multicenter StudySteroid use before pediatric cardiac operations using cardiopulmonary bypass: an international survey of 36 centers.
Steroid administration before pediatric cardiac operations using cardiopulmonary bypass has been shown to modulate the inflammatory response and reduce myocardial injury. We hypothesized that current steroid administration practices among pediatric cardiac surgical centers are highly variable. ⋯ Although nearly all centers surveyed administer steroids before cardiopulmonary bypass, the type, dosing, route, and timing of administration are highly variable. The inconsistencies in these data and the pediatric literature would support the undertaking of a large, multiple-center clinical trial to evaluate the risks and benefits of steroid administration before pediatric cardiopulmonary bypass.
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Pediatr Crit Care Me · Jul 2005
Multicenter Study Comparative StudyGram-negative bacilli associated with catheter-associated and non-catheter-associated bloodstream infections and hand carriage by healthcare workers in neonatal intensive care units.
Bloodstream infections caused by Gram-negative bacilli are a substantial cause of morbidity and mortality in infants in neonatal intensive care units. This study describes the species of Gram-negative bacilli causing bloodstream infections in two neonatal intensive care units, compares characteristics of catheter-related and non-catheter-related bloodstream infections, and compares species and antibiotic resistance patterns of these organisms with those isolated from the hands of nurses working in the same neonatal intensive care units. ⋯ Gram-negative bacilli species isolated from neonatal bloodstream infections and nurses' hands varied significantly. Clean hands of providers are an unlikely source of endemic Gram-negative bacilli, suggesting that prevention strategies should focus more on control of endogenous neonatal flora or environmental sources.