Pediatr Crit Care Me
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Pediatr Crit Care Me · Jan 2008
Multicenter StudyEnd-of-life practices in seven Brazilian pediatric intensive care units.
To evaluate the incidence of life support limitation and medical practices in the last 48 hrs of life of children in seven Brazilian pediatric intensive care units (PICUs). ⋯ The incidence of life support limitation has increased among Brazilian PICUs but with significant regional differences. Do-not-resuscitate orders are still the most common practice, with scarce initiatives for withdrawing or withholding life support measures.
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Pediatr Crit Care Me · Jan 2008
Multicenter StudyPediatric interhospital transport: diagnostic discordance and hospital mortality.
Determine the rate of discordance between the reason for transport (determined by referring institution) and the final diagnosis (determined by accepting institution), identify factors associated with diagnostic discordance, and determine whether diagnostic discordance is associated with mortality and morbidity. ⋯ Discordance between primary reason for transport and diagnosis category is common in the pediatric interhospital transport population. Although discordance does not appear to lead to increased mortality, further study is needed to determine the impact of diagnostic discordance on other patient outcomes.
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Pediatr Crit Care Me · Jul 2007
Multicenter Study Comparative StudyParental involvement in treatment decisions regarding their critically ill child: a comparative study of France and Quebec.
To examine whether physicians or parents assume responsibility for treatment decisions for critically ill children and how this relates to subsequent parental experience. A significant controversy has emerged regarding the role of parents, relative to physicians, in relation to treatment decisions for critically ill children. Anglo-American settings have adopted decision-making models where parents are regarded as responsible for such life-support decisions, while in France physicians are commonly considered the decision makers. ⋯ It was remarkable that a certain degree of medical paternalism was unavoidable, regardless of the legal and ethical norms that were in place. This may not necessarily harm parents' moral experiences. Further research is required to examine parental decisional experience in other pediatric settings.
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Pediatr Crit Care Me · Jul 2007
Multicenter Study Comparative StudyContinuous venovenous hemofiltration with or without extracorporeal membrane oxygenation in children.
We report the frequency of usage, patient demographics, and outcomes in children treated with continuous venovenous hemofiltration (CVVH) in three pediatric intensive care units (PICUs), with one unit providing combined extracorporeal membrane oxygenation (ECMO) and CVVH. ⋯ Performing CVVH in a heterogeneous population with large age and weight ranges poses significant clinical and technical challenges. The low frequency of CVVH use, as well as the use of other extracorporeal therapies, also raises problems with maintaining nursing skills. Objective clinical and biochemical markers for commencing CVVH alone or in combination with ECMO remain to be defined.
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Pediatr Crit Care Me · Jul 2007
Multicenter StudyAcute lung injury in pediatric intensive care in Australia and New Zealand: a prospective, multicenter, observational study.
Acute lung injury (ALI) is poorly defined in children. The objective of this prospective study was to clarify the incidence, demographics, management strategies, outcome, and mortality predictors of ALI in children in Australia and New Zealand. ⋯ ALI in children is uncommon but has a high mortality rate. Risk factors for mortality are easily identified. Ventilatory variables and indexes of lung severity were significantly associated with mortality.