Pediatr Crit Care Me
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Pediatr Crit Care Me · May 2009
Randomized Controlled TrialEffect of alternative chest compression techniques in infant and child on rescuer performance.
Current chest compression (CC) guidelines for an infant recommend a two-finger (TF) technique with lone rescuer and a two- thumb (TT) technique with two rescuers, and for a child either an one hand (OH) or a two hand (TH) technique with one or two rescuers. The effect of a 30:2 compression:ventilation ratio using these techniques on CC quality and rescuer fatigue is unknown. We hypothesized that during lone rescuer CC, TT technique, in infant and TH in child achieve better compression depth (CD) without additional rescuer fatigue compared with TF and OH, respectively. ⋯ Two-thumb compression provides higher CD and CP compared with TF without any evidence of decay in quality and additional rescuer fatigue over 5 minutes. There was no significant difference in child CC quality or rescuer fatigue between OH and TH. Two-thumb technique is preferred for infant CC and our data support the current guidelines for child CC.
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Pediatr Crit Care Me · May 2009
Blood product transfusions and clinical outcomes in pediatric patients with acute lung injury.
There are data suggesting that blood product transfusions increase the risk of developing acute lung injury (ALI) in adults, and may be associated with increased mortality in adults with ALI. A possible association between transfusions and adverse outcomes of pediatric patients with ALI has not been studied previously. We tested the hypothesis that blood product transfusions to pediatric patients with ALI within the first 72 hours of the diagnosis would be associated with increased mortality and prolonged mechanical ventilation. ⋯ The transfusion of FFP is associated with an increased risk of mortality in children with ALI. The association between FFP and mortality in children with ALI should be investigated further.
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Pediatr Crit Care Me · May 2009
CommentA critical appraisal of "transfusion strategies for patients in pediatric intensive care units" by Lacroix J, Hebert PC, Hutchison, et al (N Engl J Med 2007; 356:1609-1619).
To review the findings and discuss the implications of transfusion strategies in stable critically ill children. ⋯ Using a restrictive transfusion protocol with a transfusion threshold of 7 g/dL in stable critically ill children is as safe as using a liberal protocol and can decrease the number of patients exposed to RBC transfusions.
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Pediatr Crit Care Me · May 2009
Reduction of hospital mortality and of preventable cardiac arrest and death on introduction of a pediatric medical emergency team.
To determine the effect of a medical emergency team (MET) on the incidence of unexpected cardiac arrest and death. ⋯ Introduction of a MET was associated with reduction of total hospital death and reduction of preventable cardiac arrest and death with increased survival in wards of a pediatric hospital. MET calling criteria identified some but not all children at risk of unexpected cardiac arrest and death.
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Pediatr Crit Care Me · May 2009
Case ReportsInfantile iron poisoning: challenges in diagnosis and management.
To describe the clinical course and treatment of an infant with iron poisoning. ⋯ This case illustrates the importance of including toxic exposure in the differential diagnosis of neonatal shock of unknown etiology. Because of physiologic immaturity, iron poisoning in young infants poses special diagnostic and therapeutic challenges.