Pediatr Crit Care Me
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Pediatr Crit Care Me · May 2007
Case ReportsInstitutional policies on determination of medically inappropriate interventions: use in five pediatric patients.
To describe recent experience using the Texas Advance Directives Act to facilitate care of terminally ill children managed in the two tertiary pediatric hospitals of the Texas Medical Center, Houston, TX. ⋯ Use of institutional policies in accordance with the Texas Advance Directives Act may assist in the care of terminally ill children and their families.
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Pediatr Crit Care Me · May 2007
Mortality before and after initiation of a computerized physician order entry system in a critically ill pediatric population.
A worrisome increase in mortality has been reported recently following the initiation of a computerized physician order entry (CPOE) system in a critically ill pediatric transport population. We tested the hypothesis that such a mortality increase did not occur after the initiation of CPOE in a pediatric population that was directly admitted to the neonatal and pediatric intensive care units at Montefiore Medical Center during two 6-month periods before CPOE and one 6-month period immediately after CPOE was initiated. Mortality in the pre- and post-CPOE time periods was compared, and adjustment for potentially confounding covariates was performed. ⋯ Mortality did not increase during CPOE initiation.
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Pediatr Crit Care Me · May 2007
Pertussis: severe clinical presentation in pediatric intensive care and its relation to outcome.
To describe our institutional experience in the management of infants and children with pertussis admitted during a 20-yr period (January 1985 through December 2004) and also to study the relation between method of presentation and outcome. ⋯ Patients with pertussis, presenting as apnea (with or without cough paroxysms), treated in the pediatric intensive care unit had 100% survival. However, pneumonia as the main reason for admission and the need for circulatory support is associated with a very poor outcome. A deeper understanding of the molecular basis of Bordetella pertussis and its relation to the human host might offer means for future therapies.
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Pediatr Crit Care Me · May 2007
Case ReportsSuccessful use of extracorporeal membrane oxygenation in severe necrotizing pneumonia caused by Staphylococcus aureus.
To report the successful use of extracorporeal membrane oxygenation (ECMO) as rescue therapy for severe necrotizing pneumonia secondary to infection by the Staphylococcus aureus species. ⋯ ECMO as rescue support should be considered in a timely fashion for refractory hypoxemic respiratory failure resulting from S. aureus pneumonia, including patients with necrotizing pneumonia. Use of ECMO support in such cases, coupled with aggressive measures aimed at minimizing bleeding, such as the use of activated factor VII, may result in excellent short- and long-term outcomes for such patients.
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Pediatr Crit Care Me · May 2007
Transhepatic Broviac catheter placement for long-term central venous access in critically ill children with complex congenital heart disease.
Critically ill children with cardiac disease often require prolonged central venous access. Thrombosis of systemic veins or the need to preserve vessels for future cardiac procedures limits sites for placement of central venous catheters in these patients. This study evaluates the use of Broviac placement via the transhepatic approach for this patient population. ⋯ Transhepatic Broviac catheters can be used safely in critically ill children with cardiac disease and remain indwelling for adequate periods of time. This modality of prolonged vascular access should be considered for children whose veins are occluded or need to be preserved for future procedures.