Pediatric clinics of North America
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Pediatr. Clin. North Am. · Jun 2013
Review Historical ArticleThe evolving model of pediatric critical care delivery in North America.
The past 50 years have witnessed the emergence and evolution of the modern pediatric ICU and the specialty of pediatric critical care medicine. ICUs have become key in the delivery of health care services. ⋯ The evolution of critical care medicine also has seen the rise of critical care nursing and other critical care staff collaborating in multidisciplinary teams. Delivery of optimal critical care requires standardized, reliable, and evidence-based processes, such as bundles, checklists, and formalized communication processes.
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Pediatr. Clin. North Am. · Jun 2013
ReviewAdvances in recognition, resuscitation, and stabilization of the critically ill child.
Advances in early recognition, effective response, and high-quality resuscitation before, during, and after cardiac arrest have resulted in improved survival for infants and children over the past 10 years. This review addresses several key factors that can make a difference in survival outcomes, including the etiology of pediatric cardiac arrests in and out of hospital, mechanisms and techniques of circulation of blood flow during cardiopulmonary resuscitation (CPR), quality of CPR, meticulous postresuscitative care, and effective training. Monitoring and quality improvement of each element in the system of resuscitation care are increasingly recognized as key factors in saving lives.
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Telemedicine technologies involve real-time, live, interactive video and audio communication and allow pediatric critical care physicians to have a virtual presence at the bedside of any critically ill child. Telemedicine use is increasing and will be a common technology in remote emergency departments, inpatient wards, and pediatric intensive care units. There is mounting data that demonstrate that the use of telemedicine technologies can result in higher quality of care, more efficient resource use and improved cost-effectiveness, and higher satisfaction among patients, parents, and remote providers compared to current models of care.
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Pediatr. Clin. North Am. · Jun 2013
ReviewAdvances in monitoring and management of pediatric acute lung injury.
This article focuses on the respiratory management and monitoring of pediatric acute lung injury (ALI) as a specific cause for respiratory failure. Definitive, randomized, controlled trials in pediatrics to guide optimal ventilatory management are few. ⋯ Careful monitoring of the patient's respiratory status with airway graphic analysis and capnography can be helpful. Definitive data are needed in the pediatric population to assist in the care of infants, children, and adolescents with ALI to improve survival and functional outcome.
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Pediatr. Clin. North Am. · Jun 2013
ReviewAcute kidney injury in children: an update on diagnosis and treatment.
The concept and definition of acute kidney injury (AKI) in adults and children has undergone significant change in recent years. Biomarker assessment is aiding in description, defining and understanding timing of AKI. ⋯ Treatment remains problematic, but growing experience with pediatric continuous renal replacement therapies has improved the delivery of care in children. Increasingly, continuous renal replacement therapy is provided in combination with other extracorporeal technologies, and approaches are advancing to improve combined therapy use.