Journal of pediatric intensive care
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Sugammadex is a novel pharmacologic agent, which reverses neuromuscular blockade with a mechanism that differs from acetylcholinesterase inhibitors such as neostigmine. There is a growing body of literature demonstrating its efficacy in pediatric patients of all ages. Prospective trials have demonstrated a more rapid and more complete reversal of rocuronium-induced neuromuscular blockade than the acetylcholinesterase inhibitor, neostigmine. ⋯ It may also be effective in situations where reversal of neuromuscular blockade is problematic including patients with neuromyopathic conditions or when acetylcholinesterase inhibitors are contraindicated. This article reviews the physiology of neuromuscular transmission as well as the published literature, regarding the use of sugammadex in pediatric population including the pediatric intensive care unit population. Clinical applications are reviewed, adverse effects are discussed, and dosing algorithms are presented.
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The initial host immune response to sepsis in children is characterized by a proinflammatory surge that can be associated with fever, capillary leak, and organ dysfunction. There is, however, a concurrent anti-inflammatory response that results in hyporesponsiveness of innate and adaptive immune cells. ⋯ While anti-inflammatory therapies have largely been unsuccessful at improving outcomes from adult and pediatric sepsis, the use of immunostimulatory therapies such as granulocyte macrophage colony-stimulating factor (GM-CSF) in patients with sepsis-induced immunoparalysis shows promise. A greater understanding of the risk factors for immunoparalysis along with the development and execution of immunophenotype-specific clinical trials of strategies to optimize innate and adaptive immune function are needed to further improve outcomes in septic children.
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J Pediatr Intensive Care · Sep 2018
ReviewManagement of the Difficult Airway in the Pediatric Patient.
Loss of airway control in children, if not resolved quickly, will lead to devastating consequences. Successful management of the pediatric difficult airway, both anticipated and unanticipated, is facilitated by preprocedure assessment and preparation. ⋯ This review outlines the importance of airway assessment and advanced airway equipment for children. It also discusses difficult airway management techniques and algorithms for the management and rescue of the pediatric difficult airway.
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When confounding variables exist that inhibit the ability to diagnose brain death clinically in pediatric patients, ancillary tests may provide additional information for the practitioner in evaluating for the presence or absence of brain death. Multiple options exist but differ in availability, ease of administration, cost, safety profile, and reliability to accurately diagnose brain death. ⋯ At this time, there is not an ancillary test with 100% reliability in diagnosing brain death that can replace the clinical brain death exam. Therefore, practitioners need to understand the strengths and limitations of the ancillary studies available at their hospital.
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J Pediatr Intensive Care · Sep 2014
ReviewEthical challenges with the advancement of hematopoietic stem cell transplant.
Advancements in medical science and pediatric intensive care have significantly improved outcomes for children undergoing hematopoietic stem cell transplantation (HSCT). Critical care management of HSCT patients requires pediatric intensivists to deal with ethical issues including aggressiveness of care and futility, limiting treatment, shared decision-making with families of critically ill children, and decision-making in the context of multi-disciplinary management of complex patients. This paper will discuss the fundamental ethical principles to enable pediatric intensivists to address questions of medical decision-making. ⋯ A framework for end of life communication with families will be provided. Finally, this paper will discuss the potential conflicts resulting from multi-disciplinary care of the HSCT patient in the pediatric intensive care unit. As medical management of the HSCT patient continues to evolve, awareness of the ethical issues surrounding their care is important for both patient and provider.