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Total 141452 results found since Jan 2013.

Measurement of Dead Space Fraction Upon ICU Admission Predicts Length of Stay and Clinical Outcomes Following Bidirectional Cavopulmonary Anastomosis*
We describe an association of alveolar dead space fraction with postoperative outcomes in patients undergoing bidirectional cavopulmonary anastomosis. Design: In a retrospective case-control study, we examined for associations between alveolar dead space fraction ([PaCO2 – end-tidal CO2]/PaCO2), arterial oxyhemoglobin saturation, and transpulmonary gradient upon postoperative ICU admission with a composite primary outcome (requirement for surgical or catheter-based intervention, death, or transplant prior to hospital discharge, defining cases) and several secondary endpoints in infants following bidirectional cavopulm...
Source: Pediatric Critical Care Medicine - January 1, 2018 Category: Pediatrics Tags: Cardiac Intensive Care Source Type: research

Modification and Assessment of the Bedside Pediatric Early Warning Score in the Pediatric Allogeneic Hematopoietic Cell Transplant Population
Objectives: To determine the validity of the Bedside Pediatric Early Warning Score system in the hematopoietic cell transplant population, and to determine if the addition of weight gain further strengthens the association with need for PICU admission. Design: Retrospective cohort study of pediatric allogeneic hematopoietic cell transplant patients from 2009 to 2016. Daily Pediatric Early Warning Score and weights were collected during hospitalization. Logistic regression was used to identify associations between maximum Pediatric Early Warning Score or Pediatric Early Warning Score plus weight gain and the need for P...
Source: Pediatric Critical Care Medicine - May 1, 2018 Category: Pediatrics Tags: Quality and Safety Source Type: research

Hybrid Extracorporeal Therapies as a Bridge to Pediatric Liver Transplantation*
Conclusions: Hybrid extracorporeal therapies can be effectively implemented in pediatric liver failure as a bridge to transplantation. Overall complexity and heavy resource utilization need to be carefully considered in instituting these therapies in suitable candidates.
Source: Pediatric Critical Care Medicine - July 1, 2018 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Critical Care Compendium update
LITFL’s Critical Care Compendium is a comprehensive collection of pages concisely covering the core topics and controversies of critical care. Currently there are almost 1,500 entries with more in the works… Some pages are more developed than others, and all the pages are being constantly revised and improved. Links to new references and online resources are added daily, with an emphasis on those that are free and open access (FOAM!). These pages originated from the FCICM exam study notes created by Dr Jeremy Fernando in 2011, and have been updated, modified and added to since. As such will be particularly us...
Source: Life in the Fast Lane - November 17, 2013 Category: Emergency Medicine Doctors Authors: Chris Nickson Tags: Critical Care Compendium Education eLearning Emergency Medicine Featured CCC LITFL collection Source Type: blogs

Evaluation of Endotoxemia After Pediatric Cardiac Surgery With the Endotoxin Activity Assay: An Exploratory Prospective Cohort Study
Objective: Children with congenital heart diseases undergoing surgery with cardiopulmonary bypass are exposed to a high risk of perioperative endotoxemia. The aim of our study was to prospectively evaluate endotoxin assay activity reference levels during the postoperative phase of infants undergoing cardiac surgery for congenital heart disease and to assess their association with perioperative variables and postoperative infections. Design: Prospective exploratory single-center cohort study. Setting: Tertiary pediatric cardiac ICU. Patients: Infants undergoing cardiac surgery with cardiopulmonary bypass were enrolled. E...
Source: Pediatric Critical Care Medicine - February 1, 2016 Category: Pediatrics Tags: Online Brief Report Source Type: research

Cardiac Surgery–Associated Kidney Injury in Children and Renal Oximetry
Conclusions: Findings demonstrate that preoperative oxygen supply/demand balance is an important predictor of cardiac surgery–associated acute kidney injury, suggesting lower preoperative (and intraoperative) renal blood flow may be protective. There is not yet a definite link between remote ischemic preconditioning and prevention of cardiac surgery–associated acute kidney injury; however, renal protective effects of sublethal ischemia should continue to be explored.
Source: Pediatric Critical Care Medicine - September 1, 2018 Category: Pediatrics Tags: Cardiac Intensive Care Source Type: research

Severe Sepsis in Pediatric Liver Transplant Patients: The Emergence of Multidrug-Resistant Organisms
Conclusions: We report that multidrug-resistant organisms are increasingly being identified as causative pathogens for sepsis in pediatric liver transplant recipients and are associated with significantly higher odds for mechanical ventilation and higher organ failure. The emergence of multidrug-resistant organism infections in pediatric liver transplant patients has implications for patient outcomes, antibiotic stewardship, and infection prevention strategies.
Source: Pediatric Critical Care Medicine - July 1, 2019 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Association Between Continuous Kidney Replacement Therapy Clearance and Outcome in Pediatric Patients With Hyperammonemia Not Due to Inborn Error of Metabolism
CONCLUSIONS: In our single-center retrospective study, we failed to find an association between clearance on CKRT and improved survival nor decreased cerebral edema on head imaging. In fact, we failed to find an association between ammonia level and mortality, after controlling for illness severity.
Source: Pediatric Critical Care Medicine - July 1, 2022 Category: Pediatrics Tags: Online Brief Reports Source Type: research

High Levels of Morbidity and Mortality Among Pediatric Hematopoietic Cell Transplant Recipients With Severe Sepsis: Insights From the Sepsis PRevalence, OUtcomes, and Therapies International Point Prevalence Study*
Objectives: Pediatric severe sepsis is a major cause of morbidity and mortality worldwide, and hematopoietic cell transplant patients represent a high-risk population. We assessed the epidemiology of severe sepsis in hematopoietic cell transplant patients, describing patient outcomes compared with children with no history of hematopoietic cell transplant. Design: Secondary analysis of the Sepsis PRevalence, OUtcomes, and Therapies point prevalence study, comparing demographics, sepsis etiology, illness severity, organ dysfunction, and sepsis-related treatments in patients with and without hematopoietic cell transplant...
Source: Pediatric Critical Care Medicine - December 1, 2017 Category: Pediatrics Tags: Feature Articles Source Type: research

Reducing Pressure Injuries in a Pediatric Cardiac Care Unit: A Quality Improvement Project
The purpose of this quality improvement project was to develop an evidence-based protocol designed for pressure injury prevention for neonates and children in a pediatric cardiac care unit located in the Midwestern United States. The ultimate goal of the project was dissemination across all pediatric critical care and acute care inpatient arenas, but the focus of this initial iteration was neonates and children requiring cardiac surgery, extracorporeal support in the form of extracorporeal membranous oxygenation and ventricular assist devices in the cardiac care unit, or cardiac transplantation. A protocol based upon the N...
Source: Journal of Wound, Ostomy and Continence Nursing - November 1, 2018 Category: Nursing Tags: Wound Care Source Type: research

Therapeutic Plasma Exchange in Critically Ill Children Requiring Intensive Care
Conclusion: Our results indicate that, in specialized centers, therapeutic plasma exchange can be performed relatively safely in critically ill children, alone or in combination with continuous renal replacement therapy and extracorporeal membrane oxygenation. Outcome in children requiring therapeutic plasma exchange alone is excellent. However, survival decreases with the number of failed organs and the need for continuous renal replacement therapy and extracorporeal membrane oxygenation.
Source: Pediatric Critical Care Medicine - February 1, 2018 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Comparison of Transplant Waitlist Outcomes for Pediatric Candidates Supported by Ventricular Assist Devices Versus Medical Therapy
Objectives: Ventricular assist devices have gained popularity in the management of refractory heart failure in children listed for heart transplantation. Our primary aim was to compare the composite endpoint of all-cause pretransplant mortality and loss of transplant eligibility in children who were treated with a ventricular assist device versus a medically managed cohort. Design: This was a retrospective cohort analysis. Settings: Data were obtained from the Scientific Registry of Transplant Recipients. Patients: The at-risk population (n = 1,380) was less than 18 years old, either on a ventricular assist devi...
Source: Pediatric Critical Care Medicine - May 1, 2018 Category: Pediatrics Tags: Cardiac Intensive Care Source Type: research

Benefits of Early Mobilization After Pediatric Liver Transplantation*
Objective: To evaluate the impact of early mobilization after pediatric liver transplantation in the PICU. Design: A 70-month retrospective before-after study. Setting: Medical and surgical PICU with 20 beds at a tertiary children’s hospital. Patients: Seventy-five patients 2–18 years old who underwent liver transplantation and could walk before surgery. Intervention: We meticulously planned and implemented an early mobilization intervention, a multifaceted framework for early mobilization practice in the PICU focusing on a multidisciplinary team approach. Measurements and Main Results: There was a sig...
Source: Pediatric Critical Care Medicine - February 1, 2019 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Extracorporeal Membrane Oxygenation Support After Heart Transplantation in Children—Outcomes of a Single Center Cohort
Conclusions: Extracorporeal membrane oxygenation can be effectively used to rescue patients with graft dysfunction after heart transplantation but is associated with high early mortality. Factors associated with mortality within 12 months include presence of congenital heart disease, renal dysfunction, elevated pulmonary vascular resistance indexed to body surface area and in those supported with extracorporeal membrane oxygenation late after heart transplantation, significant human leukocyte antigen sensitization.
Source: Pediatric Critical Care Medicine - April 1, 2020 Category: Pediatrics Tags: Feature Cardiac Intensive Care Source Type: research

Shock Index, Coronary Perfusion Pressure, and Rate Pressure Product As Predictors of Adverse Outcome After Pediatric Cardiac Surgery
Conclusions: Both shock index and coronary perfusion pressure may offer predictive value for adverse outcomes following cardiac surgery in children, although they are not superior to the primary hemodynamic variables.
Source: Pediatric Critical Care Medicine - January 1, 2021 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research