Story Category: PICU

Upvote Story 11
There were both similarities and differences in tracheal intubation practice and outcomes across international PICUs. Fewer adverse tracheal intubation–associated events were reported from International versus North American PICUs. International PICUs used cuffed endotracheal tube less often and had higher proportion of endotracheal tube change. Adverse tracheal intubation–associated events and desaturation occurrence (oxygen saturation < 80%) were evaluated. A total of 1,134 and 9,376 TIs from... Read More | Comment
Upvote Story 10
Pediatric critical care nephrology is a complex and highly specialized field, presenting challenges and management strategies that are often quite distinct from those seen in adult practice. Therefore, it is high time to address all the topics in the field of critical care nephrology in children in a unique book which is the first of its kind. This book covers the basics as well as... Read More | Comment
Upvote Story 7
The safety of cuffed endotracheal tubes in the neonatal and critically ill pediatric population continues to be questioned due to the theoretical risk of acquired subglottic stenosis. The incidence of acquired subglottic stenosis in the high-risk mixed surgical and medical critically ill pediatric cohort using high-volume, low-pressure cuffed endotracheal tube policy has not yet been described. We report no single case of acquired subglottic stenosis... Read More | Comment
Upvote Story 4
Mobilization of critically ill children, many with central lines, endotracheal tubes, and other life-saving devices, is associated with potential risks and complications. Hence, concerns about safety often guide staff perceptions about PICU mobility. These complications may include, but are not limited to, hemodynamic instability, accidental tube or line dislodgement, falls, pain, and anxiety. However, multiple studies have reported that early mobilization of critically ill children... Read More | Comment
Upvote Story 8
Severe traumatic brain injury is a clinically heterogeneous disease that can be accompanied by a range of neurologic impairment and a variety of injury patterns at presentation. This secondary analysis of prospectively collected data identifies several characteristics associated with outcome among children with severe traumatic brain injury. Future, larger trials are needed to better characterize phenotypes within this population. Baseline, clinical, and CT characteristics of... Read More | Comment
Upvote Story 5
The mortality rate is lower among children admitted to specialist pediatric intensive care units (ICUs) than among those admitted to mixed adult and pediatric units in non-tertiary hospitals. In the UK, however, few children receive intensive care in specialist pediatric units. We compared the ICU mortality rate in children from the area of the Trent Health Authority, UK, with the rate in children from Victoria,... Read More | Comment
Upvote Story 10
The proportion of pediatric patients undergoing percutaneous extracorporeal membrane oxygenation cannulation is increasing. Mechanical and physiologic complications occur with both methods of cannulation, but percutaneous cannulation appears safe in this cohort. Further analysis is needed to evaluate long-term outcomes with this technique. Of 3,501 patients identified, 77.2% underwent open cannulation, with the frequency of open cannulation decreasing over the study period from approximately 80% to... Read More | Comment
Upvote Story 11
If you mainly treat adults or both adults and children like me, then you have probably heard the (very annoying) quote, “kids are not just small adults”, and so I won’t say it again. Well, I guess I just did, but at least I wont stop at this quote, but attempt to explain how kids are not small adults, and how this may impact their... Read More | Comment
Upvote Story 12
A valuable resource for certification preparation and the daily nutrition care of pediatric patients focusing on the importance of nutrition to the growth and development of children. Written with an interdisciplinary evidence-based approach, it is designed to meet the educational needs of any discipline involved in the nutrition care of pediatric patients. This edition features 37 fully revised and updated chapters and is designed to... Read More | Comment
Upvote Story 4
Sepsis in children is typically presumed to be bacterial in origin until proven otherwise, but frequently bacterial cultures ultimately return negative. Although the incidence of viral-induced sepsis is not precisely known, it is suspected to be common and may represent an important subset of children with “culture-negative sepsis.” It is therefore critical for clinicians to suspect and test for viral infection in children with culture-negative... Read More | Comment
Upvote Story 5
Since bronchiolitis is a clinical diagnosis, there is no test, including viral testing and radiography, which rules it in or out (Schuh et al 2007). Sadly, despite multiple guidelines (NICE, AAP, CPS), there has also been no “magic bullet” in terms of treatment. Hypertonic saline has been tried for acute bronchiolitis. A systematic review of this treatment modality was covered on SGEM#157. The bottom line... Read More | Comment
Upvote Story 3
Improvements in acute respiratory distress syndrome (ARDS) outcomes in adults have been achieved along-side demonstration of the superiority of low-tidal volume ventilation, the relative advantage of a restrictive fluid strategy and the characterization of the main effectors of ventilator-induced lung injury. The heterogeneity of the group of patients defined as “ARDS” on pragmatic criteria is widely recognized. “Lumping” together patients with different ages, etiologies, time... Read More | Comment
Upvote Story 6
Margaret Parker, MD, MCCM, speaks with Stefanie G. Ames, MD, about the article “Hospital Variation in Risk-Adjusted Pediatric Sepsis Mortality,” published in the May 2018 issue of Pediatric Critical Care Medicine. Dr. Ames discusses study findings regarding the development of a method to evaluate hospital pediatric sepsis performance and how to assess hospital variation in risk-adjusted sepsis mortality in a large state-wide sample. Dr. Ames... Read More | Comment
Upvote Story 9
While representing the cutting edge of civilization everywhere, mothers and their newborn infants are a population particularly vulnerable to sepsis.1 By recognizing the importance of antiseptic prophylaxis (handwashing), Ignaz Semmelweis directly confronted this particular human sepsis vulnerability and simultaneously codified maternal/neonatal sepsis and infection prevention. Accordingly he has been hailed as the “Defender of Motherhood.” However, despite this seminal discovery nearly 170 years ago, maternal/neonatal... Read More | Comment
Upvote Story 7
Aminophylline administration provided a measure of increased diuresis, regardless of dosage, and theophylline trough levels. Therefore, achieving a prescribed therapeutic trough level may not be necessary for full diuretic effect. Because, as opposed to the diuretic effect, the side effect profile of aminophylline is dose-dependent, low maintenance dosing may optimize the balance between providing adjunctive diuretic effect while minimizing the risk of toxicity. Patient cohort... Read More | Comment