evidence based care and outcomes in critically ill children

... communicate, and easier nursing care [2] It is, however, not without risk and there continues to be considerable debate regarding the optimal timing of tracheostomy In an attempt to balance the risks and ... patients randomized to the late group did not require tracheostomy points out the inherent difficulty in making this prediction In this study, this determination was made by clinicians and lacked ... the findings of reduced mortality, ICU length of stay, and duration of mechanical ventilation are quite striking, which raises the question, why? By reducing work of breathing [3] and improving...

Ngày tải lên: 12/08/2014, 22:22

... plasma DNA and C-reactive protein, N Terminal-brain natriuretic peptide or procalcitonin Plasma DNA was significantly higher in patients who died in intensive care or in the hospital following discharge ... stratification and prediction of inhospital and overall morbidity and mortality in a range of conditions including stroke [6], myocardial infarction [11], cancer [8] and trauma [12] In stroke patients, ... UK), using primers for the β-globin gene, a housekeeping gene involved in the formation of a functioning haemoglobin molecule This gene has been used successfully in previous studies measuring plasma...

Ngày tải lên: 12/08/2014, 23:23

... creatinine • In our study, correlations with creatinine clearance and creatinine clearance estimated by Schwartz formula are better for cystatin C and beta2-microglobulin than for serum creatinine ... low-molecular-weight proteins in critically ill children The aim of this study was to evaluate the accuracies of serum Cr, serum cystatin C, and B2M as markers of GFR in critically ill children by comparing their ... creatinine in our study • In our experience, serum cystatin C and beta2microglobulin are confirmed as simple and useful markers, better than serum creatinine, to detect acute kidney disease in critically...

Ngày tải lên: 13/08/2014, 03:21

... Stricker K, Einfalt J, Bauer P, Metnitz PG, Moreno RP, Takala J: Variability in outcome and resource use in intensive care units Intensive Care Med 2007, 33:1329-1336 Guidelines for intensive care unit ... Mechanical ventilation in critically ill cancer patients: outcome and utilisation of resources Support Care Cancer 1999, 7:95-99 Hinds CJ, Martin R, Quinton P: Intensive care for patients with ... of the European Society of Intensive Care Medicine Intensive Care Med 1996, 22:707-710 Piccirillo JF, Wells CK, Sasaki CT, Feinstein AR: New clinical severity staging system for cancer of the...

Ngày tải lên: 13/08/2014, 11:22

... Effect of intensive insulin therapy on insulin sensitivity in the critically ill J Clin Endocrinol Metab 2007, 92:3890-3897 28 Faustino EV, Apkon M: Persistent hyperglycemia in critically ill children ... with insulin in critically ill patients Lancet 2005, 365:53-9 Andreelli F, Jacquier D, Troy S: Molecular aspects of insulin therapy in critically ill patients Curr Opin Clin Nutr Metab Care 2006, ... absolute insulin deficiency Those children may derive clinical benefit from insulin replacement, analogous to using insulin to treat type DM Practitioners may need to rethink insulin administration and...

Ngày tải lên: 13/08/2014, 15:22

... assessment (SOFA) and serum creatinine at CRRT initiation and CRRT downtime (hours); for IRRT the covariates included were age (10-years increments), sex and RIFLE class at IRRT initiation In addition ... HM, Ronco C: Beginning and Ending Supportive Therapy for the Kidney (B.E.S.T Kidney) Investigators Writing Committee Patient and kidney survival by dialysis modality in critically ill patients with ... Critical Care Vol 13 No Vesconi et al Introduction Materials and methods Acute kidney injury (AKI) requiring renal replacement therapy (RRT) occurs in to 6% of critically ill patients and is associated...

Ngày tải lên: 13/08/2014, 16:20

... critical care trials group: Prophylaxis against deep vein thrombosis in critically ill patients with severe renal insufficiency with low molecular weight heparin dalteparin; An assessment of safety and ... competing interests Published: 12 May 2010 References Robinson S, Zincuk A, Strom T, Larsen TB, Rasmussen B, Toft P: Enoxaparin effective dosage for intensive care patients: double blinded randomised ... with anti-Xa, anti-IIa activities, and D-dimer plasma levels in patients receiving a low molecular weight heparin, enoxaparin or tinzaparin, to prevent deep vein thrombosis after hip surgery Br...

Ngày tải lên: 13/08/2014, 20:22

... helpful in answering some of these questions Even in the absence of such evidence, it would seem prudent our best to minimize sedation and to initiate PT/OT as early as possible Competing interests ... competing interests Author details Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA 2The Clinical Research, Investigation, and Systems Modeling of Acute Illness ... reinitiate sedation, the timing of extubation, and ICU and hospital discharge that may have accounted for differences in outcomes Finally, despite reduction in days with delirium no information is provided...

Ngày tải lên: 13/08/2014, 21:21

... the minimum amount required for processing and storage Urine processing was similar to that in previous studies [18,19], in order to limit variations in findings resulting from differences in sample ... another urinary AKI biomarker, interleukin-18, is elevated in critically ill adult patients who later die, which can complicate the interpretation of urinary interleukinn-18 in the most severely ill ... analysis sample handling required minimal time and effort (approximately 10 min) DeSamples were shipped to Cincinnati Children' s Hospital Medical Center for uNGAL and creatinine measurement;...

Ngày tải lên: 13/08/2014, 08:20

... required that combine pharmacokinetics and pharmacodynamics with continuous EEG and BIS monitoring to determine the safety and efficacy of barbiturate-induced comas in children Competing interests The ... medical intensive care: applications and limitations Intensive Care Med 1990, 16:60-68 Grindstaff RJ, Tobias JD: Applications of bispectral index monitoring in the pediatric intensive care unit J Intensive ... barbiturate-induced coma in critically ill children who require intensive neuro-monitoring For this purpose, BIS recordings were compared with standard full-channel EEG recordings Materials and methods Patients...

Ngày tải lên: 13/08/2014, 08:20

... blood flows, thus increasing capillary shear forces and reducing protein layering, with the consequent decrease in membrane clotting and the prolongation of filter life [6] In a prospective study, ... and participated in the study design, data collection and analysis, and drafting of the manuscript EC, JU, SM, and MJS participated in the data collection and analysis and drafting of the manuscript ... receiving continuous renal replacement therapy Kidney Int 2005, 67:653-658 Fernández C, López-Herce J, Flores JC, Galaviz D, Rupérez M, Brandstrup KB, Bustinza A: Prognosis in critically ill children...

Ngày tải lên: 13/08/2014, 11:22

... continuous renal replacement therapy in children Kidney Int 2009, 75:312-316 Demirjian S, Teo BW, Paganini EP: Alkalemia during continuous renal replacement therapy and mortality in critically ill ... hypochloremia, and hypophosphatemia increased significantly during CRRT, requiring an increase in the concentration of these electrolytes in the dialysis and replacement fluids and/ or intravenous ... Spain) in the first 35 patients and the Prisma (Hospal®, Barcelona, Spain) in the remaining 139 The caliber of the catheters used was between 4F and 11F and the filters were between 0.04 m2 and...

Ngày tải lên: 13/08/2014, 20:21

... storage time and clinical outcome in critically ill children • In critically ill children, transfusion of RBC units stored for 14 days or longer is independently associated with an increased occurrence ... Goldstein B, Hanson J, Li H, Randolph A: Anemia, blood loss, and blood transfusions in North American children in the intensive care unit Am J Resp Crit Care Med 2008, 178:26-33 Spinella PC, Perkins ... transfusions and nosocomial infections in critically ill patients Crit Care Med 2006, 34:2302-2308 quiz 2309 44 Bilgin YM, Watering LM van de, Eijsman L, Versteegh MI, Brand R, van Oers MH, Brand A:...

Ngày tải lên: 13/08/2014, 20:21

... without septal lines 45 interstitial edema with septal lines 50 mixed interstitial and alveolar edema with some sparing of pulmonary region 55 mixed interstitial and alveolar edema involving entire ... minute and indexed to body surface area (l/min/m2) Global end diastolic volume is expressed in milliliters and indexed to body surface area (ml/m2) Extravascular lung water is also expressed in ... measured in critically ill children using the transpulmonary thermodilution technique does not correlate with a chest x-ray score of pulmonary edema • Extravascular lung water in critically ill children...

Ngày tải lên: 13/08/2014, 20:22

... repair 13 26 survived 10 M 36 15.0 Meningococcal disease survived 11 M 9.0 Meningococcal disease survived 12 F 14 10.0 Meningococcal disease 28 survived 13 M 9.0 Inborn error of metabolism 12 88 survived ... Drowning 19 17 85 Patient Age Weight number Gender (months) (kg) F 24 Probability of death PIM % Outcome 60 survived F 83 18.0 Reconstruction of pulmonary artery 18 16 survived F 23 14.0 Abdominal ... 16 survived F 23 14.0 Abdominal surgery 78 17 survived F 8.5 RSV 16 15 11 survived F 31 16.0 Meningococcal disease 22 19 survived F 4.8 Arterial switch operation 13 10 39 survived F 7.1 Tetrology...

Ngày tải lên: 13/08/2014, 21:21

... detecting a correlation Values were reported from 24 patients and the reasons for treatment in the intensive care unit were quite variable The primary diagnosis necessitating treatment in the intensive ... useful in children, indexing is likely to be relevant in this cohort where the range of reported weights is up to 152  kg EVLW was inversely correlated with height in this study; this finding supports ... routinely in clinical practice may have limited value in young children Lemson and colleagues’ study, however, raises many important questions that should prompt further research in this field in...

Ngày tải lên: 13/08/2014, 21:21

... male with traumatic brain injury requiring mechanical ventilation and norepinephrine to maintain his cerebral perfusion pressure The arrows indicate when insulin was started and stopped per our ... variety of critically ill children • Our findings suggest that with further examination, existing CGM technology may be a useful adjunct in the detection and management of glucose disorders in critically ... most robust evidence to date that these devices can be used safely and provide clinically meaningful information, even in the smallest and most critically ill pediatric patients In conjunction...

Ngày tải lên: 13/08/2014, 21:21

... M, Phillips R, Davis R, Desbiens N, Connors A, Teno J: Outcomes and cost-effectiveness of initiating dialysis and continuing aggressive care in seriously ill hospitalized adults SUPPORT Investigators ... severe enough, in the opinion of the treating intensivist, to warrant the initiation of RRT This definition was selected because the initiation of RRT in critically ill patients has clinical relevance ... in 68 (28%), hyperkalemia in 59 (25%), and toxins in (2%) The modality of renal replacement in the ICU was exclusively CRRT in 147, exclusively IHD in 48, and some combination of regimens using...

Ngày tải lên: 12/08/2014, 23:20

... significance: points in zone A have no clinical implications (clinically accurate measurement), and points in zone B lead to an appropriate clinical decision Only points lying in zones C, D, and E would ... Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R: Intensive insulin therapy in critically ill patients N Engl J Med 2001, 345:1359-1367 Krinsley JS: Effect of an intensive ... (Figure 3) Ninety-four point three percent of values were inside the 95% confidence interval In the Clarke error grid, 87.3% were in zone A and 100% were in the clinically acceptable zones A and B...

Ngày tải lên: 13/08/2014, 03:20

... members (starting during the phase when the patient is still unconscious) by promoting family-centred decision-making and supporting next of kin to choose appropriate interactions during their bedside ... medications and timing of return to previous employment at 12 months During the ICU stay, sedation was induced using propofol, fentanyl and/ or midazolam infusions, depending on the patient’s clinical ... clinical psychologists and a trained and supervised staff of intensivists and nurses, whose purpose is to provide emotional support and coping strategies to conscious patients with critical illness...

Ngày tải lên: 14/08/2014, 07:21