Objectives: To update the American Academy of Pediatrics and Society of Critical Care Medicine’s ... more Objectives: To update the American Academy of Pediatrics and Society of Critical Care Medicine’s 2004 Guidelines and levels of care for PICU. Design: A task force was appointed by the American College of Critical Care Medicine to follow a standardized and systematic review of the literature using an evidence-based approach. The 2004 Admission, Discharge and Triage Guidelines served as the starting point, and searches in Medline (Ovid), Embase (Ovid), and PubMed resulted in 329 articles published from 2004 to 2016. Only 21 pediatric studies evaluating outcomes related to pediatric level of care, specialized PICU, patient volume, or personnel. Of these, 13 studies were large retrospective registry data analyses, six small single-center studies, and two multicenter survey analyses. Limited high-quality evidence was found, and therefore, a modified Delphi process was used. Liaisons from the American Academy of Pediatrics were included in the panel representing critical care, surgical, a...
Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue, 2009
OBJECTIVE To observe the effect of low-dose hydrocortisone on the requirement of norepinephrine a... more OBJECTIVE To observe the effect of low-dose hydrocortisone on the requirement of norepinephrine and lactate clearance in patients with refractory septic shock, and to investigate the effect of stress dose corticosteroids in reversing septic shock and improving tissue oxygen supply. METHODS Seventy-seven septic shock patients with hypotension refractory to fluids and administration of norepinephrine were randomly divided into control and treatment groups. In treatment group intravenous injection of low-dose hydrocortisone was given on top of the treatment given in control group for 14 days. The mean arterial pressure (MAP), lactate clearance and the data of norepinephrine use were compared between two groups during the course of treatment. RESULTS The number of patients requiring norepinephrine was significantly lower and the MAP was significantly higher in 24 hours, 7 days, 14 days than those at the beginning of treatment in both groups (all P<0.01). Compare to the control group,...
To the Editor.— We read with interest the paper by Gaylord et al,1 in which a statistical method ... more To the Editor.— We read with interest the paper by Gaylord et al,1 in which a statistical method was developed for predicting mortality in low birth weight infants. Using a multivariate linear discriminant analysis to determine the variables most predictive of death, they were able to predict mortality in infants of less than 1,500 g birth weight who developed pulmonary interstitial emphysema using only birth weight and the highest peak expiratory pressure on day 1 of life.
The t(4;11)(q21;q23) chromosomal abnormality was identified in 40 (2%) of 1,986 children with new... more The t(4;11)(q21;q23) chromosomal abnormality was identified in 40 (2%) of 1,986 children with newly diagnosed acute lymphoblastic leukemia (ALL). This translocation was associated with female sex (63%), age less than 1 year (60%), hyperleukocytosis (median leukocyte count, 156.5 x 10(9)/L), CD10-/CD19+ B-precursor cell immunophenotype, and myeloid-associated antigen (CD15) expression (63%). Nearly all cases had at least some CD24- blast cells. The CD10-/CD15%/CD19+/CD24/+ phenotype was found in 20 of the 32 t(4;11) cases tested. None of the 40 cases had the cytogenetic finding of hyperdiploidy greater than 50, which is a favorable prognostic feature. For clinical comparison, the t(4;11) cases were divided into three groups according to age at diagnosis: less than 1 year (n = 24), 1 to 9 years (n = 8), and greater than or equal to 10 years (n = 8). Compared with older patients, infants were more likely to have initial central nervous system leukemia (P = .05) and less likely to have ...
the Institute of Medicine con-cluded that between 44 000 and 98 000 deaths per year occur in hosp... more the Institute of Medicine con-cluded that between 44 000 and 98 000 deaths per year occur in hospitals in the United States as a re-sult of errors. Since publication, these data have captured the attention of the nation,2,3 resulting in aggressive calls for further research,4,5 regulatory interven-tions,6-8 third-party payer involve-ment,9,10 and health care organization initiatives to improve this situation.One such initiative, promoted by the Insti-tute for Healthcare Improvement known as the 100 000 Lives Cam-paign, recommended 6 strategies to de-crease the number of preventable in-patient deaths in the United States by 100 000 during the period betweenDe-cember 2004 and June 2006.11 One of these 6 recommended strategieswas the implementation of a rapid response team (RRT). An RRT, also known as amedical re-sponse team or medical emergency team, is a multidisciplinary teammost frequently consisting of intensive care For editorial comment see p 2311.
Seven children with immunocompromised states were referred to the pediatric bronchoscopy service ... more Seven children with immunocompromised states were referred to the pediatric bronchoscopy service for evaluation of pneumonia. Flexible fiberoptic bronchoscopy accompanied with bronchoalveolar lavage was performed in all seven of these children. A definitive diagnosis was made for six of these seven patients. The diagnosis included Pneumocystis carinii in three, Candida albicans in two, and cytomegalovirus in one. There were no complications associated with the procedure. Flexible fiberoptic bronchoscopy with bronchoalveolar lavage should be considered early in the evaluation of the immunocompromised child with pneumonia.
Idiopathic pulmonary hemosiderosis (IPH) is an uncommon disease found predominantly in pediatric ... more Idiopathic pulmonary hemosiderosis (IPH) is an uncommon disease found predominantly in pediatric patients. It can produce severe chronic pulmonary injury that results in chronic hypoxemia, pulmonary insufficiency, and progressive pulmonary fibrosis, leading to irreversible pulmonary hypertension and death. We studied the pulmonary hemodynamics in an 9-yr-old boy with IPH to determine if pulmonary hypertension contributed to exacerbations of this disease. Our results showed that this patient demonstrated pulmonary hypertension during acute exacerbations. Initially, the elevated pulmonary artery pressure responded both to oxygen and to a pulmonary vasodilator in the form of nitroglycerin. However, this improvement was not sustained. We conclude that pulmonary hypertension is probably a result of chronic hypoxemia experienced by patients with pulmonary hemosiderosis. Further investigation is warranted to assess whether or not intervention aimed at reducing pulmonary artery pressure in IPH improves outcome.
Objectives: To update the American Academy of Pediatrics and Society of Critical Care Medicine’s ... more Objectives: To update the American Academy of Pediatrics and Society of Critical Care Medicine’s 2004 Guidelines and levels of care for PICU. Design: A task force was appointed by the American College of Critical Care Medicine to follow a standardized and systematic review of the literature using an evidence-based approach. The 2004 Admission, Discharge and Triage Guidelines served as the starting point, and searches in Medline (Ovid), Embase (Ovid), and PubMed resulted in 329 articles published from 2004 to 2016. Only 21 pediatric studies evaluating outcomes related to pediatric level of care, specialized PICU, patient volume, or personnel. Of these, 13 studies were large retrospective registry data analyses, six small single-center studies, and two multicenter survey analyses. Limited high-quality evidence was found, and therefore, a modified Delphi process was used. Liaisons from the American Academy of Pediatrics were included in the panel representing critical care, surgical, a...
Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue, 2009
OBJECTIVE To observe the effect of low-dose hydrocortisone on the requirement of norepinephrine a... more OBJECTIVE To observe the effect of low-dose hydrocortisone on the requirement of norepinephrine and lactate clearance in patients with refractory septic shock, and to investigate the effect of stress dose corticosteroids in reversing septic shock and improving tissue oxygen supply. METHODS Seventy-seven septic shock patients with hypotension refractory to fluids and administration of norepinephrine were randomly divided into control and treatment groups. In treatment group intravenous injection of low-dose hydrocortisone was given on top of the treatment given in control group for 14 days. The mean arterial pressure (MAP), lactate clearance and the data of norepinephrine use were compared between two groups during the course of treatment. RESULTS The number of patients requiring norepinephrine was significantly lower and the MAP was significantly higher in 24 hours, 7 days, 14 days than those at the beginning of treatment in both groups (all P<0.01). Compare to the control group,...
To the Editor.— We read with interest the paper by Gaylord et al,1 in which a statistical method ... more To the Editor.— We read with interest the paper by Gaylord et al,1 in which a statistical method was developed for predicting mortality in low birth weight infants. Using a multivariate linear discriminant analysis to determine the variables most predictive of death, they were able to predict mortality in infants of less than 1,500 g birth weight who developed pulmonary interstitial emphysema using only birth weight and the highest peak expiratory pressure on day 1 of life.
The t(4;11)(q21;q23) chromosomal abnormality was identified in 40 (2%) of 1,986 children with new... more The t(4;11)(q21;q23) chromosomal abnormality was identified in 40 (2%) of 1,986 children with newly diagnosed acute lymphoblastic leukemia (ALL). This translocation was associated with female sex (63%), age less than 1 year (60%), hyperleukocytosis (median leukocyte count, 156.5 x 10(9)/L), CD10-/CD19+ B-precursor cell immunophenotype, and myeloid-associated antigen (CD15) expression (63%). Nearly all cases had at least some CD24- blast cells. The CD10-/CD15%/CD19+/CD24/+ phenotype was found in 20 of the 32 t(4;11) cases tested. None of the 40 cases had the cytogenetic finding of hyperdiploidy greater than 50, which is a favorable prognostic feature. For clinical comparison, the t(4;11) cases were divided into three groups according to age at diagnosis: less than 1 year (n = 24), 1 to 9 years (n = 8), and greater than or equal to 10 years (n = 8). Compared with older patients, infants were more likely to have initial central nervous system leukemia (P = .05) and less likely to have ...
the Institute of Medicine con-cluded that between 44 000 and 98 000 deaths per year occur in hosp... more the Institute of Medicine con-cluded that between 44 000 and 98 000 deaths per year occur in hospitals in the United States as a re-sult of errors. Since publication, these data have captured the attention of the nation,2,3 resulting in aggressive calls for further research,4,5 regulatory interven-tions,6-8 third-party payer involve-ment,9,10 and health care organization initiatives to improve this situation.One such initiative, promoted by the Insti-tute for Healthcare Improvement known as the 100 000 Lives Cam-paign, recommended 6 strategies to de-crease the number of preventable in-patient deaths in the United States by 100 000 during the period betweenDe-cember 2004 and June 2006.11 One of these 6 recommended strategieswas the implementation of a rapid response team (RRT). An RRT, also known as amedical re-sponse team or medical emergency team, is a multidisciplinary teammost frequently consisting of intensive care For editorial comment see p 2311.
Seven children with immunocompromised states were referred to the pediatric bronchoscopy service ... more Seven children with immunocompromised states were referred to the pediatric bronchoscopy service for evaluation of pneumonia. Flexible fiberoptic bronchoscopy accompanied with bronchoalveolar lavage was performed in all seven of these children. A definitive diagnosis was made for six of these seven patients. The diagnosis included Pneumocystis carinii in three, Candida albicans in two, and cytomegalovirus in one. There were no complications associated with the procedure. Flexible fiberoptic bronchoscopy with bronchoalveolar lavage should be considered early in the evaluation of the immunocompromised child with pneumonia.
Idiopathic pulmonary hemosiderosis (IPH) is an uncommon disease found predominantly in pediatric ... more Idiopathic pulmonary hemosiderosis (IPH) is an uncommon disease found predominantly in pediatric patients. It can produce severe chronic pulmonary injury that results in chronic hypoxemia, pulmonary insufficiency, and progressive pulmonary fibrosis, leading to irreversible pulmonary hypertension and death. We studied the pulmonary hemodynamics in an 9-yr-old boy with IPH to determine if pulmonary hypertension contributed to exacerbations of this disease. Our results showed that this patient demonstrated pulmonary hypertension during acute exacerbations. Initially, the elevated pulmonary artery pressure responded both to oxygen and to a pulmonary vasodilator in the form of nitroglycerin. However, this improvement was not sustained. We conclude that pulmonary hypertension is probably a result of chronic hypoxemia experienced by patients with pulmonary hemosiderosis. Further investigation is warranted to assess whether or not intervention aimed at reducing pulmonary artery pressure in IPH improves outcome.
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