Adverse Heart-Lung Interactions in Ventilator-induced Lung Injury.

Rationale: In the original 1974 in vivo study of ventilator-induced lung injury, Webb and Tierney reported that high Vt with zero positive end-expiratory pressure caused overwhelming lung injury, subsequently shown by others to be due to lung shear stress.

Objectives: To reproduce the lung injury and edema examined in the Webb and Tierney study and to investigate the underlying mechanism thereof.

Methods: Sprague-Dawley rats weighing approximately 400 g received mechanical ventilation for 60 minutes according to the protocol of Webb and Tierney (airway pressures of 14/0, 30/0, 45/10, 45/0 cm HO).

Early critical care course in children after liver transplant.

Objective. To review the critical care course of children receiving orthotopic liver transplantation (OLT). Methods.

Anemia among Pediatric Critical Care Survivors: Prevalence and Resolution.

To determine the incidence of anemia among pediatric critical care survivors and to determine whether it resolves within 6 months of discharge. Design. A prospective observational study.

Coagulation assessment in children with diabetic ketoacidosis.

Objectives: To assess potential hypercoagulability during diabetic ketoacidosis in children.

Design: A prospective, controlled pilot study.

Setting: University-affiliated pediatric critical care unit and emergency department in a tertiary care children's hospital.

Transient blindness as the primary symptom of acute hyponatremia post surgery.

Hyponatremia is a common electrolyte abnormality among children and adults. Visual disturbance associated with hyponatremia has been described in the past; however, all of these cases presented primarily with other classical signs and symptoms of hyponatremia, such as seizures, gastrointestinal upset, lethargy, or headache. We present a child who developed blindness on post-operative day #6 after resection of a brain tumour.

Resuscitation volume in paediatric non-haemorrhagic blunt trauma.

Introduction: Trauma is a major cause of paediatric morbidity and mortality, yet knowledge of fluid resuscitation is limited. Our objectives were to determine current practises in resuscitation volume (RV) administered to paediatric non-haemorrhagic (NH) blunt trauma patients and to identify fluid related complications.

Methods: We examined data from 139 trauma patients 1-17 years of age with an injury severity score ≥ 12 resuscitated at a Trauma-designated Children's Hospital.

Dehydration in children with diabetic ketoacidosis: a prospective study.

Objectives: To investigate the association between the degree of patient dehydration on presentation with diabetic ketoacidosis (DKA) and clinical and laboratory parameters obtained on admission.

Design: Prospective descriptive study.

Setting: A tertiary care children's hospital.

Complications of mechanical ventilation in the pediatric population.

Background: Mechanical ventilation (MV) strategies are continuously evolving in an effort to minimize adverse events. The objective of this study was to determine the complications associated with MV in children.

Study Design: Prospective observational study.

Neonatal myocardial infarction secondary to umbilical venous catheterization: A case report and review of the literature.

Neonatal acute myocardial infarction (MI) is a rare event, with a high mortality rate. Early recognition and intensive care management can be successful, and it requires a high index of suspicion in cases of unknown cardiogenic shock. The lack of access to cardiac catheterization should not delay management.

Positive end-expiratory pressure improves survival in a rodent model of cardiopulmonary resuscitation using high-dose epinephrine.

Background: Multiple interventions have been tested in models of cardiopulmonary resuscitation (CPR) to optimize drug use, chest compressions, and ventilation. None has studied the effects of positive end-expiratory pressure (PEEP) on outcome. We hypothesized that because PEEP can reverse pulmonary atelectasis, lower pulmonary vascular resistance, and potentially improve cardiac output, its use during CPR would increase survival.

Lung contusion in children--early computed tomography versus radiography.

Objective: To investigate, in children, the correlation between the extent of lung contusion as detected on early radiologic examination (chest radiograph [CXR] and/or thoracic computed tomography [TCT]) and subsequent clinical outcome measures.

Design: Retrospective chart review study with blinded assessment of thoracic imaging.

Setting: A university-affiliated, level 1 designated pediatric trauma center.

External ventricular drains in pediatric patients.

Objective: To determine the indications and complications of external ventricular drain (EVD) placement in pediatric patients.

Design: Retrospective chart review.

Setting: University associated, tertiary-level Children's Hospital.

Vascular remodeling protects against ventilator-induced lung injury in the in vivo rat.

Background: The role of the pulmonary vasculature in the pathogenesis of ventilator-induced lung injury is not well established. In this study, the authors investigated the effect of vascular remodeling due to chronic pulmonary hypertension on susceptibility to ventilator-induced lung injury. The authors hypothesized that the enhanced vascular tensile strength associated with pulmonary vascular remodeling would protect against ventilator-induced lung injury.

Elective tracheostomy in mechanically ventilated children in Canada.

Objective: To determine the current practice and opinions of paediatric intensivists in Canada regarding tracheostomy in children with potentially reversible conditions which are anticipated to require prolonged mechanical ventilation.

Design And Setting: Self-administered survey among paediatric intensivists within paediatrics critical care units (PCCU) across Canada.

Measurements And Results: All 16 PCCUs participated in the survey with a response rate of 81% (63 physicians).

Incomplete distal renal tubular acidosis affects growth in children.

Background: Incomplete distal renal tubular acidosis (idRTA) is recognized as an underlying aetiology in recurrent nephrolithiasis. Until the recently reported high prevalence of idRTA in adults with osteoporosis, the effect of idRTA on skeletal parameters was not known. We hypothesize that idRTA has a potential to affect height in the paediatric population.

Have changes in ventilation practice improved outcome in children with acute lung injury?

Objectives: To describe the changes that have occurred in mechanical ventilation in children with acute lung injury in our institution over the last 10-15 yrs and to examine the impact of these changes, in particular of the delivered tidal volume on mortality.

Design: Retrospective study.

Setting: University-affiliated children's hospital.

Secondary abdominal compartment syndrome in a case of pediatric trauma shock resuscitation.

Objective: To report a rare case of secondary abdominal compartment syndrome during shock resuscitation in a pediatric trauma patient.

Design: Case report and literature review.

Setting: A community hospital and a designated children's trauma hospital.

Drotrecogin alfa (activated) treatment in a neonate with sepsis and multi organ failure.

The administration of drotrecogin alfa (activated) improves outcome in adult patients with severe sepsis. Since the published pediatric experience with this drug is limited, the role of drotrecogin alfa (activated) in children, and especially in newborns is not well established. We describe a 3-day-old neonate with septic shock and multiorgan system failure, including circulatory, respiratory, renal failure, and disseminated intravascular coagulation, refractory to intensive fluid resuscitation and inotrope support.

Lung development and susceptibility to ventilator-induced lung injury.

Rationale: Ventilator-induced lung injury has been predominantly studied in adults.

Objectives: To explore the effects of age and lung development on susceptibility to such injury.

Methods: Ex vivo isolated nonperfused rat lungs (infant, juvenile, and adult) were mechanically ventilated where VT was based on milliliters per kilogram of body weight or as a percentage of the measured total lung capacity (TLC).

High-frequency oscillation in children after Fontan operation.

OBJECTIVE: The increase in intrathoracic pressure produced by positive-pressure ventilation has been shown to have an adverse effect on pulmonary blood flow after Fontan operations. OBJECTIVE: The main objective was to compare the hemodynamic effect of high-frequency oscillation ventilation (HFOV) with intermittent positive-pressure ventilation (IPPV) in children after Fontan operations. DESIGN: Prospective study.

Survey of critical care management of severe traumatic head injury in Israel.

Objective: To survey the current monitoring and treatment policies for patients with severe traumatic brain injury (STBI) in Israel, and to compare the management of pediatric and adult intensive care units (ICUs).

Design: Questionnaires were sent to the medical directors of all ICUs managing STBI patients.

Results: All 21 ICUs responded to the questionnaire.

Continuous renal replacement therapy for non-renal indications: experience in children.

Background: The role of continuous renal replacement therapy in patients with acute renal failure is well recognized. CRRT has also become an important modality of treatment in various acute situations without renal failure.

Objectives: To describe our experience with CRRT in acutely ill infants and children without renal failure.