Hydrogen Sulfide in Exhaled Gases From Ventilated Septic Neonates and Children: A Preliminary Report.

Objectives: There is increasing interest in hydrogen sulfide as a marker of pathologic conditions or predictors of outcome. We speculate that as hydrogen sulfide is a diffusible molecule, if there is an increase in plasma hydrogen sulfide in sepsis, it may accumulate in the alveolar space and be detected in exhaled gas. We wished to determine whether we could detect hydrogen sulfide in exhaled gases of ventilated children and neonates and if the levels changed in sepsis.

Selective digestive tract decontamination in critically ill patients.

Introduction: Selective decontamination of the digestive tract (SDD) has been proposed to prevent endogenous and exogenous infections and to reduce mortality in critically ill patients. Although the efficacy of SDD has been confirmed by randomized controlled trials (RCTs) and systematic reviews, SDD has been the subject of intense controversy, based mainly on an insufficient evidence of efficacy and on concerns about resistance.

Areas Covered: This article reviews the philosophy, the current evidence on the efficacy of SDD and the issue of emergence of resistance.

Effect of patient- and team-related factors on stabilization time during pediatric intensive care transport.

Objectives: To examine the effects of patient- and transport-related factors on the time spent at the referring hospital by an intensive care retrieval team to stabilize critically ill children and to study the relationship between stabilization time and patient outcome.

Design: : Analysis of prospectively collected data during pediatric intensive care transport.

Setting: A dedicated regional pediatric intensive care retrieval service performing interhospital transports in England.

A pilot study of neonatal and pediatric esophageal pulse oximetry.

Background: In this pilot study we explored the suitability of the esophagus as a new measuring site for blood oxygen saturation (Spo(2)) in neonates.

Methods: A new miniaturized esophageal pulse oximeter has been developed. Five patients (one child and four neonates) were studied.

Effects of blood sample volume on hematocrit in critically ill children and neonates.

Background: There are no studies correlating the volume of blood taken from children and hematocrit (Hct) stability, relating those changes to duration of stay, severity of illness or weight. Earlier studies in neonates suggest that repeated sampling results in a drop in Hct.

Aim: To characterize the changes in Hct in children of all ages admitted to intensive care over a 5-day period following routine blood volume sampling.

Asymmetric dimethyl arginine and symmetric dimethyl arginine levels in infants with persistent pulmonary hypertension of the newborn.

Objective: We investigated whether infants with persistent pulmonary hypertension had elevated levels of asymmetric dimethyl arginine, an endogenous inhibitor of nitric oxide synthase, and symmetric dimethyl arginine, a regioisomer.

Design: Prospective observational cohort study.

Setting: A 10-bed neonatal intensive care unit in a tertiary referral center.

Terlipressin bolus induces systemic vasoconstriction in septic shock.

Objective: To report the use of a synthetic, long-acting, vasopressin analog, terlipressin, as an effective vasoconstrictor in septic shock.

Design: Case report.

Setting: A 22-bed pediatric intensive care unit in a tertiary referral center.

Comparison of the bispectral index monitor with the Comfort score in assessing level of sedation of critically ill children.

Objective: To compare the value of bispectral index as a monitor of sedation in critically ill children with a validated sedation scoring system.

Design: Prospective convenience sample.

Setting: Paediatric intensive care unit in a tertiary paediatric centre.

Compared with specialist registrars, experienced staff nurses shorten the duration of weaning neonates from mechanical ventilation.

Objective: To compare the overall performance of specially trained neonatal nurses acting autonomously, unsupervised, and without a protocol with specialist registrars when weaning neonates from mechanical ventilation.

Design: Prospective, randomized, controlled trial.

Setting: A single neonatal intensive care unit.

All great truths are iconoclastic: selective decontamination of the digestive tract moves from heresy to level 1 truth.

Objective: The objective was to compare evidence of the effectiveness, costs and safety of the traditional parenteral antibiotic-only approach against that gathered from 53 randomised trials involving more than 8,500 patients and six meta-analyses on selective decontamination of the digestive tract (SDD) to control infection on the intensive care unit (ICU). PHILOSOPHY: Traditionalists believe that all infections are due to breaches of hygiene except those established in the first 2 days, and that all micro-organisms can cause death. In contrast, newer insights show that transmission via the hands of carers are responsible only for infections occurring after one week, and that only a limited range of 15 potential pathogens contribute to mortality.