An Evaluation of a New Debriefing Framework: REFLECT.

Background: Postresuscitation debriefing (PRD) is recommended by the American Heart Association guidelines but is infrequently performed. Prior studies have identified barriers for pediatric emergency medicine (PEM) fellows including lack of a standardized curriculum.

Objective: Our objective was to create and assess the feasibility of a time-limited, structured PRD framework entitled REFLECT: Review the event, Encourage team participation, Focused feedback, Listen to each other, Emphasize key points, Communicate clearly, and Transform the future.

Application of a modified microbiologic criterion for identifying pediatric ventilator-associated pneumonia.

Background: Prevention of ventilator-associated pneumonia (VAP) is a major patient safety goal, but accurate identification of VAP in pediatric patients remains challenging.

Methods: We performed a retrospective cohort study to demonstrate feasibility of endotracheal culture and Gram's stain to support VAP diagnosis. Pediatric intensive care unit and cardiac intensive care unit patients with ≥ 1 endotracheal specimen having growth of ≥ 1 organism in conjunction with moderate/many polymorphonuclear leukocytes (ie, the modified microbiologic criterion) were included.

National Survey of Pediatric Emergency Medicine Fellows on Debriefing After Medical Resuscitations.

Background: Medical resuscitations of critically ill children in the emergency department are stressful events requiring a coordinated team effort. Current guidelines recommend debriefing after such events to improve future performance. Debriefing practices within pediatric emergency departments by pediatric emergency medicine (PEM) fellows in the United States has not been studied.

Dexmedetomidine as a primary sedative agent after single-stage airway reconstruction.

Objective: To examine the outcomes of children receiving dexmedetomidine after single-stage airway reconstruction.

Study Design: Historical cohort study.

Setting: Tertiary care children's hospital.

The rising incidence of intentional ingestion of ethanol-containing hand sanitizers.

Objective: To describe a case of intentional ingestion of hand sanitizer in our hospital and to review published cases and those reported to the American Association of Poison Control Centers' National Poison Data System.

Design: A case report, a literature review of published cases, and a query of the National Poison Data System.

Setting: Medical intensive care unit.

The endotracheal tube air leak test does not predict extubation outcome in critically ill pediatric patients.

Objective: Endotracheal tube air leak pressures are used to predict postextubation upper airway compromise such as stridor, upper airway obstruction, or risk of reintubation. To determine whether the absence of an endotracheal tube air leak (air leak test >/=30 cm H2O) measured during the course of mechanical ventilation predicts extubation failure in infants and children.

Design: Prospective, blinded cohort.

Extubation criteria in infants and children.

Predictors of extubation outcome attempt to provide objective data that may help to modify clinical decision making at the bedside. This article reviews the subjective and objective extubation readiness predictors tested in the pediatric medical literature. An understanding of the predictive capacity of the extubation criteria is vital for the critical care physician.

Successful treatment of acute chest syndrome with high-frequency oscillatory ventilation in pediatric patients.

Severe acute chest syndrome afflicts patients with sickle cell disease and can cause hypoxemia refractory to conventional treatments. Obstructive mucus plugging and the development of acute respiratory distress syndrome may underlie the pathophysiology of refractory hypoxemia in acute chest syndrome. Although high-frequency oscillatory ventilation (HFOV) is well established in the treatment of pediatric acute respiratory distress syndrome, there is no support in the literature for its role in managing hypoxemia in acute chest syndrome.