Incidence of opioid-induced constipation in the pediatric intensive care unit: A descriptive cohort study.

Background: Opioid-induced constipation (OIC) is a well-known phenomenon, although there is limited literature evaluating the incidence of OIC in children admitted to the pediatric intensive care unit (PICU). The primary aim of this study was to determine the incidence of OIC in the PICU and to determine if it is associated with a higher rate of morbidities or prolonged length of stay (LOS).

Methods: We conducted a single-center retrospective chart review from July 1, 2014, to June 30, 2015, in our PICU.

Successful use of inhaled epoprostenol as rescue therapy for pediatric ARDS.

Severe pediatric ARDS remains a significant challenge for clinicians, and management strategies are essentially limited to lung protective ventilation strategies, and adjunct approaches such as prone positioning, steroids, surfactant, and inhaled nitric oxide in unique situations. Inhaled nitric oxide produces pulmonary vasodilation in ventilated regions of the lung, shunting blood away from poorly ventilated areas and thus optimizing the ventilation perfusion ratio. A subset of patients with ARDS are known to be non-responders to nitric oxide, and selective pulmonary vasodilators such as Epoprostenol can be useful as rescue therapy in such cases.

A rare case of group A streptococcal toxic-shock syndrome in a postpartum adolescent leading to multi-organ failure.

Teenage pregnancy is not uncommon, but given the age of the patient, experience, and competency among medical providers varies. While toxic-shock syndrome from group A streptococcus is rare in teenage pregnancy, observed is a gap in care of bridging.

Burn-induced myocardial depression in a pediatric patient leading to fulminant cardiogenic shock and multiorgan failure requiring extracorporeal life support.

Cardiac stress is a critical determinant of outcomes associated with severe thermal injury. The cardiovascular response to a catecholamine-mediated surge from severe burns passes through two phases. Initial hypovolemia with myocardial depression leads to a low cardiac output, which then progresses to a hyperdynamic-hypermetabolic phase with increased cardiac output.

Intravenous immunoglobulin for acute hemorrhagic leukoencephalitis refractory to plasmapheresis.

Intravenous immunoglobulin therapy should be considered in pediatric acute hemorrhagic leukoencephalitis that is refractory to steroid and plasmapheresis.

Giant cell myocarditis causing refractory ventricular tachycardia in a pediatric patient.

Giant cell myocarditis should be considered in all pediatric patients with refractory ventricular arrhythmia. Endomyocardial biopsy should be obtained to confirm the diagnosis of giant cell myocarditis.

Case report of male child with elevated lipoprotein (a) leading to acute ischemic stroke.

Acute ischemic stroke (AIS) in children is rare with almost 40% diagnosed as cryptogenic. One possible mechanism associated with AIS is an elevated Lipoprotein (a) [Lp(a)] level. Here, we discuss the case of an 11-year old boy who presented with multiple thrombotic strokes secondary to elevated Lp(a), which was identified as the only risk factor and immediately treated with lipoprotein apheresis (LA).

Safety of Enteral Feedings in Critically Ill Children Receiving Vasoactive Agents.

Background: The objective of this retrospective study was to evaluate the safety of enteral feeding in children receiving vasoactive agents (VAs).

Methods: Patients aged 1 month to 18 years with a pediatric intensive care unit stay for ≥96 hours during 2007 and 2008 who received any VA (epinephrine, norepinephrine, vasopressin, milrinone, dopamine, and dobutamine) were included and categorized into fed and nonfed groups. Their demographics, clinical characteristics, type and dose of VA, and presence of gastrointestinal (GI) outcomes were obtained.