Legal and Ethical Considerations for Requiring Consent for Apnea Testing in Brain Death Determination.

The past decade has witnessed escalating legal and ethical challenges to the diagnosis of death by neurologic criteria (DNC). The legal tactic of demanding consent for the apnea test, if successful, can halt the DNC. However, US law is currently unsettled and inconsistent in this matter.

Parents Demand and Teenager Refuses Epidural Anesthesia.

A 15-year-old girl is scheduled to undergo an upper lobectomy to debulk metastatic Ewing sarcoma. The anesthesiologist recommended placement of a thoracic epidural catheter to provide postoperative analgesia. The patient did not want a needle to be placed near her spine.

Blood pressure in adults with short stature skeletal dysplasias.

Hypertension, compounded by obesity, contributes to cardiovascular disease and mortality. Data describing hypertension prevalence in adults with short stature skeletal dysplasias are lacking, perhaps due to poor fit of typical adult blood pressure cuffs on rhizomelic or contracted upper extremities. Through health screening research, blood pressure was measured in short stature adults attending support group meetings and skeletal dysplasia clinics.

Susceptibility weighted imaging in infants with staged embolization of vein of Galen aneurysmal malformations.

Background And Purpose: The vein of Galen aneurysmal malformation (VGAM) is a rare congenital vascular malformation with a higher morbidity and mortality, especially in neonates. Ultrasound, CT and MR are usually used in diagnosis and treatment monitoring of these disorders. In this current study, we aim to examine utility of SWI in evaluation of treatment response in infants with VGAM.

Protocol for the HAPPY Hearts study: cardiovascular screening for the early detection of future adverse cardiovascular outcomes in middle-aged and older women: a prospective, observational cohort study.

Introduction: Efforts to identify individuals at a higher risk for adverse cardiovascular outcomes focus on traditional risk factors, such as age, sex, smoking status, blood pressure and and cholesterol; however, this approach does not directly assess cardiovascular function and may underestimate the risk of experiencing adverse cardiovascular outcomes in women. This prospective, observational cohort study will examine the ability of the Heart Attack Prevention Program for You (HAPPY) Hearts screening protocol, a series of non-invasive procedures to identify middle-aged and older women who are at an elevated risk for experiencing an adverse cardiovascular event in the 5-year period after screening. The predictive value of the HAPPY Hearts protocol will also be compared with the Framingham Risk Score to determine the sensitivity for estimating risk for an adverse cardiovascular outcome.

Membrane Oxygenator Use With Biventricular Assist Device: Facilitation of Support and Lung Recovery.

We present the use of a low-resistance membrane oxygenator (Quadrox D, Maquet) in series with a pulsatile right ventricular assist device (Berlin Heart EXCOR, Berlin Heart) in a patient with biventricular support who required high-frequency oscillatory ventilation (HFOV), due to refractory acute respiratory distress syndrome associated with Cytomegalovirus pneumonia. The high mean airway pressure associated with the use of HFOV resulted in a significant negative impact on left ventricular assist device (LVAD) filling that led to a combined respiratory and metabolic acidosis and the need for vasopressor support. Oxygenator placement enabled transition to conventional ventilation and the discontinuation of vasopressor support.

Resistive Index Variability in Anterior Cerebral Artery Measurements During Daily Transcranial Duplex Sonography: A Predictor of Cerebrovascular Complications in Infants Undergoing Extracorporeal Membrane Oxygenation?

Objectives: The purpose of this study was to determine the value of resistive index (RI) variability in predicting cerebrovascular complications during extracorporeal membrane oxygenation (ECMO).

Methods: This retrospective study included 36 infants treated by ECMO. The RI was measured on daily transfontanellar duplex sonography, obtained first without fontanel compression and then after gentle compression with the transducer.

PICU Up!: Impact of a Quality Improvement Intervention to Promote Early Mobilization in Critically Ill Children.

Objective: To determine the safety and feasibility of an early mobilization program in a PICU.

Design: Observational, pre-post design.

Setting: PICU in a tertiary academic hospital in the United States.

Genetic variation in the oxytocin receptor gene is associated with a social phenotype in autism spectrum disorders.

Oxytocin regulates social behavior in animal models. Research supports an association between genetic variation in the oxytocin receptor gene (OXTR) and autism spectrum disorders (ASD). In this study, we examine the association between the OXTR gene and a specific social phenotype within ASD.

The heat is on... thermal epiglottitis as a late presentation of airway steam injury.

Background: Thermal epiglottitis is a rare but potentially life-threatening disease. Diagnosis requires a thorough history and high clinical level of suspicion, particularly in children. Thermal epiglottitis from steam inhalation can have a slow onset without oropharyngeal signs of thermal injury, findings that can hide the clinical diagnosis.

Variability in anticoagulation management of patients on extracorporeal membrane oxygenation: an international survey.

Objective: The objective of this study was to determine current practices of anticoagulation in patients on extracorporeal membrane oxygenation.

Design: Internet-based cross-sectional survey distributed between November 2010 and May 2011.

Setting: Extracorporeal Life Support Organization-registered extracorporeal membrane oxygenation centers internationally.

Pulmonary function in a cohort of New York City Police Department emergency responders since the 2001 World Trade Center disaster.

Objective: Comparing pulmonary function since the 2001 World Trade Center disaster, with preexposure data, in a New York City Police Department Emergency Responder cohort, without history of repetitive respiratory exposures.

Methods: A total of 206 New York City Police Department Emergency Services Unit members reported Arrival Time, Exposure Location, Duration, Smoking History, Respirator Mask Usage, and Respiratory Symptoms, and underwent clinical evaluation and follow-up spirometry, in 2002 and 2007.

Results: A mean decline in forced vital capacity of 190 mL (3.

Food and Drug Administration approval for medications used in the pediatric intensive care unit: a continuing conundrum.

Objectives: Many drugs used in the pediatric intensive care unit are administered "off label," i.e., they have been neither thoroughly tested for efficacy and safety nor approved for use in children.

Unrecognized burden of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus carriage in the pediatric intensive care unit.

Routinely, children's hospitals use data from clinical cultures to estimate the burden of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) carriage. In our pediatric intensive care unit, a program of weekly surveillance cultures uncovered an unrecognized reservoir of MRSA and VRE carriers. This weekly surveillance enabled more accurate estimates of the incidence rates of MRSA and VRE carriage and led to an increased number of isolation-days for patients.

Reduction of catheter-associated bloodstream infections in pediatric patients: experimentation and reality.

Objective: Few data exist on successes at reducing pediatric catheter-associated bloodstream infections (CA-BSI). The objective was to eradicate CA-BSI with a multifaceted pediatric-relevant intervention proven effective in adult patients.

Design: Prospective cohort of pediatric intensive care (PICU) patients with historical controls.

Do not attempt resuscitation orders in pediatrics.

Do-not-attempt resuscitation orders are becoming more common in pediatrics, particularly as programs for hospice and palliative care in children develop. Concomitantly, there arises the need to decide when it is appropriate to use these technologies. It is at this point that the skills of relationship building, listening, and empathic concern become indispensable.

Analysis of Epstein-Barr virus reservoirs in paired blood and breast cancer primary biopsy specimens by real time PCR.

Introduction: Epstein-Barr virus (EBV) is present in over 90% of the world's population. This infection is considered benign, even though in limited cases EBV is associated with infectious and neoplastic conditions. Over the past decade, the EBV association with breast cancer has been constantly debated.