Antifibrinolytic Drugs for the Prevention of Bleeding in Pediatric Cardiac Surgery on Cardiopulmonary Bypass: A Systematic Review and Meta-analysis.

Background: Bleeding is one of the commonest complications affecting children undergoing cardiac surgery on cardiopulmonary bypass. Antifibrinolytic drugs are part of a multifaceted approach aimed at reducing bleeding, though sufficiently sized pediatric studies are sparse, and dosing algorithms are heterogeneous. Our objective was to evaluate the efficacy and safety of antifibrinolytic agents as well as the effectiveness of different dosing regimens in pediatric cardiac surgery using cardiopulmonary bypass.

Strategies for Prevention and Management of Bleeding Following Pediatric Cardiac Surgery on Cardiopulmonary Bypass: A Scoping Review.

Objective: We aimed to systematically describe, via a scoping review, the literature reporting strategies for prevention and management of mediastinal bleeding post pediatric cardiopulmonary bypass surgery.

Data Sources: MEDLINE, EMBASE, PubMed, and Cochrane CENTRAL Register.

Study Selection: Two authors independently screened publications from 1980 to 2016 reporting the effect of therapeutic interventions on bleeding-related postoperative outcomes, including mediastinal drain loss, transfusion, chest re-exploration rate, and coagulation variables.

Predicting fluid responsiveness in 100 critically ill children: the effect of baseline contractility.

Purpose: Fluid overload is a risk factor for poor outcome in intensive care; thus volume loading should be tailored towards patients who are likely to increase stroke volume. We aimed to evaluate the paediatric predictive ability (stroke volume increase of at least 15 % after fluid bolus) of novel and established volumetric and dynamic haemodynamic variables, and assess the influence of baseline contractility on response.

Methods: We assessed 142 volume loading episodes (10 ml/kg crystalloid) in 100 critically ill ventilated children, median (interquartile) weight 10 (5.

Unplanned extubation in a paediatric intensive care unit: prospective cohort study.

Purpose: Unplanned extubation (UE) is an important paediatric intensive care unit (PICU) quality indicator. Studies on UE have been modest in size, with accurate UE rate calculation potentially hampered by ventilation episodes recorded in calendar days. We wished to document UE rates, outcomes, associated factors and quantify error when calendar days rather than exact timings are used.

Neonatal decompensation before surgery in hypoplastic left heart syndrome: a case control study.

Objective: Prior to Norwood 1 surgery, neonates with hypoplastic left heart syndrome (HLHS) are at risk of decompensation from systemic underperfusion secondary to pulmonary overcirculation. We examined whether preoperative temporal profiles of physiological and laboratory variables differed between neonates who did and did not decompensate preoperatively.

Design: Case control study.

The temporal relationship between glucose-corrected serum sodium and neurological status in severe diabetic ketoacidosis.

Objective: Cerebral oedema is a potentially devastating complication of diabetic ketoacidosis (DKA). The relationship between osmolar changes, acid-base changes and development of cerebral oedema during therapy is unclear.

Design: Retrospective cohort study on 53 children with severe DKA (mean pH at presentation 6.

The relationship among thromboelastography, hemostatic variables, and bleeding after cardiopulmonary bypass surgery in children.

Background: Mediastinal bleeding is common after pediatric cardiopulmonary bypass (CPB) surgery. Thromboelastography (TEG) may predict bleeding and provide insight into likely mechanisms. We aimed to (a) compare perioperative temporal profiles of TEG and laboratory hemostatic variables between patients with significant hemorrhage (BLEED) and those without (CONTROL), (b) investigate the relationship between TEG variables and routine hemostatic variables, and (c) develop a model for prediction of bleeding.

Hyperchloremia is the dominant cause of metabolic acidosis in the postresuscitation phase of pediatric meningococcal sepsis.

Objective: Metabolic acidosis is common in septic shock, yet few data exist on its etiological temporal profile during resuscitation; this is partly due to limitations in bedside monitoring tools (base excess, anion gap). Accurate identification of the type of acidosis is vital, as many therapies used in resuscitation can themselves produce metabolic acidosis.

Design: Retrospective, cohort study.

Retrospective evaluation of a paediatric intensivist-led flexible bronchoscopy service.

Objective: To demonstrate the diagnostic yield, therapeutic role and safety of flexible bronchoscopy via an intensivist-led service in critically ill children.

Design: Retrospective chart review.

Setting: Regional paediatric intensive care unit.

The influence of hyperchloraemia on acid base interpretation in diabetic ketoacidosis.

Objectives: During the acute treatment of diabetic ketoacidosis we (a) determined the temporal incidence of hyperchloraemia, and (b) quantified the influence of hyperchloraemia on interpretation of common blood gas derived acid base parameters, namely base deficit and bicarbonate.

Design And Setting: Retrospective chart review in two regional paediatric intensive care units.

Measurements And Results: Stewart's physicochemical theory was used to develop regression equations quantifying the acidifying effect of hyperchloraemia on both base deficit and bicarbonate.

Validation of a method to partition the base deficit in meningococcal sepsis: a retrospective study.

Introduction: The base deficit is a useful tool for quantifying total acid-base derangement, but cannot differentiate between various aetiologies. The Stewart-Fencl equations for strong ions and albumin have recently been abbreviated; we hypothesised that the abbreviated equations could be applied to the base deficit, thus partitioning this parameter into three components (the residual being the contribution from unmeasured anions).

Methods: The two abbreviated equations were applied retrospectively to blood gas and chemistry results in 374 samples from a cohort of 60 children with meningococcal septic shock (mean pH 7.

"Early" delayed sternal closure following pediatric cardiac surgery.

Background: Delayed sternal closure is commonly used following pediatric cardiopulmonary bypass surgery for many reasons including support of the failing myocardium. We hypothesized that, as a result of improvements in perioperative care, sternal closure could be achieved at an earlier postoperative time than the 3 to 5 days typically reported in the literature.

Methods: Retrospective chart review of all bypass surgery (n = 585) performed in a single center over a 3-year period (2000-2002).

The strong ion gap predicts mortality in children following cardiopulmonary bypass surgery.

Objective: Stewart's strong ion theory quantifies unmeasured tissue acids produced following hypoxia or hypoperfusion, by calculation of the strong ion gap. Our study objectives were as follows: a) to determine the 24-hr profile of the strong ion gap following cardiopulmonary bypass surgery; and b) to compare the prognostic value in terms of intensive care unit mortality of this variable with blood lactate.

Design: Prospective, observational study.

Early application of generic mortality risk scores in presumed meningococcal disease.

Objective: Mortality from meningococcal disease typically occurs within 24 hrs of intensive care unit (ICU) admission. An early, accurate mortality-risk tool may aid in trial design for novel therapies. We assessed the performance of two generic scores that assign mortality risk within 1 hr of ICU admission: the Preintensive Care Pediatric Risk of Mortality (Pre-ICU PRISM) and Pediatric Index of Mortality (PIM).

Use of oral clonidine for sedation in ventilated paediatric intensive care patients.

Objectives: We aimed to document our experience with oral clonidine when used as a sedative in combination with intravenous morphine and lorazepam in a group of mechanically ventilated children with single-organ, respiratory failure. In particular, our objectives were to establish the relationship between oral dose, plasma concentration, and sedative effect, and second, to document the side-effect profile.

Design: Prospective, cohort study over a 72-h period.

Adverse events in a paediatric intensive care unit: relationship to workload, skill mix and staff supervision.

Objectives: A systems approach proposes that hospital adverse events (AE) represent a failure of the organization rather than the individual, and are more likely when sub-optimal working conditions occur. We analysed AE using a systems approach to (a) investigate the association between AE occurrence and "latent" risk factors, which included temporal, workload, skill mix and supervision issues, and (b) document interactions between clinically related risk factors.

Design: Prospective observational study.

Effects of feeding on gastric tonometric measurements in critically ill children.

Objective: To determine the effect of gastric feeding on the measurement of gastric intramucosal PCO2 (PiCO2) and its derived gastric intramucosal PCO2-arterial PCO2 difference (PiCO2-PaCO2 difference) and gastric intramucosal pH (pHi) in a group of critically ill children using recirculating gas tonometry.

Design: Prospective clinical pilot study.

Setting: Sixteen bed pediatric intensive care unit.

Measurement of cardiac output and tissue perfusion.

Recent technologic innovations have allowed a greater scope for cardiac output measurement in critically ill children. There is a move toward both less invasive and continuous methods, several of which also offer novel measures of preload. Many of the new methods are still undergoing preliminary evaluation in the pediatric population and will be summarized in this article.

Amylin is associated with delayed gastric emptying in critically ill children.

Objectives: Amylin is a novel 37 amino acid that is secreted together with insulin from the pancreas in response to enteral nutrient intake. As a potent inhibitor of gastric motility it plays an important role in the control of carbohydrate absorption. In this study we aimed to determine the relationship between amylin levels and gastric emptying in critically ill children.