High-Dose Sedation and Analgesia During Extracorporeal Membrane Oxygenation: A Focus on the Adjunctive Use of Ketamine.

Use of ketamine in patients requiring extracorporeal membrane oxygenation (ECMO) has rarely been reported, and the optimal dosing strategy remains unclear. A patient admitted with hypoxic respiratory failure required ECMO in addition to continuous infusion of low-dose ketamine following titration of opioid and sedative medications to high doses. After initiation of ketamine, infusion rates of opioids and/or sedatives were maintained or decreased.

Chloramphenicol toxicity revisited: a 12-year-old patient with a brain abscess.

Chloramphenicol, a broad-spectrum antibiotic, is rarely used in the United States due to its well-described adverse effects. Because of its limited use, many clinicians are unfamiliar with its indications, spectrum of activity, and potential adverse drug effects. We describe a 12-year-old patient who presented after two craniotomies for a persistent brain abscess complicated by long-term chloramphenicol administration.

Central venous access via external jugular vein in children.

Objective: To determine the success rate and complications of using the external jugular (EJ) vein for central venous access in pediatric patients.

Methods: Prospective cohort study of children who underwent attempts at EJ vein central venous access while receiving care in an 11-bed pediatric intensive care unit at an urban children's hospital.

Results: Over a period of 15 months, 50 patients had EJ venous cannulation attempts.

Acute liver failure in children.

Objective: To review the incidence, etiologies, pathophysiology, and treatment of acute liver failure (ALF) in children. Emphasis will be placed on the initial management of the multiple organ system involvement of ALF.

Method: MEDLINE search from 1970 to March 2005 was performed.

Pediatric hyperglycemic hyperosmolar syndrome: diagnostic difficulties and high mortality rate.

Childhood obesity has become a pandemic health care problem. A complication of childhood obesity is type 2 diabetes mellitus which has increased 10-fold in the past 20 years. A serious complication of type 2 diabetes mellitus is hyperglycemic hyperosmolar syndrome (HHS).

Pediatric extracorporeal membrane oxygenation (ECMO): a review of the first ten years of experience at the Medical University of South Carolina.

ECMO can be life saving in pulmonary emergencies unresponsive to conventional ICU support. ECMO technology and expertise has increased immensely over the last decade. Our experience, and others, has demonstrated that the earlier the referral to an ECMO center, the better chance of survival these patients will have.

Critical care challenges in the adult ECMO patient.

Extracorporeal membrane oxygenation (ECMO) represents an alternative method of pulmonary support for the critically ill patient with severe respiratory distress. It is commonly used in the neonatal and pediatric populations and is being used with increasing frequency in adults. Although ECMO is not new to the intensive care unit setting, it is usually considered a last resort measure in the adult population.

Pneumococcus-induced T-antigen activation in hemolytic uremic syndrome and anemia.

The hemolytic uremic syndrome (HUS) is most commonly associated with Escherichia coli, but has been associated with other infections such as Streptococcus pneumoniae. Pneumococcus-induced HUS carries an increased risk of mortality and renal morbidity compared with E. coli-induced HUS.

Intrapleural instillation of fibrinolytic agents for treatment of pleural empyema.

Objective: To describe the use of intrapleural instillation of fibrinolytic agents as adjunctive therapy for children with complicated pleural effusions and empyema.

Design: Retrospective chart review.

Setting: Tertiary care children's hospital in an academic medical center.