Clinical Outcomes of Acute Respiratory Failure Associated With Noninvasive and Invasive Ventilation in a Pediatric ICU.

Background: It remains unknown if pediatric patients failing initial noninvasive ventilation (NIV) experience worse clinical outcomes than those successfully treated with NIV or those primarily intubated.

Methods: This was a single-center, retrospective review of patients admitted with acute respiratory failure to the University of Michigan pediatric intensive care or cardiothoracic ICUs and receiving NIV or invasive mechanical ventilation as first-line therapy.

Results: One hundred seventy subjects met inclusion criteria and were enrolled: 65 NIV success, 55 NIV failure, and 50 invasive mechanical ventilation alone.

The Bereaved Parent Needs Assessment: a new instrument to assess the needs of parents whose children died in the pediatric intensive care unit*.

Objectives: To evaluate the reliability and validity of the Bereaved Parent Needs Assessment, a new instrument to measure parents' needs and need fulfillment around the time of their child's death in the pediatric intensive care unit. We hypothesized that need fulfillment would be negatively related to complicated grief and positively related to quality of life during bereavement.

Design: Cross-sectional survey.

The evolution of patient selection criteria and indications for extracorporeal life support in pediatric cardiopulmonary failure: next time, let's not eat the bones.

Bill James, baseball statistician and author, tells the story of hungry cavemen sitting about a campfire, waiting for tomatoes to ripen. One has the inspiration to throw an ox on the fire, and the first barbecue ensued and was endured. After eating, the conversation goes something like this.

A normal capillary refill time of ≤ 2 seconds is associated with superior vena cava oxygen saturations of ≥ 70%.

Objective: To test the hypothesis that a normal capillary refill time (CRT) ≤ 2 seconds is associated with superior vena cava oxygen saturation (ScvO₂) ≥ 70% in critically ill children.

Study Design: Two-year, prospective study in a tertiary-level pediatric intensive care unit. Whenever ScvO₂ measurements were obtained, central (forehead/sternum) and peripheral (finger/toe) CRTs were concomitantly assessed.

Continuous quality improvement: reducing unplanned extubations in a pediatric intensive care unit.

Objective: Unplanned extubation (UEX) is a potentially serious complication of mechanical ventilation. Limited information is available regarding factors that contribute to UEXs and subsequent reintubation of children. We monitored UEXs in our pediatric intensive care unit (PICU) for a 5-year period to assess the incidence and patient conditions associated with UEX and to evaluate whether targeted interventions were associated with a reduced rate of UEXs.

Survival and renal function in pediatric patients following extracorporeal life support with hemofiltration.

OBJECTIVE: To determine variables associated with survival in pediatric patients treated with hemofiltration while receiving extracorporeal life support and to determine the probability for recovery of renal function among survivors. DESIGN: Retrospective database analysis. SETTING: University of Michigan pediatric nephrology database.

Cisatracurium infusion for neuromuscular blockade in the pediatric intensive care unit: A dose-finding study.

OBJECTIVE: To evaluate the safety and efficacy of cisatracurium besylate, a neuromuscular blocking agent in infants zero to 2 yrs of age. DESIGN: An open-label study to evaluate efficacy and safety of cisatracurium as a continuous infusion in infants. SETTING: A tertiary pediatric intensive care unit.

Complications of intermittent prone positioning in pediatric patients receiving extracorporeal membrane oxygenation for respiratory failure.

Study Objective: To describe the safety and risks of placing pediatric patients in the prone position during extracorporeal membrane oxygenation (ECMO) for the treatment of respiratory failure.

Design: Single-center retrospective cohort study.

Setting: Tertiary pediatric ICUs.

Use of extracorporeal life support as a bridge to pediatric cardiac transplantation.

Background: Extracorporeal life support (ECLS) has been used for post-cardiotomy rescue, but its use as a bridge to heart transplantation (OHT) in patients with post-surgical or end-stage ventricular failure remains controversial.

Methods: Records were reviewed for patients receiving ECLS for ventricular failure from January 1991 to August 2001. Patients listed for OHT were analyzed separately.

Pediatric extracorporeal life support after high frequency ventilation: predictors of survival.

Previous studies of extracorporeal life support in pediatric patients have identified variables associated with survival. However, none of these studies focused on extracorporeal life support after failure of high frequency ventilation (HFV). In the present study, we determined variables associated with survival for pediatric respiratory failure patients who received HFV prior to extracorporeal life support, using data reported to the Extracorporeal Life Support Organization Registry from 1992 to 1998.

Extracorporal life support for pulmonary hemorrhage in children: a case series.

Objective: To examine the use and outcome of extracorporeal life support in children with severe respiratory failure caused by pulmonary hemorrhage.

Design: Retrospective case series report.

Setting: Pediatric intensive care unit in a university children's hospital.