Impact of intensive care unit supportive care on the physiology of Ebola virus disease in a universally lethal non-human primate model.

Background: There are currently limited data for the use of specific antiviral therapies for the treatment of Ebola virus disease (EVD). While there is anecdotal evidence that supportive care may be effective, there is a paucity of direct experimental data to demonstrate a role for supportive care in EVD. We studied the impact of ICU-level supportive care interventions including fluid resuscitation, vasoactive medications, blood transfusion, hydrocortisone, and ventilator support on the pathophysiology of EVD in rhesus macaques infected with a universally lethal dose of Ebola virus strain Makona C07.

Delivering Prolonged Intensive Care to a Non-human Primate: A High Fidelity Animal Model of Critical Illness.

Critical care needs have been rising in recent decades as populations age and comorbidities increase. Sepsis-related admissions to critical care contribute up to 50% of volume and septic shock carries a 35-54% fatality rate. Improvements in sepsis-related care and mortality would have a significant impact of a resource-intensive area of health care delivery.

Apneic Oxygenation during Rapid Sequence Intubation in Critically Ill Children.

This prospective case series documented hypoxemia and potential complications associated with apneic oxygenation in critically ill pediatric patients during rapid sequence intubation. Forty-four patients received apneic oxygenation via nasal cannula at rates of 5, 10, and 15 L/min for ages <4, 4 to 12, and 12 to 18 years, respectively. Pre- and postintubation attempt mean Spo were 98.

Building a novel pediatric intensive care iPad handover aid for residents.

There is no consensus on how effective patient handover in the pediatric intensive care unit should occur. Complex patients with rapidly moving clinical trajectories are difficult to summarize and comprehend. We aimed to redesign our current handover instrument to encourage higher-level cognitive interactions, questioning and understanding for pediatric residents.

Air transported pediatric rescue extracorporeal membrane oxygenation: a single institutional review.

Background: Pediatric extracorporeal membrane oxygenation (ECMO) programs are sophisticated endeavors usually found only in high-volume cardiac surgical programs. Worldwide, many cardiology programs do not have on-site pediatric cardiac surgery expertise. Our single-center experience shows that an organized multidisciplinary rescue-ECMO program, in collaboration with an accepting facility, can achieve survival rates comparable to modern era on-site ECMO.

Severe traumatic brain injury in children elevates glial fibrillary acidic protein in cerebrospinal fluid and serum.

Objectives: 1) To determine the levels of glial fibrillary acidic protein (GFAP) in both cerebrospinal fluid and serum; 2) to determine whether serum GFAP levels correlate with functional outcome; and 3) to determine whether therapeutic hypothermia, as compared with normothermia, alters serum GFAP levels in children with severe traumatic brain injury (TBI).

Design: Laboratory-based analyses; postrandomized, controlled trial.

Setting: Four Canadian pediatric intensive care units and a university-affiliated laboratory.

Potential pediatric intensive care unit demand/capacity mismatch due to novel pH1N1 in Canada.

Objective: To investigate the possibility of pediatric intensive care unit shortfalls, using pandemic models for a range of attack rates and durations. The emergence of the swine origin pH1N1 virus has led to concerns about shortfalls in our ability to provide pediatric ventilation and critical care support.

Design: Modeling of pediatric intensive care demand based on pH1N1 predictions using simulation techniques.

Critical illness in children with influenza A/pH1N1 2009 infection in Canada.

Objective: To describe characteristics, treatment, and outcomes of critically ill children with influenza A/pandemic influenza A virus (pH1N1) infection in Canada.

Design: An observational study of critically ill children with influenza A/pH1N1 infection in pediatric intensive care units (PICUs).

Setting: Nine Canadian PICUs.

Extracorporeal lung support for patients who had severe respiratory failure secondary to influenza A (H1N1) 2009 infection in Canada.

Background: From March to July 2009, influenza A (H1N1) 2009 (H1N1-2009) virus emerged as a major cause of respiratory failure that required mechanical ventilation. A small proportion of patients who had this condition developed severe respiratory failure that was unresponsive to conventional therapeutic interventions. In this report, we describe characteristics, treatment, and outcomes of critically ill patients in Canada who had H1N1-2009 infection and were treated with extracorporeal lung support (ECLS).