Non-Intentional N-Acetylcysteine Overdose Associated with Cerebral Edema and Brain Death.

N-acetylcysteine is the established treatment for acetaminophen toxicity. This medication's complex dosing schedule engenders a high incidence of medication errors. While nuisance side effects are common, only rare case reports describe serious outcomes associated with N-acetylcysteine administration, all of which take place in the setting of non-intentional N-acetylcysteine overdose.

Association Between Acute Kidney Injury Duration and Outcomes in Critically Ill Children.

Objectives: Acute kidney injury occurs frequently in children during critical illness and is associated with increased morbidity, mortality, and health resource utilization. We aimed to examine the association between acute kidney injury duration and these outcomes.

Design: Retrospective cohort study.

Intravenous Fluid Prescription Practices in Critically Ill Children: A Shift in Focus from Natremia to Chloremia?

Our objective is to evaluate intravenous (IV) fluid prescription practice patterns in critically ill children in the first 72 hours of pediatric intensive care unit (PICU) admission and to evaluate the incidence and predictors of hyperchloremic metabolic acidemia (HCMA) and the association between HCMA and adverse outcomes. This retrospective cohort study was conducted in two tertiary-care Canadian PICUs. Children aged 0 to 18 years admitted to the PICU between January 2015 and January 2016 who received at least 50% of their calculated maintenance fluid requirements parenterally during the first 24 hours of admission were included.

Predicting early outcomes of liver transplantation in young children: The EARLY study.

Aim: To determine potentially modifiable predictors of early outcomes after liver transplantation in children of age < 3 years.

Methods: This study was a retrospective chart review including all consecutive children of age less than 3-years-old having had a liver transplant done at the Western Canadian referral center from June 2005 to June 2015. Pre-specified potential predictor variables and primary and secondary outcomes were recorded using standard definitions and a case report form.

Expectations for the methodology and translation of animal research: a survey of the general public, medical students and animal researchers in North America.

To determine what are considered acceptable standards for animal research (AR) methodology and translation rate to humans, a validated survey was sent to: a) a sample of the general public, via Sampling Survey International (SSI; Canada), Amazon Mechanical Turk (AMT; USA), a Canadian city festival (CF) and a Canadian children's hospital (CH); b) a sample of medical students (two first-year classes); and c) a sample of scientists (corresponding authors and academic paediatricians). There were 1379 responses from the general public sample (SSI, n = 557; AMT, n = 590; CF, n = 195; CH, n = 102), 205/330 (62%) medical student responses, and 23/323 (7%, too few to report) scientist responses. Asked about methodological quality, most of the general public and medical student respondents expect that: AR is of high quality (e.

Nutritional support for critically ill children.

Background: Nutritional support in the critically ill child has not been well investigated and is a controversial topic within paediatric intensive care. There are no clear guidelines as to the best form or timing of nutrition in critically ill infants and children. This is an update of a review that was originally published in 2009.

The ethics of animal research: a survey of the public and scientists in North America.

Background: To determine whether the public and scientists consider common arguments (and counterarguments) in support (or not) of animal research (AR) convincing.

Methods: After validation, the survey was sent to samples of public (Sampling Survey International (SSI; Canadian), Amazon Mechanical Turk (AMT; US), a Canadian city festival and children's hospital), medical students (two second-year classes), and scientists (corresponding authors, and academic pediatricians). We presented questions about common arguments (with their counterarguments) to justify the moral permissibility (or not) of AR.

Expectations for methodology and translation of animal research: a survey of health care workers.

Background: Health care workers (HCW) often perform, promote, and advocate use of public funds for animal research (AR); therefore, an awareness of the empirical costs and benefits of animal research is an important issue for HCW. We aim to determine what health-care-workers consider should be acceptable standards of AR methodology and translation rate to humans.

Methods: After development and validation, an e-mail survey was sent to all pediatricians and pediatric intensive care unit nurses and respiratory-therapists (RTs) affiliated with a Canadian University.

The ethics of animal research: a survey of pediatric health care workers.

Introduction: Pediatric health care workers (HCW) often perform, promote, and advocate use of public funds for animal research (AR). We aim to determine whether HCW consider common arguments (and counterarguments) in support (or not) of AR convincing.

Design: After development and validation, an e-mail survey was sent to all pediatricians and pediatric intensive care unit nurses and respiratory therapists (RTs) affiliated with a Canadian University.

A survey of American neurologists about brain death: understanding the conceptual basis and diagnostic tests for brain death.

Background: Neurologists often diagnose brain death (BD) and explain BD to families in the intensive care unit. This study was designed to determine whether neurologists agree with the standard concept of death (irreversible loss of integrative unity of the organism) and understand the state of the brain when BD is diagnosed.

Methods: A previously validated survey was mailed to a random sample of 500 board-certified neurologists in the United States.

Donation after cardiocirculatory death: a call for a moratorium pending full public disclosure and fully informed consent.

Many believe that the ethical problems of donation after cardiocirculatory death (DCD) have been "worked out" and that it is unclear why DCD should be resisted. In this paper we will argue that DCD donors may not yet be dead, and therefore that organ donation during DCD may violate the dead donor rule. We first present a description of the process of DCD and the standard ethical rationale for the practice.

Reduction in hospital mortality over time in a hospital without a pediatric medical emergency team: limitations of before-and-after study designs.

Objective: To determine whether hospital mortality has decreased over time in a hospital that has not introduced a pediatric medical emergency team (PMET).

Design: Retrospective observational study.

Setting: Quaternary children's hospital.

The apnea test: rationale, confounders, and criticism.

The apnea test is recommended for the diagnosis of brain death. There are several reasons this test should be reconsidered. Confounding factors for performing the test are vaguely and poorly specified.

Nutritional support for critically ill children.

Background: Nutritional support in the critically ill child has not been well investigated and is a controversial topic within paediatric intensive care. There are no clear guidelines as to the best form or timing of nutrition in critically ill infants and children.

Objectives: To assess the impact of enteral and total parenteral nutrition on clinically important outcomes for critically ill children.

Heparin-bonded central venous catheters do not reduce thrombosis in infants with congenital heart disease: a blinded randomized, controlled trial.

Background: Infants with congenital heart disease who require central venous lines are at increased risk of thrombosis. Heparin-bonded catheters provide protection from thrombotic events in some children. However, heparin-bonded catheters may not be as effective in infants View Article and Find Full Text PDF

The approach to delayed resuscitation in paediatric cardiac arrest: A survey of paediatric intensivists in Canada.

Aim: To determine how long a period of having had no cardiopulmonary-resuscitation (CPR) (delay time) is considered to result in subsequent futile efforts at resuscitation.

Methods: In 2007 a survey was mailed to all 77 paediatric intensivists in Canada. Three scenarios of witnessed cardiac arrest were presented: out-of-hospital, in-hospital, and in-hospital with extracorporeal-CPR (E-CPR).

Survey of pediatricians' opinions on donation after cardiac death: are the donors dead?

Objective: There has been debate in the ethics literature as to whether the donation-after-cardiac-death donor is dead after 5 minutes of absent circulation. We set out to determine whether pediatricians consider the donation-after-cardiac-death donor as dead.

Methods: A survey was mailed to all 147 pediatricians who are affiliated with the university teaching children's hospital.

Two-year survival, mental, and motor outcomes after cardiac extracorporeal life support at less than five years of age.

Objective: Comprehensive outcome assessment of children receiving cardiac extracorporeal life support.

Methods: From 2000 to 2004, 39 consecutive children (aged 1 day to 4.4 years) had cardiac extracorporeal life support.

Donation after cardiac death: a survey of university student opinions on death and donation.

Objective: To determine if university students consider the donation after cardiac death donor as dead.

Design: Survey.

Setting: University students.

A survey to determine the understanding of the conceptual basis and diagnostic tests used for brain death by neurosurgeons in Canada.

Objective: To determine the understanding of the conceptual basis and diagnostic tests used for brain death (BD) by neurosurgeons in Canada.

Methods: Between February and June 2006, a previously developed survey was mailed to every neurosurgeon in Canada.

Results: Of 223 surveys mailed, 147 (66%) were returned; of these, 128 (87%) were completed and analyzed.

Some questions about brain death: a case report.

A 13-year-old girl had an anaphylactic cardiac arrest with 45 minutes of resuscitation. After rewarming on day 3, a first examination was compatible with brain death, including an apnea test. Shortly thereafter, a stimulus to the trapezius muscle above the clavicles resulted in bilateral lower-limb withdrawal.

Brain death: understanding of the conceptual basis by pediatric intensivists in Canada.

Objective: To determine whether pediatric intensivists in Canada are aware of the controversies regarding the concept of brain death (BD).

Design: Prospective survey.

Setting: From February to April 2004, a survey was mailed to each intensivist in the 15 pediatric intensive care units across the 8 provinces of Canada.

Clinically important venous thromboembolism in pediatric critical care: a Canadian survey.

Purpose: Pediatric venous thromboembolism (VTE) is becoming an increasingly recognized morbidity associated with critical illness. The objective of this survey is to identify the patient factors and radiological features that pediatric intensivists consider more or less likely to make a venous thrombosis (VTE) clinically important in their patients.

Materials And Methods: Our definition of clinically important VTE was a VTE likely to result in short- or long-term morbidity or mortality if left untreated.

Inability to predict outcome of acute respiratory distress syndrome in children when using high frequency oscillation.

Objective: To (a) describe the experience with high-frequency oscillation (HFO) in children with acute respiratory distress syndrome (ARDS) unresponsive to conventional ventilation; (b) compare observed survival to that predicted by pediatric mortality scores and (c) determine if oxygenation index changes during HFO can predict survival.

Design: Retrospective, observational study.

Setting: A university hospital pediatric intensive care unit.

Treatment of life-threatening post-haemorrhagic anaemia with cell-free haemoglobin solution in an adolescent Jehovah's Witness.

Severe blood loss carries an increased risk of a fatal outcome in patients who do not consent to the use of blood products. For patients who base this decision on a religious belief system, such as the Jehovah's Witnesses, important distinctions may exist between the appropriateness of various blood products. We describe the first successful use of purified human cell-free haemoglobin solution in a paediatric patient, in this case in the management of life-threatening anaemia in a 14-year-old female Jehovah's Witness with immune thrombocytopenia.