Bivalirudin in pediatric patients maintained on extracorporeal life support.

Objective: Anticoagulation with heparin is standard of care for patients maintained on extracorporeal life support. Very limited evidence exists for the use of alternative anticoagulants during extracorporeal life support. Patients with heparin-induced thrombocytopenia, heparin resistance, and evidence of significant thrombosis while on heparin may be candidates for alternative anticoagulation.

Caspases inhibition decreases neurological sequelae in meningitis.

Objective: To evaluate the effects of sustained caspase inhibition during the acute phase of meningitis-induced brain injury. Changes in neurobehavioral performance were the primary outcome variables.

Design: Randomized prospective animal study.

Right-sided superior vena cava draining into the left atrium: a rare anomaly of systemic venous return.

The most commonly encountered systemic thoracic venous anomaly is a persistent left superior vena cava that drains into the right atrium via the coronary sinus. A much rarer systemic venous anomaly is that of isolated anomalous drainage of a normally positioned right superior vena cava (RSVC) into the left atrium (LA). This has been reported in approximately 20 patients with the diagnosis usually being made by cardiac catheterization.

Clinical trials in pediatric traumatic brain injury: unique challenges and potential responses.

In order to optimize pediatric traumatic brain injury translational and clinical research, scientific and ethical challenges need to be recognized and addressed. Having recently conducted a multisite phase II safety/feasibility trial of magnesium sulfate as a neuroprotective agent, we supplement our own experience by a mini review of similar studies, identifying challenges and possible responses from the perspective of families, investigators, funding agencies and society.

Should age be a deciding factor in ethical decision-making?

The question of age as a factor in ethical decision-making takes two forms. The first form considers age as a factor at the societal, or policy, level, and the second as a factor in determining the capacity of the individual patient to make decisions regarding their own care. This article satisfies itself with a consideration of only the latter question.

Nurse staffing and unplanned extubation in the pediatric intensive care unit.

Objective: To determine the association between unplanned extubations and years of nurse experience and nurse-to-patient ratio in the pediatric intensive care unit (PICU).

Design: Case-control study.

Setting: University-affiliated children's hospital PICU.

Dexamethasone decreases neurological sequelae and caspase activity.

Objective: To evaluate the use of dexamethasone in a model of meningitis-induced brain injury. Changes in neurobehavioral performance were the primary outcome variables. Changes in caspase activation and markers of neuronal injury were the secondary outcome variables.

The association of race and ethnicity with rates of drug and alcohol testing among US trauma patients.

Background: Racial and ethnic minority patients often receive differential medical care compared to Caucasians. The aim of this study was to evaluate the association of race and ethnicity with rates of alcohol and drug testing among adult US trauma patients.

Methods: Data for 79,246 adults admitted to 58 institutions participating in the US National Trauma Data Bank were evaluated using multivariable, hierarchical, mixed-effects analyses to determine the odds of receiving alcohol and drug testing among different racial/ethnic groups.

Caspofungin in a pediatric patient with persistent candidemia.

Objective: To describe the response of a child with persistent fungemia to caspofungin, a member of the echinocandin class of antifungals.

Design: Descriptive case report.

Setting: Pediatric intensive care unit at a university teaching hospital.

Evaluation of race and ethnicity on alcohol and drug testing of adolescents admitted with trauma.

Objectives: To describe the incidence of alcohol and drug testing in adolescents admitted for traumatic injury and to analyze these results with reference to race, ethnicity, and gender differences.

Methods: Data were collected on adolescents (aged 12 through 17 years) from the National Trauma Data Bank. Testing statuses for alcohol and drugs were the two primary outcome variables.

Amrinone in pediatric refractory septic shock: An open-label pharmacodynamic study.

OBJECTIVE: To investigate the short-term hemodynamic effects of amrinone in pediatric patients with refractory septic shock. DESIGN: Open-label, clinical trial. SETTING: Pediatric intensive care unit.

Death of an adolescent athlete with sickle cell trait caused by exertional heat stroke.

OBJECTIVE: To report a case of fatal rhabdomyolysis secondary to exertional heat stroke and the potential influence of sickle cell trait on the outcome of this case. DESIGN: Descriptive case report. SETTING: Pediatric intensive care unit in an academic children's hospital.

Modulation of nuclear factor-kappaB activation and decreased markers of neurological injury associated with hypothermic therapy in experimental bacterial meningitis.

Objective: This study was designed to evaluate the use of moderate hypothermia in a model of meningitis-induced brain injury and its effect on the activation of nuclear factor-kappaB, biological markers of neuronal injury, and neurobehavioral performance.

Design: Randomized, prospective animal study.

Setting: University research laboratory.