Providing evidence-based care to the critically ill child including assessment, evaluation, and management in resource-limited settings provides unique challenges and limitless opportunities to significantly impact morbidity and mortality in these settings. Difficulties encountered include: determining which disease processes will benefit most from critical care in resource-limited settings, lack of triage tools and adjuncts to help with assessment, finite laboratory and radiological tests, limited understanding of key findings in critically ill/injured pediatric patients, (especially by those without pediatric focused training), and finally, lack of supplies, medicines, equipment, and training of health care providers to appropriately treat critically ill children in these resource-limited settings. In this review, the most common problems encountered and possible solutions to overcome these obstacles are discussed.
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http://dx.doi.org/10.1055/s-0036-1584677 | DOI Listing |
Ann Intensive Care
January 2025
Department of Intensive Care Medicine, Universitaire Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
Background: Continuous veno-venous hemodiafiltration (CVVHDF) is used in critically ill patients, but its impact on O₂ and CO₂ removal, as well as the accuracy of resting energy expenditure (REE) measurement using indirect calorimetry (IC) remains unclear. This study aims to evaluate the effects of CVVHDF on O₂ and CO₂ removal and the accuracy of REE measurement using IC in patients undergoing continuous renal replacement therapy.
Design: Prospective, observational, single-center study.
Brain Struct Funct
January 2025
Applied Psychology, Faculty of Education, University of Western Ontario, 1137 Western Rd, London, ON, N6G 1G7, Canada.
Children and adolescents with neurodevelopmental disorders such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) may be more susceptible to early life stress compared to their neurotypical peers. This increased susceptibility may be linked to regionally-specific changes in the striatum and amygdala, brain regions sensitive to stress and critical for shaping maladaptive behavioural responses. This study examined early life stress and its impact on striatal and amygdala development in 62 children and adolescents (35 males, mean age = 10.
View Article and Find Full Text PDFJ Clin Med
January 2025
Faculty of Medicine, "Carol-Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
: Bupropion, an atypical antidepressant and smoking cessation aid, is known for its potential to cause seizures, cardiotoxicity and neurotoxicity in overdose scenarios. However, overdoses may present variably, and muscular and renal complications, such as rhabdomyolysis and acute kidney injury (AKI), can emerge in unexpected ways. Previous reports have shown that severe overdoses can lead to a spectrum of complications, but the precise mechanisms linking bupropion overdose with rhabdomyolysis remain poorly understood.
View Article and Find Full Text PDFJ Clin Med
January 2025
Department of Critical Care Medicine, Hospital de São Francisco Xavier, Unidade Local de Saúde Lisboa Ocidental (ULSLO), Estrada Forte do Alto Duque, 1449-005 Lisbon, Portugal.
The prompt identification and correction of patient-ventilator asynchronies (PVA) remain a cornerstone for ensuring the quality of respiratory failure treatment and the prevention of further injury to critically ill patients. These disruptions, whether due to over- or under-assistance, have a profound clinical impact not only on the respiratory mechanics and the mortality associated with mechanical ventilation but also on the patient's cardiac output and hemodynamic profile. Strong evidence has demonstrated that these frequently occurring and often underdiagnosed events have significant prognostic value for mechanical ventilation outcomes and are strongly associated with prolonged ICU stays and hospital mortality.
View Article and Find Full Text PDFJ Clin Med
December 2024
Department of Critical Care Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea.
A fever is an important sign that affects patient outcomes with various etiologies in the post-decannulation period of extracorporeal membrane oxygenation (ECMO); however, the cause is not fully understood. This study aimed to investigate the characteristics and clinical implications of fevers after ECMO decannulation in critically ill patients. We conducted a retrospective, single-center study of adult patients who were successfully weaned off venoarterial (VA) or venovenous (VV) ECMO.
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