Advanced PICU articles

CPP Thresholds & Survival

Age-Specific Cerebral Perfusion Pressure Thresholds and Survival in Children and Adolescents With Severe Traumatic Brain Injury.

Baxter B. Allen et al. Pediatr Crit Care Med 2014;15:62-70

 

Conclusion:

CPP targets should be age specific.Furthermore, CPP goals above 50 or 60mmHg in adults, above 50mm Hg in 6- to 17-year olds, and above 40 mm Hg in 0- to 5-year olds seem to be appropriate targets for for treatment-based studies. Systemic hypotension had an inconsistent relationship to events of low CPP, whereas elevated intracranial pressure was significantly related to all low CPP events across all age groups.

 

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Blood Guidelines, Mod 1

Patient Blood Management Guidelines: Module 1. Critical Bleeding  Massive Transfusion

 

 

National Blood Authority, Australia. 2016

 

Conclusion:

Module that focus on evidence-based patient blood management in neonates and paediatrics. The other five modules are Perioperative, Medical, Critical Care, Obstretics & Maternity and Paediatrics & neonates. This document was developed by the Clinical/Consumer Reference Group (CRG) representing specialist colleges, organisations and societies, with the active participation of the clinical community.

 

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Blood Guidelines, Mod 6

Patient Blood Management Guidelines: Module 6. Neonatal and Paediatrics

 

 

National Blood Authority, Australia. 2016

 

Conclusion:

Module that focus on evidence-based patient blood management in neonates and paediatrics. The other five modules are critical Bleeding/Massive Transfusion, Perioperative, Medical, Critical Care and Obstretics and Maternity. This document was developed by the Clinical/Consumer Reference Group (CRG) representing specialist colleges, organisations and societies, with the active participation of the clinical community.

 

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Last PICU bed?

Who Should Get the Last PICU Bed?

 

Wightman et al. Pediatrics 2014, 5:907-912

 

Conclusion:

Ethical discussion between Dr. Del Becarro (Vice President for Medical Affairs at Seattle Children's Hospital, Dr. Aaron Wightman (nephrology fellow and bioethicus at Seattle Children's Hoapital) and Emily Largent (a doctoral student in the joint JD/PhD Program in Health Policy at Harvard University.

 

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Best interest in PICU

'Best interests' in paediatric intensive care: an empirical ethics study

Birchley G et al. Arch Dis Child 2017;0:1-6

 

Conclusion:

Sensitivity to the long-term interests of parents of children with life-limiting conditions is defensible but must be exercised proportionately. Current approaches emphasise negotiation but offer few alternatives when decisions are at an impasse. In such situations, the instrumental role played by a child's deterioration and avoidance of court risks giving insufficient weight to the child's interests.

 

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Neonatal resusc decisions

The Best-Interest Standard Is Not Applied for Neonatal Resuscitation Decisions

Javier et al. Paediatrics 2008, 121:963-

 

Conclusion:

Whether resuscitation is considered in a patient's best interests is not closely related to survival rates or disability. Newborn infants and particularly preterm infants are systematically devalued, in comparison with older patients whose outcomes are the same or worse.

 

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