Abstract:
BACKGROUND:Acute lung injury (ALI) and its more severe form, acute respiratory distress syndrome (ARDS), are devastating disorders of overwhelming pulmonary inflammation and hypoxemia, resulting in high morbidity and mortality. AIM:To provide the clinician with a summary of the literature on the epidemiology, diagnosis, and an evidence-base for management of ALI/ARDS in children. DATA SELECTION:PubMed search for clinical trials, selected literature review of other relevant studies on epidemiology and diagnosis. DATA SYNTHESIS AND RECOMMENDATIONS: Lower mortality combined with a relatively lower frequency of ALI/ARDS in children makes performance of clinical trials challenging. Based on expert opinion, the following are recommended: 1) avoid tidal volumes > or =10 mL/kg body weight; 2) keep plateau pressure < or =30 cm H2O, arterial pH at 7.30 to 7.45, and Pao2 60 to 80 torr (8 to 10.7 kPa) (Spo2 > or =90%); 3) provide sedation, analgesia, and stress ulcer prophylaxis; and 4) use a 10 g/dL hemoglobin threshold for packed red blood cell transfusion in unstable patients (shock or profound hypoxia). Evidence supports dropping the hemoglobin transfusion threshold to 7 g/dL once profound hypoxia and shock have resolved. Promising therapies for pediatric ALI/ARDS based on pediatric studies include endotracheal surfactant, high-frequency oscillatory ventilation, noninvasive ventilation, and use of extracorporeal membrane oxygenation as a rescue therapy. Promising therapies based on adult trials include use of corticosteroids for lung inflammation and fibrosis, use of 4 to 6 mL/kg tidal volumes and restrictive fluid management. Prone positioning, bronchodilators, inhaled nitric oxide, tight glucose control, and high-flow nasal cannula (HFNC) oxygen are therapies that require further study before they can be recommended for children with ALI/ARDS.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Randolph AGdoi
10.1097/CCM.0b013e3181aee5ddsubject
Has Abstractpub_date
2009-08-01 00:00:00pages
2448-54issue
8eissn
0090-3493issn
1530-0293journal_volume
37pub_type
杂志文章,评审abstract:OBJECTIVES:Less than half of the thousands of children who suffer in-hospital cardiac arrests annually survive, and neurologic injury is common among survivors. Hemodynamic-directed cardiopulmonary resuscitation improves short-term survival, but its impact on longer term survival and mitochondrial respiration-a potenti...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003620
更新日期:2019-03-01 00:00:00
abstract:OBJECTIVE:To determine whether plasma lipid hydroperoxides may be a useful marker for sepsis. DESIGN:Exploratory, open-label study. SETTING:Critical care unit at a university medical center. PATIENTS:Twelve patients with sepsis syndrome requiring hemodynamic monitoring with pulmonary artery catheters. Seven patients...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199109000-00004
更新日期:1991-09-01 00:00:00
abstract:RATIONALE:Life and death triage decisions are made daily by intensive care unit physicians. Admission to an intensive care unit is denied when intensive care unit resources are constrained, especially for the elderly. OBJECTIVE:To determine the effect of intensive care unit triage decisions on mortality and intensive ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e318232d6b0
更新日期:2012-01-01 00:00:00
abstract::The Hemoccult slide test is used frequently to test for the presence of occult blood in samples of gastric juice obtained from critically ill patients. The purpose of this study was to investigate the accuracy of this test to determine the presence of blood in human gastric juice at various pH values. Gastric aspirate...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198210000-00016
更新日期:1982-10-01 00:00:00
abstract:OBJECTIVE:Increasing evidence, including publication of the Transfusion Requirements in Critical Care trial in 1999, supports a lower hemoglobin threshold for RBC transfusion in ICU patients. However, little is known regarding the influence of this evidence on clinical practice over time in a large population-based coh...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31828e9a49
更新日期:2013-10-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to quantify the effect of hypertonic saline solution on contused and noncontused brain tissue in patients with traumatic brain injury. We hypothesize that hypertonic saline would increase the volume of brain contusion while decreasing the volume of noncontused hemispheric areas. DES...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000243797.42346.64
更新日期:2006-12-01 00:00:00
abstract:OBJECTIVE:Failure to detect clinical deterioration in the hospital is common and associated with poor patient outcomes and increased healthcare costs. Our objective was to evaluate the feasibility and accuracy of real-time risk stratification using the electronic Cardiac Arrest Risk Triage score, an electronic health r...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001716
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVES:To compare in the same patient with septic shock, respective effects of epinephrine, norepinephrine, and the combination of norepinephrine and dobutamine (5 microg/kg/min) on systemic hemodynamic parameters and gastric mucosal perfusion using gastric tonometry and laser-Doppler flowmetry techniques. DESIGN:...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199905000-00021
更新日期:1999-05-01 00:00:00
abstract::Intralipid elimination patterns were compared in 25 healthy controls, 12 patients recovering from uncomplicated cholecystectomy, and 25 critically ill patients. The intravenous fat tolerance test revealed a similar fractional removal rate (k2) in healthy controls and critically ill patients, but k2 was increased in ch...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198605000-00009
更新日期:1986-05-01 00:00:00
abstract::Two new catecholamines, dopamine and dobutamine, have found widespread use for cardiovascular support. The relative efficacy of these drugs in aiding resuscitation from cardiopulmonary arrest is unknown. Dogs were subjected to either asphyxial or fibrillatory cardiac arrest. Resuscitation was attempted with artificial...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198109000-00005
更新日期:1981-09-01 00:00:00
abstract:OBJECTIVE:Hypoxemic reperfusion attenuates brain injury secondary to severe cerebral ischemia, myocardial, and intestinal injury occurring in intestinal postischemic shock, and offers hemodynamic stabilization and attenuation of inflammatory response when applied in the resuscitation from hemorrhagic shock. In this stu...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31819b81ec
更新日期:2009-03-01 00:00:00
abstract::This study evaluates the recall of 100 patients after ICU admission. There was a wide spectrum of race, religion, occupation, and educational levels. The more common diagnoses included asthma, pneumonia, trauma, and adult respiratory distress syndrome. The average Acute Physiology and Chronic Health Evaluation (APACHE...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199009000-00012
更新日期:1990-09-01 00:00:00
abstract:OBJECTIVES:Racial/ethnic differences in palliative care resource use after stroke have been recognized, but it is unclear whether patient or hospital characteristics drive this disparity. We sought to determine whether palliative care use after intracerebral hemorrhage and ischemic stroke differs between hospitals serv...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002762
更新日期:2017-12-01 00:00:00
abstract:OBJECTIVES:With decreasing mortality in PICUs, a growing number of survivors experience long-lasting physical impairments. Early physical rehabilitation and mobilization during critical illness are safe and feasible, but little is known about the prevalence in PICUs. We aimed to evaluate the prevalence of rehabilitatio...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004291
更新日期:2020-05-01 00:00:00
abstract::Human hemoglobin (Hb) solution is being developed for use as an oxygen-delivering resuscitation fluid. Substantial improvements in the general purity and quality of experimental Hb solutions have been achieved by recent research efforts. Hb solutions now appear to be free of the undesirable biological effects that wer...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-198204000-00002
更新日期:1982-04-01 00:00:00
abstract:OBJECTIVES:To determine the point prevalence of medication errors at the time of transition of care from an ICU to non-ICU location and assess error types and risk factors for medication errors during transition of care. DESIGN:This was a multicenter, retrospective, 7-day point prevalence study. SETTING:Fifty-eight I...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000003633
更新日期:2019-04-01 00:00:00
abstract:OBJECTIVES:Recently, recombinant angiotensin-converting enzyme 2 was shown to protect mice from acute lung injury, an effect attributed to reduced bioavailability of angiotensin II. Since angiotensin-converting enzyme 2 metabolizes angiotensin II to angiotensin-(1-7), we hypothesized that this effect is alternatively m...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31828a6688
更新日期:2013-11-01 00:00:00
abstract:OBJECTIVE:Mannitol is widely used in hospitals worldwide to treat patients with high intracranial pressure and/or cerebral edema. One of the mechanisms by which mannitol is thought to affect intracranial pressure is by increasing the patient's serum osmolarity, but not the osmolarity in the brain or cerebrospinal fluid...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/01.CCM.0000050287.68977.84
更新日期:2003-02-01 00:00:00
abstract:OBJECTIVE:The role of systemic corticosteroids in pathophysiology and treatment of acute respiratory distress syndrome is controversial. Use of prehospital systemic corticosteroid therapy may prevent the development of acute respiratory distress syndrome and improve hospital outcomes. DESIGN:This is a preplanned retro...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e31828a1fc7
更新日期:2013-07-01 00:00:00
abstract::Given the multiple biological, metabolic, and pharmacologic effects of supplemental arginine, much effort has been devoted to defining its role in numerous clinical conditions. Herein, we review the multiple pathways of arginine metabolism with its various enzyme systems; the effect of arginine on nutrition, healing, ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000279188.97421.FE
更新日期:2007-09-01 00:00:00
abstract:OBJECTIVES:Sepsis results in organ dysfunction caused by a dysregulated host response, in part related to the immune response of a severe infection. Mesenchymal stromal cells are known to modulate the immune response, and expression of stromal cell-derived factor-1 regulates mobilization of neutrophils from the bone ma...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004244
更新日期:2020-05-01 00:00:00
abstract:OBJECTIVE:The administration of vasopressin during cardiopulmonary resuscitation (CPR) provides significantly more vital organ blood flow when compared with epinephrine during cardiac arrest in pigs. The effects of this potent vasoconstrictor on postresuscitation cardiovascular function remain unknown. The purpose of t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199612000-00014
更新日期:1996-12-01 00:00:00
abstract::Prolonged artificial ventilation may result in worsening gas exchange and pulmonary compliance in patients with otherwise normal lungs. Prolonged hyperinflations to 40 cm H2O can completely reverse deterioration of gas exchange and compliance in such patients. Similar efforts have effectively recruited atelectatic lun...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198712000-00001
更新日期:1987-12-01 00:00:00
abstract::Hypophosphatemia may occur in Reye's syndrome. We retrospectively studied 42 patients with Reye's syndrome to determine the frequency and degree of hypophosphatemia, to identify possible causes, and to determine whether hypophosphatemia was related to the severity of disease or mortality. Nineteen (46%) patients were ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198506000-00008
更新日期:1985-06-01 00:00:00
abstract:OBJECTIVE:To determine how top loads with different doses of carbon monoxide (CO)-saturated saline solutions (CO-saline) affect microvascular and systemic hemodynamics and to delineate the corresponding biochemical mechanisms. DESIGN:Prospective study. SETTING:University research laboratory. SUBJECTS:Male Golden Syr...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000259533.84180.C7
更新日期:2007-04-01 00:00:00
abstract:OBJECTIVE:To examine the frequency with which quality of life and treatment limitation were discussed in formal family meetings for long-stay intensive care unit patients with high risk for mortality and morbidity. DESIGN:Descriptive observational study. SETTING:Five intensive care units. PATIENTS:One hundred sixtee...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318232d8c4
更新日期:2012-02-01 00:00:00
abstract:BACKGROUND:Procalcitonin (PCT), a marker of bacterial sepsis, may also act as a mediator of the inflammatory response to infection, and thus influence outcome. OBJECTIVE:To investigate the relationship between PCT, interleukin (IL)-10, tumor necrosis factor (TNF), organ failure, and mortality in pediatric septic shock...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200007000-00068
更新日期:2000-07-01 00:00:00
abstract:OBJECTIVE:To define the epidemiology of broad-spectrum cephalosporin-resistant gram-negative bacilli in intensive care units (ICUs) during a nonoutbreak period, including the prevalence, the risk factors for colonization, the frequency of acquisition, and the rate of infection. DESIGN:Prospective cohort study. SETTIN...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199906000-00026
更新日期:1999-06-01 00:00:00
abstract::High-risk patients who survived general (noncardiac) surgery were observed to have cardiac index (CI) values averaging 4.5 L/min.m2, oxygen delivery (DO2) greater than 600 ml/min.m2, and oxygen consumption (VO2) 170 ml/min.m2 during the first 2 or three days postoperatively. Patients who subsequently died maintained r...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:
更新日期:1990-01-01 00:00:00
abstract:OBJECTIVE:To describe the symptom experiences of family members of patients at high risk for dying in the intensive care unit and to assess risk factors associated with higher symptom burden. DESIGN:Prospective, cross-sectional study. SETTING:Three intensive care units at a large academic medical center. PARTICIPANT...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e3181cf6d94
更新日期:2010-04-01 00:00:00