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São Paulo, Brazil

Ranjit S.,Pediatric Intensive Care Unit | Kissoon N.,BC Childrens Hospital
Pediatric Critical Care Medicine | Year: 2011

Objectives: To provide a comprehensive review of dengue, with an emphasis on clinical syndromes, classification, diagnosis, and management, and to outline relevant aspects of epidemiology, immunopathogenesis, and prevention strategies. Dengue, a leading cause of childhood mortality in Asia and South America, is the most rapidly spreading and important arboviral disease in the world and has a geographic distribution of >100 countries. Data Source: Boolean searches were carried out by using PubMed from 1975 to March 2009 and the Cochrane Database of Systematic Reviews from 1993 to March 2009 to identify potentially relevant articles by key search terms such as: "dengue"; "dengue fever"; "dengue hemorrhagic fever"; "dengue shock syndrome"; "severe dengue" and "immunopathogenesis, " pathogenesis," "classification," "complications, " and "management." In addition, authoritative seminal and up-to-date reviews by experts were used. Study Selection: Original research and up-to-date reviews and authoritative reviews consensus statements relevant to diagnosis and therapy were selected. Data Extraction and Synthesis: We considered the most relevant articles that would be important and of interest to the critical care practitioner as well as authoritative consensus statements from the World Health Organization and the Centers for Disease Control and Prevention. Dengue viral infections are caused by one of four single-stranded ribonucleic acid viruses of the family Flaviviridae and are transmitted by their mosquito vector, Aedes aegypti. The clinical syndromes caused by dengue viral infections occur along a continuum; most cases are asymptomatic and few present with severe forms characterized by shock. Management is predominantly supportive and includes methods to judiciously resolve shock and control bleeding while at the same time preventing fluid overload. Conclusions: Dengue is no longer confined to the tropics and is a global disease. Treatment is supportive. Outcomes can be optimized by early recognition and cautious titrated fluid replacement, especially in resource-limited environments. Copyright © 2011 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. Source


Kerklaan D.,Pediatric Intensive Care Unit
Journal of Pediatric Gastroenterology and Nutrition | Year: 2016

OBJECTIVES:: Overfeeding during critical illness is associated with adverse effects such as metabolic disturbances and increased risk of infection. Due to lack of sound studies with clinical endpoints, overfeeding is arbitrarily defined as the ratio caloric intake/measured resting energy expenditure (mREE) or alternatively as a comparison of measured respiratory quotient (RQ) to the predicted RQ based on the macronutrient intake (RQmacr). We aimed to compare definitions of overfeeding in critically ill mechanically ventilated children based on mREE, RQ and caloric intake to find an appropriate definition. METHODS:: Indirect calorimetry (IC) measurements were performed in 78 mechanically ventilated children, median age 6.3 months. Enteral and/or parenteral nutrition was provided according to the local guidelines. Definitions used to indicate overfeeding were the ratio caloric intake/mREE>110% and >120% and by the measured RQ>RQmacr +0.05. RESULTS:: The proportion of patients identified as overfed varied widely depending on the definition used, ranging from 22% (RQ>RQmacr+0.05), to 40% and 50% (caloric intake/mREE>120% and >110% respectively). Linear regression analysis showed that all patients would be identified as overfed with the definition RQ> RQmacr+0.05 when the ratio caloric intake/mREE exceeded 165%.Caloric intake was higher in children with an SD-score WFA <-2. CONCLUSIONS:: The proportion of mechanically ventilated patients identified as overfed ranged widely depending on the definition applied. These currently used definitions fail to take into account several relevant factors affecting metabolism during critical illness and are therefore not generally applicable to the PICU population. © 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Source


Johnstone L.,Pediatric Intensive Care Unit
Pediatric nursing | Year: 2010

Oral hygiene significantly affects children's well being. It is an integral part of intensive and critical care nursing because intubated and ventilated children in the Pediatric Intensive Care Unit (PICU) are dependent on the health care team to tend to their everyday basic needs. Fourteen articles were identified as being relevant to pediatric oral care in the PICU. These articles were subsequently appraised, and an oral hygiene in the PICU guideline was developed. Research highlighted the relationship between poor oral hygiene in the intensive care unit (ICU) and an increase in dental plaque accumulation, bacterial colonization of the oropharynx, and higher nosocomial infection rates, particularly ventilator-associated pneumonia. Research and a local, informal audit found the provision of oral hygiene care to PICU children varied widely and was often inadequate. Children in the PICU need their mouths regularly assessed and cleaned. Maintaining consistent, regular, and standardized oral hygiene practices in the PICU will also set an example for children and their families, encouraging and teaching them about the life-long importance of oral hygiene. Source


Ravishankar N.,Pediatric Intensive Care Unit
Journal of Pediatric Neurosciences | Year: 2015

Guillain-Barre syndrome (GBS) is a common cause of acute flaccid paralysis in children. Axonal variants of this disease are rare, and frequently life-threatening or debilitating. The course and outcome of a 17-month-old child with acute flaccid paralysis including severe respiratory involvement are presented. GBS was suspected. Nerve conduction studies demonstrated acute motor-sensory axonal neuropathy including both phrenic nerves. The difficulties with the diagnosis and management of this severe and life-threatening condition are discussed. Significant morbidity is also highlighted. Axonal variants of GBS although rare cause significant morbidity in children. Diagnosis relies solely on accurate neurophysiologic testing and is important because the available treatment options for GBS are frequently ineffective in these variants. Source


Gillis J.,Pediatric Intensive Care Unit | Tobin B.,Plunkett Center for Ethics
Pediatric Critical Care Medicine | Year: 2011

Objective: To argue that pediatric intensive care physicians have difficulties in responding to parental questions about prognostic certainty, and that this constitutes a failure in their professional responsibility to parents. Conclusions: These difficulties arise from three sources: 1) the structure and organization of contemporary intensive care, 2) the neglect of prognostication, and 3) the failure to distinguish scientific certainty from practical certainty. It is proposed that an understanding of these issues will enable physicians to respond to the parental question "How certain are you, doctor?" with more authenticity and sincerity. Copyright © 2011 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. Source

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