Pediatric Intensive Care Units - Science topic

Try with this:

Pediatric SOFA score. BTW, did you try calculate the Vasoactive Inotropic Score (VIS)?

Currently I am living in Bolivia and most of the Hospital don´t count with those services in ICU.

In Brazil there is a law that determine the presence of some of those professional (PT for example) 24/7. But that doesn´t translate into practice.

Dear Mrs.George,

Heart-centered greetings

First, thanks a lot for sharing this valuable human experience with us.

Second, I would like to appreciate the iconic client's advocacy role that the Chaplain had played! Such a great role model for all of us in health care industry.

Third, I see a great opportunity for qualitative research focusing on such courageous acts of parents.

Once again thank you very much!

V/r,

Sadeq AL-Fayyadh, PhD.

University of Baghdad,School of Nursing

I'm a little confused by the comments about "burn sites" because modern transcutaneous oxygen and carbon dioxide monitors don't burn the skin. When I was an anesthesia resident at UCLA, I had the opportunity to try the earliest version of a transcutaneous oxygen monitor, and with these primitive machines there was some concern about leaving the sensor in the same location for prolonged periods of time due to the possibility of causing tissue damage. They warmed the skin to "arterialize" capillary flow, but the heating element was not regulated by a thermostat. It was impossible to calibrate these original monitors. They provided a numerical "readout" for oxygen concentration that rose with increased tissue oxygenation, but they could not actually measure the partial pressure. There has been considerable improvment in the technology during the 50 years since I was a resident. I have purchased one of the new machines. They now measure transcutaneous CO2 as well as oxygen, and can be calibrated to measure the partial pressures of both. However, they remain far from ideal. They are very "tricky" to use. Their main advantage is that they are non-invasive, and can provide continuous measurement of the partial pressures of oxygen and carbon dioxide. The sensors are not likely to cause tissue damage, because they are now governed by a thermostat that maintains the skin temperature around 45 degrees celsius, so patient injury is no longer a concern.

I am now working with the Plexus software company to enable automatic incorporation of TcO2 and TcCO2 data into my anesthetic records, and capture readings every five minutes.

Carbon dioxide chemistry and pathophysiology is very tricky stuff. I once had an engineer who helped design modern capnographs tell me that it was necessary to install a fan in the measurement chamber of the machines to constant stir the gas mixture, because carbon dioxide has a vexing tendency to "settle" and thereby frustrate accurate measurement. Transcutaneous CO2 measurement is similarly vexed by variables. The sensor is mounted in a small plastic cup that is pasted to the skin. About five drops of saline solution must be installed in the cup before the sensor is attached. The skin must be carefully "prepped" to prevent the water from leaking out of the plastic cup "chamber" where the measurement takes place. The temperature must rise to 45 degrees before the machine begins to operate. Too much or too little water in the chamber will disrupt measurement. The sensor must be calibated each time it is applied, and if you are using it in an ICU setting it's probably a good idea to re-calibrate the sensor every hour or so. I use the machine only during short dental surgeries, and must re-calibrate between each case. It's essential to have a clear understanding of the role of carbon dioxide in the pathophysiology of oxygen transport and delivery, and CO2 data alone is meaningless in the absence of O2 data.

Exactly what are you trying to accomplish in the ICU setting? Are you performing some sort of study, or are you using the machine to manage critically ill patients?

Every neonate admitted to a Neonatal Intensive Care Unit has a high risk of complications and death. Parents should know that their child may die due to complications of the disease, and even idiosyncratic complications, which are sometimes not predictable (eg, anaphylaxis). Parents should Know that the probability of death is real and that medical staff do their best effort to reduce this risk;  we should not give false hope, but we must have in mind that despite the great risk of death, there is also a probability of survival, which, small or big, must be fought.

You have 2 problems, firstly the size of connections and secondly the lack of a reliable seal.

I remember being used (repeatedly) as a subject for the respiratory physiologists/pharmacologists when I was a resident. The standard set-up (breathing spontaneously) measured pressure and flow and the circuit included a device that occluded the airway with a diaphragm for 0.1 sec. The transient pressure gradient across  the diaphragm indicated inspiratory effort and was used as an index of respiratory drive. The lack of a cuff sealing the airway might interfere with this, but as the occlusion is only for 100 msec, you might get a useful reading.

I remember the equipment as being rather bulky, both from the tubing and the recording apparatus, but this was 50 years ago. 

So speak to your friendly local respiratory physiologists and ask if they can measure P_0.1 in your circumstances.

Good luck! 

Sonography is the most useful tool per my own experience. Clinical sign is deceiving and we experienced large subcapsular liver hematoma due to UVL without remarkable clinical sign. We probably will obtain pathological evidence after the patient is dead (too late).

Can BIS monitoring be used to assess the depth of propofol

anesthesia in the treatment of refractory status epilepticus?

*Tadeusz Musialowicz, yEsa Mervaala, zReetta Ka¨lvia¨inen, *Ari Uusaro,

Epilepsia, 51(8):1580–1586, 2010

doi: 10.1111/j.1528-1167.2009.02514.x