A5024534078- Anesthesia and Sedative Agents
- Intensive Care Unit Cognitive Disorders
- Anesthesia and Neurotoxicity Research
- Respiratory Support and Mechanisms
- Airway Management and Intubation Techniques
- Cardiac, Anesthesia and Surgical Outcomes
- Pediatric Pain Management Techniques
- Neonatal Respiratory Health Research
- Cardiac Arrest and Resuscitation
- Hemodynamic Monitoring and Therapy
- Mechanical Circulatory Support Devices
- Hemophilia Treatment and Research
- Renal function and acid-base balance
- Anesthesia and Pain Management
- Antibiotics Pharmacokinetics and Efficacy
- Blood Coagulation and Thrombosis Mechanisms
- Emergency and Acute Care Studies
- Infant Development and Preterm Care
- Pharmaceutical studies and practices
- Nitric Oxide and Endothelin Effects
- Lymphatic Disorders and Treatments
- Neuroscience of respiration and sleep
- Heart Failure Treatment and Management
- Tracheal and airway disorders
- Poisoning and overdose treatments
University of Louisville
2014-2025
Kosair Children's Hospital
2016-2025
Norton Hospital
2018-2023
Pfizer (United States)
2020
Children's Hospital of Philadelphia
2018
Johns Hopkins University
2018
University of Pennsylvania
2018
University of Utah
2018
Kennedy Krieger Institute
2018
University of Michigan
2018
A guideline that both evaluates current practice and provides recommendations to address sedation, pain, delirium management with regard for neuromuscular blockade withdrawal is not currently available.To develop comprehensive clinical guidelines critically ill infants children, specific attention seven domains of care including sedation/agitation, iatrogenic withdrawal, blockade, delirium, PICU environment, early mobility.The Society Critical Care Medicine Pediatric Pain, Agitation,...
We sought to compare the efficacy of midazolam versus dexmedetomidine for sedation during mechanical ventilation in infants and children.We performed a prospective, randomized trial pediatric intensive care unit tertiary center. Infants children requiring underwent continuous infusion either (starting dose 0.1 mg/kg/h) or 0.25 0.5 microg/kg/h) with intermittent morphine, as needed. The was assessed using Ramsay scale, score, tracheal suctioning score well bispectral monitoring.There were 10...
We present preliminary clinical experience with the use of dexmedetomidine, an alpha2 adrenergic agonist, in children. Dexmedetomidine was administered three scenarios: (i) to provide sedation during mechanical ventilation; (ii) intraoperatively for controlled hypotension orthopaedic surgical procedure; and (iii) invasive procedure. Preliminary data from studies adult population, its physiological effects potential applications paediatric anaesthesia critical care are discussed.
In patients who are mechanically ventilated in the pediatric intensive care unit (PICU), sedative and/or analgesic medications routinely provided and titrated to effect based on clinical assessment of patient. The bispectral index (BIS) monitor uses a modified electroencephalogram quantify effects central nervous system-acting drugs level consciousness. To evaluate usefulness BIS predict sedation levels PICU, we compared values with simultaneously obtained scores 24 aged 5.7 plus minus 6.1...
Children often require sedation for lengthy noninvasive procedures. Conventional agents such as chloral hydrate, benzodiazepines, or barbiturates have been associated with failure, respiratory depression, and paradoxic agitation. Dexmedetomidine is a newer alpha(2)-adrenergic receptor agonist sedative properties minimal depression. We hypothesized that it would be an effective agent these procedures.Prospective case series.Tertiary care children's hospital.Children undergoing...
Objective To describe the development of bradycardia during sedation with dexmedetomidine in a patient concurrently receiving digoxin. Design Case report. Setting The pediatric intensive care unit tertiary children's hospital. Patients A 5-wk-old infant an atrioventricular septal defect requiring mechanical ventilation for acute respiratory syncytial virus infection. Measurements and Main Results As part ongoing evaluation unit, received loading dose (0.5 μg/kg) followed by infusion (0.44...
Summary Background : Flexible fiberoptic bronchoscopy is an important diagnostic tool for pediatric pulmonologists. Because of its favorable respiratory profile, ketamine has become a popular sedative this procedure, but may be associated with unpleasant emergence reactions in the older child. Remifentanil newer, ultra‐short acting opioid that been shown to provide effective sedation and cough suppression when combined intermittent propofol boluses. However, delivery these agents as...
Summary Background : Oral premedication is often required in children to provide anxiolysis and lessen the psychological impact of hospitalization and/or procedures. We present our experience with dexmedetomidine as an oral premedicant prior procedural sedation or anesthetic induction. Methods undertook a retrospective review anesthesia service records patients who received dexmedetomidine. Results The cohort for study included 13 ranging age from 4 14 years. (mean dose: 2.6 ± 0.83 μ g·kg −1...
To evaluate the impact of obesity on adverse events and required interventions during pediatric procedural sedation.The Pediatric Sedation Research Consortium database prospectively collected sedation encounters was queried to identify patients for whom body mass index (BMI) could be calculated. Obesity defined as BMI ≥95th percentile age gender. Sedation-related outcomes, events, therapeutic were compared between obese nonobese patients.For analysis, 28,792 records eligible. A total 5,153...
Objective The authors present the use of synthetic factor VIIa to treat bleeding after cardiopulmonary bypass and surgical repair an atrial septal defect in infant with trisomy 10 pulmonary hypertension. Design Case report. Setting University-affiliated pediatric intensive care unit. Patients A 4-mo-old, 3.7-kg infant. Main Results After a single dose VIIa, there was normalization prothrombin partial thromboplastin time cessation bleeding. Conclusion potential benefits when compared...
The objectives of this study were to investigate the correlation between thromboelastography (TEG) and conventional measures anticoagulation, determine optimum values for citrated kaolin TEG R time (TEG RCK) anti-Xa activity that would minimize both bleeding thrombotic complications in pediatric neonatal patients requiring extracorporeal membranous oxygenation (ECMO). A retrospective chart review veno-venous (VV) venoarterial (VA) ECMO was performed. Combined medical cardiac ICU within a...
Summary Background : Sedation is frequently required during noninvasive radiological imaging in children. Although commonly used agents such as chloral hydrate and midazolam are generally effective, failures may occur. The authors report their experience with dexmedetomidine for rescue sedation magnetic resonance imaging. Methods A retrospective chart review was undertaken. Results cohort included five patients ranging age from 11 months to 16 years. Following the failure of other (chloral...
The Sedation Consortium on Endpoints and Procedures for Treatment, Education, Research, established by the Analgesic, Anesthetic, Addiction Clinical Trial Translations, Innovations, Opportunities, Networks public-private partnership with US Food Drug Administration, convened a meeting of sedation experts from variety clinical specialties research backgrounds objective developing recommendations procedural research. Four core outcome domains were recommended consideration in trials: (1)...
Objectives: Tracheal intubation (TI) is a critical skill for PICU attending physicians to maintain. We hypothesize that attendings perform fewer TIs and have lower success rate in programs with Pediatric Critical Care Medicine (PCCM) fellowship. Design: Retrospective study using the National Emergency Airway Registry Children (NEAR4KIDS) from July 2016 June 2020. Exposures were presence of PCCM fellowship TI maintenance program (SMP). The primary outcome was attending’s first attempt...
Nitric oxide (NO) is thought to play an important role in the regulation of neonatal pulmonary vasculature. It has been suggested that neonates with hypertension have a defective NO pathway. Therefore, we measured 1-day-old piglets exposed hypoxia (fraction inspired O 2 = 0.10) for 3 or 14 days induce 1) activity synthase (NOS) via conversion l-arginine l-citrulline and concentration precursorl-arginine isolated vessels, 2) vasodilator response donor 3-morpholinosydnonimine- N-ethylcarbamide...
We prospectively compared the accuracy of end-tidal CO2 (ETco2) and transcutaneous (TCco2) monitoring in older pediatric patients (4 yr or older) receiving mechanical ventilation for respiratory failure. ETco2 TCco2 were simultaneously monitored with arterial (Paco2) values when blood gas analysis was performed. Eighty-two sample sets compared. The to Paco2 difference 6.4 ± 6.3 mm Hg, whereas 2.6 2.0 Hg (P < 0.0001). absolute 5 less 47 82 measurements, 76 measurements 0.00001). Regression...
Continuous monitoring of ventilation during mechanical may improve patient management by facilitating proactive rather than reactive ventilator adjustments and decrease the need for repeated arterial blood gas analysis. Because their more critical pulmonary status, patients requiring high-frequency oscillatory especially benefit from continuous monitoring.Prospective evaluation correlation between transcutaneous CO2 (TC(CO2)) PaCO2 values.Tertiary care pediatric intensive unit.Fourteen...
The association between hyponatremia and intracranial pathology has been well described. When accompanied by natriuresis, most commonly attributed to inappropriate secretion of antidiuretic hormone. However, there is growing evidence suggest that many these patients may actually have cerebrally mediated salt losses, a disorder referred as the cerebral wasting syndrome (CSWS). While this reasonably described in adults, data regarding CSWS pediatric-aged remains sparse. Since fluid management...
Cyclic vomiting syndrome (CVS) is a chronic, recurrent disorder of unknown etiology characterized by episodes nausea and lasting hours or days separated symptom-free intervals weeks to months. Although several different therapeutic regimens have been suggested for CVS, there remains no standard, effective regimen. In many cases, management includes the use potent sedatives that induce prolonged durations sedation sleep. Dexmedetomidine an alpha(2) adrenergic agonist with increased...
This study evaluates the efficacy of recombinant factor VII (rVIIa) in treatment coagulation dysfunction pediatric patients.We retrospectively reviewed records patients who received rVIIa intensive care unit or operating room for coagulopathy. Case series literature were also reviewed.Ten patients, ranging age from 3 months to 19 years, 22 doses rVIIa. Seven 10 had fresh frozen plasma and cryoprecipitate before administration without effect. All a fibrinogen level above 100 mg/dl platelet...