Assuntos
Anestesiologia/tendências , Pediatria/tendências , Criança , Humanos , Medicina , Especialização , Estados UnidosRESUMO
Case mix based on diagnosis-related groups (DRGs) was studied over 3 years for duration of stay and mean charges for a pediatric intensive care unit (PICU) and a general ward (WARD) population. Case mix variation for 2403 PICU and 14,552 WARD patients was analyzed, and a subset of 856 PICU and 2222 WARD patients examined for variations in duration of stay and mean charges in nine DRGs. Whereas case mix by DRG was consistent over time for both groups, the PICU case mix differed consistently from WARD case mix (P less than 0.001). After adjustment for inflation and for differences in case mix, average stay for the PICU was 10.7 days, versus 6.1 for the WARD (P less than 0.025), with a mean charge of $7172 per PICU and $2946 per WARD patient (P less than 0.01). Furthermore, the case mix-adjusted differences in duration of stay and mean charge between the PICU and WARD populations increased over time. Pediatricians will need to address DRG-based reimbursement systems that place intensive care units, and their institutions, at a significant financial disadvantage.
Assuntos
Grupos Diagnósticos Relacionados , Unidades de Terapia Intensiva/economia , Adolescente , Criança , Pré-Escolar , Cuidados Críticos/economia , Honorários e Preços , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Maryland , Quartos de Pacientes/economia , Política PúblicaAssuntos
Afogamento/fisiopatologia , Temperatura , Adolescente , Afogamento/etiologia , Humanos , Lactente , Masculino , Síndrome de ReyeRESUMO
Three patients presenting with pulmonary edema associated with head trauma and increased intracranial pressure are described. Pulmonary edema is a clearly recognized complication of head trauma; the pathogenic mechanisms appear to be regulated by increased intracerebral pressure, sympathetically induced vascular hypertension, and increased pulmonary capillary permeability. If there is evidence that neurogenic pulmonary edema is the underlying etiology, therapeutic modalities should be directed at reducing intracranial pressure and strict attention paid to the interaction between intrathoracic and intracranial pressures in order to avoid the high mortality rate associated with this condition.
Assuntos
Traumatismos Craniocerebrais/complicações , Edema Pulmonar/etiologia , Adolescente , Criança , Feminino , Humanos , Pressão Intracraniana , Respiração com Pressão Positiva , Edema Pulmonar/fisiopatologia , Edema Pulmonar/terapiaRESUMO
Succinylcholine is a short-acting depolarizing neuromuscular blocker used to facilitate intubation; pancuronium is a longer-acting, nondepolarizing agent commonly employed to control ventilation in pediatric patients. The neuromuscular block produced by both drugs may be modified by patient age, acid-base and electrolyte status, body temperature, and drugs such as aminoglycoside antibiotics; adjustment in dose or in technique of administration may be required. Cardiovascular side-effects, primarily arrhythmias, are occasionally associated with the use of either agent. In contrast to that of succinylcholine, the paralysis from pancuronium is pharmacologically reversible with the combination of atropine and neostigmine.
Assuntos
Bloqueadores Neuromusculares/farmacologia , Succinilcolina/farmacologia , Potenciais de Ação/efeitos dos fármacos , Criança , Colinesterases/sangue , Trietiodeto de Galamina/farmacologia , Humanos , Lactente , Intubação Intratraqueal , Neostigmina/farmacologia , Bloqueadores Neuromusculares/antagonistas & inibidores , Bloqueadores Neuromusculares/metabolismo , Junção Neuromuscular/efeitos dos fármacos , Pancurônio/farmacologia , Succinilcolina/administração & dosagem , Tubocurarina/farmacologiaRESUMO
Percutaneous catheterization of the radial artery appears to be a simple and safe alternative to catheterization of the umbilical artery for monitoring critically ill neonates. This avoids the serious and potentially fatal complications associated with use of the umbilical arterial catheter, and it is also applicable to monitoring of neonates in whom the umbilical artery is no longer patent. We observed no serious sequelae in cannulation of the radial artery and think that the technique should be used more widely.