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Pediatric Circulatory Failure

Cardiogenic failure or shock encompasses a wide array of processes that result in insufficient oxygen and nutrient supply to meet the body’s metabolic needs. Shock is defined as insufficient delivery of oxygen or nutrients to tissues.

Pediatric Respiratory Failure

Respiratory failure is the most common cause of cardiac arrest in children. Failure occurs when the respiratory system is unable to exchange gases in order to meet the body's metabolic need.

Neonatal Resuscitation

An infant delivered in the emergency department (ED) or an infant presenting from an out-of-hospital delivery needs rapid assessment and possible resuscitation. Maternal history, pregnancy history, presence of gestational hypertension or diabetes, presence or absence of prenatal care, maternal age, and history of medications or drug use during pregnancy are important.

Controversial Removal of Dietary Supplements from Retailers’ Shelves

Until sound testing methodology and retailer/government oversight is honed, clinicians and consumers should discuss the appropriateness of dietary supplement use and the choice of products from reputable companies.

Lactobacillus casei Supplementation Improves Inflammatory Markers and Disease Activity Scores in Rheumatoid Arthritis

In this randomized, double-blind, placebo-controlled study, the probiotic strain Lactobacillus casei 01 was provided to women with rheumatoid arthritis at a dosage of 10⁸ colony forming units for a period of 8 weeks and compared to a placebo treatment. Disease activity score and levels of the proinflammatory cytokines tumor necrosis factor-α, interleukin-6, and interleukin-12 were found to be significantly decreased at the end of the intervention. Additional parameters of state and trait anxiety were also evaluated and were not significantly altered by therapies.

Acupuncture and Moxibustion in the Treatment of Crohn’s Disease

This randomized, placebo-controlled trial demonstrated that acupuncture and moxibustion treatment in patients with Crohn’s disease significantly improved the patient’s CD symptoms, quality of life, mucosal inflammation, serum hemoglobin, and C-reactive protein levels compared to the control group.

Live Longer: Substitute in Whole Grains

When adjusted for possible confounding variables, this analysis of U.S. men and women found an association between higher whole grain intake and lower mortality from all causes, including cardiovascular disease, but no association for cancer mortality.

The Disruptive Effects of Tablet Readers on Sleep Patterns

The use of light-emitting tablet devices prior to bedtime negatively impacts sleep patterns through disturbances in circadian rhythms.

Corticosteroids in Severe Community-Acquired Pneumonia: The Controversy Continues

Treatment failure in hospitalized patients with severe community-acquired pneumonia (CAP) is associated with an excessive inflammatory response and worse outcomes. Torres and colleagues sought to determine the effect of corticosteroids in patients with severe CAP and a significant inflammatory response. In this multicenter, randomized, double-blind, placebo-controlled trial, 120 severe CAP patients with C-reactive protein (CRP) levels >150 mg/L were randomized to receive either an IV methylprednisolone bolus of 0.5 mg/kg every 12 hours or placebo. Treatment began within 36 hours of hospital admission and lasted for 5 days. Severe CAP was defined as two out of the three minor criteria independently associated with severity including PaO₂ /FiO₂ < 250, multilobar involvement, and systolic blood pressure < 90 mmHg, or one out of two major criteria, including a requirement for mechanical ventilation or septic shock.¹ Risk class V for the Pneumonia Severity Index was also considered severe CAP.² The primary outcome was early or late treatment failure. Early treatment failure was defined as the development of shock, need for mechanical ventilation not present at baseline, or death within 72 hours of treatment. Late treatment failure was defined as radiographic progression, persistence of severe respiratory failure, development of shock, need for invasive mechanical ventilation not present at baseline, or death between 72 hours and 120 hours after treatment.

Neuromuscular Blockade and Successful Endotracheal Intubation

Previous studies have shown the utility of neuromuscular blocking agents for endotracheal intubation in the operating room and emergency department. However, airway management in the ICU often involves unplanned, emergent intubations under suboptimal conditions. This study asked whether NMBAs improved first attempt success of intubations in the ICU. Additionally, these authors asked whether succinylcholine or rocuronium improved first attempt success and the effects of NMBA on intubations using video laryngoscopy.

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