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Anemia, blood loss, and blood transfusions in North American children in the intensive care unit.

https://arctichealth.org/en/permalink/ahliterature157664
Source
Am J Respir Crit Care Med. 2008 Jul 1;178(1):26-33
Publication Type
Article
Date
Jul-1-2008
Author
Scot T Bateman
Jacques Lacroix
Katia Boven
Peter Forbes
Roger Barton
Neal J Thomas
Brian Jacobs
Barry Markovitz
Brahm Goldstein
James H Hanson
H Agnes Li
Adrienne G Randolph
Author Affiliation
Department of Pediatrics, University of Massachusetts Medical Center, H5-524, 55 Lake Avenue, North Worcester, MA 01655, USA. batemans@ummhc.org
Source
Am J Respir Crit Care Med. 2008 Jul 1;178(1):26-33
Date
Jul-1-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Anemia - etiology - therapy
Blood Specimen Collection - adverse effects
Canada
Child
Child, Preschool
Critical Illness
Erythrocyte Transfusion
Female
Hemorrhage - complications
Humans
Infant
Infant, Newborn
Intensive Care Units, Pediatric
Length of Stay
Male
Respiration, Artificial
Risk factors
United States
Abstract
Minimizing exposure of children to blood products is desirable.
We aimed to understand anemia development, blood loss, and red blood cell (RBC) transfusions in the pediatric intensive care unit (PICU).
Prospective, multicenter, 6-month observational study in 30 PICUs. Data were collected on consecutive children (
PubMed ID
18420962 View in PubMed
Less detail

Association between length of storage of red blood cell units and outcome of critically ill children: a prospective observational study.

https://arctichealth.org/en/permalink/ahliterature144347
Source
Crit Care. 2010;14(2):R57
Publication Type
Article
Date
2010
Author
Oliver Karam
Marisa Tucci
Scot T Bateman
Thierry Ducruet
Philip C Spinella
Adrienne G Randolph
Jacques Lacroix
Author Affiliation
Pediatric Critical Care Unit, CHU Sainte-Justine, Université de Montréal, 3175 chemin de la Côte Sainte-Catherine, Montreal, Canada. oliver.karam@bigo.ch
Source
Crit Care. 2010;14(2):R57
Date
2010
Language
English
Publication Type
Article
Keywords
Canada
Child
Child, Preschool
Critical Illness
Erythrocytes
Female
Humans
Male
Materials Management, Hospital
Outcome Assessment (Health Care)
Prospective Studies
Time Factors
United States
Abstract
Transfusion is a common treatment in pediatric intensive care units (PICUs). Studies in adults suggest that prolonged storage of red blood cell units is associated with worse clinical outcome. No prospective study has been conducted in children. Our objectives were to assess the clinical impact of the length of storage of red blood cell units on clinical outcome of critically ill children.
Prospective, observational study conducted in 30 North American centers, in consecutive patients aged or= 48 hours in a PICU. The primary outcome measure was the incidence of multiple organ dysfunction syndrome after transfusion. The secondary outcomes were 28-day mortality and PICU length of stay. Odds ratios were adjusted for gender, age, number of organ dysfunctions at admission, total number of transfusions, and total dose of transfusion, using a multiple logistic regression model.
The median length of storage was 14 days in 296 patients with documented length of storage. For patients receiving blood stored >or= 14 days, the adjusted odds ratio for an increased incidence of multiple organ dysfunction syndrome was 1.87 (95% CI 1.04;3.27, P = 0.03). There was also a significant difference in the total PICU length of stay (adjusted median difference +3.7 days, P or= 14 days is independently associated with an increased occurrence of multiple organ dysfunction syndrome and prolonged PICU stay.
Notes
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Comment In: Crit Care. 2010;14(3):15820565831
PubMed ID
20377853 View in PubMed
Less detail

Cardiac arrhythmias associated with severe traumatic brain injury and hypothermia therapy.

https://arctichealth.org/en/permalink/ahliterature143609
Source
Pediatr Crit Care Med. 2010 May;11(3):408-14
Publication Type
Article
Date
May-2010
Author
Macha Bourdages
Jean-Luc Bigras
Catherine A Farrell
James S Hutchison
Jacques Lacroix
Author Affiliation
Department of Pediatrics, Division of Pediatric Intensive Care Medicine, Centre Mère-Enfant du CHUQ, Université Laval, Québec, Canada. macha.bourdages@mail.chuq.qc.ca
Source
Pediatr Crit Care Med. 2010 May;11(3):408-14
Date
May-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Arrhythmias, Cardiac - etiology - therapy
Brain Injuries - complications - physiopathology
Child
Female
Humans
Hypothermia, Induced
Male
Outcome Assessment (Health Care)
Quebec
Trauma Severity Indices
Abstract
Severe head trauma and/or severe hypothermia (
Notes
Comment In: Pediatr Crit Care Med. 2010 May;11(3):439-4120453624
PubMed ID
20464781 View in PubMed
Less detail

Children with chronic conditions in pediatric intensive care units located in predominantly French-speaking regions: Prevalence and implications on rehabilitation care need and utilization.

https://arctichealth.org/en/permalink/ahliterature152411
Source
Crit Care Med. 2009 Apr;37(4):1456-62
Publication Type
Article
Date
Apr-2009
Author
Robin Cremer
Francis Leclerc
Jacques Lacroix
Dominique Ploin
Author Affiliation
Service de réanimation pédiatrique, Hôpital Jeanne de Flandre, CH&U de Lille et Université de Lille II, France. r-cremer@chru-lille.fr
Source
Crit Care Med. 2009 Apr;37(4):1456-62
Date
Apr-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Canada
Child
Child, Preschool
Chronic Disease - epidemiology - rehabilitation
Cross-Sectional Studies
France
Humans
Infant
Infant, Newborn
Intensive Care Units, Pediatric
Needs Assessment
Prevalence
Rehabilitation - statistics & numerical data
Switzerland
Young Adult
Abstract
To estimate the prevalence of chronic conditions and/or disability in intensive care units admitting children (Pediatric Intensive Care Unit [PICU]) or both neonates and children (Neonatal and Pediatric Intensive Care Unit [NPICU]) and to describe available rehabilitation resources.
A cross-sectional study on two separate days, using a web questionnaire.
NPICU/PICUs affiliated to the Groupe Francophone de Réanimation et Urgences Pédiatriques and the Réseau Mère-Enfant de la Francophonie.
Children >1 month of gestationally corrected age.
Disability was defined as a Pediatric Overall Performance Category >or=3 before admission and chronic conditions as hospitalization since birth or the presence before admission of any condition requiring ongoing pediatric subspecialty care that was expected to last >or=12 months. Intensivists indicated what rehabilitation services they would have ideally prescribed ("perceived needs") and those provided. Of 45 affiliated units, 8 PICUs and 15 NPICUs participated. Staff included or had access to a psychologist (11 and 5, respectively), a social worker (10 and 3), a physiotherapist (11 and 12), a "psychomotrician" (2 and 8), a child educator (1 and 6), and a speech-language pathologist (0 and 6). Among 289 recorded intensive care unit-days, 236 were analyzed (excluding those for children admitted after surgery): 57 concerned children hospitalized since birth and 179 children admitted from home. Among these 179 recorded intensive care unit-days, 107 concerned children with chronic conditions (including 50 concerning disabled children) and 72 previously healthy children. Thus, prevalence of chronic conditions, including children hospitalized since birth, was 67%. Rehabilitation services included respiratory physical therapy (552 visits), musculoskeletal physical therapy (71), neurologic physical therapy (37), rehabilitation for swallowing (11), and for speech-language disorders (1), representing 79% of perceived needs.
Prevalence of chronic conditions in NPICU/PICU was 67%. More attention must be paid to the rehabilitation care needs of patients during their NPICU/PICU stay and after discharge.
Notes
Comment In: Crit Care Med. 2009 Apr;37(4):1525-619318852
PubMed ID
19242335 View in PubMed
Less detail

Critically ill patients with 2009 influenza A(H1N1) infection in Canada.

https://arctichealth.org/en/permalink/ahliterature148024
Source
JAMA. 2009 Nov 4;302(17):1872-9
Publication Type
Article
Date
Nov-4-2009
Author
Anand Kumar
Ryan Zarychanski
Ruxandra Pinto
Deborah J Cook
John Marshall
Jacques Lacroix
Tom Stelfox
Sean Bagshaw
Karen Choong
Francois Lamontagne
Alexis F Turgeon
Stephen Lapinsky
Stéphane P Ahern
Orla Smith
Faisal Siddiqui
Philippe Jouvet
Kosar Khwaja
Lauralyn McIntyre
Kusum Menon
Jamie Hutchison
David Hornstein
Ari Joffe
Francois Lauzier
Jeffrey Singh
Tim Karachi
Kim Wiebe
Kendiss Olafson
Clare Ramsey
Sat Sharma
Peter Dodek
Maureen Meade
Richard Hall
Robert A Fowler
Author Affiliation
Section of Critical Care Medicine, Health Sciences Centre, JJ 399, 700 William Ave, Winnipeg, MB R3E-0Z3 Canada. akumar61@yahoo.com
Source
JAMA. 2009 Nov 4;302(17):1872-9
Date
Nov-4-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Aged, 80 and over
Anoxia - etiology
Canada - epidemiology
Child
Child, Preschool
Comorbidity
Critical Illness
Disease Outbreaks
Female
Humans
Infant
Influenza A Virus, H1N1 Subtype
Influenza, Human - complications - diagnosis - mortality - therapy
Intensive Care Units
Kaplan-Meier Estimate
Length of Stay
Male
Middle Aged
Multiple Organ Failure - etiology - mortality
Prospective Studies
Respiration, Artificial
Respiratory Distress Syndrome, Adult - etiology - mortality
Young Adult
Abstract
Between March and July 2009, the largest number of confirmed cases of 2009 influenza A(H1N1) infection occurred in North America.
To describe characteristics, treatment, and outcomes of critically ill patients in Canada with 2009 influenza A(H1N1) infection.
A prospective observational study of 168 critically ill patients with 2009 influenza A(H1N1) infection in 38 adult and pediatric intensive care units (ICUs) in Canada between April 16 and August 12, 2009.
The primary outcome measures were 28-day and 90-day mortality. Secondary outcomes included frequency and duration of mechanical ventilation and duration of ICU stay.
Critical illness occurred in 215 patients with confirmed (n = 162), probable (n = 6), or suspected (n = 47) community-acquired 2009 influenza A(H1N1) infection. Among the 168 patients with confirmed or probable 2009 influenza A(H1N1), the mean (SD) age was 32.3 (21.4) years; 113 were female (67.3%) and 50 were children (29.8%). Overall mortality among critically ill patients at 28 days was 14.3% (95% confidence interval, 9.5%-20.7%). There were 43 patients who were aboriginal Canadians (25.6%). The median time from symptom onset to hospital admission was 4 days (interquartile range [IQR], 2-7 days) and from hospitalization to ICU admission was 1 day (IQR, 0-2 days). Shock and nonpulmonary acute organ dysfunction was common (Sequential Organ Failure Assessment mean [SD] score of 6.8 [3.6] on day 1). Neuraminidase inhibitors were administered to 152 patients (90.5%). All patients were severely hypoxemic (mean [SD] ratio of Pao(2) to fraction of inspired oxygen [Fio(2)] of 147 [128] mm Hg) at ICU admission. Mechanical ventilation was received by 136 patients (81.0%). The median duration of ventilation was 12 days (IQR, 6-20 days) and ICU stay was 12 days (IQR, 5-20 days). Lung rescue therapies included neuromuscular blockade (28% of patients), inhaled nitric oxide (13.7%), high-frequency oscillatory ventilation (11.9%), extracorporeal membrane oxygenation (4.2%), and prone positioning ventilation (3.0%). Overall mortality among critically ill patients at 90 days was 17.3% (95% confidence interval, 12.0%-24.0%; n = 29).
Critical illness due to 2009 influenza A(H1N1) in Canada occurred rapidly after hospital admission, often in young adults, and was associated with severe hypoxemia, multisystem organ failure, a requirement for prolonged mechanical ventilation, and the frequent use of rescue therapies.
Notes
Comment In: JAMA. 2010 Mar 10;303(10):939-40; author reply 940-120215605
PubMed ID
19822627 View in PubMed
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Evaluation of the pediatric risk of admission score in a pediatric emergency department.

https://arctichealth.org/en/permalink/ahliterature185704
Source
Ann Emerg Med. 2003 May;41(5):630-8
Publication Type
Article
Date
May-2003
Author
Jocelyn Gravel
Serge Gouin
Devendra Amre
Sylvie Bergeron
Jacques Lacroix
Author Affiliation
Division of Emergency Medicine, Department of Pediatrics, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada. Graveljocelyn@hotmail.com
Source
Ann Emerg Med. 2003 May;41(5):630-8
Date
May-2003
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Chi-Square Distribution
Child
Child, Preschool
Emergency Service, Hospital - statistics & numerical data
Female
Hospitalization - statistics & numerical data
Hospitals, Pediatric - statistics & numerical data
Humans
Infant
Infant, Newborn
Logistic Models
Male
Patient Admission - statistics & numerical data
Predictive value of tests
Prospective Studies
Quebec
ROC Curve
Risk assessment
Severity of Illness Index
Abstract
The pediatric risk of admission (PRISA) score was developed to predict the risk for hospitalization for pediatric emergency department patients. We sought to evaluate prospectively the predictive value of the PRISA score with respect to the risk for hospitalization in a pediatric ED.
A prospective cohort study was conducted in a pediatric tertiary center ED. From November 1, 2000, to October 31, 2001, 3 periods of 8 hours each were randomly chosen monthly. During these periods, all patients triaged to the ED were evaluated. Data collection was performed by an investigator uninvolved in the patients' treatment. Data were recorded before the decision regarding hospitalization was made. Odds ratios for the risk of hospitalization related to individual criteria and PRISA scores were calculated. Discrimination and calibration of the score were assessed.
During the study periods, 1,930 patients were evaluated. Among these, 203 hospitalizations were observed, and the PRISA score predicted 235. The goodness-of-fit test demonstrated that the score had good predictive ability (chi(2)=28.15; P =.78). Receiver operating characteristic curve analysis confirmed the latter findings (area under the curve 0.79 [95% confidence interval 0.72 to 0.86]). Some individual criteria of the score did not significantly predict risk for admission.
The PRISA score is a good predictor of the risk for hospitalization in a pediatric ED. It seems more accurate for the sicker patients. Some variables of the score could be deleted or modified to optimize its accuracy.
Notes
Comment In: Ann Emerg Med. 2003 May;41(5):639-4312712030
PubMed ID
12712029 View in PubMed
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Incidence of deep vein thrombosis related to peripherally inserted central catheters in children and adolescents.

https://arctichealth.org/en/permalink/ahliterature160504
Source
CMAJ. 2007 Nov 6;177(10):1185-90
Publication Type
Article
Date
Nov-6-2007
Author
Josée Dubois
Françoise Rypens
Laurent Garel
Michèle David
Jacques Lacroix
France Gauvin
Author Affiliation
Department of Radiology, Centre hospitalier universitaire Sainte-Justine, Montréal, Que. josee-dubois@ssss.gouv.qc.ca
Source
CMAJ. 2007 Nov 6;177(10):1185-90
Date
Nov-6-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Arm - blood supply
Catheterization, Central Venous - adverse effects - statistics & numerical data
Catheterization, Peripheral - adverse effects - statistics & numerical data
Chi-Square Distribution
Child
Female
Humans
Incidence
Infusions, Intravenous
Logistic Models
Male
Multivariate Analysis
Prospective Studies
Quebec - epidemiology
Risk factors
Ultrasonography, Doppler, Duplex
Venous Thromboembolism - epidemiology - etiology - ultrasonography
Venous Thrombosis - epidemiology - etiology - ultrasonography
Abstract
Peripherally inserted central catheters (PICC) in children and adolescents are being used with increasing frequency. We sought to determine the incidence and characterize risk factors of deep vein thrombosis associated with peripherally inserted central catheters in a pediatric population.
We conducted a prospective study involving consecutive patients referred to the radiology department of a tertiary care university-affiliated hospital for insertion of a peripherally inserted central catheter. We included patients aged 18 years or less who weighed more than 2.5 kg and had a peripherally inserted central catheter successfully inserted in his or her arm between June 2004 and November 2005. The primary outcome was the occurrence of partial or complete deep vein thrombosis evaluated by clinical examination, ultrasonography and venous angiography.
A total of 214 patients (101 girls, 113 boys) were included in the study. Partial or complete deep vein thrombosis occurred in 20 patients, for an incidence of 93.5 per 1000 patients and 3.85 per 1000 catheter-days. Only 1 of the cases was symptomatic. In the univariable analyses, the only variable significantly associated with deep vein thrombosis was the presence of factor II mutation G20210A (odds ratio 7.08, 95% confidence interval 1.11-45.15, p = 0.04), a genetic mutation that increases the risk of a blood clot and that was present in 5 (2.3%) of the 214 patients.
The incidence of deep vein thrombosis related to peripherally inserted central catheters in our study was lower than the incidence related to centrally inserted venous catheters described in the pediatric literature (11%-50%).
Notes
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PubMed ID
17978273 View in PubMed
Less detail

Noninvasive therapy with helium-oxygen for severe bronchiolitis.

https://arctichealth.org/en/permalink/ahliterature171506
Source
J Pediatr. 2005 Dec;147(6):812-7
Publication Type
Article
Date
Dec-2005
Author
Jean-Michel Liet
Beatrice Millotte
Marisa Tucci
Sophie Laflammme
James Hutchison
David Creery
Thierry Ducruet
Jacques Lacroix
Author Affiliation
Service de Réanimation Pédiatrique, Centre Hospitalier Universitaire de Nantes, Nantes, France. jeanmichel@chu-nantes.fr
Source
J Pediatr. 2005 Dec;147(6):812-7
Date
Dec-2005
Language
English
Publication Type
Article
Keywords
Bronchiolitis, Viral - therapy
Canada
Double-Blind Method
Helium - therapeutic use
Humans
Infant
Infant, Newborn
Oxygen - therapeutic use
Positive-Pressure Respiration
Respiratory Syncytial Virus Infections - therapy
Respiratory Therapy - methods
Treatment Outcome
Abstract
To determine whether noninvasive therapy using a helium-oxygen mixture reduces the use of positive-pressure ventilation in the treatment of respiratory failure caused by severe bronchiolitis.
This was a multicenter, randomized, double-blind, placebo-controlled trial that recruited infants in 4 pediatric intensive care units (PICUs). A total of 39 nonintubated infants with severe bronchiolitis caused by respiratory syncytial virus (RSV) were randomly assigned within 8 hours of PICU admission to receive a helium-oxygen mixture (helium group) or an air-oxygen mixture (control group) through an inflatable head hood. The primary study outcome was the requirement for positive pressure mechanical ventilation. Results were compared using Fisher's exact test.
No differences were noted between the control and helium groups with respect to age (1.0 vs 1.1 months), prematurity, or family history of asthma or smoking. Positive pressure ventilation was judged necessary for 4 of the 21 (19.0%) infants in the control group and in 4 of the 18 (22.2%) in the helium group (relative risk = 1.17; 95% confidence interval = 0.34 to 4.01).
This study did not detect any differences between the patients in the helium group and the control group with respect to the rate of positive-pressure ventilation.
PubMed ID
16356437 View in PubMed
Less detail

Parental involvement in treatment decisions regarding their critically ill child: a comparative study of France and Quebec.

https://arctichealth.org/en/permalink/ahliterature163214
Source
Pediatr Crit Care Med. 2007 Jul;8(4):337-42
Publication Type
Article
Date
Jul-2007
Author
Franco A Carnevale
Pierre Canoui
Robin Cremer
Catherine Farrell
Amélie Doussau
Marie-Josée Seguin
Philippe Hubert
Francis Leclerc
Jacques Lacroix
Author Affiliation
Montreal Children's Hospital, Montreal, Canada. franco.carnevale@mcgill.ca
Source
Pediatr Crit Care Med. 2007 Jul;8(4):337-42
Date
Jul-2007
Language
English
Publication Type
Article
Keywords
Child, Preschool
Communication
Consumer Participation - psychology
Consumer Satisfaction
Critical Illness - therapy
Cultural Characteristics
Female
France
Humans
Infant
Intensive Care Units, Pediatric - organization & administration
Male
Nurse's Role - psychology
Parents - psychology
Paternalism
Physician's Role - psychology
Professional-Family Relations
Qualitative Research
Quebec
Abstract
To examine whether physicians or parents assume responsibility for treatment decisions for critically ill children and how this relates to subsequent parental experience. A significant controversy has emerged regarding the role of parents, relative to physicians, in relation to treatment decisions for critically ill children. Anglo-American settings have adopted decision-making models where parents are regarded as responsible for such life-support decisions, while in France physicians are commonly considered the decision makers.
Grounded theory qualitative methodology.
Four pediatric intensive care units (two in France and two in Quebec, Canada).
Thirty-one parents of critically ill children; nine physicians and 13 nurses who cared for their children.
None.
Semistructured interviews were conducted. In France, physicians were predominantly the decision makers for treatment decisions. In Quebec, decisional authority practices were more varied; parents were the most common decision maker, but sometimes it was physicians, while for some decisional responsibility depended on the type of decision to be made. French parents appeared more satisfied with their communication and relationship experiences than Quebec parents. French parents referred primarily to the importance of the quality of communication rather than decisional authority. There was no relationship between parents' actual responsibility for decisions and their subsequent guilt experience.
It was remarkable that a certain degree of medical paternalism was unavoidable, regardless of the legal and ethical norms that were in place. This may not necessarily harm parents' moral experiences. Further research is required to examine parental decisional experience in other pediatric settings.
Notes
Comment In: Pediatr Crit Care Med. 2007 Jul;8(4):400-117622923
Comment In: Pediatr Crit Care Med. 2008 Jul;9(4):451-218843252
PubMed ID
17545930 View in PubMed
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Reproducibility of blind protected bronchoalveolar lavage in mechanically ventilated children.

https://arctichealth.org/en/permalink/ahliterature189742
Source
Am J Respir Crit Care Med. 2002 Jun 15;165(12):1618-23
Publication Type
Article
Date
Jun-15-2002
Author
France Gauvin
Jacques Lacroix
Marie-Claude Guertin
François Proulx
Catherine Ann Farrell
Albert Moghrabi
Pierre Lebel
Clément Dassa
Author Affiliation
Division of Pediatric Intensive Care, Department of Pediatrics, Sainte-Justine Hospital, Québec, Canada. france_gauvin@ssss.gouv.qc.ca
Source
Am J Respir Crit Care Med. 2002 Jun 15;165(12):1618-23
Date
Jun-15-2002
Language
English
Publication Type
Article
Keywords
Adolescent
Anti-Bacterial Agents - therapeutic use
Bacteria - isolation & purification
Bronchoalveolar Lavage - adverse effects - methods
Bronchoalveolar Lavage Fluid - chemistry - cytology - microbiology
Canada
Child
Child Welfare
Child, Preschool
Equipment Safety
Female
Humans
Infant
Infant, Newborn
Male
Neutrophils - cytology - microbiology
Observer Variation
Pneumonia, Bacterial - diagnosis - drug therapy - microbiology
Prospective Studies
Reproducibility of Results
Respiration, Artificial
Severity of Illness Index
Treatment Outcome
Abstract
Blind protected bronchoalveolar lavage (BAL) could be an interesting tool in the diagnosis of ventilator-associated pneumonia in intubated children, but its reproducibility has never been evaluated. This study evaluates the reproducibility, feasibility, and safety of blind protected BAL in mechanically ventilated children. Two blind protected BAL were done, at a 2-hour interval, in 30 patients. The reproducibility of microbiologic and cytologic results was studied. A total of 60 BALs was analyzed. Bacterial growth was present in 26 of 60 BAL (43%). Reproducibility for the presence of bacteria on quantitative cultures was excellent (concordance, 93%; kappa [kappa], 0.86). Concordance for the type of bacteria isolated was 86% and for the number of bacteria was 79%. Reproducibility for the presence of neutrophils containing bacteria was perfect (concordance, 100%; kappa, 1) although only a few BALs had a positive result (8/60). Blind protected BAL was feasible in all patients and all samples were considered adequate for analysis. Complications were mostly benign and transitory except in two cases: one pneumothorax and one significant increase in intracranial pressure. Overall, blind protected BAL is a reproducible test in mechanically ventilated children, is easily feasible, and is usually well tolerated.
PubMed ID
12070062 View in PubMed
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