OBJECTIVE: To describe current opinions about stress-related mucosal disease (SRMD) prevention in Canadian pediatric intensive care units (PICUs).
METHODS: A 22-question survey covering several aspects of SRMD was sent to all identified PICU attendings in Canada.
RESULTS: Sixty-eight percent of identified attendings completed the questionnaire. Thirty-eight percent were based in Quebec, 31% in Alberta, and 31% from other provinces. Most attendings (78%) had worked in a PICU for 6 years or more. When asked about risk factors for prescribing SRMD prevention drugs (more than 1 answer was accepted), the most popular answers were prior history of gastric ulceration/bleeding (33 respondents), coagulopathy (28 respondents), and major neurologic insult (18 respondents). Almost half of the attendings (48%) mentioned that they prescribe SRMD prophylaxis directly upon PICU admission to more than 25% of their patients. Forty-nine percent of respondents subjectively estimated that clinically significant upper gastrointestinal bleeding (UGIB; defined as UGIB associated with either hypotension, transfusion within 24 hours of the event, or death) occurred in less than 1% of their patients. Fifty-seven respondents (93%) used ranitidine as first-line therapy (average dose: 4.1 mg/kg/day, mainly intravenously). As second-line therapy, 32 attendings (52%) used pantoprazole and 13 (21%) used omeprazole.
CONCLUSIONS: Despite the paucity of guidelines on SRMD prevention and the low reported incidence of clinically significant UGIB, SRMD prevention is frequently used in Canadian PICUs. Ranitidine is the first-line drug used by most attendings.
O povo Abénaki, “aqueles do pais do sol nascente”, constitui a Primeira Nação algonquina localizada no Sul da província canadense do Quebec. Ndakinna é o território ancestral dos Abenakis. Eles consideram o território como um espaço incluindo a ocupação física, o uso dos recursos e a cultura. Os dados sobre a ocupação humana do Ndakinna permanecem, porém, pouco conhecidos. Desde 1979, o Grande Conselho da Naçao Waban-Aki, habilitado pelo Conselho dos Abénakis de Odanak e o Conselho dos Abénakis de Wôlinak, tem como missão garantir o futuro da Nação Abénaki. Para este fim, o Grande Conselho usa estudos especializados para garantir a defesa dos direitos, dos interesses e a preservação da cultura da Nação.
There are very few reports describing paraplegia of spinal origin after cardiac arrest in adults and none in pediatrics. We report a case of spinal cord injury with spinal subdural hematoma after chest compressions. A 4-month-old male infant with a hypoplastic left ventricle underwent cardiac transplantation at the age of three months. Two weeks after transplant, an episode of asystole and ventricular fibrillation of unknown origin occurred. His resuscitation included a 10-minute period of chest compressions. After sedation was discontinued, the patient was found to be paraplegic. Spinal magnetic resonance imaging showed a subdural hematoma and a hemorrhagic medullary contusion extending from T4 to T10 with a subarachnoid hemorrhage extending from T10 to S2. Adequate compression to ensure support of circulation is life saving but pediatricians must be aware of the potential risk of spinal cord injury after chest compressions.
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