Continuous Neuromuscular Blockade for Bronchopulmonary Dysplasia.

OBJECTIVE: Bronchopulmonary dysplasia (BPD) is the most common late morbidity for premature infants. Continuous neuromuscular blockade (CNMB) is suggested for the most unstable phase of BPD, despite no outcome data. We explored the association between duration of CNMB for severe BPD and mortality. DESIGN: Medical record review of children <5 years old admitted from 2016 to 2022 with BPD and one or more course of CNMB for ≥14 days. RESULTS: Twelve children received a total of 20 episodes of CNMB for ≥14 days (range 14-173 d) during their hospitalization. Most (10/12) were born at <28 weeks' gestation and most (11/12) with birth weight <1,000 g; 7/12 were of Black race/ethnicity. All were hospitalized since birth. Most (10/12) were initially transferred from an outside neonatal intensive care unit (ICU), typically after a >60-day hospitalization (9/12). Half (6/12) of them had a ≥60-day stay in our neonatal ICU before transferring to our pediatric ICU for, generally, ≥90 days (8/12). The primary study outcome was survival to discharge: 2/12 survived. Both had shorter courses of CNMB (19 and 25 d); only one child who died had a course ≤25 days. Just two infants had increasing length Z-scores during hospitalization; only one infant had a final length Z-score > - 2. CONCLUSION: In this case series of infants with severe BPD, there were no survivors among those receiving ≥25 days of CNMB. Linear growth, an essential growth parameter for infants with BPD, decreased in most patients. These data do not support the use of ≥25 days of CNMB to prevent mortality in infants with severe BPD. KEY POINTS: · This is a case series of neuromuscular blockade for severe BPD.. · Neuromuscular blockade did not improve linear growth.. · Ten out of 12 infants who were on prolonged neuromuscular blockade died..

Transforming a PICU Into an Adult ICU During the Coronavirus Disease 2019 Pandemic: Meeting Multiple Needs.

We describe the process converting half of our 40-bed PICU into a negative-pressure biocontainment ICU dedicated to adult coronavirus disease 2019 patients within a 1,003-bed academic quaternary hospital. We outline the construction, logistics, supplies, provider education, staffing, and operations. We share lessons learned of working with a predominantly pediatric staff blended with adult expertise staff while maintaining elements of family-centered care typical of pediatric critical care medicine. Critically ill coronavirus disease 2019 adult patients may be cared for in a PICU and care may be augmented by implementing elements of holistic, family-centered PICU practice.

Venlafaxine and desvenlafaxine in the management of menopausal hot flashes / Venlafaxina y desvenlafaxina en el manejo de sofocos postmenopausicos

Vasomotor flushes are common complaints of women during and after menopause, affecting about 75 percent of this population. Estrogen therapy is the most effective treatment for hot flashes. However, there are a significant number of women who have contraindications or choose not to use estrogen due to potential risks such as breast cancer and thromboembolic disorders. These women need alternative options. The selective norepinephrine reuptake inhibitors, venlafaxine and desvenlafaxine, have shown efficacy in alleviating hot flashes. Objective: The purpose of this review is to assess the efficacy and tolerability of these two agents for treatment of hot flashes in healthy postmenopausal women. Methods: A literature search of the MEDLINE and Ovid databases from inception to June 2011 was conducted. Randomized controlled trials, published in English, with human participants were included. Studies included postmenopausal women, and trials with breast cancer only populations were excluded. Results: Venlafaxine reduced hot flashes by 37 to 61 percent and desvenlafaxine by 55 to 69 percent. Both agents were well tolerated. The most common adverse effects were headache, dry mouth, nausea, insomnia, somnolence, and dizziness. Conclusion: Based on the evidence, venlafaxine and desvenlafaxine are both viable options for reducing the frequency and severity of hot flashes (AU)

Los sofocos vasomotores son quejas frecuentes en mujeres durante y después de la menopausia, afectando a cerca del 75% de esta población. La terapia estrogénica es el tratamiento más efectivo para los sofocos. Sin embargo, hay un número significativo de mujeres que presentan contraindicaciones o no eligen la terapia estrogénica por los posibles riesgos como el cáncer de mama o las alteraciones tromboembólicas. Estas mujeres necesitan opciones alternativas. Los inhibidores selectivos de la recaptación de noradrenalina, venlafaxina y dexvenlafaxina, han demostrado eficacia en el alivio de los sofocos. Objetivo: El objetivo de esta revisión es evaluar la eficacia y tolerabilidad de estos dos agentes para el tratamiento de los sofocos en mujeres postmenopáusicas sanas. Métodos: Se realizó una búsqueda de la literatura en las bases de datos MEDLINE y Ovid desde su inicio a junio de 2011. Se incluyeron ensayos controlados aleatorizados, publicados en inglés, con participantes humanos. Los estudios que incluían sólo mujeres postmenopáusicas y ensayos únicamente con poblaciones de cáncer de mama fueron excluidos. Resultados: La venlafaxina redujo los sofocos en un 37 a 61% y la desvenlafaxina del 55 al 69%. Ambos agentes fueron bien tolerados. Los efectos adversos más comunes fueron dolor de cabeza, boca seca, nauseas, insomnio, somnolencia y mareos. Conclusión: Basándose en la evidencia, la venlafaxina y la desvenlafaxina son opciones viables para reducir la frecuencia y gravedad de los sofocos (AU)

Venlafaxine and desvenlafaxine in the management of menopausal hot flashes.

UNLABELLED: Vasomotor flushes are common complaints of women during and after menopause, affecting about 75 percent of this population. Estrogen therapy is the most effective treatment for hot flashes. However, there are a significant number of women who have contraindications or choose not to use estrogen due to potential risks such as breast cancer and thromboembolic disorders. These women need alternative options. The selective norepinephrine reuptake inhibitors, venlafaxine and desvenlafaxine, have shown efficacy in alleviating hot flashes. OBJECTIVE: The purpose of this review is to assess the efficacy and tolerability of these two agents for treatment of hot flashes in healthy postmenopausal women. METHODS: A literature search of the MEDLINE and Ovid databases from inception to June 2011 was conducted. Randomized controlled trials, published in English, with human participants were included. Studies included postmenopausal women, and trials with breast cancer only populations were excluded. RESULTS: Venlafaxine reduced hot flashes by 37 to 61 percent and desvenlafaxine by 55 to 69 percent. Both agents were well tolerated. The most common adverse effects were headache, dry mouth, nausea, insomnia, somnolence, and dizziness. CONCLUSIONS: Based on the evidence, venlafaxine and desvenlafaxine are both viable options for reducing the frequency and severity of hot flashes.