In this book, Andrew Harvey sets out to provide a unified and comprehensive theory of structural time series models. Unlike the traditional ARIMA models, structural time series models consist explicitly of unobserved components, such as trends and seasonals, which have a direct interpretation. As a result the model selection methodology associated with structural models is much closer to econometric methodology. The link with econometrics is made even closer by the natural way in which the models can be extended to include explanatory variables and to cope with multivariate time series. From the technical point of view, state space models and the Kalman filter play a key role in the statistical treatment of structural time series models. The book includes a detailed treatment of the Kalman filter. This technique was originally developed in control engineering, but is becoming increasingly important in fields such as economics and operations research. This book is concerned primarily with modelling economic and social time series, and with addressing the special problems which the treatment of such series poses. The properties of the models and the methodological techniques used to select them are illustrated with various applications. These range from the modellling of trends and cycles in US macroeconomic time series to to an evaluation of the effects of seat belt legislation in the UK.

Forecasting, Structural Time Series Models and the Kalman Filter

There is increasing recognition that systematic post–cardiac arrest care after return of spontaneous circulation (ROSC) can improve the likelihood of patient survival with good quality of life. This is based in part on the publication of results of randomized controlled clinical trials as well as a description of the post–cardiac arrest syndrome. 1–3 Post–cardiac arrest care has significant potential to reduce early mortality caused by hemodynamic instability and later morbidity and mortality from multiorgan failure and brain injury. 3,4 This section summarizes our evolving understanding of the hemodynamic, neurological, and metabolic abnormalities encountered in patients who are initially resuscitated from cardiac arrest. The initial objectives of post–cardiac arrest care are to ● Optimize cardiopulmonary function and vital organ perfusion. ● After out-of-hospital cardiac arrest, transport patient to an appropriate hospital with a comprehensive post–cardiac arrest treatment system of care that includes acute coronary interventions, neurological care, goal-directed critical care, and hypothermia. ● Transport the in-hospital post–cardiac arrest patient to an appropriate critical-care unit capable of providing comprehensive post–cardiac arrest care. ● Try to identify and treat the precipitating causes of the arrest and prevent recurrent arrest.

http://www.kardio.hu/feltoltott/dokumentumok/fajl_201148104747Cardiopulm_resuscit_Pt9_Post_cardiac.pdf

Part 9: Post-Cardiac Arrest Care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

The goal of therapy for bradycardia or tachycardia is to rapidly identify and treat patients who are hemodynamically unstable or symptomatic due to the arrhythmia. Drugs or, when appropriate, pacing may be used to control unstable or symptomatic bradycardia. Cardioversion or drugs or both may be used to control unstable or symptomatic tachycardia. ACLS providers should closely monitor stable patients pending expert consultation and should be prepared to aggressively treat those with evidence of decompensation.

/pdf/part-8-adult-advanced-cardiovascular-life-support-2010-344vtppnij.pdf

Part 8: Adult Advanced Cardiovascular Life Support 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Judith Jacobi, PharmD, FCCM, BCPS; Gilles L. Fraser, PharmD, FCCM; Douglas B. Coursin, MD; Richard R. Riker, MD; Dorrie Fontaine, RN, DNSc, FAAN; Eric T. Wittbrodt, PharmD; Donald B. Chalfin, MD, MS, FCCM; Michael F. Masica, MD, MPH; H. Scott Bjerke, MD; William M. Coplin, MD; David W. Crippen, MD, FCCM; Barry D. Fuchs, MD; Ruth M. Kelleher, RN; Paul E. Marik, MDBCh, FCCM; Stanley A. Nasraway, Jr, MD, FCCM; Michael J. Murray, MD, PhD, FCCM; William T. Peruzzi, MD, FCCM; Philip D. Lumb, MB, BS, FCCM. Developed through the Task Force of the American College of Critical Care Medicine (ACCM) of the Society of Critical Care Medicine (SCCM), in collaboration with the American Society of Health-System Pharmacists (ASHP), and in alliance with the American College of Chest Physicians; and approved by the Board of Regents of ACCM and the Council of SCCM and the ASHP Board of Directors

/pdf/clinical-practice-guidelines-for-the-sustained-use-of-550x8gqibj.pdf

Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult.

In contrast to adults, cardiac arrest in infants and children does not usually result from a primary cardiac cause. More often it is the terminal result of progressive respiratory failure or shock, also called an asphyxial arrest. Asphyxia begins with a variable period of systemic hypoxemia, hypercapnea, and acidosis, progresses to bradycardia and hypotension, and culminates with cardiac arrest.1

Another mechanism of cardiac arrest, ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), is the initial cardiac rhythm in approximately 5% to 15% of pediatric in-hospital and out-of-hospital cardiac arrests;2,–,9 it is reported in up to 27% of pediatric in-hospital arrests at some point during the resuscitation.6 The incidence of VF/pulseless VT cardiac arrest rises with age.2,4 Increasing evidence suggests that sudden unexpected death in young people can be associated with genetic abnormalities in myocyte ion channels resulting in abnormalities in ion flow (see “Sudden Unexplained Deaths,” below).

Since 2010 marks the 50th anniversary of the introduction of cardiopulmonary resuscitation (CPR),10 it seems appropriate to review the progressive improvement in outcome of pediatric resuscitation from cardiac arrest. Survival from in-hospital cardiac arrest in infants and children in the 1980s was around 9%.11,12 Approximately 20 years later, that figure had increased to 17%,13,14 and by 2006, to 27%.15,–,17 In contrast to those favorable results from in-hospital cardiac arrest, overall survival to discharge from out-of-hospital cardiac arrest in infants and children has not changed substantially in 20 years and remains at about 6% (3% for infants and 9% for children and adolescents).7,9

It is unclear why the improvement in outcome from in-hospital cardiac arrest has occurred, although earlier recognition and management of at-risk patients on general inpatient units …

https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.110.971101

Part 14: Pediatric Advanced Life Support 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

ObjectiveTo describe the consequences of the prolonged administration of sedative and analgesic agents to the pediatric intensive care unit (PICU) patient. The problems to be investigated include tolerance, physical dependency, and withdrawal.Data SourcesA MEDLINE search was performed of literature

Tolerance, withdrawal, and physical dependency after long-term sedation and analgesia of children in the pediatric intensive care unit.

Etomidate is a carboxylated, imidazole-containing intravenous anesthetic agent introduced into clinical anesthesia practice in 1972. Its distinctive features that make it useful as an anesthetic induction include a lack of adverse effects on hemodynamic function as well as beneficial effects on cerebral blood flow and intracranial pressure. Because of these properties, its major role in anesthetic practice has been for the induction of anesthesia in patients with diminished cardiovascular function. As opposed to the considerable reported clinical experience with etomidate in the adult population, there remains limited reported information concerning its use in pediatric patients. This article reviews the specific end-organ effects of etomidate, the reports concerning its use in pediatric patients, and its adverse effect profile.

Dexmedetomidine: applications in pediatric critical care and pediatric anesthesiology.

Background:We sought to compare the efficacy of midazolam versus dexmedetomidine for sedation during mechanical ventilation in infants and children.Methods:We performed a prospective, randomized trial in a pediatric intensive care unit in a tertiary care center. Infants and children requiring mechan

Sedation during mechanical ventilation in infants and children: dexmedetomidine versus midazolam.

We present preliminary clinical experience with the use of dexmedetomidine, an alpha2 adrenergic agonist, in children. Dexmedetomidine was administered in three clinical scenarios: (i) to provide sedation during mechanical ventilation; (ii) intraoperatively for controlled hypotension during an orthopaedic surgical procedure; and (iii) to provide sedation during an invasive procedure. Preliminary data from studies in the adult population, its physiological effects and potential applications in paediatric anaesthesia and critical care are discussed.

Initial experience with dexmedetomidine in paediatric-aged patients

Summary
Objective: To review the technology required for and the applications of transcutaneous carbon dioxide (TC-CO2) monitoring in infants and children.

Data source:  A computerized, bibliographic search regarding the applications of transcutaneous carbon dioxide (TC-CO2) monitoring in infants and children.

Results:  Although the direct measurement of PaCO2 remains the gold standard, it provides only a single measurement of what is often a rapidly changing and evolving clinical picture. Given these concerns, there remains a clinical need for a means to continuously monitor PaCO2 without the need for repeated blood gas analysis. Although initially introduced into the neonatal intensive care unit; with improvements in the technology, TC-CO2 monitoring can now be used in infants, children and even adults. When compared with end-tidal carbon dioxide (ET-CO2) monitoring techniques, TC-CO2 monitoring has been shown to be equally as accurate in patients with normal respiratory function and more accurate in patients with shunt or ventilation–perfusion inequalities. TC-CO2 monitoring can be applied in situations that generally preclude ET-CO2 monitoring such as high frequency ventilation, apnea testing, and noninvasive ventilation. TC-CO2 monitoring has also been used in spontaneously breathing children with airway and respiratory issues such as croup and status asthmaticus as well as to monitor metabolic status during treatment of acidosis related to diabetic ketoacidosis.

Conclusions:  Transcutaneous carbon dioxide monitoring may be a useful adjunct in various clinical scenarios in infants and children. It should be viewed as a complimentary technology and may be used in combination with ET-CO2 monitoring.

Joseph D. Tobias

Papers

Tolerance, withdrawal, and physical dependency after long-term sedation and analgesia of children in the pediatric intensive care unit.

Dexmedetomidine: applications in pediatric critical care and pediatric anesthesiology.

Sedation during mechanical ventilation in infants and children: dexmedetomidine versus midazolam.

Initial experience with dexmedetomidine in paediatric-aged patients

Transcutaneous carbon dioxide monitoring in infants and children.