Bhakti U Sarangi, Noopur Kulkarni, Savita Rani, A. Walimbe, Rachit Garg
Neuroparalytic snake bite presents commonly as early morning neuroparalytic syndrome with ptosis, ophthalmoplegia and respiratory muscle paralysis. However, there are multiple lesser-known constituents of the snake venom that can cause other life-threatening complications, including persistent mydriasis, alterations in blood pressure, hyponatremia, and rhabdomyolysis. Venom-derived natriuretic peptides can produce significant hyponatremia due to urinary wasting. We report a 14-year-old girl who presented with EMNPS and subsequently developed persistent profound hyponatremia, found to be due to excess urinary sodium losses, that responded well to fluid management including administration of hypertonic saline.
{"title":"Neuroparalytic snakebite resulting in cerebral salt wasting and refractory hyponatremia: A case report","authors":"Bhakti U Sarangi, Noopur Kulkarni, Savita Rani, A. Walimbe, Rachit Garg","doi":"10.4103/jpcc.jpcc_38_24","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_38_24","url":null,"abstract":"\u0000 Neuroparalytic snake bite presents commonly as early morning neuroparalytic syndrome with ptosis, ophthalmoplegia and respiratory muscle paralysis. However, there are multiple lesser-known constituents of the snake venom that can cause other life-threatening complications, including persistent mydriasis, alterations in blood pressure, hyponatremia, and rhabdomyolysis. Venom-derived natriuretic peptides can produce significant hyponatremia due to urinary wasting. We report a 14-year-old girl who presented with EMNPS and subsequently developed persistent profound hyponatremia, found to be due to excess urinary sodium losses, that responded well to fluid management including administration of hypertonic saline.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141841967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexandra W. Obremskey, Janis L. Sethness, Tarane Shafi, T. Brogan
Cardiac complications are frequently seen in patients with anorexia nervosa, with bradycardia being the most common. The degree of bradycardia can be a marker of disease severity as heart rate (HR) nadir is correlated with body mass index, total weight loss, and recent weight loss. Despite the prevalence and potential severity of bradycardia, there is limited literature evaluating the optimal management of severe bradycardia. This case report discusses a patient with a HR lower than previously reported in the literature and provides a valuable opportunity to examine the management of cardiac output in cases of severe bradycardia.
{"title":"Life-threatening bradycardia in an anorexia nervosa patient: A case report","authors":"Alexandra W. Obremskey, Janis L. Sethness, Tarane Shafi, T. Brogan","doi":"10.4103/jpcc.jpcc_29_24","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_29_24","url":null,"abstract":"\u0000 Cardiac complications are frequently seen in patients with anorexia nervosa, with bradycardia being the most common. The degree of bradycardia can be a marker of disease severity as heart rate (HR) nadir is correlated with body mass index, total weight loss, and recent weight loss. Despite the prevalence and potential severity of bradycardia, there is limited literature evaluating the optimal management of severe bradycardia. This case report discusses a patient with a HR lower than previously reported in the literature and provides a valuable opportunity to examine the management of cardiac output in cases of severe bradycardia.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute kidney injury (AKI) is a common problem in critical care settings and conferred an increased risk of morbidities and mortality. The pendulum has shifted to the increasing number of children with comorbidities exposed to potential kidney damage. AKI is a complex clinical syndrome due to heterogeneous etiology. There has been an evolution in the definition and staging of AKI over the past two decades. However, estimating glomerular filtration rate in rapidly changing kidney function remains challenging. Although biomarkers are promising in AKI identification, timing is crucial in deciding which biomarker to measure. The outcome of AKI is not always recovery, but it is an interconnected syndrome with acute and chronic kidney disease.
急性肾损伤（AKI）是重症监护环境中的常见问题，会增加发病和死亡风险。现在，越来越多患有合并症的儿童面临潜在的肾损伤。由于病因不同，AKI 是一种复杂的临床综合征。在过去二十年里，AKI 的定义和分期发生了变化。然而，在肾功能快速变化的情况下估算肾小球滤过率仍然具有挑战性。虽然生物标志物在识别 AKI 方面大有可为，但在决定测量哪种生物标志物时，时机至关重要。AKI 的结果并不总是康复，但它是一种与急性和慢性肾病相互关联的综合征。
{"title":"Challenges in estimating the severity of kidney dysfunction in critically ill children","authors":"R. Rameshkumar, M. Chidambaram, R. Bhowmick","doi":"10.4103/jpcc.jpcc_44_24","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_44_24","url":null,"abstract":"\u0000 Acute kidney injury (AKI) is a common problem in critical care settings and conferred an increased risk of morbidities and mortality. The pendulum has shifted to the increasing number of children with comorbidities exposed to potential kidney damage. AKI is a complex clinical syndrome due to heterogeneous etiology. There has been an evolution in the definition and staging of AKI over the past two decades. However, estimating glomerular filtration rate in rapidly changing kidney function remains challenging. Although biomarkers are promising in AKI identification, timing is crucial in deciding which biomarker to measure. The outcome of AKI is not always recovery, but it is an interconnected syndrome with acute and chronic kidney disease.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141841416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There is a growing body of literature that suggests increased rates of morbidity and mortality for pediatric conditions admitted on a weekend compared with weekdays. Whether this association is seen in Nigerian children presenting with neurologic emergencies is not certain. Understanding the effect of weekend admission on the outcome of pediatric neurologic emergencies is important to allocate personnel and resources more efficiently. This study was conducted to determine whether weekend and out-of-hour duty affect the outcome of neurological emergencies in children. This study used a cross-sectional analytic design over an 18-month period. Children aged 1 month–18 years presenting with neurologic emergencies were prospectively recruited over an 18-month period. The association between the dependent variable and independent variables was tested using the Chi-squared test and odds ratio. The level of statistical significance was accepted as P < 0.05. A total of 146 children with neurologic emergencies were seen during the study period with 33.6% occurring on weekends. The average duration of stay (DOS) was 7.6 (±5.7) days. There was no difference in DOS between children based on the day of admission (P = 0.241) or the hour of admission (P = 0.155). Eleven (7.5%) of study subjects died during the study period. There was no difference in outcome based on day ([weekends – 6.1% vs. weekday – 8.2%] [P = 0.896]) or hour of admission ([out-of-hour – 7.3% vs. working hours – 7.7%] [P = 0.958]). Weekend and out-of-hour duty does not affect the outcome of neurological emergencies in children.
{"title":"Does weekend and out-of-hour duty affect the outcome of neurological emergencies in children? – A prospective observational study from Southern Nigeria","authors":"P. Ikhurionan, M. T. Abiodun","doi":"10.4103/jpcc.jpcc_24_24","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_24_24","url":null,"abstract":"\u0000 \u0000 \u0000 There is a growing body of literature that suggests increased rates of morbidity and mortality for pediatric conditions admitted on a weekend compared with weekdays. Whether this association is seen in Nigerian children presenting with neurologic emergencies is not certain. Understanding the effect of weekend admission on the outcome of pediatric neurologic emergencies is important to allocate personnel and resources more efficiently. This study was conducted to determine whether weekend and out-of-hour duty affect the outcome of neurological emergencies in children.\u0000 \u0000 \u0000 \u0000 This study used a cross-sectional analytic design over an 18-month period. Children aged 1 month–18 years presenting with neurologic emergencies were prospectively recruited over an 18-month period. The association between the dependent variable and independent variables was tested using the Chi-squared test and odds ratio. The level of statistical significance was accepted as P < 0.05.\u0000 \u0000 \u0000 \u0000 A total of 146 children with neurologic emergencies were seen during the study period with 33.6% occurring on weekends. The average duration of stay (DOS) was 7.6 (±5.7) days. There was no difference in DOS between children based on the day of admission (P = 0.241) or the hour of admission (P = 0.155). Eleven (7.5%) of study subjects died during the study period. There was no difference in outcome based on day ([weekends – 6.1% vs. weekday – 8.2%] [P = 0.896]) or hour of admission ([out-of-hour – 7.3% vs. working hours – 7.7%] [P = 0.958]).\u0000 \u0000 \u0000 \u0000 Weekend and out-of-hour duty does not affect the outcome of neurological emergencies in children.\u0000","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141851418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Takotsubo cardiomyopathy constitutes an acute cardiac condition that mimics acute myocardial infarction in the absence of coronary artery disease. We present a case of a 7-month-old girl, who was admitted in the pediatric intensive care unit (PICU) at a tertiary care hospital for clinical deterioration with underlying familial hemophagocytic lymphohistiocytosis. During the PICU stay, on echocardiography, the patient had severe cardiac contractility compromise with a characteristic pattern of regional wall motion abnormalities of the left ventricle. This, in combination with elevated cardiac enzymes, led to the diagnosis of takotsubo cardiomyopathy.
{"title":"Takotsubo cardiomyopathy in a 7-month-old infant with familial hemophagocytic lymphohistiocytosis: A case report","authors":"Payal Gupta, S. S. Patil, U. Pillay","doi":"10.4103/jpcc.jpcc_35_24","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_35_24","url":null,"abstract":"\u0000 Takotsubo cardiomyopathy constitutes an acute cardiac condition that mimics acute myocardial infarction in the absence of coronary artery disease. We present a case of a 7-month-old girl, who was admitted in the pediatric intensive care unit (PICU) at a tertiary care hospital for clinical deterioration with underlying familial hemophagocytic lymphohistiocytosis. During the PICU stay, on echocardiography, the patient had severe cardiac contractility compromise with a characteristic pattern of regional wall motion abnormalities of the left ventricle. This, in combination with elevated cardiac enzymes, led to the diagnosis of takotsubo cardiomyopathy.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141842080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sonya Susan George, Arun K. Kurian, Sajan Philip George, Lakshmanan Jeyasheelan, B. Yadav
Laryngoscopy and intubation remain critical in pediatric patients as compared to adult patients due to different anatomy. This study was conducted to compare the Cormack and Lehane grade (CL) of laryngoscopy, percentage of glottic opening (POGO) score, and the efficacy of backward upward rightward pressure (BURP) maneuver to improve laryngoscopy grade with or without the use of intubation pillow. A randomized controlled trial was done from January 2020 to July 2020 on 68 children with 34 children in Group 1 (with intubation pillow) and 34 patients in Group 2 (without intubation pillow). Children between 5 and 12 years of age (the American Society of Anesthesiologists class I and II) planned for surgery under general anesthesia with endotracheal tube were included in this study. Pillow of 4 cm size was used in 5–9 years and 6 cm pillow in 9–12 years of age group. Macintosh laryngoscope was used for intubation. CL grading and POGO score were assessed. BURP maneuver was given in cases of difficult laryngoscopy of CL grade above 2 and its effect on improvement in CL grading was measured. Group 1 children had significantly more CL grade I (83.3% vs. 16.7%); significantly lesser CL Grade IIb (23.1% vs. 76.9%, P = 0.001); and significantly more POGO score (97% vs. 86%, P < 0.05) than Group 2. The use of BURP maneuver significantly improved the laryngoscopy view in both the groups. The use of intubation pillow in children between 5 and 12 years of age facilitated better laryngoscopy view and POGO score.
{"title":"Evaluating the impact of intubation pillow on laryngoscopy grade in children: A Randomized controlled trial","authors":"Sonya Susan George, Arun K. Kurian, Sajan Philip George, Lakshmanan Jeyasheelan, B. Yadav","doi":"10.4103/jpcc.jpcc_16_24","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_16_24","url":null,"abstract":"\u0000 \u0000 \u0000 Laryngoscopy and intubation remain critical in pediatric patients as compared to adult patients due to different anatomy. This study was conducted to compare the Cormack and Lehane grade (CL) of laryngoscopy, percentage of glottic opening (POGO) score, and the efficacy of backward upward rightward pressure (BURP) maneuver to improve laryngoscopy grade with or without the use of intubation pillow.\u0000 \u0000 \u0000 \u0000 A randomized controlled trial was done from January 2020 to July 2020 on 68 children with 34 children in Group 1 (with intubation pillow) and 34 patients in Group 2 (without intubation pillow). Children between 5 and 12 years of age (the American Society of Anesthesiologists class I and II) planned for surgery under general anesthesia with endotracheal tube were included in this study. Pillow of 4 cm size was used in 5–9 years and 6 cm pillow in 9–12 years of age group. Macintosh laryngoscope was used for intubation. CL grading and POGO score were assessed. BURP maneuver was given in cases of difficult laryngoscopy of CL grade above 2 and its effect on improvement in CL grading was measured.\u0000 \u0000 \u0000 \u0000 Group 1 children had significantly more CL grade I (83.3% vs. 16.7%); significantly lesser CL Grade IIb (23.1% vs. 76.9%, P = 0.001); and significantly more POGO score (97% vs. 86%, P < 0.05) than Group 2. The use of BURP maneuver significantly improved the laryngoscopy view in both the groups.\u0000 \u0000 \u0000 \u0000 The use of intubation pillow in children between 5 and 12 years of age facilitated better laryngoscopy view and POGO score.\u0000","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Sudeep, S. Angurana, Harshita Nori, S. Naganur, Anmol Bhatia
Tracheobronchial compression due to cardiovascular disease is a rare cause of respiratory distress in children, and common causes include vascular slings and rings, abnormal origin of major vessels, and left atrial enlargement. Intrathoracic airway compression due to pericardial effusion is a rare cause of respiratory distress in children. Here, we present a 6-month-old male child who presented with respiratory distress due to extraluminal compression of the left main bronchus by large pericardial effusion leading to left lung collapse, which improved after pericardiocentesis.
{"title":"Left main bronchus compression by massive pericardial effusion: A rare cause of respiratory distress in an infant: A case report","authors":"K. Sudeep, S. Angurana, Harshita Nori, S. Naganur, Anmol Bhatia","doi":"10.4103/jpcc.jpcc_34_24","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_34_24","url":null,"abstract":"\u0000 Tracheobronchial compression due to cardiovascular disease is a rare cause of respiratory distress in children, and common causes include vascular slings and rings, abnormal origin of major vessels, and left atrial enlargement. Intrathoracic airway compression due to pericardial effusion is a rare cause of respiratory distress in children. Here, we present a 6-month-old male child who presented with respiratory distress due to extraluminal compression of the left main bronchus by large pericardial effusion leading to left lung collapse, which improved after pericardiocentesis.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141840624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Juan Enrique García Maytorena, Yanyn Ameyaly Cabrera Antonio, Kassandra Aglae Salazar Vázquez, A. Alatorre, V. Martínez
Traumatic brain injury (TBI) is a prevalent condition in the pediatric population. An index between the diameter of the optic nerve sheath diameter (ONSD) and the transverse eyeball transverse diameter (ETD) measured in the tomographic scan has been described in adults, with a cutoff value of ≥0.25 for predicting poor neurologic prognoses. This study was conducted to analyze the relationship between the index ONSD/ETD with the neurological outcome in children with severe TBI. This was single-center, retrospective study, conducted from March 2021 to November 2022. Patients older than 30 days and up to 16 years of age admitted with severe TBI were included in the study. Measurements of the ONSD/ETD index by cranial tomography were calculated. The population was divided into two groups, one with index ≥0.25 and other with index <0.25. Glasgow Outcome Scale-Extended (GOSE) and outcome were compared between groups. Thirty patients were recruited. Patients with inde × 0.25 or higher had a lower GOSE (60% (1–2 points) vs. 60% (7–8 points)), more days of mechanical ventilation (MV) (8 days, interquartile range IQR 5–17 days vs. 3 days, IQR 2–4 days P = 0.005), and more length of pediatric intensive care unit (PICU) stay (12 days, IQR 9–23 days vs. 5 days, IQR 4–8 days P = 0.007) than patients with index <0.25. The ONSD/ETD index was a reliable indicator for predicting the neurological outcome of patients with severe TBI. An index ≥0.25 was associated with more days of PICU stay and MV with worse neurological outcomes.
创伤性脑损伤（TBI）是儿科常见病。在成人中已描述了在断层扫描中测量的视神经鞘直径（ONSD）和眼球横向直径（ETD）之间的指数，其临界值为≥0.25，用于预测不良的神经预后。本研究旨在分析ONSD/ETD指数与严重创伤性脑损伤儿童神经系统预后之间的关系。 这是一项单中心回顾性研究，研究时间为 2021 年 3 月至 2022 年 11 月。研究纳入了住院30天以上、16岁以下的严重创伤性脑损伤患者。研究人员通过头颅断层扫描计算了ONSD/ETD指数。研究对象分为两组，一组指数≥0.25，另一组指数＜0.25。比较两组的格拉斯哥结果量表扩展版（GOSE）和结果。 共招募了 30 名患者。与指数<0.25的患者相比，inde × 0.25或更高的患者GOSE较低（60%（1-2分） vs. 60%（7-8分）），机械通气（MV）天数较多（8天，四分位数间距IQR为5-17天 vs. 3天，IQR为2-4天 P = 0.005），儿科重症监护室（PICU）住院时间较长（12天，IQR为9-23天 vs. 5天，IQR为4-8天 P = 0.007）。 ONSD/ETD指数是预测严重创伤性脑损伤患者神经系统预后的可靠指标。指数≥0.25与PICU住院天数和MV与较差的神经功能预后有关。
{"title":"Tomographic index (ONSD/ETD) as a predictor of short-term neurological outcome in children with severe traumatic brain injury: A single-center retrospective observational study from Mexico","authors":"Juan Enrique García Maytorena, Yanyn Ameyaly Cabrera Antonio, Kassandra Aglae Salazar Vázquez, A. Alatorre, V. Martínez","doi":"10.4103/jpcc.jpcc_15_24","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_15_24","url":null,"abstract":"\u0000 \u0000 \u0000 Traumatic brain injury (TBI) is a prevalent condition in the pediatric population. An index between the diameter of the optic nerve sheath diameter (ONSD) and the transverse eyeball transverse diameter (ETD) measured in the tomographic scan has been described in adults, with a cutoff value of ≥0.25 for predicting poor neurologic prognoses. This study was conducted to analyze the relationship between the index ONSD/ETD with the neurological outcome in children with severe TBI.\u0000 \u0000 \u0000 \u0000 This was single-center, retrospective study, conducted from March 2021 to November 2022. Patients older than 30 days and up to 16 years of age admitted with severe TBI were included in the study. Measurements of the ONSD/ETD index by cranial tomography were calculated. The population was divided into two groups, one with index ≥0.25 and other with index <0.25. Glasgow Outcome Scale-Extended (GOSE) and outcome were compared between groups.\u0000 \u0000 \u0000 \u0000 Thirty patients were recruited. Patients with inde × 0.25 or higher had a lower GOSE (60% (1–2 points) vs. 60% (7–8 points)), more days of mechanical ventilation (MV) (8 days, interquartile range IQR 5–17 days vs. 3 days, IQR 2–4 days P = 0.005), and more length of pediatric intensive care unit (PICU) stay (12 days, IQR 9–23 days vs. 5 days, IQR 4–8 days P = 0.007) than patients with index <0.25.\u0000 \u0000 \u0000 \u0000 The ONSD/ETD index was a reliable indicator for predicting the neurological outcome of patients with severe TBI. An index ≥0.25 was associated with more days of PICU stay and MV with worse neurological outcomes.\u0000","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sasidaran Kandasamy, K. G. S. Reddy, Nivesh Subburaj
Acute kidney injury (AKI) is a multifaceted syndrome with diverse etiologies encountered very frequently in all critical care service units. Time and again, multiple researchers have proven its independent contribution to increasing morbidity and mortality in hospitalized children and adults. This undeniable fact has guided the development of newer strategies and logical concepts that have led to new modalities of treating AKI. In the absence of curative medical therapy, kidney replacement therapy (KRT) is considered the primary supportive therapy for AKI, and when initiated at the right time, it has the potential to bridge the gap toward cure. Among all KRT methods, blood-based dialysis occupies a prominent role and has now become the cornerstone of treatment for critically ill children with AKI. Two major methods usually employed are “intermittent hemolysis” (IHD) and “continuous kidney replacement therapy” (CKRT). Currently, a third method called “sustained low-efficiency dialysis (SLED)” is gaining momentum in critical care. It is a hybrid method; in simpler terms, it is a slow and prolonged IHD that may carry a few of the critical merits of CKRT. This narrative review article sheds light on SLED, as well as its comparison to IHD in critical care practice.
急性肾损伤（AKI）是一种多方面的综合征，其病因多种多样，在所有重症监护病房中都会经常遇到。许多研究人员一再证明，急性肾损伤会导致住院儿童和成人的发病率和死亡率上升。这一不可否认的事实指导着人们开发出更新的策略和逻辑概念，并由此产生了治疗 AKI 的新方法。在缺乏根治性药物治疗的情况下，肾脏替代疗法（KRT）被认为是治疗 AKI 的主要支持性疗法，如果在适当的时候启动，它有可能弥补治愈的差距。在所有 KRT 方法中，血液透析占有重要地位，现已成为治疗 AKI 重症患儿的基石。通常采用的两种主要方法是 "间歇性溶血"（IHD）和 "持续性肾脏替代疗法"（CKRT）。目前，第三种称为 "持续低效透析（SLED）"的方法在重症监护领域的应用越来越广泛。这是一种混合方法；简单地说，它是一种缓慢而持久的 IHD，可能具有 CKRT 的一些关键优点。这篇叙述性综述文章介绍了 SLED 及其与重症监护实践中的 IHD 的比较。
{"title":"Similarities and differences between intermittent hemodialysis and sustained low-efficiency dialysis","authors":"Sasidaran Kandasamy, K. G. S. Reddy, Nivesh Subburaj","doi":"10.4103/jpcc.jpcc_48_24","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_48_24","url":null,"abstract":"\u0000 Acute kidney injury (AKI) is a multifaceted syndrome with diverse etiologies encountered very frequently in all critical care service units. Time and again, multiple researchers have proven its independent contribution to increasing morbidity and mortality in hospitalized children and adults. This undeniable fact has guided the development of newer strategies and logical concepts that have led to new modalities of treating AKI. In the absence of curative medical therapy, kidney replacement therapy (KRT) is considered the primary supportive therapy for AKI, and when initiated at the right time, it has the potential to bridge the gap toward cure. Among all KRT methods, blood-based dialysis occupies a prominent role and has now become the cornerstone of treatment for critically ill children with AKI. Two major methods usually employed are “intermittent hemolysis” (IHD) and “continuous kidney replacement therapy” (CKRT). Currently, a third method called “sustained low-efficiency dialysis (SLED)” is gaining momentum in critical care. It is a hybrid method; in simpler terms, it is a slow and prolonged IHD that may carry a few of the critical merits of CKRT. This narrative review article sheds light on SLED, as well as its comparison to IHD in critical care practice.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Satheesh Ponnarmeni, Sasidaran Kandasamy, J. Shobana
Continuous renal replacement therapy (CRRT) is one of the commonly used extracorporeal blood purification therapies and its use in the pediatric population has increased in the past two decades due to the availability of safer machines which allow lower blood flow rate and dialysate flow rate. The usual indication for initiation of CRRT is for solute clearance and or fluid removal in oliguric patients with acute kidney injury. Knowledge regarding the principles of solute removal and fluid removal along with the application of these mechanisms in different modes of CRRT helps the physician to decide on the appropriate therapy for the given patient. Understanding the concept of CRRT dose and the factors to be considered in the prescription for achieving the preset targets of CRRT is vital for the efficient utilization of the therapy.
{"title":"Significance of effluent dose in continuous renal replacement therapy in children","authors":"Satheesh Ponnarmeni, Sasidaran Kandasamy, J. Shobana","doi":"10.4103/jpcc.jpcc_49_24","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_49_24","url":null,"abstract":"\u0000 Continuous renal replacement therapy (CRRT) is one of the commonly used extracorporeal blood purification therapies and its use in the pediatric population has increased in the past two decades due to the availability of safer machines which allow lower blood flow rate and dialysate flow rate. The usual indication for initiation of CRRT is for solute clearance and or fluid removal in oliguric patients with acute kidney injury. Knowledge regarding the principles of solute removal and fluid removal along with the application of these mechanisms in different modes of CRRT helps the physician to decide on the appropriate therapy for the given patient. Understanding the concept of CRRT dose and the factors to be considered in the prescription for achieving the preset targets of CRRT is vital for the efficient utilization of the therapy.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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