Shraddha Sunthwal, Sagar S. Lad, V. Khadilkar, A. Botre, Nandan Yardi, R. Ganacharya, Sahil Lad
In pediatric patients, neurological manifestation of COVID-19 infection has been reported in acute and postinfectious stages. Hashimoto encephalopathy (HE) is the most common cause of hypothyroidism in children with prevalence being 1.2%. More than 200 cases of HE have been reported in adults. Only 60 cases have been reported in children. We present a case of a 2-year-old girl with status epilepticus and respiratory failure needing prolonged ventilation. Her COVID-19 antibody and antithyroid antibodies (anti-thyroid peroxidase and anti-thyroglobulin) were positive. Her thyroid profile was abnormal. Her clinical state improved after receiving an intravenous immunoglobulin and pulse dose of methylprednisolone. This suggests that complete recovery for such patients can be achieved with early detection and immunomodulatory treatment.
{"title":"Steroid-responsive encephalopathy in autoimmune thyroiditis in a 2-year-old child after COVID-19 infection: A case report","authors":"Shraddha Sunthwal, Sagar S. Lad, V. Khadilkar, A. Botre, Nandan Yardi, R. Ganacharya, Sahil Lad","doi":"10.4103/jpcc.jpcc_9_24","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_9_24","url":null,"abstract":"In pediatric patients, neurological manifestation of COVID-19 infection has been reported in acute and postinfectious stages. Hashimoto encephalopathy (HE) is the most common cause of hypothyroidism in children with prevalence being 1.2%. More than 200 cases of HE have been reported in adults. Only 60 cases have been reported in children. We present a case of a 2-year-old girl with status epilepticus and respiratory failure needing prolonged ventilation. Her COVID-19 antibody and antithyroid antibodies (anti-thyroid peroxidase and anti-thyroglobulin) were positive. Her thyroid profile was abnormal. Her clinical state improved after receiving an intravenous immunoglobulin and pulse dose of methylprednisolone. This suggests that complete recovery for such patients can be achieved with early detection and immunomodulatory treatment.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141138304","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}
Nicholas J. Costable, John M. Costable, Glenn Rabin
Choking is a leading cause of injury and death among children under the age of five. Despite notable advances in technology, regulations, and education, the prevalence of choking incidents and related fatalities persists as a global issue, demanding the implementation of improved assistance methods. This study aims to assess the efficacy of an innovative airway clearance device, LifeVac, in aiding children aged 5 and under in choking emergencies. and Methods: LifeVac LLC maintained a comprehensive database of voluntary reports documenting the utilization of their device in choking emergencies over 10 years, collected through a dedicated website. Collected data included the age and sex of the choking victim, preexisting medical conditions, nature of the object causing airway obstruction, whether basic life support protocol was followed before employing the LifeVac, number of pulls required to dislodge the obstructing object, and adverse events. A total of 299 children were reported to have received assistance with the LifeVac device in choking emergencies. The age range of the assisted children varied from 3 days old to 5 years. One hundred and fifty-seven children were boys. There were 19 reports of preexisting conditions. The most common obstructing objects were plastic, mucus, candy, meat, and fruits. The number of pulls required to successfully dislodge the object ranged from 1 to 10. No failures were reported. LifeVac should be considered a valuable complement to standard life support techniques in choking emergencies, particularly for at-risk groups such as children under the age of 5.
{"title":"The use of LifeVac, a novel airway clearance device, in the assistance of choking victims aged five and under: Results of a retrospective 10-year observational study","authors":"Nicholas J. Costable, John M. Costable, Glenn Rabin","doi":"10.4103/jpcc.jpcc_3_24","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_3_24","url":null,"abstract":"\u0000 \u0000 Choking is a leading cause of injury and death among children under the age of five. Despite notable advances in technology, regulations, and education, the prevalence of choking incidents and related fatalities persists as a global issue, demanding the implementation of improved assistance methods. This study aims to assess the efficacy of an innovative airway clearance device, LifeVac, in aiding children aged 5 and under in choking emergencies.\u0000 \u0000 \u0000 \u0000 \u0000 and\u0000 Methods: LifeVac LLC maintained a comprehensive database of voluntary reports documenting the utilization of their device in choking emergencies over 10 years, collected through a dedicated website. Collected data included the age and sex of the choking victim, preexisting medical conditions, nature of the object causing airway obstruction, whether basic life support protocol was followed before employing the LifeVac, number of pulls required to dislodge the obstructing object, and adverse events.\u0000 \u0000 \u0000 \u0000 A total of 299 children were reported to have received assistance with the LifeVac device in choking emergencies. The age range of the assisted children varied from 3 days old to 5 years. One hundred and fifty-seven children were boys. There were 19 reports of preexisting conditions. The most common obstructing objects were plastic, mucus, candy, meat, and fruits. The number of pulls required to successfully dislodge the object ranged from 1 to 10. No failures were reported.\u0000 \u0000 \u0000 \u0000 LifeVac should be considered a valuable complement to standard life support techniques in choking emergencies, particularly for at-risk groups such as children under the age of 5.\u0000","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141131522","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}
Shriyansh Kulshrestha, Niha Khan, Banani Poddar, Afzal Azim
Bee stings commonly result in minor reactions, but severe cases can lead to systemic complications including anaphylaxis and multiorgan dysfunction. We present a case of an 8-year-old child experiencing severe bee sting envenomation, manifesting as various organ dysfunctions including acute kidney injury and acute pancreatitis. Renal replacement therapy was effective in managing renal dysfunction. Further research is warranted to explore targeted antivenom therapies for severe bee sting reactions. Prompt recognition and a multidisciplinary approach are crucial for successful management. Further research into specific treatments is needed to improve outcomes in such cases.
{"title":"Pediatric bee sting envenomation with multiorgan challenge: A case report","authors":"Shriyansh Kulshrestha, Niha Khan, Banani Poddar, Afzal Azim","doi":"10.4103/jpcc.jpcc_14_24","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_14_24","url":null,"abstract":"Bee stings commonly result in minor reactions, but severe cases can lead to systemic complications including anaphylaxis and multiorgan dysfunction. We present a case of an 8-year-old child experiencing severe bee sting envenomation, manifesting as various organ dysfunctions including acute kidney injury and acute pancreatitis. Renal replacement therapy was effective in managing renal dysfunction. Further research is warranted to explore targeted antivenom therapies for severe bee sting reactions. Prompt recognition and a multidisciplinary approach are crucial for successful management. Further research into specific treatments is needed to improve outcomes in such cases.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141141875","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}
Neutrophil–lymphocyte ratio (NLR) has recently gained popularity as a simple, inexpensive, and highly accurate inflammatory marker. When the differential count of leukocytes is checked following it is characterized by leukocytosis with an increase in neutrophil count and a decline in lymphocyte counts. This study was conducted to assess whether alteration in the differential count of leukocytes following envenomation has the ability to diagnose and predict the severity and prognosis in children and to derive a cutoff value for the same. This prospective observational study was done in the pediatric intensive care unit (ICU) of a tertiary care hospital from July 2019 to June 2020. From the complete blood count of patients done at admission, NLR1 was calculated. All patients were treated as per the national snake bite treatment protocol. The amount of antisnake venom (ASV) given, duration of hospital stay, and ICU stay were correlated with NLR1 values. An NLR value of 3.35 can predict envenomation with 95% sensitivity and 100% specificity. Similarly, an NLR value of 6.72 can predict the need for more than 10 ASV vials with a sensitivity of 93% and specificity of 97%, and an NLR value of 6.72 can predict the occurrence of major complications with a sensitivity of 89.3% and specificity of 94%. NLR can differentiate poisonous snake bites from nonpoisonous bites and can also predict the severity of the envenomation.
{"title":"Role of neutrophil–lymphocyte ratio in the management of children with snake bite envenomation: A single-center prospective observational study","authors":"Kutty Vijayaragavan, Jeyaraman Balasubramanian, Raghavendran Venkataramanan, Velusamy Manigandan","doi":"10.4103/jpcc.jpcc_10_24","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_10_24","url":null,"abstract":"\u0000 \u0000 Neutrophil–lymphocyte ratio (NLR) has recently gained popularity as a simple, inexpensive, and highly accurate inflammatory marker. When the differential count of leukocytes is checked following it is characterized by leukocytosis with an increase in neutrophil count and a decline in lymphocyte counts. This study was conducted to assess whether alteration in the differential count of leukocytes following envenomation has the ability to diagnose and predict the severity and prognosis in children and to derive a cutoff value for the same.\u0000 \u0000 \u0000 \u0000 This prospective observational study was done in the pediatric intensive care unit (ICU) of a tertiary care hospital from July 2019 to June 2020. From the complete blood count of patients done at admission, NLR1 was calculated. All patients were treated as per the national snake bite treatment protocol. The amount of antisnake venom (ASV) given, duration of hospital stay, and ICU stay were correlated with NLR1 values.\u0000 \u0000 \u0000 \u0000 An NLR value of 3.35 can predict envenomation with 95% sensitivity and 100% specificity. Similarly, an NLR value of 6.72 can predict the need for more than 10 ASV vials with a sensitivity of 93% and specificity of 97%, and an NLR value of 6.72 can predict the occurrence of major complications with a sensitivity of 89.3% and specificity of 94%.\u0000 \u0000 \u0000 \u0000 NLR can differentiate poisonous snake bites from nonpoisonous bites and can also predict the severity of the envenomation.\u0000","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141140225","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}
Fluid overload (FO) is a common and challenging complication encountered among critically ill children admitted to pediatric intensive care unit (PICU), posing significant risks for morbidity and mortality. The pathophysiology of FO involves disruptions in fluid balance, exacerbated by underlying medical conditions, critical illness, and therapeutic interventions. Assessment of fluid status relies on a combination of clinical evaluation, laboratory tests, and imaging studies, with a focus on early detection and intervention to prevent complications. Management strategies for FO in the PICU encompass both preventive and therapeutic approaches. Prevention involves judicious fluid resuscitation, dynamic fluid assessment, advanced hemodynamic monitoring, careful monitoring of fluid input and output, early recognition of at-risk patients, and individualized approach. Therapeutic interventions may include diuretic therapy, optimization of hemodynamic support, and renal replacement therapy tailored to individual patient needs. Challenges in managing FO in PICU include balancing the need for adequate tissue perfusion with the risk of exacerbating FO and preventing complications such as electrolyte disturbances and organ dysfunction. Multidisciplinary collaboration, evidence-based practices, and continuous monitoring are essential for successful fluid management in critically ill children. This review aims to provide a comprehensive overview of the current understanding and management strategies for FO among critically ill children.
{"title":"Fluid overload in critically ill children: A narrative review","authors":"S. Charaya, S. Angurana","doi":"10.4103/jpcc.jpcc_31_24","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_31_24","url":null,"abstract":"Fluid overload (FO) is a common and challenging complication encountered among critically ill children admitted to pediatric intensive care unit (PICU), posing significant risks for morbidity and mortality. The pathophysiology of FO involves disruptions in fluid balance, exacerbated by underlying medical conditions, critical illness, and therapeutic interventions. Assessment of fluid status relies on a combination of clinical evaluation, laboratory tests, and imaging studies, with a focus on early detection and intervention to prevent complications. Management strategies for FO in the PICU encompass both preventive and therapeutic approaches. Prevention involves judicious fluid resuscitation, dynamic fluid assessment, advanced hemodynamic monitoring, careful monitoring of fluid input and output, early recognition of at-risk patients, and individualized approach. Therapeutic interventions may include diuretic therapy, optimization of hemodynamic support, and renal replacement therapy tailored to individual patient needs. Challenges in managing FO in PICU include balancing the need for adequate tissue perfusion with the risk of exacerbating FO and preventing complications such as electrolyte disturbances and organ dysfunction. Multidisciplinary collaboration, evidence-based practices, and continuous monitoring are essential for successful fluid management in critically ill children. This review aims to provide a comprehensive overview of the current understanding and management strategies for FO among critically ill children.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141143600","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}
Kirti Pai, Jyothi Jayaram, Siva Vyasam, Wrik Laha, Ujjwal Chawla, Chirag Thakur, Joseph L Mathew, Raneta K. Paul, Anmol Bhatia, S. Angurana
Postinfectious bronchiolitis obliterans (PIBO) is a rare, chronic form of obstructive lung disease characterized by obliteration of small airways leading to clinical and radiological manifestations of smaller airway obstruction. Adenovirus is the most common viral pathogen associated with PIBO in the pediatric population. We report a 7-month-old male who developed PIBO following severe viral pneumonia to highlight the significance of early diagnosis, challenges faced during the clinical course, treatment of acute exacerbations, and long-term care.
{"title":"Postinfectious bronchiolitis obliterans: An uncommon complication of severe viral pneumonia in an infant: A case report","authors":"Kirti Pai, Jyothi Jayaram, Siva Vyasam, Wrik Laha, Ujjwal Chawla, Chirag Thakur, Joseph L Mathew, Raneta K. Paul, Anmol Bhatia, S. Angurana","doi":"10.4103/jpcc.jpcc_7_24","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_7_24","url":null,"abstract":"Postinfectious bronchiolitis obliterans (PIBO) is a rare, chronic form of obstructive lung disease characterized by obliteration of small airways leading to clinical and radiological manifestations of smaller airway obstruction. Adenovirus is the most common viral pathogen associated with PIBO in the pediatric population. We report a 7-month-old male who developed PIBO following severe viral pneumonia to highlight the significance of early diagnosis, challenges faced during the clinical course, treatment of acute exacerbations, and long-term care.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141133831","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}
The hemodynamic profile in multisystem inflammatory syndrome in children (MIS-C) has not been well described. Therefore, we conducted the study utilizing electrocardiometry (EC) to assess the hemodynamic characteristics in MIS-C patients presenting with shock. and Methods: This pilot prospective observational study was conducted in the pediatric intensive care unit of a tertiary care hospital. Children between 2 months and 18 years meeting the WHO criteria for MIS-C presenting with shock during second COVID-19 pandemic were included in the study. All patients underwent measurement of hemodynamic profile with EC for the initial 48 h of enrollment. Based on EC assessment at enrolment, the systemic vascular resistance index (SVRi) of 1000–1600 dyn s/cm5/m2 was regarded as normal. The hemodynamic categorization was defined as vasodilatory shock in EC (VDEC) (SVRi <1000 dyn s/[cm5/m2]) and vasoconstrictive shock in EC (VCEC) (SVRi > 1600 dyn s/[cm5/m2]). Thirty-one children met the WHO case definition of MIS-C during the study period. Sixteen children with shock were enrolled and studied. Clinically, 7 (43.75%) children had cold shock, whereas 9 (56.25%) had warm shock. The measured baseline (mean [standard deviation]) hemodynamic variables were cardiac index (CI) of 6 ± 1.41 L/min/m2, stroke volume variation of 23% ±9.6%, SVRi of 954.75 ± 263.35 dyn s/(cm5/m2), and thoracic fluid content of 51.18 ± 17.26 ml. VDEC was the predominant manifestation (87.5%) based on EC. Vasodilatory shock was the predominant phenotype observed in critically ill children with MIS-C with shock by EC assessment.
{"title":"Role of electrocardiometry in hemodynamic assessment of children with shock in multisystem inflammatory syndrome following COVID-19: A single-center prospective observational study","authors":"A. Lalitha, Suman Sudha Moharana, Santu Ghosh","doi":"10.4103/jpcc.jpcc_96_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_96_23","url":null,"abstract":"\u0000 \u0000 The hemodynamic profile in multisystem inflammatory syndrome in children (MIS-C) has not been well described. Therefore, we conducted the study utilizing electrocardiometry (EC) to assess the hemodynamic characteristics in MIS-C patients presenting with shock.\u0000 \u0000 \u0000 \u0000 \u0000 and\u0000 Methods: This pilot prospective observational study was conducted in the pediatric intensive care unit of a tertiary care hospital. Children between 2 months and 18 years meeting the WHO criteria for MIS-C presenting with shock during second COVID-19 pandemic were included in the study. All patients underwent measurement of hemodynamic profile with EC for the initial 48 h of enrollment. Based on EC assessment at enrolment, the systemic vascular resistance index (SVRi) of 1000–1600 dyn s/cm5/m2 was regarded as normal. The hemodynamic categorization was defined as vasodilatory shock in EC (VDEC) (SVRi <1000 dyn s/[cm5/m2]) and vasoconstrictive shock in EC (VCEC) (SVRi > 1600 dyn s/[cm5/m2]).\u0000 \u0000 \u0000 \u0000 Thirty-one children met the WHO case definition of MIS-C during the study period. Sixteen children with shock were enrolled and studied. Clinically, 7 (43.75%) children had cold shock, whereas 9 (56.25%) had warm shock. The measured baseline (mean [standard deviation]) hemodynamic variables were cardiac index (CI) of 6 ± 1.41 L/min/m2, stroke volume variation of 23% ±9.6%, SVRi of 954.75 ± 263.35 dyn s/(cm5/m2), and thoracic fluid content of 51.18 ± 17.26 ml. VDEC was the predominant manifestation (87.5%) based on EC.\u0000 \u0000 \u0000 \u0000 Vasodilatory shock was the predominant phenotype observed in critically ill children with MIS-C with shock by EC assessment.\u0000","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141145250","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}
Acid-base disorders are common in critically ill patients and contribute significantly to mortality and morbidity. Metabolic acidosis (MA) can be measured by pH, base deficit, serum bicarbonate, and anion gap. A study was conducted to determine the incidence and type of MA among children admitted to the pediatric intensive care unit (PICU) and to assess its roles as a predictor of outcomes in them. Over 1 year, 100 children between 1 month and 12 years of age who presented to the PICU with an MA or developed it within 24 h of admission were prospectively enrolled. Clinicodemographic data, pediatric sequential organ failure assessment score at admission, clinical outcome, and serial measurements of anion gap, serum lactate, and bicarbonate level were recorded. The incidence of MA was 60.2% with a majority (52%) being high anion gap metabolic acidosis (HAGMA). The predominant condition (39%) leading to MA was catecholamine-resistant shock with organ dysfunction. Peak lactate value and bicarbonate nadir had a significant positive correlation with the duration of mechanical ventilation and inotropic support, but only peak lactate value was significantly associated with mortality. A peak lactate value of 2.19 mmol/L yielded the highest sensitivity and specificity for predicting mortality. There was no association was found between peak anion gap and morbidity or mortality. MA was observed in 60% of children in PICU, with HAGMA being the most common type. Peak lactate value and bicarbonate nadir were correlated with high morbidity, but only peak lactate value was significantly associated with mortality.
{"title":"Metabolic acidosis as a predictor of outcome in critically ill children – A single-center prospective observational study","authors":"Madhushree Datta, Sanjay Haldar, Arnab Biswas, Sandipan Sen, Moumita Samanta, Tapan Kumar Sinha Mahapatra","doi":"10.4103/jpcc.jpcc_8_24","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_8_24","url":null,"abstract":"\u0000 \u0000 Acid-base disorders are common in critically ill patients and contribute significantly to mortality and morbidity. Metabolic acidosis (MA) can be measured by pH, base deficit, serum bicarbonate, and anion gap. A study was conducted to determine the incidence and type of MA among children admitted to the pediatric intensive care unit (PICU) and to assess its roles as a predictor of outcomes in them.\u0000 \u0000 \u0000 \u0000 Over 1 year, 100 children between 1 month and 12 years of age who presented to the PICU with an MA or developed it within 24 h of admission were prospectively enrolled. Clinicodemographic data, pediatric sequential organ failure assessment score at admission, clinical outcome, and serial measurements of anion gap, serum lactate, and bicarbonate level were recorded.\u0000 \u0000 \u0000 \u0000 The incidence of MA was 60.2% with a majority (52%) being high anion gap metabolic acidosis (HAGMA). The predominant condition (39%) leading to MA was catecholamine-resistant shock with organ dysfunction. Peak lactate value and bicarbonate nadir had a significant positive correlation with the duration of mechanical ventilation and inotropic support, but only peak lactate value was significantly associated with mortality. A peak lactate value of 2.19 mmol/L yielded the highest sensitivity and specificity for predicting mortality. There was no association was found between peak anion gap and morbidity or mortality.\u0000 \u0000 \u0000 \u0000 MA was observed in 60% of children in PICU, with HAGMA being the most common type. Peak lactate value and bicarbonate nadir were correlated with high morbidity, but only peak lactate value was significantly associated with mortality.\u0000","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141136618","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}
{"title":"Therapeutic plasma exchange – To do or not to do?","authors":"Indira Jayakumar","doi":"10.4103/jpcc.jpcc_88_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_88_23","url":null,"abstract":"","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139300067","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}
Sarah Almutiri, Lamis Al-Qahtani, Shahad Abdu, Remmaz Aynousah, Sarah Alotaibi, Leenah Alhadrami, Yara Arfaj, S. Bahaidarah
Background: Patients with Down syndrome (DS) are known to have an increased risk of congenital heart diseases, which can be a predictor of prolonged mechanical ventilation (PMV) after cardiac surgery. PMV is a factor that enhances postoperative complications and morbidities. Thus, we aimed to explore the risk factors of the PMV, and relevant complications associated with it. Subjects and Methods: This retrospective study included 94 patients with DS who underwent 97 cardiac repair surgeries between 2010 and 2022. Patients were dichotomized into two groups. The first group was with the patients on mechanical ventilation (MV) for <72 h and the PMV group with MV for more than ≥72 h. Results: We reviewed the association between various risk factors and PMV in patients with DS. The presence of seizure disorder (P = 0.028), preoperative administration of prostaglandin (P = 0.028), and continuous positive airway pressure (CPAP) (P = 0.043) had significantly increased risk of PMV. We found a significantly increased incidence of sepsis (P = 0.009), delayed sternal closure (P = 0.01), feeding intolerance (P = 0.014), prolonged intensive care unit (ICU) stay (P = 0.0001), and pulmonary collapse (P = 0.001) in patients with PMV. There was no difference in the incidence of pulmonary hypertension, postoperative respiratory infection, pneumothorax, and chylothorax between children between the two groups. Conclusions: The presence of seizure disorder, preoperative usage of prostaglandin, and CPAP were significant risk factors for PMV. Incidence of sepsis, delayed sternal closure, feeding intolerance, prolonged ICU stay, and pulmonary collapse was significantly higher with PMV.
{"title":"Complications of prolonged mechanical ventilation after cardiac surgery in children with Down syndrome: A single-center retrospective observational study","authors":"Sarah Almutiri, Lamis Al-Qahtani, Shahad Abdu, Remmaz Aynousah, Sarah Alotaibi, Leenah Alhadrami, Yara Arfaj, S. Bahaidarah","doi":"10.4103/jpcc.jpcc_63_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_63_23","url":null,"abstract":"Background: Patients with Down syndrome (DS) are known to have an increased risk of congenital heart diseases, which can be a predictor of prolonged mechanical ventilation (PMV) after cardiac surgery. PMV is a factor that enhances postoperative complications and morbidities. Thus, we aimed to explore the risk factors of the PMV, and relevant complications associated with it. Subjects and Methods: This retrospective study included 94 patients with DS who underwent 97 cardiac repair surgeries between 2010 and 2022. Patients were dichotomized into two groups. The first group was with the patients on mechanical ventilation (MV) for <72 h and the PMV group with MV for more than ≥72 h. Results: We reviewed the association between various risk factors and PMV in patients with DS. The presence of seizure disorder (P = 0.028), preoperative administration of prostaglandin (P = 0.028), and continuous positive airway pressure (CPAP) (P = 0.043) had significantly increased risk of PMV. We found a significantly increased incidence of sepsis (P = 0.009), delayed sternal closure (P = 0.01), feeding intolerance (P = 0.014), prolonged intensive care unit (ICU) stay (P = 0.0001), and pulmonary collapse (P = 0.001) in patients with PMV. There was no difference in the incidence of pulmonary hypertension, postoperative respiratory infection, pneumothorax, and chylothorax between children between the two groups. Conclusions: The presence of seizure disorder, preoperative usage of prostaglandin, and CPAP were significant risk factors for PMV. Incidence of sepsis, delayed sternal closure, feeding intolerance, prolonged ICU stay, and pulmonary collapse was significantly higher with PMV.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139291971","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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