Massive gastrointestinal (GI) bleed frequently presents as a pediatric emergency, which needs to be aggressively managed and thoroughly investigated. We report the case of a 9-month-old infant who presented with a massive GI bleed due to foreign body ingestion. The chest X-ray showed a hairpin lodgment in the stomach. The patient had recurrent GI bleeds leading to shock. Once stabilized, a hairpin was retrieved from his gastric rugae folds by upper GI endoscopy. Our case highlights the need of looking beyond the routine causes in cases of intractable GI bleed, especially in the pediatric age group.
{"title":"Massive upper gastrointestinal bleed masquerading as portal hypertension due to foreign body ingestion in an infant: A case report","authors":"Shaifalika Thakur, S. Kishore, Rakesh Kumar","doi":"10.4103/jpcc.jpcc_16_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_16_23","url":null,"abstract":"Massive gastrointestinal (GI) bleed frequently presents as a pediatric emergency, which needs to be aggressively managed and thoroughly investigated. We report the case of a 9-month-old infant who presented with a massive GI bleed due to foreign body ingestion. The chest X-ray showed a hairpin lodgment in the stomach. The patient had recurrent GI bleeds leading to shock. Once stabilized, a hairpin was retrieved from his gastric rugae folds by upper GI endoscopy. Our case highlights the need of looking beyond the routine causes in cases of intractable GI bleed, especially in the pediatric age group.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42377929","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":"Updates on pediatric respiratory critical care: Part I","authors":"F. Shaikh","doi":"10.4103/jpcc.jpcc_36_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_36_23","url":null,"abstract":"","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47354568","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 necrotizing encephalopathy of childhood (ANEC) is a clinico-radiological diagnosis characterized by acute onset, and progressive febrile encephalopathy preceded by viral-associated febrile illness and carries a very poor prognosis. We present a case of 9-year-old child with dengue virus-induced necrotizing encephalopathy who was managed with pulse methylprednisolone therapy followed by oral prednisolone. The rarity of ANEC in association with dengue and good neurological recovery with supportive treatment made us to report this case.
{"title":"Acute necrotizing encephalopathy of childhood as a complication of dengue infection: A case report","authors":"M. Dar, Vidushi Bhat, Surbhi Bhardwaj","doi":"10.4103/jpcc.jpcc_10_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_10_23","url":null,"abstract":"Acute necrotizing encephalopathy of childhood (ANEC) is a clinico-radiological diagnosis characterized by acute onset, and progressive febrile encephalopathy preceded by viral-associated febrile illness and carries a very poor prognosis. We present a case of 9-year-old child with dengue virus-induced necrotizing encephalopathy who was managed with pulse methylprednisolone therapy followed by oral prednisolone. The rarity of ANEC in association with dengue and good neurological recovery with supportive treatment made us to report this case.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47159506","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}
In pediatric patients with acute respiratory illnesses, the widespread availability of heated humidified high-flow nasal cannula (HHHFNC) devices, ease of use, and increased compliance have increased their use in conditions such as pneumonia, acute respiratory failure, asthma, and acute respiratory distress syndrome. Due to the patient comfort and ease of use of HHHFNC, there are widely used. Similarly, the use of NIV is increasing due to the availability of better interfaces and non-invasive ventilators (NIV) for use in infants The conundrum has been regarding the generation of positive end-expiratory pressure in these open circuits of the HHHFNC devices versus the pressures delivered by the closed circuits in the NIV devices. This article reviewed the latest literature based on the clinical conditions and the rationale for selecting respiratory support in common acute respiratory illnesses.
{"title":"How to choose between high-flow nasal cannula, continuous positive airway pressure, and bilevel positive airway pressure in children with acute respiratory illness","authors":"R. Narayanan, R. Ashwath Ram, M. Sundaram","doi":"10.4103/jpcc.jpcc_33_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_33_23","url":null,"abstract":"In pediatric patients with acute respiratory illnesses, the widespread availability of heated humidified high-flow nasal cannula (HHHFNC) devices, ease of use, and increased compliance have increased their use in conditions such as pneumonia, acute respiratory failure, asthma, and acute respiratory distress syndrome. Due to the patient comfort and ease of use of HHHFNC, there are widely used. Similarly, the use of NIV is increasing due to the availability of better interfaces and non-invasive ventilators (NIV) for use in infants The conundrum has been regarding the generation of positive end-expiratory pressure in these open circuits of the HHHFNC devices versus the pressures delivered by the closed circuits in the NIV devices. This article reviewed the latest literature based on the clinical conditions and the rationale for selecting respiratory support in common acute respiratory illnesses.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45995041","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}
Mechanical ventilation is one of the common lifesaving interventions used in the care of critically ill children admitted to the pediatric intensive care unit. However, it may induce lung inflammation that can cause or aggravates lung injury. Ventilator-induced lung injury (VILI) is defined as acute lung injury inflicted or aggravated by mechanical ventilation. In the presence of preexisting lung disease (pneumonia and acute respiratory distress syndrome), the immune system hyper-reactivity may lead to cascading lung injury due to mechanical ventilation. The possible mechanisms postulated are too high tidal volume (volutrauma), excessive pressure (barotrauma), repetitive opening and closure of alveoli (atelectotrauma), inflammation (biotrauma), oxygen toxicity, adverse heart–lung interactions, deflation-related injuries, effort-related injuries, and genetic variation in expression of inflammatory mediators. Prevention is the most important strategy for VILI by using lung-protective mechanical ventilation strategies to prevent volutrauma, barotrauma, and atelectotrauma. Low tidal volume ventilation, optimal positive end-expiratory pressure and FiO2, limiting plateau pressure, neuromuscular blockers, and prone positioning are some of the important strategies to prevent and treat VILI. VILI has the potential to cause significant morbidity, mortality, and long-term pulmonary sequelae. The clinical relevance of VILI is poorly understood in critically ill children due to lack of pediatric literature, and most of the information are derived from the adult literature. In this review, we will elucidate the epidemiology, etiopathogenesis, clinical evaluation, management, and measures to attenuate or prevent VILI.
{"title":"Ventilator-induced lung injury in children","authors":"S. Angurana, K. Sudeep, Shankar Prasad","doi":"10.4103/jpcc.jpcc_27_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_27_23","url":null,"abstract":"Mechanical ventilation is one of the common lifesaving interventions used in the care of critically ill children admitted to the pediatric intensive care unit. However, it may induce lung inflammation that can cause or aggravates lung injury. Ventilator-induced lung injury (VILI) is defined as acute lung injury inflicted or aggravated by mechanical ventilation. In the presence of preexisting lung disease (pneumonia and acute respiratory distress syndrome), the immune system hyper-reactivity may lead to cascading lung injury due to mechanical ventilation. The possible mechanisms postulated are too high tidal volume (volutrauma), excessive pressure (barotrauma), repetitive opening and closure of alveoli (atelectotrauma), inflammation (biotrauma), oxygen toxicity, adverse heart–lung interactions, deflation-related injuries, effort-related injuries, and genetic variation in expression of inflammatory mediators. Prevention is the most important strategy for VILI by using lung-protective mechanical ventilation strategies to prevent volutrauma, barotrauma, and atelectotrauma. Low tidal volume ventilation, optimal positive end-expiratory pressure and FiO2, limiting plateau pressure, neuromuscular blockers, and prone positioning are some of the important strategies to prevent and treat VILI. VILI has the potential to cause significant morbidity, mortality, and long-term pulmonary sequelae. The clinical relevance of VILI is poorly understood in critically ill children due to lack of pediatric literature, and most of the information are derived from the adult literature. In this review, we will elucidate the epidemiology, etiopathogenesis, clinical evaluation, management, and measures to attenuate or prevent VILI.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47956992","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}
Bronchiolitis and status asthmaticus are common diagnoses encountered in the pediatric intensive care unit setting with overlapping clinical manifestations that can create perplexity in treatment following hospital admission. While there are clear first-line therapies for each of these medical conditions, the use of adjunct therapies has been inconsistent and more dependent on provider preference at times. In this review, a brief introduction to the epidemiology, clinical presentation, and diagnosis allows for a review of proposed therapies to highlight the distinctions between these two entities.
{"title":"Differences and similarities in severe bronchiolitis and status asthmaticus","authors":"Alicia R. Williams, Archana V Dhar","doi":"10.4103/jpcc.jpcc_24_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_24_23","url":null,"abstract":"Bronchiolitis and status asthmaticus are common diagnoses encountered in the pediatric intensive care unit setting with overlapping clinical manifestations that can create perplexity in treatment following hospital admission. While there are clear first-line therapies for each of these medical conditions, the use of adjunct therapies has been inconsistent and more dependent on provider preference at times. In this review, a brief introduction to the epidemiology, clinical presentation, and diagnosis allows for a review of proposed therapies to highlight the distinctions between these two entities.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41395206","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}
B. Kirthiga, I. Jayakumar, R. Uppuluri, Revathi Raj
Hematopoietic stem cell transplant (HSCT) is the only potentially curative option for severe combined immunodeficiency (SCID) as they are extremely vulnerable to infections. Immunocompromised children are at a higher risk of SARS-CoV-2 infection with prolonged virus shedding, but have a milder disease unlike adults. However, mortality risk increases with neutropenia and in the early transplant period. For these reasons, HSCT is generally deferred when a patient is infected with SARS-COV-2. This decision has to be individualized taking into account the risk of disease progression with delay in transplant. We describe a case of a SCID infant, who had multiple, life-threatening infections (methicillin-resistant Staphylococcus aureus liver abscess, Escherichia coli sepsis, and disseminated Bacillus Calmette-Guerinosis) referred for HSCT. He unfortunately developed SARS-COV-2 infection after the conditioning was commenced for haploidentical stem cell transplant. Foreseeing many challenges with COVID, the transplant was undertaken in the pediatric intensive care unit (PICU) setting. Anticipation, recognition, and timely intervention in the PICU of exaggerated posttransplant cytokine release syndrome and pancreatitis enabled a successful outcome. To the best of our knowledge, this is the youngest pediatric HSCT performed to date with active SARS-COV-2 and first in India.
{"title":"Cytokine storm in HSCT for severe combined immunodeficiency infant with SARS-COV-2: PICU challenges - A case report","authors":"B. Kirthiga, I. Jayakumar, R. Uppuluri, Revathi Raj","doi":"10.4103/jpcc.jpcc_90_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_90_22","url":null,"abstract":"Hematopoietic stem cell transplant (HSCT) is the only potentially curative option for severe combined immunodeficiency (SCID) as they are extremely vulnerable to infections. Immunocompromised children are at a higher risk of SARS-CoV-2 infection with prolonged virus shedding, but have a milder disease unlike adults. However, mortality risk increases with neutropenia and in the early transplant period. For these reasons, HSCT is generally deferred when a patient is infected with SARS-COV-2. This decision has to be individualized taking into account the risk of disease progression with delay in transplant. We describe a case of a SCID infant, who had multiple, life-threatening infections (methicillin-resistant Staphylococcus aureus liver abscess, Escherichia coli sepsis, and disseminated Bacillus Calmette-Guerinosis) referred for HSCT. He unfortunately developed SARS-COV-2 infection after the conditioning was commenced for haploidentical stem cell transplant. Foreseeing many challenges with COVID, the transplant was undertaken in the pediatric intensive care unit (PICU) setting. Anticipation, recognition, and timely intervention in the PICU of exaggerated posttransplant cytokine release syndrome and pancreatitis enabled a successful outcome. To the best of our knowledge, this is the youngest pediatric HSCT performed to date with active SARS-COV-2 and first in India.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42575355","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}
L. Tiwari, M. Jayashree, A. Jindal, D. Khera, Amrita Banerjee, G. Bhatt, Shalu Gupta, N. Jerath, Meenu Singh, P. Singh
Pediatric critical care is highly sophisticated and precise and is possible only in specialized areas such as pediatric intensive care units (PICUs) or high dependency units equipped with round-the-clock monitoring facilities, skilled and trained staff, and treatment equipment. The need for critical care beds was sharply felt during the COVID-19 pandemic and the Government of India launched the COVID-19 emergency response and health system preparedness package: phase II (ECRP-II) with a hub and spoke model to strengthen pediatric critical care delivery at district level under the skilled supervision of state-level PICUs of the identified center of excellence (CoE). The CoEs will have well-equipped PICUs providing tele-ICU service, mentoring, and technical hand-holding to the district pediatric unit. This model was envisioned to be extended to critically ill children with nonCOVID illnesses after the pandemic abates. For achieving the proposed objectives under the ECRP-II scheme, this guideline aims to provide a practical framework for setting up comprehensive pediatric care units at district hospitals and medical colleges (spoke) well connected with a CoE (hub) for teleconsultation, knowledge exchange, referral, and back referral between hub and spokes.
{"title":"Practical guideline for setting up a comprehensive pediatric care unit for critical care delivery at district hospitals and medical colleges under ECRP-II","authors":"L. Tiwari, M. Jayashree, A. Jindal, D. Khera, Amrita Banerjee, G. Bhatt, Shalu Gupta, N. Jerath, Meenu Singh, P. Singh","doi":"10.4103/jpcc.jpcc_12_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_12_23","url":null,"abstract":"Pediatric critical care is highly sophisticated and precise and is possible only in specialized areas such as pediatric intensive care units (PICUs) or high dependency units equipped with round-the-clock monitoring facilities, skilled and trained staff, and treatment equipment. The need for critical care beds was sharply felt during the COVID-19 pandemic and the Government of India launched the COVID-19 emergency response and health system preparedness package: phase II (ECRP-II) with a hub and spoke model to strengthen pediatric critical care delivery at district level under the skilled supervision of state-level PICUs of the identified center of excellence (CoE). The CoEs will have well-equipped PICUs providing tele-ICU service, mentoring, and technical hand-holding to the district pediatric unit. This model was envisioned to be extended to critically ill children with nonCOVID illnesses after the pandemic abates. For achieving the proposed objectives under the ECRP-II scheme, this guideline aims to provide a practical framework for setting up comprehensive pediatric care units at district hospitals and medical colleges (spoke) well connected with a CoE (hub) for teleconsultation, knowledge exchange, referral, and back referral between hub and spokes.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49251723","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}
Shreeshail V. Benakanal, G. Manoj, K. Vikas, B. Manjula
Necrotizing pneumonia (NP) is a rare and severe complication of bacterial community-acquired pneumonia associated with high morbidity and mortality rate. We present a case series admitted in the pediatric intensive care unit (PICU) of our tertiary care hospital for 6 months. Five cases (positive blood culture) were selected based on the features of pneumonia with moderate-to-severe respiratory distress at admission. All cases are treated with antibiotics (piperacillin/tazobactam and vancomycin) as per blood culture and sensitivity results and oxygen therapy by high-flow nasal cannula/mechanical ventilation based on the decision of the treating physicians. Intercostal drainage tube was inserted for all empyema/pneumothorax cases. Decortication was done in two cases. Out of five cases, three cases were recovered after prolonged treatment in PICU and two cases succumbed to death in the 2nd week of hospitalization. Treatment of necrotizing pneumonia should be initiated early with broad-spectrum antibiotics along with staphylococcal cover till culture reports are awaited.
{"title":"Necrotizing pneumonia in pediatric intensive care unit: A case series","authors":"Shreeshail V. Benakanal, G. Manoj, K. Vikas, B. Manjula","doi":"10.4103/jpcc.jpcc_92_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_92_22","url":null,"abstract":"Necrotizing pneumonia (NP) is a rare and severe complication of bacterial community-acquired pneumonia associated with high morbidity and mortality rate. We present a case series admitted in the pediatric intensive care unit (PICU) of our tertiary care hospital for 6 months. Five cases (positive blood culture) were selected based on the features of pneumonia with moderate-to-severe respiratory distress at admission. All cases are treated with antibiotics (piperacillin/tazobactam and vancomycin) as per blood culture and sensitivity results and oxygen therapy by high-flow nasal cannula/mechanical ventilation based on the decision of the treating physicians. Intercostal drainage tube was inserted for all empyema/pneumothorax cases. Decortication was done in two cases. Out of five cases, three cases were recovered after prolonged treatment in PICU and two cases succumbed to death in the 2nd week of hospitalization. Treatment of necrotizing pneumonia should be initiated early with broad-spectrum antibiotics along with staphylococcal cover till culture reports are awaited.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42770172","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":"Fluid prescription: It is time to act","authors":"Mullai Baalaaji","doi":"10.4103/jpcc.jpcc_1_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_1_23","url":null,"abstract":"","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46641361","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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