K. Harish, Garima Gupta, Deepak Kumar, H. Pemde, Snehanshu Roychoudhari
Background: Maintenance intravenous fluids (IVFs) play a key role in patient management. However, the type of fluids that has to be used should be prudently selected. Past surveys depict the tendency of residents to prescribe hypotonic fluids, following the traditional practice. The increased incidence of hyponatremia has been reported with the use of hypotonic fluids. The study was conducted to investigate the composition and volume of maintenance IVFs prescribed by pediatricians in various clinical settings. Subjects and Methods: A predesigned questionnaire was generated online and distributed via E-mail to pediatricians from teaching institutes, general hospitals, and private clinics. Different clinical scenarios were created, and respondents were asked the composition and volume of IVFs to be prescribed. Results: A total of 438 responses were analyzed. Hypotonic fluids for maintenance therapy were selected by 47% of respondents irrespective of patient's age and clinical condition, whereas 83% opted for hypotonic fluids for infants <2 months, and half of them prescribed very hypotonic fluids in these infants. Isotonic fluids were considered significant in central nervous system infections, head trauma, and as an initial fluid for the management of shock. Variability is evident for the preference of hypotonic versus isotonic fluids and is affected by the clinical position, experience, and workplace of the respondents. Conclusions: The outcome of this survey portrays that the participants are not well aware of the fluid management protocols for children. Formulation of universal guidelines and their implementation is required as the priority to overcome this uncertainty to provide the best care to pediatric patients.
{"title":"Prescription practices related to maintenance intravenous fluid in children: A cross sectional, electronic media based survey","authors":"K. Harish, Garima Gupta, Deepak Kumar, H. Pemde, Snehanshu Roychoudhari","doi":"10.4103/jpcc.jpcc_79_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_79_22","url":null,"abstract":"Background: Maintenance intravenous fluids (IVFs) play a key role in patient management. However, the type of fluids that has to be used should be prudently selected. Past surveys depict the tendency of residents to prescribe hypotonic fluids, following the traditional practice. The increased incidence of hyponatremia has been reported with the use of hypotonic fluids. The study was conducted to investigate the composition and volume of maintenance IVFs prescribed by pediatricians in various clinical settings. Subjects and Methods: A predesigned questionnaire was generated online and distributed via E-mail to pediatricians from teaching institutes, general hospitals, and private clinics. Different clinical scenarios were created, and respondents were asked the composition and volume of IVFs to be prescribed. Results: A total of 438 responses were analyzed. Hypotonic fluids for maintenance therapy were selected by 47% of respondents irrespective of patient's age and clinical condition, whereas 83% opted for hypotonic fluids for infants <2 months, and half of them prescribed very hypotonic fluids in these infants. Isotonic fluids were considered significant in central nervous system infections, head trauma, and as an initial fluid for the management of shock. Variability is evident for the preference of hypotonic versus isotonic fluids and is affected by the clinical position, experience, and workplace of the respondents. Conclusions: The outcome of this survey portrays that the participants are not well aware of the fluid management protocols for children. Formulation of universal guidelines and their implementation is required as the priority to overcome this uncertainty to provide the best care to pediatric patients.","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":"44528013","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":"Phenotyping the multisystem inflammatory syndrome in children","authors":"M. Sundaram, Grace Leeuwen","doi":"10.4103/jpcc.jpcc_11_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_11_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":"47486612","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}
Introduction: Multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 caused significant health concerns worldwide. In our center, we had encountered the first wave of MIS-C from June 2020 to January 2021, whereas the second wave surged up from April 2021 to August 2021. In this study, we have done a comparative analysis of different phenotypes of MIS-C seen during these two waves. Subjects and Methods: This was a single-center observational study where the children fulfilled the WHO criteria for MIS-C were included in the study. Clinical and laboratory findings, course of the illness, treatment, and outcome were noted down, and the patients were followed up. Depending on the presentations, cases were classified in four different phenotypes (Type 1: MIS-C overlapping with acute COVID-19, Type 2: MIS-C with shock/MIS-C with multiple organ dysfunction syndrome (MODS), Type 3: MIS-C Kawasaki disease phenotype, Type 4: Mild MIS-C/Febrile inflammatory state), and a comparative analysis of these phenotypes in the two waves was done. Results: There were 86 cases in 7 months during the first wave, whereas 102 cases in 5-month duration during the second wave. The clinical manifestations and laboratory findings were compared, type 2 phenotypes increased in proportion requiring more pediatric intensive care unit admissions. Mortality was seen during the 2nd wave which was absent in our cohort during the first wave. Conclusions: MIS-C typically showed a spectrum of disease manifestations starting from a mild febrile inflammatory state to full-blown MODS. Early phenotypic differentiation and targeted immunomodulatory therapy depending on the phenotype had shown to be useful.
{"title":"A single-center experience from Eastern India depicting the epidemiology and phenotypic variations of Multisystem inflammatory syndrome in children (MISC) associated with SARS-CoV2 seen after first wave and second wave of COVID 19","authors":"Mimi Ganguly, P. Giri, S. Basu","doi":"10.4103/jpcc.jpcc_99_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_99_22","url":null,"abstract":"Introduction: Multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 caused significant health concerns worldwide. In our center, we had encountered the first wave of MIS-C from June 2020 to January 2021, whereas the second wave surged up from April 2021 to August 2021. In this study, we have done a comparative analysis of different phenotypes of MIS-C seen during these two waves. Subjects and Methods: This was a single-center observational study where the children fulfilled the WHO criteria for MIS-C were included in the study. Clinical and laboratory findings, course of the illness, treatment, and outcome were noted down, and the patients were followed up. Depending on the presentations, cases were classified in four different phenotypes (Type 1: MIS-C overlapping with acute COVID-19, Type 2: MIS-C with shock/MIS-C with multiple organ dysfunction syndrome (MODS), Type 3: MIS-C Kawasaki disease phenotype, Type 4: Mild MIS-C/Febrile inflammatory state), and a comparative analysis of these phenotypes in the two waves was done. Results: There were 86 cases in 7 months during the first wave, whereas 102 cases in 5-month duration during the second wave. The clinical manifestations and laboratory findings were compared, type 2 phenotypes increased in proportion requiring more pediatric intensive care unit admissions. Mortality was seen during the 2nd wave which was absent in our cohort during the first wave. Conclusions: MIS-C typically showed a spectrum of disease manifestations starting from a mild febrile inflammatory state to full-blown MODS. Early phenotypic differentiation and targeted immunomodulatory therapy depending on the phenotype had shown to be useful.","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":"48650630","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}
Aluminum phosphide (ALP) poisoning is one of the most common and lethal poisonings with no antidote available till now. Inhalation or ingestion of ALP leads to the production of phosphine gas when exposed to moisture. We here report an adolescent female with alleged consumption of ALP available as celphos tablet, followed by severe metabolic acidosis and cardiogenic shock. Rapid timely initiation of venoarterial extracorporeal membrane oxygenation leads to intact neurological outcome and survival. Timely referral to higher center with extracorporeal life support facility is a key.
{"title":"Venoarterial extracorporeal membrane oxygenation in aluminum phosphide poisoning: A case report","authors":"Ravi Sharma, Shivani Mukherjee, Kanupriya Chaturvedi, Nitasha Sharma, Lakshmi Khoj, RajivKumar Bansal","doi":"10.4103/jpcc.jpcc_101_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_101_22","url":null,"abstract":"Aluminum phosphide (ALP) poisoning is one of the most common and lethal poisonings with no antidote available till now. Inhalation or ingestion of ALP leads to the production of phosphine gas when exposed to moisture. We here report an adolescent female with alleged consumption of ALP available as celphos tablet, followed by severe metabolic acidosis and cardiogenic shock. Rapid timely initiation of venoarterial extracorporeal membrane oxygenation leads to intact neurological outcome and survival. Timely referral to higher center with extracorporeal life support facility is a key.","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":"43019958","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}
Rahul Gupta, R. Chaudhary, A. Mathur, K. Mangal, A. Shukla, A. Bhandari, R. Jain, Kapil Garg
The occurrence of necrotizing fasciitis in children with acute lymphoblastic leukemia (ALL) has been reported with malignancies during granulocytopenic episodes from chemotherapy. Perforation of Meckel's diverticulum in children with leukemia is very rare. Only one case has been reported in the literature till now. A 10-year-old male presented with acute abdomen and was diagnosed with perforation peritonitis due to a perforated Meckel diverticulum receiving chemotherapy for relapse of B-cell ALL. In addition, the patient was a known case of celiac disease. Intraoperatively, due to the hemodynamic instability and thrombocytopenia, it was decided to perform a resection of the ileum bearing the pathology with a double-barrel ileostomy. He developed necrotizing fasciitis of the anterior abdominal wall due to Group A streptococci and overwhelming Gram-positive sepsis. The patient was managed comprehensively with multiple platelets concentrates, fasciotomy of the abdominal wall, and multiple debridements under the cover of broad-spectrum antibiotics. Histopathology of the resected Meckel's diverticulum showed ectopic gastric mucosa. Two months later, split-thickness skin grafting was performed. Early diagnosis and prompt surgical management may prevent mortality associated with both the delayed presentation of bowel perforation and necrotizing fasciitis in ALL patients.
{"title":"Necrotizing fasciitis complicating perforated Meckel's diverticulum in a patient with acute lymphoblastic leukemia relapse: A case report","authors":"Rahul Gupta, R. Chaudhary, A. Mathur, K. Mangal, A. Shukla, A. Bhandari, R. Jain, Kapil Garg","doi":"10.4103/jpcc.jpcc_87_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_87_22","url":null,"abstract":"The occurrence of necrotizing fasciitis in children with acute lymphoblastic leukemia (ALL) has been reported with malignancies during granulocytopenic episodes from chemotherapy. Perforation of Meckel's diverticulum in children with leukemia is very rare. Only one case has been reported in the literature till now. A 10-year-old male presented with acute abdomen and was diagnosed with perforation peritonitis due to a perforated Meckel diverticulum receiving chemotherapy for relapse of B-cell ALL. In addition, the patient was a known case of celiac disease. Intraoperatively, due to the hemodynamic instability and thrombocytopenia, it was decided to perform a resection of the ileum bearing the pathology with a double-barrel ileostomy. He developed necrotizing fasciitis of the anterior abdominal wall due to Group A streptococci and overwhelming Gram-positive sepsis. The patient was managed comprehensively with multiple platelets concentrates, fasciotomy of the abdominal wall, and multiple debridements under the cover of broad-spectrum antibiotics. Histopathology of the resected Meckel's diverticulum showed ectopic gastric mucosa. Two months later, split-thickness skin grafting was performed. Early diagnosis and prompt surgical management may prevent mortality associated with both the delayed presentation of bowel perforation and necrotizing fasciitis in ALL patients.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41954041","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":"Quantification of microcirculatory failure: Is it far from reality?","authors":"S. Angurana, Sittal Thapa","doi":"10.4103/jpcc.jpcc_94_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_94_22","url":null,"abstract":"","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45352187","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}
Bhavana Kayarat, Shreyas Gutte, Souravi Pal, B. Poddar, A. Azim, M. Gurjar
The incidence of massive intravascular hemolysis causing pancreatitis is 25%; however, it is an often missed entity. Proinflammatory and immunoregulatory cytokines during hemolysis along with heme-induced neutrophil activation, chemoattraction, and disturbance in microcirculation are suggested as causative factors. We describe a case of glucose-6-phosphate dehydrogenase deficiency in a child which was latent through his childhood, triggering a hemolytic episode induced by Leptospira infection. In a patient with acute hemolysis, presenting with severe epigastric pain, one should therefore be aware of the possibility of the occurrence of pancreatitis.
{"title":"Acute pancreatitis due to massive hemolysis in a child with glucose-6-phosphate dehydrogenase deficiency: A case Report","authors":"Bhavana Kayarat, Shreyas Gutte, Souravi Pal, B. Poddar, A. Azim, M. Gurjar","doi":"10.4103/jpcc.jpcc_76_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_76_22","url":null,"abstract":"The incidence of massive intravascular hemolysis causing pancreatitis is 25%; however, it is an often missed entity. Proinflammatory and immunoregulatory cytokines during hemolysis along with heme-induced neutrophil activation, chemoattraction, and disturbance in microcirculation are suggested as causative factors. We describe a case of glucose-6-phosphate dehydrogenase deficiency in a child which was latent through his childhood, triggering a hemolytic episode induced by Leptospira infection. In a patient with acute hemolysis, presenting with severe epigastric pain, one should therefore be aware of the possibility of the occurrence of pancreatitis.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47225499","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}
Background: The Pediatric Sequential Organ Failure Assessment (pSOFA) score is a scoring system used to assess the severity of organ dysfunction in critically ill children. The aim of this study was to evaluate the effectiveness of the pSOFA lactate (pSOFA-L) score in predicting the clinical outcome of critically ill children. Subjects and Methods: This hospital-based, prospective, observational study was conducted in the pediatric intensive care unit of medical college from North India. A total of 100 children were included. Parameters pertaining to the various organ systems as designated in the pSOFA-L score were studied and compared the score with the clinical outcome. Results: In this study, there were 56 survivors and 44 nonsurvivors. On receiver operating characteristics curve analysis, the cutoff value of the pSOFA-L score in predicting mortality was 10 with a sensitivity of 81.8% and specificity of 85.7% and area under the curve: 0.882, which is statistically significant (P < 0.001). In the present study, the mortality rate was 11.3%, 18.2%, and 70.5% in children with pSOFA-L score <9, 9–11, and >11, respectively. On bivariate analysis of the survivor and nonsurvivor group, nonsurvivors had a significantly higher pSOFA-L score (P = 0.000). The mean lactate level was significantly higher among nonsurvivor group (3.02 ± 1.59 vs. 1.75 ± 1.19, P = 0.000). Conclusions: pSOFA-L score is accurate in predicting mortality, with a higher score indicating a poor outcome. The study also found a significant relationship between serum lactate levels and the pSOFA-L score, with higher lactate levels indicating a poor prognosis.
{"title":"The role of pediatric sequential organ failure assessment lactate score in predicting the clinical outcome of critically ill children: A single-center, prospective, observational study","authors":"Nitika Maheshwari, Neha Agarwal","doi":"10.4103/jpcc.jpcc_17_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_17_23","url":null,"abstract":"Background: The Pediatric Sequential Organ Failure Assessment (pSOFA) score is a scoring system used to assess the severity of organ dysfunction in critically ill children. The aim of this study was to evaluate the effectiveness of the pSOFA lactate (pSOFA-L) score in predicting the clinical outcome of critically ill children. Subjects and Methods: This hospital-based, prospective, observational study was conducted in the pediatric intensive care unit of medical college from North India. A total of 100 children were included. Parameters pertaining to the various organ systems as designated in the pSOFA-L score were studied and compared the score with the clinical outcome. Results: In this study, there were 56 survivors and 44 nonsurvivors. On receiver operating characteristics curve analysis, the cutoff value of the pSOFA-L score in predicting mortality was 10 with a sensitivity of 81.8% and specificity of 85.7% and area under the curve: 0.882, which is statistically significant (P < 0.001). In the present study, the mortality rate was 11.3%, 18.2%, and 70.5% in children with pSOFA-L score <9, 9–11, and >11, respectively. On bivariate analysis of the survivor and nonsurvivor group, nonsurvivors had a significantly higher pSOFA-L score (P = 0.000). The mean lactate level was significantly higher among nonsurvivor group (3.02 ± 1.59 vs. 1.75 ± 1.19, P = 0.000). Conclusions: pSOFA-L score is accurate in predicting mortality, with a higher score indicating a poor outcome. The study also found a significant relationship between serum lactate levels and the pSOFA-L score, with higher lactate levels indicating a poor prognosis.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135749292","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}
Background: Many cases of multisystem inflammatory syndrome in children (MIS-C) are reported in post-COVID-19 cases. It is a serious complication of COVID-19, with a high mortality rate in low-income countries compared to high-income countries. This study was conducted to find out predictors of mortality in MIS-C. Subjects and Methods: In this prospective observational study, 81 children with MIS-C were enrolled. Detailed clinical features, laboratory parameters, treatment, and outcome of cases were recorded. After the determination of individual factors associated with mortality by univariate analysis, a binary logistic regression model of significant factors associated with mortality was developed. Results: Fever, breathlessness, conjunctivitis, and pain abdomen were major presenting complaints at admission. Fifty-seven (70.3%) were presented with shock, of which 31 (54.4%) had normotensive shock and 26 (45.6%) had hypotensive shock. There were 8 (9.8%) deaths in the study group. Association of pneumonia, acute respiratory distress syndrome, and acute kidney injury were significantly high among nonsurvivors. Levels of lactate dehydrogenase (LDH), interleukin-6, and prothrombin time (international normalized ratio) were significantly higher in nonsurvivors than survivors. On binary logistic regression, raised LDH and the use of a mechanical ventilator were found to be independent predictors of death (P < 0.05). Conclusions: Shock was the predominant manifestation in children with MIS-C. Raised LDH and the use of mechanical ventilators were found to be independent predictors of death in cases of MIS-C.
{"title":"Predictors of mortality with multisystem inflammatory syndrome in children (MIS-C): A single centre prospective observational study from Eastern India","authors":"NirmalKumar Mohakud, BijayKumar Meher, Isha Panda, JyotiPrakash Sahoo, Geetachand Acharya, Martina Mohanty, Sarthak Naik, PradeepKumar Jena","doi":"10.4103/jpcc.jpcc_22_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_22_23","url":null,"abstract":"Background: Many cases of multisystem inflammatory syndrome in children (MIS-C) are reported in post-COVID-19 cases. It is a serious complication of COVID-19, with a high mortality rate in low-income countries compared to high-income countries. This study was conducted to find out predictors of mortality in MIS-C. Subjects and Methods: In this prospective observational study, 81 children with MIS-C were enrolled. Detailed clinical features, laboratory parameters, treatment, and outcome of cases were recorded. After the determination of individual factors associated with mortality by univariate analysis, a binary logistic regression model of significant factors associated with mortality was developed. Results: Fever, breathlessness, conjunctivitis, and pain abdomen were major presenting complaints at admission. Fifty-seven (70.3%) were presented with shock, of which 31 (54.4%) had normotensive shock and 26 (45.6%) had hypotensive shock. There were 8 (9.8%) deaths in the study group. Association of pneumonia, acute respiratory distress syndrome, and acute kidney injury were significantly high among nonsurvivors. Levels of lactate dehydrogenase (LDH), interleukin-6, and prothrombin time (international normalized ratio) were significantly higher in nonsurvivors than survivors. On binary logistic regression, raised LDH and the use of a mechanical ventilator were found to be independent predictors of death (P < 0.05). Conclusions: Shock was the predominant manifestation in children with MIS-C. Raised LDH and the use of mechanical ventilators were found to be independent predictors of death in cases of MIS-C.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135748917","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}
Background: The aim of the study was to evaluate the utility of lactate, central venous oxygen saturation (ScvO2), and the difference in venous and arterial CO2 partial pressures (delta pCO2) levels and their relationship with the prognosis of critically ill children with circulatory failure in the pediatric intensive care unit (PICU). Subjects and Methods: Thirty children with circulatory failure who were admitted to the PICU of a tertiary university hospital between January 15 and November 1, 2020, were evaluated in this prospective observational study. Lactate levels, ScVO2, and delta pCO2 levels were evaluated on admission and at hours 4, 12, and 24 (T0, T4, T12, T24) in the PICU. Results: The mortality of the children with circulatory failure was 30% (n = 9). Arterial and venous lactate levels were highly correlated at T0, T4, T12, T24 (P < 0.001; P < 0.001; P < 0.001; P < 0.001, respectively). Nonsurvivors had always higher arterial lactate levels (T0, T4, T12, T24) (P = 0.019, P = 0.007, P = 0.002, P = 0.0003, respectively) and higher delta pCO2 at T0 (P = 0.039) when compared with survivors. Receiver operating characteristic analysis showed that T0 arterial lactate levels (area under the curve [AUC] 0.788, P = 0.019), T24 arterial lactate (AUC 0.918, P < 0,001), and T0 delta pCO2 levels (AUC 0,741, P = 0.039) and were predictive of mortality. Conclusions: Lactate remains the most important marker of microcirculatory dysfunction in critically ill children with circulatory failure. Delta pCO2 may be an additional marker of microcirculatory dysfunction in critically ill children.
{"title":"Utility of lactate, central venous oxygen saturation, and the difference in venous and arterial CO2 partial pressures (delta pCO2) levels in quantifying microcirculatory failure: A single-center prospective observational study","authors":"Emrullah Ayguler, G. Gençay, D. Demirkol","doi":"10.4103/jpcc.jpcc_28_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_28_22","url":null,"abstract":"Background: The aim of the study was to evaluate the utility of lactate, central venous oxygen saturation (ScvO2), and the difference in venous and arterial CO2 partial pressures (delta pCO2) levels and their relationship with the prognosis of critically ill children with circulatory failure in the pediatric intensive care unit (PICU). Subjects and Methods: Thirty children with circulatory failure who were admitted to the PICU of a tertiary university hospital between January 15 and November 1, 2020, were evaluated in this prospective observational study. Lactate levels, ScVO2, and delta pCO2 levels were evaluated on admission and at hours 4, 12, and 24 (T0, T4, T12, T24) in the PICU. Results: The mortality of the children with circulatory failure was 30% (n = 9). Arterial and venous lactate levels were highly correlated at T0, T4, T12, T24 (P < 0.001; P < 0.001; P < 0.001; P < 0.001, respectively). Nonsurvivors had always higher arterial lactate levels (T0, T4, T12, T24) (P = 0.019, P = 0.007, P = 0.002, P = 0.0003, respectively) and higher delta pCO2 at T0 (P = 0.039) when compared with survivors. Receiver operating characteristic analysis showed that T0 arterial lactate levels (area under the curve [AUC] 0.788, P = 0.019), T24 arterial lactate (AUC 0.918, P < 0,001), and T0 delta pCO2 levels (AUC 0,741, P = 0.039) and were predictive of mortality. Conclusions: Lactate remains the most important marker of microcirculatory dysfunction in critically ill children with circulatory failure. Delta pCO2 may be an additional marker of microcirculatory dysfunction in critically ill children.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43606891","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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