{"title":"Pediatric tracheostomy – From a rare procedure to an elective procedure","authors":"P. Sharma","doi":"10.4103/jpcc.jpcc_95_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_95_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":"42053178","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}
Accidental poisoning with household products is one of the leading causes of involuntary injuries among children in low- and middle-income countries. Podophyllin poisoning is a rare and potentially fatal occurrence. The podophyllotoxin is a lipid-soluble cytotoxic compound with no antidote and its toxicity includes life-threatening neurological and multisystem complications. We report a case of a 2-year-old girl with accidental podophyllin poisoning causing multi-organ dysfunction who did not survive despite timely aggressive support and explore the possibility of early use of activated charcoal and role of extra-corporeal therapies such as hemoperfusion as a life-saving measure in such situations.
{"title":"Fatal podophyllin poisoning with multi-organ toxicity: A case report","authors":"BhaktiU Sarangi, Shridhar Jadhav, Ajay Walimbe, Manikiran Reddy, Siddhi Gawhale, RHema Priya","doi":"10.4103/jpcc.jpcc_47_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_47_23","url":null,"abstract":"Accidental poisoning with household products is one of the leading causes of involuntary injuries among children in low- and middle-income countries. Podophyllin poisoning is a rare and potentially fatal occurrence. The podophyllotoxin is a lipid-soluble cytotoxic compound with no antidote and its toxicity includes life-threatening neurological and multisystem complications. We report a case of a 2-year-old girl with accidental podophyllin poisoning causing multi-organ dysfunction who did not survive despite timely aggressive support and explore the possibility of early use of activated charcoal and role of extra-corporeal therapies such as hemoperfusion as a life-saving measure in such situations.","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":"135750691","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}
Qalab Abbas, Awais Abbas, FarisAbdul Aziz, NaveedUr Rehman Siddiqui, Yasmin Hashwani, Iraj Khan, AniqaAbdul Rasool, Anwar Ul Haque
Background: Patients admitted to critical care need timely interventions after evaluating all clinical parameters. This study aims to assess the impact of the comprehensive rounding checklist on physician compliance and patient-related outcomes in a multidisciplinary pediatric intensive care unit (PICU). Subjects and Methods: This prospective observational study was conducted in two phases over period of 2 months at multidisciplinary PICU from Pakistan. A structured rounding checklist of 35 components encompassing patient care was introduced and implemented in the PICU. During the preimplementation phase, a nurse took notes of relevant patient clinical details missed by the physician during the round, included them in the rounding checklist. And during the implementation phase, the nurse actively intervened when a physician did not discuss a particular component during the round. All components discussed were check marked. Results: The checklist was completed for 812 rounds (162 patients) in preimplementation and 2348 rounds (590 patients) in the postimplementation phase. Most frequently missed components in the preimplementation phase were checking for surgical site infection (8.9%), discharge plan (7.5%), deep vein thrombosis (DVT) prophylaxis (7.3%), and ventilator-associated pneumonia bundles (7.0%). Whereas, during the postimplementation phase, resident teaching (8.0%), discharge plan (7.2%), and DVT prophylaxis (6.5%) were most frequently missed. Hospital length of stay decreased from 4.5 ± 3.7 to 4.1 ± 2.9 days (P = 0.05), and overall mortality decreased from 19% to 11.4% (P < 0.05). Conclusions: Introducing the checklist with a prompter, improved physician compliance and patient-related outcomes in our PICU.
{"title":"Impact of introduction of a rounding checklist in a pediatric intensive care unit of a developing country: A quality improvement project","authors":"Qalab Abbas, Awais Abbas, FarisAbdul Aziz, NaveedUr Rehman Siddiqui, Yasmin Hashwani, Iraj Khan, AniqaAbdul Rasool, Anwar Ul Haque","doi":"10.4103/jpcc.jpcc_67_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_67_23","url":null,"abstract":"Background: Patients admitted to critical care need timely interventions after evaluating all clinical parameters. This study aims to assess the impact of the comprehensive rounding checklist on physician compliance and patient-related outcomes in a multidisciplinary pediatric intensive care unit (PICU). Subjects and Methods: This prospective observational study was conducted in two phases over period of 2 months at multidisciplinary PICU from Pakistan. A structured rounding checklist of 35 components encompassing patient care was introduced and implemented in the PICU. During the preimplementation phase, a nurse took notes of relevant patient clinical details missed by the physician during the round, included them in the rounding checklist. And during the implementation phase, the nurse actively intervened when a physician did not discuss a particular component during the round. All components discussed were check marked. Results: The checklist was completed for 812 rounds (162 patients) in preimplementation and 2348 rounds (590 patients) in the postimplementation phase. Most frequently missed components in the preimplementation phase were checking for surgical site infection (8.9%), discharge plan (7.5%), deep vein thrombosis (DVT) prophylaxis (7.3%), and ventilator-associated pneumonia bundles (7.0%). Whereas, during the postimplementation phase, resident teaching (8.0%), discharge plan (7.2%), and DVT prophylaxis (6.5%) were most frequently missed. Hospital length of stay decreased from 4.5 ± 3.7 to 4.1 ± 2.9 days (P = 0.05), and overall mortality decreased from 19% to 11.4% (P < 0.05). Conclusions: Introducing the checklist with a prompter, improved physician compliance and patient-related outcomes in our PICU.","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":"135750979","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}
Muhammad Shahzad, YasserAbdulrhman Alheraish, ReemMohamed Beheri, Khaled Alarwan
Congenital heart defects (CHDs), the most common major birth defects, undergo effective surgical care in the last decade, enhancing survival. After heart surgery, mechanical, infectious, and noninfectious causes induce pediatric pulmonary problems. Necrotizing enterocolitis and feeding intolerance are frequent digestive issues. Diuretics relieve fluid excess, but early dialysis may help in cardiac intensive care unit (CICU) patients. Cumulative insulin dosages improve postoperative hyperglycemia. Noncardiac organ system problems are common in current pediatric cardiac intensive care units including seizures needing anti-epileptics. While, managing the patients in CICU, one must consider noncardiac organ system integrity and function.
{"title":"Integrated care in cardiac intensive care unit for noncardiovascular complications in children after open-heart surgery: A comprehensive review","authors":"Muhammad Shahzad, YasserAbdulrhman Alheraish, ReemMohamed Beheri, Khaled Alarwan","doi":"10.4103/jpcc.jpcc_58_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_58_23","url":null,"abstract":"Congenital heart defects (CHDs), the most common major birth defects, undergo effective surgical care in the last decade, enhancing survival. After heart surgery, mechanical, infectious, and noninfectious causes induce pediatric pulmonary problems. Necrotizing enterocolitis and feeding intolerance are frequent digestive issues. Diuretics relieve fluid excess, but early dialysis may help in cardiac intensive care unit (CICU) patients. Cumulative insulin dosages improve postoperative hyperglycemia. Noncardiac organ system problems are common in current pediatric cardiac intensive care units including seizures needing anti-epileptics. While, managing the patients in CICU, one must consider noncardiac organ system integrity and function.","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":"135751001","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}
Coronavirus disease 2019 (COVID-19) infection in children predominantly presents with milder symptoms and is apparently less severe. However, 2% of acute pediatric COVID-19 cases possessed severe manifestations. Here, we describe a case study of a 4-year-old boy suffering from acute COVID-19 infection that presented like an adult ARDS requiring prolonged ventilation and medical course complicated with hospital-acquired infection and thrombosis which is very rarely seen. After 45 days of mechanical ventilation, the child was successfully weaned off from ventilatory support. Notably, analysis of the current literature revealed that this represents the longest reported hospitalization and ventilation period for a child presenting with COVID-19 pneumonia with potential complications. It highlights the importance of allowing sufficient time for clinical interventions to take effect, even when the prognosis appears poor. Hence, treating physicians should be aware of this atypical presentation.
{"title":"Coronavirus disease 2019 pneumonia with acute respiratory distress syndrome in a child requiring prolonged mechanical ventilation: A case report","authors":"Sagar Lad, Shraddha Sunthwal, Sanjay Bafna, Rajesh Kulkarni, Preeti Lad, Salma Ahmadi, Raj Ganacharya","doi":"10.4103/jpcc.jpcc_59_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_59_23","url":null,"abstract":"Coronavirus disease 2019 (COVID-19) infection in children predominantly presents with milder symptoms and is apparently less severe. However, 2% of acute pediatric COVID-19 cases possessed severe manifestations. Here, we describe a case study of a 4-year-old boy suffering from acute COVID-19 infection that presented like an adult ARDS requiring prolonged ventilation and medical course complicated with hospital-acquired infection and thrombosis which is very rarely seen. After 45 days of mechanical ventilation, the child was successfully weaned off from ventilatory support. Notably, analysis of the current literature revealed that this represents the longest reported hospitalization and ventilation period for a child presenting with COVID-19 pneumonia with potential complications. It highlights the importance of allowing sufficient time for clinical interventions to take effect, even when the prognosis appears poor. Hence, treating physicians should be aware of this atypical presentation.","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":"135748731","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}
Hemophagocytic lymphohistiocytosis (HLH) is a rare, potentially lethal condition characterized by the activation of macrophages, natural killer cells, and T-cells, leading to a dysregulated immune response. Genetic mutations cause primary HLH; infections, tumors, or autoimmunity can trigger secondary HLH. Dengue infections can rarely be complicated by secondary HLH, which is a potential cause of mortality apart from shock or hemorrhage. A high index of suspicion is needed as clinical features are nonspecific and overlap with dengue. We report three children with dengue infection complicated by secondary HLH. All three children recovered with timely management.
{"title":"Secondary hemophagocytic lymphohistiocytosis in children with dengue: A case series","authors":"Nirosha Ponnuraj, Manoj Kumar, Saravanan Muthuarumugam, Reghupathy Panneerselvam","doi":"10.4103/jpcc.jpcc_45_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_45_23","url":null,"abstract":"Hemophagocytic lymphohistiocytosis (HLH) is a rare, potentially lethal condition characterized by the activation of macrophages, natural killer cells, and T-cells, leading to a dysregulated immune response. Genetic mutations cause primary HLH; infections, tumors, or autoimmunity can trigger secondary HLH. Dengue infections can rarely be complicated by secondary HLH, which is a potential cause of mortality apart from shock or hemorrhage. A high index of suspicion is needed as clinical features are nonspecific and overlap with dengue. We report three children with dengue infection complicated by secondary HLH. All three children recovered with timely management.","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":"135750981","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}
Myxedema crisis is a condition with high mortality. It affects adults more often than children. Patients present with low blood pressure, low pulse, low body temperature, hypoventilation, and gastrointestinal dysfunction. Here, we present a case report of a teenage girl who was diagnosed with acquired hypothyroidism at the age of 7 years and was effectively treated with oral thyroxine in myxedema crisis.
{"title":"Myxedema crisis in an adolescent girl, successfully treated by oral thyroxine: A case report","authors":"Krutika Tandon, Rahul Tandon, Amit Kumar, Shradha Patel, Sandip Mori, Fenil Thakkar","doi":"10.4103/jpcc.jpcc_40_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_40_23","url":null,"abstract":"Myxedema crisis is a condition with high mortality. It affects adults more often than children. Patients present with low blood pressure, low pulse, low body temperature, hypoventilation, and gastrointestinal dysfunction. Here, we present a case report of a teenage girl who was diagnosed with acquired hypothyroidism at the age of 7 years and was effectively treated with oral thyroxine in myxedema crisis.","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":"135750967","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":"Sedation in critically ill mechanically ventilated children: Common though contentious","authors":"Vijai William, S. Angurana","doi":"10.4103/jpcc.jpcc_91_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_91_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":"45991146","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}
P. Kumar, Abhilasha Somashekhar, G. Basavaraja, K. Sanjay, A. Fathima, Praveen Baskar
Background: Advances in neonatal and pediatric intensive care have increased the number of children who survive with disabilities. The management of the tracheostomized child is a complex and demanding assignment as they have higher rates of complications. Ideally, the decannulation process should proceed once the child no longer requires mechanical ventilation and the underlying pathology has resolved or been reversed. This study highlights our experience in managing pediatric tracheostomy decannulation at a tertiary care center. Subjects and Methods: This was a single-center, prospective study conducted at the tertiary care pediatric hospital for a period of 1 year. Children with tracheostomy in situ who got admitted for laryngotracheobronchoscopy and decannulation were included. Results: Indication of tracheostomy was broadly divided into reasons causing upper airway obstruction and those requiring prolonged intubation. It showed that 82% were due to prolonged intubation, in which 85.3% were due to neurological reasons. The success rate for decannulation was 97%. Age of child, duration of intubation, posttracheostomy period, and type of tracheostomy tube had no significant correlation with outcome of tracheostomy decannulation. Conclusions: Resolution of primary indication for tracheostomy is required before planning of tracheotomy decannulation. Bronchoscopic airway evaluation and decannulation trial in operation theater is needed for successful decannulation. There was no impact of age, duration of intubation, posttracheostomy period, and type of tracheostomy tube on the outcome of tracheostomy decannulation.
{"title":"Pediatric tracheostomy decannulation: A prospective study at a tertiary care centre","authors":"P. Kumar, Abhilasha Somashekhar, G. Basavaraja, K. Sanjay, A. Fathima, Praveen Baskar","doi":"10.4103/jpcc.jpcc_77_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_77_22","url":null,"abstract":"Background: Advances in neonatal and pediatric intensive care have increased the number of children who survive with disabilities. The management of the tracheostomized child is a complex and demanding assignment as they have higher rates of complications. Ideally, the decannulation process should proceed once the child no longer requires mechanical ventilation and the underlying pathology has resolved or been reversed. This study highlights our experience in managing pediatric tracheostomy decannulation at a tertiary care center. Subjects and Methods: This was a single-center, prospective study conducted at the tertiary care pediatric hospital for a period of 1 year. Children with tracheostomy in situ who got admitted for laryngotracheobronchoscopy and decannulation were included. Results: Indication of tracheostomy was broadly divided into reasons causing upper airway obstruction and those requiring prolonged intubation. It showed that 82% were due to prolonged intubation, in which 85.3% were due to neurological reasons. The success rate for decannulation was 97%. Age of child, duration of intubation, posttracheostomy period, and type of tracheostomy tube had no significant correlation with outcome of tracheostomy decannulation. Conclusions: Resolution of primary indication for tracheostomy is required before planning of tracheotomy decannulation. Bronchoscopic airway evaluation and decannulation trial in operation theater is needed for successful decannulation. There was no impact of age, duration of intubation, posttracheostomy period, and type of tracheostomy tube on the outcome of tracheostomy decannulation.","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":"49069058","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":"Choice of antiepileptic in benzodiazepines refractory convulsive status epilepticus in children","authors":"B. Mukund, V. Bhat","doi":"10.4103/jpcc.jpcc_97_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_97_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":"48262515","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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