Several scoring systems have been used to objectively assess the severity of illness and to predict the short-term mortality among critically ill children. The Pediatric Risk of Mortality-III (PRISM-III) and Pediatric Index of Mortality-3 (PIM-3) are the commonly used severity scores; and Pediatric Logistic Organ Dysfunction-2 (PELOD-2), Sequential Organ Failure Assessment (SOFA), and pediatric SOFA (pSOFA) are organ dysfunction scoring systems.[1–6] In addition, these scoring systems are also useful in assessing the performance of different units, monitoring the quality of pediatric intensive care and benchmarking, and further improvement in performance. SOFA was introduced in 1996 by Vincent et al.[6] to assess the severity of organ dysfunction in critically ill adult patients with sepsis. SOFA score objectively evaluates the organ dysfunction using six organ system variables (clinical and laboratory) that measure the disease severity during the stay in the intensive care unit. Recently, pSOFA score was devised and validated by adapting the original SOFA score with two additional changes: age-adjusted cutoffs for the cardiovascular and renal systems and inclusion of noninvasive surrogates of lung injury (SpO2/FiO2 ratio in addition to PaO2/FiO2 ratio) in the respiratory criteria.[5,7,8] Since SOFA score requires multiple clinical and laboratory data, its use may be potentially challenging, especially in resource-limited settings. Keeping in mind the limitations of SOFA, quick SOFA (qSOFA) score was developed to help clinicians to identify patients at risk of sepsis, by assessing predictive validity using mortality as an outcome more likely occur in patients with sepsis. qSOFA requires only three clinical examination components (i.e., systolic blood pressure, respiratory rate, and Glasgow Coma Scale).[9] qSOFA has been used in low-resource settings.[10] More recently, it has been demonstrated that addition of point-of-care venous lactate to qSOFA was superior to qSOFA alone to predict sepsis-related mortality among adults.[11] Similarly, Kumbar and Chandrashekhara[12] evaluated pSOFA with lactate (pSOFA-L) to predict the mortality among critically ill children (n = 75) and demonstrated that pSOFA-L score had good ability to predict mortality (area under the curve [AUC] = 0.92, cutoff value 10.5, P < 0.001). The mortality rate in children with pSOFA-L <9, 9–11, and >11 was 26.1%, 38.9%, and 50%, respectively. The PRISM-III, PIM-3, and PELOD-2 scores are commonly used to predict mortality and these were validated and calibrated in large populations. However, pSOFA and pSOFA-L are newer ones and these need to be validated in large studies. There is some evidence that SOFA or pSOFA has better accuracy to predict mortality in critically ill children than the PRISM-III or PELOD-2 score or other organ dysfunction scores.[5,13–15] The performance of available severity and organ dysfunction scoring systems to predict mortality among critically ill childr
{"title":"Unified severity and organ dysfunction scoring system in pediatric intensive care unit: A pressing priority","authors":"SureshKumar Angurana, ManinderSingh Dhaliwal, Abhijit Choudhary","doi":"10.4103/jpcc.jpcc_50_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_50_23","url":null,"abstract":"Several scoring systems have been used to objectively assess the severity of illness and to predict the short-term mortality among critically ill children. The Pediatric Risk of Mortality-III (PRISM-III) and Pediatric Index of Mortality-3 (PIM-3) are the commonly used severity scores; and Pediatric Logistic Organ Dysfunction-2 (PELOD-2), Sequential Organ Failure Assessment (SOFA), and pediatric SOFA (pSOFA) are organ dysfunction scoring systems.[1–6] In addition, these scoring systems are also useful in assessing the performance of different units, monitoring the quality of pediatric intensive care and benchmarking, and further improvement in performance. SOFA was introduced in 1996 by Vincent et al.[6] to assess the severity of organ dysfunction in critically ill adult patients with sepsis. SOFA score objectively evaluates the organ dysfunction using six organ system variables (clinical and laboratory) that measure the disease severity during the stay in the intensive care unit. Recently, pSOFA score was devised and validated by adapting the original SOFA score with two additional changes: age-adjusted cutoffs for the cardiovascular and renal systems and inclusion of noninvasive surrogates of lung injury (SpO2/FiO2 ratio in addition to PaO2/FiO2 ratio) in the respiratory criteria.[5,7,8] Since SOFA score requires multiple clinical and laboratory data, its use may be potentially challenging, especially in resource-limited settings. Keeping in mind the limitations of SOFA, quick SOFA (qSOFA) score was developed to help clinicians to identify patients at risk of sepsis, by assessing predictive validity using mortality as an outcome more likely occur in patients with sepsis. qSOFA requires only three clinical examination components (i.e., systolic blood pressure, respiratory rate, and Glasgow Coma Scale).[9] qSOFA has been used in low-resource settings.[10] More recently, it has been demonstrated that addition of point-of-care venous lactate to qSOFA was superior to qSOFA alone to predict sepsis-related mortality among adults.[11] Similarly, Kumbar and Chandrashekhara[12] evaluated pSOFA with lactate (pSOFA-L) to predict the mortality among critically ill children (n = 75) and demonstrated that pSOFA-L score had good ability to predict mortality (area under the curve [AUC] = 0.92, cutoff value 10.5, P < 0.001). The mortality rate in children with pSOFA-L <9, 9–11, and >11 was 26.1%, 38.9%, and 50%, respectively. The PRISM-III, PIM-3, and PELOD-2 scores are commonly used to predict mortality and these were validated and calibrated in large populations. However, pSOFA and pSOFA-L are newer ones and these need to be validated in large studies. There is some evidence that SOFA or pSOFA has better accuracy to predict mortality in critically ill children than the PRISM-III or PELOD-2 score or other organ dysfunction scores.[5,13–15] The performance of available severity and organ dysfunction scoring systems to predict mortality among critically ill childr","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":"82 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135749286","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}
“Checklists are a memory aid, they remind you of what you already know and prompt you to think about what you don’t.” -Atul Gawande In medicine and especially in the realm of intensive care units (ICUs), it is often the little things that make the maximum impact on the patient outcomes. One such tool, often underestimated in its simplicity yet profound in its impact, is the checklist. As we navigate the complex and high-stakes environment of the pediatric ICU (PICU), the implementation of checklists emerges as a crucial element in ensuring not only optimal patient outcomes but also a smoother workflow and enhanced communication. The concept of using checklists in health care is not a novel one. Aviation and other high-reliability organizations have demonstrated the life-saving potential of standardized procedures and task lists[1,2] In the context of the PICU, where a multitude of health-care professionals collaborate to deliver intricate and often urgent care, checklists provide a structured approach that can mitigate errors, foster teamwork, and promote a culture of accountability. At the heart of this approach lies the principle of “cognitive offloading,” where routine and critical tasks are documented and systematically checked off. This reduces the burden on health-care professionals’ working memory, enabling them to focus more on clinical decision-making and patient interactions.[3] Rounding is one part of the medicine that remains diverse. The direction, duration, and discussion on rounds may vary immensely depending on who is leading them. Holodinsky et al. surveyed adult ICUs in Canada and found considerable variation in rounding practices within and between institutions.[4] In this edition of the Journal of Pediatric Critical Care, Abbas et al. have published their quality improvement study, in which they have assessed the impact of introduction of a rounding checklist in a PICU.[5] In their before–after study, they assessed the impact of a 35-point rounding checklist on the coverage of patient care components, length of PICU stay, and health-care-associated infections. They demonstrated that, with the introduction of this checklist, the discussion on most components improved and overall compliance improved from 70% to 99%, which was in line with existing data.[6] They even demonstrated a reduction in length of PICU stay, health-care-associated infections, and mortality, with the introduction of this checklist. This significant impact on hard outcomes seems to have stemmed from increased compliance with the interventions of proven benefit such as infection control bundles, antibiotic stewardship, and nutrition optimization. The authors did a commendable job in preparing a nearly comprehensive checklist which included the various components of patient care in the PICU, including all organ systems, reminders for health-care-associated infections, nursing care, nutrition, and pharmacotherapy. They also included a reminder for resident teac
{"title":"Are my bedside rounds in critical care unit complete? – The undeniable power of a checklist","authors":"Vijai William, ManjinderSingh Randhawa","doi":"10.4103/jpcc.jpcc_70_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_70_23","url":null,"abstract":"“Checklists are a memory aid, they remind you of what you already know and prompt you to think about what you don’t.” -Atul Gawande In medicine and especially in the realm of intensive care units (ICUs), it is often the little things that make the maximum impact on the patient outcomes. One such tool, often underestimated in its simplicity yet profound in its impact, is the checklist. As we navigate the complex and high-stakes environment of the pediatric ICU (PICU), the implementation of checklists emerges as a crucial element in ensuring not only optimal patient outcomes but also a smoother workflow and enhanced communication. The concept of using checklists in health care is not a novel one. Aviation and other high-reliability organizations have demonstrated the life-saving potential of standardized procedures and task lists[1,2] In the context of the PICU, where a multitude of health-care professionals collaborate to deliver intricate and often urgent care, checklists provide a structured approach that can mitigate errors, foster teamwork, and promote a culture of accountability. At the heart of this approach lies the principle of “cognitive offloading,” where routine and critical tasks are documented and systematically checked off. This reduces the burden on health-care professionals’ working memory, enabling them to focus more on clinical decision-making and patient interactions.[3] Rounding is one part of the medicine that remains diverse. The direction, duration, and discussion on rounds may vary immensely depending on who is leading them. Holodinsky et al. surveyed adult ICUs in Canada and found considerable variation in rounding practices within and between institutions.[4] In this edition of the Journal of Pediatric Critical Care, Abbas et al. have published their quality improvement study, in which they have assessed the impact of introduction of a rounding checklist in a PICU.[5] In their before–after study, they assessed the impact of a 35-point rounding checklist on the coverage of patient care components, length of PICU stay, and health-care-associated infections. They demonstrated that, with the introduction of this checklist, the discussion on most components improved and overall compliance improved from 70% to 99%, which was in line with existing data.[6] They even demonstrated a reduction in length of PICU stay, health-care-associated infections, and mortality, with the introduction of this checklist. This significant impact on hard outcomes seems to have stemmed from increased compliance with the interventions of proven benefit such as infection control bundles, antibiotic stewardship, and nutrition optimization. The authors did a commendable job in preparing a nearly comprehensive checklist which included the various components of patient care in the PICU, including all organ systems, reminders for health-care-associated infections, nursing care, nutrition, and pharmacotherapy. They also included a reminder for resident teac","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135749287","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: Estimating the morbidity and mortality in the emergency department (ED) only allows the pediatricians to assess the prognosis of the patient and plan therapies accordingly. This study was conducted to develop and validate a simple scoring system and establish a correlation between clinical parameters and the outcome of the patient. Subjects and Methods: Nine parameters, i.e., body temperature, respiratory rate, heart rate, blood pressure (BP), pulse oxygen saturation (SpO2), capillary refill time, level of sensorium, presence of seizure, and random blood sugar level, were documented, at the time of admission. Parameters were assigned a score of “0” if it is normal. An abnormality in the above parameters were indicated by a score ranging from 1 to 3. The primary outcome was assessed in terms of death/survival. Results: Out of the total, 57.2% required critical care, and mortality was reported in 14.75% of cases. On univariate analysis, seven clinical parameters were significantly associated with mortality. In multivariate logistic regression analysis, abnormalities in BP, SpO2, and temperature were independent predictors of mortality (P < 0.05). The receiver operating characteristic was 0.798 (95% confidence interval, 0.755–0.836; P < 0.0001) for the outcome of mortality (the predictive ability of score of 79.8%). The patients with scores 1–5, 6–10, and >10 had 4.923, 23.143, and 112.0 higher odds of mortality, respectively. Conclusions: This scoring system predicts the severity of illness and outcome with a sensitivity of 71.19% and specificity of 72.14%, respectively, in the ED. Higher scores predict unfavorable outcomes in these children.
{"title":"Simplified scoring system to predict outcome in pediatric patients admitted through emergency department from a tertiary care teaching hospital of North India","authors":"Anita Kumari, Prakhar Gupta, Ruchika Bhatnagar, Kanika Aggarwal, None Ruby","doi":"10.4103/jpcc.jpcc_62_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_62_23","url":null,"abstract":"Background: Estimating the morbidity and mortality in the emergency department (ED) only allows the pediatricians to assess the prognosis of the patient and plan therapies accordingly. This study was conducted to develop and validate a simple scoring system and establish a correlation between clinical parameters and the outcome of the patient. Subjects and Methods: Nine parameters, i.e., body temperature, respiratory rate, heart rate, blood pressure (BP), pulse oxygen saturation (SpO2), capillary refill time, level of sensorium, presence of seizure, and random blood sugar level, were documented, at the time of admission. Parameters were assigned a score of “0” if it is normal. An abnormality in the above parameters were indicated by a score ranging from 1 to 3. The primary outcome was assessed in terms of death/survival. Results: Out of the total, 57.2% required critical care, and mortality was reported in 14.75% of cases. On univariate analysis, seven clinical parameters were significantly associated with mortality. In multivariate logistic regression analysis, abnormalities in BP, SpO2, and temperature were independent predictors of mortality (P < 0.05). The receiver operating characteristic was 0.798 (95% confidence interval, 0.755–0.836; P < 0.0001) for the outcome of mortality (the predictive ability of score of 79.8%). The patients with scores 1–5, 6–10, and >10 had 4.923, 23.143, and 112.0 higher odds of mortality, respectively. Conclusions: This scoring system predicts the severity of illness and outcome with a sensitivity of 71.19% and specificity of 72.14%, respectively, in the ED. Higher scores predict unfavorable outcomes in these children.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135750988","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 ideal extracorporeal membrane oxygenation (ECMO) modality choice (venoarterial [VA] versus venovenous [VV]) for a primary respiratory reason is complex and multifactorial. There is an increasing need to identify the ideal (VV vs. VA) support modality in this population. The objective of this study was to compare survival outcomes of subjects with respiratory failure who could have received VV or VA ECMO. Subjects and Methods: Children ≤20 kg requiring ECMO for respiratory indications from January 2015 to December 2019 were identified retrospectively from the Extracorporeal Life Support Organization registry. To identify a cohort eligible for VV, we excluded subjects receiving cardiac support therapies and included only those receiving mechanical ventilation with a positive end expiratory pressure ≥10 or high frequency oscillatory ventilation or had a PaO2/FiO2 ratio ≤200 or an oxygenation index ≥16. Subjects were grouped by initial cannulation strategy. Statistical approach utilized doubly robust propensity weighted logistic regression and primary outcome was survival to hospital discharge. Results: Of 1686 VV candidates, 871 underwent VV and 815 VA ECMO for a respiratory indication. VV ECMO was associated with higher survival (odds ratio: 1.57; confidence interval: 1.22–2.03, P < 0.001). Conclusions: VV ECMO selection for subjects with respiratory failure was associated with lower mortality in small pediatric and neonatal patients.
背景:理想的体外膜氧合(ECMO)模式选择(静脉动脉[VA]还是静脉静脉[VV])是一个复杂和多因素的主要呼吸原因。在这一人群中，越来越需要确定理想的(VV vs. VA)支持方式。本研究的目的是比较可以接受VV或VA ECMO的呼吸衰竭患者的生存结果。研究对象和方法:从体外生命支持组织(Extracorporeal Life Support Organization)注册表中回顾性地确定2015年1月至2019年12月需要ECMO治疗呼吸指征的≤20 kg儿童。为了确定符合VV的队列，我们排除了接受心脏支持治疗的受试者，只纳入了呼气末正压≥10或高频振荡通气的机械通气患者，或PaO2/FiO2比≤200或氧合指数≥16的患者。受试者按初始插管策略分组。统计方法采用双稳健倾向加权logistic回归，主要结局为生存至出院。结果:在1686名VV候选人中，871人接受了VV, 815人接受了呼吸指征的VA ECMO。VV ECMO与更高的生存率相关(优势比:1.57;置信区间:1.22-2.03,P < 0.001)。结论:为呼吸衰竭患者选择VV ECMO可降低儿童和新生儿患者的死亡率。
{"title":"Comparing outcomes of venovenous versus venoarterial extracorporeal membrane oxygenation in neonatal and pediatric respiratory failure: A retrospective review of Extracorporeal Life Support Organization registry","authors":"JamieM Furlong-Dillard, YanaB Feygin, RonW Reeder, JohnnaS Wilson, DavidG Blauvelt, DeannaR Todd-Tzanetos, StewartR Carter, PetaM. A. Alexander, DavidK Bailly","doi":"10.4103/jpcc.jpcc_65_23","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_65_23","url":null,"abstract":"Background: The ideal extracorporeal membrane oxygenation (ECMO) modality choice (venoarterial [VA] versus venovenous [VV]) for a primary respiratory reason is complex and multifactorial. There is an increasing need to identify the ideal (VV vs. VA) support modality in this population. The objective of this study was to compare survival outcomes of subjects with respiratory failure who could have received VV or VA ECMO. Subjects and Methods: Children ≤20 kg requiring ECMO for respiratory indications from January 2015 to December 2019 were identified retrospectively from the Extracorporeal Life Support Organization registry. To identify a cohort eligible for VV, we excluded subjects receiving cardiac support therapies and included only those receiving mechanical ventilation with a positive end expiratory pressure ≥10 or high frequency oscillatory ventilation or had a PaO2/FiO2 ratio ≤200 or an oxygenation index ≥16. Subjects were grouped by initial cannulation strategy. Statistical approach utilized doubly robust propensity weighted logistic regression and primary outcome was survival to hospital discharge. Results: Of 1686 VV candidates, 871 underwent VV and 815 VA ECMO for a respiratory indication. VV ECMO was associated with higher survival (odds ratio: 1.57; confidence interval: 1.22–2.03, P < 0.001). Conclusions: VV ECMO selection for subjects with respiratory failure was associated with lower mortality in small pediatric and neonatal patients.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135750996","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}
S. Anupama, V. Poovazhagi, R. Nisha, S. Kumar, J. Sathya
Background: Status epilepticus (SE) is the most common neurologic emergency in the pediatric age group often serious and life-threatening. Although newer drugs were used, morbidity and mortality are still high. This study was done to compare the efficacy of levetiracetam with the existing second-line drug fosphenytoin in the treatment of SE. Subjects and Methods: This was a prospective, randomized parallel group trial from Pediatric Intensive Care Unit of a Tertiary Care Institute. One hundred children were recruited according to the inclusion and exclusion criteria, 50 in fosphenytoin group and 50 in levetiracetam group. Two groups were compared with respect to clinical cessation of seizures, recurrence, adverse event, and outcome. Results: Male-to-female ratio was 1.45:1. Seizure were controlled in 37 (74%) in fosphenytoin group and 28 (56%) in levetiracetam group) (P = 0.059). The mean time for cessation of seizures was 11.16 ± 3.58 min in fosphenytoin group as compared to was 12.78 ± 3.07 min in levetiracetam group (P = 0.059) The seizure recurrence in first 24 h (18 [36%] vs. 12 [24%]) (P = 0.643) and development of shock (14 [28%] vs. 11 [22%]) (P = 0.488) was comparable in two groups. Overall mortality was 10 (20%) in fosphenytoin group as compared to 7 (14%) levetiracetam group (P = 0.281). Conclusions: Efficacy of intravenous levetiracetam is comparable to fosphenytoin as a second-line medication in the management of convulsive SE in children.
{"title":"Comparison of levetiracetam as second-line drug with fosphenytoin in convulsive status epilepticus among children: A single center, open-label randomized controlled trial","authors":"S. Anupama, V. Poovazhagi, R. Nisha, S. Kumar, J. Sathya","doi":"10.4103/jpcc.jpcc_52_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_52_22","url":null,"abstract":"Background: Status epilepticus (SE) is the most common neurologic emergency in the pediatric age group often serious and life-threatening. Although newer drugs were used, morbidity and mortality are still high. This study was done to compare the efficacy of levetiracetam with the existing second-line drug fosphenytoin in the treatment of SE. Subjects and Methods: This was a prospective, randomized parallel group trial from Pediatric Intensive Care Unit of a Tertiary Care Institute. One hundred children were recruited according to the inclusion and exclusion criteria, 50 in fosphenytoin group and 50 in levetiracetam group. Two groups were compared with respect to clinical cessation of seizures, recurrence, adverse event, and outcome. Results: Male-to-female ratio was 1.45:1. Seizure were controlled in 37 (74%) in fosphenytoin group and 28 (56%) in levetiracetam group) (P = 0.059). The mean time for cessation of seizures was 11.16 ± 3.58 min in fosphenytoin group as compared to was 12.78 ± 3.07 min in levetiracetam group (P = 0.059) The seizure recurrence in first 24 h (18 [36%] vs. 12 [24%]) (P = 0.643) and development of shock (14 [28%] vs. 11 [22%]) (P = 0.488) was comparable in two groups. Overall mortality was 10 (20%) in fosphenytoin group as compared to 7 (14%) levetiracetam group (P = 0.281). Conclusions: Efficacy of intravenous levetiracetam is comparable to fosphenytoin as a second-line medication in the management of convulsive SE in children.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":"10 1","pages":"18 - 23"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44100562","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}
M. Jose, Ardra Prakash, Neetu Gupta, Santhilal Subhash, C. Shijukumar, P. Joji
Background: Sedation management is a crucial element of pediatric critical care medicine, aiming at reducing children's anxiety, distress, and oxygen demand. Prolonged administration of sedatives may result in drug tolerance and physical dependency. Abrupt discontinuation of these drugs in children may cause withdrawal symptoms. Our study aims to evaluate the choice and adequacy of sedation in ventilated children using the University of Michigan Sedation Scale score. Subjects and Methods: All the children aged between 1 and 12 years who were subjected to invasive ventilation during the time period October 2019 to June 2021 in the tertiary care pediatric intensive care unit (PICU) were included in the study. Results: Of the 35 children enrolled in the study, most of them spend the majority of their time in adequate sedation which accounts for around 87.1% of the total time of ventilation. Fentanyl and midazolam were the most frequently used drug combination. Oversedation and undersedation accounted for 7.9% and 5% of total ventilation hours, respectively. Out of 35 children, 10 (28%) developed iatrogenic withdrawal symptoms and 4 (11%) developed severe withdrawal symptoms. Conclusions: Fentanyl and midazolam were the most frequently used drug combination for attaining adequate sedation in our PICU. Irrespective of adequate sedation, no increase in the incidence of iatrogenic withdrawal syndrome, undersedation, or oversedation was noted in our study population.
{"title":"Choice and adequacy of sedation in critically ill mechanically ventilated children: A single center prospective observational study","authors":"M. Jose, Ardra Prakash, Neetu Gupta, Santhilal Subhash, C. Shijukumar, P. Joji","doi":"10.4103/jpcc.jpcc_61_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_61_22","url":null,"abstract":"Background: Sedation management is a crucial element of pediatric critical care medicine, aiming at reducing children's anxiety, distress, and oxygen demand. Prolonged administration of sedatives may result in drug tolerance and physical dependency. Abrupt discontinuation of these drugs in children may cause withdrawal symptoms. Our study aims to evaluate the choice and adequacy of sedation in ventilated children using the University of Michigan Sedation Scale score. Subjects and Methods: All the children aged between 1 and 12 years who were subjected to invasive ventilation during the time period October 2019 to June 2021 in the tertiary care pediatric intensive care unit (PICU) were included in the study. Results: Of the 35 children enrolled in the study, most of them spend the majority of their time in adequate sedation which accounts for around 87.1% of the total time of ventilation. Fentanyl and midazolam were the most frequently used drug combination. Oversedation and undersedation accounted for 7.9% and 5% of total ventilation hours, respectively. Out of 35 children, 10 (28%) developed iatrogenic withdrawal symptoms and 4 (11%) developed severe withdrawal symptoms. Conclusions: Fentanyl and midazolam were the most frequently used drug combination for attaining adequate sedation in our PICU. Irrespective of adequate sedation, no increase in the incidence of iatrogenic withdrawal syndrome, undersedation, or oversedation was noted in our study population.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":"10 1","pages":"30 - 35"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41684558","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: Despite tremendous advances and new guidelines for the management of pediatric septic shock, the mortality and morbidity associated with it remain unacceptably high. This study was conducted to evaluate the impact of adherence to the American College of Critical Care Medicine (ACCM) guidelines in the management of septic shock in pediatric intensive care units (PICU). Subjects and Methods: This was a hospital-based prospective observational study conducted in the 15-bedded PICU of a tertiary care hospital in Utter Pradesh, India. Children from 1 month to 18 years of age admitted to the PICU with septic shock were included in the study as per definitions given by ACCM guidelines. The children who were managed strictly adhering to ACCM guidelines were labeled as the adherent group and those who were managed with any deviation from these guidelines were considered as the nonadherent group. The two groups were compared with respect to outcome. Results: In this study, the prevalence of septic shock was 54.4% in PICU. Out of 124 cases of septic shock, 93 were from the adherent group and 31 were from the nonadherent group. Recovery was significantly higher (p-0.012) in children among the adherent group (56 [60.21%] vs. 11 [35.48%]) than in the nonadherent group. The hemodynamic stability achieved within 48 h among the adherent group was higher in comparison to the nonadherent group (39 [56%] vs. 6 [8.5%]) making this a significant (P = 0.007) observation. Conclusions: Strict adherence to the ACCM guidelines was associated with favorable outcomes in the management of septic shock in children.
{"title":"The impact of adherence to the American College of Critical Care Medicine 2017 guidelines in the management of septic shock in pediatric intensive care units: A prospective observational study","authors":"G. Kochar, P. Tripathi, P. Rai, P. Prasad","doi":"10.4103/jpcc.jpcc_48_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_48_22","url":null,"abstract":"Background: Despite tremendous advances and new guidelines for the management of pediatric septic shock, the mortality and morbidity associated with it remain unacceptably high. This study was conducted to evaluate the impact of adherence to the American College of Critical Care Medicine (ACCM) guidelines in the management of septic shock in pediatric intensive care units (PICU). Subjects and Methods: This was a hospital-based prospective observational study conducted in the 15-bedded PICU of a tertiary care hospital in Utter Pradesh, India. Children from 1 month to 18 years of age admitted to the PICU with septic shock were included in the study as per definitions given by ACCM guidelines. The children who were managed strictly adhering to ACCM guidelines were labeled as the adherent group and those who were managed with any deviation from these guidelines were considered as the nonadherent group. The two groups were compared with respect to outcome. Results: In this study, the prevalence of septic shock was 54.4% in PICU. Out of 124 cases of septic shock, 93 were from the adherent group and 31 were from the nonadherent group. Recovery was significantly higher (p-0.012) in children among the adherent group (56 [60.21%] vs. 11 [35.48%]) than in the nonadherent group. The hemodynamic stability achieved within 48 h among the adherent group was higher in comparison to the nonadherent group (39 [56%] vs. 6 [8.5%]) making this a significant (P = 0.007) observation. Conclusions: Strict adherence to the ACCM guidelines was associated with favorable outcomes in the management of septic shock in children.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":"9 1","pages":"208 - 212"},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47084900","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":"Refractory status epilepticus in children: What Indian scenario needs now and future?","authors":"R. Rameshkumar","doi":"10.4103/jpcc.jpcc_73_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_73_22","url":null,"abstract":"","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":"9 1","pages":"191 - 192"},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43650908","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: Epidemiological data on childhood status epilepticus (SE) limited in India. This study depicts clinical profiles, etiology, and outcomes of convulsive refractory SE (RSE) and compares the results with cases of nonrefractory SE (NRSE). Subjects and Methods: This observational, cross-sectional study enrolled 300 children aged 1 month to 18 years, presenting with convulsive SE at a tertiary care hospital. Details of children who progressed to RSE were compared to those without RSE. Results: In the acute symptomatic etiology group, common causes for RSE were central nervous system infections (33.8%), cryptogenic etiology (13.8%), and remote symptomatic etiology (7%). RSE iwas associated with a higher rate of complications (58% Vs 24%) as compared to NRSE. Thirty percent of cases that progressed to RSE needed ventilator support as compared to only 8% of cases in the NRSE group. RSE was also associated with higher rates of shock (25%), AKI (16%), transaminitis (25%), acute liver failure (5.69%), multiple organ dysfunction score (12.6%), and acidosis (53%) as compared to NRSE. RSE was associated with higher mortality (28%) and morbidity (32%) as compared to NRSE cases. Cryptogenic etiology led to the highest mortality (33.3%) in cases of RSE while acute symptomology was associated with the highest morbidity (62%). Conclusions: RSE is a serious pediatric emergency that requires prompt recognition and management. Clinical knowledge and early administration of appropriate antiepileptic drugs at health-care facilities is the key to reduce morbidity and mortality.
引言:印度儿童癫痫持续状态(SE)的流行病学数据。本研究描述了惊厥性难治性SE (RSE)的临床特征、病因和结局，并将结果与非难治性SE (NRSE)进行了比较。对象和方法:这项观察性横断面研究纳入了300名1个月至18岁的儿童，在三级保健医院出现惊厥性SE。将进展为RSE的儿童的细节与未进展为RSE的儿童进行比较。结果:急性症状组RSE的常见病因为中枢神经系统感染(33.8%)、隐源性病因(13.8%)和远端症状病因(7%)。与NRSE相比，RSE与更高的并发症发生率相关(58% Vs 24%)。30%进展为RSE的病例需要呼吸机支持，而NRSE组只有8%的病例需要。与NRSE相比，RSE还与较高的休克(25%)、AKI(16%)、转氨炎(25%)、急性肝衰竭(5.69%)、多器官功能障碍评分(12.6%)和酸中毒(53%)发生率相关。与NRSE病例相比，RSE与更高的死亡率(28%)和发病率(32%)相关。在RSE病例中，隐源性病因导致的死亡率最高(33.3%)，而急性症状导致的发病率最高(62%)。结论:RSE是一种严重的儿科急症，需要及时认识和处理。临床知识和在卫生保健机构早期使用适当的抗癫痫药物是降低发病率和死亡率的关键。
{"title":"Clinical, etiological profile and outcomes of convulsive refractory and non-refractory status epilepticus at a tertiary care centre: A prospective observational study","authors":"Nishant Gopaal, D. Bagri, Jagdish Sharma","doi":"10.4103/jpcc.jpcc_42_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_42_22","url":null,"abstract":"Introduction: Epidemiological data on childhood status epilepticus (SE) limited in India. This study depicts clinical profiles, etiology, and outcomes of convulsive refractory SE (RSE) and compares the results with cases of nonrefractory SE (NRSE). Subjects and Methods: This observational, cross-sectional study enrolled 300 children aged 1 month to 18 years, presenting with convulsive SE at a tertiary care hospital. Details of children who progressed to RSE were compared to those without RSE. Results: In the acute symptomatic etiology group, common causes for RSE were central nervous system infections (33.8%), cryptogenic etiology (13.8%), and remote symptomatic etiology (7%). RSE iwas associated with a higher rate of complications (58% Vs 24%) as compared to NRSE. Thirty percent of cases that progressed to RSE needed ventilator support as compared to only 8% of cases in the NRSE group. RSE was also associated with higher rates of shock (25%), AKI (16%), transaminitis (25%), acute liver failure (5.69%), multiple organ dysfunction score (12.6%), and acidosis (53%) as compared to NRSE. RSE was associated with higher mortality (28%) and morbidity (32%) as compared to NRSE cases. Cryptogenic etiology led to the highest mortality (33.3%) in cases of RSE while acute symptomology was associated with the highest morbidity (62%). Conclusions: RSE is a serious pediatric emergency that requires prompt recognition and management. Clinical knowledge and early administration of appropriate antiepileptic drugs at health-care facilities is the key to reduce morbidity and mortality.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":"9 1","pages":"197 - 203"},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42167484","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}
S. Pandey, Ravi Sharma, A. Sharma, Praveen Sharma, R. Bansal
Cor triatriatum is a rare congenital heart disease (0.1% of all congenital cardiac defects). Most patients are identified shortly after birth with the evaluation of a distressed or cyanotic neonate. However, when the presentation is delayed, primary symptoms may mimic reactive airway disease. We present an 11-year-old adolescent male who presented with obstructive sleep apnea-like features initially, on further evaluation showed features of severe pneumonia. There was clinical and radiological dissociation with the findings.
{"title":"An unusual presentation of Cor-triatriatum as respiratory distress in adolescent male: A case report","authors":"S. Pandey, Ravi Sharma, A. Sharma, Praveen Sharma, R. Bansal","doi":"10.4103/jpcc.jpcc_59_22","DOIUrl":"https://doi.org/10.4103/jpcc.jpcc_59_22","url":null,"abstract":"Cor triatriatum is a rare congenital heart disease (0.1% of all congenital cardiac defects). Most patients are identified shortly after birth with the evaluation of a distressed or cyanotic neonate. However, when the presentation is delayed, primary symptoms may mimic reactive airway disease. We present an 11-year-old adolescent male who presented with obstructive sleep apnea-like features initially, on further evaluation showed features of severe pneumonia. There was clinical and radiological dissociation with the findings.","PeriodicalId":34184,"journal":{"name":"Journal of Pediatric Critical Care","volume":"9 1","pages":"219 - 222"},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48130811","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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