Mireille Liboiron, M. Malone, Clare C. Brown, P. Prodhan
Abstract Hemolytic uremic syndrome (HUS) is a triad of hemolytic anemia, thrombocytopenia, and acute renal failure. In critically ill children with HUS, extrarenal manifestations may require intensive care unit admission and extracorporeal membrane oxygenation (ECMO) support. Outcomes specific to HUS and ECMO in children have not been well investigated. The primary aim of this project was to query a multicenter database to identify risk factors associated with mortality in HUS patients supported on ECMO. A secondary aim was to identify factors associated with ECMO utilization in children with HUS. Utilizing the Pediatric Health Information System database (January 2004 and September 2018), this retrospective, multicenter cohort study identified the index HUS hospitalization among children aged 0 to 18 years. Univariate analysis was used to compare demographics, clinical characteristics, and procedures to identify risk factors associated with adverse outcomes. Among 4,144 subjects, 37 were supported on ECMO. Survival for those on ECMO support was 54%. Among nonsurvivors, 59% of deaths occurred within 14 days of hospitalization. The mean hospital LOS was 15.9 days in nonsurvivors versus 53.9 days for survivors ( p < 0.001). When comparing subjects supported on ECMO to those who were not, patients with ECMO support had statistically longer hospital LOS and higher rates of extrarenal involvement ( p < 0.001). This study found a mortality rate of 46% among HUS patients requiring ECMO. The investigated clinical risk factors were not associated with mortality among the ECMO population. The study identifies risk factors associated with ECMO utilization in children with HUS.
{"title":"Extracorporeal Membrane Oxygenation and Hemolytic Uremic Syndrome in Children: Outcome Review of a Multicenter National Database","authors":"Mireille Liboiron, M. Malone, Clare C. Brown, P. Prodhan","doi":"10.1055/s-0042-1758478","DOIUrl":"https://doi.org/10.1055/s-0042-1758478","url":null,"abstract":"Abstract Hemolytic uremic syndrome (HUS) is a triad of hemolytic anemia, thrombocytopenia, and acute renal failure. In critically ill children with HUS, extrarenal manifestations may require intensive care unit admission and extracorporeal membrane oxygenation (ECMO) support. Outcomes specific to HUS and ECMO in children have not been well investigated. The primary aim of this project was to query a multicenter database to identify risk factors associated with mortality in HUS patients supported on ECMO. A secondary aim was to identify factors associated with ECMO utilization in children with HUS. Utilizing the Pediatric Health Information System database (January 2004 and September 2018), this retrospective, multicenter cohort study identified the index HUS hospitalization among children aged 0 to 18 years. Univariate analysis was used to compare demographics, clinical characteristics, and procedures to identify risk factors associated with adverse outcomes. Among 4,144 subjects, 37 were supported on ECMO. Survival for those on ECMO support was 54%. Among nonsurvivors, 59% of deaths occurred within 14 days of hospitalization. The mean hospital LOS was 15.9 days in nonsurvivors versus 53.9 days for survivors ( p < 0.001). When comparing subjects supported on ECMO to those who were not, patients with ECMO support had statistically longer hospital LOS and higher rates of extrarenal involvement ( p < 0.001). This study found a mortality rate of 46% among HUS patients requiring ECMO. The investigated clinical risk factors were not associated with mortality among the ECMO population. The study identifies risk factors associated with ECMO utilization in children with HUS.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"46 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77577839","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}
Xiuhua L Bozarth, P. Ko, Hao Bao, N. Abend, R. Watson, Pingping Qu, L. Dervan, L. Morgan, Mark S. Wainwright, John McGuire, Edward Novotny
This study aimed to compare short-term outcomes at pediatric intensive care unit (PICU) discharge in critically ill children with and without continuous electroencephalography (cEEG) monitoring. We retrospectively compared 234 patients who underwent cEEG with 2294 patients without cEEG. Propensity score matching was used to compare patients with seizures and status epilepticus between cEEG and historical cohorts. The EEG cohort had higher in-hospital mortality, worse Pediatric Cerebral Performance Category (PCPC) scores, and greater PCPC decline at discharge. In patients with status epilepticus, the PCPC decline was higher in the cEEG cohort. PCPC decline at PICU discharge was associated with cEEG monitoring in patients with status epilepticus.
{"title":"Use of Continuous EEG Monitoring and Short-Term Outcomes in Critically Ill Children","authors":"Xiuhua L Bozarth, P. Ko, Hao Bao, N. Abend, R. Watson, Pingping Qu, L. Dervan, L. Morgan, Mark S. Wainwright, John McGuire, Edward Novotny","doi":"10.1055/s-0042-1749433","DOIUrl":"https://doi.org/10.1055/s-0042-1749433","url":null,"abstract":"This study aimed to compare short-term outcomes at pediatric intensive care unit (PICU) discharge in critically ill children with and without continuous electroencephalography (cEEG) monitoring. We retrospectively compared 234 patients who underwent cEEG with 2294 patients without cEEG. Propensity score matching was used to compare patients with seizures and status epilepticus between cEEG and historical cohorts. The EEG cohort had higher in-hospital mortality, worse Pediatric Cerebral Performance Category (PCPC) scores, and greater PCPC decline at discharge. In patients with status epilepticus, the PCPC decline was higher in the cEEG cohort. PCPC decline at PICU discharge was associated with cEEG monitoring in patients with status epilepticus.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"46 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81409754","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}
Kenchappa Yashaswini, A. Lalitha, Giri Subramanian Naresh Kanna, John Michael Raj A.
Objectives Multisystem inflammatory syndrome in children (MIS-C) is a post Severe Acute Respiratory Syndrome Coronavirus2 (SARS CoV2) immune dissonance seen in the pediatric population. The current study is an attempt to understand the subtleties of diverse phenotypes, immunotherapeutics, and short-term outcome parameters of MIS-C. Materials and Methods Children admitted to the pediatric intensive care unit (PICU) between 1 month and 18 years, satisfying MIS-C criteria, were enrolled in this retrospective observational study. They were stratified into different phenotypes like shock, Kawasaki disease, and nonspecific phenotypes. Respiratory, vasoactive support, and outcomes were analyzed using appropriate statistical methods. Results Seventy-five children presented with MIS-C during the study period. The mean age was 66 months with 54.6% females. Coronavirus disease (COVID) antibody was positive for 41 (54%), real time-reverse rranscription polymerase chain reaction (RT-PCR) positivity was positive in 16 (21.3%), and rapid antigen test was positive in 10 (13%). Common symptoms included fever (100%), rash (30%), conjunctival congestion (29.7%), and cardiovascular (68% with shock) involvement. Notable differences in shock phenotype were identified including Pediatric Risk of Mortality III score, inflammatory markers, cardiac involvement, need for inotropes, and ventilation. In total, 32% received intravenous immunoglobulin and 48% glucocorticoids. The overall mortality in children with MIS-C was 9 (12%). The need for mechanical ventilation (odds ratio 10.94, confidence interval [2.06, 58.06], p-value <0.005) was noted as an independent predictor of mortality by logistic regression. Conclusion MIS-C showed a significant cardiovascular involvement at presentation, necessitating intensive care and immunomodulatory therapies. There were higher odds of mortality in the ventilated cohort.
儿童多系统炎症综合征(multi - system inflammatory syndrome in children, MIS-C)是一种发生在儿童人群中的严重急性呼吸系统综合征冠状病毒2 (SARS CoV2)后的免疫失调。目前的研究试图了解misc的不同表型、免疫治疗和短期结果参数的微妙之处。材料与方法本回顾性观察研究纳入1个月至18岁的儿童重症监护病房(PICU)，符合MIS-C标准。他们被分为不同的表型，如休克、川崎病和非特异性表型。采用适当的统计方法对呼吸、血管活性支持和结果进行分析。结果75例患儿在研究期间出现misc。平均年龄66个月，女性占54.6%。冠状病毒病(COVID)抗体阳性41例(54%)，实时逆转录聚合酶链反应(RT-PCR)阳性16例(21.3%)，快速抗原试验阳性10例(13%)。常见症状包括发热(100%)、皮疹(30%)、结膜充血(29.7%)和心血管(68%伴有休克)受累。休克表型的显著差异包括儿科死亡风险III评分、炎症标志物、心脏受累、肌力药物需求和通气。总共32%的患者接受了免疫球蛋白静脉注射，48%的患者接受了糖皮质激素静脉注射。MIS-C患儿的总死亡率为9(12%)。通过logistic回归发现，机械通气需求(优势比10.94，可信区间[2.06,58.06]，p值<0.005)是死亡率的独立预测因子。结论MIS-C表现为明显的心血管累及，需要重症监护和免疫调节治疗。通气组的死亡率较高。
{"title":"Clinical Profile of Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2 Admitted to Pediatric Intensive Care Unit","authors":"Kenchappa Yashaswini, A. Lalitha, Giri Subramanian Naresh Kanna, John Michael Raj A.","doi":"10.1055/s-0042-1750300","DOIUrl":"https://doi.org/10.1055/s-0042-1750300","url":null,"abstract":"\u0000 Objectives Multisystem inflammatory syndrome in children (MIS-C) is a post Severe Acute Respiratory Syndrome Coronavirus2 (SARS CoV2) immune dissonance seen in the pediatric population. The current study is an attempt to understand the subtleties of diverse phenotypes, immunotherapeutics, and short-term outcome parameters of MIS-C.\u0000 Materials and Methods Children admitted to the pediatric intensive care unit (PICU) between 1 month and 18 years, satisfying MIS-C criteria, were enrolled in this retrospective observational study. They were stratified into different phenotypes like shock, Kawasaki disease, and nonspecific phenotypes. Respiratory, vasoactive support, and outcomes were analyzed using appropriate statistical methods.\u0000 Results Seventy-five children presented with MIS-C during the study period. The mean age was 66 months with 54.6% females. Coronavirus disease (COVID) antibody was positive for 41 (54%), real time-reverse rranscription polymerase chain reaction (RT-PCR) positivity was positive in 16 (21.3%), and rapid antigen test was positive in 10 (13%). Common symptoms included fever (100%), rash (30%), conjunctival congestion (29.7%), and cardiovascular (68% with shock) involvement. Notable differences in shock phenotype were identified including Pediatric Risk of Mortality III score, inflammatory markers, cardiac involvement, need for inotropes, and ventilation. In total, 32% received intravenous immunoglobulin and 48% glucocorticoids. The overall mortality in children with MIS-C was 9 (12%). The need for mechanical ventilation (odds ratio 10.94, confidence interval [2.06, 58.06], p-value <0.005) was noted as an independent predictor of mortality by logistic regression.\u0000 Conclusion MIS-C showed a significant cardiovascular involvement at presentation, necessitating intensive care and immunomodulatory therapies. There were higher odds of mortality in the ventilated cohort.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"1 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76125916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Kirby, Jayshan Chagan, Catherine Adams, N. Duns, M. Haddad, S. Pearson, O. Tegg, C. Goh
The aim of this study is to evaluate the amalgamation and maturation of a Pediatric Intensive Care Outreach Service (PICOS) with a rapid response system (RRS) and associated outcomes over a 10-year period. It is a single-center retrospective study analyzing patient outcomes within the context of significant organizational changes introducing a track and trigger RRS called Between the Flags (BTF) and evolution of this system to electronic observation charting and alerts (eBTF) in a tertiary metropolitan children's hospital. Children on inpatient wards who required urgent activation of the RRS and admission to the pediatric intensive care unit (PICU) between 2009 and 2018 were included. Three cohorts were identified according to the system changes—pre-BTF (2009–2011), BTF (2012–2017), and eBTF (2017–2018). The PICOS dose (number of activations per 1000 hospital admissions) increased with the introduction of BTF and the RRS and this trend continued following eBTF. The number of PICU admissions via the PICOS did not vary across the decade. When comparing the pre-BTF to the BTF group, PICU mortality decreased (p < 0.05), Pediatric Index of Mortality 2 Risk of Death scores improved, and hospital length of stay decreased (p < 0.05) in the BTF group. Introduction of a track and trigger RRS and electronic charting augmenting an existing PICOS is associated with increasing dose and workload, with no significant impact on PICU admission rates or length of stay. PICOS patient mortality has notably decreased with the introduction of an RRS; however, this impact was not sustained with the addition of electronic charting and alerts in the patient medical record.
{"title":"A Decade of Pediatric Intensive Care Outreach and the Deteriorating Child—The Relationship between Dose and Outcomes in a Tertiary Children's Hospital","authors":"L. Kirby, Jayshan Chagan, Catherine Adams, N. Duns, M. Haddad, S. Pearson, O. Tegg, C. Goh","doi":"10.1055/s-0042-1750298","DOIUrl":"https://doi.org/10.1055/s-0042-1750298","url":null,"abstract":"The aim of this study is to evaluate the amalgamation and maturation of a Pediatric Intensive Care Outreach Service (PICOS) with a rapid response system (RRS) and associated outcomes over a 10-year period. It is a single-center retrospective study analyzing patient outcomes within the context of significant organizational changes introducing a track and trigger RRS called Between the Flags (BTF) and evolution of this system to electronic observation charting and alerts (eBTF) in a tertiary metropolitan children's hospital. Children on inpatient wards who required urgent activation of the RRS and admission to the pediatric intensive care unit (PICU) between 2009 and 2018 were included. Three cohorts were identified according to the system changes—pre-BTF (2009–2011), BTF (2012–2017), and eBTF (2017–2018). The PICOS dose (number of activations per 1000 hospital admissions) increased with the introduction of BTF and the RRS and this trend continued following eBTF. The number of PICU admissions via the PICOS did not vary across the decade. When comparing the pre-BTF to the BTF group, PICU mortality decreased (p < 0.05), Pediatric Index of Mortality 2 Risk of Death scores improved, and hospital length of stay decreased (p < 0.05) in the BTF group. Introduction of a track and trigger RRS and electronic charting augmenting an existing PICOS is associated with increasing dose and workload, with no significant impact on PICU admission rates or length of stay. PICOS patient mortality has notably decreased with the introduction of an RRS; however, this impact was not sustained with the addition of electronic charting and alerts in the patient medical record.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90326398","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}
Nisha Toteja, Rohit Sasidharan, Sachin Kumar, K. Zaman, V. Singh, Vineet Jaiswal, K. Srivastava, H. Tiwari, M. Mittal
The aim of this study was to evaluate the role of serum ferritin (SF) and PRISM-III (Pediatric Risk of Mortality) score in predicting mortality in critically ill children aged 6 months to 15 years diagnosed with acute encephalitis syndrome (AES) admitted to the pediatric intensive care unit (PICU). This prospective observational study was conducted in the PICU of a tertiary teaching hospital in Northern India between July 2018 and June 2019. The primary outcome was to determine the association of admission SF levels with mortality. Secondary outcomes included estimating the prevalence of hyperferritinemia and comparing SF with PRISM-III scores in predicting mortality. Etiology could be established in 85.5% (n = 219) of the 256 children enrolled. Scrub typhus accounted for nearly two-thirds of the cases (60.5%), while dengue and Japanese encephalitis were the next common diagnoses. The median [interquartile range] SF at admission was significantly higher among the nonsurvivors than survivors: 514 [260–1,857] and 318 [189–699] µg/L, respectively (p = 0.029). SF and PRISM-III independently predicted mortality in AES. However, both had poor discriminatory power with area under receiver operating curve (95% confidence interval) of 0.61 (0.51–0.72) and 0.67 (0.56–0.77), respectively. Elevated SF and higher PRISM-III scores independently predicted mortality in children admitted to PICU with AES.
{"title":"Role of Serum Ferritin and PRISM-III in Predicting Mortality in Children with Acute Encephalitis Syndrome in Northern India","authors":"Nisha Toteja, Rohit Sasidharan, Sachin Kumar, K. Zaman, V. Singh, Vineet Jaiswal, K. Srivastava, H. Tiwari, M. Mittal","doi":"10.1055/s-0042-1750301","DOIUrl":"https://doi.org/10.1055/s-0042-1750301","url":null,"abstract":"The aim of this study was to evaluate the role of serum ferritin (SF) and PRISM-III (Pediatric Risk of Mortality) score in predicting mortality in critically ill children aged 6 months to 15 years diagnosed with acute encephalitis syndrome (AES) admitted to the pediatric intensive care unit (PICU). This prospective observational study was conducted in the PICU of a tertiary teaching hospital in Northern India between July 2018 and June 2019. The primary outcome was to determine the association of admission SF levels with mortality. Secondary outcomes included estimating the prevalence of hyperferritinemia and comparing SF with PRISM-III scores in predicting mortality. Etiology could be established in 85.5% (n = 219) of the 256 children enrolled. Scrub typhus accounted for nearly two-thirds of the cases (60.5%), while dengue and Japanese encephalitis were the next common diagnoses. The median [interquartile range] SF at admission was significantly higher among the nonsurvivors than survivors: 514 [260–1,857] and 318 [189–699] µg/L, respectively (p = 0.029). SF and PRISM-III independently predicted mortality in AES. However, both had poor discriminatory power with area under receiver operating curve (95% confidence interval) of 0.61 (0.51–0.72) and 0.67 (0.56–0.77), respectively. Elevated SF and higher PRISM-III scores independently predicted mortality in children admitted to PICU with AES.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"43 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81873184","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}
Isaque Nilton dos Santos, Carolina Teixeira Goulart Peano, E. S. Soares, H. I. Cimarosti
Abstract Considering that neonatal pain is a relevant matter given its implications and consequences, many neonates, particularly those undergoing critical care, are subjected to analgo-sedation therapies, which commonly includes treatment with opioids and benzodiazepines. These drugs, however, can induce tolerance and dependency, leading to the development of the so-called iatrogenic withdrawal syndrome (IWS) which is observed following discontinuation of these therapeutic agents particularly when utilized for a prolonged period of time (≥5 days). IWS consists of signs and symptoms manifested especially in young children, such as term and premature newborns in the neonatal intensive care unit, who are less capable of metabolizing and eliminating these drugs, compared with older patients. In this study, we review assessment tools that were developed to identify, evaluate, and manage children affected by IWS. The studies reviewed demonstrate that optimal management of IWS includes consideration of alternate routes of drug administration, the need for adequate time for drug tapering, and also the presence of planned rescue therapy when encountering cases refractory to ongoing management. Equally important is prevention of IWS which can be accomplished with the implementation of drug rotation protocols and, adherence to evidenced-based guidelines which facilitate an overall decline in the use and duration of opioids and benzodiazepines. Finally, our review strongly supports the need for more research on IWS in neonates given their increased susceptibility and sparse published data for this age group.
{"title":"Iatrogenic Withdrawal Syndrome in Critically Ill Neonates: A Review of Mechanisms, Assessment, Management, and Prevention","authors":"Isaque Nilton dos Santos, Carolina Teixeira Goulart Peano, E. S. Soares, H. I. Cimarosti","doi":"10.1055/s-0042-1758873","DOIUrl":"https://doi.org/10.1055/s-0042-1758873","url":null,"abstract":"Abstract Considering that neonatal pain is a relevant matter given its implications and consequences, many neonates, particularly those undergoing critical care, are subjected to analgo-sedation therapies, which commonly includes treatment with opioids and benzodiazepines. These drugs, however, can induce tolerance and dependency, leading to the development of the so-called iatrogenic withdrawal syndrome (IWS) which is observed following discontinuation of these therapeutic agents particularly when utilized for a prolonged period of time (≥5 days). IWS consists of signs and symptoms manifested especially in young children, such as term and premature newborns in the neonatal intensive care unit, who are less capable of metabolizing and eliminating these drugs, compared with older patients. In this study, we review assessment tools that were developed to identify, evaluate, and manage children affected by IWS. The studies reviewed demonstrate that optimal management of IWS includes consideration of alternate routes of drug administration, the need for adequate time for drug tapering, and also the presence of planned rescue therapy when encountering cases refractory to ongoing management. Equally important is prevention of IWS which can be accomplished with the implementation of drug rotation protocols and, adherence to evidenced-based guidelines which facilitate an overall decline in the use and duration of opioids and benzodiazepines. Finally, our review strongly supports the need for more research on IWS in neonates given their increased susceptibility and sparse published data for this age group.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"17 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87021681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In response to the burden of coronavirus disease 2019 (COVID-19) and overwhelmed intensive care unit (ICU) resources, some pediatric intensive care units (PICUs) have had to adapt. The purpose of this study was to assess the criticality, scope of diagnosis, and outcomes of an adult cohort admitted to a Canadian PICU. A retrospective chart review was completed on all patients between 17 and 50 years of age admitted to the PICU between June 2020 and December 2021. Admission data included body mass index (BMI), admission sequential organ failure assessment score (SOFA), COVID-19 status, diagnosis, and comorbidities. The duration of ventilatory support, PICU and hospital admission, and mortality and discharge disposition were assessed. Discrete variables were reported as percentages and continuous data as means with standard deviations or medians with interquartile range. Sixty-five adult patients were admitted to the PICU for a total of 437 days, with a mean SOFA score of 6.6 and the overall mortality rate of 4.6%. Six patients were diagnosed with COVID-19 pneumonia, were admitted with a mean SOFA score of 11.8 and a BMI of 38.3 kg/m2, and all were discharged to the ward. During the COVID-19 pandemic, pediatric intensivists in a Canadian PICU managed adult patients up to 50 years of age with high criticality and broad-ranging diagnoses with a low mortality rate. PICUs may be a safe critical care decompression option for adult ICUs during future endemics or pandemics.
{"title":"Adult Admissions to a Canadian PICU during the COVID-19 Pandemic","authors":"Tanya R Holt, Leanne Smith, G. Hansen","doi":"10.1055/s-0042-1747928","DOIUrl":"https://doi.org/10.1055/s-0042-1747928","url":null,"abstract":"In response to the burden of coronavirus disease 2019 (COVID-19) and overwhelmed intensive care unit (ICU) resources, some pediatric intensive care units (PICUs) have had to adapt. The purpose of this study was to assess the criticality, scope of diagnosis, and outcomes of an adult cohort admitted to a Canadian PICU. A retrospective chart review was completed on all patients between 17 and 50 years of age admitted to the PICU between June 2020 and December 2021. Admission data included body mass index (BMI), admission sequential organ failure assessment score (SOFA), COVID-19 status, diagnosis, and comorbidities. The duration of ventilatory support, PICU and hospital admission, and mortality and discharge disposition were assessed. Discrete variables were reported as percentages and continuous data as means with standard deviations or medians with interquartile range. Sixty-five adult patients were admitted to the PICU for a total of 437 days, with a mean SOFA score of 6.6 and the overall mortality rate of 4.6%. Six patients were diagnosed with COVID-19 pneumonia, were admitted with a mean SOFA score of 11.8 and a BMI of 38.3 kg/m2, and all were discharged to the ward. During the COVID-19 pandemic, pediatric intensivists in a Canadian PICU managed adult patients up to 50 years of age with high criticality and broad-ranging diagnoses with a low mortality rate. PICUs may be a safe critical care decompression option for adult ICUs during future endemics or pandemics.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"35 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88968528","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}
Felina Mille, A. Romer, Tarif A. Choudhury, Adrian D. Zurca, S. B. Peddy, K. Widmeier, Marjorie A. Hamburger, Venkatramanan Shankar
Abstract We developed a novel cardiac critical care bootcamp consisting of didactic, small group, and simulation sessions. The bootcamp was remote due to the COVID-19 pandemic and included telesimulation. We aimed to assess learners' reactions to the bootcamp and their perception of telesimulation. Paired anonymous surveys were administered before and after participation. Surveys assessed participants' comfort in independently managing cardiac critical care scenarios, perceptions of telesimulation, barriers to its effectiveness, and specific feedback on course components. Forty-three fellows from 10 institutions joined the bootcamp over 2 years. Thirty-eight pre- and 28 postcourse surveys were completed. The course was rated good or excellent by all respondents, and 27/28 rated the material as appropriate to their level of training. Based on feedback from 2020, the electrophysiology sessions were converted to a small group format in 2021; positive assessment of these sessions improved from 65 to 90–100%. The telesimulations were highly rated, with 83–94% of participants in 2020 and 90–100% in 2021 rating them as good or excellent. Participants' views on telesimulation improved following the course, with 78% (14/18) post- versus 50% preparticipation agreeing that telesimulation is an effective educational tool ( p = 0.06) and 56% (10/18) post- versus 67% (12/18) pre-rating telesimulation as less effective than in person simulation ( p = 0.04). Identified limitations of telesimulation were limited active participation, lack of realism, impaired flow of conversation, and audiovisual and technical concerns. Telesimulation is feasible in cardiac critical care education and was an acceptable alternative to in person simulation for course participants.
{"title":"Development and Optimization of a Remote Pediatric Cardiac Critical Care Bootcamp Using Telesimulation","authors":"Felina Mille, A. Romer, Tarif A. Choudhury, Adrian D. Zurca, S. B. Peddy, K. Widmeier, Marjorie A. Hamburger, Venkatramanan Shankar","doi":"10.1055/s-0043-1767736","DOIUrl":"https://doi.org/10.1055/s-0043-1767736","url":null,"abstract":"Abstract We developed a novel cardiac critical care bootcamp consisting of didactic, small group, and simulation sessions. The bootcamp was remote due to the COVID-19 pandemic and included telesimulation. We aimed to assess learners' reactions to the bootcamp and their perception of telesimulation. Paired anonymous surveys were administered before and after participation. Surveys assessed participants' comfort in independently managing cardiac critical care scenarios, perceptions of telesimulation, barriers to its effectiveness, and specific feedback on course components. Forty-three fellows from 10 institutions joined the bootcamp over 2 years. Thirty-eight pre- and 28 postcourse surveys were completed. The course was rated good or excellent by all respondents, and 27/28 rated the material as appropriate to their level of training. Based on feedback from 2020, the electrophysiology sessions were converted to a small group format in 2021; positive assessment of these sessions improved from 65 to 90–100%. The telesimulations were highly rated, with 83–94% of participants in 2020 and 90–100% in 2021 rating them as good or excellent. Participants' views on telesimulation improved following the course, with 78% (14/18) post- versus 50% preparticipation agreeing that telesimulation is an effective educational tool ( p = 0.06) and 56% (10/18) post- versus 67% (12/18) pre-rating telesimulation as less effective than in person simulation ( p = 0.04). Identified limitations of telesimulation were limited active participation, lack of realism, impaired flow of conversation, and audiovisual and technical concerns. Telesimulation is feasible in cardiac critical care education and was an acceptable alternative to in person simulation for course participants.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"16 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82947767","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. Tripathi, Tara Osman, Mina Hafzalah, Kejin Lee, Drew A. Whalen
Purpose This article assesses the correlation of respiratory variation in inferior vena cava (IVC) with central venous pressure (CVP) in children. Secondary objective was to evaluate IVC variability with clinical hydration status. Methods IVC variability was assessed at the subcostal (SC) and right lateral (RL) region, and collapsibility index (CI) (spontaneously breathing) and distensibility index (DI) (positive pressure) and IVC/aortic ratio were calculated. Partial correlations were calculated between CI/DI with CVP adjusting for body mass index and age. Sensitivity of CI and DI to predict clinical dehydration was calculated using receiver operating characteristic curves. Results A total of 145 ultrasounds were performed on 72 patients (41% positive pressure). Only RL CI in spontaneously breathing patients strongly correlated with CVP (r = –0.65, p < 0.001). A moderate correlation was observed between CI and DI from SC and RL regions (r's = 0.38 and 0.47). Among spontaneously breathing patients, a significant difference was observed in the SC CI based on hydration status. For patients on positive pressure, IVC/aortic ratio had a significant difference. SC CI had the highest area under the curve (0.82) to detect dehydration with 80% sensitivity/87% specificity for a cutoff of 40%. Conclusion SC CI is the most reliable measure to assess the hydration status of spontaneously breathing children, while the IVC/aortic ratio performs well for patients under positive pressure. RL CI has strong negative correlation with CVP in spontaneously breathing patients.
{"title":"Correlation of Ultrasound-Based Hydration Assessment Measures with CVP and Clinical Hydration Status among Children Admitted to the PICU: A Prospective Observational Study","authors":"S. Tripathi, Tara Osman, Mina Hafzalah, Kejin Lee, Drew A. Whalen","doi":"10.1055/s-0042-1746430","DOIUrl":"https://doi.org/10.1055/s-0042-1746430","url":null,"abstract":"\u0000 Purpose This article assesses the correlation of respiratory variation in inferior vena cava (IVC) with central venous pressure (CVP) in children. Secondary objective was to evaluate IVC variability with clinical hydration status.\u0000 Methods IVC variability was assessed at the subcostal (SC) and right lateral (RL) region, and collapsibility index (CI) (spontaneously breathing) and distensibility index (DI) (positive pressure) and IVC/aortic ratio were calculated. Partial correlations were calculated between CI/DI with CVP adjusting for body mass index and age. Sensitivity of CI and DI to predict clinical dehydration was calculated using receiver operating characteristic curves.\u0000 Results A total of 145 ultrasounds were performed on 72 patients (41% positive pressure). Only RL CI in spontaneously breathing patients strongly correlated with CVP (r = –0.65, p < 0.001). A moderate correlation was observed between CI and DI from SC and RL regions (r's = 0.38 and 0.47). Among spontaneously breathing patients, a significant difference was observed in the SC CI based on hydration status. For patients on positive pressure, IVC/aortic ratio had a significant difference. SC CI had the highest area under the curve (0.82) to detect dehydration with 80% sensitivity/87% specificity for a cutoff of 40%.\u0000 Conclusion SC CI is the most reliable measure to assess the hydration status of spontaneously breathing children, while the IVC/aortic ratio performs well for patients under positive pressure. RL CI has strong negative correlation with CVP in spontaneously breathing patients.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"27 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83336933","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}
Raymond Parlar-Chun, Meaghan Lafferty-Prather, V. M. Gonzalez, Hanna Huh, Guenet H Degaffe, Monaliza S. Evangelista, S. Gavvala, S. Khera, A. Gourishankar
Objectives In this article, we aimed to determine if there is a difference in length of respiratory support between nasoduodenal (NDT) and nasogastric tube (NGT) feedings in patients with bronchiolitis on high-flow nasal cannula (HFNC). Methods A single-center nonblinded parallel randomized control trial at a tertiary care hospital was designed. Pediatric patients ≤ 12 months old with bronchiolitis, on HFNC, requiring nutrition via a feeding tube were eligible. Patients were randomized to NGT or NDT and stratified into low- and high-risk groups. Length of respiratory support was the primary outcome. Secondary outcomes included length of stay, number of emesis events, maximum level of respiratory support, number of X-rays to confirm tube placement, number of attempts to place the tube by staff, adverse events during placement, instances of pediatric intensive care unit admission, and emergency room visits and hospital readmissions within 7 and 30 days after discharge. Results Forty patients were randomized, 20 in each arm. There were no significant differences in baseline characteristics. We found no significant difference in length of respiratory support between the two groups (NGT 0.84 incidence rate ratio [0.58, 1.2], p = 0.34). None of the secondary outcomes showed significant differences. Each arm reported one adverse event: nasal trauma in the NGT group and pneumothorax in the NDT group. Conclusion For infants with bronchiolitis on HFNC that need enteric tube feedings, we find no difference in duration of respiratory support or other clinically relevant outcomes for those with NGT or NDT. These results should be interpreted in the context of a limited sample size and an indirect primary outcome of length of respiratory support that may be influenced by other factors besides aspiration events.
{"title":"Randomized Trial to Compare Nasoduodenal Tube and Nasogastric Tube Feeding in Infants with Bronchiolitis on High-Flow Nasal Cannula","authors":"Raymond Parlar-Chun, Meaghan Lafferty-Prather, V. M. Gonzalez, Hanna Huh, Guenet H Degaffe, Monaliza S. Evangelista, S. Gavvala, S. Khera, A. Gourishankar","doi":"10.1055/s-0042-1746178","DOIUrl":"https://doi.org/10.1055/s-0042-1746178","url":null,"abstract":"\u0000 Objectives In this article, we aimed to determine if there is a difference in length of respiratory support between nasoduodenal (NDT) and nasogastric tube (NGT) feedings in patients with bronchiolitis on high-flow nasal cannula (HFNC).\u0000 Methods A single-center nonblinded parallel randomized control trial at a tertiary care hospital was designed. Pediatric patients ≤ 12 months old with bronchiolitis, on HFNC, requiring nutrition via a feeding tube were eligible. Patients were randomized to NGT or NDT and stratified into low- and high-risk groups. Length of respiratory support was the primary outcome. Secondary outcomes included length of stay, number of emesis events, maximum level of respiratory support, number of X-rays to confirm tube placement, number of attempts to place the tube by staff, adverse events during placement, instances of pediatric intensive care unit admission, and emergency room visits and hospital readmissions within 7 and 30 days after discharge.\u0000 Results Forty patients were randomized, 20 in each arm. There were no significant differences in baseline characteristics. We found no significant difference in length of respiratory support between the two groups (NGT 0.84 incidence rate ratio [0.58, 1.2], p = 0.34). None of the secondary outcomes showed significant differences. Each arm reported one adverse event: nasal trauma in the NGT group and pneumothorax in the NDT group.\u0000 Conclusion For infants with bronchiolitis on HFNC that need enteric tube feedings, we find no difference in duration of respiratory support or other clinically relevant outcomes for those with NGT or NDT. These results should be interpreted in the context of a limited sample size and an indirect primary outcome of length of respiratory support that may be influenced by other factors besides aspiration events.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"123 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88209934","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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