Kimberley Harper, Jessica Anderson, Julie S. Pingel, K. Boyle, Li Wang, C. Lindsell, A. Sweeney, Kristina A. Betters
Abstract Objective This article compares patient outcomes before and after implementation of a risk stratified pediatric sedation weaning protocol. Methods This observational cohort study, in a 30-bed tertiary care pediatric intensive care unit (PICU), included patients requiring opioid, benzodiazepine, and/or dexmedetomidine infusions. Outcomes (duration of wean, PICU length of stay [LOS], and Withdrawal Assessment Tool [WAT-1] scores) were collected by retrospective chart review for 12 months before and after protocol implementation. The influence of the protocol was assessed using an interrupted time series (ITS) analysis. Results There were 49 patients before and 47 patients after protocol implementation. Median opioid wean duration preprotocol was 10.5 days (interquartile range [IQR]: 4.25, 20.75) versus 9.0 days (IQR: 5.0, 16.75) postprotocol ( p = 0.66). Median benzodiazepine wean duration was 11.5 days (IQR: 3.0, 19.8) preprotocol versus 5.0 days (IQR: 2.0, 13.5) postprotocol ( p = 0.31). Median alpha-agonist wean duration was 7.0 days (IQR: 3.5, 17.0) preprotocol versus 3 days (IQR: 1.0, 14.0) postprotocol ( p = 0.03). The ITS indicated a reduction in opioid wean by 6.7 days ( p = 0.35), a reduction in benzodiazepine wean by 13.4 days ( p = 0.12), and a reduction in alpha-agonist wean by 12.9 days ( p = 0.06). WAT-1 scores > 3 (12.6% preprotocol vs. 9.9% postprotocol, p = 0.569) and PICU LOS (16.0 days [IQR: 11.0, 26.0] vs. 17.0 days [IQR: 11.0, 26.5], p = 0.796) did not differ between groups. Conclusion Implementation of a risk stratified sedation weaning protocol in the PICU was associated with a significant reduction in alpha-agonist wean duration without a significant increase in withdrawal symptoms.
{"title":"Outcomes Associated with a Pediatric Intensive Care Unit Sedation Weaning Protocol","authors":"Kimberley Harper, Jessica Anderson, Julie S. Pingel, K. Boyle, Li Wang, C. Lindsell, A. Sweeney, Kristina A. Betters","doi":"10.1055/s-0043-1769119","DOIUrl":"https://doi.org/10.1055/s-0043-1769119","url":null,"abstract":"Abstract Objective This article compares patient outcomes before and after implementation of a risk stratified pediatric sedation weaning protocol. Methods This observational cohort study, in a 30-bed tertiary care pediatric intensive care unit (PICU), included patients requiring opioid, benzodiazepine, and/or dexmedetomidine infusions. Outcomes (duration of wean, PICU length of stay [LOS], and Withdrawal Assessment Tool [WAT-1] scores) were collected by retrospective chart review for 12 months before and after protocol implementation. The influence of the protocol was assessed using an interrupted time series (ITS) analysis. Results There were 49 patients before and 47 patients after protocol implementation. Median opioid wean duration preprotocol was 10.5 days (interquartile range [IQR]: 4.25, 20.75) versus 9.0 days (IQR: 5.0, 16.75) postprotocol ( p = 0.66). Median benzodiazepine wean duration was 11.5 days (IQR: 3.0, 19.8) preprotocol versus 5.0 days (IQR: 2.0, 13.5) postprotocol ( p = 0.31). Median alpha-agonist wean duration was 7.0 days (IQR: 3.5, 17.0) preprotocol versus 3 days (IQR: 1.0, 14.0) postprotocol ( p = 0.03). The ITS indicated a reduction in opioid wean by 6.7 days ( p = 0.35), a reduction in benzodiazepine wean by 13.4 days ( p = 0.12), and a reduction in alpha-agonist wean by 12.9 days ( p = 0.06). WAT-1 scores > 3 (12.6% preprotocol vs. 9.9% postprotocol, p = 0.569) and PICU LOS (16.0 days [IQR: 11.0, 26.0] vs. 17.0 days [IQR: 11.0, 26.5], p = 0.796) did not differ between groups. Conclusion Implementation of a risk stratified sedation weaning protocol in the PICU was associated with a significant reduction in alpha-agonist wean duration without a significant increase in withdrawal symptoms.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"123 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83000450","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}
N. Shah, Radha B. Patel, Pranali Awadhare, Tracy McCallin, U. Bhalala
Abstract Noninvasive hemodynamic monitoring devices have been introduced to better quantify fluid responsiveness in pediatric shock; however, current evidence for their use is inconsistent. This review aims to examine available noninvasive hemodynamic monitoring techniques for assessing fluid responsiveness in children with shock. A comprehensive literature search was conducted using PubMed and Google Scholar, examining published studies until December 31, 2022. Articles were identified using initial keywords: [noninvasive] AND [fluid responsiveness]. Inclusion criteria included age 0 to 18, use of noninvasive techniques, and the emergency department (ED) or pediatric intensive care unit (PICU) settings. Abstracts, review papers, articles investigating intraoperative monitoring, and non-English studies were excluded. The methodological index for nonrandomized studies (MINORS) score was used to assess impact of study bias and all study components were aligned with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Our review yielded 1,353 articles, 17 of which met our inclusion criteria, consisting of 618 patients. All were prospective observational studies performed in the ED ( n = 3) and PICU ( n = 14). Etiologies of shock were disclosed in 13/17 papers and consisted of patients in septic shock (38%), cardiogenic shock (29%), and hypovolemic shock (23%). Noninvasive hemodynamic monitors included transthoracic echocardiography (TTE) ( n = 10), ultrasonic cardiac output monitor (USCOM) ( n = 1), inferior vena cava ultrasonography ( n = 2), noninvasive cardiac output monitoring (NICOM)/electrical cardiometry ( n = 5), and >2 modalities ( n = 1). To evaluate fluid responsiveness, most commonly examined parameters included stroke volume variation ( n = 6), cardiac index (CI) ( n = 6), aortic blood flow peak velocity (∆ V peak ) ( n = 3), and change in stroke volume index ( n = 3). CI increase >10% predicted fluid responsiveness by TTE in all ages; however, when using NICOM, this increase was only predictive in children >5 years old. Additionally, ∆SV of 10 to 13% using TTE and USCOM was deemed predictive, while no studies concluded distensibility index by transabdominal ultrasound to be significantly predictive. Few articles explore implications of noninvasive hemodynamic monitors in evaluating fluid responsiveness in pediatric shock, especially in the ED setting. Consensus about their utility remains unclear, reiterating the need for further investigations of efficacy, accuracy, and applicability of these techniques.
{"title":"Assessing Fluid Responsiveness Using Noninvasive Hemodynamic Monitoring in Pediatric Shock: A Review","authors":"N. Shah, Radha B. Patel, Pranali Awadhare, Tracy McCallin, U. Bhalala","doi":"10.1055/s-0043-1771347","DOIUrl":"https://doi.org/10.1055/s-0043-1771347","url":null,"abstract":"Abstract Noninvasive hemodynamic monitoring devices have been introduced to better quantify fluid responsiveness in pediatric shock; however, current evidence for their use is inconsistent. This review aims to examine available noninvasive hemodynamic monitoring techniques for assessing fluid responsiveness in children with shock. A comprehensive literature search was conducted using PubMed and Google Scholar, examining published studies until December 31, 2022. Articles were identified using initial keywords: [noninvasive] AND [fluid responsiveness]. Inclusion criteria included age 0 to 18, use of noninvasive techniques, and the emergency department (ED) or pediatric intensive care unit (PICU) settings. Abstracts, review papers, articles investigating intraoperative monitoring, and non-English studies were excluded. The methodological index for nonrandomized studies (MINORS) score was used to assess impact of study bias and all study components were aligned with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Our review yielded 1,353 articles, 17 of which met our inclusion criteria, consisting of 618 patients. All were prospective observational studies performed in the ED ( n = 3) and PICU ( n = 14). Etiologies of shock were disclosed in 13/17 papers and consisted of patients in septic shock (38%), cardiogenic shock (29%), and hypovolemic shock (23%). Noninvasive hemodynamic monitors included transthoracic echocardiography (TTE) ( n = 10), ultrasonic cardiac output monitor (USCOM) ( n = 1), inferior vena cava ultrasonography ( n = 2), noninvasive cardiac output monitoring (NICOM)/electrical cardiometry ( n = 5), and >2 modalities ( n = 1). To evaluate fluid responsiveness, most commonly examined parameters included stroke volume variation ( n = 6), cardiac index (CI) ( n = 6), aortic blood flow peak velocity (∆ V peak ) ( n = 3), and change in stroke volume index ( n = 3). CI increase >10% predicted fluid responsiveness by TTE in all ages; however, when using NICOM, this increase was only predictive in children >5 years old. Additionally, ∆SV of 10 to 13% using TTE and USCOM was deemed predictive, while no studies concluded distensibility index by transabdominal ultrasound to be significantly predictive. Few articles explore implications of noninvasive hemodynamic monitors in evaluating fluid responsiveness in pediatric shock, especially in the ED setting. Consensus about their utility remains unclear, reiterating the need for further investigations of efficacy, accuracy, and applicability of these techniques.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"262 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91188800","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}
Abstract Health care throughput is the progression of patients from admission to discharge, limited by bed occupancy and hospital capacity. This study examines heart center throughput, cascading effects of limited beds, transfer delays, and nursing staffing on outcomes utilizing elective surgery cancellation during the initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic wave. This study was a retrospective single-center study of staffing, adverse events, and transfers. The study period was January 1, 2018 to December 31, 2020 with the SARS-CoV-2 period March to May 2020. There were 2,589 patients, median age 5 months (6 days–4 years), 1,543 (60%) surgical and 1,046 (40%) medical. Mortality was 3.9% ( n = 101), median stay 5 days (3–11 days), median 1:1 nurse staffing 40% (33–48%), median occupancy 54% (43–65%) for step-down unit, and 81% (74–85%) for cardiac intensive care unit. Every 10% increase in step-down unit occupancy had a 0.5-day increase in cardiac intensive care unit stay ( p = 0.044), 2.1% increase in 2-day readmission ( p = 0.023), and 2.6% mortality increase ( p < 0.001). Every 10% increase in cardiac intensive care unit occupancy had 3.4% increase in surgical delay ( p = 0.016), 6.5% increase in transfer delay ( p = 0.020), and a 15% increase in total reported adverse events ( p < 0.01). Elective surgery cancellation is associated with reduced high occupancy days (23–10%, p < 0.001), increased 1:1 nursing (34–55%, p < 0.001), decreased transfer delays (19–4%, p = 0.008), and decreased mortality (3.7–1.5%, p = 0.044). In conclusion, Elective surgery cancellation was associated with increased 1:1 nursing and decreased mortality. Increased cardiac step-down unit occupancy was associated with longer cardiac intensive care unit stay, increased transfer, and surgical delays.
{"title":"The Association of Bedside Nurse Staffing on Patient Outcomes and Throughput in a Pediatric Cardiac Intensive Care Unit","authors":"Michael P. Fundora, Jiayi Liu, D. Kc, C. Calamaro","doi":"10.1055/s-0043-1769118","DOIUrl":"https://doi.org/10.1055/s-0043-1769118","url":null,"abstract":"Abstract Health care throughput is the progression of patients from admission to discharge, limited by bed occupancy and hospital capacity. This study examines heart center throughput, cascading effects of limited beds, transfer delays, and nursing staffing on outcomes utilizing elective surgery cancellation during the initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic wave. This study was a retrospective single-center study of staffing, adverse events, and transfers. The study period was January 1, 2018 to December 31, 2020 with the SARS-CoV-2 period March to May 2020. There were 2,589 patients, median age 5 months (6 days–4 years), 1,543 (60%) surgical and 1,046 (40%) medical. Mortality was 3.9% ( n = 101), median stay 5 days (3–11 days), median 1:1 nurse staffing 40% (33–48%), median occupancy 54% (43–65%) for step-down unit, and 81% (74–85%) for cardiac intensive care unit. Every 10% increase in step-down unit occupancy had a 0.5-day increase in cardiac intensive care unit stay ( p = 0.044), 2.1% increase in 2-day readmission ( p = 0.023), and 2.6% mortality increase ( p < 0.001). Every 10% increase in cardiac intensive care unit occupancy had 3.4% increase in surgical delay ( p = 0.016), 6.5% increase in transfer delay ( p = 0.020), and a 15% increase in total reported adverse events ( p < 0.01). Elective surgery cancellation is associated with reduced high occupancy days (23–10%, p < 0.001), increased 1:1 nursing (34–55%, p < 0.001), decreased transfer delays (19–4%, p = 0.008), and decreased mortality (3.7–1.5%, p = 0.044). In conclusion, Elective surgery cancellation was associated with increased 1:1 nursing and decreased mortality. Increased cardiac step-down unit occupancy was associated with longer cardiac intensive care unit stay, increased transfer, and surgical delays.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74924735","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}
Pub Date : 2023-02-02eCollection Date: 2023-03-01DOI: 10.1055/s-0043-1761465
{"title":"Contributing Reviewers in 2022.","authors":"","doi":"10.1055/s-0043-1761465","DOIUrl":"10.1055/s-0043-1761465","url":null,"abstract":"","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"12 1","pages":"i-iv"},"PeriodicalIF":0.7,"publicationDate":"2023-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9894688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10644530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-13eCollection Date: 2024-09-01DOI: 10.1055/s-0042-1760634
Michele E Smith, Meghan Gray, Patrick T Wilson
Continuous positive airway pressure (CPAP) is a form of noninvasive ventilation used to support pediatric patients with acute respiratory infections. Traditional CPAP interfaces have been associated with inadequate seal, mucocutaneous injury, and aerosolization of infectious particles. The helmet interface may be advantageous given its ability to create a complete seal, avoid skin breakdown, and decrease aerosolization of viruses. We aim to measure tolerability and safety in a pediatric population in the United States and ascertain feedback from parents and health care providers. We performed a prospective, open-label, single-armed feasibility study to assess tolerability and safety of helmet CPAP. Pediatric patients 1 month to 5 years of age admitted to the pediatric intensive care unit with pulmonary infections who were on CPAP for at least 2 hours were eligible. The primary outcome was percentage of patients tolerating helmet CPAP for 4 hours. Secondary measures included the rate of adverse events and change in vital signs. Qualitative feedback was obtained from families, nurses, and respiratory therapists. Five patients were enrolled and 100% tolerated helmet CPAP the full 4-hour study period. No adverse events or significant vital sign changes were observed. All family members preferred to continue the helmet interface, nursing staff noted it made cares easier, and respiratory therapists felt the set up was easy. Helmet CPAP in pediatric patients is well-tolerated, safe, and accepted by medical staff and families in the United States future randomized controlled trials measuring its effectiveness compared with traditional CPAP interfaces are needed.
{"title":"Acceptance and Tolerability of Helmet CPAP in Pediatric Bronchiolitis and Pneumonia: A Feasibility Study.","authors":"Michele E Smith, Meghan Gray, Patrick T Wilson","doi":"10.1055/s-0042-1760634","DOIUrl":"10.1055/s-0042-1760634","url":null,"abstract":"<p><p>Continuous positive airway pressure (CPAP) is a form of noninvasive ventilation used to support pediatric patients with acute respiratory infections. Traditional CPAP interfaces have been associated with inadequate seal, mucocutaneous injury, and aerosolization of infectious particles. The helmet interface may be advantageous given its ability to create a complete seal, avoid skin breakdown, and decrease aerosolization of viruses. We aim to measure tolerability and safety in a pediatric population in the United States and ascertain feedback from parents and health care providers. We performed a prospective, open-label, single-armed feasibility study to assess tolerability and safety of helmet CPAP. Pediatric patients 1 month to 5 years of age admitted to the pediatric intensive care unit with pulmonary infections who were on CPAP for at least 2 hours were eligible. The primary outcome was percentage of patients tolerating helmet CPAP for 4 hours. Secondary measures included the rate of adverse events and change in vital signs. Qualitative feedback was obtained from families, nurses, and respiratory therapists. Five patients were enrolled and 100% tolerated helmet CPAP the full 4-hour study period. No adverse events or significant vital sign changes were observed. All family members preferred to continue the helmet interface, nursing staff noted it made cares easier, and respiratory therapists felt the set up was easy. Helmet CPAP in pediatric patients is well-tolerated, safe, and accepted by medical staff and families in the United States future randomized controlled trials measuring its effectiveness compared with traditional CPAP interfaces are needed.</p>","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"13 1","pages":"296-302"},"PeriodicalIF":0.5,"publicationDate":"2023-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11379528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73090023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract The aim of this study was to determine the ability of neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) to predict the severity of illness as assessed by two scoring systems, namely, Pediatric Logistic Organ Dysfunction-2 (PELOD-2) and Pediatric Risk of Mortality-III (PRISM-III) and outcome. This was a retrospective cohort study wherein all critically ill children aged 1 month to 18 years admitted in the pediatric intensive care unit from January 2021 to October 2022 were included. Children with chronic systemic diseases and hematological illness were excluded from the study. Demographic details, diagnosis, PRISM-III-24 and PELOD-2 scores at admission, and outcome were retrieved from the hospital case records. NLR and PLR values were compared among high and normal PRISM-III and PELOD-2 groups as well as among survivors and nonsurvivors. A total of 325 patients with critical illness were included with a mean (standard deviation) age of 7(5) years and a male: female ratio of 3:2. The values of NLR were significantly higher among the patients with high PRISM-III (2.2 vs. 1.3, p -value = 0.006) and PELOD-2 (2 vs. 1.4, p -value = 0.015) groups compared with normal. The NLR and PLR were significantly higher among the nonsurvivors compared with the survivors (2.3 vs. 1.4, p -value = 0.013, and 59.4 vs. 27.3, p -value = 0.016 for NLR and PLR, respectively). The area under the receiver operating characteristics curve for NLR and PLR was 0.617 and 0.609, respectively. A high PLR, PRISM-III, and PELOD-2 were the factors found to be independently associated with mortality on multiple logistic regression analysis. Patients with high NLR are associated with more severe illness at admission. NLR and PLR are useful parameters to predict mortality.
本研究的目的是确定中性粒细胞淋巴细胞比率(NLR)和血小板淋巴细胞比率(PLR)预测疾病严重程度的能力，通过两个评分系统评估，即儿科Logistic器官功能障碍-2 (PELOD-2)和儿科死亡风险- iii (PRISM-III)和结局。这是一项回顾性队列研究，纳入了2021年1月至2022年10月在儿科重症监护病房住院的所有1个月至18岁的危重患儿。患有慢性全身性疾病和血液系统疾病的儿童被排除在研究之外。从医院病例记录中检索患者的人口学细节、诊断、入院时PRISM-III-24和PELOD-2评分以及结果。比较PRISM-III和PELOD-2高和正常组以及幸存者和非幸存者的NLR和PLR值。共纳入325例危重患者，平均(标准差)年龄为7(5)岁，男女比例为3:2。高PRISM-III组(2.2 vs. 1.3, p值= 0.006)和PELOD-2组(2 vs. 1.4, p值= 0.015)NLR值明显高于正常组。非幸存者的NLR和PLR明显高于幸存者(NLR和PLR分别为2.3比1.4,p值= 0.013,59.4比27.3,p值= 0.016)。NLR和PLR的受试者工作特征曲线下面积分别为0.617和0.609。多重logistic回归分析发现，高PLR、PRISM-III和PELOD-2是与死亡率独立相关的因素。NLR高的患者入院时疾病更严重。NLR和PLR是预测死亡率的有用参数。
{"title":"Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio as Predictors of Disease Severity and Mortality in Critically Ill Children: A Retrospective Cohort Study","authors":"S. Shenoy, S. Patil","doi":"10.1055/s-0043-1768661","DOIUrl":"https://doi.org/10.1055/s-0043-1768661","url":null,"abstract":"Abstract The aim of this study was to determine the ability of neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) to predict the severity of illness as assessed by two scoring systems, namely, Pediatric Logistic Organ Dysfunction-2 (PELOD-2) and Pediatric Risk of Mortality-III (PRISM-III) and outcome. This was a retrospective cohort study wherein all critically ill children aged 1 month to 18 years admitted in the pediatric intensive care unit from January 2021 to October 2022 were included. Children with chronic systemic diseases and hematological illness were excluded from the study. Demographic details, diagnosis, PRISM-III-24 and PELOD-2 scores at admission, and outcome were retrieved from the hospital case records. NLR and PLR values were compared among high and normal PRISM-III and PELOD-2 groups as well as among survivors and nonsurvivors. A total of 325 patients with critical illness were included with a mean (standard deviation) age of 7(5) years and a male: female ratio of 3:2. The values of NLR were significantly higher among the patients with high PRISM-III (2.2 vs. 1.3, p -value = 0.006) and PELOD-2 (2 vs. 1.4, p -value = 0.015) groups compared with normal. The NLR and PLR were significantly higher among the nonsurvivors compared with the survivors (2.3 vs. 1.4, p -value = 0.013, and 59.4 vs. 27.3, p -value = 0.016 for NLR and PLR, respectively). The area under the receiver operating characteristics curve for NLR and PLR was 0.617 and 0.609, respectively. A high PLR, PRISM-III, and PELOD-2 were the factors found to be independently associated with mortality on multiple logistic regression analysis. Patients with high NLR are associated with more severe illness at admission. NLR and PLR are useful parameters to predict mortality.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"92 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80506431","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}
We read with interest the recently published article titled “ Inborn Errors of Metabolism in a Tertiary Pediatric Intensive Care Unit ” by Lipari et al 1 and want to make few important comments. Authors enrolled 65 cases of inborn errors of metabolism (IEMs) with 88 admission to a pediatric intensive care unit (PICU) in Portugal over a period 11 years (2009 – 2019) accounting for 2% of PICU admissions. The children with intoxication disorders, energy metabolism defects, complex molecules, and other disorders accounted for 35.4% ( n ¼ 23), 32.3% ( n ¼ 21), 26.2% ( n ¼ 17), and 6.1% ( n ¼ 4), respectively. The median age at admission to PICU was 3 years (range: 3 days – 21 years) and 70.4% ( n ¼ 62) admissions were for metabolic decompensation and 29.5% ( n ¼ 26) were elective/scheduled surgery/procedure admissions. The reasons for decompensation included infections (55.4%, n ¼ 36) and metabolic stress during neonatal period (18.7%, n ¼ 12). The common clinical presentations were respiratory failure (34.1%, 30/88) and neurological deterioration (29.5%, 26/88). The treatment included mechanical ventilation ( n ¼ 30), continuous venovenous hemodia fi ltration (CVVHDF) ( n ¼ 16), speci fi c nutritional management, and supportive care. The median duration of PICU stay was 3.6 days (range:
{"title":"Inborn Errors of Metabolism in Pediatric Intensive Care Unit: Much More to Understand.","authors":"Puspraj Awasthi, Suresh Kumar Angurana","doi":"10.1055/s-0041-1731022","DOIUrl":"https://doi.org/10.1055/s-0041-1731022","url":null,"abstract":"We read with interest the recently published article titled “ Inborn Errors of Metabolism in a Tertiary Pediatric Intensive Care Unit ” by Lipari et al 1 and want to make few important comments. Authors enrolled 65 cases of inborn errors of metabolism (IEMs) with 88 admission to a pediatric intensive care unit (PICU) in Portugal over a period 11 years (2009 – 2019) accounting for 2% of PICU admissions. The children with intoxication disorders, energy metabolism defects, complex molecules, and other disorders accounted for 35.4% ( n ¼ 23), 32.3% ( n ¼ 21), 26.2% ( n ¼ 17), and 6.1% ( n ¼ 4), respectively. The median age at admission to PICU was 3 years (range: 3 days – 21 years) and 70.4% ( n ¼ 62) admissions were for metabolic decompensation and 29.5% ( n ¼ 26) were elective/scheduled surgery/procedure admissions. The reasons for decompensation included infections (55.4%, n ¼ 36) and metabolic stress during neonatal period (18.7%, n ¼ 12). The common clinical presentations were respiratory failure (34.1%, 30/88) and neurological deterioration (29.5%, 26/88). The treatment included mechanical ventilation ( n ¼ 30), continuous venovenous hemodia fi ltration (CVVHDF) ( n ¼ 16), speci fi c nutritional management, and supportive care. The median duration of PICU stay was 3.6 days (range:","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"11 4","pages":"355-358"},"PeriodicalIF":0.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9649296/pdf/10-1055-s-0041-1731022.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9965902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Troch, Alexandra Lazzara, Flora N. Yazigi, Carly E. Blatt, Avery W. Zierk, B. Chalk, L. Prichett, Sofia Perazzo, K. Rais-Bahrami, R. Boss
Abstract Pediatric chronic critical illness (PCCI) is characterized by prolonged and recurrent hospitalizations, multiorgan conditions, and use of medical technology. Our prior work explored the mismatch between intensive care unit (ICU) acute care models and the chronic needs of patients with PCCI. The objective of this study was to examine whether the number and frequency of treatment weans in ICU care were associated with clinical setbacks and/or length of stay for patients with PCCI. A retrospective chart review of the electronic medical record for 300 pediatric patients with PCCI was performed at the neonatal intensive care unit, pediatric intensive care unit, and cardiac intensive care unit of two urban children's hospitals. Daily patient care data related to weans and setbacks were collected for each ICU day. Data were analyzed using multilevel mixed multiple logistic regression analysis and a multilevel mixed Poisson regression. The patient-week level adjusted regression analysis revealed a strong correlation between weans and setbacks: three or more weekly weans yielded an odds ratio of 3.35 (95% confidence interval [CI] = 2.06–5.44) of having one or more weekly setback. There was also a correlation between weans and length of stay, three or more weekly weans were associated with an incidence rate ratio of 1.09 (95% CI = 1.06–1.12). Long-stay pediatric ICU patients had more clinical setbacks and longer hospitalizations if they had more than two treatment weans per week. This suggests that patients with PCCI may benefit from a slower pace of care than is traditionally used in the ICU. Future research to explore the causative nature of the correlation is needed to improve the care of such challenging patients.
儿童慢性危重症(PCCI)的特点是长期和反复住院，多器官疾病和使用医疗技术。我们之前的工作探讨了重症监护病房(ICU)急性护理模式与PCCI患者的慢性需求之间的不匹配。本研究的目的是研究ICU护理中的治疗次数和频率是否与PCCI患者的临床挫折和/或住院时间有关。对两家城市儿童医院的新生儿重症监护室、儿科重症监护室和心脏重症监护室的300名PCCI儿科患者的电子病历进行回顾性图表审查。每天收集与断奶和挫折相关的患者日常护理数据。数据分析采用多水平混合多元逻辑回归分析和多水平混合泊松回归。患者-周水平调整的回归分析显示，体重和挫折之间存在很强的相关性:三次或更多的每周体重产生一个或更多的每周挫折的比值比为3.35(95%可信区间[CI] = 2.06-5.44)。妊娠期与住院时间也有相关性，每周妊娠3次或更多与1.09的发病率比相关(95% CI = 1.06-1.12)。长期住院的儿科ICU患者如果每周接受两次以上的治疗，则会有更多的临床挫折和更长的住院时间。这表明PCCI患者可能受益于较慢的护理速度，而不是传统的ICU治疗。未来的研究需要探索相关性的因果性质，以改善对这些具有挑战性的患者的护理。
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F. Savorgnan, S. Flores, Rohit S. Loomba, Sebastián Acosta
Abstract The aim of the study was to evaluate the hemodynamic and oximetric changes in patients with parallel circulation (Norwood, hybrid, and BT-shunted) after sodium bicarbonate bolus administration. This study was a retrospective analysis of physiologic data. To eliminate confounders, sodium bicarbonate boluses concurrently administered with normal saline, 5% albumin, epinephrine boluses, blood transfusions, change in vasoactive inotropic score or mechanical circulatory support were excluded. Blood pressure, arterial oxygen saturation, heart rate (HR), and cerebral and renal near infrared spectroscopy were continuously recorded from 1-hour pre to 1-hour post each intervention. Out of 429 boluses, 293 boluses met the inclusion criteria. Measurements show an increase in blood pressure ( p = 0.01) and HR ( p < 0.01), and a decrease in pulmonary-to-systemic flow ratio ( p = 0.02) and renal oxygen extraction ratio (rOER) ( p = 0.04) at some point during the first hour postbolus. The arterial oxygen saturation increased, and the rOER decreased for those patients with pre-bolus pH < 7.20 and/or pre-bolus serum bicarbonate level < 18 mEq/L, according to linear regression models ( p < 0.05). Sodium bicarbonate was associated with improvement of hemodynamic and oximetric parameters in this cohort, particularly for those patients with pH < 7.20 and/or serum bicarbonate level < 18 mEq/L. This finding is consistent with an increase in cardiac output due to the removal of the acidotic negative inotropic effect by the sodium bicarbonate.
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Pub Date : 2022-11-21eCollection Date: 2023-03-01DOI: 10.1055/s-0042-1758746
Hüseyin Çaksen
One-hundred and twenty-four thousand prophets came from the first Prophet Adam (Alayhi As-Salam [AS]), the first man, to the last Prophet Muhammad (Salla Allahu Alayhi Wa Sallam [SAW]).1 The Prophet Isa (AS) is one of the five greatest (ulul-azm) prophets. The others are Nuh (AS), Ibrahim (AS), Musa (AS), and Muhammad (SAW).2 Jesus (Isa) is the prophet who is mentioned as Isa, Ibn Maryam, and Messiah in the Quran, who is given the Bible, who is reported to give the good news of Muhammad (SAW), who is described as “a spirit and word from Allah,” but who is emphasized as a servant. Isa (AS) performed many miracles, such as resurrecting the dead by Allah’s leave. He resurrects Lazarus, who was dead 4 days ago.3 The prophets’ miracles were mentioned in the Quran, so that people imitate these miracles and make similar ones. Herein, we discussed the Prophet Isa’s (AS) the miracle of “bringing the dead into life” from the Islamic perspective to emphasize that Isa (AS) addressed today’s intensivists with this miracle. The All-Wise Quran sends the prophets to man’s communities as leaders and vanguards of spiritual and moral progress. Similarly, it gives all of them several wonders and makes them the masters and foremen in regard to mankind’s material progress, and commands men to follow them absolutely. Thus, just as by speaking of the spiritual and moral perfections of the prophets, it is encouraging people to benefit from them, so too in discussing their miracles it is inferring encouragement to achieve similar things and to imitate them. It may even be said that like spiritual and moral attainments, material attainments and wonders were first given to mankind as a gift by the hand of miracles.1 The Quran says about Isa’s (AS) miracles as follows: “I (Isa) heal those born blind, and the lepers, and I (Isa) bring the dead into life, by Allah’s leave.”4,5Nursi1 interpreted this ayat as follows: Just as the Quran explicitly urges man to follow Isa’s (AS) high morals, so it allusively encourages him toward the elevated art and dominical medicine of which Isawas the master. The ayat indicates the following: “Remedies may be found for even themost chronic ills. Inwhich case, Oman!, O calamity-afflicted sons of Adem (AS)! Don’t despair! Whatever the ill, its cure is possible. Search for it and you will find it. It is even possible to give a temporary tinge of life to death.”And in meaning Almighty Allah is saying through the figurative tongue of this ayat: “Oman! I gave two gifts to one of My servants who abandoned the world for Me. One was the remedy for spiritual ills, and the other the cure for physical sicknesses. Moribund hearts were raised to life through the light of guidance, and sick people who were as though dead found health through his breath and cure. You too may find the cure for every ill in the pharmacy of My wisdom. Work to find it! If you seek, you will certainly find.” Thus, this ayat traces the limit that is far ahead of man’s present progr
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