K. Wollny, A. Metcalfe, K. Benzies, S. Parsons, T. Sajobi, D. Mcneil
The purpose of this study was to describe the care of intubated patients in pediatric critical care. Acknowledging there are several perceived factors that contribute to unplanned extubations, a secondary objective was to describe how practice variation may relate to observed differences in unplanned extubation rates. A survey about practices related to the care of intubated patients was distributed to all pediatric intensive care units (PICUs) participating in the Virtual Pediatric Systems (VPS, LLC). Unplanned extubation rates for 2019 to 2020 were obtained from VPS. Univariate and bivariate analyses were performed to describe the responses, with unplanned extubation rates calculated as means. The text responses about perceived causes of unplanned extubation in participants' sites were explored using thematic content analysis. A total of 44 PICUs were included in this study (response rate 37.0%). The mean unplanned extubation rate for the sample was 0.41 (95% confidence interval: 0.31–0.50) per 100 intubation days. Variability was found across several aspects that impact care, including staffing, the frequency of procedures (e.g., chest radiography), and treatment-related goals (e.g., sedation and mobilization). The perceived causes of unplanned extubations in the sample included patient-, staff-, and equipment-related factors. We found practice variability in pediatric critical care units related to the care of intubated patients, which may contribute to the frequency of adverse events. As evidence emerges and professional associations and organizations recommend the best practices, knowledge translation will be required for the implementation and deimplementation of practices to improve the quality of care in PICUs.
{"title":"Practice Variability and Unplanned Extubation Rates across Pediatric Intensive Care Units","authors":"K. Wollny, A. Metcalfe, K. Benzies, S. Parsons, T. Sajobi, D. Mcneil","doi":"10.1055/s-0042-1757625","DOIUrl":"https://doi.org/10.1055/s-0042-1757625","url":null,"abstract":"The purpose of this study was to describe the care of intubated patients in pediatric critical care. Acknowledging there are several perceived factors that contribute to unplanned extubations, a secondary objective was to describe how practice variation may relate to observed differences in unplanned extubation rates. A survey about practices related to the care of intubated patients was distributed to all pediatric intensive care units (PICUs) participating in the Virtual Pediatric Systems (VPS, LLC). Unplanned extubation rates for 2019 to 2020 were obtained from VPS. Univariate and bivariate analyses were performed to describe the responses, with unplanned extubation rates calculated as means. The text responses about perceived causes of unplanned extubation in participants' sites were explored using thematic content analysis. A total of 44 PICUs were included in this study (response rate 37.0%). The mean unplanned extubation rate for the sample was 0.41 (95% confidence interval: 0.31–0.50) per 100 intubation days. Variability was found across several aspects that impact care, including staffing, the frequency of procedures (e.g., chest radiography), and treatment-related goals (e.g., sedation and mobilization). The perceived causes of unplanned extubations in the sample included patient-, staff-, and equipment-related factors. We found practice variability in pediatric critical care units related to the care of intubated patients, which may contribute to the frequency of adverse events. As evidence emerges and professional associations and organizations recommend the best practices, knowledge translation will be required for the implementation and deimplementation of practices to improve the quality of care in PICUs.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84893329","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}
Tarek A. Abdelaziz, M. Romih, W. Ismail, Khadija A.L. Mabrouk Emhalhal, E. Baz
This study aimed to assess the relationship between non-thyroidal illness syndrome (NTIS) and extubation outcomes in pediatric patients requiring mechanical ventilation. This prospective cohort study included 59 patients who underwent mechanical ventilation in the pediatric intensive care unit of a tertiary care university hospital from July 2020 to June 2021. Each patient underwent laboratory testing including serum levels of thyroid-stimulating hormone (TSH), free T3 (fT3), free T4 (fT4), and reverse T3 (rT3) on the first and third days of mechanical ventilation. On the first day of mechanical ventilation, 62.7% of patients had low fT3, which significantly increased to 78% of patients on the third day. In comparison to values on day one, median levels of fT3 and fT4 significantly decreased and rT3 significantly increased on day three. However, no significant differences were found in the median TSH levels over the same time span. Thirty-five patients (59%) survived while 24 patients (41%) did not survive. Compared with survivors, non-survivors had significantly higher median serum TSH levels on day one, while all other thyroid function tests assays did not significantly differ between days one and three. Of note, serum TSH, fT3, fT4, and rT3 levels, on the first and third days, did not differ significantly between patients who experienced extubation failure and extubation success. To the best of our knowledge, this is the first study to examine thyroid function values in mechanically ventilated children to determine their correlation with extubation outcomes. In this study, NTIS did not correlate with extubation outcomes in critically ill children undergoing mechanical ventilation.
{"title":"Correlation of Nonthyroidal Illness Syndrome with Extubation Outcome in Mechanically Ventilated Children: A Prospective Cohort Study","authors":"Tarek A. Abdelaziz, M. Romih, W. Ismail, Khadija A.L. Mabrouk Emhalhal, E. Baz","doi":"10.1055/s-0042-1757477","DOIUrl":"https://doi.org/10.1055/s-0042-1757477","url":null,"abstract":"This study aimed to assess the relationship between non-thyroidal illness syndrome (NTIS) and extubation outcomes in pediatric patients requiring mechanical ventilation. This prospective cohort study included 59 patients who underwent mechanical ventilation in the pediatric intensive care unit of a tertiary care university hospital from July 2020 to June 2021. Each patient underwent laboratory testing including serum levels of thyroid-stimulating hormone (TSH), free T3 (fT3), free T4 (fT4), and reverse T3 (rT3) on the first and third days of mechanical ventilation. On the first day of mechanical ventilation, 62.7% of patients had low fT3, which significantly increased to 78% of patients on the third day. In comparison to values on day one, median levels of fT3 and fT4 significantly decreased and rT3 significantly increased on day three. However, no significant differences were found in the median TSH levels over the same time span. Thirty-five patients (59%) survived while 24 patients (41%) did not survive. Compared with survivors, non-survivors had significantly higher median serum TSH levels on day one, while all other thyroid function tests assays did not significantly differ between days one and three. Of note, serum TSH, fT3, fT4, and rT3 levels, on the first and third days, did not differ significantly between patients who experienced extubation failure and extubation success. To the best of our knowledge, this is the first study to examine thyroid function values in mechanically ventilated children to determine their correlation with extubation outcomes. In this study, NTIS did not correlate with extubation outcomes in critically ill children undergoing mechanical ventilation.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"49 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77398146","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 : 2022-10-11eCollection Date: 2024-09-01DOI: 10.1055/s-0042-1757480
Colin J Sallee, Julie C Fitzgerald, Lincoln S Smith, Joseph R Angelo, Megan C Daniel, Shira J Gertz, Deyin D Hsing, Kris M Mahadeo, Jennifer A McArthur, Courtney M Rowan
The aim of the study is to examine the relationship between fluid overload (FO) and severity of respiratory dysfunction in children posthematopoietic cell transplantation (HCT) with pediatric acute respiratory distress syndrome (PARDS). This investigation was a secondary analysis of a multicenter retrospective cohort of children (1month to 21 years) postallogeneic HCT with PARDS receiving invasive mechanical ventilation (IMV) from 2009 to 2014. Daily FO % (FO%) and daily oxygenation index (OI) were calculated for each patient up to the first week of IMV (day 0 = intubation). Linear mixed-effect regression was employed to examine whether FO% and OI were associated on any day during the study period. In total, 158 patients were included. Severe PARDS represented 63% of the cohort and had higher mortality (78 vs. 42%, p <0.001), fewer ventilator free days at 28 (0 [IQR: 0-0] vs. 14 [IQR: 0-23], p <0.001), and 60 days (0 [IQR: 0-27] v. 45 [IQR: 0-55], p <0.001) relative to nonsevere PARDS. Increasing FO% was strongly associated with higher OI ( p <0.001). For children with 10% FO, OI was higher by nearly 5 points (adjusted β , 4.6, 95% CI: [2.9, 6.3]). In subgroup analyses, the association between FO% and OI was strongest among severe PARDS ( p <0.001) and during the first 3 days elapsed from intubation ( p <0.001). FO% was associated with lower PaO 2 /FiO 2 (adjusted β , -1.92, 95% CI: [-3.11, -0.73], p = 0.002), but not mean airway pressure ( p = 0.746). In a multicenter cohort of children post-HCT with PARDS, FO was independently associated with oxygenation impairment. The associations were strongest among children with severe PARDS and early in the course of IMV.
本研究的目的是探讨儿童造血后细胞移植（HCT）合并小儿急性呼吸窘迫综合征（PARDS）患者体液超载（FO）与呼吸功能障碍严重程度之间的关系。本研究是对2009年至2014年接受有创机械通气（IMV）的异基因HCT后PARDS患儿（1个月至21岁）的多中心回顾性队列进行的二次分析。计算每位患者至IMV第一周（第0天=插管）的每日FO% （FO%）和每日氧合指数（OI）。采用线性混合效应回归来检验在研究期间的任何一天FO%和OI是否相关。共纳入158例患者。严重PARDS占队列的63%，死亡率更高（78比42%，p p p β, 4.6, 95% CI:[2.9, 6.3]）。在亚组分析中，FO%和OI之间的相关性在严重PARDS中最强(p p 2 /FiO 2（校正后的β， -1.92, 95% CI: [-3.11, -0.73], p = 0.002），但在平均气道压力中没有相关性（p = 0.746）。在hct后PARDS患儿的多中心队列中，FO与氧合损伤独立相关。这种关联在严重PARDS患儿和IMV病程早期最为明显。
{"title":"Fluid Overload in Pediatric Acute Respiratory Distress Syndrome after Allogeneic Hematopoietic Cell Transplantation.","authors":"Colin J Sallee, Julie C Fitzgerald, Lincoln S Smith, Joseph R Angelo, Megan C Daniel, Shira J Gertz, Deyin D Hsing, Kris M Mahadeo, Jennifer A McArthur, Courtney M Rowan","doi":"10.1055/s-0042-1757480","DOIUrl":"10.1055/s-0042-1757480","url":null,"abstract":"<p><p>The aim of the study is to examine the relationship between fluid overload (FO) and severity of respiratory dysfunction in children posthematopoietic cell transplantation (HCT) with pediatric acute respiratory distress syndrome (PARDS). This investigation was a secondary analysis of a multicenter retrospective cohort of children (1month to 21 years) postallogeneic HCT with PARDS receiving invasive mechanical ventilation (IMV) from 2009 to 2014. Daily FO % (FO%) and daily oxygenation index (OI) were calculated for each patient up to the first week of IMV (day 0 = intubation). Linear mixed-effect regression was employed to examine whether FO% and OI were associated on any day during the study period. In total, 158 patients were included. Severe PARDS represented 63% of the cohort and had higher mortality (78 vs. 42%, <i>p</i> <0.001), fewer ventilator free days at 28 (0 [IQR: 0-0] vs. 14 [IQR: 0-23], <i>p</i> <0.001), and 60 days (0 [IQR: 0-27] v. 45 [IQR: 0-55], <i>p</i> <0.001) relative to nonsevere PARDS. Increasing FO% was strongly associated with higher OI ( <i>p</i> <0.001). For children with 10% FO, OI was higher by nearly 5 points (adjusted <i>β</i> , 4.6, 95% CI: [2.9, 6.3]). In subgroup analyses, the association between FO% and OI was strongest among severe PARDS ( <i>p</i> <0.001) and during the first 3 days elapsed from intubation ( <i>p</i> <0.001). FO% was associated with lower PaO <sub>2</sub> /FiO <sub>2</sub> (adjusted <i>β</i> , -1.92, 95% CI: [-3.11, -0.73], <i>p</i> = 0.002), but not mean airway pressure ( <i>p</i> = 0.746). In a multicenter cohort of children post-HCT with PARDS, FO was independently associated with oxygenation impairment. The associations were strongest among children with severe PARDS and early in the course of IMV.</p>","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"46 1","pages":"286-295"},"PeriodicalIF":0.5,"publicationDate":"2022-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11379529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80721263","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}
Metabolic disturbances frequently occur in neonatal seizures either as an underlying cause or as an associated abnormality. A prompt recognition of metabolic abnormalities and early therapy are necessary to avoid poor neurological outcome. Neonates with clinical seizures were enrolled in the study. Diagnostic evaluation included complete blood count, sepsis screen, and estimation of blood glucose, serum sodium, calcium and magnesium before instituting any specific treatment. Metabolic abnormalities were considered as isolated when hypoxic ischemic encephalopathy (HIE), sepsis, intracranial hemorrhage, and polycythemia were ruled out. Among 80 newborns with clinical seizures, one metabolic abnormality was detected in 46 (57.5%) newborns. The commonest metabolic abnormality observed was hypoglycemia, noted in 22/80 (27.5%) newborns. Hypocalcemia was the second common abnormality, noted in 10/80 (12.5%) newborns. Isolated metabolic abnormalities were observed in 23.8% (19/80) of newborns with seizures. Associated morbidities with seizures included HIE in 21 (26.3%) and sepsis in 28 (35%). Hypoglycemia was the commonest isolated metabolic abnormality (12.5%). Metabolic abnormalities co-existed with HIE in nine out of 21 neonates and with sepsis in eight out of 28 neonates. Hypoglycemia was the common abnormality associated with both the conditions. Inborn errors of metabolism constituted 8.8% of the cohort studied (7 of 80 patients). A metabolic abnormality was detected in more than 50% neonates with clinical seizures enrolled in our study. Metabolic abnormality also co-exists in neonates with HIE as well as sepsis-related seizures.
{"title":"Metabolic Abnormalities in Association with Clinical Neonatal Seizures in an Indian Tertiary Care Centre","authors":"R. Y., Sandeep Pd","doi":"10.1055/s-0042-1757479","DOIUrl":"https://doi.org/10.1055/s-0042-1757479","url":null,"abstract":"Metabolic disturbances frequently occur in neonatal seizures either as an underlying cause or as an associated abnormality. A prompt recognition of metabolic abnormalities and early therapy are necessary to avoid poor neurological outcome. Neonates with clinical seizures were enrolled in the study. Diagnostic evaluation included complete blood count, sepsis screen, and estimation of blood glucose, serum sodium, calcium and magnesium before instituting any specific treatment. Metabolic abnormalities were considered as isolated when hypoxic ischemic encephalopathy (HIE), sepsis, intracranial hemorrhage, and polycythemia were ruled out. Among 80 newborns with clinical seizures, one metabolic abnormality was detected in 46 (57.5%) newborns. The commonest metabolic abnormality observed was hypoglycemia, noted in 22/80 (27.5%) newborns. Hypocalcemia was the second common abnormality, noted in 10/80 (12.5%) newborns. Isolated metabolic abnormalities were observed in 23.8% (19/80) of newborns with seizures. Associated morbidities with seizures included HIE in 21 (26.3%) and sepsis in 28 (35%). Hypoglycemia was the commonest isolated metabolic abnormality (12.5%). Metabolic abnormalities co-existed with HIE in nine out of 21 neonates and with sepsis in eight out of 28 neonates. Hypoglycemia was the common abnormality associated with both the conditions. Inborn errors of metabolism constituted 8.8% of the cohort studied (7 of 80 patients). A metabolic abnormality was detected in more than 50% neonates with clinical seizures enrolled in our study. Metabolic abnormality also co-exists in neonates with HIE as well as sepsis-related seizures.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"1 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83499499","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}
The aim of the study is to provide a comprehensive review of vascular complications secondary to peripheral arterial catheterization in preterm and term neonates. The systematic review consisted of searching PubMed, Scopus, Google Scholar, Cochrane Database of Systematic Reviews, and references of journals using pre-trialed MeSH terms and articles. Eight studies were included for full text analysis from 2,369 initial articles: six retrospective reviews and two prospective studies. Rate of complication was 8.6% and all complications were ischemic in nature. Complications most often occurred in neonates with pulmonary/cardiac comorbidities and lower gestational ages. No association was found for weight and sex of neonates. The radial artery site presented with lower rates of complication of 6% and the femoral presented with the highest (16%). Complications predominately occurred in catheter sizes larger than 22 gauge and most often within 1 day of insertion. A low rate of complications (7.4%) was observed in studies that used heparinized saline at the time of catheterization. This study demonstrates an increasing overall rate of complications with ischemia presenting as the most common complication. There seems to be an association between gestational age, comorbidities, site of catheter, size of catheter, and duration of catheter with such complications. This study also demonstrates the association between the use of heparinized saline and a reduction in rate of complications. The authors advocate for a national data collection tool of all pediatric arterial catheters and its complications to be able to analyze and work on best practice to minimize life changing iatrogenic complications.
本研究的目的是全面回顾外周动脉导管置入术对早产儿和足月新生儿血管并发症的影响。系统评价包括检索PubMed, Scopus, Google Scholar, Cochrane系统评价数据库，以及使用预试用MeSH术语和文章的期刊参考文献。8项研究纳入了2369篇初始文章的全文分析:6项回顾性研究和2项前瞻性研究。并发症发生率为8.6%，并发症均为缺血性并发症。并发症最常发生在肺/心脏合并症和低胎龄的新生儿中。没有发现新生儿的体重和性别有关联。桡动脉部位的并发症发生率较低，为6%，股骨部位的并发症发生率最高(16%)。并发症主要发生在导管尺寸大于22号，最常见的是在1天内插入。在置管时使用肝素化生理盐水的研究中观察到低并发症发生率(7.4%)。本研究表明，以缺血为最常见并发症的并发症的总体发生率正在增加。胎龄、合并症、导管位置、导管大小和导管持续时间似乎与此类并发症有关。这项研究也证明了使用肝素化生理盐水与并发症发生率降低之间的联系。作者主张建立一个全国性的儿童动脉导管及其并发症的数据收集工具，以便能够分析和制定最佳实践，以最大限度地减少改变生活的医源性并发症。
{"title":"Complications of Peripheral Arterial Access in Preterm and Term Neonates: A Systematic Review","authors":"Yangmyung Ma, A. Salem, A. Jester","doi":"10.1055/s-0042-1757476","DOIUrl":"https://doi.org/10.1055/s-0042-1757476","url":null,"abstract":"The aim of the study is to provide a comprehensive review of vascular complications secondary to peripheral arterial catheterization in preterm and term neonates. The systematic review consisted of searching PubMed, Scopus, Google Scholar, Cochrane Database of Systematic Reviews, and references of journals using pre-trialed MeSH terms and articles. Eight studies were included for full text analysis from 2,369 initial articles: six retrospective reviews and two prospective studies. Rate of complication was 8.6% and all complications were ischemic in nature. Complications most often occurred in neonates with pulmonary/cardiac comorbidities and lower gestational ages. No association was found for weight and sex of neonates. The radial artery site presented with lower rates of complication of 6% and the femoral presented with the highest (16%). Complications predominately occurred in catheter sizes larger than 22 gauge and most often within 1 day of insertion. A low rate of complications (7.4%) was observed in studies that used heparinized saline at the time of catheterization. This study demonstrates an increasing overall rate of complications with ischemia presenting as the most common complication. There seems to be an association between gestational age, comorbidities, site of catheter, size of catheter, and duration of catheter with such complications. This study also demonstrates the association between the use of heparinized saline and a reduction in rate of complications. The authors advocate for a national data collection tool of all pediatric arterial catheters and its complications to be able to analyze and work on best practice to minimize life changing iatrogenic complications.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"59 11-12","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72606547","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}
Suman Das, K. Chatterjee, Gobinda Mondal, D. Paul, Lopamudra Mishra
Multisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory process leading to multiorgan failure and shock, occurring during the acute or post-infectious stage of severe acute respiratory syndrome coronavirus (SARS-CoV-2), and has two subtypes: para-infectious and post-infectious varieties. The new onset of refractory status epilepticus has rarely been described as the presenting feature of MIS-C. This retrospective study, conducted at Dr. B.C. Roy Post Graduate Institute of Pediatric Sciences, included children hospitalized between August 1, 2020 and July 31, 2021, with new-onset refractory status epilepticus (NORSE) and subsequently diagnosed to have MIS-C. Their clinico-demographic variables, treatment courses during hospital stays, laboratory reports, radiological and electrophysiological findings, and outcomes at discharge and follow-up over 1 year were recorded. At their 12 month visits, their motor disabilities (primary) and continuation of anti-epileptic drugs, and persistence of magnetic resonance imaging (MRI) brain abnormalities (secondary) were the outcome measures. The characteristics of the patients in the para-infectious and post-infectious groups were compared using the Mann-Whitney U test for continuous variables and the Chi-square test for categorical variables. There were eight and 10 patients in groups A and B, respectively. Patients in group B had significantly higher age, more prolonged refractory status epilepticus (RSE), use of anesthetics and ventilation, and longer pediatric intensive care unit (PICU) stay, while other clinical and laboratory parameters and short and long-term outcomes were not significantly different between the two groups. Eight patients developed hemiparesis, while two had quadriparesis in the acute stage, but 15 (83%) patients had complete recovery from their motor deficits by 1 year. At 1-year follow-up, 33 and 39% of patients, respectively, had abnormal MRI and electroencephalogram (EEG). Acute disseminated encephalitis and acute leukoencephalopathy were the most commonly observed MRI abnormalities in the acute phase, with prolonged persistence of cerebritis in patients in the post-infectious group, warranting long-term immunomodulation. Combined immunotherapy with intravenous immunoglobulin and steroids was effective in the acute phase. However, long-term anti-epileptic therapy was needed in both groups.
{"title":"The Clinical Characteristics and Prognosis of Children Presenting with New Onset Refractory Status Epilepticus in COVID-19 Related Multisystem Inflammatory Syndrome","authors":"Suman Das, K. Chatterjee, Gobinda Mondal, D. Paul, Lopamudra Mishra","doi":"10.1055/s-0042-1757478","DOIUrl":"https://doi.org/10.1055/s-0042-1757478","url":null,"abstract":"Multisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory process leading to multiorgan failure and shock, occurring during the acute or post-infectious stage of severe acute respiratory syndrome coronavirus (SARS-CoV-2), and has two subtypes: para-infectious and post-infectious varieties. The new onset of refractory status epilepticus has rarely been described as the presenting feature of MIS-C. This retrospective study, conducted at Dr. B.C. Roy Post Graduate Institute of Pediatric Sciences, included children hospitalized between August 1, 2020 and July 31, 2021, with new-onset refractory status epilepticus (NORSE) and subsequently diagnosed to have MIS-C. Their clinico-demographic variables, treatment courses during hospital stays, laboratory reports, radiological and electrophysiological findings, and outcomes at discharge and follow-up over 1 year were recorded. At their 12 month visits, their motor disabilities (primary) and continuation of anti-epileptic drugs, and persistence of magnetic resonance imaging (MRI) brain abnormalities (secondary) were the outcome measures. The characteristics of the patients in the para-infectious and post-infectious groups were compared using the Mann-Whitney U test for continuous variables and the Chi-square test for categorical variables. There were eight and 10 patients in groups A and B, respectively. Patients in group B had significantly higher age, more prolonged refractory status epilepticus (RSE), use of anesthetics and ventilation, and longer pediatric intensive care unit (PICU) stay, while other clinical and laboratory parameters and short and long-term outcomes were not significantly different between the two groups. Eight patients developed hemiparesis, while two had quadriparesis in the acute stage, but 15 (83%) patients had complete recovery from their motor deficits by 1 year. At 1-year follow-up, 33 and 39% of patients, respectively, had abnormal MRI and electroencephalogram (EEG). Acute disseminated encephalitis and acute leukoencephalopathy were the most commonly observed MRI abnormalities in the acute phase, with prolonged persistence of cerebritis in patients in the post-infectious group, warranting long-term immunomodulation. Combined immunotherapy with intravenous immunoglobulin and steroids was effective in the acute phase. However, long-term anti-epileptic therapy was needed in both groups.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"39 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86549239","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}
J. F. Jennings, S. Nett, R. Umoren, R. Murray, A. Kessel, N. Napolitano, M. Adu-Darko, K. Biagas, Philipp Jung, Debra A. Spear, S. Parsons, R. Breuer, K. Meyer, M. Malone, Asha N. Shenoi, Anthony Y. Lee, Palen Mallory, Awni M. Al-Subu, Keiko M. Tarquinio, Lily B. Glater, M. Toal, J. Lee, M. Pinto, L. Polikoff, Erin Own, Iris Toedt-Pingel, Mioko Kasagi, Laurence Ducharme-Crevier, M. Motomura, Masafumi Gima, Serena P. Kelly, J. Panisello, G. Nuthall, K. Gladen, J. Shults, V. Nadkarni, A. Nishisaki
Tracheal intubation (TI) in critically ill children is a life-saving but high-risk procedure that involves multiple team members with diverse clinical skills. We aim to examine the association between the provider-reported teamwork rating and the occurrence of adverse TI-associated events (TIAEs). A retrospective analysis of prospectively collected data from 45 pediatric intensive care units in the National Emergency Airway Registry for Children (NEAR4KIDS) database from January 2013 to March 2018 was performed. A composite teamwork score was generated using the average of each of five (7-point Likert scale) domains in the teamwork assessment tool. Poor teamwork was defined as an average score of 4 or lower. Team provider stress data were also recorded with each intubation. A total of 12,536 TIs were reported from 2013 to 2018. Approximately 4.1% (n = 520) rated a poor teamwork score. TIs indicated for shock were more commonly associated with a poor teamwork score, while those indicated for procedures and those utilizing neuromuscular blockade were less commonly associated with a poor teamwork score. TIs with poor teamwork were associated with a higher occurrence of adverse TIAE (24.4% vs 14.4%, p < 0.001), severe TIAE (13.7% vs 5.9%, p < 0.001), and peri-intubation hypoxemia < 80% (26.4% vs 17.9%, p < 0.001). After adjusting for indication, provider type, and neuromuscular blockade use, poor teamwork was associated with higher odds of adverse TIAEs (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.35–2.34), severe TIAEs (OR, 2.23; 95% CI, 1.47–3.37), and hypoxemia (OR, 1.63; 95% CI, 1.25–2.03). TIs with poor teamwork were independently associated with a higher occurrence of TIAEs, severe TIAEs, and hypoxemia.
危重儿童的气管插管是一项挽救生命但高风险的手术，涉及具有不同临床技能的多名团队成员。我们的目的是检查提供者报告的团队合作评级与不良ti相关事件(tiae)发生之间的关系。回顾性分析了2013年1月至2018年3月期间国家儿童急诊气道登记处(NEAR4KIDS)数据库中45个儿科重症监护病房前瞻性收集的数据。使用团队合作评估工具中的五个(7分李克特量表)域的平均值生成一个综合团队合作得分。糟糕的团队合作被定义为平均得分为4分或更低。每次插管时还记录了团队提供者的压力数据。2013年至2018年共报告了12536起此类事件。大约4.1% (n = 520)认为团队合作得分较低。对于休克的ti通常与较差的团队合作得分相关，而对于手术和使用神经肌肉阻断的ti则较少与较差的团队合作得分相关。团队合作能力差的ti患者发生不良TIAE (24.4% vs 14.4%， p < 0.001)、严重TIAE (13.7% vs 5.9%， p < 0.001)和插管周围低氧血症< 80% (26.4% vs 17.9%， p < 0.001)的几率较高。在调整适应证、提供者类型和神经肌肉阻断剂使用后，团队合作能力差与不良tiae的高发生率相关(优势比[OR]， 1.77;95%可信区间[CI]， 1.35-2.34)，严重tiae (OR, 2.23;95% CI, 1.47-3.37)和低氧血症(OR, 1.63;95% ci, 1.25-2.03)。团队合作能力差的TIs与tiae、严重tiae和低氧血症的发生率较高独立相关。
{"title":"The Association of Teamwork and Adverse Tracheal Intubation–Associated Events in Advanced Airway Management in the PICU","authors":"J. F. Jennings, S. Nett, R. Umoren, R. Murray, A. Kessel, N. Napolitano, M. Adu-Darko, K. Biagas, Philipp Jung, Debra A. Spear, S. Parsons, R. Breuer, K. Meyer, M. Malone, Asha N. Shenoi, Anthony Y. Lee, Palen Mallory, Awni M. Al-Subu, Keiko M. Tarquinio, Lily B. Glater, M. Toal, J. Lee, M. Pinto, L. Polikoff, Erin Own, Iris Toedt-Pingel, Mioko Kasagi, Laurence Ducharme-Crevier, M. Motomura, Masafumi Gima, Serena P. Kelly, J. Panisello, G. Nuthall, K. Gladen, J. Shults, V. Nadkarni, A. Nishisaki","doi":"10.1055/s-0042-1756715","DOIUrl":"https://doi.org/10.1055/s-0042-1756715","url":null,"abstract":"Tracheal intubation (TI) in critically ill children is a life-saving but high-risk procedure that involves multiple team members with diverse clinical skills. We aim to examine the association between the provider-reported teamwork rating and the occurrence of adverse TI-associated events (TIAEs). A retrospective analysis of prospectively collected data from 45 pediatric intensive care units in the National Emergency Airway Registry for Children (NEAR4KIDS) database from January 2013 to March 2018 was performed. A composite teamwork score was generated using the average of each of five (7-point Likert scale) domains in the teamwork assessment tool. Poor teamwork was defined as an average score of 4 or lower. Team provider stress data were also recorded with each intubation. A total of 12,536 TIs were reported from 2013 to 2018. Approximately 4.1% (n = 520) rated a poor teamwork score. TIs indicated for shock were more commonly associated with a poor teamwork score, while those indicated for procedures and those utilizing neuromuscular blockade were less commonly associated with a poor teamwork score. TIs with poor teamwork were associated with a higher occurrence of adverse TIAE (24.4% vs 14.4%, p < 0.001), severe TIAE (13.7% vs 5.9%, p < 0.001), and peri-intubation hypoxemia < 80% (26.4% vs 17.9%, p < 0.001). After adjusting for indication, provider type, and neuromuscular blockade use, poor teamwork was associated with higher odds of adverse TIAEs (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.35–2.34), severe TIAEs (OR, 2.23; 95% CI, 1.47–3.37), and hypoxemia (OR, 1.63; 95% CI, 1.25–2.03). TIs with poor teamwork were independently associated with a higher occurrence of TIAEs, severe TIAEs, and hypoxemia.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"48 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83603071","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}
Deepika Agarwal, S. Alam, R. Mazahir, R. Singh, B. Maini
Abstract Assessment of the severity of illness is very important in intensive care unit care for quality assessment, assessing prognosis, and proper counseling. The goal of the study was to see how well the Pediatric Early Warning Sign (PEWS) score predicted the outcome of pediatric intensive care unit patients. This prospective cross-sectional study included children younger than 18 years. PEWS was calculated at presentation. The outcomes analyzed were mortality (primary outcome), need for mechanical ventilation, inotropic support, and length of stay (LOS). A median score was calculated and compared across the outcome groups. The performance of the PEWS was assessed for calibration and discrimination, and the best cutoff was determined. This study included 237 patients with a median score of 6 (range 4–9). Twenty-two (9.3%) patients required ventilator support and 66 (26.6%) inotropic support. The overall mortality rate was 5.1%, and 16.4% had prolonged LOS (>4 days). The median score of patients was significantly higher among those who died (8.5 vs. 6; p = 0.001), required ventilator support (8 vs. 6; p = 0.001), inotropic support (7 vs. 6; p = 0.030), and prolonged LOS (7 vs. 6; p = 0.001). On calibration, PEWS was found to have a good fit to predict mortality, the need for ventilator support, inotropic support, and prolonged LOS. Receiver operating characteristic curves for the PEWS model yield an area under the curve of 0.966 for mortality, 0.951 for ventilator support, 0.626 for inotropic support, and 0.760 for prolonged LOS. A cutoff value of > 7 was found to be the best to predict the outcome. PEWS is a robust tool to easily prognosticate the patient on the basis of clinical parameters.
病情严重程度评估在重症监护病房的护理质量评估、预后评估和适当的咨询中非常重要。该研究的目的是观察儿科早期预警信号(PEWS)评分对儿科重症监护病房患者预后的预测效果。这项前瞻性横断面研究包括18岁以下的儿童。PEWS在提交时计算。结果分析为死亡率(主要结果)、机械通气需求、肌力支持和住院时间(LOS)。计算并比较各结果组的中位数得分。评估了PEWS的校准和判别性能，并确定了最佳截止点。该研究纳入237例患者，中位评分为6(范围4-9)。22例(9.3%)患者需要呼吸机支持，66例(26.6%)患者需要肌力支持。总死亡率为5.1%，其中16.4%的患者LOS延长(>4天)。死亡患者的中位评分显著高于死亡患者(8.5比6;P = 0.001)，需要呼吸机支持(8 vs. 6;P = 0.001)，肌力支持(7 vs. 6;p = 0.030)，延长的LOS (7 vs. 6;P = 0.001)。校正后，PEWS可以很好地预测死亡率、呼吸机支持需求、肌力支持和延长的LOS。PEWS模型的受试者工作特征曲线下，死亡率曲线下面积为0.966，呼吸机支持曲线下面积为0.951，肌力支持曲线下面积为0.626，延长LOS曲线下面积为0.760。发现截断值> 7是预测结果的最佳值。PEWS是一个强大的工具，可以根据临床参数轻松预测患者的预后。
{"title":"Utility of Pediatric Early Warning Sign Score in Predicting Outcome of PICU Admissions at a Suburban Tertiary Care Hospital","authors":"Deepika Agarwal, S. Alam, R. Mazahir, R. Singh, B. Maini","doi":"10.1055/s-0042-1759730","DOIUrl":"https://doi.org/10.1055/s-0042-1759730","url":null,"abstract":"Abstract Assessment of the severity of illness is very important in intensive care unit care for quality assessment, assessing prognosis, and proper counseling. The goal of the study was to see how well the Pediatric Early Warning Sign (PEWS) score predicted the outcome of pediatric intensive care unit patients. This prospective cross-sectional study included children younger than 18 years. PEWS was calculated at presentation. The outcomes analyzed were mortality (primary outcome), need for mechanical ventilation, inotropic support, and length of stay (LOS). A median score was calculated and compared across the outcome groups. The performance of the PEWS was assessed for calibration and discrimination, and the best cutoff was determined. This study included 237 patients with a median score of 6 (range 4–9). Twenty-two (9.3%) patients required ventilator support and 66 (26.6%) inotropic support. The overall mortality rate was 5.1%, and 16.4% had prolonged LOS (>4 days). The median score of patients was significantly higher among those who died (8.5 vs. 6; p = 0.001), required ventilator support (8 vs. 6; p = 0.001), inotropic support (7 vs. 6; p = 0.030), and prolonged LOS (7 vs. 6; p = 0.001). On calibration, PEWS was found to have a good fit to predict mortality, the need for ventilator support, inotropic support, and prolonged LOS. Receiver operating characteristic curves for the PEWS model yield an area under the curve of 0.966 for mortality, 0.951 for ventilator support, 0.626 for inotropic support, and 0.760 for prolonged LOS. A cutoff value of > 7 was found to be the best to predict the outcome. PEWS is a robust tool to easily prognosticate the patient on the basis of clinical parameters.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"161 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86744881","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 Cuffed endotracheal tubes (ETTs) are becoming increasingly used in neonates; nevertheless, current data in the literature mostly include infants over 3,000 g in weight. The aim of this study was to compare the use of cuffed and uncuffed ETTs in neonates in the neonatal intensive care unit of a tertiary children's hospital, assessing the presence of airway complications. We performed a single-center retrospective cohort study. Our study included all term neonates receiving cuffed ETTs over the period from January 2019 to December 2021. The controls were all neonates receiving an uncuffed ETT over the same period. Twenty-five patients were intubated with cuffed ETTs in the study period. The group receiving cuffed ETTs was compared with 53 patients receiving uncuffed ETTs. All cuffed ETTs were inserted in the operating room by anesthesiologists. Comparing the outcomes of the cuffed ETT group with controls, there were no significant differences in the number of unplanned extubations, reintubation episodes, ventilator-associated pneumonia, episodes of atelectasis, the use of dexamethasone, or vocal cord paresis. No unplanned extubation was observed in the cuffed ETT group, and no cases of subglottic stenosis were observed in either of the groups. This retrospective study with a small sample size suggests that the use of cuffed ETTs in surgical patients >2,000 g in weight is not associated with an increase in airway complications. Well-designed randomized controlled trials are needed to compare cuffed ETTs with uncuffed ETTs.
{"title":"Cuffed Endotracheal Tubes in Neonates","authors":"N. Gaspar, G. Rocha, Américo Gonçalves","doi":"10.1055/s-0043-1764154","DOIUrl":"https://doi.org/10.1055/s-0043-1764154","url":null,"abstract":"Abstract Cuffed endotracheal tubes (ETTs) are becoming increasingly used in neonates; nevertheless, current data in the literature mostly include infants over 3,000 g in weight. The aim of this study was to compare the use of cuffed and uncuffed ETTs in neonates in the neonatal intensive care unit of a tertiary children's hospital, assessing the presence of airway complications. We performed a single-center retrospective cohort study. Our study included all term neonates receiving cuffed ETTs over the period from January 2019 to December 2021. The controls were all neonates receiving an uncuffed ETT over the same period. Twenty-five patients were intubated with cuffed ETTs in the study period. The group receiving cuffed ETTs was compared with 53 patients receiving uncuffed ETTs. All cuffed ETTs were inserted in the operating room by anesthesiologists. Comparing the outcomes of the cuffed ETT group with controls, there were no significant differences in the number of unplanned extubations, reintubation episodes, ventilator-associated pneumonia, episodes of atelectasis, the use of dexamethasone, or vocal cord paresis. No unplanned extubation was observed in the cuffed ETT group, and no cases of subglottic stenosis were observed in either of the groups. This retrospective study with a small sample size suggests that the use of cuffed ETTs in surgical patients >2,000 g in weight is not associated with an increase in airway complications. Well-designed randomized controlled trials are needed to compare cuffed ETTs with uncuffed ETTs.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"76 12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83437044","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}
Hemananda K Muniraman, R. Kibe, A. Namjoshi, A. Song, A. Lakshmanan, R. Ramanathan, M. Biniwale
Objectives This article evaluates correlation and agreement between oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) (SF) ratio and partial pressure of oxygen (PaO2)/FiO2 (PF) ratio. It also derives and validates predictive PF ratio from noninvasive SF ratio measurements for clinically relevant PF ratios and derives SF ratio equivalent of PF ratio cutoffs used to define acute lung injury (ALI, PF < 300) and acute respiratory distress syndrome (ARDS, PF < 200). Methods Retrospective cohort study including neonates with respiratory failure over a 6-year study period. Correlation and agreement between PF ratio with SF ratio was analyzed by Pearson's correlation coefficient and Bland–Altman analysis. Generalized estimating equation was used to derive PF ratio from measured PF ratio and derive corresponding SF ratio for PF ratio cutoffs for ALI and ARDS. Results A total of 1,019 paired measurements from 196 neonates with mean 28 (± 4.7) weeks' gestational age and 925 (± 1111) g birth weight were analyzed. Strong correlation was noted between SF ratio and PF ratio (r = 0.90). Derived PF ratios from regression (1/PF = –0.0004304 + 2.0897987/SF) showed strong accuracy measures for PF ratio cutoffs < 200 (area under the curve [AUC]: 0.85) and < 100 (AUC: 0.92) with good agreement. Equivalent SF ratio to define ALI was < 450, moderate ARDS was < 355, and severe ARDS was < 220 with strong accuracy measures (AUC > 0.81, 0.84, and 0.93, respectively). Conclusion SF ratio correlated strongly with PF ratio with good agreement between derived PF ratio from noninvasive SpO2 source and measure PF ratio. Derived PF ratio may be useful to reliably assess severity of respiratory failure in neonates. Further studies are needed to validate SF ratio with clinical illness severity and outcomes.
{"title":"Evaluation of Correlation and Agreement between SpO2/FiO2 ratio and PaO2/FiO2 ratio in Neonates","authors":"Hemananda K Muniraman, R. Kibe, A. Namjoshi, A. Song, A. Lakshmanan, R. Ramanathan, M. Biniwale","doi":"10.1055/s-0042-1756716","DOIUrl":"https://doi.org/10.1055/s-0042-1756716","url":null,"abstract":"\u0000 Objectives This article evaluates correlation and agreement between oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) (SF) ratio and partial pressure of oxygen (PaO2)/FiO2 (PF) ratio. It also derives and validates predictive PF ratio from noninvasive SF ratio measurements for clinically relevant PF ratios and derives SF ratio equivalent of PF ratio cutoffs used to define acute lung injury (ALI, PF < 300) and acute respiratory distress syndrome (ARDS, PF < 200).\u0000 Methods Retrospective cohort study including neonates with respiratory failure over a 6-year study period. Correlation and agreement between PF ratio with SF ratio was analyzed by Pearson's correlation coefficient and Bland–Altman analysis. Generalized estimating equation was used to derive PF ratio from measured PF ratio and derive corresponding SF ratio for PF ratio cutoffs for ALI and ARDS.\u0000 Results A total of 1,019 paired measurements from 196 neonates with mean 28 (± 4.7) weeks' gestational age and 925 (± 1111) g birth weight were analyzed. Strong correlation was noted between SF ratio and PF ratio (r = 0.90). Derived PF ratios from regression (1/PF = –0.0004304 + 2.0897987/SF) showed strong accuracy measures for PF ratio cutoffs < 200 (area under the curve [AUC]: 0.85) and < 100 (AUC: 0.92) with good agreement. Equivalent SF ratio to define ALI was < 450, moderate ARDS was < 355, and severe ARDS was < 220 with strong accuracy measures (AUC > 0.81, 0.84, and 0.93, respectively).\u0000 Conclusion SF ratio correlated strongly with PF ratio with good agreement between derived PF ratio from noninvasive SpO2 source and measure PF ratio. Derived PF ratio may be useful to reliably assess severity of respiratory failure in neonates. Further studies are needed to validate SF ratio with clinical illness severity and outcomes.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"221 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89150195","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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