Sophie Martin, G. Du Pont-Thibodeau, A. Seely, G. Emeriaud, C. Herry, M. Recher, J. Lacroix, Laurence Ducharme-Crevier
Abstract The aim of this study was to assess the feasibility of continuous monitoring of heart rate variability (HRV) in children with traumatic brain injury (TBI) hospitalized in a pediatric intensive care unit (PICU) and collect preliminary data on the association between HRV, neurological outcome, and complications. This is a prospective observational cohort study in a tertiary academic PICU. Children admitted to the PICU ≤24 hours after moderate or severe TBI were included in the study. Children suspected of being brain dead at PICU entry or with a pacemaker were excluded. Children underwent continuous monitoring of electrocardiographic (ECG) waveforms over 7 days post-TBI. HRV analysis was performed retrospectively, using a standardized, validated HRV analysis software (CIMVA). The occurrence of medical complications (“event”: intracranial hypertension, cerebral hypoperfusion, seizure, and cardiac arrest) was prospectively documented. Outcome of children 6 months post-TBI was assessed using the Glasgow Outcome Scale – Extended Pediatric (GOS-E Peds). Fifteen patients were included over a 20-month period. Thirteen patients had ECG recordings available and 4 had >20% of missing ECG data. When ECG was available, HRV calculation was feasible (average 88%; range 70–97%). Significant decrease in overall HRV coefficient of variation and Poincaré SD2 ( p < 0.05) at 6 hours post–PICU admission was associated with an unfavorable outcome (defined as GOS-E Peds ≥ 3, or a deterioration of ≥2 points over baseline score). Several HRV metrics exhibited significant and nonsignificant variation in HRV during event. This study demonstrates that it is feasible to monitor HRV in the PICU provided ECG data are available; however, missing ECG data are not uncommon. These preliminary data suggest that altered HRV is associated with unfavorable neurological outcome and in-hospital medical complications. Larger prospective studies are needed to confirm these findings and to explore if HRV offers reliable and clinically useful prediction data that may help clinical decision making.
{"title":"Heart Rate Variability in Children with Moderate and Severe Traumatic Brain Injury: A Prospective Observational Study","authors":"Sophie Martin, G. Du Pont-Thibodeau, A. Seely, G. Emeriaud, C. Herry, M. Recher, J. Lacroix, Laurence Ducharme-Crevier","doi":"10.1055/s-0042-1759877","DOIUrl":"https://doi.org/10.1055/s-0042-1759877","url":null,"abstract":"Abstract The aim of this study was to assess the feasibility of continuous monitoring of heart rate variability (HRV) in children with traumatic brain injury (TBI) hospitalized in a pediatric intensive care unit (PICU) and collect preliminary data on the association between HRV, neurological outcome, and complications. This is a prospective observational cohort study in a tertiary academic PICU. Children admitted to the PICU ≤24 hours after moderate or severe TBI were included in the study. Children suspected of being brain dead at PICU entry or with a pacemaker were excluded. Children underwent continuous monitoring of electrocardiographic (ECG) waveforms over 7 days post-TBI. HRV analysis was performed retrospectively, using a standardized, validated HRV analysis software (CIMVA). The occurrence of medical complications (“event”: intracranial hypertension, cerebral hypoperfusion, seizure, and cardiac arrest) was prospectively documented. Outcome of children 6 months post-TBI was assessed using the Glasgow Outcome Scale – Extended Pediatric (GOS-E Peds). Fifteen patients were included over a 20-month period. Thirteen patients had ECG recordings available and 4 had >20% of missing ECG data. When ECG was available, HRV calculation was feasible (average 88%; range 70–97%). Significant decrease in overall HRV coefficient of variation and Poincaré SD2 ( p < 0.05) at 6 hours post–PICU admission was associated with an unfavorable outcome (defined as GOS-E Peds ≥ 3, or a deterioration of ≥2 points over baseline score). Several HRV metrics exhibited significant and nonsignificant variation in HRV during event. This study demonstrates that it is feasible to monitor HRV in the PICU provided ECG data are available; however, missing ECG data are not uncommon. These preliminary data suggest that altered HRV is associated with unfavorable neurological outcome and in-hospital medical complications. Larger prospective studies are needed to confirm these findings and to explore if HRV offers reliable and clinically useful prediction data that may help clinical decision making.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"82 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76165298","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}
K. Wollny, Cameron B. Williams, R. Al-Abdwani, Carol Cartelle, J. Macartney, H. Frndova, Norbert Chin, C. Parshuram
Abstract The aim of this study was to quantify associations between the risk of unplanned extubation and patient-, environment-, and care-related factors in pediatric critical care and to compare outcomes between children who did and did not experience an unplanned extubation. This is a retrospective case–control analysis including patients <18 years who experienced an unplanned extubation during intensive care unit (ICU) admission (2004–2014). Cases were matched by age, duration of mechanical ventilation, and date to control patients (4:1) who were intubated but did not experience an unplanned extubation. Conditional logistic regression was used to evaluate associations between unplanned extubations and the abstracted characteristics. We identified 1,601 eligible controls matched to 458 case patients. When adjusted for confounders, eight variables were associated with unplanned extubation: three patient-related factors (previous ICU admission, previous intubation, and the volume of secretions); one environment-related factor (patient room setup); and four care-related factors (intubation route, and the use of sedation, muscle relaxation, and restraints). Patients who had an unplanned extubation had longer length of stay, but lower rate of mortality. This is the largest case–control study identifying variables associated with unplanned extubation in pediatric critical care. Several are potentially modifiable and may provide opportunities to improve quality of care in controlled ICU environments.
{"title":"Unplanned Extubations in Pediatric Critical Care: A Case–Control Study","authors":"K. Wollny, Cameron B. Williams, R. Al-Abdwani, Carol Cartelle, J. Macartney, H. Frndova, Norbert Chin, C. Parshuram","doi":"10.1055/s-0042-1759878","DOIUrl":"https://doi.org/10.1055/s-0042-1759878","url":null,"abstract":"Abstract The aim of this study was to quantify associations between the risk of unplanned extubation and patient-, environment-, and care-related factors in pediatric critical care and to compare outcomes between children who did and did not experience an unplanned extubation. This is a retrospective case–control analysis including patients <18 years who experienced an unplanned extubation during intensive care unit (ICU) admission (2004–2014). Cases were matched by age, duration of mechanical ventilation, and date to control patients (4:1) who were intubated but did not experience an unplanned extubation. Conditional logistic regression was used to evaluate associations between unplanned extubations and the abstracted characteristics. We identified 1,601 eligible controls matched to 458 case patients. When adjusted for confounders, eight variables were associated with unplanned extubation: three patient-related factors (previous ICU admission, previous intubation, and the volume of secretions); one environment-related factor (patient room setup); and four care-related factors (intubation route, and the use of sedation, muscle relaxation, and restraints). Patients who had an unplanned extubation had longer length of stay, but lower rate of mortality. This is the largest case–control study identifying variables associated with unplanned extubation in pediatric critical care. Several are potentially modifiable and may provide opportunities to improve quality of care in controlled ICU environments.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"3 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74216135","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}
Valeria Erazo-Martínez, Ingrid Ruiz-Ordóñez, C. Alvarez, L. Serrano, C. Aragón, G. Tobón, S. Concha, R. Lasso, Lyna- Ramírez
Most autoimmune diseases (AIDs) during childhood debut with more severe and aggressive forms, with life-threatening conditions that increase the need for intensive care therapy. This study describes the clinical, laboratory, and health outcome features of pediatric patients with AIDs admitted to the pediatric intensive care unit (PICU). This is a retrospective cross-sectional study that included the clinical records of all pediatric patients with AIDs admitted to the PICU between 2011 and 2020 in Cali, Colombia. In total, 225 PICU admissions from 136 patients were evaluated. Median age was 13 (11–15) years, and the median disease duration was 15 (5–38.5) months. Systemic lupus erythematosus was the most prevalent disease (91, 66.9%), followed by vasculitis (27, 19.8%). The leading cause of PICU admission was AID activity (95, 44.3%). C-reactive-protein levels were associated with infections (p <0.0394). Mortality occurred in 12 (8.8%) patients secondary to AID activity, primarily, diffuse alveolar hemorrhage (6, 50%). A longer disease duration was associated with mortality (p <0.00398). AID activity was the leading cause of PICU admission and mortality. Pulse steroid therapy, mechanical ventilation, and inotropic and vasopressor support were associated with nonsurvival.
{"title":"Characterization of Pediatric Patients with Rheumatological Diseases Admitted to a Single Tertiary Health Hospital's Pediatric Intensive Care Unit in Latin America","authors":"Valeria Erazo-Martínez, Ingrid Ruiz-Ordóñez, C. Alvarez, L. Serrano, C. Aragón, G. Tobón, S. Concha, R. Lasso, Lyna- Ramírez","doi":"10.1055/s-0042-1755444","DOIUrl":"https://doi.org/10.1055/s-0042-1755444","url":null,"abstract":"Most autoimmune diseases (AIDs) during childhood debut with more severe and aggressive forms, with life-threatening conditions that increase the need for intensive care therapy. This study describes the clinical, laboratory, and health outcome features of pediatric patients with AIDs admitted to the pediatric intensive care unit (PICU). This is a retrospective cross-sectional study that included the clinical records of all pediatric patients with AIDs admitted to the PICU between 2011 and 2020 in Cali, Colombia. In total, 225 PICU admissions from 136 patients were evaluated. Median age was 13 (11–15) years, and the median disease duration was 15 (5–38.5) months. Systemic lupus erythematosus was the most prevalent disease (91, 66.9%), followed by vasculitis (27, 19.8%). The leading cause of PICU admission was AID activity (95, 44.3%). C-reactive-protein levels were associated with infections (p <0.0394). Mortality occurred in 12 (8.8%) patients secondary to AID activity, primarily, diffuse alveolar hemorrhage (6, 50%). A longer disease duration was associated with mortality (p <0.00398). AID activity was the leading cause of PICU admission and mortality. Pulse steroid therapy, mechanical ventilation, and inotropic and vasopressor support were associated with nonsurvival.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82378270","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 Catecholamine-resistant shock, also known as vasoplegia, is a challenging entity with a significant risk of mortality. We seek to provide further data on the safety and effectiveness of methylene blue (MB) for vasoplegic shock in the pediatric population. We conducted a retrospective observational study of pediatric patients admitted to the pediatric intensive care unit or pediatric cardiac intensive care unit at Mount Sinai Kravis Children's Hospital from 2011 to 2021 who received MB for refractory shock. A list of patients was obtained by performing a pharmaceutical query from 2011 to 2021 for “MB.” Chart review was performed to determine indication for use and to collect demographic and clinical data. There were 33 MB administrations: 18 administrations (16 unique patients) for vasoplegic shock, 11 for surgical dye, and 4 for methemoglobinemia. The median age was 5 years (interquartile range [IQR]: 0.08, 13). Ten patients required MB following congenital cardiac repair (62.5%); one administration for myocarditis, septic shock, postcardiac arrest, high output chylothorax, scoliosis repair, and one multisystem inflammatory syndrome in children. No patients experienced hemolytic anemia or serotonin syndrome following administration. The median dose of MB was 1 mg/kg. Vasoactive-inotrope score (VIS) improved in 4 out of 18 administrations at 1 hour. Mean arterial pressure (MAP) improved in 10 out of 18 administrations at 1 hour. Systolic blood pressure (SBP) improved in 8 out of 18 administrations at 1 hour. VIS, MAP, and SBP improved in 8 out of 18 administrations at 6 hours. MB may be safely considered as rescue therapy in catecholamine-resistant shock in pediatrics.
{"title":"Methylene Blue Use in Pediatrics","authors":"R. Moss, K. Derespina, J. Frye, S. Kaushik","doi":"10.1055/s-0042-1760297","DOIUrl":"https://doi.org/10.1055/s-0042-1760297","url":null,"abstract":"Abstract Catecholamine-resistant shock, also known as vasoplegia, is a challenging entity with a significant risk of mortality. We seek to provide further data on the safety and effectiveness of methylene blue (MB) for vasoplegic shock in the pediatric population. We conducted a retrospective observational study of pediatric patients admitted to the pediatric intensive care unit or pediatric cardiac intensive care unit at Mount Sinai Kravis Children's Hospital from 2011 to 2021 who received MB for refractory shock. A list of patients was obtained by performing a pharmaceutical query from 2011 to 2021 for “MB.” Chart review was performed to determine indication for use and to collect demographic and clinical data. There were 33 MB administrations: 18 administrations (16 unique patients) for vasoplegic shock, 11 for surgical dye, and 4 for methemoglobinemia. The median age was 5 years (interquartile range [IQR]: 0.08, 13). Ten patients required MB following congenital cardiac repair (62.5%); one administration for myocarditis, septic shock, postcardiac arrest, high output chylothorax, scoliosis repair, and one multisystem inflammatory syndrome in children. No patients experienced hemolytic anemia or serotonin syndrome following administration. The median dose of MB was 1 mg/kg. Vasoactive-inotrope score (VIS) improved in 4 out of 18 administrations at 1 hour. Mean arterial pressure (MAP) improved in 10 out of 18 administrations at 1 hour. Systolic blood pressure (SBP) improved in 8 out of 18 administrations at 1 hour. VIS, MAP, and SBP improved in 8 out of 18 administrations at 6 hours. MB may be safely considered as rescue therapy in catecholamine-resistant shock in pediatrics.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"6 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87093804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Becker, Gwenyth A. Fischer, C. Hornik, Omar Alibrahim, Kelechi N. Iheagwara, K. Abulebda, Andora L. Bass, Katherine Irby, A. Subbaswamy, Elizabeth Zivick, Jill Sweney, A. Stormorken, Erin E. Barker, Shruthi Mahadaveiah, R. Lutfi, Michael C McCrory, John M. Costello, K. Ackerman, Jennifer C. Munoz-Pareja, B. Feger, J. Dean, D. F. Hanley, R. Greenberg, Radhika Avadhani, Richard E. Thompson, D. Benjamin, Christoph P. Hornik, K. Zimmerman
Abstract Objectives This article observes the mean daily dose of fentanyl required for adequate sedation in critically ill, mechanically ventilated children randomized to receive dexmedetomidine or placebo. Methods We conducted Dexmedetomidine Opioid Sparing Effect in Mechanically Ventilated Children (DOSE), a multicenter, double-blind, randomized, placebo-controlled, dose-escalating trial. We enrolled children aged 35 weeks postmenstrual to 17 years (inclusive) admitted across 13 pediatric multidisciplinary and cardiac intensive care units. Adequate sedation was based on a State Behavioral Score and Richmond Agitation-Sedation Scale of –1 or lower. Only the first two dexmedetomidine dosing cohorts opened for enrollment, due to early trial closure during the coronavirus 2019 pandemic. Thirty children were randomized over 13 months and included in the analyses. Results Demographic and baseline characteristics were not different between dexmedetomidine and placebo cohorts. Similarly, mean daily fentanyl use was not different, using an unadjusted mixed regression model that considered treatment, time, and a treatment-by-time interaction. Adverse events and safety events of special interest were not different between cohorts. Conclusion The DOSE trial revealed that dexmedetomidine added to fentanyl does not impact safety and may not spare fentanyl use in critically ill children, although the trial did not meet its recruitment goals, due to early closure during the coronavirus 2019 pandemic. More rigorous inpatient pediatric trials like DOSE that study critically ill, mechanically ventilated children are needed. Despite the many obstacles faced, the DOSE trial presents challenges from which the greater research community can learn and use to optimize future therapeutic trials in children.
{"title":"Dexmedetomidine Opioid Sparing Effect in Mechanically Ventilated Children (DOSE): Trial of Fentanyl versus Fentanyl + Dexmedetomidine for Maintenance of Sedation","authors":"M. Becker, Gwenyth A. Fischer, C. Hornik, Omar Alibrahim, Kelechi N. Iheagwara, K. Abulebda, Andora L. Bass, Katherine Irby, A. Subbaswamy, Elizabeth Zivick, Jill Sweney, A. Stormorken, Erin E. Barker, Shruthi Mahadaveiah, R. Lutfi, Michael C McCrory, John M. Costello, K. Ackerman, Jennifer C. Munoz-Pareja, B. Feger, J. Dean, D. F. Hanley, R. Greenberg, Radhika Avadhani, Richard E. Thompson, D. Benjamin, Christoph P. Hornik, K. Zimmerman","doi":"10.1055/s-0043-1769117","DOIUrl":"https://doi.org/10.1055/s-0043-1769117","url":null,"abstract":"Abstract Objectives This article observes the mean daily dose of fentanyl required for adequate sedation in critically ill, mechanically ventilated children randomized to receive dexmedetomidine or placebo. Methods We conducted Dexmedetomidine Opioid Sparing Effect in Mechanically Ventilated Children (DOSE), a multicenter, double-blind, randomized, placebo-controlled, dose-escalating trial. We enrolled children aged 35 weeks postmenstrual to 17 years (inclusive) admitted across 13 pediatric multidisciplinary and cardiac intensive care units. Adequate sedation was based on a State Behavioral Score and Richmond Agitation-Sedation Scale of –1 or lower. Only the first two dexmedetomidine dosing cohorts opened for enrollment, due to early trial closure during the coronavirus 2019 pandemic. Thirty children were randomized over 13 months and included in the analyses. Results Demographic and baseline characteristics were not different between dexmedetomidine and placebo cohorts. Similarly, mean daily fentanyl use was not different, using an unadjusted mixed regression model that considered treatment, time, and a treatment-by-time interaction. Adverse events and safety events of special interest were not different between cohorts. Conclusion The DOSE trial revealed that dexmedetomidine added to fentanyl does not impact safety and may not spare fentanyl use in critically ill children, although the trial did not meet its recruitment goals, due to early closure during the coronavirus 2019 pandemic. More rigorous inpatient pediatric trials like DOSE that study critically ill, mechanically ventilated children are needed. Despite the many obstacles faced, the DOSE trial presents challenges from which the greater research community can learn and use to optimize future therapeutic trials in children.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"74 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84519144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Malone, Erin E. Bennett, Olivia Irby, S. Pasala, R. Sanders, B. Spray, A. Dalabih
Mechanical ventilation (MV) is an integral part of the care of the critically ill child, and contemporary MV includes a myriad of sophisticated modalities that should be tailored to specific disease pathology and severity. This requires Pediatric Critical Care Medicine (PCCM) physicians to have comprehensive training and experience with various modes. We sought to assess and describe the current landscape of MV practices and training from PCCM fellowship programs. To describe current MV practices and training in PCCM fellowship programs and assess the different modes of MV to which trainees are exposed, a piloted survey was sent to all 67 American PCCM fellowship program directors (PDs) in 2019. Forty-eight (71.6%) of PCCM PDs responded. Our survey shows that PCCM fellows are not uniformly exposed to the same MV modalities, and PDs' perception of fellows' competency in managing MV is variable. Our results suggest that there is a lack of exposure to the various modes of “conventional” MV, as well as inconsistent education about less-utilized “nonconventional” MV. Additionally, we found that PDs are aware of their fellows' limited exposure to various modalities, as many practice patterns are institution specific. This study identified gaps in MV education and training and advocates for PCCM fellowship programs to identify these deficiencies to equip all trainees with a solid knowledge base that will prepare them to utilize any mode of MV in their future practice.
{"title":"Perspectives on Current Mechanical Ventilation Use and Training in Pediatric Critical Care Medicine Fellowship Programs in the United States","authors":"M. Malone, Erin E. Bennett, Olivia Irby, S. Pasala, R. Sanders, B. Spray, A. Dalabih","doi":"10.1055/s-0042-1755442","DOIUrl":"https://doi.org/10.1055/s-0042-1755442","url":null,"abstract":"Mechanical ventilation (MV) is an integral part of the care of the critically ill child, and contemporary MV includes a myriad of sophisticated modalities that should be tailored to specific disease pathology and severity. This requires Pediatric Critical Care Medicine (PCCM) physicians to have comprehensive training and experience with various modes. We sought to assess and describe the current landscape of MV practices and training from PCCM fellowship programs. To describe current MV practices and training in PCCM fellowship programs and assess the different modes of MV to which trainees are exposed, a piloted survey was sent to all 67 American PCCM fellowship program directors (PDs) in 2019. Forty-eight (71.6%) of PCCM PDs responded. Our survey shows that PCCM fellows are not uniformly exposed to the same MV modalities, and PDs' perception of fellows' competency in managing MV is variable. Our results suggest that there is a lack of exposure to the various modes of “conventional” MV, as well as inconsistent education about less-utilized “nonconventional” MV. Additionally, we found that PDs are aware of their fellows' limited exposure to various modalities, as many practice patterns are institution specific. This study identified gaps in MV education and training and advocates for PCCM fellowship programs to identify these deficiencies to equip all trainees with a solid knowledge base that will prepare them to utilize any mode of MV in their future practice.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"47 11 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76517551","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}
R. B. Hunter, Herodes Guzman, Jessica M Winters, K. Lord, M. Kirschen, V. Srinivasan
The diagnosis and management of central diabetes insipidus in critically ill children is not standardized. Our objective was to characterize differences between Pediatric Critical Care Medicine (PCCM) and Pediatric Endocrinology (PE) clinicians in the diagnosis and management of new-onset CDI in the pediatric intensive care unit. We also sought to characterize knowledge gaps among general pediatrics (GP) residents. This is a scenario-based survey to assess patterns of diagnosis and management of new-onset CDI that was distributed to PCCM, PE, and GP clinicians who work in a quaternary care urban children's hospital. Of 275 PCCM, PE, and GP clinicians surveyed, 158 (57%) responded. More PCCM than PE clinicians relied on serum sodium levels (96 vs. 75%, p <0.01) and more PE than PCCM clinicians relied on serum osmolality (91 vs. 40%, p < .001) for diagnosis. Fewer PCCM than PE clinicians favored restricting IV fluids to two-thirds maintenance rate (4 vs. 37%, p <0.001). More PCCM than PE clinicians favored a starting dose of 0.5 milli-units/kg/h for IV vasopressin infusion (76 vs. 53%, p = 0.048). More PCCM clinicians than PE clinicians favored titrating the IV vasopressin infusion every 20 minutes (24 vs. 2%, p = 0.02), whereas more PE clinicians than PCCM clinicians favored titration every 60 minutes (38 vs. 14%, p = 0.03). GP residents earlier in training had greater self-reported gaps in knowledge. We observed substantial variability in the diagnosis and management of new-onset CDI in critically ill children among PCCM, PE, and GP clinicians. There is a need for greater standardization in care of these patients.
{"title":"Diagnosis and Management of New-Onset Central Diabetes Insipidus in Critically Ill Children Varies between Pediatric Critical Care Medicine and Pediatric Endocrinology Clinicians","authors":"R. B. Hunter, Herodes Guzman, Jessica M Winters, K. Lord, M. Kirschen, V. Srinivasan","doi":"10.1055/s-0042-1756309","DOIUrl":"https://doi.org/10.1055/s-0042-1756309","url":null,"abstract":"The diagnosis and management of central diabetes insipidus in critically ill children is not standardized. Our objective was to characterize differences between Pediatric Critical Care Medicine (PCCM) and Pediatric Endocrinology (PE) clinicians in the diagnosis and management of new-onset CDI in the pediatric intensive care unit. We also sought to characterize knowledge gaps among general pediatrics (GP) residents. This is a scenario-based survey to assess patterns of diagnosis and management of new-onset CDI that was distributed to PCCM, PE, and GP clinicians who work in a quaternary care urban children's hospital. Of 275 PCCM, PE, and GP clinicians surveyed, 158 (57%) responded. More PCCM than PE clinicians relied on serum sodium levels (96 vs. 75%, p <0.01) and more PE than PCCM clinicians relied on serum osmolality (91 vs. 40%, p < .001) for diagnosis. Fewer PCCM than PE clinicians favored restricting IV fluids to two-thirds maintenance rate (4 vs. 37%, p <0.001). More PCCM than PE clinicians favored a starting dose of 0.5 milli-units/kg/h for IV vasopressin infusion (76 vs. 53%, p = 0.048). More PCCM clinicians than PE clinicians favored titrating the IV vasopressin infusion every 20 minutes (24 vs. 2%, p = 0.02), whereas more PE clinicians than PCCM clinicians favored titration every 60 minutes (38 vs. 14%, p = 0.03). GP residents earlier in training had greater self-reported gaps in knowledge. We observed substantial variability in the diagnosis and management of new-onset CDI in critically ill children among PCCM, PE, and GP clinicians. There is a need for greater standardization in care of these patients.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"27 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88810367","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}
Rohit S. Loomba, S. Uppuluri, P. Chandra, Faeeq Yousef, V. Dorsey, J. S. Farias, S. Flores, E. Villarreal
The purpose of this retrospective study was to investigate the effects of a single dose of aminophylline on urine output and fluid balance in children admitted to the cardiac intensive care unit. A retrospective study was performed to compare variables of interest before and 24 hours after aminophylline administration in children under the age of 18 years who were admitted to the cardiac intensive care unit at our institution from January 2011 onwards. Variables of interest included age, weight, aminophylline dose, concurrently administered diuretics, specific hemodynamic parameters, and blood urea nitrogen and creatinine levels. Variables such as urine output and fluid balance were measured through a binary endpoint. Data were compared in a paired fashion and continuous variables were compared through paired t-tests. Analyses were conducted using SPSS Version 23.0. A total of 14 patients were included in the study. There was no significant change in hemodynamic parameters or creatinine levels before and after intravenous aminophylline administration of 5 mg/kg. There was a significant difference in urine output, fluid balance, and blood urea nitrogen levels from the baseline value. Concurrent usage of diuretics did not show significant association with a difference in urine output or fluid balance from baseline. No significant adverse reactions were noted 24 hours after administration of aminophylline. Use of aminophylline dosed at 5 mg/kg is safe and leads to improvement in urine output and fluid balance without negatively impacting systemic oxygen delivery or renal filtration function.
本回顾性研究的目的是探讨单剂量氨茶碱对入住心脏重症监护病房的儿童尿量和体液平衡的影响。我们进行了一项回顾性研究，比较2011年1月以来我院心脏重症监护病房收治的18岁以下儿童给药前和给药后24小时的相关变量。感兴趣的变量包括年龄、体重、氨茶碱剂量、同时使用利尿剂、特定血流动力学参数、血尿素氮和肌酐水平。尿量和体液平衡等变量通过一个二元终点来测量。数据以配对方式比较，连续变量通过配对t检验进行比较。采用SPSS Version 23.0进行分析。研究共纳入14例患者。静脉给药5 mg/kg氨茶碱前后血液动力学参数和肌酐水平无明显变化。尿量、体液平衡和血尿素氮水平与基线值有显著差异。与基线相比，同时使用利尿剂与尿量或体液平衡的差异没有显著关联。给药24小时后未见明显不良反应。使用5mg /kg剂量的氨茶碱是安全的，可以改善尿量和液体平衡，而不会对全身氧输送或肾脏滤过功能产生负面影响。
{"title":"The Effect of Aminophylline on Urine Output and Fluid Balance after a Single Dose in Children Admitted to the Pediatric Cardiac Intensive Care Unit","authors":"Rohit S. Loomba, S. Uppuluri, P. Chandra, Faeeq Yousef, V. Dorsey, J. S. Farias, S. Flores, E. Villarreal","doi":"10.1055/s-0042-1755443","DOIUrl":"https://doi.org/10.1055/s-0042-1755443","url":null,"abstract":"The purpose of this retrospective study was to investigate the effects of a single dose of aminophylline on urine output and fluid balance in children admitted to the cardiac intensive care unit. A retrospective study was performed to compare variables of interest before and 24 hours after aminophylline administration in children under the age of 18 years who were admitted to the cardiac intensive care unit at our institution from January 2011 onwards. Variables of interest included age, weight, aminophylline dose, concurrently administered diuretics, specific hemodynamic parameters, and blood urea nitrogen and creatinine levels. Variables such as urine output and fluid balance were measured through a binary endpoint. Data were compared in a paired fashion and continuous variables were compared through paired t-tests. Analyses were conducted using SPSS Version 23.0. A total of 14 patients were included in the study. There was no significant change in hemodynamic parameters or creatinine levels before and after intravenous aminophylline administration of 5 mg/kg. There was a significant difference in urine output, fluid balance, and blood urea nitrogen levels from the baseline value. Concurrent usage of diuretics did not show significant association with a difference in urine output or fluid balance from baseline. No significant adverse reactions were noted 24 hours after administration of aminophylline. Use of aminophylline dosed at 5 mg/kg is safe and leads to improvement in urine output and fluid balance without negatively impacting systemic oxygen delivery or renal filtration function.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"20 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82554904","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 : 2022-09-14eCollection Date: 2024-12-01DOI: 10.1055/s-0042-1756307
Joseph G Kohne, Erin F Carlton, Stephen M Gorga, Acham Gebremariam, Michael W Quasney, Jerry Zimmerman, Sarah L Reeves, Ryan P Barbaro
Objectives This study aimed to test whether early oxygenation failure severity categories (absent/mild/moderate/severe) were associated with health-related quality of life (HRQL) deterioration among children who survived sepsis-related acute respiratory failure. Methods We performed a secondary analysis of a study of community-acquired pediatric septic shock, Life After Pediatric Sepsis Evaluation. The primary outcome was an adjusted decline in HRQL ≥ 25% below baseline as assessed 3 months following admission. Logistic regression models were built to test the association of early oxygenation failure including covariates of age and nonrespiratory Pediatric Logistic Organ Dysfunction-2 score. Secondarily, we tested if there was an adjusted decline in HRQL at 6 and 12 months and functional status at 28 days. Results We identified 291 children who survived to discharge and underwent invasive ventilation. Of those, that 21% (61/291) had mild oxygenation failure, 20% (58/291) had moderate, and 17% (50/291) had severe oxygenation failure. Fifteen percent of children exhibited a decline in HRQL of at least 25% from their baseline at the 3-month follow-up time point. We did not identify an association between the adjusted severity of oxygenation failure and decline in HRQL ≥ 25% at 3-, 6-, or 12-month follow-up. Children with oxygenation failure were more likely to exhibit a decline in functional status from baseline to hospital discharge, but results were similar across severity categories. Conclusion Our findings that children of all oxygenation categories are at risk of HRQL decline suggest that those with mild lung injury should not be excluded from comprehensive follow-up, but more work is needed to identify those at the highest risk.
{"title":"Oxygenation Severity Categories and Long-Term Quality of Life among Children who Survive Septic Shock.","authors":"Joseph G Kohne, Erin F Carlton, Stephen M Gorga, Acham Gebremariam, Michael W Quasney, Jerry Zimmerman, Sarah L Reeves, Ryan P Barbaro","doi":"10.1055/s-0042-1756307","DOIUrl":"10.1055/s-0042-1756307","url":null,"abstract":"<p><p><b>Objectives</b> This study aimed to test whether early oxygenation failure severity categories (absent/mild/moderate/severe) were associated with health-related quality of life (HRQL) deterioration among children who survived sepsis-related acute respiratory failure. <b>Methods</b> We performed a secondary analysis of a study of community-acquired pediatric septic shock, Life After Pediatric Sepsis Evaluation. The primary outcome was an adjusted decline in HRQL ≥ 25% below baseline as assessed 3 months following admission. Logistic regression models were built to test the association of early oxygenation failure including covariates of age and nonrespiratory Pediatric Logistic Organ Dysfunction-2 score. Secondarily, we tested if there was an adjusted decline in HRQL at 6 and 12 months and functional status at 28 days. <b>Results</b> We identified 291 children who survived to discharge and underwent invasive ventilation. Of those, that 21% (61/291) had mild oxygenation failure, 20% (58/291) had moderate, and 17% (50/291) had severe oxygenation failure. Fifteen percent of children exhibited a decline in HRQL of at least 25% from their baseline at the 3-month follow-up time point. We did not identify an association between the adjusted severity of oxygenation failure and decline in HRQL ≥ 25% at 3-, 6-, or 12-month follow-up. Children with oxygenation failure were more likely to exhibit a decline in functional status from baseline to hospital discharge, but results were similar across severity categories. <b>Conclusion</b> Our findings that children of all oxygenation categories are at risk of HRQL decline suggest that those with mild lung injury should not be excluded from comprehensive follow-up, but more work is needed to identify those at the highest risk.</p>","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"159 1","pages":"408-414"},"PeriodicalIF":0.5,"publicationDate":"2022-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11584271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91125457","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}
Simon Gates, Ellie Melkuhn, Brenda Morrow, George Ntoumenopoulos, Harriet Shannon, Emma Shkurka
1Division of Pediatric Critical Care, Department of Children’s Therapy, Nottingham Children’s Hospital, Nottingham, United Kingdom 2Division of Pediatric Respiratory, Department of Children’s Physiotherapy, Evelina London, Children’s Hospital, London, United Kingdom 3Department of Pediatrics, University of Cape Town, Cape Town, South Africa 4Division of Critical Care, Department of Physiotherapy, St Vincent’s Hospital, Sydney, Australia 5Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, London, United Kingdom 6Division of Pediatric Critical Care, Department of Physiotherapy, Great Ormond Street Hospital for Children, London, United Kingdom
{"title":"Refractory Atelectasis and Response to Chest Physiotherapy.","authors":"Simon Gates, Ellie Melkuhn, Brenda Morrow, George Ntoumenopoulos, Harriet Shannon, Emma Shkurka","doi":"10.1055/s-0041-1728639","DOIUrl":"https://doi.org/10.1055/s-0041-1728639","url":null,"abstract":"1Division of Pediatric Critical Care, Department of Children’s Therapy, Nottingham Children’s Hospital, Nottingham, United Kingdom 2Division of Pediatric Respiratory, Department of Children’s Physiotherapy, Evelina London, Children’s Hospital, London, United Kingdom 3Department of Pediatrics, University of Cape Town, Cape Town, South Africa 4Division of Critical Care, Department of Physiotherapy, St Vincent’s Hospital, Sydney, Australia 5Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, London, United Kingdom 6Division of Pediatric Critical Care, Department of Physiotherapy, Great Ormond Street Hospital for Children, London, United Kingdom","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"11 3","pages":"265-266"},"PeriodicalIF":0.7,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9345668/pdf/10-1055-s-0041-1728639.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9333369","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}
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