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High-flow nasal oxygen in infants and children for early respiratory management of pneumonia-induced acute hypoxemic respiratory failure: the CENTURI randomized clinical trial 高流量鼻氧用于婴幼儿肺炎引发的急性低氧血症呼吸衰竭的早期呼吸管理:CENTURI 随机临床试验
Pub Date : 2024-04-01 DOI: 10.1007/s44253-024-00031-8
Sasidaran Kandasamy, R. Rameshkumar, Thangavelu Sangaralingam, N. Krishnamoorthy, N. C. G. Shankar, Vimalraj Vijayakumar, B. Sridharan
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引用次数: 0
Safety of primary nasotracheal intubation in the pediatric intensive care unit (PICU). 儿科重症监护室(PICU)中初级鼻气管插管的安全性。
Pub Date : 2024-01-01 Epub Date: 2024-02-23 DOI: 10.1007/s44253-024-00035-4
Laurence Ducharme-Crevier, Jamie Furlong-Dillard, Philipp Jung, Fabrizio Chiusolo, Matthew P Malone, Shashikanth Ambati, Simon J Parsons, Conrad Krawiec, Awni Al-Subu, Lee A Polikoff, Natalie Napolitano, Keiko M Tarquinio, Asha Shenoi, Andrea Talukdar, Palen P Mallory, John S Giuliano, Ryan K Breuer, Krista Kierys, Serena P Kelly, Makoto Motomura, Ron C Sanders, Ashley Freeman, Yuki Nagai, Lily B Glater-Welt, Joseph Wilson, Mervin Loi, Michelle Adu-Darko, Justine Shults, Vinay Nadkarni, Guillaume Emeriaud, Akira Nishisaki

Background: Nasal tracheal intubation (TI) represents a minority of all TI in the pediatric intensive care unit (PICU). The risks and benefits of nasal TI are not well quantified. As such, safety and descriptive data regarding this practice are warranted.

Methods: We evaluated the association between TI route and safety outcomes in a prospectively collected quality improvement database (National Emergency Airway Registry for Children: NEAR4KIDS) from 2013 to 2020. The primary outcome was severe desaturation (SpO2 > 20% from baseline) and/or severe adverse TI-associated events (TIAEs), using NEAR4KIDS definitions. To balance patient, provider, and practice covariates, we utilized propensity score (PS) matching to compare the outcomes of nasal vs. oral TI.

Results: A total of 22,741 TIs [nasal 870 (3.8%), oral 21,871 (96.2%)] were reported from 60 PICUs. Infants were represented in higher proportion in the nasal TI than the oral TI (75.9%, vs 46.2%), as well as children with cardiac conditions (46.9% vs. 14.4%), both p < 0.001. Severe desaturation or severe TIAE occurred in 23.7% of nasal and 22.5% of oral TI (non-adjusted p = 0.408). With PS matching, the prevalence of severe desaturation and or severe adverse TIAEs was 23.6% of nasal vs. 19.8% of oral TI (absolute difference 3.8%, 95% confidence interval (CI): - 0.07, 7.7%), p = 0.055. First attempt success rate was 72.1% of nasal TI versus 69.2% of oral TI, p = 0.072. With PS matching, the success rate was not different between two groups (nasal 72.2% vs. oral 71.5%, p = 0.759).

Conclusion: In this large international prospective cohort study, the risk of severe peri-intubation complications was not significantly higher. Nasal TI is used in a minority of TI in PICUs, with substantial differences in patient, provider, and practice compared to oral TI.A prospective multicenter trial may be warranted to address the potential selection bias and to confirm the safety of nasal TI.

背景:在儿科重症监护室(PICU)的所有气管插管中,鼻腔气管插管(TI)只占少数。鼻腔气管插管的风险和益处尚未得到很好的量化。因此,有必要提供有关这种做法的安全性和描述性数据:我们评估了 2013 年至 2020 年期间前瞻性收集的质量改进数据库(全国儿童紧急气道注册:NEAR4KIDS)中 TI 途径与安全结果之间的关联。根据 NEAR4KIDS 的定义,主要结果是严重不饱和(SpO2 与基线相比 > 20%)和/或严重不良 TI 相关事件 (TIAE)。为了平衡患者、医疗服务提供者和实践协变量,我们利用倾向得分(PS)匹配来比较鼻腔和口腔 TI 的结果:60 个 PICU 共报告了 22,741 例 TI [鼻腔 870 例(3.8%),口腔 21,871 例(96.2%)]。婴儿在鼻腔 TI 中的比例高于口腔 TI(75.9% 对 46.2%),患有心脏病的儿童在鼻腔 TI 中的比例也高于口腔 TI(46.9% 对 14.4%),两者的 P = 0.408)。在 PS 匹配的情况下,严重饱和度降低或严重不良 TIAEs 的发生率为:鼻腔 TI 23.6% 对口腔 TI 19.8%(绝对差异 3.8%,95% 置信区间 (CI):- 0.07,7.7%),P = 0.055。鼻腔 TI 的首次尝试成功率为 72.1%,而口腔 TI 为 69.2%,P = 0.072。在 PS 匹配的情况下,两组的成功率没有差异(鼻腔 72.2% 对口腔 71.5%,P = 0.759):结论:在这项大型国际前瞻性队列研究中,发生严重插管周围并发症的风险并没有明显增加。鼻腔插管术在 PICU 的插管术中只占少数,与口腔插管术相比,鼻腔插管术在患者、提供者和实践方面存在很大差异。可能需要进行前瞻性多中心试验,以解决潜在的选择偏差并确认鼻腔插管术的安全性。
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引用次数: 0
Evaluating associations between late intensive care admission and mortality, intensive care days, and organ dysfunctions: a secondary analysis of data from the EPOCH cluster randomized trial 评估重症监护晚期入院与死亡率、重症监护天数和器官功能障碍之间的关系:EPOCH随机试验数据的二次分析
Pub Date : 2023-11-06 DOI: 10.1007/s44253-023-00019-w
Ari R. Joffe, Karen Dryden-Palmer, Leah Shadkowski, Helena Frndova, Vinay Nadkarni, George Tomlinson, Christopher Parshuram
Abstract Purpose To determine whether late admission to pediatric intensive care (ICU) from hospital wards is associated with patient outcomes. Methods Secondary analysis of prospectively collected data from an international multicenter cluster-randomized trial. Clinical deterioration events with urgent ICU admission were defined as late if the Children’s Resuscitation Intensity Scale was > 2 (indicating critical care interventions started from 12 h pre- to 1 h post-urgent ICU admission). The association of late admission with primary outcomes (ICU and hospital mortality) was estimated using logistically generalized estimating equation models adjusted for PIM2 probability of death. Results There were 2979 clinical deterioration events in 2502 patients, including 620 (20.8%) late ICU admissions. ICU mortality of the last urgent ICU admission was 15.4% for late compared to 4.5% for non-late ICU admission (PIM-adjusted OR (95%CI) 1.63 (1.14, 2.33), p < 0.01). Hospital mortality was 19.7% in late compared to 6.0% for non-late urgent ICU admission (PIM-adjusted OR 1.56 (1.12, 2.16), p < 0.01). Late ICU admissions accounted for 20.9% of clinical deterioration events, and 90/179 (50.2.0%) of ICU and 103/222 (46.4%) of hospital deaths after clinical deterioration events. Secondary outcomes associated with late ICU admission included longer ICU stay (2.3 days, p = 0.02), more ventilation days (407/1000 ICU days, p < 0.0001), and more frequent treatment with dialysis, inhaled nitric oxide, and extracorporeal membrane oxygenation ( p < 0.01). Conclusion Late ICU admission from hospital wards was associated with higher ICU and hospital mortality, greater use of ICU technologies, and longer ICU stays. How to prevent late ICU admission and its consequences requires further study.
目的探讨小儿重症监护(ICU)住院时间晚是否与患者预后相关。方法对一项国际多中心集群随机试验的前瞻性数据进行二次分析。如果儿童复苏强度量表为>2(表示重症监护干预从急诊ICU入院前12小时至入院后1小时开始)。使用经PIM2死亡概率调整的logistic广义估计方程模型估计延迟入院与主要结局(ICU和住院死亡率)的关联。结果2502例患者发生2979例临床恶化事件,其中晚期入ICU患者620例(20.8%)。最后一次紧急ICU入院的死亡率,晚期为15.4%,非晚期为4.5% (pim校正OR (95%CI) 1.63 (1.14, 2.33), p <0.01)。晚期住院死亡率为19.7%,非晚期急诊ICU住院死亡率为6.0%(经pim调整OR为1.56 (1.12,2.16),p <0.01)。晚期ICU入院占临床恶化事件的20.9%,临床恶化事件后ICU死亡占90/179(50.2.0%),住院死亡占103/222(46.4%)。与ICU晚期入院相关的次要结局包括ICU住院时间较长(2.3天,p = 0.02),通气天数较多(407/1000 ICU天,p <0.0001),并且更频繁地进行透析、吸入一氧化氮和体外膜氧合治疗(p <0.01)。结论ICU晚期住院患者的ICU死亡率和住院死亡率较高,ICU技术的使用较多,ICU住院时间较长。如何预防ICU晚期入院及其后果有待进一步研究。
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引用次数: 0
Distribution and trajectory of vital signs from high-frequency continuous monitoring during pediatric critical care transport 儿童重症监护运输过程中高频连续监测生命体征的分布和轨迹
Pub Date : 2023-09-27 DOI: 10.1007/s44253-023-00018-x
Zhiqiang Huo, John Booth, Thomas Monks, Philip Knight, Liam Watson, Mark Peters, Christina Pagel, Padmanabhan Ramnarayan, Kezhi Li
Abstract Objective To describe comprehensively the distribution and progression of high-frequency continuous vital signs monitoring data for children during critical care transport and explore associations with patient age, diagnosis, and severity of illness. Design Retrospective cohort study using prospectively collected vital signs monitoring data linked to patient demographic and transport data. Setting A regional pediatric critical care transport team based in London, England. Patients Critically ill children (age ≤ 18 years) transported by the Children’s Acute Transport Service (CATS) at Great Ormond Street Hospital (GOSH) between January 2016 and May 2021 with available high-frequency vital signs monitoring data. Interventions None. Main results Numeric values of heart rate (HR), blood pressure (BP), respiratory rate (RR), oxygen saturations (SpO 2 ), and end-tidal carbon dioxide in ventilated children (etCO 2 ) were extracted at a frequency of one value per second totalling over 40 million data points. Age-varying vital signs (HR, BP, and RR) were standardized using Z scores. The distribution of vital signs measured in the first 10 min of monitoring during transport, and their progression through the transport, were analyzed by age group, diagnosis group and severity of illness group. A complete dataset comprising linked vital signs, patient and transport data was extracted from 1711 patients (27.7% of all transported patients). The study cohort consisted predominantly of infants (median age of 6 months, IQR 0–51), and respiratory illness (36.0%) was the most frequent diagnosis group. Most patients were invasively ventilated (70.7%). The Infection group had the highest average (+ 2.5) and range (− 5 to + 9) of HR Z scores, particularly in septic children. Infants and pre-school children demonstrated a greater reduction in the HR Z score from the beginning to the end of transport compared to older children. Conclusions Marked differences in the distribution and progression of vital signs between age groups, diagnosis groups, and severity of illness groups were observed by analyzing the high-frequency data collected during paediatric critical care transport.
摘要目的全面描述危重监护转运过程中儿童高频连续生命体征监测数据的分布和进展,探讨其与患者年龄、诊断和疾病严重程度的关系。设计回顾性队列研究,使用前瞻性收集的与患者人口统计学和交通数据相关的生命体征监测数据。设置以英国伦敦为基地的区域儿科重症监护运输团队。2016年1月至2021年5月期间由大奥蒙德街医院(GOSH)儿童急症转运服务(CATS)运送的危重儿童(年龄≤18岁)患者,具有可用的高频生命体征监测数据。干预措施。主要结果以1 / s的频率提取通气儿童心率(HR)、血压(BP)、呼吸频率(RR)、血氧饱和度(spo2)和潮末二氧化碳(etco2)的数值,总数据点超过4000万个数据点。年龄变化的生命体征(HR、BP和RR)使用Z评分进行标准化。按年龄组、诊断组、病情严重程度组分析转运过程中监测前10min生命体征分布及进展情况。从1711名患者(占所有转运患者的27.7%)中提取了包含相关生命体征、患者和转运数据的完整数据集。研究队列主要由婴儿组成(中位年龄6个月,IQR 0-51),呼吸系统疾病(36.0%)是最常见的诊断组。大多数患者采用有创通气(70.7%)。感染组的HR - Z评分平均(+ 2.5)和范围(- 5至+ 9)最高,特别是在脓毒症患儿中。与年龄较大的儿童相比,婴儿和学龄前儿童从运输开始到结束的HR - Z得分下降幅度更大。结论通过分析小儿重症监护转运过程中采集的高频数据,观察到不同年龄组、不同诊断组、不同病情严重程度患者生命体征的分布和进展有显著差异。
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引用次数: 0
Use of bi-caval cannulae for veno-venous ECMO in neonates and children 双腔管在新生儿和儿童静脉-静脉ECMO中的应用
Pub Date : 2023-08-29 DOI: 10.1007/s44253-023-00017-y
J. Awad, A. Numa, H. Ravindranathan, Peter Grant, A. Lahanas, Puneet Singh, K. Swil, Victoria Ward, Gary Williams
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引用次数: 0
Inflammatory and coagulant responses after acute respiratory failure in children of different body habitus 不同体质儿童急性呼吸衰竭后的炎症和凝血反应
Pub Date : 2023-08-29 DOI: 10.1007/s44253-023-00015-0
Shan L. Ward, H. Flori, M. Dahmer, H. Weeks, A. Sapru, M. Quasney, M. Curley, Kathleen D. Liu, M. Matthay
{"title":"Inflammatory and coagulant responses after acute respiratory failure in children of different body habitus","authors":"Shan L. Ward, H. Flori, M. Dahmer, H. Weeks, A. Sapru, M. Quasney, M. Curley, Kathleen D. Liu, M. Matthay","doi":"10.1007/s44253-023-00015-0","DOIUrl":"https://doi.org/10.1007/s44253-023-00015-0","url":null,"abstract":"","PeriodicalId":73402,"journal":{"name":"Intensive care medicine. Paediatric and neonatal","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74937182","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}
引用次数: 0
Edema description in pediatric critical care: terms, patterns, and clinical characteristics 儿科重症监护中的水肿描述:术语、模式和临床特征
Pub Date : 2023-08-25 DOI: 10.1007/s44253-023-00016-z
M. Gaetani, E. See, Saravanan Satkumaran, B. Gelbart
{"title":"Edema description in pediatric critical care: terms, patterns, and clinical characteristics","authors":"M. Gaetani, E. See, Saravanan Satkumaran, B. Gelbart","doi":"10.1007/s44253-023-00016-z","DOIUrl":"https://doi.org/10.1007/s44253-023-00016-z","url":null,"abstract":"","PeriodicalId":73402,"journal":{"name":"Intensive care medicine. Paediatric and neonatal","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82654625","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}
引用次数: 0
A combined rapid clinical and lung ultrasound score for predicting bronchiolitis severity 预测毛细支气管炎严重程度的联合快速临床和肺部超声评分
Pub Date : 2023-08-07 DOI: 10.1007/s44253-023-00012-3
A. Camporesi, R. Morello, A. Guzzardella, Ugo Maria Pierucci, F. Izzo, C. De Rose, D. Buonsenso
{"title":"A combined rapid clinical and lung ultrasound score for predicting bronchiolitis severity","authors":"A. Camporesi, R. Morello, A. Guzzardella, Ugo Maria Pierucci, F. Izzo, C. De Rose, D. Buonsenso","doi":"10.1007/s44253-023-00012-3","DOIUrl":"https://doi.org/10.1007/s44253-023-00012-3","url":null,"abstract":"","PeriodicalId":73402,"journal":{"name":"Intensive care medicine. Paediatric and neonatal","volume":"32 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85766329","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}
引用次数: 1
Furosemide and acute kidney injury: is Batman the cause of evil? 速尿和急性肾损伤:蝙蝠侠是邪恶的根源吗?
Pub Date : 2023-08-03 DOI: 10.1007/s44253-023-00014-1
Z. Ricci, Akash Deep
{"title":"Furosemide and acute kidney injury: is Batman the cause of evil?","authors":"Z. Ricci, Akash Deep","doi":"10.1007/s44253-023-00014-1","DOIUrl":"https://doi.org/10.1007/s44253-023-00014-1","url":null,"abstract":"","PeriodicalId":73402,"journal":{"name":"Intensive care medicine. Paediatric and neonatal","volume":"336 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80644978","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}
引用次数: 0
Physiological effects of standard oxygen therapy, high-flow nasal cannula, and helmet CPAP in acute bronchiolitis: a randomized cross-over study 标准氧疗、高流量鼻插管和头盔CPAP治疗急性细支气管炎的生理效应:一项随机交叉研究
Pub Date : 2023-08-03 DOI: 10.1007/s44253-023-00013-2
G. Chidini, T. Mauri, G. Conti, S. S. Catenacci, T. Marchesi, Giada Dona, M. Figini, G. Babini, E. Calderini
{"title":"Physiological effects of standard oxygen therapy, high-flow nasal cannula, and helmet CPAP in acute bronchiolitis: a randomized cross-over study","authors":"G. Chidini, T. Mauri, G. Conti, S. S. Catenacci, T. Marchesi, Giada Dona, M. Figini, G. Babini, E. Calderini","doi":"10.1007/s44253-023-00013-2","DOIUrl":"https://doi.org/10.1007/s44253-023-00013-2","url":null,"abstract":"","PeriodicalId":73402,"journal":{"name":"Intensive care medicine. Paediatric and neonatal","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88974647","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}
引用次数: 0
期刊
Intensive care medicine. Paediatric and neonatal
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