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Amagasa S, Yasuda H, Oishi T, Kodama S, Kashiura M, Moriya T. Target Temperature Management Following Pediatric Cardiac Arrest: A Systematic Review and Network Meta-Analysis to Compare the Effectiveness of the Length of Therapeutic Hypothermia. Cureus 2022; 14:e31636. [DOI: 10.7759/cureus.31636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 11/19/2022] Open
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2
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Nogueira ALM, Maciel ALDS, Querubino AC, Prado RT, Martins JR. Efficacy and Risks of Therapeutic Hypothermia after Pediatric Cardiac Arrest: A Systematic Review. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.36660/ijcs.20210246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Farias-Moeller R, Jayakar A, Guerriero RM, Carpenter JL, Wainwright MS, Harrar DB. Pediatric Critical Care Neurologists in the United States and Canada: A Survey of Clinical Practice Experience. J Child Neurol 2022; 37:288-297. [PMID: 35037772 DOI: 10.1177/08830738211070099] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To describe the characteristics of pediatric intensive care neurologists and their practice in the United States and Canada. METHODS We performed a survey-based study of child neurologists who self-identify as 'intensive care neurologists'. The survey included questions about demographics, training, pediatric neurocritical care service and job structure, teaching, academics, challenges, and views on the future of pediatric neurocritical care. RESULTS We analyzed 55 surveys. Most respondents were 31-50 years of age with ≤10 years of practice experience. Fifty-four percent identified as female. Most completed subspecialty training after child neurology residency. The majority practice at highly resourced centers with >45 intensive care unit beds. Respondents cover a variety of inpatient (critical and noncritical care) services, at times simultaneously, for a median of 19.5 weeks/y and work >70 hours/wk when on service for pediatric neurocritical care. The top 3 challenges reported were competing demands for time, excess volume, and communication with critical care medicine. Top priorities for the "ideal pediatric neurocritical care service" were attendings with training in pediatric neurocritical care or a related field and joint rounding with critical care medicine. CONCLUSION We report a survey-based analysis of the demographics and scope of practice of pediatric critical care neurologists. We highlight challenges faced and provide a framework for the further development of this rapidly growing field.
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Affiliation(s)
- Raquel Farias-Moeller
- Division of Child Neurology, Department of Neurology, Children's Wisconsin, 144182Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anuj Jayakar
- Division of Epilepsy, Department of Child Neurology, 5447Nicklaus Children's Hospital, Miami, FL, USA
| | - Rejean M Guerriero
- Division of Pediatric Neurology, Washington University Medical Center, 12275Washington University School of Medicine, Saint Louis, MO, USA
| | - Jessica L Carpenter
- Division of Pediatric Neurology, 12264University of Maryland, Baltimore, MD, USA
| | - Mark S Wainwright
- Department of Neurology, Division of Pediatric Neurology, University of Washington, Seattle, WA, USA
| | - Dana B Harrar
- Division of Neurology, Children's National Hospital, Washington, DC, USA
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Singer D. Pediatric Hypothermia: An Ambiguous Issue. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11484. [PMID: 34769999 PMCID: PMC8583576 DOI: 10.3390/ijerph182111484] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 02/06/2023]
Abstract
Hypothermia in pediatrics is mainly about small body size. The key thermal factor here is the large surface-to-volume ratio. Although small mammals, including human infants and children, are adapted to higher heat losses through their elevated metabolic rate and thermogenic capacity, they are still at risk of hypothermia because of a small regulatory range and an impending metabolic exhaustion. However, some small mammalian species (hibernators) use reduced metabolic rates and lowered body temperatures as adaptations to impaired energy supply. Similar to nature, hypothermia has contradictory effects in clinical pediatrics as well: In neonates, it is a serious risk factor affecting respiratory adaptation in term and developmental outcome in preterm infants. On the other hand, it is an important self-protective response to neonatal hypoxia and an evidence-based treatment option for asphyxiated babies. In children, hypothermia first enabled the surgical repair of congenital heart defects and promotes favorable outcome after ice water drowning. Yet, it is also a major threat in various prehospital and clinical settings and has no proven therapeutic benefit in pediatric critical care. All in all, pediatric hypothermia is an ambiguous issue whose harmful or beneficial effects strongly depend on the particular circumstances.
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Affiliation(s)
- Dominique Singer
- Division of Neonatology and Pediatric Critical Care Medicine, University Medical Center Eppendorf, 20246 Hamburg, Germany
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Prendergast E, Allen KY, Mills MG, Moran T, Harris ZL, Malakooti M, Smith CM, Wainwright MS, McCarthy-Kowols M. Targeted Temperature Management Protocol in a Pediatric Intensive Care Unit: A Quality Improvement Project. Crit Care Nurse 2021; 41:41-50. [PMID: 34595494 DOI: 10.4037/ccn2021554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND In patients with acute neurological injury, abrupt temperature change exacerbates increased intracranial pressures and negatively affects perfusion pressure and cerebral blood flow. Critical care nurses must provide coordinated and effective interventions to maintain normothermia without precipitating shivering immediately after acute neurological injury in pediatric patients. OBJECTIVE To improve hyperthermia management in a 40-bed pediatric intensive care unit, an interdisciplinary pediatric critical care team developed, implemented, and evaluated a targeted temperature management protocol. METHODS The project was guided by the organization's plan-do-study-act quality improvement process. Quality improvement was assessed retrospectively using electronic medical records of patients meeting eligibility criteria. Samples of pediatric patients who received temperature interventions were compared before and after protocol implementation. The protocol included environmental, pharmacological, and body surface cooling device interventions, as well as use of a bedside shivering assessment scale and stepwise interventions to prevent and control shivering. RESULTS Before implementation of the targeted temperature management protocol, 64% of patients had documented temperatures higher than 37.5 °C, and body surface cooling devices were used in 10% of patients. After protocol implementation, more than 80% of patients had documented temperatures higher than 37.5 °C, and body surface cooling devices were used in 62% of patients. Four patients (6%) before and 5 patients (31%) after protocol implementation were treated with body surface cooling without requiring use of neuromuscular blockade. CONCLUSIONS Creation and implementation of a targeted temperature management protocol increased nurses' documented use of body surface cooling to manage hyperthermia in pediatric intensive care unit patients with acute neurological injury.
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Affiliation(s)
- Erica Prendergast
- Erica Prendergast is a neurocritical care nurse practitioner, Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Kiona Y Allen
- Kiona Y. Allen is Medical Director of the Regenstein Cardiac Care Unit and Associate Director of the NICU-Cardiac Neurodevelopmental Program, Ann & Robert H. Lurie Children's Hospital of Chicago, and an assistant professor, Department of Pediatrics, Division of Cardiology and Division of Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michele Grimason Mills
- Michele Grimason Mills is a neurocritical care nurse practitioner, Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Thomas Moran
- Thomas Moran is Manager of Clinical Pharmacy Services, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Z Leah Harris
- Z. Leah Harris is Chairman of Pediatrics at Dell Medical School, University of Texas at Austin, and Director of the Dell Pediatric Research Institute and Physician-in-Chief at Dell Children's Medical Center, Austin, Texas
| | - Marcelo Malakooti
- Marcelo Malakooti is Associate Chief Medical Officer and Medical Director of the pediatric intensive care unit, Ann & Robert H. Lurie Children's Hospital of Chicago, and an assistant professor, Department of Pediatrics, Division of Critical Care Medicine, Northwestern University Feinberg School of Medicine
| | - Craig M Smith
- Craig Smith is an assistant professor of pediatrics and neurology, Northwestern University Feinberg School of Medicine, and faculty for pediatric critical care medicine and neurocritical care, Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Mark S Wainwright
- Mark S. Wainwright is Division Head of Pediatric Neurology, University of Washington, Seattle
| | - Maureen McCarthy-Kowols
- Maureen McCarthy-Kowols is a former nursing professional development practitioner/clinical educator, Ann & Robert H. Lurie Children's Hospital of Chicago
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Matsui S, Hirayama A, Kitamura T, Sobue T, Hayashi T, Takei H, Tanizawa N, Ohnishi Y, Kuratani S, Sameshima T, Yoshino G, Kurosawa H, Tanaka R. Target Temperature Management and Survival with Favorable Neurological Outcome After Out-of-Hospital Cardiac Arrest in Children: A Nationwide Multicenter Prospective Study in Japan. Ther Hypothermia Temp Manag 2021; 12:16-23. [PMID: 33635149 DOI: 10.1089/ther.2020.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To assess whether target temperature management (TTM) is effective for 1-month survival with favorable neurological outcome among pediatric patients who achieved return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA). The Japanese Association for Acute Medicine-out-of-hospital cardiac arrest (JAAM-OHCA) Registry, a multicenter prospective observational registry in Japan, included OHCA patients aged ≤17 years who achieved ROSC between June 2014 and December 2017. The primary outcome was 1-month survival with favorable neurological outcomes, defined as pediatric cerebral performance category 1 or 2. We conducted a propensity score analysis with inverse-probability-of-treatment weighting (IPTW) and evaluated the effect of TTM using logistic regression models with IPTW. A total of 167 patients [120 in the non-TTM group (71.9%) and 47 in the TTM group (28.1%)] were eligible for our analysis. The proportion of patients demonstrating 1-month survival with favorable neurological outcomes was 25.5% (12/47) in the TTM group and 16.7% (20/120) in the non-TTM group; there were no significant differences in favorable neurological outcomes (odds ratio, 1.36; 95% confidence interval, 0.55-3.35) between the non-TTM and TTM groups after performing adjustments with IPTW. In our study population composed of pediatric patients who achieved ROSC after OHCA, we did not find a positive association between TTM implementation and 1-month survival with favorable neurological outcomes.
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Affiliation(s)
- Satoshi Matsui
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan.,Department of Emergency and General Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Atsushi Hirayama
- Division of Public Health, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Takuro Hayashi
- Department of Emergency and General Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Hirokazu Takei
- Department of Emergency and General Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Naoko Tanizawa
- Department of Emergency and General Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Yasuhiro Ohnishi
- Department of Emergency and General Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Saori Kuratani
- Department of Emergency and General Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Tomohiro Sameshima
- Department of Emergency and General Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Go Yoshino
- Department of Emergency and General Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Hiroshi Kurosawa
- Division of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Ryojiro Tanaka
- Department of Emergency and General Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
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miR-499-5p suppresses C-reactive protein and provides neuroprotection in hypoxic-ischemic encephalopathy in neonatal rat. Neurosci Res 2020; 161:44-50. [DOI: 10.1016/j.neures.2019.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/26/2019] [Accepted: 12/03/2019] [Indexed: 12/16/2022]
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8
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Lin JJ, Hsia SH, Chiang MC, Lin KL. Clinical application of target temperature management in children with acute encephalopathy-A practical review. Biomed J 2020; 43:211-217. [PMID: 32611538 PMCID: PMC7424089 DOI: 10.1016/j.bj.2019.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/07/2019] [Accepted: 12/08/2019] [Indexed: 12/29/2022] Open
Abstract
Acute encephalopathy is a life-threatening disease involving acute brain dysfunction, and it is one of the most important causes of mortality and severe neurological sequelae in infants and children. Approximately 30% of cases of acute encephalopathy result in some degree of neurological sequelae. Although many strategies have been proposed, effective therapies to ameliorate the outcomes of acute encephalopathy have not yet been established. Target temperature management (TTM), previously termed therapeutic hypothermia, has been shown to be effective for various brain injuries due to multiple neuroprotective mechanisms, and it may be considered to be the cornerstone of neuroprotective strategies. Consequently, TTM is currently used in the neurocritical care of adult patients with cardiac arrest with shockable rhythm and perinatal asphyxia. In addition, increasing evidence also indicates that TTM could be useful in other acute encephalopathies, including status epilepticus, acute encephalitis/encephalopathy and traumatic brain injury. In this review, we discuss the recent practical aspects of TTM as a potential intervention for various acute encephalopathies in children.
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Affiliation(s)
- Jainn-Jim Lin
- Division of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital at Linkou, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Neurology, Chang Gung Children's Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Hsuan Hsia
- Division of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Chou Chiang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Neonatology, Chang Gung Children's Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuang-Lin Lin
- Division of Pediatric Neurology, Chang Gung Children's Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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9
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Chronic Pancytopenia due to Centrally Mediated Hypothermia in Two Children with Severe Neurological Impairment. CHILDREN-BASEL 2020; 7:children7040031. [PMID: 32276361 PMCID: PMC7230753 DOI: 10.3390/children7040031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/06/2020] [Accepted: 04/01/2020] [Indexed: 11/29/2022]
Abstract
We report on recurrent pancytopenia over five years in two children with severe impairment of the central nervous system. Assessment by hematology did not identify an etiology, including bone marrow biopsy in one. Both patients had sustained normalized blood cell counts following interventions to maintain or return to a temperature above 33 °C. Acute cytopenias following medically induced and environmental hypothermia have been reported. Recurrent pancytopenia due to centrally mediated hypothermia in patients with severe neurological impairment is often not recognized, putting such children at risk for unnecessary testing and transfusions. We provide a practical approach to management that is feasible for caregivers in the home setting with suggestions for monitoring.
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10
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Scher MS, Breningstall G, Gilbert D, Jordan L, Khakoo Y, LePichon JB. The 2018 Pediatric Neurology Trainee Publication Award. Pediatr Neurol 2019; 101:1. [PMID: 31623938 DOI: 10.1016/j.pediatrneurol.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Mark S Scher
- Division of Child Neurology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio.
| | - Galen Breningstall
- Division of Neurology, Department of Pediatrics, Gillette Children's Specialty Healthcare, St. Paul, Minnesota
| | - Donald Gilbert
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio
| | - Lori Jordan
- Division of Child Neurology, Department of Neurology, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee
| | - Yasmin Khakoo
- Department of Pediatrics, Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, New York
| | - Jean-Baptiste LePichon
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
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11
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Zimmer MB, Fong AY, Milsom WK. Effect of temperature, age and the pons on respiratory rhythm in the rat brainstem-spinal cord. Respir Physiol Neurobiol 2019; 273:103333. [PMID: 31634578 DOI: 10.1016/j.resp.2019.103333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 09/25/2019] [Accepted: 10/16/2019] [Indexed: 10/25/2022]
Abstract
Neonatal animals are extremely tolerant of hypothermia. However, cooling will ultimately lead to ventilatory arrest, or cessation of respiratory movements. Upon rewarming, ventilation can recover spontaneously (autoresuscitation). This study examined the effect of age (P0-P5) and the pons on respiratory-related output during hypothermic ventilatory arrest and recovery using a brainstem-spinal cord preparation of neonatal rats. As temperature fell, burst frequency slowed, burst duration increased, burst shape became fragmented and eventually respiratory arrest occurred in all preparations. Removing the pons had little effect on younger preparations (P0-P2). Older preparations (P4-P5) with the pons removed continued to burst at cooler temperatures compared to pons-intact preparations and burst durations were significantly longer. Episodic breathing patterns were observed in all preparations (all ages, pons on or off) at lower temperatures. At 27 °C, however, episodic breathing was only observed in younger preparations with the pons on. These data suggest that developmental changes occurring at the level of the pons underlie the loss of hypothermic tolerance and episodic breathing.
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Affiliation(s)
- M Beth Zimmer
- Department of Biological Sciences, Ferris State University, Big Rapids, MI, 49307, USA.
| | - Angelina Y Fong
- Department of Physiology, University of Melbourne, Parkville, Victoria, Australia
| | - William K Milsom
- Department of Zoology, University of British Columbia, Vancouver, BC, V6R 1ZT, Canada
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Williams CN, Hartman ME, Guilliams KP, Guerriero RM, Piantino JA, Bosworth CC, Leonard SS, Bradbury K, Wagner A, Hall TA. Postintensive Care Syndrome in Pediatric Critical Care Survivors: Therapeutic Options to Improve Outcomes After Acquired Brain Injury. Curr Treat Options Neurol 2019; 21:49. [PMID: 31559490 DOI: 10.1007/s11940-019-0586-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Children surviving the pediatric intensive care unit (PICU) with neurologic illness or injury have long-term morbidities in physical, cognitive, emotional, and social functioning termed postintensive care syndrome (PICS). In this article, we review acute and longitudinal management strategies available to combat PICS in children with acquired brain injury. RECENT FINDINGS Few intervention studies in this vulnerable population target PICS morbidities. Small studies show promise for both inpatient- and outpatient-initiated therapies, mainly focusing on a single domain of PICS and evaluating heterogeneous populations. While evaluating the effects of interventions on longitudinal PICS outcomes is in its infancy, longitudinal clinical programs targeting PICS are increasing. A multidisciplinary team with inpatient and outpatient presence is necessary to deliver the holistic integrated care required to address all domains of PICS in patients and families. While PICS is increasingly recognized as a chronic problem in PICU survivors with acquired brain injury, few interventions have targeted PICS morbidities. Research is needed to improve physical, cognitive, emotional, and social outcomes in survivors and their families.
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Affiliation(s)
- Cydni N Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, 707 SW Gaines St., CDRC-P, Portland, OR, 97239, USA.
- Department of Pediatrics, Division of Pediatric Critical Care, Oregon Health and Science University, Portland, OR, USA.
| | - Mary E Hartman
- Department of Pediatrics, Division of Critical Care Medicine, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Kristin P Guilliams
- Department of Pediatrics, Division of Critical Care Medicine, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
- Department of Neurology, Division of Pediatric and Developmental Neurology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Rejean M Guerriero
- Department of Neurology, Division of Pediatric and Developmental Neurology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Juan A Piantino
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, 707 SW Gaines St., CDRC-P, Portland, OR, 97239, USA
- Department of Pediatrics, Division of Pediatric Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Christopher C Bosworth
- Department of Psychology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Skyler S Leonard
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health and Science University, Portland, OR, USA
| | - Kathryn Bradbury
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health and Science University, Portland, OR, USA
| | - Amanda Wagner
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health and Science University, Portland, OR, USA
| | - Trevor A Hall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, 707 SW Gaines St., CDRC-P, Portland, OR, 97239, USA
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health and Science University, Portland, OR, USA
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13
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Buick JE, Wallner C, Aickin R, Meaney PA, de Caen A, Maconochie I, Skrifvars MB, Welsford M. Paediatric targeted temperature management post cardiac arrest: A systematic review and meta-analysis. Resuscitation 2019; 139:65-75. [PMID: 30951842 DOI: 10.1016/j.resuscitation.2019.03.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/20/2019] [Accepted: 03/20/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The International Liaison Committee on Resuscitation prioritized the need to update the review on the use of targeted temperature management (TTM) in paediatric post cardiac arrest care. In this meta-analysis, the effectiveness of TTM at 32-36 °C was compared with no target or a different target for comatose children who achieve a return of sustained circulation after cardiac arrest. METHODS Electronic databases were searched from inception to December 13, 2018. Randomized controlled trials and non-randomized studies with a comparator group that evaluated TTM in children were included. Pairs of independent reviewers extracted the demographic and outcome data, appraised risk of bias, and assessed GRADE certainty of effects. A random effects meta-analysis was undertaken where possible. RESULTS Twelve studies involving 2060 patients were included. Two randomized controlled trials provided the evidence that TTM at 32-34 °C compared with a target at 36-37.5 °C did not statistically improve long-term good neurobehavioural survival (risk ratio: 1.15; 95% CI: 0.69-1.93), long-term survival (RR: 1.14; 95% CI: 0.93-1.39), or short-term survival (risk ratio: 1.14; 95% CI: 0.96-1.36). TTM at 32-34 °C did not show statistically increased risks of infection, recurrent cardiac arrest, serious bleeding, or arrhythmias. A novel analysis suggests that another small RCT might provide enough evidence to show benefit for TTM in out-of-hospital cardiac arrest. CONCLUSION There is currently inconclusive evidence to either support or refute the use of TTM at 32-34 °C for comatose children who achieve return of sustained circulation after cardiac arrest. Future trials should focus on children with out-of-hospital cardiac arrest.
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Affiliation(s)
- Jason E Buick
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street - Room 425, Toronto, ON M5R 3M6, Canada.
| | - Clare Wallner
- Division of Emergency Medicine, McMaster University, Hamilton General Hospital, 237 Barton St E., Room 253, Hamilton, ON L8L 2X2, Canada.
| | - Richard Aickin
- Department of Paediatrics and Child Health, University of Auckland, Auckland Hospital - Building 599, 2 Park Road - Level 12, Auckland 1023, New Zealand.
| | - Peter A Meaney
- Division of Pediatric Critical Care, Stanford University, 770 Welch Road - Room 435, Palo Alto, California 94304, United States.
| | - Allan de Caen
- Pediatric Critical Care Medicine, Stollery Children's Hospital & Department of Pediatrics, University of Alberta, 11405 - 87th Avenue, Edmonton, Alberta T6G 1C9, Canada.
| | - Ian Maconochie
- Paediatric Emergency Medicine Department, Imperial College NHS Healthcare Trust, Imperial College, London W2 1NY, United Kingdom.
| | - Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Michelle Welsford
- Division of Emergency Medicine, McMaster University, Hamilton General Hospital, 237 Barton St E., Room 253, Hamilton, ON L8L 2X2, Canada.
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