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Grotberg JC, Sullivan M, McDonald RK, Despotovic V, Witt CA, Reynolds D, Lee JS, Kotkar K, Masood MF, Kraft BD, Pawale A. Acute chest syndrome from sickle cell disease successfully supported with veno-venous extracorporeal membrane oxygenation. Artif Organs 2024; 48:789-793. [PMID: 38647336 DOI: 10.1111/aor.14761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/26/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Affiliation(s)
- John C Grotberg
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mary Sullivan
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rachel K McDonald
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Vladimir Despotovic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Chad A Witt
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Daniel Reynolds
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Janet S Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kunal Kotkar
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Muhammad F Masood
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bryan D Kraft
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Amit Pawale
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Levy M, Naudin J, Geslain G, Maroni A, Koehl B, Le Bourgeois F, Poncelet G, Chomton M, Deho A, Julliand S, Dauger S, Sommet J. Factors associated with adverse outcome among children with sickle cell disease admitted to the pediatric intensive care unit: an observational cohort. Ann Intensive Care 2024; 14:55. [PMID: 38594419 PMCID: PMC11003929 DOI: 10.1186/s13613-024-01283-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/27/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is one of the most frequent inherited diseases in the world. Over the last decades, in high-income countries, an important decrease in mortality have been observed due to the improvement of care. However, children with SCD can become critically ill and require admission in Pediatric Intensive Care Units (PICU). The purpose of this study was to describe the epidemiology of children with SCD admitted to PICU for acute crisis and to identify factors associated with adverse outcome (AO). METHODS We conducted a retrospective study in a Tertiary Hospital in France including all consecutive children with SCD admitted to PICU between January 1st, 2009 and December 31, 2019. We collected baseline patient's characteristics, clinical and biological data as well as treatments and life sustaining therapies used in the PICU. Patients were defined as experiencing AO in case of death during stay and/or need for invasive mechanical ventilation (MV) and/or for non-invasive ventilation (NIV) for more than 3 days and/or need for vasopressors and/or need for renal replacement therapy. RESULTS We included 579 admissions in 395 patients, mainly of SS genotype (90%) with a median age of 9.2 years [5.5-13.4] and a median baseline hemoglobin of 8.0 g/dl (7.5-8.8). The two main reasons for admission were acute chest syndrome (ACS) (n = 331, 57%) and vaso-occlusive crisis refractory to first line therapy (n = 99, 17%). Half of patients required NIV and 47 (8%) required MV. The overall length of stay was 3 days [1-4] and seven (1%) patients died during PICU stay.There was a total of 113 (20%) admissions with AO and on multivariable analysis, baseline hemoglobin < 8 g/dL, history of bronchial obstruction and admission for ACS were associated with AO. There was no difference in the proportion of hydroxyurea treatment or exchange transfusion program between patients with AO and the other patients. CONCLUSIONS Baseline hemoglobin < 8 g/dL, history of bronchial obstruction and admission for ACS were the strongest risk factors for severe evolution in SCD children admitted to PICU. These factors could be taken into consideration when choosing the adequate therapeutic options.
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Affiliation(s)
- Michaël Levy
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France.
| | - Jérôme Naudin
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Guillaume Geslain
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Arielle Maroni
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Bérengère Koehl
- Reference Center for Sickle-Cell Disease, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Inserm U1134, Université Paris Cité, Paris, France
| | - Fleur Le Bourgeois
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Géraldine Poncelet
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Maryline Chomton
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Anna Deho
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Sébastien Julliand
- Pediatric Mobile Emergency Unit, Robert-Debré University Hospital, Assistance Publique- Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Stéphane Dauger
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Julie Sommet
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
- General Pediatrics, Pediatric infectious disease and Internal Medicine, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, ECEVE UMR 1123, Paris, France
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3
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Alsalman M, Alsalman Z, Alkhalifa HA, Alfaraj AN, Alkhalifah A, Almulihi Q. Predictors of Intensive Care Admission Among Adult Patients with Sickle Cell Disease in Eastern Province of Saudi Arabia. J Blood Med 2023; 14:671-680. [PMID: 38162949 PMCID: PMC10757811 DOI: 10.2147/jbm.s435861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024] Open
Abstract
Purpose Sickle cell disease (SCD) comprises a complex group of hematologic disorders that are collectively the most common monogenic disorder and are associated with increased risk of intensive care unit admission (ICU). The purpose of this study is to investigate factors that predict admission of adult patients with SCD to the ICU. Patients and Methods This was a cross-sectional study that enrolled adult patients with SCD from Saudi Arabia. Results A total of 107 patients with SCD, with a median age 31.9±12.1 years, were evaluated retrospectively. Regarding predictors of ICU admission, patients who indicated a history of blood transfusions were at 8.047-fold higher risk of ICU admission (OR=8.047; 95% CI=2.392-27.07; p=0.001). Patients who started hydroxyurea were at least 3.071 times more likely to be admitted than those who did not (OR=3.071; 95% CI=1.164-8.104; p=0.023). We also observed three or more hospitalizations per year to be associated with increased risk of ICU admission (OR=3.393; 95% CI=1.285-8.960; p=0.014), with those making 3 to 5 visits annually having at least 10.4 times higher risk (OR=10.38; 95% CI=10.098-98.19; p=0.041) and those with 6 to 10 ER admissions having 18 times higher risk (OR=18.00; 95% CI=2.149-150.8; p=0.008). Finally, patients with high WBC were predicted to have at least 3.34 times higher risk of ICU admission (OR=3.337; 95% CI=1.131-9.846; p=0.029). Conclusion SCD is a multi-systemic disease associated with increased morbidity and mortality. Recognition of high-risk features in patients helps to eliminate subjectivity in ICU referral decision. Frequent hospitalization and emergency visits, multiple blood transfusions, and elevated white blood cell count were significantly associated with a higher rate of ICU admission despite hydroxyurea usage.
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Affiliation(s)
- Mortadah Alsalman
- Department of Medicine, College of Medicine, King Faisal University, Alahsa, Saudi Arabia
| | - Zaenb Alsalman
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Alahsa, Saudi Arabia
| | | | - Aman N Alfaraj
- Department of Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ali Alkhalifah
- Emergency Department, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Qasem Almulihi
- Emergency Department, King Fahad University Hospital, Al Khobar, Saudi Arabia
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Alhaj Zeen M, Mohamed NE, Mady AF, Alamri MM, Alshammari S, Alshebaily AK, Hijazi H, Hegazy A. Predictors of Mortality in Adults With Sickle Cell Disease Admitted to the Intensive Care Unit in King Saud Medical City, Saudi Arabia. Cureus 2023; 15:e38817. [PMID: 37303370 PMCID: PMC10251455 DOI: 10.7759/cureus.38817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
Background Sickle cell disease (SCD) is the most common genetic blood disorder in Saudi Arabia. A limited number of studies have been conducted on SCD patients regarding their intensive care unit (ICU) admissions. We aimed to identify the cause of ICU admission in SCD patients and to identify predictors of mortality. Methodology We identified 64 patients with SCD, aged 14 years and older, who were admitted to the ICU of King Saud Medical City, Riyadh, Kingdom of Saudi Arabia, from January 1, 2017, to December 31, 2020. Results Acute chest syndrome was the most frequent primary diagnosis for ICU admission in 29 (45.3%) patients followed by vaso-occlusive crisis in 23 (35.9%) patients. Pregnancy in eight (12.5%) patients was the most prevalent co-existing condition. The median age was 29 years, with males comprising 45.3% and females comprising 54.7% of the study population. Arterial blood gas pH less than 7.2 on ICU admission (p= <0.001), hemodialysis support (p= 0.049), the use of vasopressors (p= 0.016), intubation (p= <0.001), and being intubated within the first 24 hours of ICU stay (p= 0.04) had a statistically significant association with mortality at ICU discharge out of all the variables tested. Mortality on ICU discharge was 7 (10.9%). Conclusion This was a retrospective study carried out in King Saud Medical City. Comparing the results of the study to those of similar ones conducted around the world revealed a low SCD ICU mortality rate. This low mortality may be a result of improved overall ICU care. We recommend a multi-center, prospective study in future.
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Affiliation(s)
| | | | - Ahmed F Mady
- Department of Anesthesiology and ICU, Tanta University Hospitals, Tanta, EGY
- Critical Care Medicine, King Saud Medical City, Riyadh, SAU
| | - Mohammed M Alamri
- Department of Internal Medicine, King Saud Medical City, Riyadh, SAU
| | | | | | - Huda Hijazi
- Faculty of Medicine, Almaarefa University, Riyadh, SAU
| | - Asmaa Hegazy
- Department of Internal Medicine, King Saud Medical City, Riyadh, SAU
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Ettinger NA, Guffey D, Anum SJ, Fasipe T, Katkin J, Bhar S, Airewele G, Saini A, Tubman VN. Multi-center retrospective study of children with sickle cell disease admitted to pediatric intensive care units in the United States. Sci Rep 2023; 13:6758. [PMID: 37185357 PMCID: PMC10130031 DOI: 10.1038/s41598-023-32651-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/30/2023] [Indexed: 05/17/2023] Open
Abstract
Data on outcomes and interventions for children with sickle cell disease (SCD) admitted to a pediatric intensive care units (PICU) are unknown. We provide the first comprehensive multi-center report on PICU interventions associated with death, the need for invasive respiratory support or stroke among critically ill children with SCD. We collected retrospective multi-center cohort data from January 1, 2012 to December 31, 2019 utilizing the Virtual Pediatric Systems, LLC database. We identified 3388 unique children with SCD, accounting for a total of 5264 PICU admissions from 138 PICUs. The overall mortality rate for the PICU admissions cohort was 1.8% (95/5264 PICU admissions, 95/3388 [2.8%] of all unique patients), the rate of needing of needing Invasive Respiratory Support (IRS, a composite category of exposure) was 21.3% (872/4093 PICU admissions with complete data) and the overall rate of stroke (ischemic or hemorrhagic) was 12.5% (657/5264 PICU admissions). In multivariable analysis adjusting for admission age category, sex, race/ethnicity, PRISM-3 score at admission, exposure to IRS, quartile of unit volume of patients with SCD, and patient origin, admitted children who needed invasive respiratory support (IRS) had higher adjusted odds ratios for mortality (adjusted odds ratio [aOR], 19.72; 95% confidence interval [CI] 8.98-43.29; p < 0.001), although admitted children > 2 years old had decreased aOR for needing IRS (aOR 0.25-0.62; 95% CI 0.16-0.94; p < 0.001-0.025). By contrast, admitted children > 2 years old had a strikingly increased aOR for stroke (aOR 7.57-16.32; 95% CI 2.25-52.15; p < 0.001). These groups may represent PICU-specific subsets of patients with SCD who are at higher risk for more serious illness and should deserve early consideration for referral to a pediatric institution providing comprehensive care for patients with SCD.
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Affiliation(s)
- Nicholas A Ettinger
- Division of Pediatric Critical Care, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, 6651 Main Street, MC: E1420, Houston, TX, 77030, USA.
| | - Danielle Guffey
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Shaniqua J Anum
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
| | - Titilope Fasipe
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
| | - Julie Katkin
- Division of Pulmonology, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
| | - Saleh Bhar
- Division of Pediatric Critical Care, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, 6651 Main Street, MC: E1420, Houston, TX, 77030, USA
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
| | - Gladstone Airewele
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
| | - Arun Saini
- Division of Pediatric Critical Care, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, 6651 Main Street, MC: E1420, Houston, TX, 77030, USA
| | - Venée N Tubman
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA
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Eichenauer DA, Kochanek M. [Hemolytic anemia in emergency and intensive care medicine]. Med Klin Intensivmed Notfmed 2023; 118:30-34. [PMID: 36598517 DOI: 10.1007/s00063-022-00980-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 01/05/2023]
Abstract
Hemolytic anemia (HA) is caused by premature destruction or degradation of red blood cells (RBC). Low hemoglobin, suppressed haptoglobin, reticulocytosis as well as an elevation of lactate dehydrogenase and bilirubin are common laboratory findings in HA. Intracorpuscular HA due to defects of the RBC themselves are distinguished from extracorpuscular HA due to external factors. Severity of symptoms such as fatigue and dyspnea depend on the degree of anemia. For optimal treatment of HA, a detailed evaluation of the patient history (including hereditary RBC defects, B symptoms and travel history) is necessary. Additional diagnostics (hematological diagnostics, infectious disease diagnostics, immunological diagnostics, computed tomography [CT] scan) should be performed according to the patient's individual requirements. Treatment of HA depends on the etiology. If HA is immune-mediated, immunosuppressive therapy is indicated, whereas HA due to infections usually improves after adequate anti-infective therapy. Anti-infective therapy should also be considered in patients with sickle cell disease who present with severe HA. In general, HA can be treated effectively in most cases.
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Affiliation(s)
- Dennis A Eichenauer
- Klinik I für Innere Medizin, Zentrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Matthias Kochanek
- Klinik I für Innere Medizin, Zentrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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