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Geslain G, Ponsin P, Lãzãrescu AM, Tridon C, Robin N, Riaud C, Orliaguet G. Incidence of iatrogenic withdrawal syndrome and associated factors in surgical pediatric intensive care. Arch Pediatr 2023; 30:14-19. [PMID: 36481162 DOI: 10.1016/j.arcped.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/24/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Iatrogenic withdrawal syndrome (IWS) is a complication of prolonged sedation/analgesia in pediatric intensive care unit (PICU) patients. The epidemiology of IWS is poorly understood, as validated diagnostic tools are rarely used. The main objective of our study was to use the WAT-1 score to assess the incidence of IWS in our unit. The secondary objectives were to evaluate the consequences of IWS, associated factors, and management modalities. MATERIAL AND METHODS From July 2018 to January 2019, 48 children receiving endotracheal ventilation and sedation/analgesia by continuous infusion (>48 h) of benzodiazepines and/or opioids were included. As soon as sedation/analgesia was decreased and until 72 h after its complete discontinuation, the WAT-1 score was determined every 12 h. Substitution therapy was used for 98% of patients upon opioid and/or benzodiazepine withdrawal. IWS was defined as a WAT-1 score ≥3. Factors associated with IWS were assessed by univariate analysis. RESULTS IWS occurred in 25 (52%) patients. IWS was associated with a higher number of ventilator-associated pneumonia episodes (17 [68%] vs. one [4%]) and a longer PICU stay (13 [7; 25] vs. 9.0 [5.0; 10.5]) (p<0.001). Overall, 11 patients developed IWS after less than 5 days of sedation/analgesia. Severe head injury was associated with IWS (p = 0.03). Neither sedation discontinuation nor IWS prevention was standardized. CONCLUSION The high incidence and adverse consequences of IWS require improved prevention. Risk groups should be defined and a standardized withdrawal protocol established. The occurrence of IWS should be monitored routinely using a validated score.
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Affiliation(s)
- G Geslain
- Pediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, Paris, France.
| | - P Ponsin
- Department of Pediatric Anesthesia and Intensive Care, University Hospital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - A M Lãzãrescu
- Department of Pediatric Anesthesia and Intensive Care, University Hospital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - C Tridon
- Department of Pediatric Anesthesia and Intensive Care, University Hospital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - N Robin
- Department of Pediatric Anesthesia and Intensive Care, University Hospital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - C Riaud
- Department of Pediatric Anesthesia and Intensive Care, University Hospital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - G Orliaguet
- University of Paris, Paris, France; Department of Pediatric Anesthesia and Intensive Care, University Hospital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; EA7323: Pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte, Hôpitaux Universitaires Paris Centre, University of Paris, Paris, France
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Salvador E, Oualha M, Bille E, Beranger A, Moulin F, Benaboud S, Boujaafar S, Gana I, Urien S, Zheng Y, Toubiana J, Briand C, Bustarret O, Geslain G, Renolleau S, Treluyer JM, Hirt D. Population pharmacokinetics of cefazolin in critically ill children infected with methicillin-sensitive Staphylococcus aureus. Clin Microbiol Infect 2020; 27:413-419. [PMID: 32360445 DOI: 10.1016/j.cmi.2020.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/27/2020] [Accepted: 04/21/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Cefazolin is one of curative treatments for infections due to methicillin-sensitive Staphylococcus aureus (MSSA). Both growth and critical illness may impact the pharmacokinetic (PK) parameters. We aimed to build a population PK model for cefazolin in critically ill children in order to optimize individual dosing regimens. METHODS We included all children (age < 18 years, body weight (BW) > 2.5 kg) receiving cefazolin for MSSA infection. Cefazolin total plasma concentrations were quantified by high-performance liquid chromatography. A data modelling process was performed with the software MONOLIX. Monte Carlo simulations were used in order to attain the PK target of 100% fT > 4 ×MIC. RESULTS Thirty-nine patients with a median (range) age of 7 (0.1-17) years and a BW of 21 (2.8-79) kg were included. The PK was ascribed to a one-compartment model, where typical clearance and volume of distribution estimations were 1.4 L/h and 3.3 L respectively. BW, according to the allometric rules, and estimated glomerular filtration rate (eGFR) on clearance were the two influential covariates. Continuous infusion with a dosing of 100 mg/kg/day to increase to 150 mg/kg/day for children with a BW < 10 kg or eGFR >200 mL/min/1.73m2 were the best schemes to reach the PK target of 100% fT> 4 ×MIC. CONCLUSIONS In critically ill children infected with MSSA, continuous infusion seems to be the most appropriate scheme to reach the PK target of 100 % fT > 4 ×MIC in children with normal and augmented renal function.
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Affiliation(s)
- E Salvador
- Department of Paediatric Intensive Care Unit, Necker Enfants Malades Hospital, Paris Descartes University, Sorbonne-Paris Cité, 149 Rue de Sèvres, 75015, Paris, France; Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Paris Descartes University, 27 Rue Du Faubourg Saint Jacques, 75014, Paris, France.
| | - M Oualha
- Department of Paediatric Intensive Care Unit, Necker Enfants Malades Hospital, Paris Descartes University, Sorbonne-Paris Cité, 149 Rue de Sèvres, 75015, Paris, France; Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Paris Descartes University, 27 Rue Du Faubourg Saint Jacques, 75014, Paris, France
| | - E Bille
- Microbiological Laboratory, Necker Enfants Malades Hospital, Paris Descartes University, Sorbonne-Paris Cité, 149 Rue de Sèvres, 75015, Paris, France
| | - A Beranger
- Department of Paediatric Intensive Care Unit, Necker Enfants Malades Hospital, Paris Descartes University, Sorbonne-Paris Cité, 149 Rue de Sèvres, 75015, Paris, France; Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Paris Descartes University, 27 Rue Du Faubourg Saint Jacques, 75014, Paris, France
| | - F Moulin
- Microbiological Laboratory, Necker Enfants Malades Hospital, Paris Descartes University, Sorbonne-Paris Cité, 149 Rue de Sèvres, 75015, Paris, France
| | - S Benaboud
- Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Paris Descartes University, 27 Rue Du Faubourg Saint Jacques, 75014, Paris, France; Department of Clinical Pharmacology, Cochin Hospital, Paris Descartes University, 27 Rue Du Faubourg Saint Jacques, 75014, Paris, France
| | - S Boujaafar
- Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Paris Descartes University, 27 Rue Du Faubourg Saint Jacques, 75014, Paris, France; Department of Clinical Pharmacology, Cochin Hospital, Paris Descartes University, 27 Rue Du Faubourg Saint Jacques, 75014, Paris, France
| | - I Gana
- Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Paris Descartes University, 27 Rue Du Faubourg Saint Jacques, 75014, Paris, France; Department of Clinical Pharmacology, Cochin Hospital, Paris Descartes University, 27 Rue Du Faubourg Saint Jacques, 75014, Paris, France
| | - S Urien
- Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Paris Descartes University, 27 Rue Du Faubourg Saint Jacques, 75014, Paris, France
| | - Y Zheng
- Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Paris Descartes University, 27 Rue Du Faubourg Saint Jacques, 75014, Paris, France; Department of Clinical Pharmacology, Cochin Hospital, Paris Descartes University, 27 Rue Du Faubourg Saint Jacques, 75014, Paris, France
| | - J Toubiana
- Department of General Paediatrics and Paediatric Infectious Diseases, Necker Enfants Malades Hospital, Paris Descartes University, Sorbonne-Paris Cité, 149 Rue de Sèvres, 75015, Paris, France
| | - C Briand
- Department of Paediatric Immunohaematology, Necker Enfants Malades Hospital, Paris Descartes University, Sorbonne-Paris Cité, 149 Rue de Sèvres, 75015, Paris, France
| | - O Bustarret
- Department of Surgical Paediatric Intensive Care Unit, Necker Enfants Malades Hospital, Paris Descartes University, Sorbonne-Paris Cité, 149 Rue de Sèvres, 75015, Paris, France
| | - G Geslain
- Department of Surgical Paediatric Intensive Care Unit, Necker Enfants Malades Hospital, Paris Descartes University, Sorbonne-Paris Cité, 149 Rue de Sèvres, 75015, Paris, France
| | - S Renolleau
- Department of Paediatric Intensive Care Unit, Necker Enfants Malades Hospital, Paris Descartes University, Sorbonne-Paris Cité, 149 Rue de Sèvres, 75015, Paris, France
| | - J-M Treluyer
- Department of Paediatric Intensive Care Unit, Necker Enfants Malades Hospital, Paris Descartes University, Sorbonne-Paris Cité, 149 Rue de Sèvres, 75015, Paris, France; Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Paris Descartes University, 27 Rue Du Faubourg Saint Jacques, 75014, Paris, France; Department of Clinical Pharmacology, Cochin Hospital, Paris Descartes University, 27 Rue Du Faubourg Saint Jacques, 75014, Paris, France
| | - D Hirt
- Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Paris Descartes University, 27 Rue Du Faubourg Saint Jacques, 75014, Paris, France; Department of Clinical Pharmacology, Cochin Hospital, Paris Descartes University, 27 Rue Du Faubourg Saint Jacques, 75014, Paris, France
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Geslain G, Tilea B, Heraut F, Rubinsztajn R. Smoke inhalation injury in a 2-year-old domestic fire victim. Arch Pediatr 2020; 27:223-226. [PMID: 32192813 DOI: 10.1016/j.arcped.2020.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 11/06/2019] [Accepted: 01/25/2020] [Indexed: 11/15/2022]
Abstract
Smoke inhalation injury is common in victims of domestic fires, among whom children are the most vulnerable. Cyanide poisoning may occur in addition to carbon monoxide poisoning and is challenging to diagnose. In France, the recommended antidotes are hydroxocobalamin for cyanide and hyperbaric oxygen for carbon monoxide. We managed a 26-month-old girl who sustained smoke inhalation injury with both carbon monoxide and cyanide poisoning during a house fire. Despite hydroxocobalamin and sodium thiosulfate therapy combined with hyperbaric oxygen, she had residual neurological impairments 3 months after the injury. The treatment challenges and detailed neurological follow-up data are described.
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Affiliation(s)
- G Geslain
- Pediatric Intensive Care Unit, Raymond-Poincaré Hospital, AP-HP, 92380 Garches, France.
| | - B Tilea
- Radiology, Robert-Debré Hospital, AP-HP, 75019 Paris, France
| | - F Heraut
- Physiological Explorations, Raymond-Poincaré Hospital, AP-HP, 92380 Garches, France
| | - R Rubinsztajn
- Pediatric Intensive Care Unit, Raymond-Poincaré Hospital, AP-HP, 92380 Garches, France
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