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Grandjean C, Perez MH, Ramelet AS. Comparison of clinical characteristics and healthcare resource use of pediatric chronic and non-chronic critically ill patients in intensive care units: a retrospective national registry study. Front Pediatr 2023; 11:1194833. [PMID: 37435169 PMCID: PMC10331166 DOI: 10.3389/fped.2023.1194833] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/12/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction Chronic critically ill patients (CCI) in pediatric intensive care unit (PICU) are at risk of negative health outcomes, and account for a considerable amount of ICU resources. This study aimed to (a) describe the prevalence of CCI children, (b) compare their clinical characteristics and ICU resources use with non-CCI children, and (c) identify associated risk factors of CCI. Methods A retrospective national registry study including 2015-2017 data from the eight Swiss PICUs of five tertiary and three regional hospitals, admitting a broad case-mix of medical and surgical patients, including pre- and full-term infants. CCI patients were identified using an adapted definition: PICU length of stay (LOS) ≥8 days and dependence on ≥1 PICU technology. Results Out of the 12,375 PICU admissions, 982 (8%) were CCI children and compared to non-CCI children, they were younger (2.8 vs. 6.7 months), had more cardiac conditions (24% vs. 12%), and higher mortality rate (7% vs. 2%) (p < 0.001). Nursing workload was higher in the CCI compared to the non-CCI group (22 [17-27]; 21 [16-26] respectively p < 0.001). Factors associated with CCI were cardiac (aOR = 2.241) and neurological diagnosis (aOR = 2.062), surgery (aORs between 1.662 and 2.391), ventilation support (aOR = 2.278), high mortality risk (aOR = 1.074) and agitation (aOR = 1.867). Conclusion the results confirm the clinical vulnerability and the complexity of care of CCI children as they were defined in our study. Early identification and adequate staffing is required to provide appropriate and good quality care.
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Affiliation(s)
- Chantal Grandjean
- Pediatric Intensive and Intermediate Care Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Marie-Hélène Perez
- Pediatric Intensive and Intermediate Care Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Anne-Sylvie Ramelet
- Pediatric Intensive and Intermediate Care Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Perez MH, Longchamp D, Amiet V, Natterer J, Ferry T, Boegli Y, Mauron S, Dolci M, Plaza-Wuthrich S, Di Bernardo S. Point-of-care HEMOstasis in children with congenital heart disease, the POCHEMO study: Rotational thromboelastometry and impedance aggregometry in children with cyanotic and non-cyanotic congenital heart disease. International Journal of Cardiology Congenital Heart Disease 2022. [DOI: 10.1016/j.ijcchd.2022.100383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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MacDonald I, Perez MH, Amiet V, Trombert A, Ramelet AS. Quality of clinical practice guidelines and recommendations for the management of pain, sedation, delirium and iatrogenic withdrawal in pediatric intensive care: a systematic review protocol. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2021-001293. [PMID: 36053608 PMCID: PMC8852722 DOI: 10.1136/bmjpo-2021-001293] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/16/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Inadequate management of pain and sedation in critically ill children can cause unnecessary suffering and agitation, but also delirium and iatrogenic withdrawal. It is, therefore, important to address these four interrelated conditions together. Some clinical practice guidelines (CPGs) are available for the management of pain and sedation, and a few for delirium and iatrogenic withdrawal in the paediatric intensive care unit; none address the four conditions altogether. Critical appraisal of the quality of CPGs is necessary for their recommendations to be adopted into clinical practice. The aim of this systematic review is to identify and appraise the quality of CPGs and recommendations for management of either pain, sedation, delirium and iatrogenic withdrawal. METHODS AND ANALYSIS Researchers will conduct a systematic review in electronic databases (Medline ALL (Ovid), Embase.com, CINAHL with Full Text (EBSCO), JBI EBP Database (Ovid)), guideline repositories and websites of professional societies to identify CPGs published from 2010 to date. They will then combine index and free terms describing CPGs with pain, sedation, delirium and withdrawal. The researchers will include CPGs if they can be applied in the paediatric intensive care population (newborns to 18 years old) and include recommendation(s) for assessment of at least one of the four conditions. Two independent reviewers will screen for eligibility, complete data extraction and quality assessments using the Appraisal of Guidelines for Research and Evaluation (AGREE) II and the AGREE Recommendation Excellence instruments. Researchers will report characteristics, content and recommendations from CPGs in tabulated forms. ETHICS AND DISSEMINATION Ethical approval is not required for this systematic review. Results will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42021274364.
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Affiliation(s)
- Ibo MacDonald
- University Institute of Higher Education and Research in Healthcare, University of Lausanne Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Marie-Hélène Perez
- Department of Woman Mother and Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Vivianne Amiet
- Department of Woman Mother and Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Alexia Trombert
- Medical Library, Lausanne University Hospital, Lausanne, Switzerland
| | - Anne-Sylvie Ramelet
- University Institute of Higher Education and Research in Healthcare, University of Lausanne Faculty of Biology and Medicine, Lausanne, Switzerland .,Department of Woman Mother and Child, Lausanne University Hospital, Lausanne, Switzerland
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Ferry T, Amiet V, Natterer J, Perez MH, Pfister R, Colombier S, Longchamp D. Extracorporeal cardiopulmonary resuscitation for severe chloroquine intoxication in a child - a case report. Scand J Trauma Resusc Emerg Med 2021; 29:48. [PMID: 33722251 PMCID: PMC7958095 DOI: 10.1186/s13049-021-00850-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/05/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Chloroquine use has increased worldwide recently in the setting of experimental treatment for the novel coronavirus disease (Covid-19). Nevertheless, in case of chloroquine intoxication, it can be life threatening, with cardiac arrest, due to its cardiac toxicity. CASE PRESENTATION This case study reports on a 14-years-old girl who presented in cardiac arrest after an uncommon suicide attempt by ingesting 3 g of chloroquine. After 66 min of cardio-pulmonary resuscitation (CPR), extracorporeal cardiopulmonary resuscitation (ECPR) was initiated, allowing cardiac function to recover. CONCLUSIONS Chloroquine intoxication is a rare but serious condition due to its cardiac toxicity. Use of ECPR in this case of transient toxicity allowed a favorable evolution with little neurological impairment.
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Affiliation(s)
- Thomas Ferry
- Paediatric Intensive Care, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
| | - Vivianne Amiet
- Paediatric Intensive Care, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Julia Natterer
- Paediatric Intensive Care, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Marie-Hélène Perez
- Paediatric Intensive Care, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Raymond Pfister
- Department of Cardiovascular Surgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Sébastien Colombier
- Department of Cardiovascular Surgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - David Longchamp
- Paediatric Intensive Care, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
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Grandjean C, Ullmann P, Marston M, Maitre MC, Perez MH, Ramelet AS. Sources of Stress, Family Functioning, and Needs of Families With a Chronic Critically Ill Child: A Qualitative Study. Front Pediatr 2021; 9:740598. [PMID: 34805041 PMCID: PMC8600118 DOI: 10.3389/fped.2021.740598] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022] Open
Abstract
PICU hospitalization is particularly stressful for families. When it is prolonged and the prognostic is uncertain, it can significantly and negatively affect the whole family. To date, little is known on how families with a chronic critically ill (CCI) child are affected. This national study explored the specific PICU-related sources of stress, family functioning and needs of families of CCI patients during a PICU hospitalization. This descriptive qualitative study was conducted in the eight pediatric intensive care units in Switzerland. Thirty-one families with a child meeting the CCI criteria participated in semi-structured interviews. Interviews, including mothers only (n = 12), fathers only (n = 8), or mother and father dyads (n = 11), were conducted in German, French, or English by two trained researchers/clinical nurses specialists. Interviews were recorded, transcribed verbatim, and analyzed using deductive and inductive content analyses. Five overarching themes emerged: (1) high emotional intensity, (2) PICU-related sources of stress, (3) evolving family needs, (4) multi-faceted family functioning, and (5) implemented coping strategies. Our study highlighted the importance of caring for families with CCI children. Parents reported high negative emotional responses that affect their family functioning. Families experience was highly dependent on how HCPs were able to meet the parental needs, provide emotional support, reinforce parental empowerment, and allow high quality of care coordination.
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Affiliation(s)
- Chantal Grandjean
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Pediatric Intensive Care Unit, Department Woman-Mother-Child, Department Woman-Mother-Child, Lausanne, Switzerland
| | - Pascale Ullmann
- School of Healthcare, University of Applied Sciences and Arts, Fribourg, Switzerland
| | - Mark Marston
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Pediatric Intensive Care Unit, Department Woman-Mother-Child, Department Woman-Mother-Child, Lausanne, Switzerland.,University Children's Hospital Basel, Basel, Switzerland
| | - Marie-Christine Maitre
- Pediatric Intensive Care Unit, Department Woman-Mother-Child, Department Woman-Mother-Child, Lausanne, Switzerland
| | - Marie-Hélène Perez
- Pediatric Intensive Care Unit, Department Woman-Mother-Child, Department Woman-Mother-Child, Lausanne, Switzerland
| | - Anne-Sylvie Ramelet
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Pediatric Intensive Care Unit, Department Woman-Mother-Child, Department Woman-Mother-Child, Lausanne, Switzerland
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Henzi BC, Brotschi B, Balmer C, Hennig B, Rimensberger P, Perez MH, Pfammatter JP, Beghetti M, Sekarski N, Datta AN, Fluss J, Faignart N, Hackenberg A, Regényi M, Steinlin M, Hug MI. Risk Factors for Postprocedural Arterial Ischemic Stroke in Children With Cardiac Disease. Stroke 2020; 51:e242-e245. [PMID: 32811375 DOI: 10.1161/strokeaha.120.029447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Cardiac pathologies are the second most frequent risk factor (RF) in children with arterial ischemic stroke (AIS). This study aimed to analyze RFs for AIS in children with cardiac disease and cardiac intervention. METHODS Data were drawn from the Swiss Neuropediatric Stroke Registry. Patients with cardiac disease and postprocedural AIS registered from 2000 until 2015 were analyzed for the cause of cardiac disease and for potential RFs. RESULTS Forty-seven out of 78 children with cardiac disease had a cardiac intervention. Of these, 36 presented a postprocedural AIS. Median time from cardiac intervention to symptom onset was 4 days (interquartile range, 2-8.5); time to diagnosis of AIS was 2 days (interquartile range, 0-5.8). Main RFs for postprocedural AIS were hypotension, prosthetic cardiac material, right-to-left shunt, arrhythmias, low cardiac output, and infections. CONCLUSIONS In children with postprocedural AIS, time to diagnosis was delayed. Most patients presented multiple potentially modifiable RFs as hemodynamic alterations and infections.
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Affiliation(s)
- Bettina C Henzi
- Division of Child Neurology, Department of Pediatrics, University Children's Hospital Bern, University of Bern, Switzerland (B.C.H., M.R., M.S.).,Department of Pediatric Neurology and Developmental Medicine, University of Basel, Children's Hospital Basel, Switzerland (B.C.H., A.N.D.)
| | - Barbara Brotschi
- Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Switzerland (B.B.)
| | - Christian Balmer
- Department of Pediatric Cardiology, University Children's Hospital Zurich, Switzerland (C.B.)
| | - Bert Hennig
- Division of Pediatric Intensive Care, University Children's Hospital Bern, University of Bern, Switzerland (B.H.)
| | - Peter Rimensberger
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University
Hospital of Geneva, Switzerland (P.R.)
| | - Marie-Hélène Perez
- Pediatric Intensive Care Unit, Department of Pediatrics, University Hospital of Lausanne, Switzerland (M.-H.P.)
| | - Jean-Pierre Pfammatter
- Center for Congenital Heart Disease, Departments of Cardiology and Cardiac Surgery, University Hospital of Bern, Switzerland (J.-P.P.)
| | - Maurice Beghetti
- Pediatric Cardiology Unit, University Children's Hospital HUG, Pulmonary Hypertension Program HUG, Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique (CURCCCP), University of Geneva, Switzerland (M.B.)
| | - Nicole Sekarski
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pediatrique (CURCCCP), Lausanne University Hospital, Switzerland (N.S.)
| | - Alexandre N Datta
- Department of Pediatric Neurology and Developmental Medicine, University of Basel, Children's Hospital Basel, Switzerland (B.C.H., A.N.D.)
| | - Joel Fluss
- Pediatric Neurology Unit, Geneva Children's Hospital, Switzerland (J.F.)
| | - Nicole Faignart
- Pediatric Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne University Hospital, Switzerland (N.F.)
| | - Annette Hackenberg
- Department of Pediatric Neurology, University Children's Hospital Zurich, Switzerland (A.H.)
| | - Mária Regényi
- Division of Child Neurology, Department of Pediatrics, University Children's Hospital Bern, University of Bern, Switzerland (B.C.H., M.R., M.S.)
| | - Maja Steinlin
- Division of Child Neurology, Department of Pediatrics, University Children's Hospital Bern, University of Bern, Switzerland (B.C.H., M.R., M.S.)
| | - Maja I Hug
- Department of Neonatology, University of Basel Children's Hospital (UKBB), Switzerland (M.I.H.)
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Natterer J, Rizzati F, Perez MH, Longchamp D, Amiet V, DeHalleux Q, Dao K, Ferry T. Suspected Case of Drug-Induced Acute Respiratory Distress Syndrome following Trimethoprim-Sulfamethoxazole Treatment. J Pediatr Intensive Care 2020; 11:67-71. [DOI: 10.1055/s-0040-1714707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/11/2020] [Indexed: 10/23/2022] Open
Abstract
AbstractIn this article, we reported the case of a child patient who was admitted to our PICU for severe acute respiratory distress syndrome (ARDS) while being treated with trimethoprim-sulfamethoxazole (TMP-SMX) for osteomyelitis. Based on the timing of exposure, lack of alternative explanations, and clinical course similar to previously described cases, we suspect that TMP-SMX may have triggered ARDS. Despite meeting criteria for extracorporeal membrane oxygenation cannulation, conservative management and lung recruitment with high-frequency percussive ventilation could avoid the latter.
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Affiliation(s)
- Julia Natterer
- Pediatric Intensive Care Unit, Women, Mothers and Children's Department, Faculty of Medicine and Biology, Lausanne University Hospital, Lausanne, Switzerland
| | - Frida Rizzati
- Pediatric Intensive Care Unit, Women, Mothers and Children's Department, Faculty of Medicine and Biology, Lausanne University Hospital, Lausanne, Switzerland
| | - Marie-Hélène Perez
- Pediatric Intensive Care Unit, Women, Mothers and Children's Department, Faculty of Medicine and Biology, Lausanne University Hospital, Lausanne, Switzerland
| | - David Longchamp
- Pediatric Intensive Care Unit, Women, Mothers and Children's Department, Faculty of Medicine and Biology, Lausanne University Hospital, Lausanne, Switzerland
| | - Vivianne Amiet
- Pediatric Intensive Care Unit, Women, Mothers and Children's Department, Faculty of Medicine and Biology, Lausanne University Hospital, Lausanne, Switzerland
| | - Quentin DeHalleux
- Pediatric Physiotherapy Unit, Women, Mothers and Children's Department, Faculty of Medicine and Biology, Lausanne University Hospital, Lausanne, Switzerland
| | - Kim Dao
- Service of Clinical Pharmacology, Department of Laboratories Medicine and Pathology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Thomas Ferry
- Pediatric Intensive Care Unit, Women, Mothers and Children's Department, Faculty of Medicine and Biology, Lausanne University Hospital, Lausanne, Switzerland
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Didisheim C, Ballhausen D, Choucair ML, Longchamp D, Natterer J, Ferry T, Perez MH, Amiet V. Severe Lactic Acidosis in a Critically Ill Child: Think About Thiamine! A Case Report. J Pediatr Intensive Care 2020; 10:307-310. [PMID: 34745706 DOI: 10.1055/s-0040-1713382] [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: 02/17/2020] [Accepted: 05/14/2020] [Indexed: 10/23/2022] Open
Abstract
In this article, we presented a teenager, in maintenance chemotherapy for leukemia, who was admitted for digestive symptoms related to a parasitic infection and required nutritional support with parenteral nutrition. After 6 weeks, his condition worsened with refractory shock of presumed septic origin, necessitating extracorporeal membrane oxygenation. Despite hemodynamic stabilization, his lactic acidosis worsened until thiamine supplementation was started. Lactate normalized within 12 hours. Thiamine is an essential coenzyme in aerobic glycolysis, and deficiency leads to lactate accumulation through anaerobic glycolysis. Thiamine deficiency is uncommon in the pediatric population. However, it should be considered in patients at risk of nutritional deficiencies with lactic acidosis of unknown origin.
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Affiliation(s)
- Clémence Didisheim
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Diana Ballhausen
- Department of Metabolic Disease, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Marie-Louise Choucair
- Department of Pediatrics, Pediatric Hematology Oncology Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - David Longchamp
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Julia Natterer
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Thomas Ferry
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Marie-Hélène Perez
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
| | - Vivianne Amiet
- Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital and Medicine and Biology Faculty of Lausanne, Lausanne, Switzerland
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Demaret P, Karam O, Labreuche Bst J, Chiusolo F, Mayordomo Colunga J, Erickson S, Nellis ME, Perez MH, Ray S, Tucci M, Willems A, Duhamel A, Lebrun F, Loeckx I, Mulder A, Leteurtre S. How 217 Pediatric Intensivists Manage Anemia at PICU Discharge: Online Responses to an International Survey. Pediatr Crit Care Med 2020; 21:e342-e353. [PMID: 32217901 DOI: 10.1097/pcc.0000000000002307] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the management of anemia at PICU discharge by pediatric intensivists. DESIGN Self-administered, online, scenario-based survey. SETTING PICUs in Australia/New Zealand, Europe, and North America. SUBJECTS Pediatric intensivists. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Respondents were asked to report their decisions regarding RBC transfusions, iron, and erythropoietin prescription to children ready to be discharged from PICU, who had been admitted for hemorrhagic shock, cardiac surgery, craniofacial surgery, and polytrauma. Clinical and biological variables were altered separately in order to assess their effect on the management of anemia. Two-hundred seventeen responses were analyzed. They reported that the mean (± SEM) transfusion threshold was a hemoglobin level of 6.9 ± 0.09 g/dL after hemorrhagic shock, 7.6 ± 0.10 g/dL after cardiac surgery, 7.0 ± 0.10 g/dL after craniofacial surgery, and 7.0 ± 0.10 g/dL after polytrauma (p < 0.001). The most important increase in transfusion threshold was observed in the presence of a cyanotic heart disease (mean increase ranging from 1.80 to 2.30 g/dL when compared with baseline scenario) or left ventricular dysfunction (mean increase, 1.41-2.15 g/dL). One third of respondents stated that they would not prescribe iron at PICU discharge, regardless of the hemoglobin level or the baseline scenario. Most respondents (69.4-75.0%, depending on the scenario) did not prescribe erythropoietin. CONCLUSIONS Pediatric intensivists state that they use restrictive transfusion strategies at PICU discharge similar to those they use during the acute phase of critical illness. Supplemental iron is less frequently prescribed than RBCs, and prescription of erythropoietin is uncommon. Optimal management of post-PICU anemia is currently unknown. Further studies are required to highlight the consequences of this anemia and to determine appropriate management.
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Affiliation(s)
- Pierre Demaret
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHC, Liège, Belgium.,Univ. Lille, EA 2694 - Santé Publique: épidémiologie et qualité des soins, F-59000 Lille, France
| | - Oliver Karam
- Division of Pediatric Critical Care Medicine, Children's Hospital of Richmond at VCU, Richmond, VA
| | - Julien Labreuche Bst
- Univ. Lille, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, F-59000 Lille, France
| | - Fabrizio Chiusolo
- Anesthesia and Critical Care, Bambino Gesù Children's Hospital, Rome, Italy
| | - Juan Mayordomo Colunga
- Sección de Cuidados Intensivos Pediátricos, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Spain.,CIBER-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Simon Erickson
- Division of Pediatric Critical Care, Princess Margaret Hospital, Perth, WA, Australia
| | - Marianne E Nellis
- Pediatric Critical Care Medicine, Department of Pediatrics, NY Presbyterian Hospital - Weill Cornell Medicine, New York, NY
| | - Marie-Hélène Perez
- Pediatric Intensive Care Unit, Department of Pediatrics, University Hospital of Lausanne, Lausanne, Switzerland
| | - Samiran Ray
- Pediatric Intensive Care Unit, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Marisa Tucci
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte-Justine Hospital and Université de Montréal, Montreal, QC, Canada
| | - Ariane Willems
- Pediatric Intensive Care Unit, Department of Intensive Care, Leiden Universitair Medisch Centrum, Leiden, The Netherlands
| | - Alain Duhamel
- Univ. Lille, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, F-59000 Lille, France
| | - Frédéric Lebrun
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHC, Liège, Belgium
| | - Isabelle Loeckx
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHC, Liège, Belgium
| | - André Mulder
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHC, Liège, Belgium
| | - Stéphane Leteurtre
- Univ. Lille, EA 2694 - Santé Publique: épidémiologie et qualité des soins, F-59000 Lille, France.,CHU Lille, Pediatric Intensive Care Unit, CHU Lille, F-59000 Lille, France
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Moullet C, Schmutz E, Laure Depeyre J, Perez MH, Cotting J, Jotterand Chaparro C. Physicians' perceptions about managing enteral nutrition and the implementation of tools to assist in nutritional decision-making in a paediatric intensive care unit. Aust Crit Care 2020; 33:219-227. [PMID: 32414683 DOI: 10.1016/j.aucc.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/11/2020] [Revised: 03/08/2020] [Accepted: 03/14/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND For critically ill children hospitalised in paediatric intensive care units, adequate nutrition reduces their risk of morbidity and mortality. Barriers may impede optimal nutritional support in this population. Moreover, physicians are usually responsible for prescribing nutrition, although they are not experts. Therefore, tools may be used to assist in nutritional decision-making, such as nutrition protocols. OBJECTIVES The objective of this two-stage qualitative study was to explore the perceptions of physicians about their management of enteral nutrition in a paediatric intensive care unit and the implementation of a nutrition protocol and computerised system. METHODS This study involved semistructured interviews with physicians at the Paediatric Intensive Care Unit of Lausanne University Hospital, Switzerland. Research dietitians conducted interviews before (stage one) and after (stage two) the implementation of a nutrition protocol and computerised system. During stage one, six junior physicians and five fellows were interviewed. At stage two, 12 junior physicians, 12 fellows, and five senior physicians were interviewed. Interviews were recorded, with data transcribed verbatim before a thematic analysis using a framework method. RESULTS Three themes emerged from thematic analysis: "nutritional knowledge", "nutritional practices", and "resources to manage nutrition". During stage one, physicians, especially junior physicians, reported a lack of nutritional knowledge for critically ill children and stated that nutritional issues primarily depended on senior physicians, who themselves had various practices. All physicians were in favour of a nutrition protocol and computerised system. At stage two, interviewees stated that they used both tools regularly. They reported improved nutritional knowledge, more systematic and consistent nutritional practices, and increased attention to nutrition. CONCLUSIONS The implementation of a nutrition protocol and computerised system by a multiprofessional team helped physicians in the paediatric intensive care unit to manage nutritional support and increase their attention to nutrition.
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Affiliation(s)
- Clémence Moullet
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Rue des Caroubiers 25, 1227 Carouge, Geneva, Switzerland.
| | - Elodie Schmutz
- HES-SO Master, University of Applied Sciences and Arts Western Switzerland, Avenue de Provence 6, 1007 Lausanne, University of Lausanne, Switzerland.
| | - Jocelyne Laure Depeyre
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Rue des Caroubiers 25, 1227 Carouge, Geneva, Switzerland.
| | - Marie-Hélène Perez
- Pediatric Intensive Care Unit, Lausanne University Hospital (CHUV/UNIL), Rue Du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Jacques Cotting
- Pediatric Intensive Care Unit, Lausanne University Hospital (CHUV/UNIL), Rue Du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Corinne Jotterand Chaparro
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Rue des Caroubiers 25, 1227 Carouge, Geneva, Switzerland.
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11
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Pérez Marín M, Decosterd LA, Andre P, Buclin T, Mercier T, Murray K, Rizzi M, Meylan P, Jaton-Ogay K, Opota O, Gengler C, Perez MH, Natterer J, Asner SA. Compassionate Use of Letermovir in a 2-Year-Old Immunocompromised Child With Resistant Cytomegalovirus Disease. J Pediatric Infect Dis Soc 2020; 9:96-99. [PMID: 31183500 DOI: 10.1093/jpids/piz033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 05/06/2019] [Indexed: 11/14/2022]
Abstract
Little information on the efficacy and pharmacokinetics of letermovir among immunocompromised children is currently available. We describe here the use of letermovir in a 2-year-old immunocompromised child with ganciclovir-resistant cytomegalovirus disease who required extracorporeal membrane oxygenation. Detailed information on therapeutic-drug-monitoring measures and dosage adjustments for letermovir is provided.
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Affiliation(s)
- Maria Pérez Marín
- Pediatric Intensive Care Unit, University Hospital Center and University of Lausanne, Switzerland
| | - Laurent Arthur Decosterd
- Service of Clinical Pharmacology, University Hospital Center and University of Lausanne, Switzerland
| | - Pascal Andre
- Service of Clinical Pharmacology, University Hospital Center and University of Lausanne, Switzerland
| | - Thierry Buclin
- Service of Clinical Pharmacology, University Hospital Center and University of Lausanne, Switzerland
| | - Thomas Mercier
- Service of Clinical Pharmacology, University Hospital Center and University of Lausanne, Switzerland
| | - Kristina Murray
- Pediatric Infectious Diseases and Vaccinology Unit, Woman-Mother-Child Department, University Hospital Center and University of Lausanne, Switzerland
| | - Mattia Rizzi
- Pediatric Hematology-Oncology Unit, University Hospital Center and University of Lausanne, Switzerland
| | - Pascal Meylan
- Institute of Microbiology, Department of Laboratories, University Hospital Center and University of Lausanne, Switzerland
| | - Katia Jaton-Ogay
- Institute of Microbiology, Department of Laboratories, University Hospital Center and University of Lausanne, Switzerland
| | - Onya Opota
- Institute of Microbiology, Department of Laboratories, University Hospital Center and University of Lausanne, Switzerland
| | - Carole Gengler
- Department of Pathology, University Hospital Center and University of Lausanne, Switzerland
| | - Marie-Hélène Perez
- Pediatric Intensive Care Unit, University Hospital Center and University of Lausanne, Switzerland
| | - Julia Natterer
- Pediatric Intensive Care Unit, University Hospital Center and University of Lausanne, Switzerland
| | - Sandra Andrea Asner
- Pediatric Infectious Diseases and Vaccinology Unit, Woman-Mother-Child Department, University Hospital Center and University of Lausanne, Switzerland.,Infectious Diseases Service, Department of Medicine, University Hospital Center and University of Lausanne, Switzerland
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12
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Doell C, De Mul A, Nguyen DA, Perez MH, Karam O, Cannizzaro V. Reply to: Prognostic Evaluation of Mortality after Pediatric Resuscitation Assisted by Extracorporeal Life Support. J Pediatr Intensive Care 2019; 8:193-194. [PMID: 31404921 DOI: 10.1055/s-0039-1692969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Carsten Doell
- Department of Intensive Care Medicine and Neonatology, University Children's Hospital of Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Aurélie De Mul
- Pediatric Intensive Care Unit, Department of Pediatrics, Geneva University Hospital, Geneva, Switzerland
| | - Duy-Anh Nguyen
- Pediatric Intensive Care Unit, Department of Pediatrics, Geneva University Hospital, Geneva, Switzerland
| | - Marie-Hélène Perez
- Pediatric Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Oliver Karam
- Pediatric Intensive Care Unit, Department of Pediatrics, Geneva University Hospital, Geneva, Switzerland.,Division of Pediatric Critical Care, Children's Hospital of Richmond at VCU, Richmond, VA, United States
| | - Vincenzo Cannizzaro
- Department of Intensive Care Medicine and Neonatology, University Children's Hospital of Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
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13
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Perez MH, Maitre G, Longchamp D, Amiet V, Natterer J, Ferry T, Schneider A, Plaza Wuthrich S, Di Bernardo S. CytoSorb ® hemoadsorption and mechanical circulatory support in a newborn with refractory shock after congenital heart surgery. Int J Artif Organs 2019; 42:521-524. [PMID: 30968739 DOI: 10.1177/0391398819837539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Refractory cardiogenic and vasoplegic shock after congenital heart surgery is a threatening condition leading to high morbidity and mortality. Control of hemodynamic and inflammatory response is fundamental in medical strategy. We report the case of a newborn with cardiogenic and vasoplegic shock secondary to cardiopulmonary bypass for atrioseptostomy and prostaglandin treatment in the context of hypoplastic left heart syndrome, successfully treated with a combination of mechanical circulatory support and cytokine hemoadsorption column (CytoSorb®). Vasopressor support was weaned during the time of treatment without multiple organ failure occurrence. The use of CytoSorb® cartridge inserted in an extra-corporeal circuit even in a newborn is easy and feasible, as long as some precautions are considered. Routine monitoring of drugs levels is mandatory during the use of the cartridge and immediately after.
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Affiliation(s)
- Marie-Hélène Perez
- 1 Paediatric Intensive Care Unit, Department of Paediatrics, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Guillaume Maitre
- 1 Paediatric Intensive Care Unit, Department of Paediatrics, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - David Longchamp
- 1 Paediatric Intensive Care Unit, Department of Paediatrics, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Vivianne Amiet
- 1 Paediatric Intensive Care Unit, Department of Paediatrics, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Julia Natterer
- 1 Paediatric Intensive Care Unit, Department of Paediatrics, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Thomas Ferry
- 1 Paediatric Intensive Care Unit, Department of Paediatrics, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Antoine Schneider
- 2 Adult Intensive Care Unit, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Sonia Plaza Wuthrich
- 1 Paediatric Intensive Care Unit, Department of Paediatrics, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Stefano Di Bernardo
- 3 Paediatric Cardiology Unit, Department of Paediatrics, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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14
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Poli EC, Simoni C, André P, Buclin T, Longchamp D, Perez MH, Ferry T, Schneider AG. Clindamycin clearance during Cytosorb ® hemoadsorption: A case report and pharmacokinetic study. Int J Artif Organs 2019; 42:258-262. [PMID: 30819024 DOI: 10.1177/0391398819831303] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Panton-Valentine leucocidin producing methicillin-resistant Staphylococcus aureus infections are rare but associated with very high mortality rates. We report the case of a 14-year-old patient with Panton-Valentine leucocidin producing methicillin-resistant Staphylococcus aureus infection and Influenza B pneumonia requiring veno-arterial extra-corporeal membrane oxygenator for refractory shock. In the absence of response to conventional therapy, we have inserted a Cytosorb® cartridge within the extra-corporeal membrane oxygenator circuit. A spectacular decrease in vasopressor requirements followed. Since clindamycin, a key component of Panton-Valentine leucocidin producing methicillin-resistant Staphylococcus aureus treatment, might be removed by Cytosorb® hemoadsorption, we have performed serial plasma concentrations measurements of the drug. Based on these measurements, we were able to develop a pharmacokinetic model incorporating variable plasma clearance. Patient's exposure was estimated before, during and after Cytosorb® hemoadsorption. According to this model, Cytosorb® hemoadsorption did not seem to result in significant clindamycin removal. Cytosorb® hemoadsorption during Panton-Valentine leucocidin producing methicillin-resistant Staphylococcus aureus infection appears safe and feasible and no adaptation of clindamycin dosage seems necessary.
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Affiliation(s)
- Elettra Camille Poli
- 1 Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Chiara Simoni
- 2 Paediatric Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Pascal André
- 3 Laboratory of Clinical pharmacology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Thierry Buclin
- 3 Laboratory of Clinical pharmacology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - David Longchamp
- 2 Paediatric Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Marie-Hélène Perez
- 2 Paediatric Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Thomas Ferry
- 2 Paediatric Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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15
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De Mul A, Nguyen DA, Doell C, Perez MH, Cannizzaro V, Karam O. Prognostic Evaluation of Mortality after Pediatric Resuscitation Assisted by Extracorporeal Life Support. J Pediatr Intensive Care 2018; 8:57-63. [PMID: 31093456 DOI: 10.1055/s-0038-1667012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 04/13/2018] [Accepted: 06/03/2018] [Indexed: 10/28/2022] Open
Abstract
To improve survival rates during cardiopulmonary resuscitation (CPR), some patients are put on extracorporeal life support (ECLS) during active resuscitation (ECPR). Our objective was to assess the clinical outcomes after pediatric ECPR in Switzerland and to determine pre-ECPR prognostic factors for mortality. The present study is a retrospective analysis. The study setting included three pediatric intensive care units in Switzerland that use ECPR. All patients (<16 years old) undergoing ECPR from 2008 to 2016 were included in the study. There were no interventions. Data before ECLS initiation and clinical outcomes were collected. An ECPR score was designed to predict mortality, based on variables significantly different between survivors and non-survivors. Fifty-five patients were included, with a median age of 13.5 months. Eighty percent were cardiac patients. The mortality rate was 75%. Mortality was significantly associated with CPR duration ( p = 0.02), last lactate ( p = 0.05), and last pH ( p = 0.01) before ECLS initiation. Based on these three variables, an ECPR score was designed as follows: CPR duration (in minutes): 1 point if < 40; 2 points if ≥ 40; 3 points if ≥ 60; 6 points if ≥ 105. Lactate (in mmol/L): 1 point if < 8; 2 points if ≥ 8; 3 points if ≥ 14; 6 points if ≥ 18. pH: 1 point if > 7.00; 2 points if ≤ 7.00; 3 points if ≤ 6.85; 6 points if ≤ 6.60. The area under the receiver-operating characteristic curve was 0.74. The positive predictive value of a score ≥ 9 was 94%. In our population, a score based on three variables easily available prior to ECLS initiation had good discrimination and could appropriately predict mortality. This score now needs validation in a larger population.
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Affiliation(s)
- Aurélie De Mul
- Pediatric Intensive Care Unit, Geneva University Hospital, Geneva, Switzerland
| | - Duy-Anh Nguyen
- Pediatric Intensive Care Unit, Geneva University Hospital, Geneva, Switzerland
| | - Carsten Doell
- Department of Intensive Care Medicine and Neonatology, University Children's Hospital of Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Marie-Hélène Perez
- Pediatric Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Vincenzo Cannizzaro
- Department of Intensive Care Medicine and Neonatology, University Children's Hospital of Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Oliver Karam
- Pediatric Intensive Care Unit, Geneva University Hospital, Geneva, Switzerland.,Division of Pediatric Critical Care, Children's Hospital of Richmond at VCU, Richmond, VA, United States
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16
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Sandu K, Perez MH, Longchamp D, Chollet M, Gorostidi F. Endoscopic treatment of post-supraglottoplasty stenosis. Clin Otolaryngol 2018; 43:1640-1643. [PMID: 29600585 DOI: 10.1111/coa.13108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2018] [Indexed: 11/29/2022]
Affiliation(s)
- K Sandu
- Department of Otorhinolaryngology, Lausanne University Hospital, Lausanne, Switzerland
| | - M H Perez
- Department of Pediatric Intensive Care, Lausanne University Hospital, Lausanne, Switzerland
| | - D Longchamp
- Department of Pediatric Intensive Care, Lausanne University Hospital, Lausanne, Switzerland
| | - M Chollet
- Department of Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland
| | - F Gorostidi
- Department of Otorhinolaryngology, Lausanne University Hospital, Lausanne, Switzerland
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17
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Jotterand Chaparro C, Moullet C, Taffé P, Laure Depeyre J, Perez MH, Longchamp D, Cotting J. Estimation of Resting Energy Expenditure Using Predictive Equations in Critically Ill Children: Results of a Systematic Review. JPEN J Parenter Enteral Nutr 2018; 42:976-986. [PMID: 29603276 DOI: 10.1002/jpen.1146] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/21/2017] [Accepted: 12/20/2017] [Indexed: 11/06/2022]
Abstract
Provision of adequate energy intake to critically ill children is associated with improved prognosis, but resting energy expenditure (REE) is rarely determined by indirect calorimetry (IC) due to practical constraints. Some studies have tested the validity of various predictive equations that are routinely used for this purpose, but no systematic evaluation has been made. Therefore, we performed a systematic review of the literature to assess predictive equations of REE in critically ill children. We systematically searched the literature for eligible studies, and then we extracted data and assigned a quality grade to each article according to guidelines of the Academy of Nutrition and Dietetics. Accuracy was defined as the percentage of predicted REE values to fall within ±10% or ±15% of the measured energy expenditure (MEE) values, computed based on individual participant data. Of the 993 identified studies, 22 studies testing 21 equations using 2326 IC measurements in 1102 children were included in this review. Only 6 equations were evaluated by at least 3 studies in critically ill children. No equation predicted REE within ±10% of MEE in >50% of observations. The Harris-Benedict equation overestimated REE in two-thirds of patients, whereas the Schofield equations and Talbot tables predicted REE within ±15% of MEE in approximately 50% of observations. In summary, the Schofield equations and Talbot tables were the least inaccurate of the predictive equations. We conclude that a new validated indirect calorimeter is urgently needed in the critically ill pediatric population.).
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Affiliation(s)
- Corinne Jotterand Chaparro
- Department of Nutrition and Dietetics, School of Health Professions, University of Applied Sciences Western Switzerland, Carouge, Geneva, Switzerland.,Pediatric Intensive Care Unit, Medico-Surgical Department of Pediatrics, University Hospital of Lausanne, Lausanne, Switzerland
| | - Clémence Moullet
- Department of Nutrition and Dietetics, School of Health Professions, University of Applied Sciences Western Switzerland, Carouge, Geneva, Switzerland
| | - Patrick Taffé
- Institute of Social and Preventive Medicine, Lausanne, Switzerland
| | - Jocelyne Laure Depeyre
- Department of Nutrition and Dietetics, School of Health Professions, University of Applied Sciences Western Switzerland, Carouge, Geneva, Switzerland
| | - Marie-Hélène Perez
- Pediatric Intensive Care Unit, Medico-Surgical Department of Pediatrics, University Hospital of Lausanne, Lausanne, Switzerland
| | - David Longchamp
- Pediatric Intensive Care Unit, Medico-Surgical Department of Pediatrics, University Hospital of Lausanne, Lausanne, Switzerland
| | - Jacques Cotting
- Pediatric Intensive Care Unit, Medico-Surgical Department of Pediatrics, University Hospital of Lausanne, Lausanne, Switzerland
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18
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Mauron S, Longchamp D, Perez MH, Prêtre R, Sandu K, Di Bernardo S, Boegli Y, Dolci M. Anesthetic Management for Concomitant Correction of Congenital Cardiac Defects and Long "O" Ring Tracheal Stenosis: A Role for Heliox?: Report of 2 Cases. A A Pract 2018; 10:154-156. [PMID: 29611831 PMCID: PMC5862009 DOI: 10.1213/xaa.0000000000000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present 2 infants with the rare association of long congenital tracheal stenosis, ventricular septal defect, and pulmonary hypertension. We describe a step-by-step assessment of the patients and the necessary procedures for a successful concomitant repair of both cardiac and tracheal malformations. The use of a helium-oxygen mixture (heliox) for the induction of anesthesia and pre-cardiopulmonary bypass is discussed.
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Affiliation(s)
- Sylvain Mauron
- From the Departments of Pediatric Anesthesia, Pediatric Intensive Care, Cardiovascular Surgery, Otorhinolaryngology, and Pediatric Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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19
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Maitre G, Schaffner D, Natterer J, Longchamp D, Ferry T, Diezi M, Di Bernardo S, Perez MH, Amiet V. Leukemoid Reaction in Infant Pertussis: Is There a Place for Hydroxyurea? A Case Report. Front Pediatr 2018; 6:261. [PMID: 30356838 PMCID: PMC6190881 DOI: 10.3389/fped.2018.00261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 09/03/2018] [Indexed: 01/18/2023] Open
Abstract
A 73-days old infant of 34 weeks' gestation was hospitalized with a co-infection of respiratory syncytial virus (RSV) and Bordetella pertussis (BP). She required invasive ventilation for 9 days in the context of malignant pertussis with persistent hypoxemia and hypercapnia secondary to a leukemoid reaction. Despite an increase of white blood cell (WBC) count up to 70 G/L and ensuing pulmonary hypertension, no hemodynamic compromise occurred. Without clear indication for leukapheresis nor exchange transfusion, an off-label treatment with hydroxyurea was given for 5 days with gradual decrease of WBC count, without any complication and hospital discharge on day 29. To our knowledge, no effective therapy for malignant pertussis has been described in the literature and complications are frequent with leukoreduction procedures. We discuss an alternative to invasive procedures in young infants to fulfill the need to decrease rapidly leukocyte counts in a leukemoid reaction associated with Bordetella pertussis infection. To our knowledge, hydroxyurea has never been used in malignant pertussis but is a well-known medication for oncologic and hematologic diseases such as acute myeloid leukemia or sickle cell anemia. Its effects in this setting are not well understood but the positive outcome in our patient supports the need for further studies.
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Affiliation(s)
- Guillaume Maitre
- Pediatric Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Damien Schaffner
- Pediatric Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Julia Natterer
- Pediatric Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - David Longchamp
- Pediatric Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Thomas Ferry
- Pediatric Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Manuel Diezi
- Pediatric Onco-Hematology Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Stefano Di Bernardo
- Pediatric Cardiology Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Marie-Hélène Perez
- Pediatric Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Vivianne Amiet
- Pediatric Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland
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20
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Hosseinpour AR, Perez MH, Longchamp D, Cotting J, Sekarski N, Hurni M, Prêtre R, Di Bernardo S. Age is not a good predictor of irreversibility of pulmonary hypertension in congenital cardiac malformations with left-to-right shunt. CONGENIT HEART DIS 2017; 13:210-216. [PMID: 29071783 DOI: 10.1111/chd.12545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/18/2017] [Accepted: 07/28/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Congenital cardiac malformations with high pulmonary blood flow and pressure due to left-to-right shunts are usually repaired in early infancy for both the benefits of early relief of heart failure and the fear that the concomitant pulmonary hypertension may become irreversible unless these defects are corrected at an early age. Age, however, has been a poor predictor of irreversibility of pulmonary hypertension in our experience, which is presented here. DESIGN A retrospective observational study. We defined "late" as age ≥2 years. We examined clinical, echocardiographic, and hemodynamic data from all patients aged ≥2 years with such malformations referred to us from 2004 untill 2015. SETTING Department of Pediatric Cardiology and Cardiac Surgery, University Hospital of Vaud, Lausanne, Switzerland. PATIENTS There were 39 patients, aged 2-35 years (median: 5 years), without chromosomal abnormalities. All had malformations amenable to biventricular repair, and all had high systolic right ventricular pressures by echocardiography prior to referral. INTERVENTIONS All patients underwent catheterization for assessment of pulmonary hypertension. If this was reversible, surgical correction was offered. OUTCOME MEASURES (1) Operability based on reversibility of pulmonary hypertension. (2) When surgery was offered, mortality and evidence of persisting postoperative pulmonary hypertension were examined. RESULTS Eighteen patients had no pulmonary hypertension, 5 of variable ages were inoperable due to irreversible pulmonary hypertension, and 16 had reversible pulmonary hypertension. Therefore, 34 patients underwent corrective surgery, with no immediate or late mortality. Pulmonary arterial and right ventricular pressures decreased noticeably in all operated patients. This is sustained to date; they are all asymptomatic with no echocardiographic evidence of pulmonary hypertension at a median follow-up of 7 years (range 2-13 years). CONCLUSIONS Pulmonary hypertension may still be reversible in many surprisingly old patients with left-to-right shunt lesions, who may therefore still be operable.
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Affiliation(s)
| | - Marie-Hélène Perez
- Pediatric Intensive Care, University Hospital of Vaud, Lausanne, Switzerland
| | - David Longchamp
- Pediatric Intensive Care, University Hospital of Vaud, Lausanne, Switzerland
| | - Jacques Cotting
- Pediatric Intensive Care, University Hospital of Vaud, Lausanne, Switzerland
| | - Nicole Sekarski
- Department of Pediatric Cardiology, University Hospital of Vaud, Lausanne, Switzerland
| | - Michel Hurni
- Department of Cardiac Surgery, University Hospital of Vaud, Lausanne, Switzerland
| | - René Prêtre
- Department of Cardiac Surgery, University Hospital of Vaud, Lausanne, Switzerland
| | - Stefano Di Bernardo
- Department of Pediatric Cardiology, University Hospital of Vaud, Lausanne, Switzerland
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21
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Jotterand Chaparro C, Taffé P, Moullet C, Laure Depeyre J, Longchamp D, Perez MH, Cotting J. Performance of Predictive Equations Specifically Developed to Estimate Resting Energy Expenditure in Ventilated Critically Ill Children. J Pediatr 2017; 184:220-226.e5. [PMID: 28108105 DOI: 10.1016/j.jpeds.2016.12.063] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 11/01/2016] [Accepted: 12/21/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine, based on indirect calorimetry measurements, the biases of predictive equations specifically developed recently for estimating resting energy expenditure (REE) in ventilated critically ill children, or developed for healthy populations but used in critically ill children. STUDY DESIGN A secondary analysis study was performed using our data on REE measured in a previous prospective study on protein and energy needs in pediatric intensive care unit. We included 75 ventilated critically ill children (median age, 21 months) in whom 407 indirect calorimetry measurements were performed. Fifteen predictive equations were used to estimate REE: the equations of White, Meyer, Mehta, Schofield, Henry, the World Health Organization, Fleisch, and Harris-Benedict and the tables of Talbot. Their differential and proportional biases (with 95% CIs) were computed and the bias plotted in graphs. The Bland-Altman method was also used. RESULTS Most equations underestimated and overestimated REE between 200 and 1000 kcal/day. The equations of Mehta, Schofield, and Henry and the tables of Talbot had a bias ≤10%, but the 95% CI was large and contained values by far beyond ±10% for low REE values. Other specific equations for critically ill children had even wider biases. CONCLUSIONS In ventilated critically ill children, none of the predictive equations tested met the performance criteria for the entire range of REE between 200 and 1000 kcal/day. Even the equations with the smallest bias may entail a risk of underfeeding or overfeeding, especially in the youngest children. Indirect calorimetry measurement must be preferred.
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Affiliation(s)
- Corinne Jotterand Chaparro
- Department of Nutrition and Dietetics, School of Health Professions, University of Applied Sciences Western Switzerland, Geneva 1227, Switzerland; Pediatric Intensive Care Unit, Medico-Surgical Department of Pediatrics, University Hospital of Lausanne, Lausanne 1011, Switzerland
| | - Patrick Taffé
- Institute of Social and Preventive Medicine, Lausanne 1010, Switzerland
| | - Clémence Moullet
- Department of Nutrition and Dietetics, School of Health Professions, University of Applied Sciences Western Switzerland, Geneva 1227, Switzerland
| | - Jocelyne Laure Depeyre
- Department of Nutrition and Dietetics, School of Health Professions, University of Applied Sciences Western Switzerland, Geneva 1227, Switzerland
| | - David Longchamp
- Pediatric Intensive Care Unit, Medico-Surgical Department of Pediatrics, University Hospital of Lausanne, Lausanne 1011, Switzerland
| | - Marie-Hélène Perez
- Pediatric Intensive Care Unit, Medico-Surgical Department of Pediatrics, University Hospital of Lausanne, Lausanne 1011, Switzerland
| | - Jacques Cotting
- Pediatric Intensive Care Unit, Medico-Surgical Department of Pediatrics, University Hospital of Lausanne, Lausanne 1011, Switzerland.
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Weber A, Donner B, Perez MH, Di Bernardo S, Trachsel D, Sandu K, Sekarski N. Complicated Postoperative Course after Pulmonary Artery Sling Repair and Slide Tracheoplasty. Front Pediatr 2017; 5:67. [PMID: 28443268 PMCID: PMC5385459 DOI: 10.3389/fped.2017.00067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 03/20/2017] [Indexed: 11/13/2022] Open
Abstract
Pulmonary artery sling (PAS) is a rare congenital condition in which the left pulmonary artery (LPA) arises from the right pulmonary artery, and then passes between the trachea and the esophagus to reach the left lung, thereby forming a sling around the airway. It is often associated with intrinsic tracheal stenosis due to complete cartilaginous rings. Therapeutic management nowadays consists of one-stage reimplantation of the LPA and tracheoplasty with cardiopulmonary bypass support. Here, we present a 7-week-old boy with PAS and long-segment tracheal stenosis (LSTS) who underwent surgical intervention consisting of reimplantation of the LPA and slide tracheoplasty. Multiple respiratory and cardiovascular complications marked the postoperative course. They consisted of recurrent failed attempts in weaning off mechanical ventilation due to bronchomalacia, left vocal cord paralysis, development of granulation tissue at the anastomosis and restenosis of the trachea, and the main stem bronchi requiring balloon dilatation. The patient also developed bilateral pulmonary artery thrombosis and stenosis of the LPA. After a prolonged hospitalization, the patient is doing well without any respiratory symptoms and has a good result on follow-up bronchoscopy 1 year after the initial surgery. The stenosis of the LPA responded well to percutaneous balloon dilatation 12 months after the primary surgery. The case illustrates that even though surgical techniques are improving and are in general associated with a low morbidity and mortality, management of PAS and tracheal stenosis can still be challenging. However, good long-term outcome can be achieved if the initial postoperative phase is overcome.
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Affiliation(s)
- Angelika Weber
- Pediatric Cardiology Unit, Department of Pediatrics and Pediatric Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Birgit Donner
- Division of Pediatric Cardiology, University Children's Hospital Basel, Basel, Switzerland
| | - Marie-Hélène Perez
- Pediatric Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Stefano Di Bernardo
- Pediatric Cardiology Unit, Department of Pediatrics and Pediatric Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Daniel Trachsel
- Division of Pediatric Pulmonology, University Children's Hospital Basel, Basel, Switzerland
| | - Kishore Sandu
- Airway Unit, Service of Otorhinolaryngology, University Hospital Lausanne, Lausanne, Switzerland
| | - Nicole Sekarski
- Pediatric Cardiology Unit, Department of Pediatrics and Pediatric Surgery, University Hospital Lausanne, Lausanne, Switzerland
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Jotterand Chaparro C, Laure Depeyre J, Longchamp D, Perez MH, Taffé P, Cotting J. How much protein and energy are needed to equilibrate nitrogen and energy balances in ventilated critically ill children? Clin Nutr 2015; 35:460-467. [PMID: 25912187 DOI: 10.1016/j.clnu.2015.03.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 03/23/2015] [Accepted: 03/24/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND & AIMS Protein and energy requirements in critically ill children are currently based on insufficient data. Moreover, longitudinal measurements of both total urinary nitrogen (TUN) and resting energy expenditure (REE) are lacking. The aim of this study was to investigate how much protein and energy are needed to equilibrate nitrogen and energy balances in ventilated critically ill children on the basis of daily measurements of TUN, REE and protein and energy intakes. Comparisons were made with the guidelines of the American Society for Parenteral and Enteral Nutrition and the Dietary Reference Intakes. METHODS Children with an expected duration of mechanical ventilation ≥72 h were prospectively recruited. TUN was measured by chemiluminescence, and REE was measured by indirect calorimetry. Generalised linear models for longitudinal data were used to study the relation between protein intake and nitrogen balance and to calculate the minimum intake of protein needed to achieve nitrogen equilibrium. A similar approach was used for energy. Results were compared to the recommended values. RESULTS Based on 402 measurements performed in 74 children (median age: 21 months), the mean TUN was high at 0.20 (95% CI: 0.20, 0.22) g/kg/d and the REE was 55 (95% CI: 54, 57) kcal/kg/d. Nitrogen and energy balances were achieved with 1.5 (95% CI: 1.4, 1.6) g/kg/d of protein and 58 (95% CI: 53, 63) kcal/kg/d for the entire group, but there were differences among children of different ages. Children required more protein and less energy than the Dietary Reference Intakes. CONCLUSIONS In critically ill children, TUN was elevated and REE was reduced during the entire period of mechanical ventilation. Minimum intakes of 1.5 g/kg/d of protein and 58 kcal/kg/d can equilibrate nitrogen and energy balances in children up to 4 years old. Older children require more protein.
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Affiliation(s)
- Corinne Jotterand Chaparro
- Department of Nutrition and Dietetics, School of Health Professions, University of Applied Sciences Western Switzerland (HES-SO), Rue des Caroubiers 25, 1227 Carouge, Geneva, Switzerland.
| | - Jocelyne Laure Depeyre
- Department of Nutrition and Dietetics, School of Health Professions, University of Applied Sciences Western Switzerland (HES-SO), Rue des Caroubiers 25, 1227 Carouge, Geneva, Switzerland.
| | - David Longchamp
- Paediatric Intensive Care Unit, Medico-Surgical Department of Paediatrics, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Marie-Hélène Perez
- Paediatric Intensive Care Unit, Medico-Surgical Department of Paediatrics, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Patrick Taffé
- Institute for Social and Preventive Medicine (IUMSP), Biopôle 2, Route de la Corniche 10, 1010 Lausanne, Switzerland.
| | - Jacques Cotting
- Paediatric Intensive Care Unit, Medico-Surgical Department of Paediatrics, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
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Giuliani-Poncini C, Perez MH, Cotting J, Hurni M, Sekarski N, Pfammatter JP, Di Bernardo S. Persistent left superior vena cava in cardiac congenital surgery. Pediatr Cardiol 2014; 35:71-6. [PMID: 23821295 DOI: 10.1007/s00246-013-0743-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 06/18/2013] [Indexed: 11/24/2022]
Abstract
Persistent left superior vena cava (LSVC) is a relatively frequent finding in congenital cardiac malformation. The scope of the study was to analyze the timing of diagnosis of persistent LSVC, the timing of diagnosis of associated anomalies of the coronary sinus, and the global impact on morbidity and mortality of persistent LSVC in children with congenital heart disease after cardiac surgery. Retrospective analysis of a cohort of children after cardiac surgery on bypass for congenital heart disease. Three hundred seventy-one patients were included in the study, and their median age was 2.75 years (IQR 0.65-6.63). Forty-seven children had persistent LSVC (12.7 %), and persistent LSVC was identified on echocardiography before surgery in 39 patients (83 %). In three patients (6.4 %) with persistent LSVC, significant inflow obstruction of the left ventricle developed after surgery leading to low output syndrome or secondary pulmonary hypertension. In eight patients (17 %), persistent LSVC was associated with a partially or completely unroofed coronary sinus and in two cases (4 %) with coronary sinus ostial atresia. Duration of mechanical ventilation was significantly shorter in the control group (1.2 vs. 3.0 days, p = 0.04), whereas length of stay in intensive care did not differ. Mortality was also significantly lower in the control group (2.5 vs. 10.6 %, p = 0.004). The results of study show that persistent LSVC in association with congenital cardiac malformation increases the risk of mortality in children with cardiac surgery on cardiopulmonary bypass. Recognition of a persistent LSVC and its associated anomalies is mandatory to avoid complications during or after cardiac surgery.
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MESH Headings
- Adolescent
- Cardiac Output, Low/diagnosis
- Cardiac Output, Low/epidemiology
- Cardiac Output, Low/etiology
- Cardiac Surgical Procedures/adverse effects
- Cardiac Surgical Procedures/methods
- Cardiac Surgical Procedures/mortality
- Cardiopulmonary Bypass/adverse effects
- Cardiopulmonary Bypass/methods
- Cardiopulmonary Bypass/mortality
- Child, Preschool
- Coronary Sinus/abnormalities
- Coronary Sinus/physiopathology
- Echocardiography
- Female
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/epidemiology
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/surgery
- Humans
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/epidemiology
- Hypertension, Pulmonary/etiology
- Infant, Newborn
- Male
- Mortality
- Outcome Assessment, Health Care
- Postoperative Complications/diagnosis
- Postoperative Complications/epidemiology
- Retrospective Studies
- Risk Assessment
- Switzerland/epidemiology
- Vascular Malformations/diagnosis
- Vascular Malformations/epidemiology
- Vascular Malformations/physiopathology
- Vascular Malformations/surgery
- Vena Cava, Superior/abnormalities
- Vena Cava, Superior/physiopathology
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Affiliation(s)
- Cristina Giuliani-Poncini
- Pediatric Intensive Care Unit, University Hospital Center and University of Lausanne, Lausanne, Switzerland
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25
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Joye S, Gao A, Kayemba-Kay's S, Cotting J, Perez MH. Invasive Pneumococcal Infection Despite 7-Valent Conjugated Vaccine. Clin Pract 2013; 3:e11. [PMID: 24765491 PMCID: PMC3981225 DOI: 10.4081/cp.2013.e11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 02/05/2013] [Indexed: 11/23/2022] Open
Abstract
Despite good cover with 7-valent vaccination, invasive pneumococcal infections may still be misdiagnosed and may lead to lifethreatening situations or death in young children. New serotypes are emerging and, therefore, clinicians must keep a high level of suspicion in young children regardless of their vaccination status. We report three cases of invasive pneumococcal infection due to new serotypes not covered by the 7-valent conjugated vaccine, two of which led children to death.
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Abstract
This paper describes a one-month-old girl presenting with respiratory and growth failure due to diaphragmatic paralysis associated with left brachial plexus palsy after forceps delivery. Despite continuous positive pressure ventilation and nasogastric feeding, the situation did not improve and a laparoscopic diaphragmatic plication had to be performed. When dealing with a child born with brachial plexus palsy, one must think of this possible association and if necessary proceed to the complementary radiological examinations. The treatment must avoid complications like feeding difficulties and failure to thrive, respiratory infections or atelectasis. It includes intensive support and a good evaluation of the prognosis of the lesion to decide the best moment for a surgical therapy.
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Affiliation(s)
- Odile Héritier
- Pediatric Intensive Care Unit, Department of Pediatrics, University Hospital and University of Lausanne, Lausanne, Switzerland.
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28
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Schneider AG, Perez MH, Tozzi P, Voirol P, Schoettker P, Angelillo-Scherrer A, Cotting J, Von Segesser L, Eggimann P. Recombinant factor VIIa for intractable life-threatening bleeding in patients with circulatory assist devices. Intensive Care Med 2010; 36:1620-1. [PMID: 20521024 DOI: 10.1007/s00134-010-1937-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2010] [Indexed: 11/27/2022]
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Stucki P, Perez MH, Scalfaro P, de Halleux Q, Vermeulen F, Cotting J. Feasibility of non-invasive pressure support ventilation in infants with respiratory failure after extubation: a pilot study. Intensive Care Med 2009; 35:1623-7. [DOI: 10.1007/s00134-009-1536-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 04/03/2009] [Indexed: 11/27/2022]
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30
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Schneider AS, Tozzi P, Voirol P, Schoettker P, Perez MH, Angelillo-Scherrer A, Wasserfallen J, Chiolero R, Cotting J, Von Segesser L, Eggimann P. Safety of activated recombinant factor VII in patients with circulatory assist devices. Crit Care 2009. [PMCID: PMC4084317 DOI: 10.1186/cc7595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Perez MH, Wallace WG. Differences in prey capture in grass shrimp, Palaemonetes pugio, collected along an environmental impact gradient. Arch Environ Contam Toxicol 2004; 46:81-89. [PMID: 15025167 DOI: 10.1007/s00244-002-0249-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The waterways and associated salt marshes along the western border of Staten Island, New York (Arthur Kill) have long been under environmental duress. Environmental threats include industrial and municipal discharges, oil spills, and possible leachate from landfills. These impacts are compounded due to the low flushing of this body of water. Grass shrimp, Palaemonetes pugio, inhabiting the Arthur Kill are, therefore, potentially at risk of exposure to metal and organic pollutants. Successful prey capture (of live brine shrimp, Artemia franciscana) was used to compare the relative health of shrimp collected from three sites along an environmental impact gradient. Study sites included a relatively unimpacted harbor (Great Kills Harbor, GK) and two creeks adjoining the Arthur Kill (Nassau Creek, NC, and Richmond Creek, RC). Shrimp originating from GK exhibited a rate of prey capture (6.3 prey h(-1)) that was about two times greater (p < 0.05) than that of shrimp originating from a creek behind a series of landfills (RC, 3.2 prey h(-1)). The rate of prey capture for shrimp collected from a creek impacted by historic smelting activities (NC) was intermediate (5.4 prey h(-1)). Laboratory studies with shrimp from a pristine site (Tuckerton, NJ) exposed to RC conditions (i.e., sediment and water) for eight weeks indicate that reduced prey capture can be induced in healthy shrimp. Finally, video analysis suggests that reduced prey capture in RC shrimp may not be the result of less effort, but rather the combination of (1) 80% fewer (p < 0.05) prey being captured with a lunge type of attack and (2) a greater reliance (p < 0.05) on a less efficient grab type of foraging behavior (64% success rate for RC versus 87% success rate for GK; p = 0.058). These results indicate that sublethal toxicity in environmentally impacted populations can occur and that prey capture may be used to assay the relative health of field specimens. Additionally, impaired prey capture may have important implications for the energy flow within impacted environments.
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Affiliation(s)
- M H Perez
- Center for Environmental Science, College of Staten Island, City University of New York, 6S-310, 2800 Victory Boulevard, Staten Island, New York 10314, USA
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32
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Jaitovich-Groisman I, Benlimame N, Slagle BL, Perez MH, Alpert L, Song DJ, Fotouhi-Ardakani N, Galipeau J, Alaoui-Jamali MA. Transcriptional regulation of the TFIIH transcription repair components XPB and XPD by the hepatitis B virus x protein in liver cells and transgenic liver tissue. J Biol Chem 2001; 276:14124-32. [PMID: 11278765 DOI: 10.1074/jbc.m010852200] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Human hepatitis B virus is a risk factor for the development of hepatocellular carcinoma. The hepatitis B virus x protein (HBx) has been shown to inactivate the p53 tumor suppressor protein and impair DNA repair, cell cycle, and apoptosis mechanisms. Herein we report that HBx represses two components of the transcription-repair factor TFIIH, XPB (p89), and XPD (p80), both in p53-proficient and p53-deficient liver cells. This inhibition is observed while HBx maintains its transactivation function. Expression of HBx in liver cells results in down-regulation of endogenous XPB and XPD mRNAs and proteins; this inhibition is not observed with other TFIIH subunits, XPA or PCNA. In liver tissue from HBx transgenics, XPB and XPD proteins are down-regulated in comparison to matched normal liver tissue. HBx has been shown to interact with Sp1 transcription factor and affects its DNA binding activity. Sp1 is essential for the basal promoter activity of XPB in liver cells and Drosophila SL2 cells. In the Sp1-deficient SL2 cells, HBx-induced XPB and XPD inhibition is Sp1-dependent. In summary, our results provide evidence that HBx represses the expression of key TFIIH proteins at least in part through Sp1 elements; this repression may impair TFIIH function in DNA repair mechanisms.
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MESH Headings
- Animals
- Animals, Genetically Modified
- Apoptosis
- Blotting, Western
- Cell Line
- Chloramphenicol O-Acetyltransferase/metabolism
- DNA Helicases
- DNA Repair/genetics
- DNA-Binding Proteins/metabolism
- Down-Regulation
- Drosophila
- Drosophila Proteins
- Female
- Flow Cytometry
- Gene Expression Regulation, Viral
- Humans
- Immunohistochemistry
- Liver/metabolism
- Male
- Mice
- Mice, Transgenic
- Models, Genetic
- Plasmids/metabolism
- Promoter Regions, Genetic
- Proteins/metabolism
- RNA, Messenger/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Sp1 Transcription Factor/metabolism
- TATA-Binding Protein Associated Factors
- Trans-Activators/genetics
- Trans-Activators/metabolism
- Transcription Factor TFIID
- Transcription Factor TFIIH
- Transcription Factors/genetics
- Transcription Factors, TFII
- Transcription, Genetic
- Transcriptional Activation
- Transfection
- Tumor Cells, Cultured
- Viral Regulatory and Accessory Proteins
- Xeroderma Pigmentosum Group D Protein
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Affiliation(s)
- I Jaitovich-Groisman
- Lady Davis Institute of the Sir Mortimer B. Davis Jewish General Hospital, Departments of Medicine, Pharmacology and Therapeutics, Pathology, and Oncology, Faculty of Medicine, McGill University, Montreal H3T 1E2, Canada
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