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Stenkjaer RL, Egerod I, Moszkowicz M, Ista E, Greisen G, Weis J, Pagsberg AK, Herling SF. Prospective validation of Sophia observation withdrawal symptoms: A paediatric delirium scale in critically ill children in Denmark. Aust Crit Care 2024; 37:400-406. [PMID: 37164889 DOI: 10.1016/j.aucc.2023.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 03/27/2023] [Accepted: 04/01/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Paediatric delirium (PD) is increasingly recognised as a common disorder in critically ill children with a reported prevalence ranging from 9% to 66%. We validated the PD component of the Sophia Observation withdrawal Symptoms-Paediatric Delirium (SOS-PD) scale in a Danish setting to provide increased awareness and reliable identification of this critical condition, thereby paving the way for improved pathways to targeted delirium care. OBJECTIVE The objectives of this study were to criterion validate the PD component of the SOS-PD screening tool by comparing blinded psychiatric and nurse assessments and to estimate the prevalence of delirium in critically ill children in a Danish context. METHODS A prospective observational study was performed on critically ill children aged between 3 m and 18 y, admitted to an intensive care unit, with a hospital stay of 48 h or more. Assessments took place on a fixed weekday over an 18-month period. To test accuracy and criterion validity, bedside nurses' SOS-PD assessments were compared to the reference standard, a diagnostic assessment performed by a child psychiatrist according to the Diagnostic and Statistical Manual-V criteria by use of the Vanderbilt Assessment of Delirium in Infants and Children. RESULTS We included 141 children in the study, 30 (21%) of whom were diagnosed with delirium by the child psychiatrist. The accuracy of the delirium diagnosis was 93.6% (95% confidence interval [CI]: 88.3-97.1) among the nurses' SOS-PD assessments compared to the reference standard. The SOS-PD demonstrated a high sensitivity of 83.3% (95% CI: 65.3-94.4) and a high specificity of 96.4% (95% CI: 91.0-99.0) with five false-negative and four false-positive cases. CONCLUSION The PD component of the SOS-PD tool has good accuracy and validity for assessments performed by nurses compared to a child psychiatrist's diagnosis in critically ill children in a Danish setting. We recommend the use of the SOS-PD instrument in clinical practice.
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Affiliation(s)
- Rikke Louise Stenkjaer
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Ingrid Egerod
- Department of Intensive Care, Copenhagen University Hospital Rigshospitalet Blegdamsvej 9, 2100 Copenhagen, Denmark; University of Copenhagen, Department of Clinical Medicine Copenhagen, Denmark.
| | - Mala Moszkowicz
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, Copenhagen 2900 Hellerup, Denmark.
| | - Erwin Ista
- Department of paediatric Surgery, paediatric Intensive Care, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Gorm Greisen
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, 2100 Copenhagen, Denmark; University of Copenhagen, Department of Clinical Medicine Copenhagen, Denmark.
| | - Janne Weis
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Gentofte Hospitalsvej 3A, 1. sal, Copenhagen 2900 Hellerup, Denmark.
| | - Suzanne Forsyth Herling
- The Neuroscience Centre, Copenhagen University Hospital Rigshospitalet Blegdamsvej 9, 2100 Copenhagen, Denmark; University of Copenhagen, Department of Clinical Medicine Copenhagen, Denmark.
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Vedrenne-Cloquet M, Tuffet S, Louis B, Khirani S, Collignon C, Renolleau S, Fauroux B, Carteaux G. Accuracy of tidal volume delivery by paediatric intensive care ventilators: A bench-model study. Aust Crit Care 2024:S1036-7314(24)00005-5. [PMID: 38267269 DOI: 10.1016/j.aucc.2023.12.007] [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: 08/12/2023] [Revised: 11/06/2023] [Accepted: 12/02/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Tidal volume (Vt) delivery during mechanical ventilation is influenced by gas compression, humidity, and temperature. OBJECTIVES This bench study aimed at assessing the accuracy of Vt delivery by paediatric intensive care ventilators according to the humidification system. Secondary objectives were to assess the following: (i) the accuracy of Vt delivery in ventilators with an integrated Y-piece pneumotachograph and (ii) the ability of ventilators to deliver and maintain a preset positive end-expiratory pressure. METHODS Six latest-generation intensive care ventilators equipped with a paediatric mode were tested on the ASL5000 test lung in four simulated paediatric bench models (full-term neonate, infant, preschool-age chile, and school-age child), under volume-controlled mode with a heated humidifier (HH) or a heat moisture exchanger, with various loading conditions. Three ventilators equipped with a Y-piece pneumotachograph were tested with or without the pneumotachograph in the neonatal and infant models. "Accurate Vt" delivery was defined as a volume error (percentage of the preset Vt under body temperature and pressure and saturated water vapour conditions) being ≤10 % of the absolute preset value. RESULTS Vt accuracy varied significantly across ventilators but was acceptable in almost all the ventilators and all the models, except the neonatal model. The humidification system had an impact on Vt delivery in the majority of the tested conditions (p < 0.05). The use of an HH was associated with a better Vt accuracy in four ventilators (V500, V800, R860, and ServoU) and allowed to achieve an acceptable level of volume error in the neonatal model as compared to the use of heat moisture exchanger. The use of an integrated pneumotachograph was associated with lower volume error in only one ventilator (p < 0.01). All the tested ventilators were able to maintain adequate positive end-expiratory pressure levels. CONCLUSION The humidification system affects Vt accuracy of paediatric intensive care ventilators, especially in the youngest patients for whom the HH should be preferred.
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Affiliation(s)
- Meryl Vedrenne-Cloquet
- Pediatric Sleep and Noninvasive Ventilation Unit, EA 7330 VIFASOM, AP-HP, Hôpital Necker Enfants-Malades, Paris, France; Université de Paris, Paris, France; Réanimation Médicochirurgicale Pédiatrique, AP-HP, CHU Necker-Enfants Malades, Paris, France.
| | - Samuel Tuffet
- INSERM, Université Paris Est Créteil IMRB, CNRS EMR, 7000, Créteil, France; GRC CARMAS, IMRB, Université Paris Est Créteil, Faculté de Santé de Créteil, Créteil, France; Réanimation Médicale, AP-HP, Centre Hospitalier Universitaire Henri Mondor, Créteil, France
| | - Bruno Louis
- INSERM, Université Paris Est Créteil IMRB, CNRS EMR, 7000, Créteil, France
| | - Sonia Khirani
- Pediatric Sleep and Noninvasive Ventilation Unit, EA 7330 VIFASOM, AP-HP, Hôpital Necker Enfants-Malades, Paris, France; Université de Paris, Paris, France; ASV Santé, Gennevilliers, France
| | - Charlotte Collignon
- Réanimation Médicochirurgicale Pédiatrique, AP-HP, CHU Necker-Enfants Malades, Paris, France
| | - Sylvain Renolleau
- Université de Paris, Paris, France; Réanimation Médicochirurgicale Pédiatrique, AP-HP, CHU Necker-Enfants Malades, Paris, France
| | - Brigitte Fauroux
- Pediatric Sleep and Noninvasive Ventilation Unit, EA 7330 VIFASOM, AP-HP, Hôpital Necker Enfants-Malades, Paris, France; Université de Paris, Paris, France
| | - Guillaume Carteaux
- INSERM, Université Paris Est Créteil IMRB, CNRS EMR, 7000, Créteil, France; GRC CARMAS, IMRB, Université Paris Est Créteil, Faculté de Santé de Créteil, Créteil, France; Réanimation Médicale, AP-HP, Centre Hospitalier Universitaire Henri Mondor, Créteil, France
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López J, Barba MG, Fernández SN, Solana MJ, Urbano J, Sánchez C, López-Herce J. Protocol for treatment of constipation with polyethylene glycol 3350 plus electrolytes in critically ill children. An Pediatr (Barc) 2023; 99:176-184. [PMID: 37640660 DOI: 10.1016/j.anpede.2023.05.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/02/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES No studies have analysed the effectiveness of treatment for constipation in critically ill children. The aim of this study was to assess the implementation, efficacy and safety of a treatment protocol using polyethylene glycol 3350 with electrolytes (PEG 3350 + E) for constipation in critically ill children. METHODS We conducted a single-centre prospective study in children admitted to the paediatric intensive care unit for a minimum of 72 h and who developed constipation. Children with previous gastrointestinal disorders or diseases were excluded. The patients were treated with rectal enemas or with the oral PEG 3350 + E protocol at the discretion of the treating physician. We compared clinical and demographic variables as well as adverse events (diarrhoea, abdominal distension and electrolyte imbalances). RESULTS The sample included 56 patients with a mean age of 48.2 ± 11.9 months, of who 55.4% were male. Forty-four patients (78.6%) were treated with PEG 3350 + E and 12 (21.4%) with rectal enemas. The proportion of patients that responded well to treatment was greater in the PEG 3350 + E group (79.5%) compared to the enema group (58.3%), but the difference was not statistically significant (P = .151). There were no significant differences between the groups in any of the adverse effects. Treatment with PEG 3350 + E was more effective in children aged less than 2 years (100%) compared to older children (100% vs 65.4%; P < .01), with no significant differences in the development of adverse events. CONCLUSIONS The PEG 3350 + E treatment protocol for constipation in critically ill children was effective and associated with few adverse events, even in children aged less than 2 years.
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Affiliation(s)
- Jorge López
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network, Redes de Investigación Cooperativa Orientadas a Resultados en Salud [RICORS]) (RD21/0012/0011), Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain.
| | - María G Barba
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Montepríncipe, Madrid, Spain
| | - Sarah N Fernández
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network, Redes de Investigación Cooperativa Orientadas a Resultados en Salud [RICORS]) (RD21/0012/0011), Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain
| | - María J Solana
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network, Redes de Investigación Cooperativa Orientadas a Resultados en Salud [RICORS]) (RD21/0012/0011), Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Urbano
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network, Redes de Investigación Cooperativa Orientadas a Resultados en Salud [RICORS]) (RD21/0012/0011), Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain
| | - César Sánchez
- Unidad de Gastroenterología Infantil, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, RICORS (RD21/0012/0011), Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain
| | - Jesús López-Herce
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origin Network, Redes de Investigación Cooperativa Orientadas a Resultados en Salud [RICORS]) (RD21/0012/0011), Instituto de Salud Carlos III, Universidad Complutense de Madrid, Madrid, Spain
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Fernández Montes R, Urbano Villaescusa J, Carrillo Álvarez Á, Vivanco Allende A, Solana García MJ, Díaz Coto S, Rey Galán C, López-Herce Cid J. Effect of three enteral diets with different protein contents on protein metabolism in critically ill infants: a randomized controlled trial. An Pediatr (Barc) 2023:S2341-2879(23)00120-5. [PMID: 37344303 DOI: 10.1016/j.anpede.2023.03.011] [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: 09/15/2022] [Accepted: 03/06/2023] [Indexed: 06/23/2023] Open
Abstract
INTRODUCTION The optimal intake to improve protein metabolism without producing adverse effects in seriously ill infants has yet to be established. The aim of our study was to analyse whether an increased protein intake delivered through enteral nutrition would be associated with an improvement in nitrogen balance and serum protein levels in critically ill infants. METHODS We conducted a multicentre, prospective randomized controlled trial (December 2016-June 2019). The sample consisted of critically ill infants receiving enteral nutrition assigned randomly to 3 protein content groups: standard diet (1.7 g/dL), protein-enriched diet (2.7 g/dL) and high protein-enriched diet (5.1 g/dL). Blood and urine tests were performed, and we assessed nitrogen balance at baseline and at 3-5 days of the diet. We analysed variations in nitrogen balance and serum protein levels (total protein, albumin, transferrin, prealbumin, and retinol-binding protein) throughout the study period. RESULTS Ninety-nine infants (33 per group) completed the study. We did not find any differences were between groups in demographic characteristics, severity scores or prescribed medications, except for corticosteroids, administered in a higher proportion of patients in the third group. We observed significant increases in prealbumin and retinol-binding protein levels in patients receiving the protein-enriched and high protein-enriched diets at 3-5 days compared to baseline. The nitrogen balance increased in all groups, but the differences were not significant in the high protein-enriched group. There were no differences in gastrointestinal tolerance. Patients fed high protein-enriched formula had higher levels of serum urea, with a higher incidence of hyperuraemia in this group. CONCLUSION Enteral administration of higher amounts of protein improves serum protein levels in critically ill children. A protein intake of 2.2 g/kg/day is generally safe and well tolerated, whereas an intake of 3.4 g/kg/day may produce hyperuraemia in some patients.
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Affiliation(s)
- Reyes Fernández Montes
- Unidad de Cuidados Intensivos Pediátricos, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - Javier Urbano Villaescusa
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain; Red de Salud Materno Infantil y del Desarrollo (REDSAMID), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Salud Pública y Materno-Infantil, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Ángel Carrillo Álvarez
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain; Red de Salud Materno Infantil y del Desarrollo (REDSAMID), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Salud Pública y Materno-Infantil, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Ana Vivanco Allende
- Unidad de Cuidados Intensivos Pediátricos, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - María José Solana García
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain; Red de Salud Materno Infantil y del Desarrollo (REDSAMID), Instituto de Salud Carlos III, Madrid, Spain
| | - Susana Díaz Coto
- Departamento de Estadística, Investigación Operativa y Didáctica de la Matemática, Facultad de Ciencias, Universidad de Oviedo, Oviedo, Spain
| | - Corsino Rey Galán
- Unidad de Cuidados Intensivos Pediátricos, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Spain; Red de Salud Materno Infantil y del Desarrollo (REDSAMID), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús López-Herce Cid
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain; Red de Salud Materno Infantil y del Desarrollo (REDSAMID), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Salud Pública y Materno-Infantil, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), Instituto de Salud Carlos III, Madrid, Spain
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Panagou E, Missouridou ED, Zartaloudi A, Koutelekos J, Dousis E, Dafogianni C, Vlachou E, Evagelou E. Compassion Fatigue and Compassion Satisfaction in Pediatric Intensive Care Professionals. Mater Sociomed 2023; 35:28-32. [PMID: 37095878 PMCID: PMC10122523 DOI: 10.5455/msm.2023.35.28-32] [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] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/15/2023] [Indexed: 04/26/2023] Open
Abstract
Background Paediatric ICU doctors and nurses' quality of professional life is influenced by the intense emotions and distress experienced when caring for suffering children and their families. Objective The aim of this study was to examine the prevalence of compassion satisfaction (CS) and compassion fatigue (CF) in Paediatric Intensive Care Units in Greece. Methods Out of 147 intensive care professionals in public hospitals in Greece completed the ProQOL-V scale as well as a socio-demographic and professional-life characteristics questionnaire. Results Almost two thirds of participants reported medium-risk for CF (74.8%) while 23.1% and 76.9% of professionals expressed high or medium potential for CS respectively. More than half of doctors and nurses in paediatric ICUs report being overprotective towards members of the family as a result of their professional life and that their work-life affects their attitude towards life in general. Conclusion Recognizing factors related to CF may support paediatric intensive care professionals in avoiding the costs of exposure to the trauma and loss experiences of patients and their families. A trauma-informed intensive care culture and continuing trauma-informed education may shield professionals from the erosive effects of lingering emotions which may trigger secondary traumatic stress symptoms and also facilitate adequate reflection on their emotional reactions in the landscape of intensive care.
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Affiliation(s)
- Eleni Panagou
- Athens General Children's Hospital "P. and Aglaia Kyriakou", Athens, Greece
| | | | | | - John Koutelekos
- Department of Nursing, University of West Attica, Athens, Greece
| | - Evangelos Dousis
- Department of Nursing, University of West Attica, Athens, Greece
| | | | - Eugenia Vlachou
- Department of Nursing, University of West Attica, Athens, Greece
| | - Eleni Evagelou
- Department of Nursing, University of West Attica, Athens, Greece
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Hernández Borges ÁA, Jiménez Sosa A, Pérez Hernández R, Ordóñez Sáez O, Aleo Luján E, Concha Torre A. Paediatric intensive care 'do not do' recommendations in Spain: Selection by Delphi method. An Pediatr (Barc) 2023; 98:28-40. [PMID: 36509646 DOI: 10.1016/j.anpede.2022.08.014] [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: 05/22/2022] [Accepted: 08/21/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Health care is not free of ineffective, unsafe or inefficient diagnostic and therapeutic practices. To address this, different scientific societies and health authorities have proposed 'do not do' recommendations (DNDRs). Our goal was the selection by consensus of a set of DNDRs for paediatric intensive care in Spain. MATERIAL AND METHOD The research was carried out in 2 phases: first, gathering potential DNDRs; second, selecting the most important ones, using the Delphi method, based on the prevalence of the practice to be modified, the severity of its potential risks and the ease with which it could be modified. Proposals and evaluations were both made by members of working groups of the Sociedad Española de Cuidados Intensivos Pediátricos (SECIP, Spanish Society of Paediatric Intensive Care), coordinated by email. The initial set of DNDRs was reduced based on the coefficient of variation (<80%) of the corresponding evaluations. RESULTS A total of 182 DNDRs were proposed by 30 intensivists. The 14 Delphi evaluators managed to pare down the initial set to 85 DNDRs and, after a second round, to the final set of 26 DNDRs. The care quality dimensions most represented in the final set are clinical effectiveness and patient safety. CONCLUSIONS This study allowed the selection by consensus of a series of recommendations to avoid unsafe, inefficient or ineffective practices in paediatric intensive care in Spain, which could be useful for improving the quality of clinical care in our field.
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Affiliation(s)
| | - Alejandro Jiménez Sosa
- Unidad de Investigación, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Rosalía Pérez Hernández
- UCIP, Servicio de Pediatría, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
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Lokman FL, Goh BS. Paediatric Adenotonsillectomy: Its Safety and Outcome in a Malaysian Tertiary Medical Center. Indian J Otolaryngol Head Neck Surg 2022; 74:1050-1055. [PMID: 36452792 PMCID: PMC9702251 DOI: 10.1007/s12070-020-02099-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/06/2020] [Accepted: 08/24/2020] [Indexed: 11/25/2022] Open
Abstract
Adenotonsillectomy is the commonest otorhinolaryngology surgery for paediatrics. The purpose of this study was to determine the safety and outcome of adenotonsillectomy in a tertiary center in Malaysia. This was achieved by studying the demographics, indications, co-morbidities of patients and its association with the complications of the procedure. This retrospective study was conducted from November 2011 until October 2016. Medical records of patients aged 2-12 years old who had adenotonsillectomy done in our center were retrieved for data collection. A total of 143 patients who fulfilled the inclusion and exclusion criteria were recruited. Median age was 7.52 (± 2.98 SD) years old. Allergic rhinitis was the commonest co-morbidity (40%). Recurrent tonsillitis was the main indication (60%), followed by sleep disordered breathing (SDB) without apnea (29%), obstructive sleep apnea (OSA) (7%) and other indications (4%). Post-operative paediatric intensive care unit (PICU) admission was very low (1.4%) and was reserved for those with severe OSA with complications. None of the patients admitted to PICU post-operative had respiratory complications. The prevalence of post-tonsillectomy bleeding was only 2.1%. There was no significant association between patient's co-morbidity with operative complications (p = 0.269). Adenotonsillectomy is indicated for children with recurrent tonsillitis and paediatric SDB. The two most severe complications, namely post-tonsillectomy haemorrhage and respiratory complications occurred but incidence was low. Criteria of post-operative PICU or paediatric high dependency unit admission for paediatric SDB has to be based on multiple clinical and logistics factors and not only patients co-morbidity and indication of surgery.
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Affiliation(s)
- Farah L. Lokman
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latiff, Cheras, 56000 Kuala Lumpur, Malaysia
| | - Bee See Goh
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latiff, Cheras, 56000 Kuala Lumpur, Malaysia
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Gonzalez-Dambrauskas S, Vasquez-Hoyos P, Camporesi A, Cantillano EM, Dallefeld S, Dominguez-Rojas J, Francoeur C, Gurbanov A, Mazzillo-Vega L, Shein SL, Yock-Corrales A, Karsies T. Paediatric critical COVID-19 and mortality in a multinational prospective cohort. Lancet Reg Health Am 2022; 12:100272. [PMID: 35599855 PMCID: PMC9111167 DOI: 10.1016/j.lana.2022.100272] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND To understand critical paediatric coronavirus disease 2019 (COVID-19) and evaluate factors associated with mortality in children from high and low-middle income countries. METHODS Prospective, observational study of critically ill children hospitalised for COVID-19 in 18 countries throughout North America, Latin America, and Europe between April 1 and December 31, 2020. Associations with mortality were evaluated using logistic regression. FINDINGS 557 patients (median age, 8 years; 24% <2 years) were enrolled from 55 sites (63% Latin American). Half had comorbidities. Invasive (41%) or non-invasive (20%) ventilation and vasopressors (56%) were the most common support modalities. Hospital mortality was 10% and higher in children <2 years old (15%; odds ratio 1·94, 95%CI 1·08-3·49). Most who died had pulmonary disease. When adjusted for age, sex, region, and illness severity, mortality-associated factors included cardiac (aOR 2·89; 95%CI 1·2-6·94) or pulmonary comorbidities (aOR 4·43; 95%CI 1·70-11·5), admission hypoxemia (aOR 2·44; 95%CI 1·30-4·57), and lower respiratory symptoms (aOR 2·96; 95%CI 1·57-5·59). MIS-C (aOR 0·25; 95%CI 0·1-0·61) and receiving methylprednisolone (aOR 0·5; 95%CI 0·25-0·99), IVIG (aOR 0·32; 95%CI 0·16-0·62), or anticoagulation (aOR 0·49; 95%CI 0·25-0·95) were associated with lower mortality although these associations might be limited to children >2 years old. INTERPRETATION We identified factors associated with COVID-19 mortality in critically ill children from both high and low-middle income countries, including higher mortality with younger age and COVID-related pulmonary disease but lower mortality in MIS-C. Further research is needed on optimal treatments for younger children and respiratory failure in paediatric COVID-19. FUNDING None.
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Affiliation(s)
- Sebastian Gonzalez-Dambrauskas
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network) and Cuidados Intensivos Pediátricos Especializados (CIPe) Casa de Galicia, Montevideo, Uruguay
| | - Pablo Vasquez-Hoyos
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Universidad Nacional de Colombia and Sociedad de Cirugía Hospital de San José, FUCS, Bogota, Colombia
| | - Anna Camporesi
- Division of Pediatric Anesthesia and ICU, Department of Pediatrics. Children's Hospital Vittore Buzzi, Milan, Italy
| | - Edwin Mauricio Cantillano
- UCIP. Hospital Regional del Norte, Instituto Hondureño de Seguridad Social, San Pedro Sula, Honduras
| | - Samantha Dallefeld
- Pediatric Critical Care Medicine, Dell Children's Medical Center of Central Texas, Austin, TX, USA
| | - Jesus Dominguez-Rojas
- Departamento Pediatría Universidad Nacional Federico Villarreal. UCIP Hospital de Emergencia Villa El Salvador, Lima, Perú
| | - Conall Francoeur
- Department of Pediatrics, Division of Pediatric Critical Care, CHU de Québec – Université Laval Research Center, Québec, Québec, Canada
| | - Anar Gurbanov
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Steven L. Shein
- Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Adriana Yock-Corrales
- Emergency Department. Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, CCSS. San José, Costa Rica
| | - Todd Karsies
- Division of Pediatric Critical Care, Nationwide Children's Hospital, Columbus, Ohio, USA
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Alexander EC, Deep A. Therapeutic plasma exchange in children with acute liver failure (ALF): is it time for incorporation into the ALF armamentarium? Pediatr Nephrol 2022; 37:1775-1788. [PMID: 34647173 PMCID: PMC9239959 DOI: 10.1007/s00467-021-05289-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022]
Abstract
Paediatric acute liver failure (PALF) is a rare but devastating condition with high mortality. An exaggerated inflammatory response is now recognised as pivotal in the pathogenesis and prognosis of ALF, with cytokine spill from the liver to systemic circulation implicated in development of multi-organ failure associated with ALF. With advances in medical management, especially critical care, there is an increasing trend towards spontaneous liver regeneration, averting the need for emergency liver transplantation or providing stability to the patient awaiting a graft. Hence, research is ongoing for therapies, including extracorporeal liver support devices, that can bridge patients to transplant or spontaneous liver recovery. Considering the immune-related pathogenesis and inflammatory phenotype of ALF, plasma exchange serves as an ideal liver assist device as it performs both the excretory and synthetic functions of the liver and, in addition, works as an immunomodulatory therapy by suppressing the early innate immune response in ALF. After a recent randomised controlled trial in adults demonstrated a beneficial effect of high-volume plasma exchange on clinical outcomes, this therapy was incorporated in European Association for the Study of Liver (EASL) recommendations for managing adult patients with ALF, but no guidelines exist for PALF. In this review, we discuss rationale, timing, practicalities, and existing evidence regarding the use of plasma exchange as an immunomodulatory treatment in PALF. We discuss controversies in delivery of this therapy as an extracorporeal device, and practicalities of use of plasma exchange as a 'hybrid' therapy alongside other extracorporeal liver assist devices, before finally reviewing outstanding research questions for the future.
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Affiliation(s)
- Emma C Alexander
- Paediatric Intensive Care Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Akash Deep
- Paediatric Intensive Care Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.
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10
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Affiliation(s)
- Marzena Zielinska
- Department of Anaesthesiology and Intensive Care, Wroclaw Medical University, Poland; Department of Paediatric Anaesthesiology and Intensive, University Hospital, Wroclaw, Poland.
| | - Yurii Tkachenko
- Department of Anaesthesiology and Intensive Care, Regional Specialist Hospital in Grudziac, Poland
| | - Michal Ducki
- Department of Anaesthesiology and Intensive Care, Wolski Hospital, Warsaw, Poland
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11
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Ayar G, Yalçın SS, Yırün A, Emeksiz S, Balcı A, Erkekoğlu P. Associations between pediatric intensive care procedures and urinary free-BPA levels. Environ Sci Pollut Res Int 2022; 29:13555-13563. [PMID: 34595711 DOI: 10.1007/s11356-021-16677-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Bisphenol A (BPA) is found in many medical materials used in the paediatric intensive care unit (PICU). Our aim was to evaluate how the urinary free-BPA(fBPA) and total-BPA(tBPA) levels were associated with the use of medical devices in the PICU in a prospective study. METHODS The procedures applied to the patient were recorded during the follow-up period. Three urine samples were taken on the first day of hospitalization; the seventh day, and after 30 days or when the patients were discharged. Urinary tBPA and fBPA levels were determined using high-pressure liquid chromatography. Generalized estimating equations with repetitive measures were used to determine the associations between PICU procedures and BPA levels. RESULTS A total of 115 urine samples of 40 children were studied. Mean urinary levels were 189.2 μg/g-creatinine for tBPA and 27.8 μg/g-creatinine for fBPA, and the fBPA/tBPA ratio was 27.9%. Endotracheal intubation, catheter, and haemodialysis procedures caused higher urinary fBPA levels. External drains, inhaler treatment, and the use of four or more medical devices were associated with considerably higher values of fBPA%. The increase in tBPA was positively correlated with fBPA. CONCLUSIONS fBPA levels and the fBPA/tBPA ratio varied according to the procedure and level of BPA exposure in children.
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Affiliation(s)
- Ganime Ayar
- Ministry of Health, Ankara City Hospital, Children's Hospital, Bilkent, Ankara, Turkey
| | - Sıddıka Songül Yalçın
- Faculty of Medicine, Department of Pediatrics, Hacettepe University, Sıhhiye, Ankara, Turkey.
| | - Anıl Yırün
- Faculty of Pharmacy, Department of Toxicology, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Serhat Emeksiz
- Ministry of Health, Ankara City Hospital, Children's Hospital, Bilkent, Ankara, Turkey
| | - Aylin Balcı
- Faculty of Pharmacy, Department of Toxicology, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Pınar Erkekoğlu
- Faculty of Pharmacy, Department of Toxicology, Hacettepe University, Sihhiye, Ankara, Turkey
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Kanthimathinathan HK, Buckley H, Davis PJ, Feltbower RG, Lamming C, Norman L, Palmer L, Peters MJ, Plunkett A, Ramnarayan P, Scholefield BR, Draper ES. In the eye of the storm: impact of COVID-19 pandemic on admission patterns to paediatric intensive care units in the UK and Eire. Crit Care 2021; 25:399. [PMID: 34789305 PMCID: PMC8597872 DOI: 10.1186/s13054-021-03779-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The coronavirus disease-19 (COVID-19) pandemic had a relatively minimal direct impact on critical illness in children compared to adults. However, children and paediatric intensive care units (PICUs) were affected indirectly. We analysed the impact of the pandemic on PICU admission patterns and patient characteristics in the UK and Ireland. METHODS We performed a retrospective cohort study of all admissions to PICUs in children < 18 years during Jan-Dec 2020, using data collected from 32 PICUs via a central database (PICANet). Admission patterns, case-mix, resource use, and outcomes were compared with the four preceding years (2016-2019) based on the date of admission. RESULTS There were 16,941 admissions in 2020 compared to an annual average of 20,643 (range 20,340-20,868) from 2016 to 2019. During 2020, there was a reduction in all PICU admissions (18%), unplanned admissions (20%), planned admissions (15%), and bed days (25%). There was a 41% reduction in respiratory admissions, and a 60% reduction in children admitted with bronchiolitis but an 84% increase in admissions for diabetic ketoacidosis during 2020 compared to the previous years. There were 420 admissions (2.4%) with either PIMS-TS or COVID-19 during 2020. Age and sex adjusted prevalence of unplanned PICU admission reduced from 79.7 (2016-2019) to 63.1 per 100,000 in 2020. Median probability of death [1.2 (0.5-3.4) vs. 1.2 (0.5-3.4) %], length of stay [2.3 (1.0-5.5) vs. 2.4 (1.0-5.7) days] and mortality rates [3.4 vs. 3.6%, (risk-adjusted OR 1.00 [0.91-1.11, p = 0.93])] were similar between 2016-2019 and 2020. There were 106 fewer in-PICU deaths in 2020 (n = 605) compared with 2016-2019 (n = 711). CONCLUSIONS The use of a high-quality international database allowed robust comparisons between admission data prior to and during the COVID-19 pandemic. A significant reduction in prevalence of unplanned admissions, respiratory diseases, and fewer child deaths in PICU observed may be related to the targeted COVID-19 public health interventions during the pandemic. However, analysis of wider and longer-term societal impact of the pandemic and public health interventions on physical and mental health of children is required.
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Affiliation(s)
- Hari Krishnan Kanthimathinathan
- Paediatric Intensive Care Unit, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Hannah Buckley
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Peter J. Davis
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, UK
| | | | - Caroline Lamming
- Department of Health Sciences, George Davies Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Lee Norman
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Lyn Palmer
- Department of Health Sciences, George Davies Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Mark J. Peters
- Paediatric Intensive Care, Great Ormond Street Hospital NHS Foundation Trust, NIHR Biomedical Research Centre, London, UK
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Adrian Plunkett
- Paediatric Intensive Care Unit, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - Padmanabhan Ramnarayan
- Children’s Acute Transport Service, Great Ormond Street Hospital NHS Foundation Trust, NIHR Biomedical Centre, London, UK
| | - Barnaby R. Scholefield
- Paediatric Intensive Care Unit, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Elizabeth S. Draper
- Department of Health Sciences, George Davies Centre, College of Life Sciences, University of Leicester, Leicester, UK
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Tang M, Xu M, Su S, Huang X, Zhang S. Post-Intensive Care Syndrome in Children: A Concept Analysis. J Pediatr Nurs 2021; 61:417-23. [PMID: 34687989 DOI: 10.1016/j.pedn.2021.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/29/2021] [Accepted: 10/11/2021] [Indexed: 11/21/2022]
Abstract
PROBLEM Post-intensive care syndrome in paediatrics (PICS-p) is a term used to describe newly acquired or worsened impairment in one or more aspects of a child's physical, psychological, cognitive, and social functioning after discharge from the paediatric intensive care unit (PICU). However, consensus, conceptual insights, and assessment guidance are lacking for this syndrome. Therefore, this analysis aimed to define the concept of PICS-p to help practitioners and researchers understand the syndrome in detail using the Walker and Avant approach. ELIGIBILITY CRITERIA We reviewed studies retrieved from several databases, namely PubMed, Google Scholar, Web of Science, Ovid, ScienceDirect, and the Springer database, using the following keywords: 'post-intensive care syndrome', 'PICU', 'children', 'PICS-p', and 'concept analysis'. Both quantitative and qualitative studies on PICS-p were included in the search. The articles were limited to those published up to November 21, 2020. SAMPLE Of the 762 publications selected, 24 publications met the inclusion criteria. RESULTS PICS-p is defined on the basis of the following aspects: (1) Physical dysfunction; (2) Cognitive dysfunction; (3) Psychological dysfunction; and (4) Social dysfunction. CONCLUSION With the increasing success rate of PICU treatment, reduced case fatality is no longer the only outcome of critical illness in children. The long-term outcomes in children discharged from hospitals have attracted attention from families, hospitals, and communities. IMPLICATIONS A clear definition of PICS-p will help medical staff understand PICS-p in detail and provide a theoretical basis for the diagnosis and treatment of this syndrome.
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Hasanpour M, Pouraboli B, Mohammadpour M, Tahmasebi M, Sabeti F. Challenges of paediatric palliative care in the intensive care unit during the COVID-19 pandemic. Int J Palliat Nurs 2021; 27:303-315. [PMID: 34459244 DOI: 10.12968/ijpn.2021.27.6.303] [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] [Indexed: 11/11/2022]
Abstract
BACKGROUND The integration of paediatric palliative care into the Iranian health system is essential. AIMS The aim of this study was to identify the challenges of palliative care in the paediatric intensive care unit during COVID-19 through the experiences of healthcare providers. METHODS A qualitative study with content analysis approach was conducted. Fifteen physicians and nurses were selected by purposeful sampling. The semi-structured, in-depth interviews were applied in the data collection. FINDINGS Ten main categories were extracted from data analysis, including 'caring in COVID-19', 'communication and family centre care', 'breaking bad news', palliative care training', 'pain and symptom management', 'support of the child, family and clinical team', 'physical environment', 'guidelines', 'specialised staff' and 'home based palliative care'. CONCLUSION Palliative care in the PICU faces several challenges, especially during COVID-19, but the clinical team are making every attempt to improve the comprehensive care of children and their families. Telehealth is important in COVID-19, and education is also a key component to improve palliative care in the PICU in Iran.
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Affiliation(s)
- Marzieh Hasanpour
- Professor of Nursing, NIDCAP Professional, Member of Iranian Scientific Association of Medical Education, International Coordinator of Paediatric and Neonatal Intensive Care Nursing Education Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Batool Pouraboli
- Associate Professor of Nursing, Paediatric and Neonatal Intensive Care Nursing Education Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Mohammadpour
- Assistant Professor, Paediatric Intensivist, Paediatric Critical Care Division, Department of Paediatrics, Children's Medical Centre, Tehran University of Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Mamak Tahmasebi
- Associate Professor of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, School of Medicine, Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Sabeti
- Nursing Candidate, Paediatric and Neonatal Intensive Care Nursing Education Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Ventura-Espejo L, Gracia-Darder I, Escribá-Bori S, Amador-González ER, Martín-Santiago A, Ramakers J. Patient with H syndrome, cardiogenic shock, multiorgan infiltration, and digital ischemia. Pediatr Rheumatol Online J 2021; 19:104. [PMID: 34193201 PMCID: PMC8243620 DOI: 10.1186/s12969-021-00586-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/05/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND H syndrome (HS) is a rare autoinflammatory disease caused by a mutation in the solute carrier family 29, member 3 (SCL29A3) gene. It has a variable clinical presentation and little phenotype-genotype correlation. The pathognomonic sign of HS is cutaneous hyperpigmentation located mainly in the inner thighs and often accompanied by other systemic manifestations. Improvement after tocilizumab treatment has been reported in a few patients with HS. We report the first patient with HS who presented cardiogenic shock, multiorgan infiltration, and digital ischemia. CASE PRESENTATION 8-year-old boy born to consanguineous parents of Moroccan origin who was admitted to the intensive care unit during the Coronavirus Disease-2019 (COVID-19) pandemic with tachypnoea, tachycardia, and oliguria. Echocardiography showed dilated cardiomyopathy and severe systolic dysfunction compatible with cardiogenic shock. Additionally, he presented with multiple organ dysfunction syndrome. SARS-CoV-2 polymerase chain reaction (PCR) and antibody detection by chromatographic immunoassay were negative. A previously ordered gene panel for pre-existing sensorineural hearing loss showed a pathological mutation in the SCL29A3 gene compatible with H syndrome. Computed tomography scan revealed extensive alveolar infiltrates in the lungs and multiple poor defined hypodense lesions in liver, spleen, and kidneys; adenopathy; and cardiomegaly with left ventricle subendocardial nodules. Invasive mechanical ventilation, broad antibiotic and antifungal coverage showed no significant response. Therefore, Tocilizumab as compassionate use together with pulsed intravenous methylprednisolone was initiated. Improvement was impressive leading to normalization of inflammation markers, liver and kidney function, and stabilising heart function. Two weeks later, he was discharged and has been clinically well since then on two weekly administration of Tocilizumab. CONCLUSIONS We report the most severe disease course produced by HS described so far in the literature. Our patient's manifestations included uncommon, new complications such as acute heart failure with severe systolic dysfunction, multi-organ cell infiltrate, and digital ischemia. Most of the clinical symptoms of our patient could have been explained by SARS-CoV-2, demonstrating the importance of a detailed differential diagnosis to ensure optimal treatment. Although the mechanism of autoinflammation of HS remains uncertain, the good response of our patient to Tocilizumab makes a case for the important role of IL-6 in this syndrome and for considering Tocilizumab as a first-line treatment, at least in severely affected patients.
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MESH Headings
- Antibodies, Monoclonal, Humanized/therapeutic use
- COVID-19
- Cardiomyopathy, Dilated/diagnostic imaging
- Cardiomyopathy, Dilated/physiopathology
- Cardiomyopathy, Dilated/therapy
- Child
- Glucocorticoids/therapeutic use
- Hereditary Autoinflammatory Diseases/diagnosis
- Hereditary Autoinflammatory Diseases/genetics
- Hereditary Autoinflammatory Diseases/physiopathology
- Hereditary Autoinflammatory Diseases/therapy
- Humans
- Ischemia/physiopathology
- Ischemia/therapy
- Kidney Diseases/diagnostic imaging
- Kidney Diseases/physiopathology
- Kidney Diseases/therapy
- Liver Diseases/diagnostic imaging
- Liver Diseases/physiopathology
- Liver Diseases/therapy
- Lung Diseases/diagnostic imaging
- Lung Diseases/physiopathology
- Lung Diseases/therapy
- Lymphadenopathy/diagnostic imaging
- Lymphadenopathy/physiopathology
- Lymphadenopathy/therapy
- Male
- Methylprednisolone/therapeutic use
- Multiple Organ Failure/physiopathology
- Multiple Organ Failure/therapy
- Nucleoside Transport Proteins/genetics
- Pulse Therapy, Drug
- Respiration, Artificial
- SARS-CoV-2
- Shock, Cardiogenic/physiopathology
- Shock, Cardiogenic/therapy
- Splenic Diseases/diagnostic imaging
- Splenic Diseases/physiopathology
- Splenic Diseases/therapy
- Toes/blood supply
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Laura Ventura-Espejo
- Paediatric Department, Hospital Universitario Son Espases, Carretera de Valldemosa, 79, 07120, Palma, Spain
| | - Inés Gracia-Darder
- Dermatology Department, Hospital Universitario Son Espases, Palma, Spain
| | - Silvia Escribá-Bori
- Paediatric Department, Hospital Universitario Son Espases, Carretera de Valldemosa, 79, 07120, Palma, Spain
| | | | | | - Jan Ramakers
- Paediatric Department, Hospital Universitario Son Espases, Carretera de Valldemosa, 79, 07120, Palma, Spain.
- Multidisciplinary Group for Research in Peadiatrics. Hospital Universitari Son Espases, Balearic Islands Health Research Institute (IdISBa), Carretera de Valldemossa, 79, 07120, Palma, Spain.
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16
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Sundar VV, Sehu Allavudin SF, Easaw MEPM. Factors influencing adequate protein and energy delivery among critically ill children with heart disease in pediatric intensive care unit. Clin Nutr ESPEN 2021; 43:353-359. [PMID: 34024540 DOI: 10.1016/j.clnesp.2021.03.024] [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: 10/08/2019] [Revised: 02/27/2021] [Accepted: 03/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND & AIMS Inadequate nutrition delivery in critically ill children has shown associated with poor clinical outcomes. Therefore, identifying barriers to deliver adequate nutrition is vital. The aim of this study was to identify factors influencing adequate protein and energy delivery among critically ill children with heart disease in pediatric intensive care unit (PICU). METHODS This single-centre prospective study, involved children aged from birth to 3 years old, admitted to PICU longer than 72 hours. They received either enteral nutrition (EN) or combination of EN and partial parenteral nutrition (PPN). Clinical and nutrition delivery characteristics were recorded from admission until transferred out of PICU. Multiple regression analysis at significant level p < 0.05 were used to identify independent risk factors for lower protein and energy intake. RESULTS One hundred and thirty-nine patients were included in this study with median age 6.5 (1.8-20.6) months and median PICU length of stay of 6 (4-7) days. The median energy and protein adequacy were 83.2% and 46.7%, respectively. In multivariable analysis, children who underwent surgery (AOR 0.97; 95% CI 0.27-0.75; p = 0.041), with fluid restriction (AOR 0.97; 95% CI 0.25-0.73; p = 0.041), longer length of PICU stay (AOR 0.35; 95% CI 0.18-0.64; p = 0.001) and longer feeding interruptions (AOR 3.57; 95% CI 1.39-9.15; p = 0.008) were more likely to have lower energy intake. Children at risk of malnutrition (weight-for-age Z score of < -2 SD) (AOR 2.54; 95% CI 1.12 to 5.77; p = 0.026) and longer duration of mechanical ventilation (AOR 0.73; 95% CI 0.53 to 0.98; p = 0.041) were more likely to have lower protein intake. CONCLUSION This study highlighted the factors influencing adequate protein and energy delivery in critically ill children with heart disease in PICU. Strategies to improve the nutrition delivery in this group of patients should be outlined and implemented by the dietitians along with multidisciplinary team.
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Affiliation(s)
- Vatana V Sundar
- Dietetics and Food Services, National Heart Institute, 145, Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia.
| | | | - Mary Easaw P M Easaw
- Dietetics and Food Services, National Heart Institute, 145, Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia.
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Rivas-Rangel J, García-Arellano M, Marquez-Romero JM. [Correlation between optic nerve sheath diameter and extracorporeal life support time]. An Pediatr (Barc) 2021; 96:S1695-4033(20)30521-X. [PMID: 33487565 DOI: 10.1016/j.anpedi.2020.09.021] [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: 06/23/2020] [Revised: 09/07/2020] [Accepted: 09/17/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The objective of the study was to analyse the correlation between extracorporeal life support (ECLS) and aortic cross-clamp times and optic nerve sheath diameter (ONSD). PATIENTS AND METHODS Study in a cohort of patients aged 0 to 15 years that underwent ECLS for cardiac surgery after obtention of signed informed consent. We calculated a sample size of 23 participants. First, we obtained 3 vertical and 3 horizontal measurements of the ONSD for each eye and calculated the mean of both eyes for each measurement to be used in the analysis. The measurements were made at admission and at 6 and 24hours post surgery. We retrieved the ECLS time and the aortic cross-clamp time were from the operative report. RESULTS We analysed data for 23 participants, 52.2% female, with a median age of 14 months. The median ECLS time was 60minutes; the median aortic cross-clamp time was 32minutes. The median baseline ONSD was 3.1mm. ONSD values had increased a median of 0.015mm at 6hours post surgery (P=.03). We found a positive correlation between ECLS time and ONSD values (r=0.476, p<,05). The ONSD values returned to baseline by 24hours post surgery. None of the patients developed signs or symptoms of increased intracranial pressure. CONCLUSION Our study found a correlation between ECLS time and ONSD at 24hours post surgery. We found variations in the ONSD even in patients without signs or symptoms of increased increased intracranial pressure. Further research is required to identify the factors related to these variations.
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Affiliation(s)
- Jorge Rivas-Rangel
- Unidad de Cuidados Intensivos, Departamento de Pediatría, Centenario Hospital «Miguel Hidalgo», Aguascalientes, México
| | - Maricela García-Arellano
- Unidad de Cuidados Intensivos, Departamento de Pediatría, Centenario Hospital «Miguel Hidalgo», Aguascalientes, México
| | - Juan M Marquez-Romero
- Unidad de Neurología, Departamento de Medicina Interna, HGZ 2 Instituto Mexicano del Seguro Social (IMSS), Aguascalientes, México.
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Shankar R, Leimanis ML, Newbury PA, Liu K, Xing J, Nedveck D, Kort EJ, Prokop JW, Zhou G, Bachmann AS, Chen B, Rajasekaran S. Gene expression signatures identify paediatric patients with multiple organ dysfunction who require advanced life support in the intensive care unit. EBioMedicine 2020; 62:103122. [PMID: 33248372 PMCID: PMC7704404 DOI: 10.1016/j.ebiom.2020.103122] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/21/2020] [Accepted: 10/26/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Multiple organ dysfunction syndrome (MODS) occurs in the setting of a variety of pathologies including infection and trauma. Some patients decompensate and require Veno-Arterial extra corporeal membrane oxygenation (ECMO) as a palliating manoeuvre for recovery of cardiopulmonary function. The molecular mechanisms driving progression from MODS to cardiopulmonary collapse remain incompletely understood, and no biomarkers have been defined to identify those MODS patients at highest risk for progression to requiring ECMO support. METHODS Whole blood RNA-seq profiling was performed for 23 MODS patients at three time points during their ICU stay (at diagnosis of MODS, 72 hours after, and 8 days later), as well as four healthy controls undergoing routine sedation. Of the 23 MODS patients, six required ECMO support (ECMO patients). The predictive power of conventional demographic and clinical features was quantified for differentiating the MODS and ECMO patients. We then compared the performance of markers derived from transcriptomic profiling including [1] transcriptomically imputed leukocyte subtype distribution, [2] relevant published gene signatures and [3] a novel differential gene expression signature computed from our data set. The predictive power of our novel gene expression signature was then validated using independently published datasets. FINDING None of the five demographic characteristics and 14 clinical features, including The Paediatric Logistic Organ Dysfunction (PELOD) score, could predict deterioration of MODS to ECMO at baseline. From previously published sepsis signatures, only the signatures positively associated with patient's mortality could differentiate ECMO patients from MODS patients, when applied to our transcriptomic dataset (P-value ranges from 0.01 to 0.04, Student's test). Deconvolution of bulk RNA-Seq samples suggested that lower neutrophil counts were associated with increased risk of progression from MODS to ECMO (P-value = 0.03, logistic regression, OR=2.82 [95% CI 0.63 - 12.45]). A total of 30 genes were differentially expressed between ECMO and MODS patients at baseline (log2 fold change ≥ 1 or ≤ -1 with false discovery rate ≤ 0.01). These genes are involved in protein maintenance and epigenetic-related processes. Further univariate analysis of these 30 genes suggested a signature of seven DE genes associated with ECMO (OR > 3.0, P-value ≤ 0.05, logistic regression). Notably, this contains a set of histone marker genes, including H1F0, HIST2H3C, HIST1H2AI, HIST1H4, HIST1H2BL and HIST1H1B, that were highly expressed in ECMO. A risk score derived from expression of these genes differentiated ECMO and MODS patients in our dataset (AUC = 0.91, 95% CI 0.79-1.00, P-value = 7e-04, logistic regression) as well as validation dataset (AUC= 0.73, 95% CI 0.53-0.93, P-value = 2e-02, logistic regression). INTERPRETATION This study demonstrates that transcriptomic features can serve as indicators of severity that could be superior to traditional methods of ascertaining acuity in MODS patients. Analysis of expression of signatures identified in this study could help clinicians in the diagnosis and prognostication of MODS patients after arrival to the Hospital.
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Affiliation(s)
- Rama Shankar
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA; Department of Pharmacology and Toxicology, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA.
| | - Mara L Leimanis
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA; Pediatric Intensive Care Unit, Helen DeVos Children's Hospital, 100 Michigan Street NE, Grand Rapids, MI 49503, USA.
| | - Patrick A Newbury
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA; Department of Pharmacology and Toxicology, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA
| | - Ke Liu
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA; Department of Pharmacology and Toxicology, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA.
| | - Jing Xing
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA; Department of Pharmacology and Toxicology, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA.
| | - Derek Nedveck
- Office of Research, Spectrum Health, 15 Michigan Street NE, Grand Rapids, MI 49503, USA
| | - Eric J Kort
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA; DeVos Cardiovascular Program, Van Andel Research Institute and Fredrik Meijer Heart and Vascular Institute/Spectrum Health, Grand Rapids, MI 49503, USA; Pediatric Hospitalist Medicine, Helen DeVos Children's Hospital, 100 Michigan Street NE, Grand Rapids, MI 49503, USA.
| | - Jeremy W Prokop
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA; Department of Pharmacology and Toxicology, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA.
| | - Guoli Zhou
- Biomedical Research Informatics Core (BRIC), Clinical and Translational Sciences Institute (CTSI), Michigan State University, East Lansing, MI 48824, USA.
| | - André S Bachmann
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA.
| | - Bin Chen
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA; Department of Pharmacology and Toxicology, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA.
| | - Surender Rajasekaran
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, MI 49503, USA; Pediatric Intensive Care Unit, Helen DeVos Children's Hospital, 100 Michigan Street NE, Grand Rapids, MI 49503, USA; Office of Research, Spectrum Health, 15 Michigan Street NE, Grand Rapids, MI 49503, USA.
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Verlinden I, Güiza F, Derese I, Wouters PJ, Joosten K, Verbruggen SC, Van den Berghe G, Vanhorebeek I. Time course of altered DNA methylation evoked by critical illness and by early administration of parenteral nutrition in the paediatric ICU. Clin Epigenetics 2020; 12:155. [PMID: 33081814 PMCID: PMC7576729 DOI: 10.1186/s13148-020-00947-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/08/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A genome-wide study identified de novo DNA methylation alterations in leukocytes of children at paediatric intensive care unit (PICU) discharge, offering a biological basis for their impaired long-term development. Early parenteral nutrition (early-PN) in PICU, compared with omitting PN in the first week (late-PN), explained differential methylation of 23% of the affected CpG-sites. We documented the time course of altered DNA methylation in PICU and the impact hereon of early nutritional management. RESULTS We selected 36 early-PN and 36 late-PN matched patients, and 42 matched healthy children. We quantified DNA methylation on days 3, 5 and 7 for the 147 CpG-sites of which methylation was normal upon PICU admission in this subset and altered by critical illness at PICU discharge. Methylation in patients differed from healthy children for 64.6% of the 147 CpG-sites on day 3, for 72.8% on day 5 and for 90.5% on day 7 as revealed by ANOVA at each time point. Within-patients methylation time course analyses for each CpG-site identified different patterns based on paired t test p value and direction of change. Rapid demethylation from admission to day 3 occurred for 76.2% of the CpG-sites, of which 67.9% remained equally demethylated or partially remethylated and 32.1% further demethylated beyond day 3. From admission to day 3, 19.7% of the CpG-sites became hypermethylated, of which, beyond day 3, 34.5% remained equally hypermethylated or partially demethylated again and 65.5% further hypermethylated. For 4.1% of the CpG-sites, changes only appeared beyond day 3. Finally, for the CpG-sites affected by early-PN on the last PICU day, earlier changes in DNA methylation were compared for early-PN and late-PN patients, revealing that 38.9% were already differentially methylated by day 3, another 25.0% by day 5 and another 13.9% by day 7. CONCLUSIONS Critical illness- and early-PN-induced changes in DNA methylation occurred mainly within 3 days. Most abnormalities were at least partially maintained or got worse with longer time in PICU. Interventions targeting aberrant DNA methylation changes should be initiated early.
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Affiliation(s)
- Ines Verlinden
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Fabian Güiza
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Inge Derese
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Pieter J Wouters
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Koen Joosten
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sascha C Verbruggen
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Greet Van den Berghe
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Ilse Vanhorebeek
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
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20
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Wang J, Jacob-Files E, Becerra R, Mallma G, Tantaleán da Fieno J, Nielsen KR. Sustainability of high flow in a Peruvian PICU: A qualitative analysis. Int Nurs Rev 2020; 67:352-361. [PMID: 32459012 DOI: 10.1111/inr.12589] [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: 09/14/2019] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 11/27/2022]
Abstract
AIM To describe nurse and physician perspectives on enabling factors that promote sustainability of high flow use in resource-limited settings. BACKGROUND Over 650 000 children died from respiratory infections in 2016 globally. Many deaths could be prevented with access to advanced paediatric respiratory support, but sustainability of technology in resource-limited settings remains challenging. INTRODUCTION Local providers have expertise related to site-specific barriers to sustainability. Engaging local providers during implementation can identify strategies to promote ongoing technology use beyond initial deployment. METHODS This qualitative descriptive study was conducted five focus groups with nineteen nurses and seven individual interviews with physicians in a Peruvian paediatric intensive care unit. Data were analysed using a realist thematic approach. RESULTS Providers described five important factors for high flow sustainability: (i) Applying high flow to a broader patient population, including use outside the paediatric intensive care unit to increase opportunities for practice; (ii) Establishing a multidisciplinary approach to high flow management at all hours; (iii) Willingness of nurses and physicians to adopt standardization; (iv) Ongoing high flow leadership; (v) Transparency of high flow impact, including frequent reporting of clinical outcomes of high flow patients. DISCUSSION Local providers described strategies to overcome barriers to sustainability of high flow in their clinical setting, many of which are generalizable to implementation projects in other resource-limited settings. CONCLUSION AND POLICY IMPLICATIONS These findings provide nursing, administrative leaders and policymakers with strategies to promote sustainability of new technology in resource-limited settings, including development of guidelines for appropriate clinical use, change management support, leadership development and clinical outcome reporting procedures. Administrative support and oversight are paramount to foster successful implementation in these settings.
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Affiliation(s)
- Jiayu Wang
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Elizabeth Jacob-Files
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, BJF Research, Seattle, WA, USA
| | - Rosario Becerra
- Departamento de Cuidados Intensivos Pediátricos, Instituto Nacional de Salud del Niño, Lima, Peru
| | - Gabriela Mallma
- Departamento de Cuidados Intensivos Pediátricos, Instituto Nacional de Salud del Niño, Lima, Peru
| | - José Tantaleán da Fieno
- Departamento de Cuidados Intensivos Pediátricos, Instituto Nacional de Salud del Niño, Lima, Peru.,Universidad Nacional Federico Villarreal, Lima, Peru
| | - Katie R Nielsen
- Department of Pediatrics, Critical Care Medicine, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
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21
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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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Hansson L, Wrigstad J, Wangel AM. Challenges in the handover process of the new-born with congenital heart disease. Intensive Crit Care Nurs 2020; 59:102855. [PMID: 32253120 DOI: 10.1016/j.iccn.2020.102855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/03/2020] [Accepted: 03/06/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION A new-born with congenital heart disease requires care that involves numerous specialists. Such care can be provided at tertiary referral hospitals and transportation is often needed. A crucial factor is the handover process, when the child is born at a distance, with transfer of both professional responsibility and continued care from one healthcare professional to another. AIM The aim of this study was to identify crucial factors for the receiving healthcare professionals that influence the handover process of the new-born with congenital heart disease. METHOD A cross-sectional questionnaire study with 53 receiving healthcare professionals at a paediatric intensive care unit at a tertiary referral university hospital in Sweden. The response rate was 48/53. Numerical variables were computed and a content analysis was performed. FINDINGS The handover process of the new-born with heart disease transferred to a tertiary referral hospital is complicated. A clear majority of the respondents identified one or more flaws in this process. Crucial factors identified were: relevant and structured information, clear communication, adequate patient knowledge and an enabling environment. CONCLUSION A standardised procedure in the different phases of the handover process could improve communication, the working situation for healthcare professionals and thereby increase patient safety.
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Erdoğan Ç, Turan T, Pınar B. The effect of maternal voice for procedural pain in paediatric intensive care unit: A randomised controlled trial. Intensive Crit Care Nurs 2020; 56:102767. [PMID: 31735564 DOI: 10.1016/j.iccn.2019.102767] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/24/2019] [Accepted: 10/28/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effectiveness of the maternal voice in reducing pain during painful procedures in children between one and three years old receiving treatment in paediatric intensive care unit. DESIGN AND METHODS This research was designed as a randomised controlled experimental study. Sixty children were randomised into two groups, the maternal-voice group and the controls. The children in the maternal-voice group listened to the maternal voice during the procedure. Although questionnaire forms were used to determine the descriptive characteristics of infants, the Face, Legs, Activity, Cry, Consolability (FLACC) pain assessment scale was used to evaluate pain level. Heart rate and oxygen saturation were also measured. RESULTS There were significant differences in the pain, heart rate and oxygen saturation levels between the maternal-voice and control groups. Pain levels and heart rates of the children in the experimental group during and after the painful procedures were much lower, and their oxygen saturations were higher than those of the children in the control group. PRACTIC IMPLICATIONS Distraction methods, such as listening to the maternal voice, should be used as a nursing intervention to reduce pain and decrease heart rate and increaseoxygen saturation in children during painful procedures in the paediatric intensive care unit. The maternal voice is recommended as a helpful option in cases when a pain control method is required. Future research needs to explore different interventional practices.
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Affiliation(s)
- Çiğdem Erdoğan
- Faculty of Health Science, Pediatric Nursing Department, Pamukkale University, Denizli, Turkey.
| | - Türkan Turan
- Faculty of Health Science, Pediatric Nursing Department, Pamukkale University, Denizli, Turkey.
| | - Bakiye Pınar
- Pamukkale University Hospital, Pediatric Intensive Care Unit, Pamukkale University, Denizli, Turkey
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Wong JJM, Liu S, Dang H, Anantasit N, Phan PH, Phumeetham S, Qian S, Ong JSM, Gan CS, Chor YK, Samransamruajkit R, Loh TF, Feng M, Lee JH. The impact of high frequency oscillatory ventilation on mortality in paediatric acute respiratory distress syndrome. Crit Care 2020; 24:31. [PMID: 32005285 PMCID: PMC6995130 DOI: 10.1186/s13054-020-2741-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/14/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND High-frequency oscillatory ventilation (HFOV) use was associated with greater mortality in adult acute respiratory distress syndrome (ARDS). Nevertheless, HFOV is still frequently used as rescue therapy in paediatric acute respiratory distress syndrome (PARDS). In view of the limited evidence for HFOV in PARDS and evidence demonstrating harm in adult patients with ARDS, we hypothesized that HFOV use compared to other modes of mechanical ventilation is associated with increased mortality in PARDS. METHODS Patients with PARDS from 10 paediatric intensive care units across Asia from 2009 to 2015 were identified. Data on epidemiology and clinical outcomes were collected. Patients on HFOV were compared to patients on other modes of ventilation. The primary outcome was 28-day mortality and secondary outcomes were 28-day ventilator- (VFD) and intensive care unit- (IFD) free days. Genetic matching (GM) method was used to analyse the association between HFOV treatment with the primary outcome. Additionally, we performed a sensitivity analysis, including propensity score (PS) matching, inverse probability of treatment weighting (IPTW) and marginal structural modelling (MSM) to estimate the treatment effect. RESULTS A total of 328 patients were included. In the first 7 days of PARDS, 122/328 (37.2%) patients were supported with HFOV. There were significant differences in baseline oxygenation index (OI) between the HFOV and non-HFOV groups (18.8 [12.0, 30.2] vs. 7.7 [5.1, 13.1] respectively; p < 0.001). A total of 118 pairs were matched in the GM method which found a significant association between HFOV with 28-day mortality in PARDS [odds ratio 2.3, 95% confidence interval (CI) 1.3, 4.4, p value 0.01]. VFD was indifferent between the HFOV and non-HFOV group [mean difference - 1.3 (95%CI - 3.4, 0.9); p = 0.29] but IFD was significantly lower in the HFOV group [- 2.5 (95%CI - 4.9, - 0.5); p = 0.03]. From the sensitivity analysis, PS matching, IPTW and MSM all showed consistent direction of HFOV treatment effect in PARDS. CONCLUSION The use of HFOV was associated with increased 28-day mortality in PARDS. This study suggests caution but does not eliminate equivocality and a randomized controlled trial is justified to examine the true association.
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Affiliation(s)
- Judith Ju-Ming Wong
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
| | - Siqi Liu
- Saw Swee Hock School of Public Health, National University Health System, NUS Graduate School for Integrative Science and Engineering, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore
| | - Hongxing Dang
- Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, 136 Zhongshan 2nd Rd, Yuzhong district, Chongqing, 400041, China
| | - Nattachai Anantasit
- Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Phuc Huu Phan
- National Children's Hospital, 18/879 La Thành, Láng Thượng, Đống Đa, Hanoi, Vietnam
| | - Suwannee Phumeetham
- Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road Bangkoknoi, Bangkok, 10700, Thailand
| | - Suyun Qian
- Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Rd, Xicheng District, Beijing, 100045, China
| | - Jacqueline Soo May Ong
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Chin Seng Gan
- Department of Pediatrics, University of Malaya. Jalan Universiti, 50603, Wilayah Persekutuan, Kuala Lumpur, Malaysia
| | - Yek Kee Chor
- Sarawak General Hospital, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | - Rujipat Samransamruajkit
- Critical Care Excellence Center, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University Bangkok, Bangkok, 10330, Thailand
| | - Tsee Foong Loh
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Mengling Feng
- Saw Swee Hock School of Public Health, National University Health System, NUS Graduate School for Integrative Science and Engineering, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore
| | - Jan Hau Lee
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
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Araujo da Silva AR, Jaszkowski E, Schober T, von Both U, Meyer-Buehn M, Marques AF, Farkas B, de Abreu BS, di Biase CB, Takahashi JM, de Castro LD, Leal IA, Teixeira CH, Nussbaum CF, Hoffmann F, Hübner J. Patterns of antimicrobial consumption in neonatal and pediatric intensive care units in Germany and Brazil. Eur J Clin Microbiol Infect Dis 2019; 39:249-255. [PMID: 31673879 DOI: 10.1007/s10096-019-03714-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/06/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Abstract
Antibiotic consumption (AC) is a key component of antimicrobial stewardship programs to recognize local patterns of antibiotic use. Our aim was to measure AC in neonatal units, including neonatal (NICU)/paediatric (PICU) intensive care units in different countries. We conducted a multicenter, retrospective, cohort study in three NICUs, one neonatal ward, and three PICUs with a total of 84 beds. Global and individual AC in days of therapy (DOT) and DOT per 1000 patient-days were assessed. During the study period, 2567 patients were admitted, corresponding to 4961 patient-days in neonatal units and 9243 patient-days in PICUs. Multidrug-resistant Gram-negative bacteria and methicillin-resistant Staphylococcus aureus were more frequent in Brazil than in Germany. Average AC was 386.5 and 1335.5 DOT/1000PD in German and Brazilian neonatal units, respectively. Aminopenicillins plus 3rd generation cephalosporins were the most commonly prescribed antibiotics in German neonatal units, while aminopenicillins plus aminoglycosides were the class most commonly used in Brazilian NICU. Average AC was 888.1 and 1440.7 DOT/1000PD in German and Brazilian PICUs, respectively. Antipseudomonal penicillins were most commonly used in the German PICU, and glycopeptides were the most frequently prescribed in Brazilian PICUs. Carbapenems represented 2.3-14% of total DOTs in German neonatal units and 4% in the Brazilian NICU and 13.0% in the German PICU and 6-12.2% in Brazilian PICUs. We concluded that different patterns of most commonly prescribed antibiotics were observed in neonatal units and PICUs in these two countries, probably related to different local patterns of antibiotic resistance, with a higher antibiotic consumption in Brazilian study units.
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Affiliation(s)
- André Ricardo Araujo da Silva
- Materno-Infantil Departament, Faculdade de Medicina, Universidade Federal Fluminense, Rua Marquês do Paraná 303, Niterói, RJ, 24033-900, Brazil.
| | - Elena Jaszkowski
- Infectiology Service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
| | - Tilmann Schober
- Infectiology Service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
| | - Ulrich von Both
- Infectiology Service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
| | - Melanie Meyer-Buehn
- Infectiology Service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
| | - Amanda Fáris Marques
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Beatriz Farkas
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Bernardo Silva de Abreu
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Clara Biscaia di Biase
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Jully Miyoshi Takahashi
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Luisa Dutra de Castro
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Izabel Alves Leal
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Cristiane Henriques Teixeira
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | | | - Florian Hoffmann
- Intensive Care Medicine service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
| | - Johannes Hübner
- Infectiology Service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
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Larsson Viksten J, Engerström L, Steinvall I, Samuelsson A, Fredrikson M, Walther S, Sjöberg FB. Children aged 0-16 admitted to Swedish intensive care units and paediatric intensive care units showed low mortality rates. Acta Paediatr 2019; 108:1460-1466. [PMID: 30582755 DOI: 10.1111/apa.14708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/30/2018] [Revised: 11/02/2018] [Accepted: 12/19/2018] [Indexed: 11/28/2022]
Abstract
AIM This study described the basic characteristics of children aged 0-16 years who were treated in intensive care units (ICUs) and paediatric ICUs (PICUs), compared their outcomes and examined any causes of death. METHODS This was a retrospective cohort study of admissions to 74 ICUs and three PICUs in Sweden that were recorded in the Swedish Intensive Care Registry from January 1, 2008 to December 31, 2012. RESULTS We retrieved data on 12 756 children who were admitted 17 003 times. The case mix differed between the ICUs, which were mainly admissions for injuries, accidents and observation, and PICUs, which were mainly admissions for malformations, genetic abnormalities and respiratory problems (p < 0.001). The median stays in the ICUs and PICUs were 1.4 and 3.5 days (p < 0.001), respectively. The respective crude mortality rates were 1.1% and 2.0, and the Paediatric Index of Mortality version 2 standardised mortality ratios were 0.43 and 0.50. None of these differences were significant. Most deaths were within 24 hours: About 57% in the ICUs, mainly from brain anomalies, and 13% in the PICUs, mainly from circulatory problems. CONCLUSION Sweden had a low mortality rate in both ICUs and PICUs and the children admitted to these two types of unit differed.
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Affiliation(s)
- Jessica Larsson Viksten
- Department of Anaesthesiology and Intensive Care; Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - Lars Engerström
- Department of Thoracic and Vascular Surgery; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Ingrid Steinvall
- Department of Hand Surgery, Plastic Surgery and Burns; Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - Anders Samuelsson
- Department of Anaesthesiology and Intensive Care; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Mats Fredrikson
- Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - Sten Walther
- Department of Thoracic and Vascular Surgery; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Folke B. Sjöberg
- Department of Anaesthesiology and Intensive Care; Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
- Department of Hand Surgery, Plastic Surgery and Burns; Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
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de la Oliva P, Cambra-Lasaosa FJ, Quintana-Díaz M, Rey-Galán C, Sánchez-Díaz JI, Martín-Delgado MC, de Carlos-Vicente JC, Hernández-Rastrollo R, Holanda-Peña MS, Pilar-Orive FJ, Ocete-Hita E, Rodríguez-Núñez A, Serrano-González A, Blanch L. [Admission, discharge and triage guidelines for paediatric intensive care units in Spain]. An Pediatr (Barc) 2019; 88:287.e1-287.e11. [PMID: 29728212 DOI: 10.1016/j.anpedi.2017.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 09/20/2017] [Accepted: 10/09/2017] [Indexed: 10/17/2022] Open
Abstract
A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition.
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Affiliation(s)
- Pedro de la Oliva
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario Materno-Infantil La Paz, Madrid, España; Universidad Autónoma, Madrid, España.
| | - Francisco José Cambra-Lasaosa
- Servicio Área de Críticos Pediátricos, Hospital Sant Joan de Déu, Barcelona, España; Universidad de Barcelona, Barcelona, España
| | - Manuel Quintana-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz-Carlos III, Madrid, España; Universidad Autónoma, Madrid, España
| | - Corsino Rey-Galán
- Sección de Cuidados Intensivos Pediátricos, Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Universidad de Oviedo, Oviedo, Asturias, España
| | - Juan Ignacio Sánchez-Díaz
- Sección de Cuidados Intensivos Pediátricos y Urgencias Infantiles, Hospital Universitario 12 de Octubre, Madrid, España; Universidad Complutense, Madrid, España
| | - María Cruz Martín-Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España; Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, España
| | - Juan Carlos de Carlos-Vicente
- Sección de Cuidados Intensivos Pediátricos, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
| | - Ramón Hernández-Rastrollo
- Sección de Cuidados Intensivos Pediátricos, Hospital Universitario Materno-Infantil, Badajoz, España; Universidad de Extremadura, Badajoz, España
| | - María Soledad Holanda-Peña
- Unidad de Cuidados Intensivos Materno-Infantil, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | | | - Esther Ocete-Hita
- Unidad de Cuidados Intensivos Pediátricos, Hospital Virgen de Las Nieves, Universidad de Granada, Granada, España
| | - Antonio Rodríguez-Núñez
- Servicio de Críticos y Urgencias Pediátricas, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España; Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, España
| | - Ana Serrano-González
- Servicio de Cuidados Intensivos Pediátricos, Hospital Niño Jesús, Madrid, España; Universidad Autónoma, Madrid, España
| | - Luis Blanch
- Centro de Críticos, Corporació Sanitaria Parc Taulí, Sabadell, Barcelona, España; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España; Instituto de Investigación e Innovación Parc Taulí, Sabadell, Barcelona, España
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de la Oliva P, Cambra-Lasaosa FJ, Quintana-Díaz M, Rey-Galán C, Sánchez-Díaz JI, Martín-Delgado MC, de Carlos-Vicente JC, Hernández-Rastrollo R, Holanda-Peña MS, Pilar-Orive FJ, Ocete-Hita E, Rodríguez-Núñez A, Serrano-González A, Blanch L. Admission, discharge and triage guidelines for paediatric intensive care units in Spain. Med Intensiva 2019; 42:235-246. [PMID: 29699643 DOI: 10.1016/j.medin.2017.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/10/2017] [Accepted: 10/24/2017] [Indexed: 12/16/2022]
Abstract
A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition.
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Affiliation(s)
- Pedro de la Oliva
- Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario Materno-Infantil La Paz, Madrid, España; Universidad Autónoma, Madrid, España.
| | - Francisco José Cambra-Lasaosa
- Servicio Área de Críticos Pediátricos, Hospital Sant Joan de Déu, Barcelona, España; Universidad de Barcelona, Barcelona, España
| | - Manuel Quintana-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz-Carlos III, Madrid, España; Universidad Autónoma, Madrid, España
| | - Corsino Rey-Galán
- Sección de Cuidados Intensivos Pediátricos, Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Universidad de Oviedo, Oviedo, Asturias, España
| | - Juan Ignacio Sánchez-Díaz
- Sección de Cuidados Intensivos Pediátricos y Urgencias Infantiles, Hospital Universitario 12 de Octubre, Madrid, España; Universidad Complutense, Madrid, España
| | - María Cruz Martín-Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España; Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, España
| | - Juan Carlos de Carlos-Vicente
- Sección de Cuidados Intensivos Pediátricos, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
| | - Ramón Hernández-Rastrollo
- Sección de Cuidados Intensivos Pediátricos, Hospital Universitario Materno-Infantil, Badajoz, España; Universidad de Extremadura, Badajoz, España
| | - María Soledad Holanda-Peña
- Unidad de Cuidados Intensivos Materno-Infantil, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | | | - Esther Ocete-Hita
- Unidad de Cuidados Intensivos Pediátricos, Hospital Virgen de Las Nieves, Universidad de Granada, Granada, España
| | - Antonio Rodríguez-Núñez
- Servicio de Críticos y Urgencias Pediátricas, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España; Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, España
| | - Ana Serrano-González
- Servicio de Cuidados Intensivos Pediátricos, Hospital Niño Jesús, Madrid, España; Universidad Autónoma, Madrid, España
| | - Luis Blanch
- Centro de Críticos, Corporació Sanitaria Parc Taulí, Sabadell, Barcelona, España; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España; Instituto de Investigación e Innovación Parc Taulí, Sabadell, Barcelona, España
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Rehman Siddiqui NU, Haque A, Abbas Q, Jurair H, Salam B, Sayani R. Ultrasonographic optic nerve sheath diameter Measurement for raised intracranial pressure in a Tertiary care centre of a developing country. J Ayub Med Coll Abbottabad 2018; 30:495-500. [PMID: 30632323] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Intracranial hypertension is not an uncommon life-threatening syndrome, caused by a variety of non-neurological and neurological illnesses, and quick diagnosis, timely treatment of Raised Intracranial Pressure (ICP) is associated with improved outcome. Our aim of study was to determine ultrasonographic measurement of Optic nerve sheath diameter (ONSD) for raised ICP. METHODS Prospective case series done in Emergency and Paediatric critical care unit of Aga Khan University Hospital. ONSD measurement in millimetres was done by placing linear probe of ultrasound on eye ball. RESULTS Forty-eight patients were included in study with mean age of 7.5±5.0 years with 21/48 (43.8%) between 1-8 years and 19/48 (39.6%) >8 years with 32/48 (66.7%) were male. Non-traumatic coma was most common diagnosis 41/48 (85.4%) with infectious cause being most common while Traumatic brain injury constitutes 7/48 (14.6%). Ct scan brain was done in 39/48 (81.3%) while MRI brain in rest of patients. Raised ICP was found in 83.33% (40/48) patients with Ultrasonographic ONSD measurement as compared to CT scan/MRI 14/48 (29.2%). 85% of patients, showed ultrasonographic ONSD measurement suggestive of Raised ICP with GCS ≤12. Mean ONSD with signs of raised ICP in infants 4.64 (±0.48), in 1-10 years 6.44 (±0.65), and in adolescent >10 years 6.28 (±0.62) ONSD respectively with ROC Curve showing Area Under Curve (AUC) 0.814 ( 95% CI, 0.692-0.936). CONCLUSIONS We identified threshold of Ultrasonographic ONSD measurement in infants >4.0 mm, in children 1-10 yrs >4.71 mm, in adolescent >10 yrs >5.43 mm for raised ICP with sensitivity and specificity of 100% and 60-66.7% respectively. 85% of patients showed raised ICP with Ultrasonographic ONSD measurement with GCS ≤12.
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Affiliation(s)
| | - Anwarul Haque
- Department of Paediatric and Child Health, Karachi, Pakistan
| | - Qalab Abbas
- Department of Paediatric and Child Health, Karachi, Pakistan
| | - Humaira Jurair
- Department of Paediatric and Child Health, Karachi, Pakistan
| | - Basit Salam
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Raza Sayani
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
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Hill C, Knafl KA, Docherty S, Santacroce SJ. Parent perceptions of the impact of the Paediatric Intensive Care environment on delivery of family-centred care. Intensive Crit Care Nurs 2018; 50:88-94. [PMID: 30061085 DOI: 10.1016/j.iccn.2018.07.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 02/01/2018] [Revised: 06/22/2018] [Accepted: 07/12/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To examine parent perception of how the physical and cultural environment of the paediatric intensive care unit impacted the implementation of family-centred care as outlined by the Institute for Patient and Family Centered Care. RESEARCH DESIGN A qualitative descriptive design utilizing secondary analysis from a longitudinal study. Sixty-one interviews with three mothers and three fathers (31 interviews with mothers, 30 interviews with fathers) of infants with complex congenital heart defects treated in a paediatric intensive care unit were subjected to secondary analysis via content analysis. The previously completed individual interviews with parents took place at least monthly ranging from soon after birth of their infant to one year of age or infant death, whichever occurred first. FINDINGS The family-centred care core concepts of information sharing, participation, respect and dignity were present in parent interviews. Parents indicated that the physical and cultural environment of the pediatric intensive care unit impacted their perceptions of how each of the core concepts was implemented by clinicians. The unit environment both positively and negatively impacted how parents experienced their infant's hospitalisation. CONCLUSION In the paediatric intensive care unit, family centred care operationalised as policy differed from actual parent experiences. The impact of the physical and cultural environment should be considered in the delivery of critical care, as the environment was shown to impact implementation of each of the core concepts.
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Affiliation(s)
- Carrie Hill
- University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, Campus Box 7460, Chapel Hill, NC 27599-7460, United States.
| | - Kathleen A Knafl
- University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, Campus Box 7460, Chapel Hill, NC 27599-7460, United States
| | - Sharron Docherty
- Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, United States
| | - Sheila Judge Santacroce
- University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, Campus Box 7460, Chapel Hill, NC 27599-7460, United States
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Fonzo-Christe C, Parron A, Combescure C, Rimensberger PC, Pfister RE, Bonnabry P. Younger age and in situ duration of peripheral intravenous catheters were risk factors for extravasation in a retrospective paediatric study. Acta Paediatr 2018; 107:1240-1246. [PMID: 29461646 DOI: 10.1111/apa.14280] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 08/25/2017] [Revised: 12/11/2017] [Accepted: 02/14/2018] [Indexed: 11/28/2022]
Abstract
AIM Epidemiological data on the incidence and risk factors of extravasation of peripheral intravenous catheters (PIVC) in neonates and children are scarce and that is what this study explored. METHODS This was a one-year retrospective study of all neonates and paediatric intensive care patients with at least one recorded PIVC at the Geneva University Hospitals, Switzerland, in 2013. The extravasation rate was determined for all patients, including neonates below 28 days, and for all PIVCs. Multivariate analysis of the associated risk factors was performed. RESULTS We analysed 1300 PIVC in 695 paediatric patients with a median age of 1.5 years. The overall extravasation incidence was 17.6% for all patients and 11.7% for PIVC. The overall incidence rate of PIVC extravasation was 4.5 per 100 catheters days, and the risk was highest in the 201 neonates, at 28.4%. The incidence rate four days after insertion of the PIVC was around three times higher than on day one. Neonates and the in situ duration of PIVCs were associated risk factors (p < 0.001). CONCLUSION Extravasation was frequent and neonates were particularly at risk. Younger age and longer in situ PIVC duration were independent risk factors for extravasation.
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Affiliation(s)
- C Fonzo-Christe
- Pharmacy Service; Geneva University Hospitals; Geneva Switzerland
- Neonatology and Paediatric Intensive Care Unit; Geneva University Hospitals; Geneva Switzerland
| | - A Parron
- Pharmacy Service; Geneva University Hospitals; Geneva Switzerland
| | - C Combescure
- Clinical Research Centre and Division of Clinical Epidemiology; Geneva University Hospitals; Geneva Switzerland
| | - PC Rimensberger
- Neonatology and Paediatric Intensive Care Unit; Geneva University Hospitals; Geneva Switzerland
| | - RE Pfister
- Neonatology and Paediatric Intensive Care Unit; Geneva University Hospitals; Geneva Switzerland
| | - P Bonnabry
- Pharmacy Service; Geneva University Hospitals; Geneva Switzerland
- School of Pharmaceutical Sciences; University of Geneva/University of Lausanne; Geneva Switzerland
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Malfará M, Pernassi M, Aragon D, Carlotti A. Impact of the clinical pharmacist interventions on prevention of pharmacotherapy related problems in the paediatric intensive care unit. Int J Clin Pharm 2018; 40:513-519. [PMID: 29603074 DOI: 10.1007/s11096-018-0632-x] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
Background Problems related to pharmacotherapy are common in patients admitted to the paediatric intensive care unit (PICU) and are associated with increased healthcare costs. Data on the impact of clinical pharmacist interventions to prevent pharmacotherapy-related problems and to minimize costs in the PICU are limited. Objectives To evaluate the number and type of clinical pharmacist interventions in the PICU and to determine cost savings associated with them. Setting a ten bed PICU of a tertiary-care university hospital in Brazil. Method This was a prospective, observational study conducted over 1-year. The Failure Mode and Effects Analysis (FMEA) tool was applied at the beginning of the study to assess drug-related risks in the PICU and to guide clinical pharmacist interventions. Main outcome measure Number and type of clinical pharmacist interventions and healthcare-related costs. Results One hundred sixty-two children were followed-up by the clinical pharmacist and 1586 prescriptions were evaluated; pharmacotherapy-related problems were identified in 12.4% of them. Sixteen of 75 failure modes identified by FMEA were potentially reduced by the clinical pharmacist interventions. There were 197 interventions with a cost saving of R$ 15,118.73 (US$ 4828.00). Clinical pharmacist interventions were related to drug interaction and therapeutic monitoring (34.5%), drug selection (22.3%), dosing and frequency (16.8%), prescription (13.2%) and administration (13.2%). Ninety-seven per cent of the clinical pharmacist interventions were accepted by the medical team. The interventions with larger cost savings were related to administration (39%). Conclusion The clinical pharmacist interventions minimized the risks of pharmacotherapy-related problems and contributed to the reduction of costs associated with medical prescription.
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Affiliation(s)
- Márcia Malfará
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Maria Pernassi
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Davi Aragon
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Ana Carlotti
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.
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Abstract
BACKGROUND Although child mortality is decreasing, more than half of all deaths in childhood occur in children with a life-limiting condition whose death may be expected. AIM To assess trends in place of death and identify characteristics of children who died in the community after discharge from paediatric intensive care unit. DESIGN National data linkage study. SETTING/PARTICIPANTS All children resident in England and Wales when admitted to a paediatric intensive care unit in the United Kingdom (1 January 2004 and 31 December 2014) were identified in the Paediatric Intensive Care Audit Network dataset. Linkage to death certificate data was available up to the end of 2014. Place of death was categorised as hospital (hospital or paediatric intensive care unit) or community (hospice, home or other) for multivariable logistic modelling. RESULTS The cohort consisted of 110,328 individuals. In all, 7709 deaths occurred after first discharge from paediatric intensive care unit. Among children dying, the percentage in-hospital at the time of death decreased from 83.8% in 2004 to 68.1% in 2014; 852 (0.8%) of children were discharged to palliative care. Children discharged to palliative care were eight times more likely to die in the community than children who died and had not been discharged to palliative care (odds ratio = 8.06 (95% confidence interval = 6.50-10.01)). CONCLUSIONS The proportion of children dying in hospital is decreasing, but a large proportion of children dying after discharge from paediatric intensive care unit continue to die in hospital. The involvement of palliative care at the point of discharge has the potential to offer choice around place of care and death for these children and families.
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Affiliation(s)
- Lorna K Fraser
- 1 Department of Health Sciences, University of York, York, UK
| | - Sarah Fleming
- 2 Division of Epidemiology & Biostatistics, LICAMM, University of Leeds, Leeds, UK
| | - Roger Parslow
- 2 Division of Epidemiology & Biostatistics, LICAMM, University of Leeds, Leeds, UK
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Snoep MC, Jansen NJ, Groenendaal F. Deaths and end-of-life decisions differed between neonatal and paediatric intensive care units at the same children's hospital. Acta Paediatr 2018; 107:270-275. [PMID: 28871637 PMCID: PMC5813263 DOI: 10.1111/apa.14061] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/28/2017] [Accepted: 08/31/2017] [Indexed: 11/30/2022]
Abstract
AIM We compared neonatal deaths and end-of-life decisions in a neonatal intensive care unit (NICU) and paediatric intensive care unit (PICU) in a Dutch tertiary children's hospital. SUBJECTS All 235 full-term infants who died within 28 days of life between 2003 and 2013 in the NICU (n = 199) and PICU (n = 36) were retrospectively studied. RESULTS The median length of stay was three days in the NICU and seven days in the PICU (p = 0.003). The main reasons for NICU stays were asphyxia (52.8%) and congenital malformations (42.2%), and in the PICU, they were congenital malformations (97.2%) and primarily cardiac problems (83.3%, p < 0.001). The median age of death was three days in the NICU and eight days in the PICU (p < 0.001), and mortality despite full intensive care treatment was 4.0% and 25.0%, respectively. Intensive treatment was discontinued because of poor survival chances in 25.1% of NICU and 52.8% of PICU cases (p < 0.001), and care was redirected because of expected poor quality of life in 70.9% and 22.2%, respectively. CONCLUSION Differences between the age at death and end-of-life decisions were found between full-term infants in the NICU and PICU in the same children's hospital. Underlying disorders and doctors' attitudes may have played a role.
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Affiliation(s)
- Maartje C. Snoep
- Department of Neonatology; The Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht University; Utrecht the Netherlands
- Paediatric Intensive Care; The Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht University; Utrecht the Netherlands
| | - Nicolaas J.G. Jansen
- Paediatric Intensive Care; The Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht University; Utrecht the Netherlands
| | - Floris Groenendaal
- Department of Neonatology; The Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht University; Utrecht the Netherlands
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Oulego-Erroz I, González-Cortes R, García-Soler P, Balaguer-Gargallo M, Frías-Pérez M, Mayordomo-Colunga J, Llorente-de-la-Fuente A, Santos-Herraiz P, Menéndez-Suso JJ, Sánchez-Porras M, Palanca-Arias D, Clavero-Rubio C, Holanda-Peña MS, Renter-Valdovinos L, Fernández-De-Miguel S, Rodríguez-Núñez A; RECANVA collaborative study. Ultrasound-guided or landmark techniques for central venous catheter placement in critically ill children. Intensive Care Med 2018; 44:61-72. [PMID: 29196794 DOI: 10.1007/s00134-017-4985-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess whether ultrasound guidance improves central venous catheter placement outcomes compared to the landmark technique in critically ill children. METHODS A prospective multicentre observational study was carried out in 26 paediatric intensive care units over 6 months. Children 0-18 years old who received a temporary central venous catheter, inserted using either ultrasound or landmark techniques, were eligible. The primary outcome was the first-attempt success rate. Secondary outcomes included overall placement success, number of puncture attempts, number of procedures requiring multiple punctures (> 3 punctures), number of procedures requiring punctures at more than one vein site and immediate mechanical complications. To account for potential confounding factors, we used propensity scores. Our primary analysis was based on 1:1 propensity score matching. The association between cannulation technique and outcomes in the matched cohort was estimated using generalized estimating equations and mixed-effects models to account for patient-level and hospital-level confounders. RESULTS Five hundred central venous catheter-placement procedures involving 354 patients were included. Ultrasound was used for 323 procedures, and the landmark technique was used for 177. Two hundred and sixty-six procedures were matched (133 in the ultrasound group and 133 in the landmark group). Ultrasound was associated with an increase in the first-attempt success rate [46.6 vs. 30%, odds ratio 2.09 (1.26-3.46); p < 0.001], a reduced number of puncture attempts [2 (1-3) vs. 2 (1-4), B coefficient - 0.51 (95% confidence interval - 1.01 to - 0.03), p = 0.035], and fewer overall mechanical complications [12 vs. 22.5%, odds ratio 0.47 (95% confidence interval 0.24-0.91), p = 0.025] in the matched cohort. The number of puncture attempts was the main factor associated with overall complications. CONCLUSIONS Compared with the landmark technique, ultrasound guidance was associated with an increased first-attempt success rate, a reduced number of puncture attempts, and fewer complications during central venous catheter placement in critically ill children.
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Yamaguchi RS, Noritomi DT, Degaspare NV, Muñoz GOC, Porto APM, Costa SF, Ranzani OT. Peripherally inserted central catheters are associated with lower risk of bloodstream infection compared with central venous catheters in paediatric intensive care patients: a propensity-adjusted analysis. Intensive Care Med 2017; 43:1097-1104. [PMID: 28584925 DOI: 10.1007/s00134-017-4852-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [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: 02/23/2017] [Accepted: 05/22/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE Central line-associated bloodstream infection (CLABSI) is an important cause of complications in paediatric intensive care units (PICUs). Peripherally inserted central catheters (PICCs) could be an alternative to central venous catheters (CVCs) and the effect of PICCs compared with CVCs on CLABSI prevention is unknown in PICUs. Therefore, we aimed to evaluate whether PICCs were associated with a protective effect for CLABSI when compared to CVCs in critically ill children. METHODS We have carried out a retrospective multicentre study in four PICUs in São Paulo, Brazil. We included patients aged 0-14 years, who needed a CVC or PICC during a PICU stay from January 2013 to December 2015. Our primary endpoint was CLABSI up to 30 days after catheter placement. We defined CLABSI based on the Center for Disease Control and Prevention's National Healthcare Safety Networks (NHSN) 2015 surveillance definitions. To account for potential confounders, we used propensity scores with inverse probability weighting. RESULTS A total of 1660 devices (922 PICCs and 738 CVCs) in 1255 children were included. The overall CLABSI incidence was 2.28 (95% CI 1.70-3.07)/1000 catheter-days. After covariate adjustment using propensity scores, CVCs were associated with higher risk of CLABSI (adjHR 2.20, 95% CI 1.05-4.61; p = 0.037) compared with PICCs. In a sensitivity analysis, CVCs remained associated with higher risk of CLABSI (adjHR 2.18, 95% CI 1.02-4.64; p = 0.044) after adding place of insertion and use of parenteral nutrition to the model as a time-dependent variable. CONCLUSIONS PICC should be an alternative to CVC in the paediatric intensive care setting for CLABSI prevention.
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Affiliation(s)
- Ricardo Silveira Yamaguchi
- Americas Medical Service, Americas Research and Education Institute, Rua Azevedo Macedo, 92, São Paulo, São Paulo, 04013-060, Brazil. .,Pediatric Intensive Care Unit, Hospital da Luz Vila Mariana, São Paulo, Brazil. .,Department of Pediatrics, Pediatric Intensive Care Unit, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
| | - Danilo Teixeira Noritomi
- Americas Medical Service, Americas Research and Education Institute, Rua Azevedo Macedo, 92, São Paulo, São Paulo, 04013-060, Brazil
| | - Natalia Viu Degaspare
- Americas Medical Service, Americas Research and Education Institute, Rua Azevedo Macedo, 92, São Paulo, São Paulo, 04013-060, Brazil.,Pediatric Intensive Care Unit, Hospital da Luz Vila Mariana, São Paulo, Brazil.,Department of Pediatrics, Pediatric Intensive Care Unit, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Gabriela Ortega Cisternas Muñoz
- Americas Medical Service, Americas Research and Education Institute, Rua Azevedo Macedo, 92, São Paulo, São Paulo, 04013-060, Brazil.,Pediatric Intensive Care Unit, Hospital da Luz Vila Mariana, São Paulo, Brazil.,Department of Pediatrics, Pediatric Intensive Care Unit, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Ana Paula Matos Porto
- Americas Medical Service, Americas Research and Education Institute, Rua Azevedo Macedo, 92, São Paulo, São Paulo, 04013-060, Brazil
| | - Silvia Figueiredo Costa
- Laboratory of Bacteriology (LIM 54), Department of Infectious Diseases, Medical School, University of São Paulo, São Paulo, Brazil
| | - Otavio T Ranzani
- Americas Medical Service, Americas Research and Education Institute, Rua Azevedo Macedo, 92, São Paulo, São Paulo, 04013-060, Brazil.,Pulmonary Division, Heart Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.,Department of Pulmonology, Hospital Clinic of Barcelona, IDIBAPS, CIBERES, Barcelona, Spain
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Baudin F, Buisson A, Vanel B, Massenavette B, Pouyau R, Javouhey E. Nasal high flow in management of children with status asthmaticus: a retrospective observational study. Ann Intensive Care 2017; 7:55. [PMID: 28534235 PMCID: PMC5440424 DOI: 10.1186/s13613-017-0278-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/10/2017] [Indexed: 11/30/2022] Open
Abstract
Background Asthma is the most common obstructive airway disease in children and adults. Nasal high flow (NHF) is a recent device that is now used as a primary support for respiratory distress. Several studies have reported use of NHF as a respiratory support in status asthmaticus; however, there are no data to recommend such practice. We therefore conducted this preliminary study to evaluate NHF therapy for children with status asthmaticus admitted to our PICU in order to prepare a multicentre randomized controlled study. Results Between November 2009 and January 2014, 73 patients with status asthmaticus were admitted to the PICU, of whom 39 (53%) were treated with NHF and among these 10 (26%) presented severe acidosis at admission (pH < 7.30). Thirty-four less severe children (41%) were treated with standard oxygen. For one child (2.6%) NHF failed and was then switched to non-invasive ventilation. NHF was discontinued in another patient because of the occurrence of pneumothorax after 31 h with NHF; the patient was then switched to standard oxygen therapy. Mean ± SD heart rate (165 ± 21 vs. 141 ± 25/min, p < 0.01) and respiratory rate (40 ± 13 vs. 31 ± 8/min, p < 0.01) decreased significantly, and blood gas improved in the first 24 h. In the subgroup of patients with acidosis, median [IQR] pH increased significantly between hour 0 and 2 (7.25 [7.21–7.26] vs. 7.30 [7.27–7.33], p = 0.009) and median [IQR] pCO2 decreased significantly (7.27 kPa [6.84–7.91 vs. 5.85 kPa [5.56–6.11], p = 0.007). No patient was intubated. Conclusion This retrospective study showed the feasibility and safety of NHF in children with severe asthma. Blood gas and clinical parameters were significantly improved during the first 24 h. NHF failed in only two patients, and none required invasive ventilation.
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Affiliation(s)
- Florent Baudin
- Réanimation pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500, Bron, France. .,UMR T_9405, UMRESTTE, Ifsttar, Université Claude Bernard Lyon1, Univ Lyon, 69373, Lyon, France.
| | - Alexandra Buisson
- Réanimation pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500, Bron, France
| | - Blandine Vanel
- Réanimation pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500, Bron, France
| | - Bruno Massenavette
- Réanimation pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500, Bron, France
| | - Robin Pouyau
- Réanimation pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500, Bron, France
| | - Etienne Javouhey
- Réanimation pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500, Bron, France.,UMR T_9405, UMRESTTE, Ifsttar, Université Claude Bernard Lyon1, Univ Lyon, 69373, Lyon, France
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Tandale SR, Dave N, Garasia M, Patil S, Parelkar S. A Study of Morbidity and Cost of Peripheral Venous Cannulation in Neonates Admitted to Paediatric Surgical Intensive Care Unit. J Clin Diagn Res 2017; 11:UC08-UC10. [PMID: 28511483 DOI: 10.7860/jcdr/2017/23600.9570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 11/19/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Peripheral venous access in sick neonates is indicated for administration of fluids, drugs or nutrients. AIM We conducted an audit of peripheral venous access in neonates admitted to paediatric surgical intensive care unit to study the morbidity, time spent on cannulation and cost with its use. MATERIALS AND METHODS One hundred consecutive neonates requiring hospital admission to paediatric surgical intensive care unit in a period of one year were included in the study. Peripheral venous access was secured in all patients. We conducted an audit for the number of venipuncture sites, wastage of cannulae, cost, time spent on cannulation and morbidity with its use. Neonates were divided into three groups depending on their surgical intervention. Namely, Group A (thoracic procedures), Group B (bowel surgery) and Group C (other surgery and non-operative cases). RESULTS In Group A, mean venepuncture sites were 10.66, used cannulae were 5.6, wasted cannulae were 4.3, total cost of cannulation was 870 rupees and 93.78 minutes were spent in cannulation per neonate. In Group B, mean venepuncture sites were 7.58, used cannulae were 4.35, wasted cannulae were 2.59, total cost of cannulation was 603 rupees and 59.85 minutes were spent in cannulation per neonate. In Group C mean venepuncture sites were 2.78, used cannulae were 2.9, wasted cannulae were 0.57, total cost of cannulation was 232 rupees and 26.51 minutes were spent in cannulation per neonate. Thrombophlebitis severity was greater in neonates who had longer ICU stay and ventilator dependent days. CONCLUSION Peripheral venous cannulation of longer duration is costly, time consuming, and associated with significant neonatal morbidity. It may be worthwhile to consider alternative vascular devices such as peripherally inserted central catheters or central venous catheters in such situations.
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Affiliation(s)
- Sushama Raghunath Tandale
- Paediatric Anaesthesia Fellow, Department of Anaesthesiology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Nandini Dave
- Professor, Department of Anaesthesiology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Madhu Garasia
- Professor and Head, Department of Anaesthesiology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Shalil Patil
- Resident, Department of Paediatric Surgery, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Sandesh Parelkar
- Professor and Head, Department of Paediatric Surgery, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Haque A, Ahmed SA, Rafique Z, Abbas Q, Jurair H, Ali SA. Device-associated infections in a paediatric intensive care unit in Pakistan. J Hosp Infect 2016; 95:98-100. [PMID: 27890335 DOI: 10.1016/j.jhin.2016.10.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 09/28/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
This study assessed the effect of implementation of active infection control and surveillance on the occurrence of device-associated infections (DAIs) in a paediatric intensive care unit (PICU) from 2012 to 2015. There were 1378 patients, equating to 4632 patient-days, on the PICU, and 29 DAI episodes, giving an incidence rate of 2.1% and an incidence density rate of 6.26 per 1000 patient-days. The rates of central-line-associated bloodstream infections, ventilator-associated pneumonia and catheter-related urinary tract infections were 7/1000 central-line-days, 1.17/1000 ventilator-days and 0.24/1000 urinary-catheter-days, respectively. Despite the overall low rate of DAIs in the PICU, there was a relatively high rate of central-line-associated bloodstream infections.
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Affiliation(s)
- A Haque
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan.
| | - S A Ahmed
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Z Rafique
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan; Department of Infection Control, Aga Khan University Hospital, Karachi, Pakistan
| | - Q Abbas
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - H Jurair
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - S A Ali
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
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Grandjean C, Latour JM, Cotting J, Fazan MC, Leteurtre S, Ramelet AS. Measurement of parent satisfaction in the paediatric intensive care unit - Translation, cultural adaptation and psychometric equivalence for the French-speaking version of the EMPATHIC-65 questionnaire. Intensive Crit Care Nurs 2016; 38:40-45. [PMID: 27776897 DOI: 10.1016/j.iccn.2016.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/12/2016] [Accepted: 09/18/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Within paediatric intensive care units (PICUs), only a few parent satisfaction instruments are validated and none are available for French-speaking parents. The aims of the study were to translate and culturally adapt the Dutch EMPATHIC-65 questionnaire into a French version and to test its psychometric equivalence. METHODS Two French-speaking PICUs in Switzerland and France participated. The questionnaire was translated using a standardised method and parents with PICU experience were interviewed to assess clarity of the translated version. Secondly, parents of children hospitalised for at least 24 hours and who were fluent in French, were invited to complete the French translated version of the EMPATHIC-65 questionnaire. Reliability and validity measures were used to examine its psychometric equivalence. RESULTS The overall mean clarity agreement reached 90.2% by 17 French-speaking parents. Eight unclear items have subsequently been reworded. One hundred seventy-two parents completed the French version questionnaire. Reliability and convergent validity have been confirmed by an adequate internal consistency (0.59-0.89) and convergent validity (rs 0.25-0.63, p<0.01). CONCLUSION Psychometric equivalence of the French EMPATHIC-65 questionnaire highlights the appropriateness of relying on available valid instrument to expand the availability of health instrument measure in French.
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Affiliation(s)
- Chantal Grandjean
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Medical and Surgical Department of Pediatrics, Lausanne University Hospital, Biopôle II, route de la Corniche 10, 1011 Lausanne, Switzerland.
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, 3 Portland Villas, Room 101, Drake Circus, Plymouth PL4 8AA, United Kingdom.
| | - Jacques Cotting
- Pediatric Intensive Care Unit, Medical and Surgical Department of Pediatrics, Lausanne University of Lausanne, rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Marie-Christine Fazan
- Pediatric Intensive Care Unit, Medical and Surgical Department of Pediatrics, Lausanne University of Lausanne, rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Stéphane Leteurtre
- Pediatric Intensive Care Unit, University Lille, CHU Lille, EA 2694, Santé publique: épidémiologie et qualité des soins, F-59000 Lille, France.
| | - Anne-Sylvie Ramelet
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Medical and Surgical Department of Pediatrics, Lausanne University Hospital, Biopôle II, route de la Corniche 10, 1011 Lausanne, Switzerland.
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Amigoni A, Vettore E, Brugnolaro V, Brugnaro L, Gaffo D, Masola M, Marzollo A, Pettenazzo A. High doses of benzodiazepine predict analgesic and sedative drug withdrawal syndrome in paediatric intensive care patients. Acta Paediatr 2014; 103:e538-43. [PMID: 25131427 DOI: 10.1111/apa.12777] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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: 12/23/2013] [Revised: 03/30/2014] [Accepted: 08/13/2014] [Indexed: 01/02/2023]
Abstract
AIM Critically ill children can develop withdrawal syndrome after prolonged analgesia and sedation in a paediatric intensive care unit (PICU), when treatment is stopped abruptly or reduced quickly. The aim of this study was to evaluate the incidence of withdrawal syndrome in patients after three or more days of analgesic or sedative drug therapy, using a validated scale. We also analysed the association between withdrawal syndrome and the patients' outcome and factors related to analgesia and sedation treatment. METHODS This prospective observational study analysed 89 periods of weaning from analgesia and sedation in 60 children between October 2010 and October 2011. Of these, 65% were less than six months old and 45% were admitted to the PICU after heart surgery. Withdrawal syndrome was assessed using the Withdrawal Assessment Tool-1 (WAT-1) scale. RESULTS The incidence of withdrawal syndrome was 37%, and the only variable that predicted its presence was the highest administered dose of benzodiazepine. The duration of weaning, Sophia Observational Withdrawal Symptom scale score and nurse judgment were also associated with positive WAT-1 scores. CONCLUSION Withdrawal syndrome should be considered after three or more days of analgesic or sedative treatment. A high dose of benzodiazepine increases the risk of developing withdrawal symptoms.
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Affiliation(s)
- A Amigoni
- Pediatric Intensive Care Unit; Department of Pediatrics; University-Hospital; Padua Italy
| | - E Vettore
- Department of Pediatrics; University-Hospital; Padua Italy
| | - V Brugnolaro
- Department of Pediatrics; University-Hospital; Padua Italy
| | - L Brugnaro
- Education and Training Department; University-Hospital; Padua Italy
| | - D Gaffo
- Pediatric Intensive Care Unit; Department of Pediatrics; University-Hospital; Padua Italy
| | - M Masola
- Pediatric Intensive Care Unit; Department of Pediatrics; University-Hospital; Padua Italy
| | - A Marzollo
- Pediatric Intensive Care Unit; Department of Pediatrics; University-Hospital; Padua Italy
| | - A Pettenazzo
- Pediatric Intensive Care Unit; Department of Pediatrics; University-Hospital; Padua Italy
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da Silva PSL, de Aguiar VE, Fonseca MCM. How the modified Clinical Pulmonary Infection Score can identify treatment failure and avoid overusing antibiotics in ventilator-associated pneumonia. Acta Paediatr 2014; 103:e388-92. [PMID: 24891228 DOI: 10.1111/apa.12710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/29/2013] [Accepted: 05/26/2014] [Indexed: 01/19/2023]
Abstract
AIM Although the modified Clinical Pulmonary Infection Score (CPIS) has been used to guide treatment decisions in adults with ventilator-associated pneumonia (VAP), paediatric studies are lacking. We assessed a modified CPIS tool to define VAP resolution and identify treatment failure at an early stage. METHODS We identified 70 mechanically ventilated children with VAP according to the Center for Disease Control criteria. Modified CPIS was initially measured at VAP onset and then three and five days afterwards. Children were defined as low risk or high risk based on a cut-off score of six. RESULTS There were 50 high-risk and 20 low-risk patients. Culture results were positive in 64% of the high-risk patients and just 10% of the low-risk patients. Patients on adequate therapy significantly improved their CPIS scores by day three, regardless of the likelihood of VAP. A lack of score improvement demonstrated sensitivity of 100% and specificity of 83% when it came to detecting treatment failure. The area under the receiver operating curve was 0.92. CONCLUSION Serial modified CPIS measurements showed that low-risk patients with negative cultures at day three should be considered for a short course of antibiotics. In contrast, high-risk patients with no score improvement were potentially failing their treatment.
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Affiliation(s)
- Paulo Sérgio Lucas da Silva
- Department of Pediatrics; Pediatric Intensive Care Unit; Hospital do Servidor Público Municipal; São Paulo Brazil
| | - Vânia Euzébio de Aguiar
- Department of Pediatrics; Pediatric Intensive Care Unit; Hospital do Servidor Público Municipal; São Paulo Brazil
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Mitt P, Metsvaht T, Adamson V, Telling K, Naaber P, Lutsar I, Maimets M. Five-year prospective surveillance of nosocomial bloodstream infections in an Estonian paediatric intensive care unit. J Hosp Infect 2013; 86:95-9. [PMID: 24360408 DOI: 10.1016/j.jhin.2013.11.002] [Citation(s) in RCA: 14] [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: 11/14/2012] [Accepted: 11/04/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Few studies provide rates of nosocomial bloodstream infections (BSIs) in mixed neonatal and paediatric intensive care units (PICUs). AIM To determine the rate, pathogens and outcome of BSIs in an Estonian PICU. METHODS Data were collected prospectively from 1st January 2004 to 31st December 2008 in the PICU of Tartu University Hospital. The definition criteria of the US Centers for Disease Control and Prevention were applied for the diagnosis of laboratory-confirmed BSI. FINDINGS A total of 126 episodes of BSI were identified in 89 patients (74 neonates, eight infants, seven patients aged >1 year). Among neonates 42 (57%) had birth weight <1000 g. The overall incidence of BSI was 9.2 per 100 admissions, incidence density 12.8 per 1000 patient-days. Primary BSI was diagnosed in 92 episodes. Central line (CL)-associated BSI incidence density for neonates was 8.6 per 1000 CL-days with the highest incidence (27.4) among neonates with extremely low birth weight. The most common pathogens were coagulase-negative staphylococci (43%) and Serratia marcescens (14%). Resistance to meticillin was detected in four out of seven S. aureus isolates (all were part of an outbreak) and 23% of Enterobacteriaceae were extended spectrum beta-lactamase (ESBL)-producing strains. Overall case-fatality rate was 10%. CONCLUSION We observed higher rates of BSIs in our mixed PICU than reported previously. High levels of antimicrobial resistance were detected. Future research should focus on the effects of infection control measures to prevent outbreaks and to decrease incidence of CL-associated BSI.
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Affiliation(s)
- P Mitt
- Department of Infection Control, Tartu University Hospital, Tartu, Estonia.
| | - T Metsvaht
- Department of Paediatric Intensive Care Unit, Tartu University Hospital, Tartu, Estonia
| | - V Adamson
- Department of Infection Control, Tartu University Hospital, Tartu, Estonia
| | - K Telling
- Department of Infection Control, Tartu University Hospital, Tartu, Estonia
| | - P Naaber
- Department of Microbiology, University of Tartu, Tartu, Estonia
| | - I Lutsar
- Department of Microbiology, University of Tartu, Tartu, Estonia
| | - M Maimets
- Department of Infection Control, Tartu University Hospital, Tartu, Estonia
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