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vasoactive agents and shock in children

Yan-Ran Qin, Cheng-Jun Liu, Feng Xu, Jing Li, Xiao-Yu Xiong
OBJECTIVE: To investigate the association between vasoactive-inotropic score (VIS) and prognosis in children with septic shock. METHODS: A total of 117 children with decompensated septic shock who received the treatment with vasoactive agents were enrolled. According to their prognosis, they were divided into death group with 41 children and survival group with 76 children. With the maximum VIS within the first 24 hours (24hVIS max) as the cut-off value (29.5), the children were divided into low VIS group with 78 children and high VIS group with 39 children...
February 2018: Zhongguo Dang Dai Er Ke za Zhi, Chinese Journal of Contemporary Pediatrics
Jason T Patregnani, Anthony A Sochet, Darren Klugman
OBJECTIVE: Pediatric shock represents a major cause of morbidity and mortality in the United States. Standardization of treatment such as volume resuscitation and vasoactive administration has resulted in improved patient outcomes. Vasoactives have been anecdotally associated with peripheral IV infiltration and extravasation. There is a paucity of evidence in pediatrics to determine the ideal route of vasoactive infusions and what, if any, risk factors and harm are associated with peripheral IV infiltration and extravasation...
August 2017: Pediatric Critical Care Medicine
Suchitra Ranjit, Rajeswari Natraj, Sathish Kumar Kandath, Niranjan Kissoon, Balasubramaniam Ramakrishnan, Paul E Marik
AIMS: We previously reported that vasodilatation was common in pediatric septic shock, regardless of whether they were warm or cold, providing a rationale for early norepinephrine (NE) to increase venous return (VR) and arterial tone. Our primary aim was to evaluate the effect of smaller fluid bolus plus early-NE versus the American College of Critical Care Medicine (ACCM) approach to more liberal fluid boluses and vasoactive-inotropic agents on fluid balance, shock resolution, ventilator support and mortality in children with septic shock...
October 2016: Indian Journal of Critical Care Medicine
Andréa M C Ventura, Huei Hsin Shieh, Albert Bousso, Patrícia F Góes, Iracema de Cássia F O Fernandes, Daniela C de Souza, Rodrigo Locatelli Pedro Paulo, Fabiana Chagas, Alfredo E Gilio
OBJECTIVES: The primary outcome was to compare the effects of dopamine or epinephrine in severe sepsis on 28-day mortality; secondary outcomes were the rate of healthcare-associated infection, the need for other vasoactive drugs, and the multiple organ dysfunction score. DESIGN: Double-blind, prospective, randomized controlled trial from February 1, 2009, to July 31, 2013. SETTING: PICU, Hospital Universitário da Universidade de São Paulo, Brazil...
November 2015: Critical Care Medicine
Bregje M van Paridon, Cathy Sheppard, Garcia Guerra G, Ari R Joffe
INTRODUCTION: Early administration of antibiotics for sepsis, and of fluid boluses and vasoactive agents for septic shock, is recommended. Evidence for this in children is limited. METHODS: The Alberta Sepsis Network prospectively enrolled eligible children admitted to the Pediatric Intensive Care Unit (PICU) with sepsis from 04/2012-10/2014. Demographics, severity of illness, and outcomes variables were prospectively entered into the ASN database after deferred consent...
August 17, 2015: Critical Care: the Official Journal of the Critical Care Forum
Kusum Menon, J Dayre McNally, Karen Choong, Margaret L Lawson, Tim Ramsay, James S Hutchison, Jennifer Foster, Hector R Wong
INTRODUCTION: Pediatric shock is associated with significant morbidity and limited evidence suggests treatment with corticosteroids. The objective of this study was to describe practice patterns and outcomes associated with corticosteroid use in children with shock. METHODS: We conducted a retrospective, cohort study in four pediatric intensive care units (PICU) in Canada. Patients aged newborn to 17 years admitted to PICU with shock between January 2010 and June 2011 were eligible...
November 2015: Shock
T Eoin West, Amélie von Saint André-von Arnim
Clinicians caring for patients infected with Ebola virus must be familiar not only with screening and infection control measures but also with management of severe disease. By integrating experience from several Ebola epidemics with best practices for managing critical illness, this report focuses on the clinical presentation and management of severely ill infants, children, and adults with Ebola virus disease. Fever, fatigue, vomiting, diarrhea, and anorexia are the most common symptoms of the 2014 West African outbreak...
November 2014: Annals of the American Thoracic Society
Maria Lúcia Saraiva Lobo, Ângela Taguchi, Heloísa Amaral Gaspar, Juliana Ferreira Ferranti, Werther Brunow de Carvalho, Artur Figueiredo Delgado
A case of fulminant myocarditis associated with the H1N1 influenza virus. This case report describes the patient's clinical course and emphasizes the importance of bedside echocardiography as an aid in the early diagnosis and management of children with severe myocardial dysfunction. It also discusses aspects relevant to the treatment and prognosis of fulminant myocarditis. The patient was a female, 4 years and 8 months old, previously healthy and with a history of flu symptoms in the past two weeks. The patient was admitted to the emergency room with signs of hemodynamic instability, requiring ventilatory support and vasoactive drugs...
July 2014: Revista Brasileira de Terapia Intensiva
Yuanyuan Wang, Bo Sun, Hongni Yue, Xiaofei Lin, Bing Li, Xiaochun Yang, Chunming Shan, Yujin Fan, Maotian Dong, Yixing Zhang, Wenlong Lin, Xiaofeng Zuo, Ping Su, Yongbo Heng, Jinzhong Xu, Niranjan Kissoon
OBJECTIVE: To determine the prevalence, treatment, and outcomes of sepsis at regional hospitals in Huai'an, Jiangsu, China. DESIGN: Prospective data registry using a descriptive clinical epidemiologic approach through a collaborative network. SETTING: Pediatric departments in 11 regional city and county referral hospitals serving 843,000 children (exclusive of neonates). SUBJECTS: All admissions (n = 27,836) of patients from 28 days to 15 years old from September 1, 2010, to August 31, 2011...
November 2014: Pediatric Critical Care Medicine
Raina Paul, Elliot Melendez, Anne Stack, Andrew Capraro, Michael Monuteaux, Mark I Neuman
BACKGROUND AND OBJECTIVES: Few studies have demonstrated improvement in adherence to Pediatric Advanced Life Support guidelines for severe sepsis and septic shock. We sought to improve adherence to national guidelines for children with septic shock in a pediatric emergency department with poor guideline adherence. METHODS: Prospective cohort study of children presenting to a tertiary care pediatric emergency department with septic shock. Quality improvement (QI) interventions, including repeated plan-do-study-act cycles, were used to improve adherence to a 5-component sepsis bundle, including timely (1) recognition of septic shock, (2) vascular access, (3) administration of intravenous (IV) fluid, (4) antibiotics, and (5) vasoactive agents...
May 2014: Pediatrics
Kusum Menon, Dayre McNally, Karen Choong, Margaret Sampson
OBJECTIVE: To systematically review randomized controlled trials (RCTs) of steroids conducted in children with fluid and/or vasoactive medication-dependent shock and evaluate and report on the quality and clinical and methodological heterogeneity of included trials. DATA SOURCES: MEDLINE (1946 to January Week 2, 2012), Embase (1947-January 20, 2012), Cochrane Central Register of Controlled Trials (through January 2012), and reference lists of retrieved publications...
June 2013: Pediatric Critical Care Medicine
M E Lampin, J Rousseaux, A Botte, A Sadik, R Cremer, F Leclerc
AIM: To report our 10 year experience with noradrenaline use in children with septic shock focusing on doses, routes of administration and complications. METHODS: Retrospective single-centre review of children with septic shock who received noradrenaline between 2000 and 2010. RESULTS: We identified 144 children with septic shock treated with noradrenaline, in 22% as the first-line drug. The median volume resuscitation before vasoactive agent administration was 50 mL/kg interquartile range [IQR: 30-70]...
September 2012: Acta Paediatrica
Marco Piastra, Ersilia Luca, Sonia Mensi, Federico Visconti, Daniele De Luca, Francesca Vitale, Domenico Pietrini
Circulatory failure recognition and treatment represents an important issue in critically ill infants and children. Early diagnosis and prompt institution of adequate treatment may be life-saving for pediatric patients with cardiocirculatory instability in the setting of intensive care. However, the hemodynamic status of the critically ill child is poorly reflected by baseline vital parameters or laboratory blood tests. A reliable tool for diagnosis and monitoring of evolution of both heart performance and vascular status is strictly needed...
June 2012: Current Drug Targets
Ronald M Perkin, Nick Anas
BACKGROUND: After its introduction in 1970, the use of the pulmonary artery catheter became a central part of the management of critically ill patients in adult and pediatric intensive care units. However, because it was introduced as a class II device, efficacy for its safety and clinical benefit did not exist during the early years of use. This review describes the pulmonary artery catheter and reviews the literature supporting its use. METHODOLOGY: A search of MEDLINE, PubMed, and the Cochrane Database was made to find literature about pulmonary artery catheter use...
July 2011: Pediatric Critical Care Medicine
Jerry J Zimmerman, Mark D Williams
OBJECTIVE: To assess whether corticosteroids, used as adjunctive therapy for pediatric severe sepsis, is associated with improved outcomes. DESIGN: Retrospective cohort study examining the clinical database derived from the RESOLVE (REsearching severe Sepsis and Organ dysfunction in children: a gLobal perspective, F1K-MC-EVBP) trial of activated protein C for pediatric severe sepsis. SETTING: A total of 104 pediatric centers in 18 countries from which data were originally gathered...
January 2011: Pediatric Critical Care Medicine
Karen Choong, Desmond Bohn, Douglas D Fraser, Isabelle Gaboury, James S Hutchison, Ari R Joffe, Catherine Litalien, Kusum Menon, Patrick McNamara, Roxanne E Ward
RATIONALE: Vasopressin has been proposed as a potent vasoactive agent in the treatment of vasodilatory shock in adults and children. The objective of this trial was to evaluate the efficacy and safety of vasopressin as an adjunctive agent in pediatric vasodilatory shock. METHODS: In this multicenter, double-blind trial, children with vasodilatory shock were randomized to receive low-dose vasopressin (0.0005-0.002 U/kg/min) or placebo in addition to open-label vasoactive agents...
October 1, 2009: American Journal of Respiratory and Critical Care Medicine
K Menif, A Khaldi, A Bouziri, W Kechaou, S Belhadj, A Hamdi, K Kazdaghli, N Benjaballah
GOAL: This study had for aim to determine the mortality rate and the factors affecting mortality among 70 children admitted for septic shock secondary to a community acquired infection. PATIENTS AND METHODS: A retrospective analysis was made of patients admitted between January 1998 and August 2005, in a pediatric ICU for septic shock secondary to a community-acquired infection. Neonates under 7 days of age were excluded from the study. RESULTS: Seventy cases were included and 32 (45...
December 2009: Médecine et Maladies Infectieuses
José Irazuzta, Kevin J Sullivan, Pedro Celiny R Garcia, Jefferson Pedro Piva
OBJECTIVES: Septic shock (SS) is a frequent cause for admission to the pediatric intensive care unit, requiring prompt recognition and intervention to improve outcome. Our aim is to review the relevant literature related to the diagnosis and management of SS and present a sequential management for its treatment. SOURCES: Non-systematic review of medical literature using the MEDLINE database. Articles were selected according to their relevance to the objective and according to the authors' opinions...
May 2007: Jornal de Pediatria
Guo-ping Lu, Zhu-jin Lu, Ling-en Zhang, Jun He, Jing Hu, Fang Wu
OBJECTIVE: Since continuous blood purification (CBP) has the effects of eliminating inflammatory mediators and improving organs function, CBP had been applied to treat non-renal diseases for nearly 10 years, but few studies have been conducted in children with sepsis and multiorgan dysfunction syndrome (MODS), especially in China. The present study aimed to evaluate the clinical effect of CBP in treatment of children with severe sepsis and MODS. METHODS: Twenty-two children with severe sepsis and MODS admitted to our PICU from Aug...
August 2006: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Stuart L Goldstein, Michael J G Somers, Michelle A Baum, Jordan M Symons, Patrick D Brophy, Douglas Blowey, Timothy E Bunchman, Cheryl Baker, Theresa Mottes, Nancy McAfee, Joni Barnett, Gloria Morrison, Kristine Rogers, James D Fortenberry
BACKGROUND: Critical illness leading to multi-organ dysfunction syndrome (MODS) and associated acute renal failure (ARF) is less common in children compared to adult patients. As a result, many issues plague the pediatric ARF outcome literature, including a relative lack of prospective study, a lack of modality stratification in subject populations and inconsistent controls for patient illness severity in outcome analysis. METHODS: We now report data from the first multicenter study to assess the outcome of pediatric patients with MODS receiving continuous renal replacement therapy (CRRT)...
February 2005: Kidney International
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