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Mechanical ventilation in pediatrics

Ashish Nagpal, Melissa-Moore Clingenpeel, Rajan K Thakkar, Renata Fabia, Jeffrey Lutmer
OBJECTIVE: To determine the association between fluid resuscitation volume following pediatric burn injury and impact on outcomes. METHODS: A retrospective chart review of pediatric patients (0-18 years) sustaining ≥15% TBSA burn, admitted to an American Burn Association verified pediatric burn center from 2010 to 2015. RESULTS: Twenty-seven patients met inclusion criteria and had complete data available for analysis. Fifteen (56%) patients received greater than 6ml/kg/total body surface area burn in first 24h and twelve (44%) patients received less than 6ml/kg/percent total body surface area burn in first 24h...
August 2018: Burns: Journal of the International Society for Burn Injuries
Emily Morell Balkin, Matt S Zinter, Satish K Rajagopal, Roberta L Keller, Jeffrey R Fineman, Martina A Steurer
OBJECTIVES: The disease burden and mortality of children with pulmonary hypertension are significantly higher than for the general PICU population. We aimed to develop a risk-adjustment tool predicting PICU mortality for pediatric pulmonary hypertension patients: the Pediatric Index of Pulmonary Hypertension Intensive Care Mortality score. DESIGN: Retrospective analysis of prospectively collected multicenter pediatric critical care data. SETTING: One-hundred forty-three centers submitting data to Virtual Pediatric Systems database between January 1, 2009, and December 31, 2015...
June 19, 2018: Pediatric Critical Care Medicine
Takuto Takahashi, Yusuke Okubo, Maria A Pereda, Atsuhiko Handa, Scott Miller
OBJECTIVES: Acute chest syndrome is the leading cause of death in children with sickle cell disease and is generally due to respiratory failure. Epidemiologic factors for a need for mechanical ventilation in children with acute chest syndrome require further clarification. DESIGN: Retrospective observational study. SETTING: Nationally representative pediatric inpatient records in the United States by using the Kids' Inpatient Database for the years 2003, 2006, 2009, and 2012...
June 19, 2018: Pediatric Critical Care Medicine
Stanzen Chakdour, Pankaj C Vaidya, Suresh Kumar Angurana, Jayashree Muralidharan, Meenu Singh, Sunit C Singhi
OBJECTIVE: To assess pulmonary functions of children who received mechanical ventilation for acute hypoxemic respiratory failure. DESIGN: Longitudinal study. SETTING: PICU and Pediatric Pulmonology Clinic of a tertiary care teaching hospital in North India. PATIENTS: All children, 5-12 years old, ventilated for acute hypoxemic respiratory failure in PICU from July 2012 to June 2013 and survived. INTERVENTIONS: The baseline admission variables recorded were as follows: age, sex, duration of illness, primary diagnosis at admission, Pediatric Risk of Mortality III score, lung injury score, mechanical ventilation parameters, oxygenation indices, and duration of PICU stay...
June 19, 2018: Pediatric Critical Care Medicine
Ji-Hyun Lee, Seungman Yang, Jonghyun Park, Hee Chan Kim, Eun-Hee Kim, Young-Eun Jang, Jin-Tae Kim, Hee-Soo Kim
BACKGROUND: Respiratory variations in photoplethysmography amplitude enable volume status assessment. However, the contact force between the measurement site and sensor can affect photoplethysmography waveforms. We aimed to evaluate contact force effects on respiratory variations in photoplethysmography waveforms in children under general anesthesia. METHODS: Children aged 3-5 years were enrolled. After anesthetic induction, mechanical ventilation commenced at a tidal volume of 10 mL/kg...
June 19, 2018: Paediatric Anaesthesia
Rajan K Thakkar, Zachary Diltz, Joseph D Drews, Krista K Wheeler, Junxin Shi, Racheal Devine, Renata Fabia, Mark Hall
BACKGROUND: Burns are a leading cause of morbidity in children, with infections representing the most common group of complications. Severe thermal injuries are associated with a profound inflammatory response, but the utility of laboratory values to predict infections in pediatric burn patients is poorly understood. MATERIALS AND METHODS: Our institutional burn database was queried for patients aged 18 y and younger with at least 10% total body surface area burns...
August 2018: Journal of Surgical Research
Katharine J O'Hearn, Dori-Ann Martin, Maryse Dagenais, Kusum Menon
OBJECTIVES: To determine the number of patients considered not appropriate to approach for assent within the first 24 hours of PICU admission. DESIGN: Exploratory prospective 1-month environmental scan. SETTING: Two tertiary Canadian PICUs. PATIENTS: Ninety patients age newborn to 17 years old admitted to the PICU during September 2016 (Site 1) or May 2017 (Site 2). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: At PICU admission, 81% of patients were deemed not appropriate to approach for assent most commonly due to age, influence of psychotropic medications, and/or mechanical ventilation...
June 13, 2018: Pediatric Critical Care Medicine
Jennifer R Foster, Farhana I AlOthmani, Jamie A Seabrook, Tariq AlOfisan, Yasser M AlGarni, Amrita Sarpal
OBJECTIVES: To determine the percentage of time that critically ill children have a parent at the bedside and to identify extrinsic factors that are associated with percent of time with parental presence at the bedside. DESIGN: Prospective cohort study. SETTING: PICU in a single tertiary care children's hospital. SUBJECTS: Primary two parents of all children admitted to the PICU on 12 preselected days during a 1-year period from 2014 to 2015...
June 11, 2018: Pediatric Critical Care Medicine
Edward Vincent S Faustino, Veronika Shabanova, Matthew G Pinto, Simon Li, Erin Trakas, Michael Miksa, Shira Gertz, Lee A Polikoff, Massimo Napolitano, Adele R Brudnicki, Joana A Tala, Cicero T Silva
OBJECTIVE: To determine the epidemiology of lower extremity deep venous thrombosis (DVT) in critically ill adolescents, which currently is unclear. STUDY DESIGN: We performed a multicenter, prospective, cohort study. Adolescents aged 13-17 years who were admitted to 6 pediatric intensive care units and were anticipated to receive cardiopulmonary support for at least 48 hours were eligible, unless they were admitted with DVT or pulmonary embolism or were receiving or anticipated to receive therapeutic anticoagulation...
June 8, 2018: Journal of Pediatrics
Fady M El Gendy, Muhammad S El-Mekkawy, Nagwan Y Saleh, Mona Salah El-Din Habib, Faten Ezzelarab Younis
PURPOSE: To assess the value of Presepsin and Pentraxin3 measurement in critically ill children. MATERIALS AND METHODS: Prospective observational study conducted on 80 children admitted into Pediatric Intensive Care Unit (PICU) and 80 healthy controls. Patients were evaluated for presence of sepsis. Pediatric Risk of Mortality (PRISM) and Pediatric Index of Mortality (PIM2) were calculated. Serum Presepsin and Pentraxin3 were measured within 24 h of admission...
June 3, 2018: Journal of Critical Care
Laxmi V Ghimire, Fu-Sheng Chou
BACKGROUND: Junctional ectopic tachycardia is a serious tachyarrhythmic complication following pediatric cardiac surgery. It is difficult to manage and is associated with significant morbidity and mortality. Conventional nonpharmacological and pharmacological measures have shown limited effects. Dexmedetomidine is an α2 agonist which has recently been shown in multiple studies to be effective. AIMS: The aim of this systematic review with meta-analysis was to evaluate the efficacy of prophylactic dexmedetomidine administration in the prevention of junctional ectopic tachycardia in pediatric patients following cardiac surgeries...
June 7, 2018: Paediatric Anaesthesia
Mohamed Fouad Ismail, Amr A Arafat, Tamer E Hamouda, Amira Esmat El Tantawy, Azzahra Edrees, Abdulbadee Bogis, Nashwa Badawy, Alaa B Mahmoud, Ahmed Farid Elmahrouk, Ahmed A Jamjoom
BACKGROUND: Junctional ectopic tachycardia is a serious arrhythmia that frequently occurs after tetralogy of Fallot repair. Arrhythmia prophylaxis is not feasible for all pediatric cardiac surgery patients and identification of high risk patients is required. The objectives of this study were to characterize patients with JET, identify its predictors and subsequent complications and the effect of various treatment strategies on the outcomes in selected TOF patients undergoing total repair before 2 years of age...
June 5, 2018: Journal of Cardiothoracic Surgery
Marissa A Brunetti, J William Gaynor, Lauren B Retzloff, Jessica L Lehrich, Mousumi Banerjee, Venugopal Amula, David Bailly, Darren Klugman, Josh Koch, Javier Lasa, Sara K Pasquali, Michael Gaies
OBJECTIVES: Cardiopulmonary failure in children with cardiac disease differs from the general pediatric critical care population, yet the epidemiology of extracorporeal membrane oxygenation support in cardiac ICUs has not been described. We aimed to characterize extracorporeal membrane oxygenation utilization and outcomes across surgical and medical patients in pediatric cardiac ICUs. DESIGN: Retrospective analysis of the Pediatric Cardiac Critical Care Consortium registry to describe extracorporeal membrane oxygenation frequency and outcomes...
June 2018: Pediatric Critical Care Medicine
James W Antoon, Jennifer L Goldman, Samir S Shah, Brian Lee
BACKGROUND: Severe cutaneous adverse reactions are rare yet life threatening conditions. The current management and outcomes of these conditions in U.S. children is unclear. OBJECTIVES: To characterize the current management and outcomes of Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) across U.S. children's hospitals. METHODS: We performed a retrospective cohort study of children less than 18 years of age hospitalized with a primary diagnosis of SJS or TEN at 47 U...
May 30, 2018: Journal of Allergy and Clinical Immunology in Practice
Jacqueline M Evans, Parul Dayal, Douglas L Hallam, JoAnne E Natale, Pranav Kodali, Hadley S Sauers-Ford, James P Marcin
OBJECTIVES: To compare patient factors and outcomes among children admitted to PICUs from referring versus children's hospital emergency departments (EDs). METHODS: Pediatric patients (<19 years old) admitted to PICUs from referring and children's hospital EDs from July 1, 2011 to June 30, 2013. We compared demographic and clinical factors, including severity of illness as measured by a recalibrated Pediatric Index of Mortality, version 2 score. RESULTS: Of 80 045 children from 109 PICUs, 35...
June 1, 2018: Hospital Pediatrics
Katie Parchem, Amanda Peck, Katherine Tales
Research has shown that patients who are mechanically ventilated or immobile for greater than 7 days are at increased risk for deconditioning and muscle atrophy. Immobility impacts length of stay as well as patients' ability to return to their prior level of function. As part of the safe patient-handling initiative created at Michigan Medicine, a special team of nurses and therapists was assembled to adapt an adult mobility framework for the pediatric population. The pediatric mobility model determines each patient's specific mobility "phase" based on detailed criteria...
July 2018: Critical Care Nursing Quarterly
Jennifer Guyther, Richard Lichenstein, Yonghong Gao, James A Zhou, Adebola Ajao, Priti K Bajaj, Veronica A Combs, James C King
Retrospective data evaluated increases in advanced medical support for children with medically attended acute respiratory illness (MAARI) during influenza outbreak periods (IOP). Advanced support included hospitalisation, intensive care unit admission, or mechanical ventilation, for children aged 0-17 years hospitalised in Maryland's 50 acute-care hospitals over 12 influenza seasons. Weekly numbers of positive influenza tests in the Maryland area defined IOP for each season as the fewest consecutive weeks, including the peak week containing at least 85% of positive tests with a 2-week buffer on either side of the IOP...
May 30, 2018: Epidemiology and Infection
Jason M Weissler, Eugenia H Cho, Peter F Koltz, Martin J Carney, Maxim Itkin, Pablo Laje, L Scott Levin, Yoav Dori, Suhail K Kanchwala, Stephen J Kovach
With the expanding horizon of microsurgical techniques, novel treatment strategies for lymphatic abnormalities are increasingly reported. Described in this article is the first reported use of lymphovenous anastomosis surgery to manage recalcitrant chylothoraces in infants. Chylothorax is an increasingly common postoperative complication after pediatric cardiac surgery, with a reported incidence of up to 9.2 percent in infants. Although conservative nutritional therapy has a reported 70 percent success rate in this patient population, failed conservative management leading to persistent chylothorax is associated with a significant risk of multisystem complications and mortality...
June 2018: Plastic and Reconstructive Surgery
Hansa Haftu, Tedrose Hailu, Araya Medhaniye, Teklit G/Tsadik
OBJECTIVE: To describe admission pattern and outcome with its predictor variable on the mortality of children admitted to pediatric intensive care unit (PICU), Ayder Referral Hospital, Northern Ethiopia, from September 2012 to August 2014. RESULT: From 680 admitted patients, 400 patients were analyzed. Average age at admission was 62.99 ± 60.94 months, with F:M ratio of 1:1.2. Overall (from infectious and non-infectious) the most commonly affected systems were respiratory (90/400 pts...
May 24, 2018: BMC Research Notes
Farah Chedly Thabet, Faisal Ahmed alHaffaf, Iheb Mohamed Bougmiza, Hend Ali Bafaqih, May Said Chehab, Sulaiman Abdulkareem alMohaimeed
OBJECTIVE: To evaluate whether the off-hours admission has any effect on risk-adjusted mortality and length of stay for nonelective patients admitted to a pediatric intensive care unit (PICU) without 24-hour in-house intensivist coverage. DESIGN: Prospective cohort study. SETTING: A 34-bed tertiary PICU. PATIENTS: All consecutive nonelective patients aged 0 to 14 years admitted from January 2012 to June 2015. MEASUREMENTS AND MAIN RESULTS: A total of 1254 patients were nonelectively admitted to the PICU...
January 1, 2018: Journal of Intensive Care Medicine
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