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Pediatrics Mechanical ventilation

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https://www.readbyqxmd.com/read/28935428/predictive-factors-for-the-outcome-of-high-flow-nasal-cannula-therapy-in-a-pediatric-intensive-care-unit-is-the-spo2-fio2-ratio-useful
#1
Fulya Kamit Can, Ayşe Berna Anil, Murat Anil, Neslihan Zengin, Fatih Durak, Caner Alparslan, Zeynep Goc
OBJECTIVES: To determine the predictive factors for the outcome of high-flow nasal cannula (HFNC) therapy in a pediatric intensive care unit (PICU). MATERIALS AND METHODS: We prospectively included all patients with acute respiratory distress/failure aged 1month to 18years who were admitted to the PICU between January 2015 and May 2016 and treated with HFNC as a primary support and for postextubation according to our pre-established protocol. HFNC failure was defined as the need for escalation to non-invasive ventilation (NIV) or invasive mechanical ventilation (MV)...
September 6, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28932552/chylothorax-after-pediatric-cardiac-surgery-complicates-short-term-but-not-long-term-outcomes-a-propensity-matched-analysis
#2
Nikoletta R Czobor, György Roth, Zsolt Prodán, Daniel J Lex, Erzsébet Sápi, László Ablonczy, Mihály Gergely, Edgar A Székely, János Gál, Andrea Székely
BACKGROUND: The occurrence of postoperative chylothorax in children with congenital heart disease is a rare and serious complication in cardiac intensive care units (ICUs). The aim of our study was to identify the perioperative characteristics, treatment options, resource utilization and long term complications of patients having chylothorax after a pediatric cardiac surgery. METHODS: Patients were retrospectively assessed for the presence of chylothorax between January 2002 and December 2012 in a tertiary national cardiac center...
August 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28930815/variability-in-usual-care-mechanical-ventilation-for-pediatric-acute-respiratory-distress-syndrome-time-for-a-decision-support-protocol
#3
Christopher J L Newth, Katherine A Sward, Robinder G Khemani, Kent Page, Kathleen L Meert, Joseph A Carcillo, Thomas P Shanley, Frank W Moler, Murray M Pollack, Heidi J Dalton, David L Wessel, John T Berger, Robert A Berg, Rick E Harrison, Richard Holubkov, Allan Doctor, J Michael Dean, Tammara L Jenkins, Carol E Nicholson
OBJECTIVES: Although pediatric intensivists philosophically embrace lung protective ventilation for acute lung injury and acute respiratory distress syndrome, we hypothesized that ventilator management varies. We assessed ventilator management by evaluating changes to ventilator settings in response to blood gases, pulse oximetry, or end-tidal CO2. We also assessed the potential impact that a pediatric mechanical ventilation protocol adapted from National Heart Lung and Blood Institute acute respiratory distress syndrome network protocols could have on reducing variability by comparing actual changes in ventilator settings to those recommended by the protocol...
September 19, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28930814/neurologic-and-functional-morbidity-in-critically-ill-children-with-bronchiolitis
#4
Steven L Shein, Katherine N Slain, Jason A Clayton, Bryan McKee, Alexandre T Rotta, Deanne Wilson-Costello
OBJECTIVES: Neurologic and functional morbidity occurs in ~30% of PICU survivors, and young children may be at particular risk. Bronchiolitis is a common indication for PICU admission among children less than 2 years old. Two single-center studies suggest that greater than 10-25% of critical bronchiolitis survivors have neurologic and functional morbidity but those estimates are 20 years old. We aimed to estimate the burden of neurologic and functional morbidity among more recent bronchiolitis patients using two large, multicenter databases...
September 19, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28930813/temporal-changes-in-prescription-of-neuropharmacologic-drugs-and-utilization-of-resources-related-to-neurologic-morbidity-in-mechanically-ventilated-children-with-bronchiolitis
#5
Steven L Shein, Katherine Slain, Deanne Wilson-Costello, Bryan McKee, Alexandre T Rotta
OBJECTIVES: Critically ill children with bronchiolitis may require neuropharmacologic medications and support for neuro-functional sequelae, but current practices are not well described. We aimed to describe recent trends in neuropharmacology and utilization of neuro-rehabilitation resources in mechanically ventilated children with bronchiolitis. DESIGN: Analysis of the multicenter Pediatric Health Information System database. SETTING: Forty-seven U...
September 19, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28918201/clinical-management-of-pressure-control-ventilation-an-algorithmic-method-of-patient-ventilatory-management-to-address-forgotten-but-important-variables
#6
Lonny Ashworth, Yasuhiro Norisue, Megan Koster, Jeff Anderson, Junko Takada, Hatsuyo Ebisu
Pressure controlled ventilation is a common mode of ventilation used to manage both adult and pediatric populations. However, there is very little evidence that distinguishes the efficacy of pressure controlled ventilation over that of volume controlled ventilation in the adult population. This gap in the literature may be due to the absence of a consistent and systematic algorithm for managing pressure controlled ventilation. This article provides a brief overview of the applications of both pressure controlled ventilation and volume controlled ventilation and proposes an algorithmic approach to the management of patients receiving pressure controlled ventilation...
September 6, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28914722/factors-associated-with-pediatric-ventilator-associated-conditions-in-six-u-s-hospitals-a-nested-case-control-study
#7
Noelle M Cocoros, Gregory Priebe, James E Gray, Philip Toltzis, Gitte Y Larsen, Latania K Logan, Susan Coffin, Julia S Sammons, Kathleen Deakins, Kelly Horan, Matthew Lakoma, Jessica Young, Michael Burton, Michael Klompas, Grace M Lee
OBJECTIVES: A newly proposed surveillance definition for ventilator-associated conditions among neonatal and pediatric patients has been associated with increased morbidity and mortality among ventilated patients in cardiac ICU, neonatal ICU, and PICU. This study aimed to identify potential risk factors associated with pediatric ventilator-associated conditions. DESIGN: Retrospective cohort. SETTING: Six U.S. hospitals PATIENTS:: Children less than or equal to 18 years old ventilated for greater than or equal to 1 day...
September 13, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28912041/postoperative-b-type-natriuretic-peptide-monitoring-for-the-assessment-of-the-magnitude-of-shunting-through-blalock-taussig-anastomoses
#8
Cristian Mirabile, Alessandra Mazzola, Liana Valeanu, Vanessa Lopez-Lopez, Claudio Barbanti, Camilla Biselli, Carole Hennequin, Sophie Malekzadeh-Milani, Mirela Bojan
BACKGROUND: The Modified Blalock-Taussig shunt (MBTS) is the most common palliative operation performed in patients with complex cardiac defects. Postoperative morbidity and mortality rates are high, mainly due to shunt thrombosis and over-shunting. Over-shunting may be difficult to identify postoperatively based on conventional criteria. Since plasma B-type natriuretic peptide (BNP) concentrations correlate with the magnitude of shunting in various left-to-right shunt cardiac defects, we investigated its ability to identify postoperative MBTS over-shunting...
September 6, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28895691/implementation-of-a-checklist-to-increase-adherence-to-evidence-based-practices-in-a-single-pediatric-intensive-care-unit
#9
Pablo Eulmesekian, Augusto Pérez, Silvia Díaz, Mateo Ferrero
INTRODUCTION: The use of checklists to increase adherence to evidence-based practices is not yet widespread in pediatric intensive care units. The objective of this study was to achieve 90% compliance with studied practices using an ad hoc checklist. POPULATION AND METHDOS: Time series quasiexperimental study conducted in ventilated children hospitalized in the pediatric intensive care unit. Studied practices included sedation breaks, plateau pressure ≤ 30 cm H 2O, fraction of inspired oxygen ≤ 60%, maintenance of headboard at > 30°, chlorhexidine mouthwash, weekly ventilator circuit changes, preference for enteral feeding, reduction in the threshold for blood transfusions (hemoglobin: 7 g/dL), daily consideration of spontaneous breathing trials and central venous catheter removal...
October 1, 2017: Archivos Argentinos de Pediatría
https://www.readbyqxmd.com/read/28881451/validation-of-a-pediatric-early-warning-system-for-hospitalized-pediatric-oncology-patients-in-a-resource-limited-setting
#10
Asya Agulnik, Alejandra Méndez Aceituno, Lupe Nataly Mora Robles, Peter W Forbes, Dora Judith Soberanis Vasquez, Ricardo Mack, Federico Antillon-Klussmann, Monica Kleinman, Carlos Rodriguez-Galindo
BACKGROUND: Pediatric oncology patients are at high risk of clinical deterioration, particularly in hospitals with resource limitations. The performance of pediatric early warning systems (PEWS) to identify deterioration has not been assessed in these settings. This study evaluates the validity of PEWS to predict the need for unplanned transfer to the pediatric intensive care unit (PICU) among pediatric oncology patients in a resource-limited hospital. METHODS: A retrospective case-control study comparing the highest documented and corrected PEWS score before unplanned PICU transfer in pediatric oncology patients (129 cases) with matched controls (those not requiring PICU care) was performed...
September 7, 2017: Cancer
https://www.readbyqxmd.com/read/28872714/microbial-epidemiology-of-candidemia-in-neonatal-and-pediatric-intensive-care-units-at-children-s-medical-center-tehran
#11
Arezu Charsizadeh, Hossein Mirhendi, Bahram Nikmanesh, Hamid Eshaghi, Koichi Makimura
Invasive candidiasis is a major cause of morbidity and mortality in children. However, limited data is available on the epidemiology of this infection in pediatric settings in Iran. The aim of the present study was to determine the prevalence, microbial epidemiology, risk factors, and clinical outcomes associated with candidemia in intensive care units at Children's Medical Center, Tehran, Iran. All blood and other normally sterile specimen cultures positive for Candida species, were included. Isolates were identified by morphological and molecular methods...
September 5, 2017: Mycoses
https://www.readbyqxmd.com/read/28866754/opioid-associated-iatrogenic-withdrawal-in-critically-ill-adult-patients-a-multicenter-prospective-observational-study
#12
Pan Pan Wang, Elaine Huang, Xue Feng, Charles-André Bray, Marc M Perreault, Philippe Rico, Patrick Bellemare, Paul Murgoi, Céline Gélinas, Annie Lecavalier, Dev Jayaraman, Anne Julie Frenette, David Williamson
BACKGROUND: Opioids and benzodiazepines are frequently used in the intensive care unit (ICU). Regular use and prolonged exposure to opioids in ICU patients followed by abrupt tapering or cessation may lead to iatrogenic withdrawal syndrome (IWS). IWS is well described in pediatrics, but no prospective study has evaluated this syndrome in adult ICU patients. The objective of this study was to determine the incidence of IWS caused by opioids in a critically ill adult population. This multicenter prospective cohort study was conducted at two level-1 trauma ICUs between February 2015 and September 2015 and included 54 critically ill patients...
September 2, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28861270/phosphate-disturbance-in-critically-ill-children-incidence-associated-risk-factors-and-clinical-outcomes
#13
Ahmed Nabih El Shazly, Doaa Refaey Soliman, Effat Hussien Assar, Eman Gamal Behiry, Ibrahim Abd El Naby Gad Ahmed
BACKGROUND: Hypophosphatemia is one of the common disorders that develop in critically ill patients. It has potential complications and is often unrecognized in those patients. OBJECTIVE: Determining the incidence of hypophosphatemia in critically ill children, its association with clinical outcomes and the possible risk factors. METHODS: 50 patients were enrolled in the study. Levels of serum phosphate were measured on day 1 and day 7 of PICU (Pediatric intensive care unit) stay...
September 2017: Annals of Medicine and Surgery
https://www.readbyqxmd.com/read/28843663/risk-factors-and-outcomes-of-critically-ill-patients-with-acute-brain-failure-a-novel-end-point
#14
Tarun D Singh, John C O'Horo, Ognjen Gajic, Amra Sakusic, Courtney N Day, Jay Mandrekar, Rahul Kashyap, Dereddi Raja Shekar Reddy, Alejandro A Rabinstein
OBJECTIVE: To determine the incidence, risk factors and outcomes of acute brain failure (ABF) in a mixed medical and surgical cohort of critically ill patients and its effect on ICU & hospital mortality. DESIGN: Observational electronic medical record (EMR) based retrospective cohort study of critically ill patients admitted to the ICU between 2006 and 2013. SETTING: Tertiary academic medical center. PATIENTS: Consecutive adult (>18years) critically ill patients admitted to medical and surgical ICUs...
August 18, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28842971/the-impact-of-pediatric-obesity-on-hospitalized-children-with-lower-respiratory-tract-infections-in-the-united-states
#15
Yusuke Okubo, Kotaro Nochioka, Marcia A Testa
OBJECTIVE: Obesity is the most common public health problem and is a clinically complicating risk factor among hospitalized children. The impact of pediatric obesity on the severity and morbidity of lower respiratory tract infections remains unclear. MATERIALS AND METHODS: We conducted a retrospective cohort study of bronchitis and pneumonia among children aged 2-20 years using hospital discharge records. The data were obtained from the Kid's Inpatient Database in 2003, 2006, 2009, and 2012, and were weighted to estimate the number of hospitalizations in the United States...
August 26, 2017: Clinical Respiratory Journal
https://www.readbyqxmd.com/read/28829819/evaluation-of-diaphragmatic-function-in-mechanically-ventilated-children-an-ultrasound-study
#16
En-Pei Lee, Shao-Hsuan Hsia, Hsiu-Feng Hsiao, Min-Chi Chen, Jainn-Jim Lin, Oi-Wa Chan, Chia-Ying Lin, Mei-Chin Yang, Sui-Ling Liao, Shen-Hao Lai
BACKGROUND: The recovery of diaphragmatic function is vital for successful extubation from mechanical ventilation. Recent studies have detected diaphragm atrophy in ventilated adults by using ultrasound, but no similar report has been conducted in children. In the current study, we hypothesized that mechanically ventilated children may also develop diaphragm atrophy and diaphragmatic dysfunction. MATERIALS AND METHODS: Children who were admitted to the pediatric intensive care unit and were newly intubated for mechanical ventilation were enrolled into this prospective case-control study...
2017: PloS One
https://www.readbyqxmd.com/read/28821360/development-and-implementation-of-an-early-mobility-program-for-mechanically-ventilated-pediatric-patients
#17
Kristina A Betters, Kiran B Hebbar, David Farthing, Brittany Griego, Tricia Easley, Hartley Turman, Lauren Perrino, Stephanie Sparacino, Mary L deAlmeida
PURPOSE: Early mobility (EM) is being used in adult ICUs in an effort to treat and prevent intensive care unit acquired weakness (ICU-AW) and Post-Intensive Care Syndrome (PICS). Data supports children suffer from ICU-AW and PICS as well. Our objective was to create and implement an EM protocol for pediatric patients receiving invasive mechanical ventilation. METHODS: A multidisciplinary EM committee was formed to create and implement an EM protocol in a quarternary care PICU...
August 9, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28816920/similar-metabolic-innate-immunity-and-adipokine-profiles-in-adult-and-pediatric-sepsis-versus-systemic-inflammatory-response-syndrome-a-pilot-study
#18
Theonymfi Tavladaki, Anna Maria Spanaki, Helen Dimitriou, Efmorfia Kondili, Christianna Choulaki, Dimitris Georgopoulos, George Briassoulis
OBJECTIVES: To examine whether the septic profiles of heat shock protein 72, heat shock protein 90α, resistin, adiponectin, oxygen consumption, CO2 production, energy expenditure, and metabolic pattern, along with illness severity, nutritional, and inflammatory indices, differ between adult and pediatric patients compared with systemic inflammatory response syndrome and healthy controls. To evaluate whether these biomolecules may discriminate sepsis from systemic inflammatory response syndrome in adult and pediatric patients...
August 12, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28807197/perioperative-blood-transfusion-and-complications-in-children-undergoing-surgery-for-solid-tumors
#19
Dani O Gonzalez, Jennifer N Cooper, Erica Mantell, Peter C Minneci, Katherine J Deans, Jennifer H Aldrink
BACKGROUND: The objective was to assess whether perioperative blood transfusion (PBT) is associated with postoperative complications in children undergoing surgery for a solid tumor. METHODS: Using 2012-2014 National Surgical Quality Improvement Program Pediatric data, we identified patients aged 0-18 years who underwent surgery (biopsy or resection) for solid tumors. We compared demographic, clinical, and 30-day outcome characteristics between children who did and did not receive a PBT within 72 hours after surgery...
August 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28803432/quality-of-life-in-home-ventilated-children-and-their-families
#20
Rafael González, Amaya Bustinza, Sarah N Fernandez, Miriam García, Silvia Rodriguez, Ma Ángeles García-Teresa, Mirella Gaboli, Silvia García, Olaia Sardón, Diego García, Antonio Salcedo, Antonio Rodríguez, Ma Carmen Luna, Arturo Hernández, Catalina González, Alberto Medina, Estela Pérez, Alicia Callejón, Juan D Toledo, Mercedes Herranz, Jesús López-Herce
HMV (home mechanical ventilation) in children has increased over the last years. The aim of the study was to assess perceived quality of life (QOL) of these children and their families as well as the problems they face in their daily life.We performed a multicentric cross-sectional study using a semi-structured interview about the impact of HMV on families and an evaluation questionnaire about perceived QOL by the patient and their families (pediatric quality of life questionnaire (PedsQL4.0)). We studied 41 subjects (mean age 8...
August 12, 2017: European Journal of Pediatrics
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