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Critically ill children

Ashley Gionfriddo, Mika L Nonoyama, Peter C Laussen, Peter N Cox, Megan Clarke, Alejandro A Floh
OBJECTIVES: To promote standardization, the Centers for Disease Control and Prevention introduced a new ventilator-associated pneumonia classification, which was modified for pediatrics (pediatric ventilator-associated pneumonia according to proposed criteria [PVAP]). We evaluated the frequency of PVAP in a cohort of children diagnosed with ventilator-associated pneumonia according to traditional criteria and compared their strength of association with clinically relevant outcomes. DESIGN: Retrospective cohort study...
March 15, 2018: Pediatric Critical Care Medicine
Florian Lamping, Thomas Jack, Nicole Rübsamen, Michael Sasse, Philipp Beerbaum, Rafael T Mikolajczyk, Martin Boehne, André Karch
BACKGROUND: Since early antimicrobial therapy is mandatory in septic patients, immediate diagnosis and distinction from non-infectious SIRS is essential but hampered by the similarity of symptoms between both entities. We aimed to develop a diagnostic model for differentiation of sepsis and non-infectious SIRS in critically ill children based on routinely available parameters (baseline characteristics, clinical/laboratory parameters, technical/medical support). METHODS: This is a secondary analysis of a randomized controlled trial conducted at a German tertiary-care pediatric intensive care unit (PICU)...
March 15, 2018: BMC Pediatrics
Karen C Uzark, John M Costello, Holly C DeSena, Ravi Thiagajaran, Melissa Smith-Parrish, Katja M Gist
OBJECTIVES: Pediatric cardiac intensive care continues to evolve, with rapid advances in knowledge and improvement in clinical outcomes. In the past, the Board of Directors of the Pediatric Cardiac Intensive Care Society created and subsequently updated a list of sentinel references focused on the care of critically ill children with congenital and acquired heart disease. The objective of this article is to provide clinicians with a compilation and brief summary of updated and useful references that have been published since 2012...
March 10, 2018: Pediatric Critical Care Medicine
Imran Siddiqui, Lena Jafri, Qalab Abbas, Ahmed Raheem, Anwar Ul Haque
Objective: To evaluate the clinical and prognostic utility of procalcitonin (PCT), C-reactive protein (CRP), and lactic acid in children admitted to the Pediatric Intensive Care Unit (PICU) of a university teaching hospital. Materials and Methods: Medical records of children (1 month-16 years) tested for serum PCT at the time of admission in the PICU of our hospital from July 1, 2013, to January 15, 2015, were reviewed. Within 24 h of admission, the Pediatric Risk of Mortality Score, blood cultures, white blood cell count, neutrophil counts, serum CRP, plasma lactic acid, and PCT were noted...
February 2018: Indian Journal of Critical Care Medicine
Rachael K Ross, Luke Keele, Sherri Kubis, Andrew J Lautz, Adam C Dziorny, Adam R Denson, Kathleen A O'Connor, Marianne R Chilutti, Scott L Weiss, Jeffrey S Gerber
We retrospectively studied the effect of introducing procalcitonin into clinical practice on antibiotic use within a large academic pediatric intensive care unit. In the absence of a standardized algorithm, availability of the procalcitonin assay did not reduce the frequency of antibiotic initiations or the continuation of antibiotics for greater than 72 hours.
February 8, 2018: Journal of the Pediatric Infectious Diseases Society
William Bortcosh, Ashkon Shaahinfar, Sakina Sojar, Jean E Klig
PURPOSE OF REVIEW: The diagnostic capability, efficiency and versatility of point-of-care ultrasound (POCUS) have enabled its use in paediatric emergency medicine (PEM) and paediatric critical care (PICU). This review highlights the current applications of POCUS for the critically ill child across PEM and PICU to identify areas of progress and standardized practice and to elucidate areas for future research. RECENT FINDINGS: POCUS technology continues to evolve and advance bedside clinical care for critically ill children, with ongoing research extending its use for an array of clinical scenarios, including respiratory distress, trauma and dehydration...
March 9, 2018: Current Opinion in Pediatrics
Karen Trudel, Samara Zavalkoff, Nicholas Winters, Caroline Quach, Jacques Lacroix, Patricia S Fontela
BACKGROUND: Prolonged use of indwelling catheters is associated with hospital-acquired urinary tract infections (UTIs). Literature is scarce about the factors influencing urinary catheter removal and maintenance in children. This study aims to describe the determinants of urinary catheter removal in pediatric intensive care unit (PICU) patients. METHODS: Cross-sectional survey of 171 physicians and nurses working at 2 tertiary PICUs in Montreal, Canada. We used focus groups and literature review to design the survey questions and 3 clinical scenarios...
March 5, 2018: American Journal of Infection Control
A Aramburo, Jim Todd, Elizabeth C George, Sarah Kiguli, Peter Olupot-Olupot, Robert O Opoka, Charles Engoru, Samuel O Akech, Richard Nyeko, George Mtove, Diana M Gibb, Abdel G Babiker, Kathryn Maitland
BACKGROUND: Hyperlactataemia (HL) is a biomarker of disease severity that predicts mortality in patients with sepsis and malaria. Lactate clearance (LC) during resuscitation has been shown to be a prognostic factor of survival in critically ill adults, but little data exist for African children living in malaria-endemic areas. METHODS: In a secondary data analysis of severely ill febrile children included in the Fluid Expansion as Supportive Therapy (FEAST) resuscitation trial, we assessed the association between lactate levels at admission and LC at 8 h with all-cause mortality at 72 h (d72)...
March 9, 2018: BMC Medicine
W Philip T James
BACKGROUND: This analysis sets out an overview of an IUNS presentation of a European clinician's assessment of the challenges of coping with immediate critical clinical problems and how to use metabolic and a mechanistic understanding of disease when developing nutritional policies. SUMMARY: Critically ill malnourished children prove very sensitive to both mineral and general nutritional overload, but after careful metabolic control they can cope with a high-quality, energy-rich diet provided their initial lactase deficiency and intestinal atrophy are taken into account...
March 8, 2018: Annals of Nutrition & Metabolism
John Rene Labib, Sally Kamal Ibrahem, Hala Mohamed Sleem, Mohamed M Ismail, Shaimaa A M Abd El Fatah, Marwa Rashad Salem, Amaal A Abdelaal, Hadeel Al-Hanafi
Early identification of acute lung injury (ALI) in pediatric patients at risk of mortality is important for improving outcome.Assessment of soluble form of receptor for advanced glycation end products (sRAGE) as a valid biomarker for diagnosis of ALI among critically ill, pediatric patients in addition to correlating levels of sRAGE and different outcomes of those patients.A Hospital-based case-control study was conducted in pediatric intensive care units (PICUs) at Cairo University Hospital, along a period of 6 months...
March 2018: Medicine (Baltimore)
Andrew J Lautz, Kelly C Martin, Akira Nishisaki, Christopher P Bonafide, Roberta L Hales, Elizabeth A Hunt, Vinay M Nadkarni, Robert M Sutton, Donald L Boyer
OBJECTIVES: Miscommunication has been implicated as a leading cause of medical errors, and standardized handover programs have been associated with improved patient outcomes. However, the role of structured handovers in pediatric emergencies remains unclear. We sought to determine if training with an airway, breathing, circulation, situation, background, assessment, recommendation handover tool could improve the transmission of essential patient information during multidisciplinary simulations of critically ill children...
March 7, 2018: Hospital Pediatrics
Nita Khandelwal, Catherine L Hough, Lois Downey, Ruth A Engelberg, Shannon S Carson, Douglas B White, Jeremy M Kahn, Derek M Jones, Mary D Key, Wen Reagan, Laura S Porter, J Randall Curtis, Christopher E Cox
OBJECTIVES: Little is known about the experience of financial stress for patients who survive critical illness or their families. Our objective was to describe the prevalence of financial stress among critically ill patients and their families, identify clinical and demographic characteristics associated with this stress, and explore associations between financial stress and psychologic distress. DESIGN: Secondary analysis of a randomized trial comparing a coping skills training program and an education program for patients surviving acute respiratory failure and their families...
March 2, 2018: Critical Care Medicine
Lvlin Chen, Tiangui Li, Fang Fang, Yu Zhang, Andrew Faramand
BACKGROUND: Hyperglycemia is prevalent in patients in the pediatric intensive care unit. The purpose of this study was to describe the benefits and risks of tight glucose control (TGC) in critically ill children. METHODS: A systemic review and meta-analysis of the literature was carried out on randomized controlled trials of TGC in critically ill children admitted to the pediatric intensive care unit. The databases searched were Medline, Embase, and CENTRAL databases until May 1, 2017...
March 4, 2018: Critical Care: the Official Journal of the Critical Care Forum
Paula Lozano, Amy Houtrow
Self-management improves health outcomes in chronic illness not only by improving adherence to the treatment plan but also by building the individual's capacity to navigate challenges and solve problems. Support for self-management is a critical need among children and adolescents with (medically and/or socially) complex chronic conditions. Self-management support refers to services that health systems and community agencies provide to persons with chronic illness and their families to facilitate self-management; it is a collaboration between the patient, family, and care providers...
March 2018: Pediatrics
Danton S Char, Sandra Soo-Jin Lee, David Magnus, Mildred Cho
PurposeTo investigate the potential impacts of whole-genome sequencing (WGS) in the pediatric critical-care context, we examined how clinicians caring for critically ill children with congenital heart disease (CHD) anticipate and perceive the impact of WGS on their decision-making process and treatment recommendations.MethodsWe conducted semistructured in-person and telephone interviews of clinicians involved in the care of critically ill children with CHD at a high-volume pediatric heart center. We qualitatively analyzed the transcribed interviews...
March 1, 2018: Genetics in Medicine: Official Journal of the American College of Medical Genetics
Anna Clebone
PURPOSE OF REVIEW: Trauma is the most common cause of pediatric mortality. Much of the research that led to life-saving interventions in adults, however, has not been replicated in the pediatric population. Children have important physiologic and anatomic differences from adults, which impact hemostasis and transfusion. Hemorrhage is a leading cause of death in trauma, and children have important differences in their coagulation profiles. Transfusion strategies, including the massive transfusion protocol and use of antifibrinolytics, are still controversial...
April 2018: Current Opinion in Anaesthesiology
Laurel Willig, Erin Paquette, D Micah Hester, Bradley A Warady, John D Lantos
A 3-month-old boy with failure to thrive was referred to a nephrology clinic after a diagnostic workup for failure to thrive revealed a serum urea nitrogen level of 95 mg/dL and creatinine level of 3.6 mg/dL. A renal ultrasound revealed marked bilateral hydronephrosis with little remaining renal cortex in either kidney. A voiding cystourethrogram revealed evidence of posterior urethral valves. The child had no evident comorbidities. Fulguration of the valves was successfully performed but did not lead to improvement in kidney function...
February 28, 2018: Pediatrics
Samantha W Gee, Philip L Holt, Michael J Stoner
INTRODUCTION: Critically ill children who require transfer to tertiary care centers often require transport by specialized transport teams (TT). These interfacility transports require a medical control physician (MCP). Traditionally this role is assigned to fellows who are taught "on-the-job", but achieving competency in communication for those trained this way may not be optimal. We sought to close this curriculum gap by developing a MCP training program immersing emergency medicine (EM) and critical care (CC) fellows together with TT members to manage a simulated patient...
March 2018: Air Medical Journal
Katarzyna Marshall, Halley Martin, Kim Siarkowski Amer
Friends can provide encouragement and support during stressful times. Friends are even more important for children coping with chronic illness such as adolescents managing insulin dependent diabetes mellitus (IDDM). Nurses need to recognize that the knowledge and care of both the children coping with diabetes and friends can be critical. This study explored perceptions of adolescents managing diabetes and their peers. The non-affected peers and adolescents with IDDM ranged in age between 15-18 were studied using an exploratory qualitative method...
March 2018: Comprehensive Child and Adolescent Nursing
Laura S Peterson, Cecilia Gállego Suárez, Hannah E Segaloff, Cameron Griffin, Emily T Martin, Folafoluwa O Odetola, Kanakadurga Singer
OBJECTIVE: To evaluate the effect of overweight and obesity on outcomes and resource use among patients with sepsis in the pediatric intensive care unit (PICU). DESIGN: Retrospective analysis of clinical characteristics, resource use, and mortality among children 0 to 20 years of age admitted to the C.S. MottChildren's Hospital PICU (University of Michigan) between January 2009 and December 2015, with a diagnostic code for sepsis at admission (based on International Classification of Diseases, Ninth Revision- Clinical Modification codes) and with weight and height measurements at PICU admission...
January 1, 2018: Journal of Intensive Care Medicine
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