Archives of Pediatric Critical Care最新文献

{"title":"The importance of nutritional support in critically ill pediatric patients: a focus on refeeding syndrome","authors":"W. Jhang","doi":"10.32990/apcc.2023.00087","DOIUrl":"https://doi.org/10.32990/apcc.2023.00087","url":null,"abstract":"","PeriodicalId":148143,"journal":{"name":"Archives of Pediatric Critical Care","volume":"94 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139131764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of disseminated intravascular coagulation in critically ill pediatric patients","authors":"W. Jhang","doi":"10.32990/apcc.2023.00080","DOIUrl":"https://doi.org/10.32990/apcc.2023.00080","url":null,"abstract":"","PeriodicalId":148143,"journal":{"name":"Archives of Pediatric Critical Care","volume":"39 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139132674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refeeding syndrome in critically ill children: understanding, prevention, and management","authors":"Younga Kim","doi":"10.32990/apcc.2023.00073","DOIUrl":"https://doi.org/10.32990/apcc.2023.00073","url":null,"abstract":"malnour-ished individuals such as concentration camp detainees and pris-oners of war [1]. This condition arises when individuals who have experienced prolonged periods of undernutrition are rein-troduced to regular nutrition, which can lead to a sharp increase","PeriodicalId":148143,"journal":{"name":"Archives of Pediatric Critical Care","volume":"5 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139135867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for mortality in critically ill pediatric patients receiving continuous renal replacement therapy","authors":"Sujeung Kang, H. Choi","doi":"10.32990/apcc.2023.00031","DOIUrl":"https://doi.org/10.32990/apcc.2023.00031","url":null,"abstract":"Background: Continuous renal replacement therapy is administered increasingly often in pediatric cases of acute kidney injury. However, the mortality rate remains quite high in these patients. Therefore, this study aimed to investigate the risk factors for mortality in critically ill pediatric patients receiving continuous renal replacement therapy. Methods: A retrospective review was conducted on 96 patients who were admitted to a pediatric intensive care unit and underwent continuous renal replacement therapy from January 2013 to December 2022. Results: Of the 96 patients, 47 survived and 49 died, resulting in a mortality rate of 51%. Multivariate analysis showed that each additional vasoactive inotropic agent yielded an odds ratio (OR) of 5.233 (95% confidence interval [CI], 1.804–15.176) for mortality ( p =0.002). Additionally, higher risks of mortality were found for each increase of 1 mmol/L in the lactate level (OR, 1.076; 95% CI, 1.023–1.131; p =0.004) and each 1-day increase in the duration of continuous renal replacement therapy (OR, 1.043; 95% CI, 1.004– 1.084; p =0.030). Conclusion: An increased number of vasoactive inotropic agents, higher lactate levels, and a longer duration of continuous renal replacement therapy were associated with an increased risk of mortality. The management of hypotension and therapeutic interventions for high lactate levels are expected to shorten the duration of continuous renal replacement therapy, thereby reducing the risk of mortality","PeriodicalId":148143,"journal":{"name":"Archives of Pediatric Critical Care","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116709239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of an estimating equation for the baseline creatinine level in critically ill pediatric patients","authors":"S. Park, W. Jhang","doi":"10.32990/apcc.2023.00010","DOIUrl":"https://doi.org/10.32990/apcc.2023.00010","url":null,"abstract":"Background: The current diagnostic criteria for acute kidney injury mainly rely on baseline serum creatinine (SCr-base). However, this information is frequently missing or unavailable for a significant number of hospitalized patients. In this study, we developed an estimating equation (EE) for SCr-base and validated its performance in critically ill pediatric patients. Methods: This single-center retrospective study included patients admitted to the pediatric intensive care unit (PICU) at a tertiary care children’s hospital between January 2016 and July 2020. These patients had a measured SCr-base (mSCr-base) within 3 months prior to admission and initial SCr value at PICU admission (SCr-adm). The patients were divided by admission date into a derivation cohort and a validation cohort for the development and validation of the EE. Results: In total, 761 children were included in the study (605 in the derivation cohort and 156 in the validation cohort). We employed linear regression analysis to develop the following EE: eSCr-base=0.159+(–0.031)×sex+(0.355×SCr-adm)+(0.006×weight for height z-score). Compared to other imputation methods for SCr-base, such as SCr-adm and SCr-base determined by back-calculation with an assumed estimated glomerular filtration rate of 75 mL/min/1.73 m 2 (SCr-eGFR75), eSCr-base demonstrated higher agreement with mSCr-base, exhibiting less bias (0.005) and narrower limits of agreement (LOA) interval (0.506). Conclusion: eSCr-base calculated through an EE showed better agreement with mSCr-base, with less bias and a smaller LOA interval than other currently used methods (SCr-adm and SCr-eGFR75). Further large-scale studies are necessary for validation and widespread adoption.","PeriodicalId":148143,"journal":{"name":"Archives of Pediatric Critical Care","volume":"146 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120885119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of fluid therapy during the first 12 hours after septic shock onset in pediatric patients","authors":"E. Ha, W. Jhang, S. Park","doi":"10.32990/apcc.2023.00038","DOIUrl":"https://doi.org/10.32990/apcc.2023.00038","url":null,"abstract":"Background: Initial fluid therapy is the cornerstone of hemodynamic resuscitation in pediatric patients with septic shock. This study investigated the association between fluid therapy during the first 12 hours after septic shock onset and the outcomes of pediatric patients. Methods: This retrospective, observational study included consecutive pediatric patients with septic shock who were admitted to a multidisciplinary pediatric intensive care unit between January 2012 and December 2019. Data on total fluid administration within the first 12 hours of septic shock onset, patient characteristics, and outcome measurements were collected from validated electronic medical records. Results: In total, 144 cases were included (overall 28-day mortality rate, 20.1%). Significant differences were found between survivors and non-survivors in the proportion of fluid received within the first 3 hours (36.9% vs. 25.4%, p =0.004) and within the last 3 hours (18.9% vs. 21.3%, p =0.031). The mortality rate was lower in patients who received a higher proportion of fluid within the first 3 hours (13.9% vs. 26.4%, p =0.048). Conversely, those with a higher proportion of fluid in the last 3 hours had a significantly higher mortality rate (29.6% vs. 14.4%, p =0.025). Multivariable logistic regression analysis revealed that a higher proportion of fluid within the first 3 hours was associated with decreased mortality (odds ratio [OR], 0.951; 95% confidence interval [CI], 0.918–0.986; p =0.028), while a higher proportion within the last 3 hours was associated with increased mortality (OR, 2.761; 95% CI, 1.175–6.495; p =0.020). Conclusion: Higher fluid intake during the initial 3 hours after septic shock onset was linked to a reduction in 28-day mortality among pediatric patients; conversely, higher fluid volume during the final 3 hours of the 12-hour period post-onset was correlated with worse survival outcomes. Providing an adequate fluid volume within the first 3 hours, followed by a more conservative approach to fluid administration, may contribute to decreased mortality.","PeriodicalId":148143,"journal":{"name":"Archives of Pediatric Critical Care","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131172348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shining forward: small steps toward a brighter future in pediatric critical care—Launching Archives of Pediatric Critical Care (APCC)","authors":"W. Jhang","doi":"10.32990/apcc.2023.00045","DOIUrl":"https://doi.org/10.32990/apcc.2023.00045","url":null,"abstract":"","PeriodicalId":148143,"journal":{"name":"Archives of Pediatric Critical Care","volume":"98 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114392967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sufentanil use in critically ill children: a single-center experience","authors":"S. Park, W. Jhang","doi":"10.32990/apcc.2023.00017","DOIUrl":"https://doi.org/10.32990/apcc.2023.00017","url":null,"abstract":"Background: Critically ill children often require pain management or sedation due to their underlying conditions or the need for intensive care. However, the available drug options and their clinical reliability are frequently limited for these patients. This study explored the utility of sufentanil as an analgosedative in critically ill pediatric patients, drawing on clinical experience. Methods: This single-center retrospective observational cohort study included patients under 19 years of age admitted to the pediatric intensive care unit (PICU) in a tertiary care children’s hospital between March 2021 and September 2022, in whom sufentanil was used as the first-choice continuous analgosedative drug. Results: In total, 225 patients were included. The most common reason for PICU admission was postoperative care (34.7%), followed by respiratory failure (20.0%), and cardiac problems (17.3%). The initial median starting and maximum doses of sufentanil were 0.5 μg/kg/hr (interquartile range [IQR], 0.3–1.0). The median durations of sufentanil use, mechanical ventilation support, and PICU stay were 1 days (IQR, 4–12), 6 days (IQR, 1–17) and 9 days (IQR, 5–27), respectively. In 199 (88.4%) patients, an appropriate analgesia/sedation level was achieved with sufentanil alone. However, 26 patients required additional drugs such as midazolam and ketamine infusion after administering the maximum dose of sufentanil, indicating the necessity for supplementary agents. No significant adverse effects or withdrawal symptoms were associated with sufentanil use. Conclusion: Sufentanil","PeriodicalId":148143,"journal":{"name":"Archives of Pediatric Critical Care","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125500795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The application and effect of neurally adjusted ventilatory assist","authors":"S. Park","doi":"10.32990/apcc.2023.00024","DOIUrl":"https://doi.org/10.32990/apcc.2023.00024","url":null,"abstract":"Although mechanical ventilation is a life-saving intervention for the management of acute respiratory failure, it can cause complications such as ventilator-induced lung injury and ventilator-induced diaphragmatic dysfunction, adversely affecting the outcomes of critically ill patients. Hence, methods of implementing lung-and diaphragm-protective ventilation are currently a major topic of discussion in intensive care medicine. Unlike other modes of partial ventilator assistance, which adopt conventional pneumatic signals (flow, volume, and airway pressure) to drive and control the ventilator operation, neurally adjusted ventilatory assist (NAVA) uses the electrical activity of the diaphragm, which is the best signal for estimating the respiratory drive, to control triggering, cycling, and the magnitude of assistance. Based on this concept, NAVA has the ability to avoid over-and under-assistance, improve patient-ventilator interaction and synchrony, and potentially play a role in lung-and diaphragm-protective ventilation. However, it remains to be determined whether these advantages translate into improved clinical outcomes.","PeriodicalId":148143,"journal":{"name":"Archives of Pediatric Critical Care","volume":"96 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116499982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}