Journal of Pediatric Intensive Care最新文献_第10页

Terminal Withdrawal of Mechanical Ventilation in a PICU 重症监护病房中机械通气的终止

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2022-08-10 DOI: 10.1055/s-0043-1768031

J. Baird, N. Piracha, Max E. Lindeman

{"title":"Terminal Withdrawal of Mechanical Ventilation in a PICU","authors":"J. Baird, N. Piracha, Max E. Lindeman","doi":"10.1055/s-0043-1768031","DOIUrl":"https://doi.org/10.1055/s-0043-1768031","url":null,"abstract":"Abstract Data regarding a terminal withdrawal of mechanical ventilation (TWMV) in pediatric patients, in particular the time to death, would be helpful to family and hospital staff. This retrospective case series will review the TWMV in pediatric intensive care unit (PICU) patients at our hospital between 2015 and 2020. There were 222 PICU deaths and 53 of these patients died following a TWMV. The time to death was <1 hour in 37 patients, from 1 to 24 hours in 12 patients, and >24 hours in 4 patients. Neither age nor the duration of mechanical ventilation prior to TWMV was associated with time to death. TWMV was complicated by concurrent withdrawal of cardiac support devices in 9 patients and by a recent cardiac arrest in 3 patients (1 of whom also had a cardiac support device withdrawal), and the time to death for these 11 patients was less than 1 hour ( p = 0.01 vs. all others). The time to death for those without concurrent withdrawal of cardiac support devices or recent cardiac arrest was shorter in those with a higher fraction of inspired oxygen but was not associated with positive end expiratory pressure. Time to death following a TWMV was less than a day in more than 90% of our patients and was not associated with patient age or the duration of mechanical ventilation. However, in patients without a recent cardiac arrest or concurrent withdrawal of cardiac support devices, nearly 1 in 10 survived a TWMV for more than a day, while those with a recent cardiac arrest or concurrent withdrawal of cardiac support devices survived for less than an hour.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88676217","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}

引用次数: 0

Mitigation and Outcomes of Difficult Bag-Mask Ventilation in Critically Ill Children 危重患儿袋式面罩通气困难的缓解和结果

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2022-08-03 DOI: 10.1055/s-0042-1760413

C. Daigle, Elizabeth K Laverriere, B. Bruins, J. Lockman, J. Fiadjoe, Nancy McGowan, N. Napolitano, J. Shults, V. Nadkarni, A. Nishisaki

{"title":"Mitigation and Outcomes of Difficult Bag-Mask Ventilation in Critically Ill Children","authors":"C. Daigle, Elizabeth K Laverriere, B. Bruins, J. Lockman, J. Fiadjoe, Nancy McGowan, N. Napolitano, J. Shults, V. Nadkarni, A. Nishisaki","doi":"10.1055/s-0042-1760413","DOIUrl":"https://doi.org/10.1055/s-0042-1760413","url":null,"abstract":"Abstract Difficult bag-mask ventilation (BMV) occurs in 10% of pediatric intensive care unit (PICU) tracheal intubations (TI). The reasons clinicians identify difficult BMV in the PICU and the interventions used to mitigate that difficulty have not been well-studied. This is a prospective, observational, single-center study. A patient-specific data form was sent to PICU physicians supervising TIs from November 2019 through December 2020 to identify the presence of difficult BMV, attempted interventions used, and perceptions about intervention success. The dataset was linked and merged with the local TI quality database to assess safety outcomes. Among 305 TIs with response (87% response rate), 267 (88%) clinicians performed BMV during TI. Difficult BMV was reported in 28 of 267 patients (10%). Commonly reported reasons for difficult BMV included: facial structure (50%), high inspiratory pressure (36%), and improper mask fit (21%). Common interventions were jaw thrust (96%) and an airway adjunct (oral airway 50%, nasal airway 7%, and supraglottic airway 11%), with ventilation improvement in 44% and 73%, respectively. Most difficult BMV was identified before neuromuscular blockade (NMB) administration (96%) and 67% (18/27) resolved after NMB administration. The overall success in improving ventilation was 27/28 (96%). TI adverse outcomes (hemodynamic events, emesis, and/or hypoxemia <80%) are associated with the presence of difficult BMV (10/28, 36%) versus non-difficult BMV (20/239, 8%, p < 0.001). Difficult BMV is common in critically ill children and is associated with increased TI adverse outcomes. Airway adjunct placement and NMB use are often effective in improving ventilation.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81528578","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}

引用次数: 0

Patient-Specific Factors Associated with Dexmedetomidine Dose Requirements in Critically Ill Children 危重儿童右美托咪定剂量需求与患者特异性因素相关

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2022-08-02 DOI: 10.1055/s-0042-1753537

Karryn R. Crisamore, P. Empey, Jonathan H. Pelletier, R. Clark, Christopher M. Horvat

{"title":"Patient-Specific Factors Associated with Dexmedetomidine Dose Requirements in Critically Ill Children","authors":"Karryn R. Crisamore, P. Empey, Jonathan H. Pelletier, R. Clark, Christopher M. Horvat","doi":"10.1055/s-0042-1753537","DOIUrl":"https://doi.org/10.1055/s-0042-1753537","url":null,"abstract":"The objective of this study was to evaluate patient-specific factors associated with dexmedetomidine dose requirements during continuous infusion. A retrospective cross-sectional analysis of electronic health record-derived data spanning 10 years for patients admitted with a primary respiratory diagnosis at a quaternary children's hospital and who received a dexmedetomidine continuous infusion (n = 346 patients) was conducted. Penalized regression was used to select demographic, clinical, and medication characteristics associated with a median daily dexmedetomidine dose. Identified characteristics were included in multivariable linear regression models and sensitivity analyses. Critically ill children had a median hourly dexmedetomidine dose of 0.5 mcg/kg/h (range: 0.1–1.8), median daily dose of 6.7 mcg/kg/d (range: 0.9–38.4), and median infusion duration of 1.6 days (range: 0.25–5.0). Of 26 variables tested, 15 were selected in the final model with days of dexmedetomidine infusion (β: 1.9; 95% confidence interval [CI]: 1.6, 2.3), median daily morphine milligram equivalents dosing (mg/kg/d) (β: 0.3; 95% CI: 0.1, 0.5), median daily ketamine dosing (mg/kg/d) (β: 0.2; 95% CI: 0.1, 0.3), male sex (β: −1.1; 95% CI: −2.0, −0.2), and non-Black reported race (β: −1.2; 95% CI: −2.3, −0.08) significantly associated with median daily dexmedetomidine dose. Approximately 56% of dose variability was explained by the model. Readily obtainable information such as demographics, concomitant medications, and duration of infusion accounts for over half the variability in dexmedetomidine dosing. Identified factors, as well as additional environmental and genetic factors, warrant investigation in future studies to inform precision dosing strategies.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86915329","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}

引用次数: 1

Outcomes of Pediatric Drowning in the Pediatric Intensive Care Unit 儿科重症监护病房儿童溺水的结局

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2022-07-28 DOI: 10.1055/s-0042-1751267

Rebecca K. Aures, J. Rosenthal, Ashley Chandler, T. Raybould, M. Flaherty

{"title":"Outcomes of Pediatric Drowning in the Pediatric Intensive Care Unit","authors":"Rebecca K. Aures, J. Rosenthal, Ashley Chandler, T. Raybould, M. Flaherty","doi":"10.1055/s-0042-1751267","DOIUrl":"https://doi.org/10.1055/s-0042-1751267","url":null,"abstract":"Drowning remains a leading cause of death in children. Knowledge of outcomes of these patients who survive drowning but require critical care is lacking. We aim to study the current mortality rate, describe interventions and associated diagnoses, and examine factors related to risk of death in drowning victims admitted to the pediatric intensive care unit (PICU). We conducted a retrospective multicenter cohort study utilizing data from the Virtual Pediatric Systems Database in 143 PICUs between January 1, 2010, and December 31, 2019. Patients between 0 and 18 years of age admitted to a PICU with a diagnosis of drowning were included. The primary outcome was death prior to hospital discharge. Predictors included demographics, critical care interventions, and associated diagnoses. Odds ratios were calculated using multivariate logistic regression. There were 4,855 patients admitted with drowning across the study period. The overall PICU mortality rate in this cohort was 18.7%. Factors associated with an increased odds of death included being transported from an outside hospital, mechanical ventilation, central line placement, cardiac arrest, respiratory failure, and hypoxic ischemic encephalopathy. In 2,479 patients requiring mechanical ventilation, 63 were treated with extracorporeal membrane oxygenation which was not associated with mortality. This data provide updated insight into pediatric drowning victims requiring critical care and their prognosis, as it relates to the interventions they receive. Overall PICU mortality rates for drowning are higher than overall PICU mortality and mortality from other causes of injury. These findings have implications for the care of drowned children in ICU environments and in continued preventive efforts.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90445371","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}

引用次数: 0

Beyond Vital Signs: Pediatric Sepsis Screening that Includes Organ Failure Assessment Detects Patients with Worse Outcomes 超越生命体征:包括器官衰竭评估在内的儿科败血症筛查可检测出预后较差的患者

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2022-07-28 DOI: 10.1055/s-0042-1753536

Jesseca A. Paulsen, Karen M. Wang, Isabella M. Masler, Jessica Hicks, S. Green, Jeremy M. Loberger

{"title":"Beyond Vital Signs: Pediatric Sepsis Screening that Includes Organ Failure Assessment Detects Patients with Worse Outcomes","authors":"Jesseca A. Paulsen, Karen M. Wang, Isabella M. Masler, Jessica Hicks, S. Green, Jeremy M. Loberger","doi":"10.1055/s-0042-1753536","DOIUrl":"https://doi.org/10.1055/s-0042-1753536","url":null,"abstract":"Pediatric sepsis screening is recommended. The 2005 Goldstein criteria, the basis of our institutional sepsis screening tool (ISST), correlate poorly with clinically diagnosed sepsis. The study objective was to retrospectively evaluate the ISST sensitivity compared with the Pediatric Sequential Organ Failure Assessment (pSOFA). This was a single-center retrospective cohort study. The primary outcome was pSOFA score and ISST sensitivity for severe sepsis. Secondary outcomes included clinical outcome measures. In this severe sepsis cohort (N = 491), pSOFA and ISST sensitivity were 57.6 and 61.1%, respectively. In regression analysis for a positive pSOFA, positive blood culture (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.1–4.3, p = 0.025), older age (OR 1.006, 95% CI 1.003–1.009, p < 0.001), and pulmonary infectious source (OR 3.3, 95% CI 1.6–6.5, p = 0.001) demonstrated independent association. In regression analysis for a positive ISST, older age (OR 1.003, 95% CI 1–1.006, p = 0.031) and intra-abdominal infectious source (OR 0.3, 95% CI 0.1–0.8, p = 0.014) demonstrated independent association. A negative ISST was associated with higher intensive care unit (ICU) admission prevalence (p = 0.01) and fewer ICU-free days (p = 0.018). A positive pSOFA score was associated with higher ICU admission prevalence, vasopressor requirement, and vasopressor days as well as fewer ICU, hospital, and mechanical ventilation-free days (all p < 0.001). Exploratory analysis combining the ISST and pSOFA into a hybrid screen demonstrated superior sensitivity (84.3%) and outcome discrimination. The pSOFA demonstrated noninferior sensitivity to a Goldstein-based institutional sepsis screening model. Further, pSOFA was a better discriminator of poor clinical outcomes. An exploratory hybrid screening model shows superior performance but will require prospective study.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88270627","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}

引用次数: 0

Early Oral Rehydration Therapy in Diabetic Ketoacidosis: A Randomized Controlled Study 早期口服补液治疗糖尿病酮症酸中毒:一项随机对照研究

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2022-07-28 DOI: 10.1055/s-0042-1753459

S. Kola, Shalu Gupta, Virendra Kumar

{"title":"Early Oral Rehydration Therapy in Diabetic Ketoacidosis: A Randomized Controlled Study","authors":"S. Kola, Shalu Gupta, Virendra Kumar","doi":"10.1055/s-0042-1753459","DOIUrl":"https://doi.org/10.1055/s-0042-1753459","url":null,"abstract":"\u0000 Objectives We aimed to compare the efficacy of oral versus intravenous (IV) fluid therapy in correcting dehydration in diabetic ketoacidosis (DKA) when pH was ≥ 7.25 and Glasgow coma scale (GCS) score was ≥12. We also compared the time to resolution of DKA.\u0000 Subjects Children aged ≤18 years with DKA were included in the study. In our pilot study, 40 children were enrolled from June 2018 to April 2019 and divided into two groups after achieving pH ≥ 7.25 and GCS score ≥ 12.\u0000 Materials and Methods This was an open-label, parallel-arm, randomized control trial conducted in the pediatric intensive care unit of a tertiary referral hospital in North India. The IV group (control group) received treatment as per the standard protocol, whereas the oral group (trial group) received only oral fluids; IV fluid was withheld for 48 hours. Dehydration was clinically assessed on admission and after 48 hours, and the proportion of children achieving correction of dehydration was compared. Biochemical parameters were measured over time, and the time taken for resolution was compared between groups.\u0000 Results Both groups achieved successful correction of dehydration. No significant difference was observed in the time taken from randomization to complete resolution of DKA. Hyperchloremia improved significantly earlier in the oral group after randomization.\u0000 Conclusion Early institution of oral rehydration strategy after achieving pH ≥ 7.25 and GCS score ≥ 12 was effective in correcting dehydration at a rate comparable to standard IV rehydration. Hyperchloremia was observed to resolve earlier in patients that received oral rehydration therapy.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89569287","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}

引用次数: 0

Outcomes of Extracorporeal Life Support in Children with Meningococcal Septicemia: A Retrospective Cohort Study. 脑膜炎球菌败血症患儿体外生命支持的结果:一项回顾性队列研究。

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2022-07-28 eCollection Date: 2023-12-01 DOI: 10.1055/s-0042-1750302

Brandon Michael Henry, Alexis Benscoter, Tanya Perry, Maria Helena Santos de Oliveira, Andrew Misfeldt, David S Cooper

{"title":"Outcomes of Extracorporeal Life Support in Children with Meningococcal Septicemia: A Retrospective Cohort Study.","authors":"Brandon Michael Henry, Alexis Benscoter, Tanya Perry, Maria Helena Santos de Oliveira, Andrew Misfeldt, David S Cooper","doi":"10.1055/s-0042-1750302","DOIUrl":"10.1055/s-0042-1750302","url":null,"abstract":"Meningococcal disease is associated with high mortality despite aggressive antibiotic therapy and intensive care support. Patients may develop refractory hypotension and acute respiratory distress syndrome in which extracorporeal membrane oxygenation (ECMO) could serve as a life-saving rescue therapy. However, there is limited data regarding the outcomes of ECMO support in the setting of meningococcal disease. This retrospective analysis of prospectively collected data from Extracorporeal Life Support Organization registry (1989-2019) enrolled children (29 days-18 years old) with Neisseria meningitidis infection receiving ECMO for any support type and mode. A total of 122 patients underwent a single course of ECMO support, equating to 122 ECMO runs. The overall survival-to-discharge rate was 46.7%. Patients receiving pulmonary venovenous (VV) ECMO had the highest survival-to-discharge of 85.7%, while those receiving venoarterial (VA) ECMO for pulmonary indications had a survival of 32.4%. Patients receiving VA ECMO support for cardiac indications had a survival-to-discharge rate of 60.9%. Those needing extracorporeal cardiopulmonary resuscitation (ECPR) had a poor survival (14.3%). Hemorrhagic complications were common, occurring in 43.4% of patients, but not found to be associated with mortality (complication was present in 47.7% of deceased and 38.6% of survivors, p = 0.31). Multivariable logistic regression analysis revealed that neurologic complications were associated with increased odds of mortality (odds ratio: 44.11; 95% confidence interval: 4.95-393.08). ECMO can be utilized as rescue therapy in children with refractory cardiopulmonary failure in setting of meningococcemia. Patients who require pulmonary VV or cardiac ECMO have the best ECMO outcomes. However, the use of ECMO in those suffering cardiac arrest (ECPR) should be undertaken with caution.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87637141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Extracorporeal Membrane Oxygenation and Hemolytic Uremic Syndrome in Children: Outcome Review of a Multicenter National Database 儿童体外膜氧合和溶血性尿毒症综合征:多中心国家数据库的结果回顾

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2022-07-18 DOI: 10.1055/s-0042-1758478

Mireille Liboiron, M. Malone, Clare C. Brown, P. Prodhan

{"title":"Extracorporeal Membrane Oxygenation and Hemolytic Uremic Syndrome in Children: Outcome Review of a Multicenter National Database","authors":"Mireille Liboiron, M. Malone, Clare C. Brown, P. Prodhan","doi":"10.1055/s-0042-1758478","DOIUrl":"https://doi.org/10.1055/s-0042-1758478","url":null,"abstract":"Abstract Hemolytic uremic syndrome (HUS) is a triad of hemolytic anemia, thrombocytopenia, and acute renal failure. In critically ill children with HUS, extrarenal manifestations may require intensive care unit admission and extracorporeal membrane oxygenation (ECMO) support. Outcomes specific to HUS and ECMO in children have not been well investigated. The primary aim of this project was to query a multicenter database to identify risk factors associated with mortality in HUS patients supported on ECMO. A secondary aim was to identify factors associated with ECMO utilization in children with HUS. Utilizing the Pediatric Health Information System database (January 2004 and September 2018), this retrospective, multicenter cohort study identified the index HUS hospitalization among children aged 0 to 18 years. Univariate analysis was used to compare demographics, clinical characteristics, and procedures to identify risk factors associated with adverse outcomes. Among 4,144 subjects, 37 were supported on ECMO. Survival for those on ECMO support was 54%. Among nonsurvivors, 59% of deaths occurred within 14 days of hospitalization. The mean hospital LOS was 15.9 days in nonsurvivors versus 53.9 days for survivors ( p < 0.001). When comparing subjects supported on ECMO to those who were not, patients with ECMO support had statistically longer hospital LOS and higher rates of extrarenal involvement ( p < 0.001). This study found a mortality rate of 46% among HUS patients requiring ECMO. The investigated clinical risk factors were not associated with mortality among the ECMO population. The study identifies risk factors associated with ECMO utilization in children with HUS.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77577839","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}

引用次数: 0

Use of Continuous EEG Monitoring and Short-Term Outcomes in Critically Ill Children 危重儿童连续脑电图监测与短期预后的应用

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Journal of Pediatric Intensive Care Pub Date : 2022-07-12 DOI: 10.1055/s-0042-1749433

Xiuhua L Bozarth, P. Ko, Hao Bao, N. Abend, R. Watson, Pingping Qu, L. Dervan, L. Morgan, Mark S. Wainwright, John McGuire, Edward Novotny

引用次数: 0

Clinical Profile of Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2 Admitted to Pediatric Intensive Care Unit 儿科重症监护室收治的SARS-CoV-2相关儿童多系统炎症综合征的临床特征

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2022-07-11 DOI: 10.1055/s-0042-1750300

Kenchappa Yashaswini, A. Lalitha, Giri Subramanian Naresh Kanna, John Michael Raj A.

{"title":"Clinical Profile of Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2 Admitted to Pediatric Intensive Care Unit","authors":"Kenchappa Yashaswini, A. Lalitha, Giri Subramanian Naresh Kanna, John Michael Raj A.","doi":"10.1055/s-0042-1750300","DOIUrl":"https://doi.org/10.1055/s-0042-1750300","url":null,"abstract":"\u0000 Objectives Multisystem inflammatory syndrome in children (MIS-C) is a post Severe Acute Respiratory Syndrome Coronavirus2 (SARS CoV2) immune dissonance seen in the pediatric population. The current study is an attempt to understand the subtleties of diverse phenotypes, immunotherapeutics, and short-term outcome parameters of MIS-C.\u0000 Materials and Methods Children admitted to the pediatric intensive care unit (PICU) between 1 month and 18 years, satisfying MIS-C criteria, were enrolled in this retrospective observational study. They were stratified into different phenotypes like shock, Kawasaki disease, and nonspecific phenotypes. Respiratory, vasoactive support, and outcomes were analyzed using appropriate statistical methods.\u0000 Results Seventy-five children presented with MIS-C during the study period. The mean age was 66 months with 54.6% females. Coronavirus disease (COVID) antibody was positive for 41 (54%), real time-reverse rranscription polymerase chain reaction (RT-PCR) positivity was positive in 16 (21.3%), and rapid antigen test was positive in 10 (13%). Common symptoms included fever (100%), rash (30%), conjunctival congestion (29.7%), and cardiovascular (68% with shock) involvement. Notable differences in shock phenotype were identified including Pediatric Risk of Mortality III score, inflammatory markers, cardiac involvement, need for inotropes, and ventilation. In total, 32% received intravenous immunoglobulin and 48% glucocorticoids. The overall mortality in children with MIS-C was 9 (12%). The need for mechanical ventilation (odds ratio 10.94, confidence interval [2.06, 58.06], p-value <0.005) was noted as an independent predictor of mortality by logistic regression.\u0000 Conclusion MIS-C showed a significant cardiovascular involvement at presentation, necessitating intensive care and immunomodulatory therapies. There were higher odds of mortality in the ventilated cohort.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76125916","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}

引用次数: 0