Journal of Pediatric Intensive Care最新文献_第2页

Troponin I as an Independent Biomarker of Outcome in Children with Systemic Inflammatory Response. 肌钙蛋白I作为全身性炎症反应儿童预后的独立生物标志物。

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Journal of Pediatric Intensive Care Pub Date : 2023-09-01 DOI: 10.1055/s-0041-1731432

Heitor P Leite, Rodrigo Medina, Emilio L Junior, Tulio Konstantyner

{"title":"Troponin I as an Independent Biomarker of Outcome in Children with Systemic Inflammatory Response.","authors":"Heitor P Leite, Rodrigo Medina, Emilio L Junior, Tulio Konstantyner","doi":"10.1055/s-0041-1731432","DOIUrl":"https://doi.org/10.1055/s-0041-1731432","url":null,"abstract":"Cardiac troponin-I (cTnI) is a biomarker of myocardial injury with implications for clinical outcomes. May other contributing factors that could affect outcomes have not been uniformly considered in pediatric studies. We hypothesized that there is an association between admission serum cTnI and outcomes in critically ill children taking into account the magnitude of the acute systemic inflammatory response syndrome (SIRS), serum lactate concentrations, and nutritional status. Second, we tested for potential factors associated with elevated serum cTnI. This was a prospective cohort study in 104 children (median age: 21.3 months) consecutively admitted to a pediatric intensive care unit (PICU) of a teaching hospital with SIRS and without previous chronic diseases. Primary outcome variables were PICU-free days, ventilator-free days, and 30-day mortality. Exposure variables were serum cTnI concentration on admission, revised pediatric index of mortality (PIM2), pediatric logistic organ dysfunction (PELOD-2), hypotensive shock, C-reactive protein, procalcitonin, and serum lactate on admission, and malnutrition. Elevated cTnI (>0.01 μg/L) was observed in 24% of patients, which was associated with the reduction of ventilator-free days (β coefficient = - 4.97; 95% confidence interval [CI]: -8.03; -1.91) and PICU-free days (β coefficient = - 5.76; 95% CI: -8.97; -2.55). All patients who died had elevated serum cTnI. The increase of 0.1 μg/L in cTnI concentration resulted in an elevation of 2 points in the oxygenation index (β coefficient = 2.0; 95% CI: 1.22; 2.78, p < 0.001). The PIM2 score, hypotensive shock in the first 24 hours, and serum lactate were independently associated with elevated cTnI on admission. We conclude that elevated serum cTnI on admission is independently associated with adverse outcomes in children with SIRS and without associated chronic diseases.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"12 3","pages":"203-209"},"PeriodicalIF":0.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10411187/pdf/10-1055-s-0041-1731432.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9979475","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

Predictors of Failure of Noninvasive Ventilation in Critically Ill Children. 危重儿童无创通气失败的预测因素。

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2023-09-01 DOI: 10.1055/s-0041-1731433

Alyson K Baker, Andrew L Beardsley, Brian D Leland, Elizabeth A Moser, Riad L Lutfi, A Ioana Cristea, Courtney M Rowan

{"title":"Predictors of Failure of Noninvasive Ventilation in Critically Ill Children.","authors":"Alyson K Baker, Andrew L Beardsley, Brian D Leland, Elizabeth A Moser, Riad L Lutfi, A Ioana Cristea, Courtney M Rowan","doi":"10.1055/s-0041-1731433","DOIUrl":"https://doi.org/10.1055/s-0041-1731433","url":null,"abstract":"Noninvasive ventilation (NIV) is a common modality employed to treat acute respiratory failure. Most data guiding its use is extrapolated from adult studies. We sought to identify clinical predictors associated with failure of NIV, defined as requiring intubation. This single-center retrospective observational study included children admitted to pediatric intensive care unit (PICU) between July 2014 and June 2016 treated with NIV, excluding postextubation. A total of 148 patients was included. Twenty-seven (18%) failed NIV. There was no difference between the two groups with regard to age, gender, comorbidities, or etiology of acute respiratory failure. Those that failed had higher admission pediatric risk of mortality ( p = 0.01) and pediatric logistic organ dysfunction ( p = 0.002) scores and higher fraction of inspired oxygen (FiO 2 ; p = 0.009) at NIV initiation. Failure was associated with lack of improvement in tachypnea. At 6 hours of NIV, the failure group had worsening tachypnea with a median increase in respiratory rate of 8%, while the success group had a median reduction of 18% ( p = 0.06). Multivariable Cox's proportional hazard models revealed FiO 2 at initiation and worsening respiratory rate at 1- and 6-hour significant risks for failure of NIV. Failure was associated with a significantly longer PICU length of stay (success [2.8 days interquartile range (IQR): 1.7, 5.5] vs. failure [10.6 days IQR: 5.6, 13.2], p < 0.001). NIV can be successfully employed to treat acute respiratory failure in pediatric patients. There should be heightened concern for NIV failure in hypoxemic patients whose tachypnea is unresponsive to NIV. A trend toward improvement should be closely monitored.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"12 3","pages":"196-202"},"PeriodicalIF":0.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10411242/pdf/10-1055-s-0041-1731433.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10033148","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: 1

Prothrombin Complex Concentrate Utilization in Children's Hospitals. 凝血酶原浓缩液在儿童医院的应用。

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2023-09-01 DOI: 10.1055/s-0041-1731686

Jeffrey E Lutmer, Christian Mpody, Eric A Sribnick, Takaharu Karube, Joseph D Tobias

{"title":"Prothrombin Complex Concentrate Utilization in Children's Hospitals.","authors":"Jeffrey E Lutmer, Christian Mpody, Eric A Sribnick, Takaharu Karube, Joseph D Tobias","doi":"10.1055/s-0041-1731686","DOIUrl":"https://doi.org/10.1055/s-0041-1731686","url":null,"abstract":"Prothrombin complex concentrates (PCCs) are used to manage bleeding in critically ill children. We performed a repeat cross-sectional study using the Pediatric Health Information System registry to describe PCC utilization in the U.S. children's hospitals over time and determine the relationship between PCC use and specific risk factors for bleeding. We included children < 18 years who received three-factor or four-factor PCC during hospital admission between January 2015 and December 2020 to describe the association between PCC therapy, anticoagulation therapies, and inherited or acquired bleeding diatheses. PCC use steadily increased over the 6-year study period (from 1.3 to 4.6 per 10,000 encounters). Patients exhibited a high degree of critical illness, with 85.0% requiring intensive care unit admission and a mortality rate of 25.8%. PCCs were used in a primarily emergent or urgent fashion (32.6 and 39.3%, respectively) and more frequently in surgical cases (79.0% surgical vs. 21.0% medical). Coding analysis suggested a low rate of chronic anticoagulant use which was supported by review of concomitant anticoagulant medications. PCC use is increasing in critically ill children and does not correlate with specific anticoagulant therapy use or other bleeding risk factors. These findings suggest PCC use is not limited to vitamin K antagonist reversal. Indications, efficacy, and safety of PCC therapy in children require further study.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"12 3","pages":"219-227"},"PeriodicalIF":0.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10411157/pdf/10-1055-s-0041-1731686.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9979479","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

Description and Validation of a Novel Score (Flow Index) as a Clinical Indicator of the Level of Respiratory Support to Children on High Flow Nasal Cannula. 新评分(流量指数)作为高流量鼻插管儿童呼吸支持水平的临床指标的描述和验证。

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2023-09-01 DOI: 10.1055/s-0041-1731021

Sandeep Tripathi, Jeremy S Mcgarvey, Nadia Shaikh, Logan J Meixsell

{"title":"Description and Validation of a Novel Score (Flow Index) as a Clinical Indicator of the Level of Respiratory Support to Children on High Flow Nasal Cannula.","authors":"Sandeep Tripathi, Jeremy S Mcgarvey, Nadia Shaikh, Logan J Meixsell","doi":"10.1055/s-0041-1731021","DOIUrl":"https://doi.org/10.1055/s-0041-1731021","url":null,"abstract":"This study's objective was to describe and validate flow index (flow rate × FiO 2 /weight) as a method to report the degree of respiratory support by high flow nasal cannula (HFNC) in children. We conducted a retrospective chart review of children managed with HFNC from January 1, 2015 to December 31, 2019. Variables included in the flow index (weight, fraction of inspired oxygen [FiO 2 ], flow rate) and outcomes (hospital and intensive care unit [ICU] length of stay [LOS], escalation to the ICU) were extracted from medical records. Max flow index was defined by the earliest timestamp when patients FiO 2 × flow rate was maximum. Step-wise regression was used to determine the relationship between outcome (LOS and escalation to ICU) and flow index. Fifteen hundred thirty-seven patients met the study criteria. The median first and maximum flow indexes of the population were 24.1 and 38.1. Both first and maximum flow indexes showed a significant correlation with the LOS ( r = 0.25 and 0.31, p < 0.001). Correlation for the index was stronger than that of the variables used to calculate them and remained significant after controlling for age, race, sex, and diagnoses. Mild, moderate, and severe categories of first and max flow index were derived using quartiles, and they showed significant age and diagnosis independent association with LOS. Patients with first flow index >20 and maximum flow index >59.5 had increased odds ratio of escalation to ICU (odds ratio: 2.39 and 8.08). The first flow index had a negative association with rapid response activation. Flow index is a valid measure for assessing the degree of respiratory support for children on HFNC.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"12 3","pages":"173-179"},"PeriodicalIF":0.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10411057/pdf/10-1055-s-0041-1731021.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9979476","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: 1

Performance of Platelet Mass Index as a Marker of Severity for Sepsis and Septic Shock in Children. 血小板质量指数作为儿童脓毒症和感染性休克严重程度的指标。

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2023-09-01 DOI: 10.1055/s-0041-1731434

Madhuradhar Chegondi, Niranjan Vijayakumar, Ramya Deepthi Billa, Aditya Badheka, Oliver Karam

{"title":"Performance of Platelet Mass Index as a Marker of Severity for Sepsis and Septic Shock in Children.","authors":"Madhuradhar Chegondi, Niranjan Vijayakumar, Ramya Deepthi Billa, Aditya Badheka, Oliver Karam","doi":"10.1055/s-0041-1731434","DOIUrl":"https://doi.org/10.1055/s-0041-1731434","url":null,"abstract":"Platelet mass index (PMI) as a prognostic indicator in pediatric sepsis has not been previously reported. In this retrospective observational study, we evaluated PMI's performance as a prognostic indicator in children aged younger than 18 years with sepsis and septic shock in relationship with survival. Over 5 years, we collected data from 122 children admitted to our pediatric intensive care unit (PICU). PMI accuracy was assessed with sensitivity and specificity and its discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Median PMI values on days 1 and 3 of PICU admission were lower among nonsurvivors. On day 1 of PICU admission, a cutoff PMI value of 1,450 fL/nL resulted in a sensitivity of 72% and a specificity of 69%, and the AUC was 0.70 (95% confidence interval [CI]: 0.55-0.86). Similarly, on day 3, a cutoff of 900 fL/nL resulted in a sensitivity of 71% and a specificity of 70%, and the AUC was 0.76 (95% CI: 0.59-0.92). Our exploratory study suggests that low PMI in children with septic shock is associated with increased mortality. Considering the PMI's fair performance, further studies should be performed to assess its clinical value.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"12 3","pages":"228-234"},"PeriodicalIF":0.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10411082/pdf/10-1055-s-0041-1731434.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9981676","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: 2

Extubation to High-Flow Nasal Cannula in Infants Following Cardiac Surgery: A Retrospective Cohort Study. 婴儿心脏手术后拔管至高流量鼻插管:一项回顾性队列研究。

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2023-09-01 DOI: 10.1055/s-0041-1730933

Hannah Stevens, Julien Gallant, Jennifer Foster, David Horne, Kristina Krmpotic

{"title":"Extubation to High-Flow Nasal Cannula in Infants Following Cardiac Surgery: A Retrospective Cohort Study.","authors":"Hannah Stevens, Julien Gallant, Jennifer Foster, David Horne, Kristina Krmpotic","doi":"10.1055/s-0041-1730933","DOIUrl":"https://doi.org/10.1055/s-0041-1730933","url":null,"abstract":"High-flow nasal cannula (HFNC) therapy is commonly used in the pediatric intensive care unit (PICU) for postextubation respiratory support. This hypothesis-generating retrospective cohort study aimed to compare postextubation PICU length of stay in infants extubated to HFNC and low flow oxygen (LF) in PICU following cardiac surgery. Of 136 infants (newborn to 1 year) who were intubated and mechanically ventilated in PICU following cardiac surgery, 72 (53%) were extubated to HFNC and 64 (47%) to LF. Compared with patients extubated to LF, those extubated to HFNC had significantly longer durations of cardiopulmonary bypass (152 vs. 109 minutes; p = 0.002), aortic cross-clamp (90 vs. 63 minutes; p = 0.003), and invasive mechanical ventilation (3.2 vs. 1.6 days; p < 0.001), although demographic and preoperative clinical variables were similar. No significant difference was observed in postextubation PICU length of stay between HFNC and LF groups in unadjusted analysis (3.3 vs. 2.6 days, respectively; p = 0.19) and after controlling for potential confounding variables (F [1,125] = 0.17, p = 0.68, R 2 = 0.16). Escalation of therapy was similar between HFNC and LF groups (8.3 vs. 14.1%; p = 0.41). HFNC was effective as rescue therapy for six patients in the LF group requiring escalation of therapy. Need for reintubation was similar between HFNC and LF groups (8.3 vs. 4.7%; p = 0.5). Although extubation to HFNC was associated with a trend toward longer postextubation PICU length of stay and was successfully used as rescue therapy for several infants extubated to LF, our results must be interpreted with caution given the limitations of our study.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"12 3","pages":"167-172"},"PeriodicalIF":0.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10411109/pdf/10-1055-s-0041-1730933.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9979473","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

Is Provider Training Level Associated with First Pass Success of Endotracheal Intubation in the Pediatric Intensive Care Unit? 儿科重症监护病房医护人员培训水平与气管插管首次通过成功与否有关吗?

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2023-09-01 DOI: 10.1055/s-0041-1731024

Chetna K Pande, Kelsey Stayer, Thomas Rappold, Madeleine Alvin, Keri Koszela, Sapna R Kudchadkar

{"title":"Is Provider Training Level Associated with First Pass Success of Endotracheal Intubation in the Pediatric Intensive Care Unit?","authors":"Chetna K Pande, Kelsey Stayer, Thomas Rappold, Madeleine Alvin, Keri Koszela, Sapna R Kudchadkar","doi":"10.1055/s-0041-1731024","DOIUrl":"https://doi.org/10.1055/s-0041-1731024","url":null,"abstract":"Endotracheal intubation is a life-saving procedure in critically ill pediatric patients and a foundational skill for critical care trainees. Multiple intubation attempts are associated with increased adverse events and increased morbidity and mortality. Thus, we aimed to determine patient and provider factors associated with first pass success of endotracheal intubation in the pediatric intensive care unit (PICU). This prospective, single-center quality improvement study evaluated patient and provider factors associated with multiple intubation attempts in a tertiary care, academic, PICU from May 2017 to May 2018. The primary outcome was the number of tracheal intubation attempts. Predictive factors for first pass success were analyzed by using univariate and multivariable logistic regression analysis. A total of 98 intubation encounters in 75 patients were analyzed. Overall first pass success rate was 67% (66/98), and 7% (7/98) of encounters required three or more attempts. A Pediatric critical care medicine (PCCM) fellow was the first laryngoscopist in 94% (92/98) of encounters with a first pass success rate of 67% (62/92). Age of patient, history of difficult airway, provider training level, previous intubation experience, urgency of intubation, and time of day were not predictive of first pass success. First pass success improved slightly with increasing fellow year (fellow year = 1, 66%; fellow year = 2, 68%; fellow year = 3, 69%) but was not statistically significant. We identified no intrinsic or extrinsic factors associated with first pass intubation success. At a time when PCCM fellow intubation experience is at risk of declining, PCCM fellows should continue to take the first attempt at most intubations in the PICU.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"12 3","pages":"180-187"},"PeriodicalIF":0.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10411123/pdf/10-1055-s-0041-1731024.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9979477","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: 2

Ventilator-Associated Pneumonia Caused by Carbapenem-Resistant Gram-Negative Bacteria in a Pediatric Intensive Care Unit 儿童重症监护病房由碳青霉烯耐药革兰氏阴性菌引起的呼吸机相关肺炎

Journal of Pediatric Intensive Care Pub Date : 2023-08-28 DOI: 10.1055/s-0043-1772818

Melis Deniz, Hande Şenol, Tugba Erat, Hatice Feray Arı, Ümit Altug, Eylem Kıral, Kerim Parlak, Hadice Özçınar

{"title":"Ventilator-Associated Pneumonia Caused by Carbapenem-Resistant Gram-Negative Bacteria in a Pediatric Intensive Care Unit","authors":"Melis Deniz, Hande Şenol, Tugba Erat, Hatice Feray Arı, Ümit Altug, Eylem Kıral, Kerim Parlak, Hadice Özçınar","doi":"10.1055/s-0043-1772818","DOIUrl":"https://doi.org/10.1055/s-0043-1772818","url":null,"abstract":"Abstract We aimed to analyze risk factors of ventilator-associated pneumonia (VAP) caused by multidrug-resistant (MDR), pan-drug-resistant (PDR), and extensively drug-resistant (XDR) gram-negative bacteria (GNB) in a pediatric intensive care unit (PICU). This retrospective study evaluated pediatric patients diagnosed with VAP at a tertiary referral hospital. Of the 46 children in the present study, 40 (86.9%) had VAP caused by MDR-, XDR-, and PDR-GNB. Most patients (60.9%) had spent >28 days in the PICU at the time of diagnosis. Respiratory failure necessitating PICU admission was associated with XDR infection-induced VAP (p = 0.034). High rates of prior broad-spectrum antibiotic use were observed in patients with XDR GNB-induced VAP. VAP induced by MDR-, XDR-, and PDR-GNB occurred more frequently than that caused by drug-susceptible GNB in PICU patients. Long stays for more than 28 days in the PICU and past use of broad-spectrum antibiotics can lead to the development of XDR-GNB-induced VAP. The high antibiotic resistance rates detected in our study highlight the importance of strict infection control measures and antimicrobial stewardship programs in PICUs.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136350404","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

Assessing Passive Leg Raise Test in Pediatric Shock Using Electrical Cardiometry 使用电子心脏测量法评估小儿休克中的被动抬腿试验

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2023-06-17 DOI: 10.1055/s-0043-1777798

Angela Pham, Nikhil R. Shah, Shreya Chandran, Patrick Fueta, Estela O'Daniell, Jessica Burleson, Sarah Cottingham, Halil Sari, Ravi S. Samraj, Utpal Bhalala

{"title":"Assessing Passive Leg Raise Test in Pediatric Shock Using Electrical Cardiometry","authors":"Angela Pham, Nikhil R. Shah, Shreya Chandran, Patrick Fueta, Estela O'Daniell, Jessica Burleson, Sarah Cottingham, Halil Sari, Ravi S. Samraj, Utpal Bhalala","doi":"10.1055/s-0043-1777798","DOIUrl":"https://doi.org/10.1055/s-0043-1777798","url":null,"abstract":"Abstract Passive leg raise (PLR) is widely used to incite an autobolus to assess fluid responsiveness in adults; however, there is a paucity of studies exploring its utility in children. Our study aimed to analyze the efficacy of PLR in determining fluid responsiveness in children presenting with shock using electrical cardiometry. Patients in the age group of 0 to 20 years who presented in shock to our children's hospital emergency department were evaluated. Multiple hemodynamic metrics including, heart rate, systolic/diastolic blood pressure, cardiac output (CO), stroke index, stroke volume (SV), flow time corrected (FTC), and left ventricular ejection time (LVET) were recorded using the noninvasive ICON device and compared at baseline and post-PLR. A total of 68 patients had pre- and post-PLR data available for review between June and July 2022. Median age was 7 years (54% male); most common etiology was hypovolemic (67.6%) shock. Following PLR, there was no significant change in most hemodynamic parameters, including SV and CO; however, there was a significant difference in FTC (301 [pre-PLR] vs. 307 [post-PLR], p = 0.016) (ms) and LVET (232 [pre-PLR] vs. 234 [post-PLR], p = 0.014) (ms). A significantly higher proportion of children diagnosed with septic shock demonstrated fluid responsiveness (ΔSV ≥ 10% from baseline) compared with those with hypovolemic shock ( p = 0.036). This study demonstrated no identifiable fluid responsiveness (ΔSV ≥ 10% from baseline) following PLR; however, a significantly higher proportion of children suffering from septic shock demonstrated fluid responsiveness compared with those with hypovolemic shock. Larger studies are needed to further assess the utility of PLR, as well as other modalities, in determining fluid responsiveness in children.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"52 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139369536","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

The Prevalence of Second Victim Syndrome and Emotional Distress in Pediatric Intensive Care Providers. 儿童重症监护提供者中第二受害者综合征和情绪困扰的患病率。

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2023-06-01 DOI: 10.1055/s-0041-1731666

Michael Wolf, Kathleen Smith, Mohua Basu, Kurt Heiss

{"title":"The Prevalence of Second Victim Syndrome and Emotional Distress in Pediatric Intensive Care Providers.","authors":"Michael Wolf, Kathleen Smith, Mohua Basu, Kurt Heiss","doi":"10.1055/s-0041-1731666","DOIUrl":"https://doi.org/10.1055/s-0041-1731666","url":null,"abstract":"Pediatric critical care providers are at higher risk of second victim syndrome (SVS) and emotional distress after a poor patient outcome, unanticipated adverse event, medical error, or patient-related injury. We sought to determine the prevalence of SVS within our intensive care units (ICUs) and evaluate the adequacy of current institutional peer support. A validated survey tool, the second victim experience and support tool was sent electronically to all ICU providers in our pediatric health care system. Of 950 recipients, there were 266 respondents (28%). Sixty-one per cent of respondents were nurses; 19% were attending physicians, advanced practice providers, and fellows; 88% were females; 42% were aged 25 to 34 years; and 43% had worked in the ICU for 0 to 5 years. The most common emotion experienced was psychological distress (42%) and one-third of respondents questioned their self-efficacy as a provider after a second victim event. Support from colleagues, supervisors, and the institution was perceived as low. Support from a respected peer was the most desired type of support by 81% of respondents. Emotional distress and SVS are commonly found among pediatric ICU providers and the level of support is perceived as inadequate. Developing and deploying a peer support program are crucial to staff's well-being and resilience in the high-stress ICU environment.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"12 2","pages":"125-130"},"PeriodicalIF":0.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10113016/pdf/10-1055-s-0041-1731666.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9379231","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: 1