Journal of Pediatric Intensive Care最新文献

{"title":"Variability in Clinician Awareness of Intravenous Fluid Administration in Critical Illness: A Prospective Cohort Study","authors":"Stephen M. Gorga, Alexander L. Sliwicki, J. Sturza, E. Carlton, R. Barbaro, Rajit K. Basu","doi":"10.1055/s-0042-1758476","DOIUrl":"https://doi.org/10.1055/s-0042-1758476","url":null,"abstract":"Abstract Intravenous (IV) fluids are commonly administered to critically ill children, but clinicians lack effective guidance for the correct dose and duration of therapy resulting in variation of prescribing habits which harm children. It is unknown if clinicians recognize the amount of IV fluid that patients receive. We aimed to determine clinician's accuracy in the identification of the volume of IV fluids patients will receive over the next 24 hours. Prospective cohort study enrolled all patients admitted to the pediatric intensive care unit (PICU) from May to August 2021 at the University of Michigan's C.S. Mott Children's Hospital PICU. For each patient, clinicians estimated the volume of IV fluid that patients will receive in the next 24 hours. The primary outcome was accuracy of the estimation defined as predicted volume of IV fluids versus actual volume administered within 10 mL/kg or 500 mL depending on patient's weight. We tested for differences in accuracy by clinician type using chi-square tests. There were 259 patients for whom 2,295 surveys were completed by 177 clinicians. Clinicians' estimates were accurate 48.8% of the time with a median difference of 10 (1–26) mL/kg. We found that accuracy varied between clinician type: bedside nurses were most accurate at 64.3%, and attendings were least accurate at 30.5%. PICU clinicians have poor recognition of the amount of IV fluids their patients will receive in the subsequent 24-hour period. Estimate accuracy varied by clinician's role and improved over time, which may suggest opportunities for improvement.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"20 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82385469","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":"Lived Experiences of Delirium in Critically Ill Children: A Qualitative Study","authors":"Jasmin Moradi, Mirriam Mikhail, Laurie Lee, C. Traube, A. Sarti, K. Choong","doi":"10.1055/s-0042-1758695","DOIUrl":"https://doi.org/10.1055/s-0042-1758695","url":null,"abstract":"Abstract The aim of this study was to understand the lived experiences of delirium in critically ill children. We conducted phenomenological qualitative interviews with critically ill pediatric survivors aged 0 to 18 years who had experienced delirium, along with their family caregivers and health care providers, from pediatric intensive care units in two tertiary care children's hospitals in Canada. Cases were identified if they had a Cornell Assessment of Pediatric Delirium (CAPD) score of ≥ 9 for at least 48 hours. Thirteen interviews were conducted, representing 10 index patients with delirium (age range: 7 weeks to 17 years). Participants shared experiences that were divided into themes of delirium symptoms, the impact of delirium, and their experience with the care of delirium. Within each theme, subthemes were identified. Symptoms of delirium included hallucinations, fluctuating symptoms, and lack of eye contact. Children were often described as “not himself/herself.” Delirium had long-lasting impact on patients; memories remained prominent even after the hospital stay. Family members and health care providers often felt helpless and ill-prepared to manage delirium. The delirium experience had significant impact on loved ones, causing persistent and vicarious suffering after the critical illness course. Family members and health care providers prioritized nonpharmacological strategies, family presence, and education as key strategies for delirium management. The lived experience of delirium in both infants and older children is physically, psychologically, and emotionally distressing. Given the traumatic long-term consequences, there is an urgent need to target delirium education, management, and prevention to improve long-term outcomes in PICU survivors and their families. Trial Registration number:  NCT04168515.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82134467","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":"Higher Dosage of Acetaminophen Associated with Lower Risk of Acute Kidney Injury after Pediatric Cardiac Surgery","authors":"Melissa Nater, J. Wong, Nobuyuki Ikeda, Brian Heenan, Rohit S. Loomba, Jamie S. Penk","doi":"10.1055/s-0043-57234","DOIUrl":"https://doi.org/10.1055/s-0043-57234","url":null,"abstract":"Abstract Acute kidney injury (AKI) after pediatric cardiac surgery is manifested by injury along multiple pathways. One of these is oxidative injury related to hemolysis and subsequent deposition of hemoglobin in the kidney. Acetaminophen inhibits hemoprotein-catalyzed lipid peroxidation associated with hemolysis and in turn, may attenuate renal injury. We performed a retrospective chart review of patients undergoing pediatric cardiac surgery. A randomized controlled trial previously performed dictated a regimented, high dosage, acetaminophen. A historical cohort who received ad hoc acetaminophen prior to that study and that met the same inclusion/exclusion criteria were also analyzed, as patients from that era were likely to have less acetaminophen administered. The patients were divided into those who developed AKI and those who did not and those groups were compared by total acetaminophen dose. Important inclusion criteria included age 3 months to 4 years who underwent cardiac surgery via midline sternotomy and were extubated within 3 hours of admission. Patients with preexisting or chronic kidney disease were excluded. A total of 181 patients were included. Of these, 69 (38%) developed AKI. There were no significant pre- or intraoperative risk differences in characteristics between those who developed AKI and those who did not. Acetaminophen dose did significantly differ between those who developed AKI and those who did not with lower acetaminophen dose in the AKI group (30 vs. 50 mg/kg, p -value = 0.01). A multivariate analysis was performed which found that higher acetaminophen dosage and lower immediate postoperative hemoglobin were independently associated with a lower risk of AKI. AKI occurs in ∼38% after pediatric cardiac surgery. Most often this is stage 1 AKI and resolves after a day. After adjusting for other covariables, higher acetaminophen dose may be associated with lower risk of AKI. This does not prove that acetaminophen given prospectively will reduce AKI. Further studies are needed.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"53 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86721194","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":"Acute Kidney Injury and Hemolytic Uremic Syndrome in Severe Pneumococcal Pneumonia—A Retrospective Analysis in Pediatric Intensive Care Unit","authors":"C. Kuok, Mei Lam Natalie Hsu, Stephanie Hui Fung Lai, K. Wong, W. Chan","doi":"10.1055/s-0042-1759528","DOIUrl":"https://doi.org/10.1055/s-0042-1759528","url":null,"abstract":"Abstract Objectives:  This study aimed to evaluate the prevalence of acute kidney injury (AKI) and hemolytic uremic syndrome (HUS) in severe pediatric pneumonia due to Streptococcus pneumoniae and to identify factors associated with AKI and HUS in these patients. Methods:  We retrospectively analyzed pediatric patients who were admitted to our pediatric intensive care unit due to severe pneumococcal pneumonia between 2013 and 2019. Results:  Forty-two patients with a median age of 4.3 years were included. Among these patients, 14 (33.3%) developed AKI, including seven (16.7%) stage 1, two (4.8%) stage 2, and five (11.9%) stage 3 AKI. Features of HUS were present in all of the patients with stage 3 AKI, and four required renal replacement therapy (RRT), with a median duration of 10.5 days (range 3 to 16 days). All patients with HUS required mechanical ventilation and inotropic supports. Patients with lower leukocyte and platelet counts, serum sodium and bicarbonate levels, positive urine dipstick (heme or protein ≥ 2 + ), and presence of bacteremia were associated with stage 2 and 3 AKI. Conclusions:  Pediatricians should be aware of the relatively high prevalence of kidney involvement in severe pneumococcal pneumonia, with one-third having AKI and 11.9% developing HUS. Majority (80%) of HUS patients required RRT. Positive urine dipstick, serum sodium, and bicarbonate at presentation, which can be measured in point-of-care tests, may potentially be useful as quick tests to stratify the risks of moderate-to-severe AKI.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":"37 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75564626","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":"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":"39 1","pages":""},"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}

{"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":"26 1","pages":""},"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}

{"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":"30 1","pages":""},"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}

{"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":"3 1","pages":""},"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}

{"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":"13 1","pages":""},"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}

{"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":"41 1","pages":""},"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}