Hyperoxemia among Pediatric Intensive Care Unit Patients Receiving Oxygen Therapy

2021 ◽  
Author(s):  
Azadeh R. Fayazi ◽  
Matteo Sesia ◽  
Kanwaljeet J. S. Anand
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Oxygen Therapy ◽  
Oxygen Toxicity ◽  
Pediatric Intensive Care ◽  
Retrospective Chart Review ◽  
Organ Injury ◽  
Arterial Blood Gas ◽  
Arterial Blood

AbstractSupratherapeutic oxygen levels consistently cause oxygen toxicity in the lungs and other organs. The prevalence and severity of hyperoxemia among pediatric intensive care unit (PICU) patients remain unknown. This was the first study to examine the prevalence and duration of hyperoxemia in PICU patients receiving oxygen therapy. This is a retrospective chart review. This was performed in a setting of 36-bed PICU in a quaternary-care children's hospital. All the patients were children aged <18 years, admitted to the PICU for ≥24 hours, receiving oxygen therapy for ≥12 hours who had at least one arterial blood gas during this time.There was no intervention. Of 5,251 patients admitted to the PICU, 614 were included in the study. On average, these patients received oxygen therapy for 91% of their time in the PICU and remained hyperoxemic, as measured by pulse oximetry, for 65% of their time on oxygen therapy. Patients on oxygen therapy remained hyperoxemic for a median of 38 hours per patient and only 1.1% of patients did not experience any hyperoxemia. Most of the time (87.5%) patients received oxygen therapy through a fraction of inspired oxygen (FiO2)-adjustable device. Mean FiO2 on noninvasive support was 0.56 and on invasive support was 0.37. Mean partial pressure of oxygen (PaO2) on oxygen therapy was 108.7 torr and 3,037 (42.1%) of PaO2 measurements were >100 torr. Despite relatively low FiO2, PICU patients receiving oxygen therapy are commonly exposed to prolonged hyperoxemia, which may contribute to ongoing organ injury.

scholarly journals Mean difference of Electrolyte Level measured in Arterial Blood gases and measured in Laboratory in Children presenting in Pediatric Intensive Care Unit

2021 ◽  
pp. 3-6
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Blood Gases ◽  
P Value ◽  
Arterial Blood Gases ◽  
K Value ◽  
Electrolyte Level ◽  
Arterial Blood

Background: Electrolytes are measured in arterial and venous blood by arterial blood gas analyzer and the auto-analyzers respectively. Objective: To determine the mean difference in electrolyte level in arterial blood gases (ABGs) level versus laboratory serum electrolyte level in the children admitted in the pediatric intensive care unit. Methodology: This cross-sectional study was conducted at department of Pediatrics, the Children’s Hospital and Institute of Child Health, Lahore from 1st December 2015 to 31st May 2016. Total of 125 children fulfilling inclusion criteria were enrolled in the study from pediatric intensive care unit. The ABGs (whole blood) electrolytes were obtained immediately after collection, using ABGs analyzer. Serum electrolytes were analyzed in the central laboratory of the institution. Reports were assessed and levels of sodium and potassium was noted from reports of ABGs and laboratory. Results: Mean NA+ value on ABGs and from laboratory was 134.66 and 132.26 (p= 0.01). Mean K+ value from on ABGs and from laboratory was 4.51 and 4.28. (p= 0.071). In age group 1-5 and 6-10 years, K+ level was high in ABGs value (p-value=0.065 & p-value=0.073). However, in age group 11-15 years K+ level was significantly higher in ABGs value as that of laboratory value (p-value=0.014). The same trend was observed in male and female children that mean NA+ and K+ value with ABGs was significantly higher as compared to that of laboratory value. Conclusion: NA+ and K+ in arterial blood gases level were different from laboratory serum electrolyte level in children admitted to pediatric intensive care unit. Clinician should be aware of differences so that potential misdiagnosis does not occur and unnecessary treatment or investigation can’t be performed.

Comparison of Non-Invasive Oscillometric and Intra-Arterial Blood Pressure Measurements in Children Admitted to the Pediatric Intensive Care Unit

2021 ◽  
Author(s):  
Jaswinder Kaur ◽  
Siddharth Bhargava ◽  
Puneet Aulakh Pooni ◽  
Deepak Bhat ◽  
Gurdeep S. Dhooria ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Arterial Blood Pressure ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Non Invasive ◽  
Arterial Blood ◽  
The Difference

AbstractIntra-arterial blood pressure (IABP) measurement, although considered the gold standard in critically ill children, is associated with certain risks and lacks widespread availability. This study was conducted to determine the differences and agreements between oscillometric non-invasive blood pressure (NIBP) and invasive IABP measurements in children. Inclusion criteria consisted of children (from 1 month to 18 years) admitted to the pediatric intensive care unit (PICU) of a teaching hospital who required arterial catheter insertion for blood pressure (BP) monitoring. The comparison between IABP and NIBP was studied using paired t-test, Bland–Altman analysis, and Pearson's correlation coefficient. In total, 4,447 pairs of simultaneously recorded hourly NIBP and IABP measurements were collected from 65 children. Mean differences between IABP and NIBP were −3.6 ± 12.85, −4.7 ± 9.3, and −3.12 ± 9.30 mm Hg for systolic, diastolic, and mean arterial BP, respectively (p < 0.001), with wide limits of agreement. NIBP significantly overestimated BP (p < 0.001) in all three BP states (hypotensive, normotensive, and hypertensive), except systolic blood pressure (SBP) during hypertension where IABP was significantly higher. The difference in SBP was most pronounced during hypotension. The difference in SBP was significant in children <10 years (p < 0.001), with the maximum difference being in infants. It was insignificant in adolescents (p = 0.28) and underweight children (p = 0.55). NIBP recorded significantly higher BP in all states of BP except SBP in the hypertensive state. SBP measured by NIBP tended to be the most reliable in adolescents and underweight children. NIBP was the most unreliable in infants, obese children, and during hypotension.

scholarly journals Impact of a Drug Shortage on Medication Errors and Clinical Outcomes in the Pediatric Intensive Care Unit

2015 ◽  
Vol 20 (6) ◽  
pp. 453-461 ◽  
Author(s):  
Kaitlin M. Hughes ◽  
Elizabeth S. Goswami ◽  
Jennifer L. Morris
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Adverse Events ◽  
Pediatric Intensive Care Unit ◽  
Clinical Pharmacist ◽  
Pediatric Intensive Care ◽  
Retrospective Chart Review ◽  
Prescribing Errors ◽  
Drug Shortage

OBJECTIVES: The purpose of this study was to assess the rate of prescribing errors, resulting adverse events, and patient outcomes associated with sedation and analgesia in the pediatric intensive care unit (PICU) before and during a national shortage of fentanyl and injectable benzodiazepines. METHODS: A retrospective chart review was performed of patients admitted to the PICU with at least 1 prescribed order for a sedative or analgesic agent during the time periods of January to February of 2011 and 2012. Initial orders for sedative and analgesic agents were identified and investigated for appropriateness of dose and were assessed for error-associated adverse events. Orders were stratified by timing in regard to clinical pharmacist on-site availability. Demographic and outcome information, including unintended extubations, ventilator days, and PICU length of stay, were gathered. RESULTS: One hundred sixty-nine orders representing 72 patients and 179 orders representing 75 patients in 2011 and 2012, respectively, were included in analysis. No differences were found in the rate of prescribing errors in 2011 and 2012 (33 errors in 169 orders vs. 39 errors in 179 orders, respectively, p=0.603). No differences were found in rates of prescribing errors in regard to clinical pharmacist on-site availability. A significant increase was seen in unintended extubations per 100 ventilator days, with 0.15 in 2011 vs. 1.13 in 2012, respectively (p&lt;0.001). A significant decrease was seen in ventilator days per patient (p&lt;0.001) and PICU length of stay per patient (p=0.019). CONCLUSIONS: There were no differences in rates of prescribing errors before versus during the fentanyl and benzodiazepine shortage.

Radiation Exposure in Pediatric Intensive Care Unit Patients: How Much Is Too Much?

2018 ◽  
Vol 57 (12) ◽  
pp. 1391-1397
Author(s):  
Yamini S. Kapileshwarkar ◽  
Laura T. Smith ◽  
Susan M. Szpunar ◽  
Premchand Anne
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Radiation Exposure ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Retrospective Chart Review ◽  
High Radiation ◽  
High Exposure ◽  
Computed Tomography Scans ◽  
Minimize Radiation Exposure

We aimed to determine median cumulative radiation exposure in pediatric intensive care unit (PICU) patients, proportion of patients with high radiation exposure (above annual average radiation per person of 6.2 mSv), and determine risk factors for high exposure. This was a retrospective chart review of PICU patients up to 18 years of age admitted to a large community hospital over 2 years. Radiologic studies and radiation exposure were determined for each patient, and total hospital radiation exposure was classified as high (>6.2 mSv) or not (≤6.2 mSv). Median radiation exposure per patient was 0.2 mSv (interquartile range = 2.1) and 11.7% of patients received >6.2 mSv radiation during their hospitalization. Factors associated with high radiation exposure included admission for trauma or surgery, number of computed tomography scans, age, and PICU length of stay (all P < .0001). We concluded that subsets of PICU patients are at risk of high radiation exposure. Policies and protocols may help minimize radiation exposure among PICU patients.

scholarly journals Frequency of and Risk Factors for Acute Kidney Injury Associated With Vancomycin Use in the Pediatric Intensive Care Unit

2016 ◽  
Vol 21 (6) ◽  
pp. 486-493 ◽  
Author(s):  
Sarah Bonazza ◽  
Lauren C. Bresee ◽  
Timothy Kraft ◽  
B. Catherine Ross ◽  
Deonne Dersch-Mills
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Retrospective Chart Review ◽  
Primary Objective ◽  
Vancomycin Trough

BACKGROUND: Published information evaluating frequency of and risk factors for vancomycin-induced acute kidney injury (AKI) in the pediatric intensive care unit (PICU) population is conflicting. OBJECTIVES: The primary objective was to describe the proportion of our PICU patients who developed AKI with intravenous (IV) vancomycin. The secondary objective was to describe the associated potential risk factors. METHODS: Pediatric patients (0–18 years) who received their first IV vancomycin dose in the PICU were evaluated in this retrospective chart review. AKI was defined based on Pediatric-Modified RIFLE (pRIFLE) criteria. Patient demographics, vancomycin trough concentrations, concomitant nephrotoxins, and estimated creatinine clearance changes were analyzed. RESULTS: Of 265 patients included, the primary outcome of AKI (defined by meeting any pRIFLE criteria) occurred in 62 (23.4%) patients (48 category R, 11 category I, 3 category F). Patients who received vancomycin treatment for = 5 days were more likely to develop AKI (unadjusted odds ratio [uOR]: 2.52; 95% confidence interval [CI]: 1.11–5.73), as were patients with a maximum vancomycin trough level = 20 mg/L (OR: 2.99; 95% CI: 1.54–5.78) and patients on 1 (uOR: 2.29; 95% CI: 1.12–4.66) or more concurrent nephrotoxin (uOR: 3.11; 95% CI: 1.43–6.77). Among nephrotoxins, patients receiving furosemide concomitantly with vancomycin were more likely to develop AKI (uOR: 3.47; 95% CI: 1.92–6.27). After adjustment, only furosemide was a significant predictor of risk of AKI/AKI (adjusted OR: 3.52; 95% CI: 1.88–6.62). The study was limited by its retrospective and observational design, and confounding variables. CONCLUSIONS: Patients who were receiving vancomycin with concurrent furosemide were at highest risk of developing AKI.

scholarly journals Comparison between high-flow nasal oxygen cannula and conventional oxygen therapy after extubation in pediatric intensive care unit

2018 ◽  
Vol 60 (2) ◽  
pp. 126 ◽  
Author(s):  
Başak Akyıldız ◽  
Sedat Öztürk ◽  
Nazan Ülgen-Tekerek ◽  
Selim Doğanay ◽  
Süreyya Burcu Görkem
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Oxygen Therapy ◽  
Pediatric Intensive Care ◽  
High Flow
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