Association between Vasoactive Inotropic Score and adverse outcome in pediatric septic shock patients admitted at the Pediatric Intensive Care Unit

Background Sepsis is a commonly seen emergency case in the pediatric intensive care unit.1 Severe sepsis mortality rate in developed country andin developing country such as Indonesia are 9% and 50-70%, respectively. Furthennore, the mortality rate in septic shock is 80%.2 Several researches documented increasing rate of acute kidney injury (AKI) incidence correlated 'With sepsis. Clinical intervention identification may decrease AKI and sepsis incidence.Objective To identify the correlation between incidence of AKI in sepsis and in septic shock patients who was treated in pediatric intensive care unit (PICU).Methods A cross sectional study was perfonned in 37 patients diagnosed as sepsis according ACCP/SCCM criteria for children aged 1 month to 13 years. The study was conducted in Pediatric Department, Prof. Dr. R.D. Kandou hospital from April 2009 to June 2009.Results From 37 sepsis patients, 27 were boys and 10 were girls. In the sepsis group (n=27) 10 had AKI, and in the septic shock group (n= 10) had AKI. Phi correlation coefficient applied to statistically analyzed sepsis in correlation with AKI (creatinin serum and GFR). Significant Phi correlation coefficient was (r=0.117; P> 0.05)Conclusions The study concludes that there is no correlation of renal function impainnent Mth sepsis and septic shock.

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HYPOALBUMINEMIA AS A MARKER OF ADVERSE OUTCOME IN CHILDREN ADMITTED TO PEDIATRIC INTENSIVE CARE UNIT

Indian Journal of Child Health ◽

10.32677/ijch.2018.v05.i01.002 ◽

2018 ◽

Vol 05 (01) ◽

pp. 6-10 ◽

Cited By ~ 1

Author(s):

Sandeep Kumar ◽

Shrikiran Aroor ◽

Pushpa Gurudas Kini ◽

Suneel Mundkur ◽

Adel Moideen

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Adverse Outcome ◽

Pediatric Intensive Care

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MO675HEMOADSORPTION WITH CYTOSORB® CARTRIDGE IN PEDIATRIC INTENSIVE CARE UNIT – A SERIES OF FOUR CASES

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab099.0020 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Neva Bezeljak ◽

Vanja Peršič ◽

Darja Krevh Golubić ◽

Igor Vidmar ◽

Milena Andonova ◽

...

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Body Weight ◽

Intensive Care ◽

Female Patient ◽

Critically Ill ◽

Pediatric Intensive Care Unit ◽

Multiorgan Failure ◽

Pediatric Intensive Care ◽

Extracorporeal Circuit

Abstract Background and Aims Hemoadsorption with Cytosorb® cartridge is one of extracorporeal blood purification therapies increasingly used in adult intensive care units in conditions with elevated inflammatory mediators. Many positive experiences of hemodynamic improvement of patients treated with hemoadsorption have resulted in attempts of its application also in critically ill pediatric patients. Here we present a case series of four children treated with hemoadsorption in pediatric intensive care unit (PICU) of University Medical Centre Ljubljana from September 2018 to January 2019. Method All patients were mechanically ventilated and required vasopressor and inotropic support. Hemoadsorption was used as a rescue therapy after all standard treatments for their underlying condition had been insufficient. CytoSorb® cartridge was coupled with continuous veno-venous hemodialysis (CVVHD, Prismaflex system, Gambro) in pre-filter (ST60 set, Gambro) position. In children <10 kg body weight (2 infants), the extracorporeal circuit was prefilled with a 1:1 mixture of packed red blood cells and saline, with heparin added. Automated regional citrate anticoagulation was used, blood flow was 30-100 ml/min and dialysate flow 500 ml/h. Results The youngest child was 10 days old 1.9 kg premature female with acute liver failure due to gestational alloimmune liver disease. CVVHD was started for hyperammonemia and concomitant CytoSorb® for severe hyperbilirubinemia (335 umol/l). Procedure was discontinued after 6 hours due to uncontrollable sepsis and hemodynamic collapse. We managed to normalize ammonia values and reduce bilirubin concentration (116 umol/l). Further treatment was withdrawn as a result of irreversible multiorgan failure. One month old 2.5 kg female patient was treated in PICU due to necrotizing enterocolitis and refractory septic shock with multiorgan failure. Oliguric acute kidney injury (AKI) required CVVHD and later on Cytosorb ® was added as an attempt to limit severe hyperinflammatory condition. During 19 hours of treatment the need for vasopressor support was increasing and metabolic acidosis was deepening. The patient required a short resuscitation a couple of hours into the procedure due to bradycardia which resulted in catheter and CVVHD circuit thrombosis. Dialysis was discontinued as urgent surgery was necessary. The patient later died of uncontrolled septic shock. Three years old 17 kg male was admitted with meningococcal septic shock, requiring initiation of veno-arterial ECMO. Cytosorb® with CVVHD was started and attached to the ECMO circuit. A significant decline of interleukine-6 (IL-6) was achieved without any procedure-related side effect and treatment was discontinued after 68 hours as patient's clinical status notably improved. The patient survived. Five years old 20 kg female patient, actively treated for acute lymphoblastic leukemia, was admitted with E. coli sepsis. Septic shock was unresponsive to conventional treatment therefore she was started on Cytosorb® with CVVHD as oliguric AKI also developed. Two consecutive procedures were preformed, the first for 31 and the second for 37 hours. Level of IL-6 decreased (from > 5000 ng/L to 1000 ng/L) and lactate level normalized. We achieved reduction in vasopressors and oxygen need during both procedures and patient's overall status greatly improved. Conclusion Although significantly increasing the volume of extracorporeal circuit, the use of Cytosorb® cartridge within CVVHD circuit is technically feasible even in critically ill children with low body weight, if principles of pediatric renal replacement therapy are considered. More efficacy and safety data on Cytosorb® utilization are necessary before inclusion in routine clinical practice. Treatment outcome is highly dependent on primary disease and severity of patient condition.

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Improving Timely Antibiotic Administration in Pediatric Sepsis and Septic Shock in a Pediatric Intensive Care Unit

10.1542/peds.147.3_meetingabstract.467 ◽

2021 ◽

Author(s):

Jay F. Rillinger ◽

Leslie A. Hueschen

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Antibiotic Administration ◽

Pediatric Sepsis ◽

Sepsis And Septic Shock

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Cardiac Dysfunction and Serum Ferritin Level as Early Prognostic Markers in Children with Sepsis.

10.21203/rs.3.rs-126216/v1 ◽

2020 ◽

Author(s):

Nagwa Mohamed Sabry Abdelsalam Mahmoud ◽

Ahlam M. Ismail ◽

Moustafa Ahmed El Sayed Ahmed Abu Elela ◽

Islam nashaat roshdy Ahmed

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Cardiac Dysfunction ◽

Leukocyte Count ◽

Pediatric Intensive Care ◽

C Reactive Protein ◽

Reactive Protein ◽

Inotropic Score

Abstract Objective: This study aimed to evaluate the association of Cardiac dysfunction assessed by Echocardiogram study, ferritin, c-reactive protein, and leukocyte count with unfavorable outcomes in pediatric sepsis within the pediatric intensive care unit.Methods: A prospective cohort study was carried out from September 2019 to April 2020, with 40 patients admitted to a pediatric intensive care unit(PICU) at Minia University Children and Maternal hospital, aged between 28 days and 15 years. Inclusion criteria where patients diagnosed with sepsis, need for mechanical ventilation for quite 48h, and vasoactive drugs. Serum levels of C-reactive protein, ferritin, and leukocyte count were collected within 24 h of admission (D1), and 72 h (D3) after admission to PICU. Patients underwent echocardiography study to figure out the ejection fraction of the ventricle on D1 and D3. The outcomes measured through length of stay at hospital and at the pediatric intensive care unit, mechanical ventilation(MV) duration, free hours of VM, duration of use of inotropic agents, maximum inotropic score, and mortality.Results: Patients with elevated ferritin levels on D1 had less ventilator-free time and higher maximum inotropic score. Patients with cardiac dysfunction by echocardiogram on D1 had longer hospital stay pediatric intensive care unit, stay longer duration of mechanical ventilation higher maximum inotropic score, and fewer ventilator-free hoursConclusion: Cardiac dysfunction by echocardiography study and serum ferritin value was significantly related to unfavorable outcomes in pediatric patients requiring admission to PICU with sepsis.

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