scholarly journals Adverse Outcomes due to Aggressive Fluid Resuscitation in Children: A Prospective Observational Study

2018 ◽  
Vol 08 (02) ◽  
pp. 064-070 ◽  
Author(s):  
Anand Muttath ◽  
Lalitha Annayappa Venkatesh ◽  
Joe Jose ◽  
Anil Vasudevan ◽  
Santu Ghosh
Keyword(s):  
Observational Study ◽  
Critically Ill ◽  
Prospective Observational Study ◽  
Fluid Overload ◽  
Fluid Management ◽  
Oxygenation Index ◽  
Adverse Outcomes ◽  
Critically Ill Children ◽  
Mortality And Morbidity ◽  
The Impact

AbstractFluid management has a major impact on the duration, severity, and outcome of critically ill children. The aim of this study was to examine the relationship between cumulative fluid overload (CFO) with mortality and morbidity in critically ill children. This was a prospective observational study wherein children (1 month–16 years) who were critically ill (with shock requiring inotropes and/or mechanically ventilated) were enrolled. CFO was defined as the sum of daily fluid balances. Daily fluid balance was calculated as a difference between fluid intake (oral and intravenous) and output (urine output, discharge from nasogastric tube) in 24 hours. Percentage of fluid overload (FO) (PFO) was calculated as the ratio of CFO with weight at admission in kilogram. The CFO and PFO at 24, 48, 72 hours and at 7 days or end of PICU stay were calculated. A total of 291 children (244 survivors and 47 non-survivors; 47% males) were included in the final analysis. A higher mortality was observed in children with higher PFO (>20% FO: 45.8% mortality vs. 14.5% < 10% FO, p < 0.01) and CFO (10.97 ± 6.4 mL/kg in survivors vs. 13.95 ± 9.6 mL/kg in non-survivors; p = 0.022) at 72 hours. A 1% increase in fluid overload was associated with 6% and 4% increase in mortality at 72 hours and 7 days, respectively. Similarly, the impact of every 1% increase in fluid overload on both ventilation (yes/no) and acute kidney injury (AKI; yes/no) were found to be significant for both parameters at 72 hours, but only AKI had significant correlation on seventh day. In the multivariate stepwise Cox's proportional hazard model for PICU stay and hospital stay, 3% (p < 0.05) and 2% (p > 0.05) increase were found for every 1% increase in fluid overload, respectively. Oxygenation index is also associated with fluid overload with the adjusted model estimated 0.27 units (95% confidence interval: 0.18–0.36) increase per 1% increase in fluid overload. FO was associated with increased mortality and morbidity in critically ill children.

Association between plasma transfusions and clinical outcome in critically ill children: a prospective observational study

Vox Sanguinis ◽  
2013 ◽  
Vol 104 (4) ◽  
pp. 342-349 ◽  
Author(s):  
O. Karam ◽  
J. Lacroix ◽  
N. Robitaille ◽  
P. C. Rimensberger ◽  
M. Tucci
Keyword(s):  
Clinical Outcome ◽  
Observational Study ◽  
Critically Ill ◽  
Prospective Observational Study ◽  
Critically Ill Children

scholarly journals Predictors of post-extubation stridor in patients on mechanical ventilation: a prospective observational study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Aiko Tanaka ◽  
Akinori Uchiyama ◽  
Yu Horiguchi ◽  
Ryota Higeno ◽  
Ryota Sakaguchi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Spontaneous Breathing Trial ◽  
Leak Test ◽  
Endotracheal Suctioning ◽  
Cuff Leak ◽  
The Impact

AbstractThe cuff leak test (CLT) has been widely accepted as a simple and noninvasive method for predicting post-extubation stridor (PES). However, its accuracy and clinical impact remain uncertain. We aimed to evaluate the reliability of CLT and to assess the impact of pre-extubation variables on the incidence of PES. A prospective observational study was performed on adult critically ill patients who required mechanical ventilation for more than 24 h. Patients were extubated after the successful spontaneous breathing trial, and CLT was conducted before extubation. Of the 191 patients studied, 26 (13.6%) were deemed positive through CLT. PES developed in 19 patients (9.9%) and resulted in a higher reintubation rate (8.1% vs. 52.6%, p < 0.001) and longer intensive care unit stay (8 [4.5–14] vs. 12 [8–30.5] days, p = 0.01) than patients without PES. The incidence of PES and post-extubation outcomes were similar in patients with both positive and negative CLT results. Compared with patients without PES, patients with PES had longer durations of endotracheal intubation and required endotracheal suctioning more frequently during the 24-h period prior to extubation. After adjusting for confounding factors, frequent endotracheal suctioning more than 15 times per day was associated with an adjusted odds ratio of 2.97 (95% confidence interval, 1.01–8.77) for PES. In conclusion, frequent endotracheal suctioning before extubation was a significant PES predictor in critically ill patients. Further investigations of its impact on the incidence of PES and patient outcomes are warranted.

scholarly journals 2654. Myocarditis in Dengue: A Prospective Observational Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S928-S929
Author(s):  
Manish Soneja ◽  
Manasvini Bhatt ◽  
Faraz A Farooqui ◽  
Naval K Vikram ◽  
Ashutosh Biswas ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Fluid Overload ◽  
Fluid Management ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Hemodynamic Instability ◽  
Warning Signs ◽  
Severe Dengue ◽  
Cardiac Enzymes

Abstract Background Cardiac involvement in dengue fever is underdiagnosed due to low index of suspicion and overlapping clinical manifestations of capillary leak associated with dengue. The frequency of subclinical dengue myocarditis and its relative contribution to the hemodynamic instability in severe dengue needs to be explored. We studied the prevalence of myocarditis and clinical outcomes among admitted patients with dengue. Methods A prospective observational study was carried out in admitted patients with age between 18 and 65 years having confirmed dengue (NS1/IgM ELISA). Patients with electrolyte abnormalities or on medications affecting heat rhythm/ rate, pre-existing heart disease were excluded. The baseline demographic, clinical and laboratory parameters were collected. A baseline ECG was done and repeated every second day. Trop-I and NT-proBNP were done at baseline and repeated only if elevated at baseline or there were ECG changes. The cardiac enzymes were measured using enzyme-linked fluorescent assay (VIDAS, bioMérieux, France). Patients with elevated enzymes underwent 2-dimensional echocardiography. Diagnosis of myocarditis was as per ESC 2013 criteria. Fluid management was as per WHO guidelines (2009). Results A total of 183 patients were recruited with median age of 29 years (IQR 21, 37) and 31% were females. Dengue with warning signs was present in 80 (44%) and severe dengue in 45 (25%) patients. Cardiac enzymes were elevated in 27 (15%) patients (cTnI in 25, NT-proBNP in 22). Among these 27 patients, 11 [6% (2.6–9.4, 95% CI)] had echo evidence and diagnosed as having myocarditis according to ESC 2013 criteria (Figure 1). Clinical features of fluid overload were more common in myocarditis group [8 (73%) vs 4 (2%), P = Overall, 5 (2.7%) patients expired, all of them had myocarditis (5/11 = 45%). These patients had severe dengue, 2 patients developed hospital-acquired pneumonia and 1 had malaria co-infection. Among patients with raised enzymes and normal echo (n = 16), 3 patients developed clinical signs of fluid overload compared with only 1 out of 156 patients without raised enzymes (P &lt; 0.01). Conclusion Myocarditis in admitted patients with dengue is not uncommon [6% (2.6–9.4, 95% CI)] and may lead to a complicated disease course. Disclosures All authors: No reported disclosures.

Red blood cell transfusion and immune function in critically ill children: a prospective observational study

Transfusion ◽  
2014 ◽  
Vol 55 (4) ◽  
pp. 766-774 ◽  
Author(s):  
Jennifer A. Muszynski ◽  
Elfaridah Frazier ◽  
Ryan Nofziger ◽  
Jyotsna Nateri ◽  
Lisa Hanson-Huber ◽  
...  
Keyword(s):  
Observational Study ◽  
Blood Cell ◽  
Immune Function ◽  
Critically Ill ◽  
Red Blood Cell ◽  
Prospective Observational Study ◽  
Red Blood Cell Transfusion ◽  
Critically Ill Children

Failure mode and effective analysis ameliorate awareness of medical errors: a 4-year prospective observational study in critically ill children

2015 ◽  
Vol 25 (12) ◽  
pp. 1227-1234 ◽  
Author(s):  
Marco Daverio ◽  
Giuliana Fino ◽  
Brugnaro Luca ◽  
Cristina Zaggia ◽  
Andrea Pettenazzo ◽  
...  
Keyword(s):  
Observational Study ◽  
Critically Ill ◽  
Failure Mode ◽  
Medical Errors ◽  
Prospective Observational Study ◽  
Critically Ill Children ◽  
Effective Analysis

THE IMPACT OF FIXED CONCENTRATIONS SEDATION INFUSIONS ON FLUID OVERLOAD IN CRITICALLY ILL CHILDREN

2016 ◽  
Vol 101 (9) ◽  
pp. e2.43-e2 ◽  
Author(s):  
Adam Sutherland ◽  
Elizabeth Jemmett ◽  
Stephen Playfor
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Fluid Resuscitation ◽  
Representative Sample ◽  
Fluid Overload ◽  
Kidney Injury ◽  
Critically Ill Children ◽  
Intravenous Drugs ◽  
The Impact ◽  
Weight Groups

IntroductionFluid overload of 10% at 48 hrs (100 ml/kg additional fluid) is strongly associated with morbidity in critically ill children.1 Contributors include fluid resuscitation, acute kidney injury, and administration of intravenous drugs. Acute Kidney Injury has been observed to be more prevalent in infants.2 Drug infusions are historically prepared according to bodyweight to run at large volumes to facilitate end-of-bed calculation and administration. We report the impact of using standardised concentrations on fluid overload in critically ill children in a tertiary general PICU.MethodsAdministration of sedation infusions was prospectively documented using purposive sampling until a population-representative sample for age and weight was obtained. Infusion volumes were calculated in ml/kg/day for different weight groups – 0–5 kg, 5–20 kg and <20 kg – and compared with equivalent volumes for weight-based infusions.Results33 patients received sedation infusions over a 5 week period. Overall drug volumes were reduced by 50.3%(41.3 to 58.7%) from 5.19 ml/kg to 2.65 ml/kg. Greatest reduction was seen in the smallest patients (total reduction 68% (16.72 ml/kg vs 5.36 ml/kg). Midazolam volumes in patients >20 kg was observed to increase (0.75 ml/kg vs. 0.95 ml/kg) but this did not have an impact on overall fluid burden.ConclusionsWeight based sedation infusions may contribute to fluid overload related morbidity, especially in infants. An infant on morphine and midazolam at standard doses (20 mcg/kg/hr and 90 mcg/kg/hr respectively) will receive 16.7 ml/kg/day (33.4% of critical fluid overload at 48 hrs) when using weight-based infusions. Using standard concentrations reduces this volume to 5.36 ml/kg/day (10.7% of critical fluid overload at 48 hrs).

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