scholarly journals Predicting Outcome in Mechanically Ventilated Pediatric Patients

2019 ◽  
Vol 09 (02) ◽  
pp. 092-098
Author(s):  
Selman Kesici ◽  
Şenay Kenç ◽  
Ayşe Filiz Yetimakman ◽  
Benan Bayrakci
Keyword(s):  
Respiratory Failure ◽  
Mortality Risk ◽  
Pediatric Patients ◽  
Oxygenation Index ◽  
Mortality Rates ◽  
Mechanically Ventilated ◽  
Risk Of Mortality ◽  
Predicting Outcome ◽  
Expected Mortality ◽  
Pediatric Index Of Mortality

AbstractTo apply and determine whether standardized mortality scores are appropriate to predict the risk of mortality in mechanically ventilated pediatric patients, 150 patients were retrospectively evaluated. Pediatric risk of mortality (PRISM) III-24 and pediatric index of mortality (PIM)-2 scores were unable to discriminate survivors and nonsurvivors; the observed mortality rate was lower than expected mortality rates. Oxygenation index (OI) was calculated at 0, 12, 24, and 72 hours of ventilation. OI-12 and OI-72 were found to be higher in nonsurvivors. PRISM III-24 and PIM-2 scores failed to predict mortality risk in mechanically ventilated pediatric patients. OI can be used to predict degree of respiratory failure and mortality risk.

Protocolized Sedation vs Usual Care in Pediatric Patients Mechanically Ventilated for Acute Respiratory Failure

2016 ◽  
Vol 60 (4) ◽  
pp. 142-143
Author(s):  
Martha A. Q. Curley ◽  
David Wypij ◽  
R. Scott Watson ◽  
Mary Jo C. Grant ◽  
Lisa A. Asaro ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Usual Care ◽  
Pediatric Patients ◽  
Mechanically Ventilated

Venovenous Extracorporeal Membrane Oxygenation in Pediatric Respiratory Failure

2016 ◽  
Vol 82 (9) ◽  
pp. 787-788 ◽  
Author(s):  
P. Benson Ham ◽  
Brice Hwang ◽  
Linda J. Wise ◽  
K. Christian Walters ◽  
Walter L. Pipkin ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Pediatric Patients ◽  
Oxygenation Index ◽  
Lung Damage ◽  
Positive Pressure ◽  
Membrane Oxygenation ◽  
Short Run ◽  
Va Ecmo ◽  
Vv Ecmo

Conventional treatment of respiratory failure involves positive pressure ventilation that can worsen lung damage. Extracorporeal membrane oxygenation (ECMO) is typically used when conventional therapy fails. In this study, we evaluated the use of venovenous (VV)-ECMO for the treatment of severe pediatric respiratory failure at our institution. A retrospective analysis of pediatric patients (age 1–18) placed on ECMO in the last 15 years (1999–2014) by the pediatric surgery team for respiratory failure was performed. Five pediatric patients underwent ECMO (mean age 10 years; range, 2–16). All underwent VV-ECMO. Diagnoses were status asthmaticus (2), acute respiratory distress syndrome due to septic shock (1), aspergillus pneumonia (1), and respiratory failure due to parainfluenza (1). Two patients had severe barotrauma prior to ECMO initiation. Average oxygenation index (OI) prior to cannulation was 74 (range 23–122). No patients required conversion to VA-ECMO. The average ECMO run time was 4.4 days (range 2–6). The average number of days on the ventilator was 15 (range 4–27). There were no major complications due to the procedure. Survival to discharge was 100%. Average follow up is 4.4 years (range 1–15). A short run of VV-ECMO can be lifesaving for pediatric patients in respiratory failure. Survival is excellent despite severely elevated oxygen indices. VV-ECMO may be well tolerated and can be considered for severe pediatric respiratory failure.

scholarly journals Comparison of Simultaneous Capillary Blood Gases and End-Tidal Carbon Dioxide in Mechanically Ventilated Pediatric Patients with Acute Respiratory Failure

2020 ◽  
Author(s):  
Capan Konca ◽  
Mehmet Tekin ◽  
Fatih Uckardes ◽  
Samet Benli ◽  
Ahmet Kucuk
Keyword(s):  
Carbon Dioxide ◽  
Respiratory Failure ◽  
Pediatric Patients ◽  
Blood Gases ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Mechanically Ventilated ◽  
End Tidal Carbon Dioxide ◽  
End Tidal

AbstractIn the follow-up of ventilation, invasive blood gas analysis and noninvasive monitoring of end-tidal carbon dioxide (ETCO2) are used. We aimed to investigate the relationship between capillary partial pressure of carbon dioxide (PcCO2) levels and ETCO2 and also to investigate ETCO2's predictive feature of PcCO2 levels. This study included 28 female and 30 male pediatric patients; 28 patients were type-1 respiratory failure (RF), 16 patients were acute respiratory distress syndrome, and 14 patients were type-2 RF. Our results showed a significant correlation between ETCO2 and PcCO2. Although the strength of the correlation was weak throughout the measurements, the strength of this correlation increased significantly in type-2 RF.

scholarly journals Observation on the Nursing Effect of Prone Position Ventilation Applied to Children with Respiratory Failure

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Aili Peng ◽  
Litao Guo ◽  
Jing Xu ◽  
Jingrong Fan
Keyword(s):  
Carbon Dioxide ◽  
Respiratory Failure ◽  
Partial Pressure ◽  
Prone Position ◽  
Pediatric Patients ◽  
Oxygenation Index ◽  
Control Group ◽  
Arterial Partial Pressure ◽  
Arterial Blood ◽  
Experimental Group

Objective — To compare the effects of two prone position ventilation methods on children with respiratory failure, to obtain a safer and more effective way to guide clinical nursing work. Methods — 48 cases of children who were admitted to the intensive care unit of our hospital from February 2018 to August 2019 and applied mechanical ventilation were divided into groups based on a random number table. The odd numbers were included in the experimental group (continuous prone position ventilation group, the duration of continuous prone position exceeded 12 hours, a total of 25 cases). The even numbers were included in the control group (intermittent prone position ventilation group, prone position for 3 hours at a time, alternating with supine position and lateral position, total prone position duration 12 hours, a total of 23 cases). Oxygenation index (OI), PH value, arterial partial pressure of carbon dioxide (PCO2), arterial partial pressure of oxygen (PO2) at 24h, 48h, 72h of the two groups of children, as well as their ventilator use time and ICU hospital stay were compared. Results — Continuous prone position ventilation and intermittent prone position ventilation have no statistical significance on arterial blood carbon dioxide partial pressure (PaCO2), arterial blood oxygen partial pressure (PaO2), ventilator duration, ICU length of stay in children with respiratory failure (P>0.05), but with the increase of the total length of the prone position, when reaching more than 36 hours, the trend of oxygenation index (OI) of the experimental group and the control group can be seen to decline.  Conclusion — In this study, by comparing the effects of two prone position ventilation modes, it was found that intermittent prone position ventilation and continuous prone position ventilation had no difference in the treatment of children with respiratory failure. When children are treated in continuous prone and intermittent prone positions, the total prone position can last up to 36 hours, which can effectively improve the clinical treatment effect. In view of the characteristics of pediatric patients and the difficulty in nursing critically ill patients with tracheal intubation, it is recommended that pediatric patients can use intermittent prone ventilation to complete treatment when the cumulative time in the prone position reaches more than 36 hours.

scholarly journals Evaluation of Severity of Illness Scores in the Pediatric ECMO Population

2021 ◽  
Vol 9 ◽  
Author(s):  
Venessa L. Pinto ◽  
Danielle Guffey ◽  
Laura Loftis ◽  
Melania M. Bembea ◽  
Philip C. Spinella ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Pediatric Patients ◽  
Area Under The Curve ◽  
Severity Of Illness ◽  
Roc Curves ◽  
Operating Characteristics ◽  
Logistic Organ Dysfunction ◽  
Risk Of Mortality ◽  
Pediatric Icu ◽  
Pediatric Index Of Mortality

Though commonly used for adjustment of risk, severity of illness and mortality risk prediction scores, based on the first 24 h of intensive care unit (ICU) admission, have not been validated in the pediatric extracorporeal membrane oxygenation (ECMO) population. We aimed to determine the association of Pediatric Index of Mortality 2 (PIM2), Pediatric Risk of Mortality Score III (PRISM III) and Pediatric Logistic Organ Dysfunction (PELOD) scores with mortality in pediatric patients on ECMO. This was a retrospective cohort study of children ≤18 years of age included in the Pediatric ECMO Outcomes Registry (PEDECOR) from 2014 to 2018. Logistic regression and Receiver Operating Characteristics (ROC) curves were used to calculate the area under the curve (AUC) to evaluate association of mortality with the scores. Of the 655 cases, 289 (44.1%) did not survive until hospital discharge. AUCs for PIM2, PRISM III, and PELOD predicting mortality were 0.52, 0.52, and 0.51 respectively. PIM2, PRISM III, and PELOD scores are not associated with odds of mortality for pediatric patients receiving ECMO. These scores for a general pediatric ICU population should not be used for prognostication or risk stratification of a select population such as ECMO patients.

scholarly journals Protocolized Sedation vs Usual Care in Pediatric Patients Mechanically Ventilated for Acute Respiratory Failure

JAMA ◽  
2015 ◽  
Vol 313 (4) ◽  
pp. 379 ◽  
Author(s):  
Martha A. Q. Curley ◽  
David Wypij ◽  
R. Scott Watson ◽  
Mary Jo C. Grant ◽  
Lisa A. Asaro ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Usual Care ◽  
Pediatric Patients ◽  
Mechanically Ventilated

EP.FRI.948 Outcomes Following Emergency Laparotomy In The Over 70’s

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Adam Gerrard ◽  
Emily Haines ◽  
Peter Mason ◽  
Rajesh Satchidanand
Keyword(s):  
Mortality Risk ◽  
The Elderly ◽  
Mortality Rates ◽  
Emergency Laparotomy ◽  
Full Data ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Risk Scoring ◽  
Surgery In The Elderly ◽  
Future Work

Abstract Aim Surgery in the elderly carries greater risk of mortality with those who are frail being most at risk. We aimed to review our outcomes for patients 70 years of age and over, who underwent emergency laparotomy. Methods All patients aged 70 and over who had undergone emergency laparotomy within a 12-month period were included for analysis. Patient’s pre-operative risk was assessed by the P-Possum and NELA scoring along with Rockwood Frailty Scale (RFS) and the Geriatric rescue after surgery (GRAS) score.  Results 50/116 patients undergoing emergency laparotomy were aged over 70 years old. Full data was available for 47 of these. Overall 30- and 90-day mortality was 12.8% and 21.3% respectively. 90-day mortality in patients with a RFS of > 4 was 25% compared with 16% with a score of 4 or less. Those with a GRAS score <4 and 4 or greater had a 90-day mortality of 16% and 27% respectively. Where there was a P-Possom mortality risk >10% was no difference in the mortality rates, however when the NELA risk was >10%, 90 day mortality was 26.6% compared with 15.4%.  Conclusion Emergency laparotomy in the over 70’s carries much higher risk of death. Mortality risk scoring and frailty assessments are useful tools in counselling patients and their families prior to surgery. Future work will assess the predictive value of different and combined scores in this population.

scholarly journals Impact of out-of-hours admission on patient mortality: longitudinal analysis in a tertiary acute hospital

2017 ◽  
Vol 27 (6) ◽  
pp. 445-454 ◽  
Author(s):  
Lu Han ◽  
Matt Sutton ◽  
Stuart Clough ◽  
Richard Warner ◽  
Tim Doran
Keyword(s):  
Hospital Mortality ◽  
Mortality Risk ◽  
Mortality Rates ◽  
Absolute Difference ◽  
Night Time ◽  
Out Of Hours ◽  
Percentage Points ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Over Time

BackgroundEmergency hospital admission on weekends is associated with an increased risk of mortality. Previous studies have been limited to examining single years and assessing day—not time—of admission. We used an enhanced longitudinal data set to estimate the ‘weekend effect’ over time and the effect of night-time admission on all-cause mortality rates.MethodsWe examined 246 350 emergency spells from a large teaching hospital in England between April 2004 and March 2014. Outcomes included 7-day, 30-day and in-hospital mortality rates. We conducted probit regressions to estimate the impact on the absolute difference in the risk of mortality of two key predictors: (1) admission on weekends (19:00 Friday to 06:59 Monday); and (2) night-time admission (19:00 to 06:59). Logistic regressions were used to estimate ORs for relative mortality risk differences.ResultsCrude 30-day mortality rate decreased from 6.6% in 2004/2005 to 5.2% in 2013/2014. Adjusted mortality risk was elevated for all out-of-hours periods. The highest risk was associated with admission on weekend night-times: 30-day mortality increased by 0.6 percentage points (adjusted OR: 1.17, 95% CI 1.10 to 1.25), 7-day mortality by 0.5 percentage points (adjusted OR: 1.23, 95% CI 1.12 to 1.34) and in-hospital mortality by 0.5 percentage points (adjusted OR: 1.14, 95% CI 1.08 to 1.21) compared with admission on weekday daytimes. Weekend night-time admission was associated with increased mortality risk in 9 out of 10 years, but this was only statistically significant (p<0.05) in 5 out of 10 years.ConclusionsThere is an increased risk of mortality for patients admitted as emergencies both on weekends and during the night-time. These effects are additive, so that the greatest risk of mortality occurs in patients admitted during the night on weekends. This increased risk appears to be consistent over time, but the effects are small and are not statistically significant in individual hospitals in every year.

scholarly journals Healthcare-related impact of gout in hospitalized patients in Spain

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Diego Benavent ◽  
Diana Peiteado ◽  
María Ángeles Martinez-Huedo ◽  
María Hernandez-Hurtado ◽  
Alejandro Balsa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Kidney Disease ◽  
Mortality Rates ◽  
Progressive Increase ◽  
Cerebrovascular Diseases ◽  
Hospitalized Patients ◽  
Data Set ◽  
Private Hospitals ◽  
Risk Of Mortality ◽  
General Mortality

AbstractTo analyze the epidemiology, clinical features and costs of hospitalized patients with gout during the last decade in Spain. Retrospective observational study based on data from the Minimum Basic Data Set (MBDS) from the Spanish National Health Service database. Patients ≥ 18 years with any gout diagnosis at discharge who had been admitted to public or private hospitals between 2005 and 2015 were included. Patients were divided in two periods: p1 (2005–2010) and p2 (2011–2015) to compare the number of hospitalizations, mean costs and mortality rates. Data from 192,037 patients with gout was analyzed. There was an increase in the number of hospitalized patients with gout (p < 0.001). The more frequent comorbidities were diabetes (27.6% of patients), kidney disease (26.6%) and heart failure (19.3%). Liver disease (OR 2.61), dementia (OR 2.13), cerebrovascular diseases (OR 1.57), heart failure (OR 1.41), and kidney disease (OR 1.34) were associated with a higher mortality risk. Women had a lower risk of mortality than men (OR 0.85). General mortality rates in these hospitalized patients progressively increased over the years (p < 0.001). In addition, costs gradually rose, presenting a significant increase in p2 even after adjusting for inflation (p = 0.001). A progressive increase in hospitalizations, mortality rates and cost in hospitalized patients with gout was observed. This harmful trend in a preventable illness highlights the need for change and the search for new healthcare strategies.

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