Characteristics of Medically Transported Critically Ill Children with Respiratory Failure in Latin America: Implications for Outcomes

2021 ◽  
Author(s):  
Jesus A. Serra ◽  
Franco Díaz ◽  
Pablo Cruces ◽  
Cristobal Carvajal ◽  
Maria J. Nuñez ◽  
...  
Keyword(s):  
Latin America ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Critically Ill ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Factors Associated ◽  
Resource Limited

AbstractSeveral challenges exist for referral and transport of critically ill children in resource-limited regions such as Latin America; however, little is known about factors associated with clinical outcomes. Thus, we aimed to describe the characteristics of critically ill children in Latin America transferred to pediatric intensive care units for acute respiratory failure to identify risk factors for mortality. We analyzed data from 2,692 patients admitted to 28 centers in the Pediatric Collaborative Network of Latin America Acute Respiratory Failure Registry. Among patients referred from another facility (773, 28%), nonurban transports were independently associated with mortality (adjusted odds ratio = 9.4; 95% confidence interval: 2.4–36.3).

Clinical Features and Risk Factors Associated with Mortality in Critically ill Children Requiring Continuous Renal Replacement Therapy

2020 ◽  
Author(s):  
Muhterem Duyu ◽  
Ceren Turkozkan
Keyword(s):  
Risk Factors ◽  
Respiratory Failure ◽  
Renal Replacement Therapy ◽  
Renal Disease ◽  
Continuous Renal Replacement Therapy ◽  
Critically Ill ◽  
Odds Ratio ◽  
Critically Ill Children ◽  
Factors Associated ◽  
High Lactate

Abstract Background: The aims of this study were to describe the epidemiology and demographic characteristics of critically ill children requiring continuous renal replacement therapy (CRRT) at our pediatric intensive care unit (PICU) and to explore risk factors associated with mortality. Methods: A retrospective cohort of 121 critically ill children who received CRRT from May 2015 to May 2020 in the PICU of a tertiary healthcare institution was evalauted. The demographic information, admission diagnosis, indication for CRRT, clinical variables at the initiation of CRRT, time related variables and the laboratory results at initiation of CRRT were compared between survivors and non-survivors.Results: The most common diagnoses were renal disease (30.6%), hemato-oncological disease (12.4%), and sepsis (11.6%). The overall mortality was 29.8%. When compared according to diagnosis at admission, we found that patients with hemato-oncologic disease (73.3%) and those with pneumonia/respiratory failure (72.7%) had the highest mortality, while patients with renal disease had the lowest mortality (5.4%). The most common CRRT indications were: electrolyte or acid base imbalance (38.8%), acute kidney injury (29.8%) and fluid overload (14.9%). There was no relationship between mortality and indication for CRRT. The time interval between PICU admission and CRRT initiation was also unassociated with mortality (p=0.146). In patients diagnosed with sepsis, time until the initiation of CRRT was significantly shorter in survivors compared to non-survivors (p=0.004). Based on multivariate logistic regression, presence of comorbidity (odds ratio: 5.71; %95 CI: 1.16-27.97), being diagnosed with pneumonia/respiratory failure at admission (odds ratio: 16.16; %95 CI: 1.56-167.01), and high lactate level at the initiation of CRRT (odds ratio: 1.43; %95 CI: 1.17-1.79) were independently associated with mortality.Conclusions: In the context of the population studied mortality rate was lower than previously reported. In critically ill children requiring CRRT, mortality seems to be related to underlying disease, presence of comorbidity, and high lactate levels at CRRT initiation. We also found that early initiation of CRRT in sepsis can reduce mortality.

Predictors of Failure of Noninvasive Ventilation in Critically Ill Children

2021 ◽  
Author(s):  
Alyson K. Baker ◽  
Andrew L. Beardsley ◽  
Brian D. Leland ◽  
Elizabeth A. Moser ◽  
Riad L. Lutfi ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Respiratory Rate ◽  
Noninvasive Ventilation ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Clinical Predictors ◽  
Failure Group ◽  
Logistic Organ Dysfunction ◽  
Fraction Of Inspired Oxygen

AbstractNoninvasive ventilation (NIV) is a common modality employed to treat acute respiratory failure. Most data guiding its use is extrapolated from adult studies. We sought to identify clinical predictors associated with failure of NIV, defined as requiring intubation. This single-center retrospective observational study included children admitted to pediatric intensive care unit (PICU) between July 2014 and June 2016 treated with NIV, excluding postextubation. A total of 148 patients was included. Twenty-seven (18%) failed NIV. There was no difference between the two groups with regard to age, gender, comorbidities, or etiology of acute respiratory failure. Those that failed had higher admission pediatric risk of mortality (p = 0.01) and pediatric logistic organ dysfunction (p = 0.002) scores and higher fraction of inspired oxygen (FiO2; p = 0.009) at NIV initiation. Failure was associated with lack of improvement in tachypnea. At 6 hours of NIV, the failure group had worsening tachypnea with a median increase in respiratory rate of 8%, while the success group had a median reduction of 18% (p = 0.06). Multivariable Cox's proportional hazard models revealed FiO2 at initiation and worsening respiratory rate at 1- and 6-hour significant risks for failure of NIV. Failure was associated with a significantly longer PICU length of stay (success [2.8 days interquartile range (IQR): 1.7, 5.5] vs. failure [10.6 days IQR: 5.6, 13.2], p < 0.001). NIV can be successfully employed to treat acute respiratory failure in pediatric patients. There should be heightened concern for NIV failure in hypoxemic patients whose tachypnea is unresponsive to NIV. A trend toward improvement should be closely monitored.

scholarly journals Patterns of Sedation Weaning in Critically Ill Children Recovering From Acute Respiratory Failure*

2016 ◽  
Vol 17 (1) ◽  
pp. 19-29 ◽  
Author(s):  
Kaitlin M. Best ◽  
Lisa A. Asaro ◽  
Linda S. Franck ◽  
David Wypij ◽  
Martha A. Q. Curley
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Critically Ill ◽  
Critically Ill Children

scholarly journals Gastrointestinal complications in critically ill children: Experience from a resource-limited country

2021 ◽  
Vol 37 (3) ◽  
Author(s):  
Sidra Ishaque ◽  
Marium Shakir ◽  
Asma Ladak ◽  
Anwar Ul Haque
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
University Hospital ◽  
Critically Ill Children ◽  
Ethical Review ◽  
Gastrointestinal Complications ◽  
Resource Limited

Objectives: To determine the frequency and predictors of outcome of gastrointestinal complications (GIC) in critically ill children. Methods: This descriptive study was prospectively conducted in The Pediatric Intensive Care Unit (PICU), The Aga Khan University Hospital (AKUH), Karachi, from September 2015 to January 2017. After obtaining approval from the Ethical Review Committee of AKUH and informed consent from the parents, all children (aged one month to 18 years), of either gender, admitted to the Pediatric Intensive Care Unit (PICU) during the study period were included. The frequency of the defined GIC: vomiting, high gastric residue volume (GRV), diarrhea, constipation, and gastrointestinal bleed were recorded daily for the first week of the PICU stay. The data was collected by the primary investigator on a predesigned data collection form with inclusion of variables and predictors in light of existing literature and local expertise. The questionnaire was shared with the Pediatric Critical Care Medicine faculty and a consensus was sought on the elements to be incorporated. Results: GIC developed within the first 48 hours of admission in 78 (41%) patients. Of the patients who developed GIC, 37 (47.4%) patients developed high GRV: 31 (39.7%) patients developed constipation, 18 (23.1%) patients developed vomiting, 14 (17.9%) patients developed abdominal distension. With regards to prevalence by occurrence, 32/78 (41%) of patients presented with two GI complications, followed by 21 patients (27%) who presented with a single GIC. Only 11 patients (14%) presented with more than three complications. Median length of stay was higher in patients with GIC (8 days) than with those who did not develop GIC (4 days). The frequency of gastrointestinal complications was significantly higher in children receiving mechanical ventilation, on sedatives and relaxants and those with multiorgan dysfunction syndrome (MODS) and inotropes Conclusion: GI complications are a frequent occurrence in the PICU and are associated with worse clinical outcomes. The use of sedative drugs and the presence of shock with MODS were amongst the important contributing factors. doi: https://doi.org/10.12669/pjms.37.3.3493 How to cite this:Ishaque S, Shakir M, Ladak A, Anwar-Ul-Haque. Gastrointestinal complications in critically ill children: Experience from a resource-limited country. Pak J Med Sci. 2021;37(3):---------. doi: https://doi.org/10.12669/pjms.37.3.3493 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Dexmedetomidine Use in Critically Ill Children With Acute Respiratory Failure*

2016 ◽  
Vol 17 (12) ◽  
pp. 1131-1141 ◽  
Author(s):  
Mary Jo C. Grant ◽  
James B. Schneider ◽  
Lisa A. Asaro ◽  
Brenda L. Dodson ◽  
Brent A. Hall ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Critically Ill ◽  
Critically Ill Children

Prognostic value of extravascular lung water index in critically ill children with acute respiratory failure

2010 ◽  
Vol 37 (1) ◽  
pp. 124-131 ◽  
Author(s):  
Riccardo Lubrano ◽  
Corrado Cecchetti ◽  
Marco Elli ◽  
Caterina Tomasello ◽  
Giuliana Guido ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Critically Ill ◽  
Extravascular Lung Water ◽  
Prognostic Value ◽  
Critically Ill Children ◽  
Lung Water ◽  
Extravascular Lung Water Index ◽  
Water Index

Abstract P050: A QUERY OF THE DIABETES PARADOX IN TAKOTSUBO CARDIOMYOPATHY

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Temidayo Abe ◽  
Kikelomo Olaosebikan ◽  
Ajibola babatunde ◽  
Tolulope Abe ◽  
Temitope Tobun
Keyword(s):  
Atrial Fibrillation ◽  
Respiratory Failure ◽  
Cardiogenic Shock ◽  
Acute Respiratory Failure ◽  
Takotsubo Cardiomyopathy ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Increased Risk ◽  
Stratified Analysis ◽  
Overall Mortality

Background: Observational studies have demonstrated a low prevalence of diabetes mellitus (DM) in patients with takotsubo cardiomyopathy (TCM) and also suggested a possible protective role due to underlying autonomic neuropathy. its impact on TCM outcomes is unclear. Methods: We recruited 8081 patients from 2011, 2012 National Inpatient Sample, 6325 had TCM while 1756 had TCM with DM. Our outcomes of interest were overall mortality, mechanical hemodynamic support (MHS), acute respiratory failure(ARF), cardiac arrest (SCA), cardiogenic shock (CS), and stroke. Logistic regression was used to estimate the adjusted odds ratio of the outcomes in the study compared to the control group while stratified analysis was used to adjust for sex both accounting for underlying comorbidities. Results: The mean age was 60.4 years. There was no difference in overall mortality (4.1% vs 3.5%; P =0.154), cardiogenic shock (6.2% vs 6.2%; P=0.905), atrial fibrillation (11.1 vs 11.8; P= 0.224), stroke (1.9% vs 2.3%; P= 0.139) and MHS (2.3% vs 2.8%; P= 0.086). The rate of acute respiratory failure was significantly higher in DM+TCM patients compared to TCM alone (20.8% vs 18.2%; P= 0.021). Table 1 reveals the adjusted odds ratio for outcomes while table 2 stratified analysis based on age and sex. Patients with TCM+ DM have higher odds for acute respiratory failure and the use of MHS. The stratified analysis revealed that compared to TCM alone, females with TCM +DM are more likely to develop acute respiratory failure, stroke, and the use of MHS, while male patients were more likely to develop atrial fibrillation. Conclusion: Underlying DM is associated with an increased risk for poor outcomes in patients with TCM.

Sign in / Sign up

Export Citation Format

Share Document