Clinical Profile and Predictors of Outcome in Children with Acute Fulminant Myocarditis Receiving Intensive Care: A Single Center Experience

2021 ◽  
Author(s):  
Muralidharan Jayashree ◽  
Manisha Patil ◽  
Govindappa Benakatti ◽  
Manoj K. Rohit ◽  
Sunit Singhi ◽  
...  
Keyword(s):  
Intensive Care ◽  
Acute Myocarditis ◽  
Treated Group ◽  
Fulminant Myocarditis ◽  
Ivig Treatment ◽  
High Morbidity ◽  
Predictors Of Outcome ◽  
Care Needs ◽  
Multiorgan Dysfunction ◽  
Inotrope Score

AbstractAcute myocarditis in children is associated with high morbidity and mortality, with limited data on intravenous immunoglobulin (IVIG) treatment and outcome. Our goal was to describe clinical, treatment profile, and predictors of outcome in children with acute fulminant myocarditis (AFM) receiving intensive care. Case records of 120 children with clinical diagnosis of acute myocarditis from January 2008 to December 2018 were analyzed retrospectively. AFM was seen in 89 (74.2%) children of which nearly two-thirds (54 [60.7%]) were hypotensive at admission. The median (interquartile range [IQR]) ejection fraction on echocardiography was 25 (18.5–36%). Eighty-two children (68.3%) received IVIG. Intensive care needs were mechanical ventilation (n = 71; 59.2%) and inotrope support (n = 89; 74.2%); median inotrope score being 30 (IQR: 20–55). Twenty-one children died (17.5%). Fever (p = 0.004), arrhythmia (p = 0.03), shock (p = 0.015), higher inotrope score (p = 0.0001), need for ventilation (p = 0.025), acidosis (p = 0.013), AKI (p = 0.0001), transaminitis (p = 0.0001), and multiorgan dysfunction (p = 0.0001) were associated with mortality. The mortality was significantly less in IVIG treated group (12.1 vs. 28.9%; p = 0.02). On multiple logistic regression, MODS (p = 0.002) was independent predictor of mortality while IVIG treatment (p = 0.004) was favorably associated with survival. AFM complicated by multiorgan dysfunction carried a poor prognosis. IVIG was associated with survival benefit.

scholarly journals Clinical profile, intensive care needs and predictors of outcome in children with drowning: A developing country perspective

2018 ◽  
Vol 5 (7) ◽  
pp. 64
Author(s):  
Ashish Agarwal ◽  
Karthi Nallasamy ◽  
Jayashree Muralidharan ◽  
Arun Baranwal ◽  
Arun Bansal ◽  
...  
Keyword(s):  
Intensive Care ◽  
Developing Country ◽  
Clinical Profile ◽  
Predictors Of Outcome ◽  
Care Needs

scholarly journals Complement C9 expression is associated with damaged myocardial cells in pediatric sudden death cases of fulminant myocarditis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Akari Takaya Uno ◽  
Masahito Hitosugi ◽  
Mami Nakamura ◽  
Tomoyuki Nakanishi ◽  
Takahiro Mima ◽  
...  
Keyword(s):  
Sudden Death ◽  
Acute Myocarditis ◽  
Lymphocytic Infiltration ◽  
Pericardial Fluid ◽  
Sirtuin 1 ◽  
Fulminant Myocarditis ◽  
Myocardial Cells ◽  
Hematoxylin And Eosin ◽  
Hematoxylin And Eosin Staining ◽  
Complement C9

Abstract Background Because disease progression is so fast in sudden death of acute fulminant myocarditis, damage of myocardial cells is not evident in routine hematoxylin and eosin staining. To understand damage to myocardial cells and the mechanism of sudden death, immunohistochemical staining was performed for two forensic autopsy cases. Case presentation The patients were a healthy 5-year-old girl and 8-year-old boy. They suddenly died within 2 days of appearance of flu-like symptoms. An autopsy showed accumulation of yellowish-clear pericardial fluid containing fibrin deposits, fluid blood in the heart, and congestion of visceral organs. Histologically, minor necrosis or degeneration of myocardial cells with mainly lymphocytic infiltration was observed sometimes in tissue sections. Immunohistochemically, positive complement C9 staining and negative sirtuin 1 staining were found. These findings suggested wide damage of myocardial cells, even in regions with no marked changes in myocardial cells with hematoxylin and eosin staining. These areas corresponded to those with strong accumulation of lymphocytes. Conclusions Immunohistochemistry for complement C9 and sirtuin 1 might become a new tool for evaluating damage of myocardial cells of fulminant acute myocarditis.

Barriers to High Quality End of Life Care in the Surgical Intensive Care Unit

2020 ◽  
pp. 104990912096997
Author(s):  
Ricardo Diaz Milian
Keyword(s):  
Intensive Care ◽  
End Of Life ◽  
Conflicts Of Interest ◽  
Quality Care ◽  
Surgical Intensive Care Unit ◽  
Care Needs ◽  
Surgical Intensive Care ◽  
Quality Reporting ◽  
Number Of Patients ◽  
Hospice And Palliative Care

End of life discussions frequently take place in surgical intensive care units, as a significant number of patients die while admitted to the hospital, and surgery is common during the last month of life. Multiple barriers exist to the initiation of these conversations, including: miscommunication between clinicians and surrogates, a paternalistic approach to surgical patients, and perhaps, conflicts of interest as an unwanted consequence of surgical quality reporting. Goal discordant care refers to the care that is provided to a patient that is incapacitated and that is not concordant to his/her wishes. This is a largely unrecognized medical error with devastating consequences, including inappropriate prolongation of life and non-beneficial therapy utilization. Importantly, hospice and palliative care needs to be recognized as quality care in order to deter the incentives that might persuade clinicians from offering these services.

An Assessment of Health Needs in Selected Nigeria Villages

1985 ◽  
Vol 6 (2) ◽  
pp. 161-169 ◽  
Author(s):  
Collins O. Airhihenbuwa
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Cost Of Care ◽  
Health Care Facilities ◽  
High Morbidity ◽  
Community Members ◽  
Care Needs ◽  
Medical Institutions ◽  
Poor Access ◽  
Care Facilities

Two hundred and fifty five heads of households in Iyekuselu District, Bendel State Nigeria, were interviewed. Fifteen villages were randomly selected from the 107 villages that make up the district. There is high morbidity of infectious diseases identified in the study. Limited number of medical professionals and medical institutions present problems of availability of services. This is compounded by high cost of medical services and poor access to health care facilities. The self-perceived health care needs of the heads of households are disease prevention, availability of health services, improved accessibility to health care facilities and reduced cost of care. There is a strong need for health education programs in these villages. This should be attempted with the cooperation of community members, so as to attain the goal of promoting health and preventing diseases.

Dengue infection with multiorgan dysfunction: SOFA score, arterial lactate and serum albumin levels are predictors of outcome

2015 ◽  
Vol 41 (11) ◽  
pp. 2029-2030 ◽  
Author(s):  
Sameer Jog ◽  
Shirish Prayag ◽  
Prasad Rajhans ◽  
Kapil Zirpe ◽  
Subhal Dixit ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Sofa Score ◽  
Dengue Infection ◽  
Predictors Of Outcome ◽  
Arterial Lactate ◽  
Multiorgan Dysfunction

scholarly journals MOBILISASI PROGRESIF TERHADAP PERUBAHAN TEKANAN DARAH PASIEN DI INTENSIVE CARE UNIT (ICU)

2016 ◽  
Vol 12 (1) ◽  
Author(s):  
Ainnur Rahmanti ◽  
Dyah Kartika Putri
Keyword(s):  
Blood Pressure ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Respiratory Function ◽  
Lateral Position ◽  
High Morbidity ◽  
Left Lateral Position ◽  
Critical Patients

Patient with critical condition had high morbidity and mortality rate. This condition is worsened by long term immobilization. Instability vital sign made nurses stationed delayed mobilization activities in ICU. Progressive mobilization must be started for ICU patient to decrease respiratory function, level of awareness and cardiovascular function. The objective of this study was to identify progressive mobilization activities on blood pressure parameters among critical patients in ICU. The design of this study was quai experiment design. Thirty respondents were included to the study using concequtive sampling. Progressive mobilization was given with head of bed 300 (HOB 300), head of bed450 (HOB 450) with  passive range of motion, continued with right and left lateral position. Anova repeated measurement was used to identify mean difference each of blood pressure. The result of this study show there is two moment sistolic change between HOB 300 to HOB 450 and HOB 450 to right lateral position (3,3%). There is nine moment diastolic change between HOB 450 to right lateral position (16,7%).   Keywords: blood pressure, ICU, Progressive mobilization

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