Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2—Case Series of a Pediatric Intensive Care Unit in Portugal

2021 ◽  
Author(s):  
João Miranda ◽  
Marta Grilo ◽  
Carolina Baptista ◽  
Ana Reis e Melo ◽  
Margarida Tavares ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Invasive Mechanical Ventilation ◽  
Ventilatory Support ◽  
Case Series ◽  
Pediatric Intensive Care ◽  
Left Ventricular ◽  
Clinical Approach ◽  
High Flow Oxygen

AbstractPediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PIMS-TS) is a novel condition with persistent fever, inflammation, and single or multiorgan dysfunction. We aimed to describe the characteristics of children more severely affected and our clinical approach. We retrospectively collected clinical, treatment, and early outcomes data during a 3-month period in a pediatric intensive care unit (PICU) of a tertiary university hospital in Portugal. Twelve children who fulfilled the Royal College of Pediatrics and Child Health case definition were hospitalized, seven needed PICU admission. Median age was 13 years and three were overweight, with no other comorbidity. All had positive immunoglobulin G antibodies for SARS-CoV-2. All presented with prolonged fever, asthenia, hypotension, and shock. Other prominent symptoms were abdominal complaints and rash. All patients had leukocytosis, neutrophilia, and marked elevation of inflammatory markers. Cardiac involvement was observed in all patients with elevated levels of troponin and B-type natriuretic peptide along with left ventricular hypokinesis. Depressed left ventricular function was observed in four patients. All patients received broad-spectrum antibiotics, intravenous immunoglobulin, methylprednisolone, low-dose aspirin, and vasoactive medications. Four patients received prophylactic enoxaparin. All patients needed supplementary oxygen; however, high-flow oxygen therapy and noninvasive ventilatory support with positive end-expiratory pressure were required in three and two patients, respectively. Five patients required invasive mechanical ventilation. The mean duration of PICU stay was 7.1 days. The median Pediatric Risk of Mortality-III score was 9 and no mortality was observed. PIMS-TS demands a prompt and multidisciplinary approach. Risk factors, best clinical pathway, and long-term complications are still unknown.

Weaning From Noninvasive Ventilatory Support in Infants With Severe Bronchiolitis: An Observational Study

2021 ◽  
Author(s):  
Julie Cassibba ◽  
Claire Freycon ◽  
Julia Doutau ◽  
Isabelle Pin ◽  
Alexandre Bellier ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Pediatric Intensive Care Unit ◽  
Positive Airway Pressure ◽  
Ventilatory Support ◽  
Winter Season ◽  
Pediatric Intensive Care ◽  
High Flow Nasal Cannula ◽  
Tertiary Center

Abstract Background: The aim of the study was to analyze the weaning success, the type of weaning procedures, and weaning duration in consecutive infants hospitalized over a winter season in a Pediatric Intensive Care Unit.Methods: A retrospective observational study in a pediatric intensive care unit in a tertiary center. Infants hospitalized for a severe bronchiolitis were included and the weaning procedure from continuous positive airway pressure (CPAP), noninvasive ventilation (NIV) or high flow nasal cannula (HFNC) was analyzed.Results: Data from 95 infants (median age 47 days) were analyzed. On admission, 26 (27%), 46 (49%) and 23 (24%) infants were supported by CPAP, NIV and HFNC, respectively. One (4%), nine (20%) and one (4%) infants failed weaning while supported by CPAP, NIV or HFNC, respectively (p=0.1). In infants supported by CPAP, CPAP was stopped directly in 5 patients (19%) while HFNC was used as an intermediate ventilatory support in 21 (81%). The duration of weaning was shorter for HFNC (17 hours, [IQR 0-26]) than for CPAP (24 hours, [14-40]) and NIV (28 hours, [19-49]) (p<0.01).Conclusions: The weaning phase represent a large proportion of noninvasive ventilatory support duration in infants with bronchiolitis. The weaning procedure following a “step down” strategy may lead to an increase in duration of weaning.

scholarly journals Gross motor developmental dysfunctional outcomes in infantile and toddler pediatric intensive care unit survivors

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Chun-Feng Yang ◽  
Yang Xue ◽  
Jun-Yan Feng ◽  
Fei-Yong Jia ◽  
Yu Zhang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Motor Function ◽  
Linear Regression Analysis ◽  
Invasive Mechanical Ventilation ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Gross Motor ◽  
Link Type

Abstract Background Increasing studies have focused on motor function/dysfunction in PICU survivors; however, most studies have focused on adults and older children. This study investigated gross motor developmental function outcomes in infantile and toddler pediatric intensive care unit (PICU) survivors and the factors associated with gross motor developmental functions. Methods This observational study was conducted in the PICU of the First Hospital of Jilin University between January 2019 and March 2019. Thirty-five eligible patients were divided into the dysfunctional (n = 24) or non-dysfunctional (n = 11) group according to the results of the Peabody Developmental Motor Scales, Second Edition (PDMS-2). Baseline gross motor function for all participants before PICU admission was measured via the Age and Stages Questionnaires, Third Edition (ASQ-3). The PDMS-2 was used to evaluate gross motor development function before PICU discharge. Results The gross motor developmental dysfunction incidence was 68.6%. Linear correlation analysis showed that the gross motor quotient (GMQ) was positively correlated with the pediatric critical illness score (PCIS, r = 0.621, P < 0.001), and negatively correlated with length of PICU stay (r = − 0.556, P = 0.001), days sedated (r = − 0.602, P < 0.001), days on invasive mechanical ventilation (IMV; r = − 0.686, P < 0.001), and days on continuous renal replacement therapy (CRRT; r = − 0.538, P = 0.001). Linear regression analysis showed that IMV days (β = − 0.736, P = 0.001), sepsis (β = − 18.111, P = 0.003) and PCIS (β = 0.550, P = 0.021) were independent risk factors for gross motor developmental dysfunction. Conclusions Gross motor developmental dysfunction in infantile and toddler PICU survivors is more common and may be exacerbated by experiences associated with longer IMV days and increasing illness severity combined with sepsis. Trial registration The trial ‘Early rehabilitation intervention for critically ill children’ has been registered at http://www.chictr.org.cn/showproj.aspx?proj=23132. Registration number: ChiCTR1800020196.

scholarly journals Gross Motor Developmental Dysfunctional Outcomes in Infantile and Toddler Pediatric Intensive Care Unit Survivors

2019 ◽  
Author(s):  
Chun-Feng Yang ◽  
Yang Xue ◽  
Jun-Yan Feng ◽  
Fei-Yong Jia ◽  
Yu Zhang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Motor Function ◽  
Motor Development ◽  
Linear Regression Analysis ◽  
Invasive Mechanical Ventilation ◽  
Pediatric Intensive Care ◽  
Older Children ◽  
Gross Motor

Abstract Background: Increasing studies have focused on motor function/dysfunction in PICU survivors; however, most studies have focused on adults and older children. This study investigated gross motor developmental function outcomes in infantile and toddler pediatric intensive care unit (PICU) survivors and the factors associated with gross motor developmental functions. Methods: This observational study was conducted in the PICU of the First Hospital of Jilin University between January 2019 and March 2019. Thirty-five eligible patients were divided into the dysfunctional (n=24) or non-dysfunctional (n=11) group according to the results of the Peabody Developmental Motor Scales, Second Edition (PDMS-2). Baseline gross motor function for all participants before PICU admission was measured via the Age and Stages Questionnaires, Third Edition (ASQ-3). The PDMS-2 was used to evaluate gross motor development function before PICU discharge. Results: The gross motor developmental dysfunction incidence was 68.6%. Linear correlation analysis showed that the gross motor quotient (GMQ) was positively correlated with the pediatric critical illness score (PCIS, r=0.621, P<0.001), and negatively correlated with length of PICU stay (r=-0.556, P=0.001), days sedated (r=-0.602, P<0.001), days on invasive mechanical ventilation (IMV; r=-0.686, P<0.001), and days on continuous renal replacement therapy (CRRT; r=-0.538, P=0.001). Linear regression analysis showed that IMV days (β=-0.736, P=0.001), sepsis (β=-18.111, P=0.003) and PCIS (β=0.550, P=0.021) were independent risk factors for gross motor developmental dysfunction Conclusions: Gross motor developmental dysfunction in infantile and toddler PICU survivors is more common and may be exacerbated by experiences associated with longer IMV days and increasing illness severity combined with sepsis.

Etiology of Fever and Opportunities for Reduction of Antibiotic Use in a Pediatric Intensive Care Unit

2001 ◽  
Vol 22 (08) ◽  
pp. 499-504 ◽  
Author(s):  
Philip Toltzis ◽  
Bonnie Rosolowski ◽  
Ann Salvator
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Tertiary Care ◽  
Case Series ◽  
Pediatric Intensive Care ◽  
Antibiotic Use ◽  
Critically Ill Children ◽  
Axillary Temperature ◽  
Prospective Case Series

Abstract Objective: To determine the cause of fever in critically ill children and to identify opportunities for reducing antibiotic use in this population. Design: Prospective case series. Setting: A tertiary-care medical-surgical pediatric intensive care unit (PICU). Patients: Children admitted to the PICU who experienced fever (axillary temperature &gt;38.3°C). Measurements: Consecutive children who were febrile at any point in their PICU stay were investigated over two winter seasons. Etiology of the fever was determined by physical examination and routine microbiology and radiographic tests. Three subgroups were reviewed to approximate the number of antibiotic-days that could have been reduced; namely, those with an indeterminate source, those with a documented viral infection, and those receiving a prolonged course of antibiotics. A set of standards reflecting common antibiotic use then was applied to these three patient groups. Results: Of 211 subjects, the majority (83.3%) had either a definitive or suspected focus for their fever, and nearly all of these patients were judged to have an infectious etiology. The study population received a total of 2,036 antibiotic-days. Despite the high incidence of infectious causes of fever in our subjects, however, approximately 15% of total antibiotic-days could have been reduced by applying common-use standards. Conclusions: Fever in the PICU was usually of defined focus and infectious in origin. However, among febrile patients in the PICU, substantial opportunity exists for reduction of antibiotic use. Trials determining the safety of antibiotic reduction in this population should be pursued vigorously.

scholarly journals Multicenter mortality and morbidity associated with pulmonary hypertension in the pediatric intensive care unit

2017 ◽  
Vol 8 (1) ◽  
pp. 204589321774578 ◽  
Author(s):  
Emily Morell Balkin ◽  
Martina A. Steurer ◽  
Elise A. Delagnes ◽  
Matt S. Zinter ◽  
Satish Rajagopal ◽  
...  
Keyword(s):  
Heart Failure ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Pulmonary Hypertension ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Clinical Decision Making ◽  
Invasive Mechanical Ventilation ◽  
Pediatric Intensive Care ◽  
Severity Scores

Despite advances in the diagnosis and management of pediatric pulmonary hypertension (PH), children with PH represent a growing inpatient population with significant morbidity and mortality. To date, no studies have described the clinical characteristics of children with PH in the pediatric intensive care unit (PICU). A retrospective multicenter cohort study of 153 centers in the Virtual PICU Systems database who submitted data between 1 January 2009 and 31 December 2015 was performed. A total of 14,880/670,098 admissions (2.2%) with a diagnosis of PH were identified. Of these, 2190 (14.7%) had primary PH and 12,690 (85.3%) had secondary PH. Mortality for PH admissions was 6.8% compared to 2.3% in those admitted without PH (odds ratio = 3.1; 95% confidence interval = 2.9–3.4). Compared to patients admitted to the PICU without PH, those with PH were younger, had longer length of stay, higher illness severity scores, were more likely to receive invasive mechanical ventilation, cardiopulmonary resuscitation, extracorporeal membrane oxygenation, and more likely to have co-diagnoses of sepsis, heart failure, and respiratory failure. In a multivariate model, factors significantly associated with mortality for children with PH included age < 6 months or > 16 years, invasive mechanical ventilation, and co-diagnoses of heart failure, sepsis, hemoptysis, disseminated intravascular coagulation, stroke, and multi-organ dysfunction syndrome. Despite therapeutic advances, the disease burden and mortality of children with PH remains significant. Further investigation of the risk factors associated with clinical deterioration and mortality in this population could improve the ability to prognosticate and inform clinical decision-making.

scholarly journals Gross Motor Developmental Dysfunctional Outcomes in Infantile and Toddler Pediatric Intensive Care Unit Survivors

2019 ◽  
Author(s):  
Chun-Feng Yang ◽  
Yang Xue ◽  
Jun-Yan Feng ◽  
Fei-Yong Jia ◽  
Yu Zhang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Motor Function ◽  
Linear Regression Analysis ◽  
Invasive Mechanical Ventilation ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Gross Motor

Abstract Background: Increasing studies have focused on motor function/dysfunction in PICU survivors; however, most studies have focused on adults and older children. This study investigated gross motor developmental function outcomes in infantile and toddler pediatric intensive care unit (PICU) survivors and the factors associated with gross motor developmental functions. Methods: This observational study was conducted in the PICU of the First Hospital of Jilin University between January 2019 and March 2019. Thirty-five eligible patients were divided into the dysfunctional (n=24) or non-dysfunctional (n=11) group according to the results of the Peabody Developmental Motor Scales, Second Edition (PDMS-2). Baseline gross motor function for all participants before PICU admission was measured via the Age and Stages Questionnaires, Third Edition (ASQ-3). The PDMS-2 was used to evaluate gross motor development function before PICU discharge. Results: The gross motor developmental dysfunction incidence was 68.6%. Linear correlation analysis showed that the gross motor quotient (GMQ) was positively correlated with the pediatric critical illness score (PCIS, r=0.621, P<0.001), and negatively correlated with length of PICU stay (r=-0.556, P=0.001), days sedated (r=-0.602, P<0.001), days on invasive mechanical ventilation (IMV; r=-0.686, P<0.001), and days on continuous renal replacement therapy (CRRT; r=-0.538, P=0.001). Linear regression analysis showed that IMV days (β=-0.736, P=0.001), sepsis (β=-18.111, P=0.003) and PCIS (β=0.550, P=0.021) were independent risk factors for gross motor developmental dysfunction Conclusions: Gross motor developmental dysfunction in infantile and toddler PICU survivors is more common and may be exacerbated by experiences associated with longer IMV days and increasing illness severity combined with sepsis. Trial Registration: The trial ‘Early rehabilitation intervention for critically ill children’ has been registered at http://www.chictr.org.cn/showproj.aspx?proj=23132. Registration number: ChiCTR1800020196. Keywords: Gross Motor Developmental Function; Sepsis; Mechanical Ventilation; Pediatric Intensive Care Unit; Infant; Toddler

scholarly journals Gross Motor Developmental Dysfunctional Outcomes in Infantile and Toddler Pediatric Intensive Care Unit Survivors

2019 ◽  
Author(s):  
Chun-Feng Yang ◽  
Yang Xue ◽  
Jun-Yan Feng ◽  
Fei-Yong Jia ◽  
Yu Zhang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Motor Function ◽  
Motor Development ◽  
Linear Regression Analysis ◽  
Invasive Mechanical Ventilation ◽  
Pediatric Intensive Care ◽  
Older Children ◽  
Gross Motor

Abstract Background: Increasing studies have focused on motor function/dysfunction in PICU survivors; however, most studies have focused on adults and older children. This study investigated gross motor developmental function outcomes in infantile and toddler pediatric intensive care unit (PICU) survivors and the factors associated with gross motor developmental functions. Methods: This observational study was conducted in the PICU of the First Hospital of Jilin University between January 2019 and March 2019. Thirty-five eligible patients were divided into the dysfunctional (n=24) or non-dysfunctional (n=11) group according to the results of the Peabody Developmental Motor Scales, Second Edition (PDMS-2). Baseline gross motor function for all participants before PICU admission was measured via the Age and Stages Questionnaires, Third Edition (ASQ-3). The PDMS-2 was used to evaluate gross motor development function before PICU discharge. Results: The gross motor developmental dysfunction incidence was 68.6%. Linear correlation analysis showed that the gross motor quotient (GMQ) was positively correlated with the pediatric critical illness score (PCIS, r=0.621, P<0.001), and negatively correlated with length of PICU stay (r=-0.556, P=0.001), days sedated (r=-0.602, P<0.001), days on invasive mechanical ventilation (IMV; r=-0.686, P<0.001), and days on continuous renal replacement therapy (CRRT; r=-0.538, P=0.001). Linear regression analysis showed that IMV days (β=-0.736, P=0.001), sepsis (β=-18.111, P=0.003) and PCIS (β=0.550, P=0.021) were independent risk factors for gross motor developmental dysfunction Conclusions: Gross motor developmental dysfunction in infantile and toddler PICU survivors is more common and may be exacerbated by experiences associated with longer IMV days and increasing illness severity combined with sepsis.

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