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 >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 1134. Antibiotic Indications and Appropriateness in the Pediatric Intensive Care Unit: A 10 Center Point Prevalence Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S403-S404
Author(s):  
Kathleen Chiotos ◽  
Jennifer Blumenthal ◽  
Juri Boguniewicz ◽  
Debra Palazzi ◽  
Emily Berkman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Antibiotic Use ◽  
Empiric Therapy ◽  
Point Prevalence ◽  
Prevalence Study ◽  
Point Prevalence Study

Abstract Background Antibiotics are prescribed in up to 80% of pediatric intensive care unit (PICU) patients, but multicenter studies systematically evaluating antibiotic indications and appropriateness in this high-utilizing population are lacking. Methods A multicenter point prevalence study was conducted at 10 geographically diverse tertiary care US children’s hospitals. All PICU patients < 21 years of age who were receiving systemic antibiotics at 8:00 AM on each study day were included. Study days occurred in February and March 2019. Data were abstracted by critical care and/or infectious diseases trained clinicians using standardized data collection forms and definitions of antibiotic appropriateness. Results 408 of 732 PICU patients (56%) received 618 antibiotics on the two study days. Empiric therapy for suspected bacterial infections without sepsis was the most common indication for antibiotics (22%), followed by treatment of community-acquired pneumonia and empiric therapy for septic shock (12% each, Figure 1). Overall, 194 antibiotic orders (32%) were classified as inappropriate and 158 patients (39%) received at least one inappropriate antibiotic. Vancomycin, cefepime, and ceftriaxone were the antibiotics most often inappropriately prescribed (Figure 2). Antibiotics prescribed inappropriately for the top 5 indications shown in Figure 1 accounted for 77% of all inappropriate antibiotic use. Prolonged ( >4 days) empiric therapy and prolonged ( >24 hours) post-operative prophylaxis were the most common reasons antibiotics prescribed for these indications were classified as inappropriate. Pneumonia and ventilator-associated infections were the most common infections for which antibiotics were prescribed inappropriately (46%). Reasons for inappropriate antibiotic use included lack of evidence supporting a bacterial infection (no radiographic infiltrate or significant increase in respiratory support) and use of unnecessarily broad antibiotics (Table 1). Conclusion Inappropriate antibiotic use is common in the PICU, particularly for pneumonia. Studies focused on defining optimal treatment strategies, as well as improved diagnostic approaches to curtail prolonged courses of empiric therapy, should be prioritized. Disclosures All authors: No reported disclosures.

Mortality Review of Children Admitted in Pediatric Intensive Care Unit Over One Year in a Tertiary Care Hospital

2021 ◽  
Vol 6 (1) ◽  
pp. 1369-1372
Author(s):  
Pun Narayan Shrestha ◽  
Sumit Agrawal ◽  
Kosh Raj R C ◽  
Prakash Joshi ◽  
Ajit Rayamajhi
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Congenital Heart ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Care Hospital ◽  
Female Ratio

Introduction: Childhood mortality is still high in developing countries. This can be reduced with good preventive and curative services especially with critical care. The treatment of critically ill children must be focused for better outcome. The pediatrics deaths audit and review provide feedback to health workers and to the institution. The outcome measures of critical care medicine include mortality, morbidity and disability rate. Objectives: The aim of this study is to review the causes and mode of death in children and length of PICU (pediatric intensive care unit) stay. Methodology: A retrospective study was conducted of the patients who were admitted and died within the period of 16 July 2019 to 15 July, 2020 at PICU of Kanti Children Hospital (KCH). Variables recorded were patient's demography, diagnosis, co- morbidities, complications, length of PICU stay (LOS), mode and time of death. Data were tabulated into MS Excel and analyzed using SPSS version 23. Result: Out of 718 admitted children, 99 (13.78%) died with male to female ratio of 1.8:1. The maximum death (75%) was observed in less than five year of age and most of them were from outside the Kathmandu valley. The leading causes of death were pneumonia (28%), sepsis (20%) and congenital heart diseases (21%). The common complications seen were disseminated intravascular coagulation (DIC), multi- organ dysfunction syndrome (MODS), acute kidney injury (AKI) (5.1 %) and acute respiratory distress syndrome (ARDS) (6.1%) and co- morbidities were congenital heart disease (CHD) (18.2%) and global developmental delay (GDD) (9.1%). Mechanical ventilation was needed in 80.8%. Most of the cases (86%) died despite active treatment and (75%) during off hours (4pm-9am). Conclusion: Pneumonia, sepsis and CHD were the main reason of death and most of them were from outside the valley. 

Mobilization Therapy in the Pediatric Intensive Care Unit: A Multidisciplinary Quality Improvement Initiative

2018 ◽  
Vol 27 (3) ◽  
pp. 194-203 ◽  
Author(s):  
Blair R. L. Colwell ◽  
Cydni N. Williams ◽  
Serena P. Kelly ◽  
Laura M. Ibsen
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Tertiary Care ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Improvement Project

Background Mobilization is safe and associated with improved outcomes in critically ill adults, but little is known about mobilization of critically ill children. Objective To implement a standardized mobilization therapy protocol in a pediatric intensive care unit and improve mobilization of patients. Methods A goal-directed mobilization protocol was instituted as a quality improvement project in a 20-bed cardiac and medical-surgical pediatric intensive care unit within an academic tertiary care center. The mobilization goal was based on age and severity of illness. Data on severity of illness, ordered activity limitations, baseline functioning, mobilization level, complications of mobilization, and mobilization barriers were collected. Goal mobilization was defined as a ratio of mobilization level to severity of illness of 1 or greater. Results In 9 months, 567 patient encounters were analyzed, 294 (52%) of which achieved goal mobilization. The mean ratio of mobilization level to severity of illness improved slightly but nonsignificantly. Encounters that met mobilization goals were in younger (P = .04) and more ill (P &lt; .001) patients and were less likely to have barriers (P &lt; .001) than encounters not meeting the goals. Complication rate was 2.5%, with no difference between groups (P = .18). No serious adverse events occurred. Conclusions A multidisciplinary, multiprofessional, goal-directed mobilization protocol achieved goal mobilization in more than 50% of patients in this pediatric intensive care unit. Undermobilized patients were older, less ill, and more likely to have mobilization barriers at the patient and provider level.

scholarly journals A Study of Acute Kidney Injury in a Tertiary Care Pediatric Intensive Care Unit

2020 ◽  
Author(s):  
Akanksha C. Parikh ◽  
Milind S. Tullu
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Hospital Stay ◽  
Pediatric Intensive Care Unit ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Critically Ill Children

AbstractThe objective of this study was to calculate the incidence, severity, and risk factors for acute kidney injury (AKI) in a tertiary care pediatric intensive care unit (PICU). Also, to assess the impact of AKI and its varying severity on mortality and length of hospital and PICU stays. A prospective observational study was performed in children between 1 month and 12 years of age admitted to the PICU between July 1, 2013, and July 31, 2014 (13 months). The change in creatinine clearance was considered to diagnose and stage AKI according to pediatric risk, injury, failure, loss, and end-stage renal disease criteria. The risk factors for AKI and its impact on PICU stay, hospital stay, and mortality were evaluated. Of the total 220 patients enrolled in the study, 161 (73.2%) developed AKI, and 59 cases without AKI served as the “no AKI” (control) group. Majority (57.1%) of children with AKI had Failure grade of AKI, whereas 26.1% had Risk grade and 16.8% had Injury grade of AKI. Infancy (p = 0.000), hypovolemia (p = 0.005), shock (p = 0.008), and sepsis (p = 0.022) were found to be significant risk factors for AKI. Mortality, PICU stay, and hospital stay were comparable in children with and without AKI as well as between the various grades of renal injury (i.e., Failure, Risk, and Injury). An exceedingly high incidence of AKI, especially of the severe Failure grade was observed in critically ill children. Infancy and frequent PICU occurrences such as sepsis, hypovolemia, and shock predisposed to AKI.

Morbidity Pattern and Outcome of Patients Admitted into a Pediatric Intensive Care Unit in India

2014 ◽  
Vol 5 ◽  
pp. IJCM.S13902 ◽  
Author(s):  
Blessing I. Abhulimhen-Iyoha ◽  
Suneel Kumar Pooboni ◽  
Nanda Kishore Kumar Vuppali
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Common Disease ◽  
Duration Of Stay ◽  
Desirable Outcome

Background Intensive care has become very important in the management of critically ill children who require advanced airway, respiratory, and hemodynamic supports and are usually admitted into the pediatric intensive care unit (PICU) with the aim of achieving an outcome better than if the patients were admitted into other parts of the hospital. It becomes important to audit admissions and their outcome, which may help to modify practices if necessary following thorough introspection, leading to better patient outcomes. Objective To evaluate the morbidity pattern and outcome of admissions into the PICU of a tertiary care center in India. Methods A retrospective study in which records of admissions (from August 2012 to June 2013) were obtained from the PICU records. Information retrieved included age, sex, diagnosis, duration of stay in the unit, and outcome. Results Mean age of the studied 341 patients was 40.01 ± 45.79 months; 50.7% were infants and 59.8% were males. The three most common disease categories admitted were cardiovascular disease (41.1%), neurological disorders (12.0%), and respiratory disease (10.0%). The mean duration of stay in PICU was 3.2 ± 4.5 days. The overall mortality rate was 2.1%. Conclusion Mortality is low in our PICU. We conclude that a well-equipped intensive care unit with modern and innovative intensive care greatly facilitates the care of critically ill patients giving desirable outcome. An expansion of the pediatric wards is advocated to enhance cost–-effective management of patients and avoid unnecessary stretch of the PICU facilities.

Intravenous Immunoglobulin Use In Critically Ill Children

2021 ◽  
Vol 44 (3) ◽  
pp. E11-18
Author(s):  
Camille Jutras ◽  
Nancy Robitaille ◽  
Michael Sauthier ◽  
Geneviève Du Pont-Thibodeau ◽  
Jacques Lacroix ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Streptococcal Toxic Shock Syndrome ◽  
Solid Organ ◽  
Ivig Infusion

Purpose: The use of intravenous immunoglobulins (IVIG) has increased significantly in the last decade causing challenges for blood suppliers to respond to the demand. Indications for which IVIG infusion should be given to critically ill children remain unclear. The objective of this study is to characterize the epidemiology of IVIG use in this population. Methods: We performed a single-center retrospective cohort study of all patients aged between 3 days and 18 years who received at least one IVIG infusion while hospitalized in the pediatric intensive care unit of the Centre hospitalier universitaire (CHU) Sainte-Justine, Montréal Quebec (Canada) between January 1, 2013 and December 31, 2018. Results: One hundred and seventy-two patients received a total of 342 IVIG infusions over the study period. Most common indications for IVIG infusions were staphylococcal or streptococcal toxic shock syndrome (n=53/342, 15.5%), immunoglobulin replacement in chylothorax (n=37/342, 10.9%), prophylaxis following bone marrow transplantation (n=31/342, 9.1%), myocarditis (n=25/342, 7.3%) and post-solid organ transplant complications (n=21/342, 6.1%). The median dose of IVIG per infusion was 0.95 g/kg (IQR 0.5-1.0) and median number of IVIG infusions per patient was one (IQR: 1-2). Seventy-nine percent of IVIG infusions given were administrated for off-label indications with regards to Health Canada recommendations. Conclusion: This study identified the most common indications for IVIG infusion in critically ill children in a tertiary care pediatric intensive care unit. Given the costs, the known adverse events associated with IVIG and the pressure that blood suppliers are facing to meet the demands, clinical trials are needed to evaluate the efficacy and safety of IVIG in conditions where use is significant.

DOZ047.61: Elective tracheostomy in critically ill children: to do or not to do? Ten year experience from an academic center in Pakistan

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
S Ishaque ◽  
F Karim ◽  
S H Qazi ◽  
Q Abbas
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Prolonged Mechanical Ventilation ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Elective Tracheostomy

Abstract Background Tracheostomy is one of the oldest and most commonly performed procedures among critically ill patients. The advantages of an elective tracheostomy in pediatric intensive care unit are improved patient comfort, lesser need for sedative drugs, early weaning from mechanical ventilation support eventually leading to reduced cost of care. Objective This study describes the frequency, indications, complications, and outcome of elective pediatric tracheostomies in critically ill children from a single pediatric intensive care unit of a tertiary care center. Design This is a retrospective cohort study of patients undergoing tracheostomy. Setting This is a pediatric intensive care unit (PICU) of a tertiary-care hospital. Patients All patients underwent tracheostomy in our PICU over the ten-year period. Main Results A total of 48 children underwent a tracheostomy, corresponding to a 1.5% of the total PICU admissions during the study period. 34/48 (71%) patients were male. A 25% of our patients undergoing a tracheostomy had an underlying CNS condition, followed closely by a respiratory problem (11/48 patients).The main indication for tracheostomy in children was prolonged mechanical ventilation secondary to respiratory 35/48 (73%), that included upper airway obstruction, foreign body aspiration or pneumonia and neurological or neuromuscular illness (6.3%) including traumatic brain injury, meningitis/encephalitis, Gullain Barre’ syndrome, and neurodegenerative disorders. Two patients died from tracheostomy-related complications, making it an overall mortality rate of 4%. Conclusion Tracheostomy in children is a relatively frequent procedure at our hospital. The commonest indication was prolonged mechanical ventilation. Early tracheostomy is associated with better patient outcomes in terms of morbidity and length of stay.

scholarly journals Implementation of a Pragmatic Biomarker-Driven Algorithm to Guide Antibiotic Use in the Pediatric Intensive Care Unit: the Optimizing Antibiotic Strategies in Sepsis (OASIS) II Study

2018 ◽  
Vol 9 (1) ◽  
pp. 36-43 ◽  
Author(s):  
Kevin J Downes ◽  
Julie C Fitzgerald ◽  
Emily Schriver ◽  
Craig L K Boge ◽  
Michael E Russo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bacterial Infection ◽  
Pediatric Intensive Care Unit ◽  
Bacterial Infections ◽  
Pediatric Intensive Care ◽  
Antibiotic Use ◽  
Antibiotic Administration ◽  
Period 2 ◽  
Rate Ratios

Abstract Background Biomarkers can facilitate safe antibiotic discontinuation in critically ill patients without bacterial infection. Methods We tested the ability of a biomarker-based algorithm to reduce excess antibiotic administration in patients with systemic inflammatory response syndrome (SIRS) without bacterial infections (uninfected) in our pediatric intensive care unit (PICU). The algorithm suggested that PICU clinicians stop antibiotics if (1) C-reactive protein &lt;4 mg/dL and procalcitonin &lt;1 ng/mL at SIRS onset and (2) no evidence of bacterial infection by exam/testing by 48 hours. We evaluated excess broad-spectrum antibiotic use, defined as administration on days 3–9 after SIRS onset in uninfected children. Incidence rate ratios (IRRs) compared unadjusted excess length of therapy (LOT) in the 34 months before (Period 1) and 12 months after (Period 2) implementation of this algorithm, stratified by biomarker values. Segmented linear regression evaluated excess LOT among all uninfected episodes over time and between the periods. Results We identified 457 eligible SIRS episodes without bacterial infection, 333 in Period 1 and 124 in Period 2. When both biomarkers were below the algorithm’s cut-points (n = 48 Period 1, n = 31 Period 2), unadjusted excess LOT was lower in Period 2 (IRR, 0.53; 95% confidence interval, 0.30–0.93). Among all 457 uninfected episodes, there were no significant differences in LOT (coefficient 0.9, P = .99) between the periods on segmented regression. Conclusions Implementation of a biomarker-based algorithm did not decrease overall antibiotic exposure among all uninfected patients in our PICU, although exposures were reduced in the subset of SIRS episodes where biomarkers were low.

scholarly journals Use of body composition and phase angle analysis for the assessment of nutritional status and clinical outcomes in critically ill children

2021 ◽  
Author(s):  
Zi-Hong Xiong ◽  
Xue-Mei Zheng ◽  
Guo-Ying Zhang ◽  
Meng-Jun Wu ◽  
Yi Qu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nutritional Status ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Phase Angle ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Duration Time

Abstract BackgroundMalnutrition is highly prevalent in critically ill children in the pediatric intensive care unit .We aimed to investigate the efficiency of bioelectrical impedance analysis (BIA) measurements and phase angle (PhA) analysis for the assessment of nutritional risk and clinical outcomes in critically ill children.MethodsThis single-center observational study included patients admitted to the Pediatric Intensive Care Unit (PICU) of Chengdu Women’s and Children’s Central Hospital. All patients underwent anthropometric measurement in the first 24 h of admission and underwent BIA measurements within 3 days after the admission. The patients were classified into different groups based on body mass index (BMI) for age. Electronic hospital medical records were reviewed to collect clinical data for each patient. All the obtained data were analyzed by the statistics method.ResultsThere were 204 patients enrolled in our study, of which 32.4% were diagnosed with malnutrition. We found that BMI, arm muscle circumference, fat mass, and %body fat were lower in the group with poorer nutritional status (P < 0.05). Evident differences in the score of the Pediatric Risk of Mortality and the duration of mechanical ventilation (MV) among the three groups with different nutritional statuses were observed (P < 0.05). Patients in the severely malnourished group had the longest duration of MV. In the MV groups, there were significant differences (P < 0.05) in albumin level, PhA, and extracellular water/total body water (ECW/TBW ratio). The ECW/TBW ratio and the time for PICU stay had a weak degree of correlation (Pearson correlation coefficient = 0.375). PhA showed a weak degree of correlation with the duration time of medical ventilation (coefficient of correlation = 0.398).ConclusionBIA can be considered an alternative way to assess nutritional status in critically ill children. ECW/TBW ratio and PhA were correlated with PICU stay and duration time of medical ventilation, respectively.

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