The Utility of Procalcitonin to Support Clinical Decision Making in Critically Ill Pediatric Patients

ABSTRACT OBJECTIVE To review the concepts involved in the decision-making process for management of pediatric patients with spinal deformity. METHODS The literature was reviewed in reference to pediatric deformity evaluation and management. RESULTS Pediatric spinal deformity includes a broad range of disorders with differing causes, natural histories, and treatments. Appropriate categorization of pediatric deformities is an important first step in the clinical decision-making process. An understanding of both nonoperative and operative treatment modalities and their indications is requisite to providing treatment for pediatric patients with spinal deformity. The primary nonoperative treatment modalities include bracing and casting, and the primary operative treatments include nonfusion instrumentation and fusion with or without instrumentation. In this article, we provide a review of pediatric spinal deformity classification and an overview of general treatment principles. CONCLUSION The decision-making process in pediatric deformity begins with appropriate diagnosis and classification of the deformity. Treatment decisions, both nonoperative and operative, are often predicated on the basis of the age of the patient and the natural history of the disorder.

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Vascular anatomical considerations and clinical decision making during insertion of the Avalon® Elite Dual Lumen single-site veno-venous ECMO cannula in children weighing less than 20 kg

Perfusion ◽

10.1177/0267659118815104 ◽

2018 ◽

Vol 34 (4) ◽

pp. 267-271 ◽

Cited By ~ 3

Author(s):

William Cory Ellis ◽

Michal Schafer ◽

Cindy S. Barrett ◽

Katie Butler ◽

Andrew Sprowell ◽

...

Keyword(s):

Decision Making ◽

Extracorporeal Membrane Oxygenation ◽

Critically Ill ◽

Mechanical Characteristics ◽

Clinical Decision Making ◽

Clinical Decision ◽

Single Site ◽

Correct Selection ◽

Critically Ill Children ◽

Clinical Strategy

The correct selection and placement of a single-site Avalon® Elite Dual Lumen Cannula for veno-venous extracorporeal membrane oxygenation (ECMO) in children weighing less than 20 kg is dependent on both the mechanical characteristics of the catheter, including length and diameter, as well as the unique vascular anatomic considerations of the patient. This manuscript describes the development of a clinical strategy, over a four-year period from 2012-2016, for cannula selection to reduce the risk of migration and malposition in 20 critically ill children weighing less than 20 kg who presented for veno-venous ECMO.

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Clinical decision-making by the emergency department resident physicians for critically ill patients

Frontiers of Medicine ◽

10.1007/s11684-012-0183-9 ◽

2012 ◽

Vol 6 (1) ◽

pp. 89-93 ◽

Cited By ~ 5

Author(s):

Tengda Xu ◽

Jun Xu ◽

Xuezhong Yu ◽

Sui Ma ◽

Zhong Wang

Keyword(s):

Decision Making ◽

Emergency Department ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Decision Making ◽

Clinical Decision ◽

Resident Physicians

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Lower blood pH as a strong prognostic factor for fatal outcomes in critically ill COVID-19 patients at an intensive care unit: A multivariable analysis

PLoS ONE ◽

10.1371/journal.pone.0258018 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0258018

Author(s):

Martin Kieninger ◽

Annemarie Sinning ◽

Timea Vadász ◽

Michael Gruber ◽

Wolfram Gronwald ◽

...

Keyword(s):

Decision Making ◽

Intensive Care ◽

Prognostic Factors ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Critically Ill ◽

Clinical Decision Making ◽

Ph Value ◽

Clinical Decision ◽

Blood Ph

Background Data of critically ill COVID-19 patients are being evaluated worldwide, not only to understand the various aspects of the disease and to refine treatment strategies but also to improve clinical decision-making. For clinical decision-making in particular, prognostic factors of a lethal course of the disease would be highly relevant. Methods In this retrospective cohort study, we analyzed the first 59 adult critically ill Covid-19 patients treated in one of the intensive care units of the University Medical Center Regensburg, Germany. Using uni- and multivariable regression models, we extracted a set of parameters that allowed for prognosing in-hospital mortality. Results Within the cohort, 19 patients died (mortality 32.2%). Blood pH value, mean arterial pressure, base excess, troponin, and procalcitonin were identified as highly significant prognostic factors of in-hospital mortality. However, no significant differences were found for other parameters expected to be relevant prognostic factors, like low arterial partial pressure of oxygen or high lactate levels. In the multivariable logistic regression analysis, the pH value and the mean arterial pressure turned out to be the most influential prognostic factors for a lethal course.

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