343: FACTORS ASSOCIATED WITH PROLONGED DISCHARGE DELAYS IN A PEDIATRIC ICU

Introduction: Our objectives are to (1) describe the pathogens, site, timing and risk factors for acquired infection during neonatal and pediatric ECMO and (2) explore the association between acquired infection and mortality. Methods: Secondary analysis of prospective data collected by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014. Clinical factors associated with acquired infection were assessed with multivariable Cox regression. Factors associated with mortality were assessed with logistic regression. Results: Of 481 patients, 247 (51.3%) were neonates and 400 (83.2%) received venoarterial ECMO. Eighty (16.6%) patients acquired one or more infections during ECMO; 60 (12.5%) patients had bacterial, 21 (4.4%) had fungal and 11 (2.3%) had viral infections. The site of infection included respiratory for 53 (11.0%) patients, bloodstream for 21 (4.4%), urine for 20 (4.2%) and other for 7 (1.5%). Candida species were most common. Median time to infection was 5.2 days (IQR 2.3, 9.6). On multivariable analysis, a greater number of procedures for ECMO cannula placement was independently associated with increased risk of acquired infection during ECMO (Hazard Ratio 2.13 (95% CI 1.22, 3.72), p<0.01) and receiving ECMO in a neonatal ICU compared to a pediatric or cardiac ICU was associated with decreased risk (Hazard Ratio pediatric ICU 4.25 (95% CI 2.20, 8.20), cardiac ICU 2.91 (95% CI 1.48, 5.71), neonatal ICU as reference, p<0.001). Acquired infection was not independently associated with mortality. Conclusion: ECMO procedures and location may contribute to acquired infection risk; however, acquired infection did not predict mortality in this study.

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Opioid Use Is Associated with ICU Delirium in Mechanically Ventilated Children

The Journal of Critical Care Medicine ◽

10.2478/jccm-2020-0026 ◽

2020 ◽

Vol 6 (3) ◽

pp. 167-174

Author(s):

Neha Gupta ◽

Allison Woolley ◽

Saurabh Talathi ◽

Ganisher Davlyatov ◽

Candice Colston ◽

...

Keyword(s):

Mechanical Ventilation ◽

A Priori ◽

Tertiary Care ◽

Critically Ill Children ◽

Opioid Use ◽

Mechanically Ventilated ◽

Opioid Dose ◽

Factors Associated ◽

Increased Risk ◽

Pediatric Icu

AbstractIntroductionPediatric delirium is a significant problem when encounterd in an intensive care unit (ICU). The pathophysiology of pediatric delirium is complex and the etiology is typically multifactorial. Even though various risk factors associated with pediatric delirium in a pediatric ICU have been identified, there is still a paucity of literature associated with the condition, especially in extremely critically ill children, sedated and mechanically ventilated.Aim of the studyTo identify factors associated with delirium in mechanically ventilated children in an ICU.Material and MethodsThis is a single-center study conducted at a tertiary care pediatric ICU. Patients admitted to the pediatric ICU requiring sedation and mechanical ventilation for >48 hours were included. Cornell Assessment of Pediatric Delirium scale was used to screen patients with delirium. Baseline demographic and clinical factors as well as daily and cumulative doses of medications were compared between patients with and without delirium. Firth’s penalized maximum likelihood logistic regression was used on a priori set of variables to examine the association of potential factors with delirium. Two regression models were created to assess the effect of daily medication doses (Model 1) as well as cumulative medication doses (Model 2) of opioids and benzodiazepines.Results95 patient visits met the inclusion criteria. 19 patients (20%) were diagnosed with delirium. Older patients (>12 years) had higher odds of developing delirium. Every 1mg/kg/day increase in daily doses of opioids was associated with an increased risk of delirium (OR=1.977, p=0.017). Likewise, 1 mg/kg increase in the cumulative opioid dose was associated with a higher odds of developing delirium (OR=1.035, p=0.022). Duration of mechanical ventilation was associated with the development of delirium in Model 1 (p=0.007).ConclusionsAge, daily and cumulative opioid dosage and the duration of mechanical ventilation are associated with the development of delirium in mechanically ventilated children.

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Noninvasive ventilation in a pediatric ICU: factors associated with failure

Jornal Brasileiro de Pneumologia ◽

10.36416/1806-3756/e20180053 ◽

2020 ◽

Vol 46 (6) ◽

pp. e20180053-e20180053

Author(s):

Rosângela Aparecida Alves Grande ◽

Gabriela Albuquerque Fernandes ◽

Daniela Pascoal Andrade ◽

Natasha Yumi Matsunaga ◽

Therezinha de Oliveira ◽

...

Keyword(s):

Noninvasive Ventilation ◽

Factors Associated ◽

Pediatric Icu

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Risk Factors Associated with Colonization of Intestine by Carbapenem Resistant Enterobacteriaceae in a Pediatric ICU

Journal of Microbiology and Infectious Diseases ◽

10.5799/jmid.748690 ◽

2020 ◽

pp. 75-81

Author(s):

Sonal SAXENA ◽

Suresh KUMAR ◽

Virender KUMAR ◽

Ravinder KAUR

Keyword(s):

Risk Factors ◽

Factors Associated ◽

Carbapenem Resistant ◽

Pediatric Icu ◽

Carbapenem Resistant Enterobacteriaceae

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Stain contamination and embedding in electron microscopy

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100141986 ◽

1986 ◽

Vol 44 ◽

pp. 50-53

Author(s):

Hilton H. Mollenhauer

Keyword(s):

Electron Microscopy ◽

Information Retrieval ◽

Epoxy Resins ◽

Image Contrast ◽

Sample Preservation ◽

Factors Associated ◽

Amount Of Information ◽

Electron Microscopical ◽

Contrast Information

Many factors (e.g., resolution of microscope, type of tissue, and preparation of sample) affect electron microscopical images and alter the amount of information that can be retrieved from a specimen. Of interest in this report are those factors associated with the evaluation of epoxy embedded tissues. In this context, informational retrieval is dependant, in part, on the ability to “see” sample detail (e.g., contrast) and, in part, on tue quality of sample preservation. Two aspects of this problem will be discussed: 1) epoxy resins and their effect on image contrast, information retrieval, and sample preservation; and 2) the interaction between some stains commonly used for enhancing contrast and information retrieval.

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