Mortality-adjusted duration of mechanical ventilation in critically ill children with symptomatic central venous line-related deep venous thrombosis*

AbstractThe presence of a central venous catheter and admission to the intensive care unit are the most important risk factors for deep venous thrombosis (DVT) in children. At least 18% of critically ill children with a catheter develop radiologically confirmed catheter-associated thrombosis. Clinically apparent thrombosis occurs in 3% of critically ill children with a catheter and is associated with 8 additional days of mechanical ventilation. Even when the thrombus is initially asymptomatic, 8 to 18% of critically ill children with catheter-associated thrombosis develop postthrombotic syndrome. Thrombosis is uncommon within 24 hours after insertion of a nontunneled catheter in critically ill children, but nearly all thrombi have developed by 4 days after insertion. Hypercoagulability during or immediately after insertion of the catheter plays an essential role in the development of thrombosis. Pharmacologic prophylaxis, including local anticoagulation with heparin-bonded catheter, has not been shown to reduce the risk of catheter-related thrombosis in children. Systemic anticoagulation in critically ill children started soon after the insertion of the catheter, however, may be beneficial. A multicenter clinical trial that is testing this hypothesis is currently underway.

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Incidence and Acute Complications of Asymptomatic Central Venous Catheter–Related Deep Venous Thrombosis in Critically Ill Children

The Journal of Pediatrics ◽

10.1016/j.jpeds.2012.06.059 ◽

2013 ◽

Vol 162 (2) ◽

pp. 387-391 ◽

Cited By ~ 46

Author(s):

Edward Vincent S. Faustino ◽

Philip C. Spinella ◽

Simon Li ◽

Matthew G. Pinto ◽

Petronella Stoltz ◽

...

Keyword(s):

Central Venous Catheter ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Critically Ill ◽

Venous Catheter ◽

Critically Ill Children ◽

Central Venous ◽

Acute Complications

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DEEP VENOUS THROMBOSIS DETECTED ON SYSTEMATIC SCREENING WITH ULTRASOUND IN SEVERE COVID-19 IS ASSOCIATED WITH HIGHER ODDS OF MECHANICAL VENTILATION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)03179-x ◽

2021 ◽

Vol 77 (18) ◽

pp. 1823

Author(s):

Mouhand F.H. Mohamed ◽

Mahmood Mubasher ◽

Mhd Baraa Habib ◽

Ibrahim Y. Abubeker

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Meta Analysis ◽

Systematic Screening

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Unfractionated Heparin (UFH) For Prevention of Central Venous Catheter Thrombotic Complications in Children: A systematic review and meta-analysis

QJM ◽

10.1093/qjmed/hcab113.022 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Marwa W Nasef ◽

Maha M El-gaffary ◽

Mervet G Mansour ◽

Esraa S Abd El Aty

Keyword(s):

Central Venous Catheter ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Unfractionated Heparin ◽

Meta Analysis ◽

Venous Catheter ◽

Controlled Trials ◽

Central Venous ◽

Thrombotic Occlusion ◽

Thrombotic Complications

Abstract Objective To determine the efficacy of unfractionated heparin in reducing central venous catheter-related deep venous thrombosis and/or catheter thrombotic occlusion in children by systematically searching the literature and conducting a meta-analysis study. Methods Four electronic databases (PubMed, Google Scholar, Elsevier’s thrombosis journal, and the Cochrane Central Register for Controlled Trials) were searched for journal peer-reviewed articles published in the period from Jan 2000 to Dec 2018. The search criteria included observational studies, and randomized controlled trials on patients aged 0–18 years with central venous catheters (CVC), which compare between the effect of UFH (flushes, lock solutions, continuous infusion, and heparin bonded catheter) and no prophylaxis (Normal saline flush or no treatment) for the prevention of CVC thrombotic complications (CVC-related deep venous thrombosis (DVT) and/or catheter thrombotic occlusion). Two authors independently reviewed and identified the eligible studies, which were assessed for study methodology including bias, and extraction of unadjusted data whenever available. To pool data from eligible studies, the meta-analysis was performed on RevMan version 5.3. Odds ratios were generated with the corresponding 95% CI through the random-effect model. Results Of the 413 articles identified, only eight studies were eligible with 1380 patients. Our results revealed that UFH was significantly superior on control group in reducing thrombotic occlusion and/or CVC-related DVT (odds ratio 0.39, 95% CI: 0.19:0.8) (p 0.01). Conclusion The published data support the hypothesis that using UFH as a thromboprophylaxis may significantly reduce catheter thrombotic complication in pediatric patients with CVC.

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Characterization of central venous catheter–associated deep venous thrombosis in infants

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2012.03.043 ◽

2012 ◽

Vol 47 (6) ◽

pp. 1159-1166 ◽

Cited By ~ 29

Author(s):

Brian W. Gray ◽

Raquel Gonzalez ◽

Kavita S. Warrier ◽

Lauren A. Stephens ◽

Robert A. Drongowski ◽

...

Keyword(s):

Central Venous Catheter ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Venous Catheter ◽

Central Venous

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Deep Venous Thrombosis: Prophylaxis and Treatment in the Critically Ill and Injured Patient

Thoracic Trauma and Critical Care ◽

10.1007/978-1-4615-1127-4_48 ◽

2002 ◽

pp. 367-374

Author(s):

Mark H. Meissner

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Critically Ill ◽

Injured Patient ◽

Thrombosis Prophylaxis ◽

Deep Venous Thrombosis Prophylaxis

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Catheter-related deep venous thrombosis in children with hemophilia

Blood ◽

10.1182/blood.v98.6.1727 ◽

2001 ◽

Vol 98 (6) ◽

pp. 1727-1731 ◽

Cited By ~ 91

Author(s):

Janna M. Journeycake ◽

Charles T. Quinn ◽

Kim L. Miller ◽

Joy L. Zajac ◽

George R. Buchanan

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Central Venous Catheters ◽

Catheter Placement ◽

Central Venous ◽

Radiographic Evidence ◽

Catheter Dysfunction ◽

The Mean ◽

Clinical Problems

Abstract Central venous catheters (CVCs) are a common adjunct to hemophilia therapy, but the risk of CVC-related deep venous thrombosis (DVT) in hemophiliacs is not well defined. In a previous study, 13 patients with CVCs had no radiographic evidence of DVT. However, recent abstracts and case studies demonstrate that DVT does occur. Therefore, this study sought to determine the frequency of DVT in children with hemophilia and long-term CVCs and to correlate venographic findings with clinical features. All hemophilia patients with tunneled subclavian CVCs in place for 12 months or more were candidates for evaluation. Patients were examined for physical signs of DVT and questioned about catheter dysfunction. Contrast venograms were obtained to identify DVT. Fifteen boys with severe hemophilia were evaluated, including 9 from the initially studied group of 13. Eight patients had evidence of DVT, 5 of whom previously had normal venograms. Five of 15 patients had clinical problems related to the CVC, all of whom had DVT. Four of 15 patients had suggestive physical signs; 3 had DVT. The mean duration of catheter placement for all patients was 57.5 months (range, 12-102 months). For patients with DVT, the mean duration was 66.6 ± 7.5 months, compared to 49.5 ± 7.2 months for patients without DVT (P = .06). No patient whose CVC was in place fewer than 48 months had an abnormal venogram. Many hemophilia patients with CVCs develop DVT of the upper venous system, and the risk increases with duration of catheter placement.

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Peritoneal dialysis in critically ill children in resource-limited setting: A prospective cohort study

Peritoneal Dialysis International ◽

10.1177/0896860820975897 ◽

2020 ◽

pp. 089686082097589

Author(s):

Pallavi Choudhary ◽

Virendra Kumar ◽

Abhijeet Saha ◽

Archana Thakur

Keyword(s):

Mechanical Ventilation ◽

Peritoneal Dialysis ◽

Renal Impairment ◽

Critically Ill ◽

Tertiary Care ◽

Kidney Injury ◽

Pediatric Intensive Care ◽

Renal Outcome ◽

Severe Dengue ◽

Critically Ill Children

Background: Peritoneal dialysis (PD) is easily available and simple lifesaving procedure in children with renal impairment. There is paucity of reports on efficacy of PD in critically ill children in presence of shock and those requiring mechanical ventilation. Methods: In this prospective observational study, efficacy and outcome of PD were evaluated in 50 critically ill children aged 1 month to 14 years admitted in pediatric intensive care unit of a tertiary care teaching hospital in India. Results: Indication of PD was acute kidney injury (AKI) in 66% of patients followed by chronic kidney disease with acute deterioration due to infectious complications in 34%. Bacterial sepsis was the most common cause of AKI (22%), others being malaria (14%) and severe dengue (12%). At initiation of PD, 26% of patients were in shock and 46% were mechanically ventilated. PD was effective and improvement in pH, bicarbonate, and lactate started within hours, with consistent improvement in estimated glomerular filtration rate by 24 h, which continued till the end of procedure, including the subgroup of patients with shock and mechanical ventilation. Total complications were seen in 14% and of which peritonitis was present in 4.0% of patients. Mortality was seen in 14% (7/50) of patients. Shock at initiation of PD (odds ratio (OR), 5.03; 95% confidence interval (CI), 0.95–26.69; p < 0.04) and requirement of mechanical ventilation (OR, 9.17; 95% CI, 1.01–83.10; p < 0.02) were associated with mortality. Conclusions: Acute PD in critically ill children with renal impairment is a lifesaving procedure. Treatment of shock with resuscitative measures and respiratory failure with mechanical ventilation, along with PD, resulted in favorable renal outcome.

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