Noninvasive Ventilation in Immunocompromised Pediatric Patients: Eight Years of Experience in a Pediatric Oncology Intensive Care Unit

Noninvasive ventilation has been used extensively to treat chronic respiratory failure associated with neuromuscular and other restrictive thoracic diseases, and is also effective in the treatment of acute respiratory failure, allowing some patients to avoid intubation. Noninvasive positive pressure ventilation is a potentially effective way to transition selected patients off endotracheal mechanical ventilation. The authors present a retrospective chart review of pediatric patients extubated with the use of noninvasive ventilation. Extubation with noninvasive positive pressure ventilation was attempted in 25 patients. The patients had a variety of diagnoses, including neuromuscular diseases, cerebral palsy with chronic respiratory insufficiency, asthma, and acute respiratory distress syndrome (ARDS), reflecting the diversity of patients with respiratory failure seen in our pediatric intensive care unit (ICU). Indications for noninvasive ventilation-assisted extubation were chronic respiratory insufficiency, clinical evidence the patient was falling extubation, or failure of a previous attempt to extubate. Extubation was successfully facilitated in 20 of 25 patients. Of the five patients failing an initial attempt at noninvasive ventilation-assisted extubation, two required tracheostomy, two were subsequently extubated with the aid of noninvasive ventilation, and one was subsequently extubated without the use of noninvasive ventilation. Risk factors for failure to successfully extubate with the assistance of noninvasive positive pressure ventilation included the patient's inability to manage respiratory tract secretions, severe upper airway obstruction, impaired mental status, and ineffective cough with mucus plugging of the large airways. AU patients had mild to moderate skin irritation due to the mask interface. No patient had any serious or long-term adverse effect of noninvasive positive pressure ventilation. All patients left the hospital alive. Noninvasive positive pressure ventilation can facilitate endotracheal extubation in pediatric patients with diverse diagnoses who have failed or who are at risk of failing extubation, including those with neuromuscular weakness.

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Does critical illness and intensive care unit treatment contribute to neurocognitive and functional morbidity in pediatric patients?

Jornal de Pediatria ◽

10.2223/jped.1729 ◽

2007 ◽

Vol 83 (6) ◽

pp. 488-490 ◽

Cited By ~ 4

Author(s):

Ramona O. Hopkins

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critical Illness ◽

Pediatric Patients ◽

Intensive Care Unit Treatment ◽

Functional Morbidity

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Characteristics and outcomes of coronavirus disease 2019 (COVID-19) in criticallyill pediatric patients admitted to the intensive care unit: A multicenter retrospective cohort study

Journal of Infection and Public Health ◽

10.1016/j.jiph.2020.12.010 ◽

2020 ◽

Author(s):

Abdulla Alfraij ◽

Abdulrahman A. Bin Alamir ◽

Abdulnasir M. Al-Otaibi ◽

Danah Alsharrah ◽

Abdulrahman Aldaithan ◽

...

Keyword(s):

Intensive Care Unit ◽

Cohort Study ◽

Intensive Care ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Pediatric Patients

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The Changing Landscape of Noninvasive Ventilation in the Intensive Care Unit

JAMA ◽

10.1001/jama.2015.12401 ◽

2015 ◽

Vol 314 (16) ◽

pp. 1697 ◽

Cited By ~ 4

Author(s):

Bhakti K. Patel ◽

John P. Kress

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Noninvasive Ventilation

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Effectiveness of noninvasive ventilation in patients admitted to the intensive care unit due to sars-CoV-2 pneumonia

Medicina Intensiva (English Edition) ◽

10.1016/j.medine.2021.10.008 ◽

2021 ◽

Author(s):

A. Belenguer Muncharaz ◽

H. Hernández-Garcés ◽

C. López-Chicote ◽

S. Ribes-García ◽

J. Ochagavía-Barbarín ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Noninvasive Ventilation

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Interrelated factors of tracheostomy in critically ill pediatric patients during their stay at ICU or PICU in Japan: a data-based analysis

10.21203/rs.2.20796/v1 ◽

2020 ◽

Author(s):

Tadashi Ishihara ◽

Hiroshi Tanaka

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Respiratory Failure ◽

Critically Ill ◽

Chronic Conditions ◽

Large Scale ◽

Pediatric Patients ◽

Upper Airway ◽

Chromosomal Anomalies ◽

Multicenter Cohort Study

Abstract Background The most common current indications of pediatric tracheostomy include prolonged ventilator dependence, often resulting from the consequences of prematurity and bronchopulmonary dysfunction, and upper airway obstruction resulting either from craniofacial or structural abnormalities of the upper airway or from hypotonia stemming from neurological or neuromuscular disturbance. The purpose of this study was to describe the indications, epidemiology, frequency, and associated factors for tracheostomy in critical pediatric patients admitted to the intensive care unit (ICU) or pediatric intensive care unit (PICU) by using the large amount of data available in the Japanese Registry of Pediatric Acute Care (JaRPAC). Methods In this retrospective multicenter cohort study, we collected data concerning pediatric tracheostomy from the JaRPAC database involving patients aged ≤ 16 years who had no tracheostomy when admitted to ICU or PICU between April 2014 and March 2017. The patients were divided into two groups: those with tracheostomies when they were discharged from the ICU or PICU and patients without tracheostomies. Interrelated factors of tracheostomy were investigated. Results A total of 23 hospitals participated, involving 6,199 pediatric patients registered in the JaRPAC database during the study period. Of the registered pediatric patients, 5,769 (95%) patients were admitted to the ICU or PICU without tracheostomies. Among the patients, 181 patients (3.1%) had undergone tracheostomies. There were significant differences in the number of chronic conditions (134, 74.0% versus 3096, 55.4%, p < 0.01), chromosomal anomalies (19, 10.5% versus 326, 5.8%, p < 0.01), urgent admission (151, 83.4% versus 3093, 55.4%, p < 0.01). More tracheostomies were performed on patients who were admitted for respiratory failure (61, 33.7% versus 926, 16.1%, p < 0.01) and for post-CPA resuscitation (40, 22.1% versus 71, 1.1%, p < 0.01). Conclusions This is the first report to use a large-scale registry of critically ill pediatric patients in Japan to describe the interrelated factors of tracheostomies during their stay in ICUs or PICUs. Chronic conditions (especially for neuromuscular disease), chromosomal anomaly, urgent admission, admission due to respiratory failure, or treatment for post-CPA resuscitation all had the possibility to be risk factors for tracheostomy.

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Extracorporeal Membrane Oxygenation: The First 10 Years Experience of a Portuguese Pediatric Intensive Care Unit

Acta Médica Portuguesa ◽

10.20344/amp.15227 ◽

2021 ◽

Vol 34 (6) ◽

pp. 435

Author(s):

Daniel Meireles ◽

Francisco Abecasis ◽

Leonor Boto ◽

Cristina Camilo ◽

Miguel Abecasis ◽

...

Keyword(s):

Intensive Care Unit ◽

Overall Survival ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Pediatric Patients ◽

Life Support ◽

Extracorporeal Life Support ◽

Pediatric Intensive Care ◽

Overall Survival Rate ◽

Clinical Complications

Introduction: In Portugal, extracorporeal membrane oxygenation (ECMO) is used in pediatric patients since 2010. The aim of this study was to describe the clinical characteristics of patients, indications, complications and mortality associated with the use of ECMO during the first 10-years of experience in the Pediatric Intensive Care Unit located in Centro Hospitalar Universitário Lisboa Norte.Material and Methods: Retrospective observational cohort study of all patients supported with ECMO in a Pediatric Intensive Care Unit, from the 1st of May 2010 up to 31st December 2019.Results: Sixty-five patients were included: 37 neonatal (≤ 28 days of age) and 28 pediatric patients (> 28 days). In neonatal cases, congenital diaphragmatic hernia was the main reason for ECMO (40% of neonatal patients and 23% of total). Among pediatric patients, respiratory distress was the leading indication for ECMO (47% of total). The median length of ECMO support was 12 days. Clinical complications were more frequent than mechanical complications (65% vs 35%). Among clinical complications, access site bleeding was the most prevalent with 38% of cases. The overall patient survival was 68% at the time of discharge (65% for neonatal and 71% for pediatric cases), while the overall survival rate in Extracorporeal Life Support Organization registry was 61%. The number of ECMO runs has been increasing since 2011, even though in a non-linear way (three cases in 2010 to 11 cases in 2019).Discussion: In the first 10 years we received patients from all over the country. Despite continuous technological developments, circuitrelated complications have a significant impact. The overall survival rate in the Pediatric Intensive Care Unit was not inferior to the one reported by the Extracorporeal Life Support Organization.Conclusion: The overall survival of our Pediatric Intensive Care Unit is not inferior to one reported by other international centers. Our experience showed the efficacy of the ECMO technique in a Portuguese centre.

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Vancomycin-induced nephrotoxicity in non-intensive care unit pediatric patients

Scientific Reports ◽

10.1038/s41598-021-00214-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shinhyeung Kwak ◽

Jeong Yeon Kim ◽

Heeyeon Cho

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Patients ◽

Trough Level ◽

Medical Center ◽

Kidney Injury ◽

Maximum Serum ◽

Serum Trough ◽

Youden’S Index

AbstractPrevious data suggested several risk factors for vancomycin-induced nephrotoxicity (VIN), including higher daily dose, long-term use, underlying renal disease, intensive care unit (ICU) admission, and concomitant use of nephrotoxic medications. We conducted this study to investigate the prevalence and risk factors of VIN and to estimate the cut-off serum trough level for predicting acute kidney injury (AKI) in non-ICU pediatric patients. This was a retrospective, observational, single-center study at Samsung Medical Center tertiary hospital, located in Seoul, South Korea. We reviewed the medical records of non-ICU pediatric patients, under 19 years of age with no evidence of previous renal insufficiency, who received vancomycin for more than 48 h between January 2009 and December 2018. The clinical characteristics were compared between patients with AKI and those without to identify the risk factors associated with VIN, and the cut-off value of serum trough level to predict the occurrence of VIN was calculated by the Youden’s index. Among 476 cases, 22 patients (4.62%) developed AKI. The Youden’s index indicated that a maximum serum trough level of vancomycin above 24.35 μg/mL predicted VIN. In multivariate analysis, longer hospital stay, concomitant use of piperacillin-tazobactam and serum trough level of vancomycin above 24.35 μg/mL were associated independently with VIN. Our findings suggest that concomitant use of nephrotoxic medication and higher serum trough level of vancomycin might be associated with the risk of VIN. This study suggests that measuring serum trough level of vancomycin can help clinicians prevent VIN in pediatric patients.

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