Coronavirus Disease 2019 in Critically Ill Children: A Narrative Review of the Literature*

Abstract Especially critically ill children are exposed to antibiotic overtreatment, mainly caused by the fear of missing out a severe bacterial infection. Potential adverse effects and selection of multi-drug resistant bacteria play minor roles in decision making. This narrative review first describes harm from antibiotics and second focuses on different aspects that could help to reduce antibiotic overtreatment without harming the patient: harm from antibiotic treatment, diagnostic approaches, role of biomarkers, timing of antibiotic therapy, empiric therapy, targeted therapy, and therapeutic drug monitoring. Wherever possible, we linked the described evidence to the current Surviving Sepsis Campaign guidelines. Antibiotic stewardship programs should help guiding antibiotic therapy for critically ill children. Impact Critically ill children can be harmed by inadequate or overuse of antibiotics. Hemodynamically unstable children with a suspicion of infection should be immediately treated with broad-spectrum antibiotics. In contrast, in hemodynamically stable children with sepsis and organ dysfunction, a time frame of 3 h for proper diagnostics may be adequate before starting antibiotics if necessary. Less and more targeted antibiotic treatment can be achieved via antibiotic stewardship programs.

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Enteral feeding and the microbiome in critically ill children: a narrative review

Translational Pediatrics ◽

10.21037/tp-20-349 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Lijia Fan ◽

Jan Hau Lee

Keyword(s):

Critically Ill ◽

Enteral Feeding ◽

Narrative Review ◽

Critically Ill Children

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Extended Duration Ketamine Infusions in Critically Ill Children: A Case Report and Review of the Literature

Journal of Pediatric Intensive Care ◽

10.1055/s-0040-1713144 ◽

2020 ◽

Author(s):

Eszter Moore ◽

Rebecca Mayes ◽

Maura Harkin ◽

Jamie L. Miller ◽

Peter N. Johnson

Keyword(s):

Case Report ◽

Critically Ill ◽

Withdrawal Symptoms ◽

Critically Ill Children ◽

Second Line ◽

Review Of The Literature ◽

Aspartate Receptor ◽

Variable Duration ◽

Extended Duration ◽

Dexmedetomidine Infusion

AbstractKetamine is an N-methyl-D-aspartate receptor antagonist that has been used as an adjunct analgesic and sedative in critically ill children. Previous reports noted that ketamine has been used for a variable duration of 12 to 408 hours for this indication. We report on the use of ketamine infusions for >720 hours as a second-line sedative in addition to an opioid and dexmedetomidine infusion in a 2-month old and 17-month old. The purpose of this case report and review of the literature is to highlight the prolonged ketamine exposure of these two patients and to provide awareness to clinicians on the potential of withdrawal with extended ketamine administration. These children were started on initials doses of 5 and 15 µg/kg/min and titrated to peak doses of 20 and 25 µg/kg/min, respectively. They were continued for a total of 987 and 792 hours, respectively. No adverse events were noted during the ketamine infusions. One patient developed possible withdrawal symptoms 17 hours after ketamine discontinuation despite tapering of the infusion. These symptoms resolved with administration of as needed intravenous opioids and benzodiazepines, and the agitation normalized within 24 hours after ketamine discontinuation. Clinicians should consider tapering ketamine infusions in children receiving >72 hours of a continuous infusion by 5 µg/kg/min every 8 to 12 hours. Patients should be monitored for potential withdrawal symptoms including anxiety, allodynia, hyperalgesia, sweating, and drowsiness.

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Venous Thromboembolism among Critically Ill Children: A Narrative Review

Seminars in Thrombosis and Hemostasis ◽

10.1055/s-0041-1722847 ◽

2021 ◽

Author(s):

Anthony A. Sochet ◽

Amy Kiskaddon ◽

Marisol Betensky ◽

Neil Goldenberg

Keyword(s):

Venous Thromboembolism ◽

Critically Ill ◽

Collaborative Research ◽

Acute Inflammation ◽

Central Venous Catheterization ◽

Narrative Review ◽

Critically Ill Children ◽

Venous Catheterization ◽

Underlying Illness ◽

Novel Coronavirus

AbstractVenous thromboembolism (VTE) is a leading cause of morbidity and mortality among hospitalized patients, including children. In recent years, it has become clear that hospitalization and critical illness bestow an increased VTE risk in pediatrics and relate to mortality and life-limiting comorbidities. For critically ill children, reported rates of VTE vary by study sampling techniques, presence of inherited or acquired thrombophilia, acute and chronic immobility, underlying illness prompting hospitalization, and clinical factors related to illness severity such as central venous catheterization, length of stay, mechanical ventilation, and patient age. Accordingly, critically ill children with new signs of venous congestion, acute inflammation, or unexplained acute organ dysfunction should be routinely evaluated for VTE. This narrative review summarizes recent and historical literature regarding risk factors, prevention, presentation, treatment, and outcomes of VTE in critically ill children. In addition, we identify knowledge gaps and priorities for future collaborative research on this vital condition. Special attention is given to the clinical trial opportunities, challenges, and ongoing efforts in thromboprophylaxis in critically ill children, including those hospitalized for disease related to novel coronavirus (COVID-19) and multisystem inflammatory disease in children.

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