scholarly journals Urinary Biomarkers and Attainment of Cefepime Therapeutic Targets in Critically Ill Children

2022 ◽  
Author(s):  
Kevin J Downes ◽  
Anna Sharova ◽  
Lauren Gianchetti ◽  
Adam S Himebauch ◽  
Julie C Fitzgerald ◽  
...  
Keyword(s):  
Critically Ill ◽  
Significant Proportion ◽  
Urinary Biomarkers ◽  
Critically Ill Children ◽  
Urinary Ngal ◽  
Suspected Sepsis ◽  
Younger Age ◽  
Log Linear ◽  
Sirs Criteria ◽  
Lower Urinary

INTRODUCTION: The recommended therapeutic target for cefepime (FEP) is the time above MIC (fT>MIC). The frequency of target attainment and risk factor for sub-therapeutic concentrations in children have not been extensively studied. METHODS: We performed a prospective observational pilot study in children in our PICU receiving standard dosing of FEP for suspected sepsis (≥2 SIRS criteria). Three FEP concentrations were measured per subject and a urine sample was collected prior to PK sampling for measurement of urinary biomarkers. We used log linear regression to calculate the fT>MIC for each subject across a range of MIC values (1-16 µg/mL). We compared clinical factors/biomarkers between patients who did and did not achieve 100% fT>MIC for 8 µg/mL (cut-point for Pseudomonas) and tested the correlation between covariates and FEP troughs. RESULTS: 21 subjects were enrolled (median SIRS criteria: 3). PK sampling occurred after a median of 5 doses (range: 3-9). 43% of subjects achieved 100% fT>MIC for an MIC of 8 µg/mL. Younger age (p=.005), higher estimated GFR (p=.03), and lower urinary NGAL (p=.006) and KIM-1 (.03) were associated with failure to attain 100% fT>8 µg/mL. Age (r = 0.53), eGFR (r = -0.58), urinary NGAL (r = 0.42) and KIM-1 (r = 0.50) were significantly correlated with FEP troughs. CONCLUSIONS: A significant proportion of critically ill children failed to attain target concentrations for treatment of Pseudomonas aeruginosa with FEP. Younger patients and those with good kidney function (high GFR, low urinary biomarkers) may be at highest risk for subtherapeutic FEP concentrations.

scholarly journals Urinary NGAL incorporation into Renal Angina Index for early detection of acute kidney injury in critically ill children

2019 ◽  
Vol 3 (2) ◽  
pp. 093-099 ◽  
Author(s):  
Ali Mohammed Abu Zeid ◽  
Doaa Youssef Mohammed* ◽  
Amal Saeed AbdAlazeem ◽  
Anas Saad Elsayed Mohammed Seddeeq ◽  
Ashraf Mohamed Elnaany
Keyword(s):  
Acute Kidney Injury ◽  
Early Detection ◽  
Critically Ill ◽  
Kidney Injury ◽  
Critically Ill Children ◽  
Urinary Ngal ◽  
Renal Angina Index ◽  
Renal Angina

Impact of Severe Sepsis on Serum and Urinary Biomarkers of Acute Kidney Injury in Critically Ill Children: An Observational Study

2013 ◽  
Vol 35 (1-3) ◽  
pp. 172-176 ◽  
Author(s):  
Matteo Di Nardo ◽  
Alessio Ficarella ◽  
Zaccaria Ricci ◽  
Rosa Luciano ◽  
Francesca Stoppa ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Severe Sepsis ◽  
Observational Study ◽  
Critically Ill ◽  
Kidney Injury ◽  
Urinary Biomarkers ◽  
Critically Ill Children

scholarly journals Intravenous Fluid Prescription Practices in Critically Ill Children: A Shift in Focus from Natremia to Chloremia?

2019 ◽  
Vol 08 (04) ◽  
pp. 218-225
Author(s):  
Adrian F. Bulfon ◽  
Hakem L. Alomani ◽  
Natalie Anton ◽  
Brooke T. Comrie ◽  
Bram Rochwerg ◽  
...  
Keyword(s):  
Critically Ill ◽  
Tertiary Care ◽  
Significant Proportion ◽  
Daily Intake ◽  
Adverse Outcomes ◽  
Critically Ill Children ◽  
Salt Solutions ◽  
Eligibility Criteria ◽  
Maintenance Fluid ◽  
Increased Risk

AbstractOur objective is to evaluate intravenous (IV) fluid prescription practice patterns in critically ill children in the first 72 hours of pediatric intensive care unit (PICU) admission and to evaluate the incidence and predictors of hyperchloremic metabolic acidemia (HCMA) and the association between HCMA and adverse outcomes. This retrospective cohort study was conducted in two tertiary-care Canadian PICUs. Children aged 0 to 18 years admitted to the PICU between January 2015 and January 2016 who received at least 50% of their calculated maintenance fluid requirements parenterally during the first 24 hours of admission were included. Children with known preexisting conditions associated with HCMA, such as renal tubular acidosis and gastrointestinal bicarbonate losses, were excluded. Of the 771 children screened, 543 met eligibility criteria and were included. The commonest prescribed maintenance fluid was 0.9% NaCl (72.9%) followed by lactated Ringer's solution (19.6%) and hypotonic solutions (4.6%). Balanced salt solutions (i.e., lactated Ringer's and Plasma-Lyte) were as commonly administered as unbalanced solutions (0.9% NaCl) for volume expansion (49.6 vs. 48.5%, respectively). Medications contributed to a significant proportion of total daily intake, in excess of bolus fluids. The incidence of hyperchloremia and HCMA was 94.9% (95% confidence interval [CI]: 93.2–96.9; 470/495) and 38.9% (95% CI: 34.6–43.2; 196/504), respectively. Predictors of HCMA were increasing combined bolus and maintenance 0.9% NaCl intake (odds ratio: 1.13; 95% CI: 1.04–1.23) and increasing severity of illness. HCMA was not associated with an increased risk of acute kidney injury, feeding intolerance, or PICU-acquired weakness. Isotonic fluids, specifically 0.9% NaCl, were the most commonly administered maintenance IV fluid in critically ill children. Sources of chloride load are not isolated to resuscitation fluids as previously suggested. Maintenance fluids and fluids administered with medications and IV flushes (fluid creep) are under-recognized significant sources of fluid and electrolyte intake in critically ill children. HCMA is common, and further prospective research is required to determine whether HCMA is indeed harmful in children. However, all significant sources of fluid should be accounted for in the design of future trials comparing balanced and unbalanced salt solutions.

Prolonged sedation in critically ill children: is dexmedetomidine a safe option for younger age? An off-label experience

2019 ◽  
Vol 85 (2) ◽  
Author(s):  
Francesca Sperotto ◽  
Maria C. Mondardini ◽  
Francesca Vitale ◽  
Marco Daverio ◽  
Emiliana Campagnano ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Children ◽  
Off Label ◽  
Safe Option ◽  
Younger Age ◽  
Prolonged Sedation

scholarly journals Diagnostic Value of Monocyte Chemoattractant Protein-1, Soluble Mannose Receptor, Presepsin, and Procalcitonin in Critically Ill Children Admitted with Suspected Sepsis

2021 ◽  
Author(s):  
Noha Hassuna ◽  
Ebtesam Elgezawy ◽  
Suzan Mousa ◽  
Reem AbdelAziz ◽  
Reham Ibrahem ◽  
...  
Keyword(s):  
Critically Ill ◽  
Ventilatory Support ◽  
Mannose Receptor ◽  
Diagnostic Value ◽  
Critically Ill Children ◽  
Suspected Sepsis ◽  
Discriminative Performance ◽  
Monocyte Chemoattractant Protein 1 ◽  
Monocyte Chemoattractant ◽  
Monocyte Chemoattractant Protein

Background: The differentiation between systemic inflammatory response syndrome (SIRS) and sepsis, which is sometimes difficult, is very important as it determines essential treatment decisions, such as selection, initiation, and duration of antibiotic therapy. Thus we aimed to investigate the diagnostic value of procalcitonin (PCT), monocyte chemoattractant protein-1 (MCP-1), soluble mannose receptor (sMR), presepsin as early biomarkers of pediatric sepsis in comparison to SIRS in a group of severely ill children. Methods: The study included 58 and 24 children diagnosed as having sepsis and SIRS without infection respectively. All the plasma levels of the studied sepsis biomarkers were measured and ROC curves were created for all the tested parameters to discriminate between sepsis and SIRS. Results: The best discriminative performance was for MCP-1 with AUC of 0.996 (0.986-1.005) with sensitivity 98.3% and specificity 100%. The sMR had the highest sensitivity (100%), with AUC equals 0.952(.0.887-1.017) and specificity of 91.8%. The cut-off values for PCT, presepsin, sMR, and MCP-1 and were: 2.1 ng/ml, 256 pg/ml, 24 ng/ml and 105 pg/ml, respectively. In septic cases, both soluble Mannose Receptor and Procalcitonin have positive correlations with the severity of sepsis (PRISM III), low GCS, ventilatory support, use of inotropic drugs, and mortality rate (r= 0.950, 0.812, 0.795, 0.732 and 0.861respectively) for soluble Mannose Receptor and (0.536, 0.473, 0.422, 0.305 and 0.474 respectively) for Procalcitonin. By the logistic regression analysis, the sMR was the only significant predictor of sepsis. Conclusion: The present study has found that sMR, presepsin, and MCP-1 are new biomarkers that can be used to differentiate between sepsis and SIRS in critically-ill children. These findings may direct clinicians in their practical decision-making and complex management of severely-ill children who need much interference in short time.

scholarly journals Thoracic Fluid Content (TFC) Measurement Using Impedance Cardiography Predicts Outcomes in Critically Ill Children

2021 ◽  
Vol 8 ◽  
Author(s):  
Lydia Sumbel ◽  
Aanchal Wats ◽  
Mohammed Salameh ◽  
Elumalai Appachi ◽  
Utpal Bhalala
Keyword(s):  
Critically Ill ◽  
Fluid Balance ◽  
Impedance Cardiography ◽  
Linear Regression Analysis ◽  
Significant Proportion ◽  
Pediatric Intensive Care ◽  
Multiple Linear Regression Analysis ◽  
Critically Ill Children ◽  
X Ray ◽  
Hospital Days

Objective: Conventional methods of fluid assessment in critically ill children are difficult and/or inaccurate. Impedance cardiography has capability of measuring thoracic fluid content (TFC). There is an insufficient literature reporting correlation between TFC and conventional methods of fluid balance and whether TFC predicts outcomes in critically ill children. We hypothesized that TFC correlates with indices of fluid balance [FIMO (Fluid Intake Minus Output) and AFIMO (Adjusted Fluid Intake Minus Output)] and is a predictor of outcomes in critically ill children.Design: Retrospective chart review.Setting: Pediatric intensive care unit of a tertiary care teaching hospital.Patients: Children <21 years, admitted to our Pediatric Intensive Care Unit (PICU) between July- November 2018 with acute respiratory failure and/or shock and who were monitored for fluid status using ICON® monitor.Interventions: None.Measurements and Main Results: We collected demographic information, data on daily and cumulative fluid balance (CFB), ventilator, PICU and hospital days, occurrence of multi-organ dysfunction syndrome (MODS), and mortality. We calculated AFIMO using insensible fluid loss. We analyzed data using correlation coefficient, chi-square test and multiple linear regression analysis. We analyzed a total 327 recordings of TFC, FIMO and AFIMO as daily records of fluid balance in 61 critically ill children during the study period. The initial TFC, FIMO, and AFIMO in ml [median (IQR)] were 30(23, 44), 300(268, 325), and 21.05(−171.3, 240.2), respectively. The peak TFC, FIMO, and AFIMO in ml were 36(26, 24), 322(286, 334), and 108.8(−143.6, 324.4) respectively. The initial CFB was 1134.2(325.6, 2774.4). TFC did not correlate well with FIMO or AFIMO (correlation coefficient of 0.02 and −0.03, respectively), but a significant proportion of patients with high TFC exhibited pulmonary plethora on x-ray chest (as defined by increased bronchovascular markings and/or presence of pleural effusion) (p = 0.015). The multiple linear regression analysis revealed that initial and peak TFC and peak and mean FIMO and AFIMO predicted outcomes (ventilator days, length of PICU, and hospital days) in critically ill children (p < 0.05).Conclusions: In our cohort of critically ill children with respiratory failure and/or shock, TFC did not correlate with conventional measures of fluid balance (FIMO/AFIMO), but a significant proportion of patients with high TFC had pulmonary plethora on chest x-ray. Both initial and peak TFC predicted outcomes in critically ill children.

scholarly journals 64. Novel Biomarkers Improve Estimation of Vancomycin Clearance in Critically Ill Children

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S43-S44
Author(s):  
Kevin J Downes ◽  
Athena F Zuppa ◽  
Anna Sharova ◽  
Lauren Gianchetti ◽  
Emily Duffey ◽  
...  
Keyword(s):  
Renal Function ◽  
Critically Ill ◽  
Urinary Biomarkers ◽  
Critically Ill Children ◽  
Research Support ◽  
Final Model ◽  
Plasma Ngal ◽  
Population Pk ◽  
Novel Biomarkers ◽  
The Impact

Abstract Background There are a paucity of robust population PK (popPK) models to inform vancomycin (VAN) dosing in critically ill children. The majority of published models incorporate peak/trough data and rely on flawed estimates of renal function. We sought to develop a popPK model for IV VAN in critically ill children utilizing novel plasma and urinary biomarkers. Methods We conducted a prospective observational study of critically ill children prescribed VAN for a suspected infection in the CHOP pediatric ICU. Children < 1 year of age and those receiving ECMO or CRRT were excluded. Five VAN samples were collected from a single dosing interval for each subject. Plasma biomarkers (creatinine [Cr], cystatin C [CysC], NGAL) and urinary biomarkers (CysC, NGAL, KIM-1, osteopontin) were collected the morning of PK sampling; urinary biomarkers were corrected for urine creatinine. Nonparametric popPK modeling was performed using Pmetrics. The impact of renal function (GFR) on VAN clearance (CL) was estimated first, comparing model performance with each biomarker (Cr and plasma CysC). The influence of age, sex, additional biomarkers, PIM3 score, and receipt of vasopressors as covariates was then assessed for relevant PK parameters. Results 30 subjects completed the study. Median age was 10 years (range 1-17); 76% were male. The majority (90%) of children received VAN for suspected sepsis. PK sampling occurred at a median of 37.7 hours (range 24.6-94.8) into VAN treatment; 136 VAN samples were included. A 2-compartment model with fixed allometric scaling of 0.75 on clearances and 1 on volumes best described the data. CysC-based GFR as a covariate on VAN CL using the HOEK formula (GFR = -4.32 + (80.35/CysC)) resulted in the best model fit. Age and plasma NGAL were also informative on VAN CL in the final model (Figure 1). During model building, urinary NGAL was also associated with VAN CL (comparable to plasma NGAL) and outperformed Cr, although it was not retained in the final model. Figure 1. Final population PK model and parameter estimates. Conclusion Plasma CysC is a better renal function estimate than Cr to inform VAN clearance in critically ill children. Urinary and plasma NGAL also improved estimation of VAN CL during popPK modeling. Novel biomarkers can better describe VAN exposures in critically ill children than reliance on Cr alone. Disclosures Kevin J. Downes, MD, Merck (Individual(s) Involved: Self): Grant/Research Support Stuart L. Goldstein, MD, Bioporto (Consultant, Grant/Research Support)

scholarly journals Derivation and Validation of Urinary TIMP-1 for Prediction of Acute Kidney Injury and Mortality in Critically Ill Children

2021 ◽  
Author(s):  
Hui Huang ◽  
Qiang Lin ◽  
Xiaomei Dai ◽  
Jiao Chen ◽  
Zhenjiang Bai ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Urinary Biomarkers ◽  
Critically Ill Children ◽  
High Morbidity ◽  
Predictive Values ◽  
Derivation Cohort ◽  
Prospective Cohorts

Abstract Background: Acute kidney injury (AKI) is associated with high morbidity and mortality. Multiple urinary biomarkers have been identified to associate with the prediction of AKI and outcomes. However, the accuracy of these urinary biomarkers for AKI and associated outcomes has not been clearly defined, especially in heterogeneous populations. The aims of the study were to compare the ability of 10 existing or potential urinary biomarkers for prediction of AKI and pediatric intensive care unit (PICU) mortality, and identify and validate the best biomarker of urinary tissue inhibitor of metalloproteinases-1 (uTIMP-1) for early prediction in heterogeneous critically ill children.Methods: A derivation-validation approach with separate critically ill cohorts was designed. We first conducted a prospective cohort study to determine the ability of 10 candidate urinary biomarkers serially measured in 123 children during the first 7 days of PICU stay and identify the best biomarker for predicting AKI and PICU mortality (derivation study). The best biomarker of uTIMP-1 from derivation was validated in a separate cohort of 357 critically ill children (validation study). AKI diagnosis was based on KDIGO classification with serum creatinine and urine output.Results: In the derivation cohort, 17 of 123 (13.8%) children developed AKI stage 3 or died during PICU stay, and both the initial and peak uTIMP-1 displayed the highest AUC of 0.87 (0.79-0.94) and 0.90 (0.84-0.96), respectively, for predicting AKI stage 3 or death. In the validation cohort, 47 of 357 (13.2%) developed AKI during the first week after admission, and 38 (10.6%) died during PICU stay. The initial uTIMP-1 level was validated to be independently associated with AKI (AOR=1.88, P=0.001), severe AKI (AOR=2.35, P<0.001), AKI stage 3 (AOR=2.87, P<0.001) and PICU mortality (AOR=1.92, P=0.019) after adjustment for potential confounders. The predictive values of uTIMP-1 for AKI, severe AKI, AKI stage 3 and PICU mortality were 0.82 (0.75-0.88), 0.84 (95%CI 0.77-0.91), 0.87 (0.81-0.94) and 0.83 (0.76-0.89), respectively.Conclusions: Urinary TIMP-1 level has been identified and validated to be independently associated with AKI and PICU mortality in independent prospective cohorts, and may be an early potential indicator of AKI and PICU mortality in critically ill children.

Social Support and Functioning Among Mothers of Critically Ill Children

2008 ◽  
Author(s):  
Christine Rini ◽  
Sharon Manne ◽  
Katherine Duhamel ◽  
Jane Austin ◽  
Jamie Ostroff ◽  
...  
Keyword(s):  
Social Support ◽  
Critically Ill ◽  
Critically Ill Children
Sign in / Sign up

Export Citation Format

Share Document