scholarly journals Gut Microbial Translocation in Critically Ill Children and Effects of Supplementation with Pre- and Pro Biotics

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Paola Papoff ◽  
Giancarlo Ceccarelli ◽  
Gabriella d'Ettorre ◽  
Carla Cerasaro ◽  
Elena Caresta ◽  
...  
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Bacterial Translocation ◽  
Ischemia Reperfusion ◽  
Intestinal Barrier ◽  
Systemic Circulation ◽  
Critically Ill Children ◽  
Positive Effects ◽  
Increased Risk ◽  
Abdominal Hypertension

Bacterial translocation as a direct cause of sepsis is an attractive hypothesis that presupposes that in specific situations bacteria cross the intestinal barrier, enter the systemic circulation, and cause a systemic inflammatory response syndrome. Critically ill children are at increased risk for bacterial translocation, particularly in the early postnatal age. Predisposing factors include intestinal obstruction, obstructive jaundice, intra-abdominal hypertension, intestinal ischemia/reperfusion injury and secondary ileus, and immaturity of the intestinal barrier per se. Despite good evidence from experimental studies to support the theory of bacterial translocation as a cause of sepsis, there is little evidence in human studies to confirm that translocation is directly correlated to bloodstream infections in critically ill children. This paper provides an overview of the gut microflora and its significance, a focus on the mechanisms employed by bacteria to gain access to the systemic circulation, and how critical illness creates a hostile environment in the gut and alters the microflora favoring the growth of pathogens that promote bacterial translocation. It also covers treatment with pre- and pro biotics during critical illness to restore the balance of microbial communities in a beneficial way with positive effects on intestinal permeability and bacterial translocation.

scholarly journals P68 Significant oral drug use in critically ill children: rational therapy or a black box?

2019 ◽  
Vol 104 (6) ◽  
pp. e45.2-e45
Author(s):  
M Mooij ◽  
J Windster ◽  
J van Rosmalen ◽  
L Hanff ◽  
D Tibboel ◽  
...  
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Oral Drug ◽  
Considerable Proportion ◽  
Intestinal Drug Absorption ◽  
Increased Risk ◽  
Rational Therapy ◽  
One Year

BackgroundThe disposition of orally prescribed drugs in critically ill children may be affected critical illness in in addition to age, resulting in erratic effects and safety. We aimed to study oral drug prescribing in the neonatal and pediatric intensive care unit (NICU and PICU).MethodsA one-year retrospective cohort study of all drug prescriptions, including route of administration for all children admitted to the NICU and PICU of the Erasmus MC-Sophia’s children’s hospital.Results1723 children with 2091 unique admissions received per admission (median [IQR]) 5 (3–10) drugs; 1 (0–2) orally and 3 (1–7) intravenously (IV). During mechanical ventilation 15% and 75% of drugs were given orally and IV, respectively. In non-ventilated patients, 27% of drugs were given orally and 60% IV. The 5 most frequently orally prescribed drugs were: vitamin K, spironolactone, oral probiotics, amphotericin B (prophylaxis) and trimethoprim.DiscussionCritically ill infants receive a considerable proportion of drugs orally. Considering that critical illness may significantly impact intestinal drug absorption, this may expose them to an increased risk of ineffective or unsafe drug therapy.Disclosure(s)Nothing to disclose

scholarly journals Nutritional Support of the Critically Ill Pediatric Patient: Foundations and Controversies

2017 ◽  
Vol 8 ◽  
pp. 117956031770110 ◽  
Author(s):  
Iván José Ardila Gómez ◽  
Carolina Bonilla González ◽  
Paula Andrea Martínez Palacio ◽  
Elida Teresa Mercado Santis ◽  
José Daniel Tibaduiza Bayona ◽  
...  
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Nutritional Support ◽  
Metabolic Stress ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
The Past ◽  
Nutritional Recommendations ◽  
Response To Stress ◽  
Nutritional Strategies

Critically ill children require nutritional support that will give them nutritional and non-nutritional support to successfully deal with their disease. In the past few years, we have been able to better understand the pathophysiology of critical illness, which has made possible the establishment of nutritional strategies resulting in an improved nutritional status, thus optimizing the pediatric intensive care unit (PICU) stay and decreasing morbidity and mortality. Critical illness is associated with significant metabolic stress. It is crucial to understand the physiological response to stress to create nutritional recommendations for critically ill pediatric patients in the PICU.

scholarly journals American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: May 2021 update on the use of intermediate intensity anticoagulation in critically ill patients

2021 ◽  
Author(s):  
Adam Cuker ◽  
Eric K. Tseng ◽  
Robby Nieuwlaat ◽  
Pantep Angchaisuksiri ◽  
Clifton Blair ◽  
...  
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Health Care Professionals ◽  
Conflicts Of Interest ◽  
Guideline Development ◽  
Thrombotic Risk ◽  
Increased Risk ◽  
American Society ◽  
The Impact

Background: COVID-19 related critical illness is associated with an increased risk of venous thromboembolism (VTE). Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians and other health care professionals in decisions about the use of anticoagulation for thromboprophylaxis in patients with COVID-19-related critical illness who do not have confirmed or suspected VTE. Methods: ASH formed a multidisciplinary guideline panel, including three patient representatives, and applied strategies to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including performing systematic evidence reviews (up to March 5, 2021). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess evidence and make recommendations, which were subject to public comment. This is an update on guidelines published in February 2021. Results: The panel agreed on one additional recommendation. The panel issued a conditional recommendation in favor of prophylactic-intensity over intermediate-intensity anticoagulation in patients with COVID-19 related-critical illness who do not have confirmed or suspected VTE. Conclusions: This recommendation was based on low certainty in the evidence, underscoring the need for further high-quality, randomized controlled trials comparing different intensities of anticoagulation in critically ill patients. Other key research priorities include better evidence on predictors of thrombosis and bleeding risk in critically ill patients with COVID-19 and the impact of non-anticoagulant therapies (e.g., antiviral agents, corticosteroids) on thrombotic risk.

scholarly journals Gastrointestinal Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

PEDIATRICS ◽  
2022 ◽  
Vol 149 (Supplement_1) ◽  
pp. S53-S58
Author(s):  
Katri V. Typpo ◽  
Sharon Y. Irving ◽  
Jose M. Prince ◽  
Nazima Pathan ◽  
Ann-Marie Brown
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Task Force ◽  
Data Extraction ◽  
Case Series ◽  
Current Evidence ◽  
Abdominal Radiograph ◽  
Critically Ill Children ◽  
Gastrointestinal Dysfunction ◽  
Plain Abdominal Radiograph

CONTEXT Prior criteria to define pediatric multiple organ dysfunction syndrome (MODS) did not include gastrointestinal dysfunction. OBJECTIVES Our objective was to evaluate current evidence and to develop consensus criteria for gastrointestinal dysfunction in critically ill children. DATA SOURCES Electronic searches of PubMed and EMBASE were conducted from January 1992 to January 2020, using medical subject heading terms and text words to define gastrointestinal dysfunction, pediatric critical illness, and outcomes. STUDY SELECTION Studies were included if they evaluated critically ill children with gastrointestinal dysfunction, performance characteristics of assessment/scoring tools to screen for gastrointestinal dysfunction, and assessed outcomes related to mortality, functional status, organ-specific outcomes, or other patient-centered outcomes. Studies of adults or premature infants, animal studies, reviews/commentaries, case series with sample size ≤10, and non-English language studies with inability to determine eligibility criteria were excluded. DATA EXTRACTION Data were abstracted from each eligible study into a standard data extraction form along with risk of bias assessment by a task force member. RESULTS The systematic review supports the following criteria for severe gastrointestinal dysfunction: 1a) bowel perforation, 1b) pneumatosis intestinalis, or 1c) bowel ischemia, present on plain abdominal radiograph, computed tomography (CT) scan, magnetic resonance imaging (MRI), or gross surgical inspection, or 2) rectal sloughing of gut mucosa. LIMITATIONS The validity of the consensus criteria for gastrointestinal dysfunction are limited by the quantity and quality of current evidence. CONCLUSIONS Understanding the role of gastrointestinal dysfunction in the pathophysiology and outcomes of MODS is important in pediatric critical illness.

scholarly journals Somatic regional oxygen saturation as an early marker of intra-abdominal hypertension in critically ill children: a pilot study

2020 ◽  
Vol 44 (2) ◽  
pp. 411-419
Author(s):  
Özden Özgür HOROZ ◽  
Nagehan ASLAN ◽  
Dinçer YILDIZDAŞ ◽  
Yasemin ÇOBAN ◽  
Yaşar SERTDEMİR ◽  
...  
Keyword(s):  
Pilot Study ◽  
Oxygen Saturation ◽  
Critically Ill ◽  
Critically Ill Children ◽  
Regional Oxygen Saturation ◽  
Early Marker ◽  
Abdominal Hypertension

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.

Incidence, Risk Factors, and Prognosis of Intra-Abdominal Hypertension in Critically Ill Children

2015 ◽  
Vol 31 (6) ◽  
pp. 403-408 ◽  
Author(s):  
Farah Chedly Thabet ◽  
Iheb Mohamed Bougmiza ◽  
May Said Chehab ◽  
Hind Ali Bafaqih ◽  
Sulaiman Abdulkareem AlMohaimeed ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Critically Ill Children ◽  
Abdominal Hypertension ◽  
Incidence Risk

scholarly journals Cognitive Dysfunction After Analgesia and Sedation: Out of the Operating Room and Into the Pediatric Intensive Care Unit

2021 ◽  
Vol 15 ◽  
Author(s):  
Ashley D. Turner ◽  
Travis Sullivan ◽  
Kurt Drury ◽  
Trevor A. Hall ◽  
Cydni N. Williams ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critical Illness ◽  
Animal Models ◽  
Critically Ill ◽  
Cognitive Dysfunction ◽  
Functional Outcomes ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Post Discharge

In the midst of concerns for potential neurodevelopmental effects after surgical anesthesia, there is a growing awareness that children who require sedation during critical illness are susceptible to neurologic dysfunctions collectively termed pediatric post-intensive care syndrome, or PICS-p. In contrast to healthy children undergoing elective surgery, critically ill children are subject to inordinate neurologic stress or injury and need to be considered separately. Despite recognition of PICS-p, inconsistency in techniques and timing of post-discharge assessments continues to be a significant barrier to understanding the specific role of sedation in later cognitive dysfunction. Nonetheless, available pediatric studies that account for analgesia and sedation consistently identify sedative and opioid analgesic exposures as risk factors for both in-hospital delirium and post-discharge neurologic sequelae. Clinical observations are supported by animal models showing neuroinflammation, increased neuronal death, dysmyelination, and altered synaptic plasticity and neurotransmission. Additionally, intensive care sedation also contributes to sleep disruption, an important and overlooked variable during acute illness and post-discharge recovery. Because analgesia and sedation are potentially modifiable, understanding the underlying mechanisms could transform sedation strategies to improve outcomes. To move the needle on this, prospective clinical studies would benefit from cohesion with regard to datasets and core outcome assessments, including sleep quality. Analyses should also account for the wide range of diagnoses, heterogeneity of this population, and the dynamic nature of neurodevelopment in age cohorts. Much of the related preclinical evidence has been studied in comparatively brief anesthetic exposures in healthy animals during infancy and is not generalizable to critically ill children. Thus, complementary animal models that more accurately “reverse translate” critical illness paradigms and the effect of analgesia and sedation on neuropathology and functional outcomes are needed. This review explores the interactive role of sedatives and the neurologic vulnerability of critically ill children as it pertains to survivorship and functional outcomes, which is the next frontier in pediatric intensive care.

scholarly journals Epidemiology of Bleeding in Critically Ill Children

2021 ◽  
Vol 9 ◽  
Author(s):  
Jake Sequeira ◽  
Marianne E. Nellis ◽  
Oliver Karam
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critical Care Unit ◽  
Critically Ill Children ◽  
Pediatric Critical Care ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Duration Of Surgery ◽  
The Impact ◽  
Bleeding Severity

Objective: Bleeding can be a severe complication of critical illness, but its true epidemiologic impact on children has seldom been studied. Our objective is to describe the epidemiology of bleeding in critically ill children, using a validated clinical tool, as well as the hemostatic interventions and clinical outcomes associated with bleeding.Design: Prospective observational cohort study.Setting: Tertiary pediatric critical care unitPatients: All consecutive patients (1 month to 18 years of age) admitted to a tertiary pediatric critical care unitMeasurements and Main Results: Bleeding events were categorized as minimal, moderate, severe, or fatal, according to the Bleeding Assessment Scale in Critically Ill Children. We collected demographics and severity at admission, as evaluated by the Pediatric Index of Mortality. We used regression models to compare the severity of bleeding with outcomes adjusting for age, surgery, and severity. Over 12 months, 902 critically ill patients were enrolled. The median age was 64 months (IQR 17; 159), the median admission predicted risk of mortality was 0.5% (IQR 0.2; 1.4), and 24% were post-surgical. Eighteen percent of patients experienced at least one bleeding event. The highest severity of bleeding was minimal for 7.9% of patients, moderate for 5.8%, severe for 3.8%, and fatal for 0.1%. Adjusting for age, severity at admission, medical diagnosis, type of surgery, and duration of surgery, bleeding severity was independently associated with fewer ventilator-free days (p < 0.001) and fewer PICU-free days (p < 0.001). Adjusting for the same variables, bleeding severity was independently associated with an increased risk of mortality (adjusted odds ratio for each bleeding category 2.4, 95% CI 1.5; 3.7, p < 0.001).Conclusion: Our data indicate bleeding occurs in nearly one-fifth of all critically ill children, and that higher severity of bleeding was independently associated with worse clinical outcome. Further multicenter studies are required to better understand the impact of bleeding in critically ill children.

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