scholarly journals Dialyzable Leukocyte Extract (Transferon™) Administration in Sepsis: Experience from a Single Referral Pediatric Intensive Care Unit

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Maria Isabel Castrejón Vázquez ◽  
Aldo Arturo Reséndiz-Albor ◽  
Mario A. Ynga-Durand ◽  
Ivonne Maciel Arciniega Martínez ◽  
Vanessa Ivonne Orellana-Villazon ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Laboratory Data ◽  
Pediatric Intensive Care ◽  
Control Group ◽  
Immunomodulatory Agents ◽  
Reactive Protein ◽  
Significant Difference ◽  
Pediatric Sepsis

Immunomodulatory agents have been proposed as therapeutic candidates to improve outcomes in sepsis. Transferon™, a dialyzable leukocyte extract (DLE), has been supported in Mexico as an immunomodulatory adjuvant in anti-infectious therapy. Here we present a retrospective study describing the experience of a referral pediatric intensive care unit (PICU) with Transferon™ in sepsis. We studied clinical and laboratory data from 123 patients with sepsis (15 in the DLE group and 108 in the control group) that were admitted to PICU during the period between January 2010 and December 2016. Transferon™ DLE use was associated with lower C reactive protein (CRP), increase in total lymphocyte counts (TLC), and decrease in total neutrophil count (TNC) 72 hours after Transferon™ DLE administration. The control group did not present any significant difference in CRP values and had lower TLC after 72 hours of admission. There was no difference in PICU length of stay between control and Transferon™ DLE group. Transferon™ DLE administration was associated with a higher survival rate at the end of PICU stay. This study shows a possible immunomodulatory effect of Transferon™ on pediatric sepsis patients.

scholarly journals Correlation between nosocomial pneumonia and ventilated patients in pediatric intensive care unit

2016 ◽  
Vol 48 (3) ◽  
pp. 170
Author(s):  
Cahya Dewi ◽  
Purnomo Suryantoro ◽  
Roni Naning
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Control Group ◽  
Case Group ◽  
Mechanical Ventilator ◽  
Significant Difference ◽  
Matched Case

Background NP (NP) especially YAP (ventilator-associated pneu-monia) is the most common infection in intensive care unit, whichcorrelates with the increasing of morbidity and mortality. Thereare some risk factors for development ofNP, the most importantone is duration of mechanical ventilator and reintubation.Objective To determine the correlation between NP and use ofmechanical ventilator in pediatric intensive care unit (PICU).Methods A matched case control study was conducted at Dr.Sardjito Hospital on all patients admitted to the PICU from2004 until 2006. Case group was defined as all patients who hadNP; age and sex matched control group included all patients notdiagnosed as NP. Statistical analysis was done by using chi-squareand t-tests as appropriate. Logistic regression analysis was doneto determine the role of risk factors.Results One-hundred and forty-one patients were included inthis study. The incidence of NP was 25. 7%. There was associa-tion between using mechanical ventilator (OR 1.08; 95%CI 1.07;8.20, P=0.036) and duration of using mechanical ventilator morethan four days (OR 1.75, 95%CI 1.87;18.02) with developmentof NP. There was a significant difference in event free survival ofNP between those using mechanical ventilator group and thosenot using mechanical ventilator group (P<O.OOl).Conclusion There is an association between the use of mechani-cal ventilator and duration of use of mechanical ventilator morethan four days with the development of NP

scholarly journals Frequency of Electrolyte Disorders and Its Effect On Mortality Among Children Admitted In Pediatric Intensive Care Unit

2021 ◽  
Vol 10 (02) ◽  
pp. 115-119
Author(s):  
Maryam Haider ◽  
Ammara Hameed ◽  
Sara Fatima ◽  
Meher Afroze ◽  
Nadeem Noor ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Serum Sodium ◽  
Laboratory Data ◽  
Pediatric Intensive Care ◽  
P Value ◽  
Electrolyte Disorders ◽  
Mortality Effect ◽  
Sodium And Potassium

Objective: To determine the frequency of electrolyte disorders, i.e., serum sodium and potassium and to evaluate its effect on mortality rate among children admitted at the pediatric intensive care unit. Study Design and Setting: This was a descriptive cross sectional study conducted at Pediatric Intensive care unit of Civil Hospital Karachi from April to December 2017 Methodology: Informed consent was obtained from 150 parents of the children who fulfill the inclusion criteria. Laboratory data (serum sodium and serum potassium) were recorded during the stay in the pediatric intensive care unit. Data was analyzed using SPSS version 20. Mean ± S.D was calculated for quantitative variables. Frequency and percentage were calculated for gender, electrolyte disorders and mortality. Effect modifiers were controlled by stratification of age, gender and electrolyte disorders (Hypernatremia, Hyponatremia, Hyperkalemia, and Hypokalemia). Post-stratification, Chi-squared test was applied. P-value = 0.05 was taken as significant. Results: Out of 150 patients, electrolyte disorders in terms of serum sodium and potassium, were found in 86(57.3%) children. Mortality in children with electrolyte disorders was found to be 46(53.5%) which was significantly higher (P<0.001) than patients without electrolyte disorders 40(46.5%). Hypernatremia was found in 48(32%), hyponatremia 24(16%), hyperkalemia 21(14%) and hypokalemia in 42(28%) patients.In comparison; of electrolyte disorders with mortality; significant association was found in hypernatremia (P<0.001), and hyperkalemia (P<0.001). Conclusion: The most common electrolyte abnormalities were hypernatremia and hypokalemia. Mortality was significantly higher in subjects with electrolyte disorders, especially hypernatremia and hyperkalemia

scholarly journals Association Between Deep Sedation from Continuous Intravenous Sedatives and Extubation Failures in Mechanically Ventilated Patients in the Pediatric Intensive Care Unit

2017 ◽  
Vol 22 (2) ◽  
pp. 106-111
Author(s):  
Jennifer M. Schultheis ◽  
Travis S. Heath ◽  
David A. Turner
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Continuous Infusion ◽  
Pediatric Intensive Care Unit ◽  
Deep Sedation ◽  
Pediatric Intensive Care ◽  
Extubation Failure ◽  
Mechanically Ventilated ◽  
Significant Difference

OBJECTIVE The primary objective of this study was to determine whether an association exists between deep sedation from continuous infusion sedatives and extubation failures in mechanically ventilated children. Secondary outcomes evaluated risk factors associated with deep sedation. METHODS This was a retrospective cohort study conducted between January 1, 2009, and October 31, 2012, in the pediatric intensive care unit (PICU) at Duke Children's Hospital. Patients were included in the study if they had been admitted to the PICU, had been mechanically ventilated for ≥48 hours, and had received at least one continuous infusion benzodiazepine and/or opioid infusion for ≥24 hours. Patients were separated into 2 groups: those deeply sedated and those not deeply sedated. Deep sedation was defined as having at least one documented State Behavioral Scale (SBS) of −3 or −2 within 72 hours prior to planned extubation. RESULTS A total of 108 patients were included in the analysis. Both groups were well matched with regard to baseline characteristics. For the primary outcome, there was no difference in extubation failures in those who were deeply sedated compared to those not deeply sedated (14 patients [22.6%] versus 7 patients [15.2%], respectively; p = 0.33). After adjusting for potential risk factors, patients with a higher weight percentile for age (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00–1.03), lower Glasgow Coma Score (GCS) score prior to intubation (OR 0.85; 95% CI 0.74–0.97), and larger maximum benzodiazepine dose (OR 1.93; 95% CI 1.01–3.71) were associated with greater odds of deep sedation. A higher GCS prior to intubation was significantly associated with increased odds of extubation failure (OR 1.19; 95% CI 1.02–1.39). CONCLUSIONS While there was no statistically significant difference in extubation failures between the 2 groups included in this study, considering the severe consequences of extubation failure, the numerical difference reported may be clinically important.

The Pediatric Intensive Care Unit as a Critical Care Setting for Adults during the COVID-19 Pandemic: A Service Evaluation

2021 ◽  
Author(s):  
Elizabeth J. A. Fitchett ◽  
Matthew Rubens ◽  
Katherine Styles ◽  
Thomas Bycroft ◽  
Simon Nadel ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Adult Patients ◽  
Pediatric Care ◽  
Organ Support ◽  
Adult Intensive Care Unit ◽  
Significant Difference

AbstractOne strategy to expand critical care capacity during the coronavirus disease 2019 (COVID-19) pandemic within the United Kingdom has been to repurpose other clinical departments, including the pediatric intensive care unit (PICU) and pediatric multidisciplinary team, to accommodate critically unwell adult patients. While multiple PICUs have treated adult patients with COVID-19, there is an absence of data on the characteristics of patients transferred to pediatric care and their resulting outcomes in comparison to standard adult intensive care unit (AICU) provision. Data were collected for all adult COVID-19 intensive care admissions between March and May 2020, in three ICUs within a single center: PICU, AICU, and theater recovery ICU (RICU). Patient characteristics, severity of illness, and outcomes were described according to the ICU where most of their bed-days occurred. Outcomes included duration of organ support and ICU admission, and mortality at 30 days. Mortality was compared between patients in PICU and the other adult ICUs, using a logistic regression model, adjusting for known confounding variables. Eighty-eight patients were included: 15 (17.0%) in PICU, 57 (64.7%) in AICU, and 16 (18.1%) in RICU. Patients' characteristics and illness severity on admission were comparable across locations, with similar organ support provided. Ten (66.7%) patients survived to hospital discharge from PICU, compared with 27 (47.4%) and nine (56.3%) patients from AICU and RICU, respectively, with no significant difference in 30-day mortality (OR 0.46, 95% CI 0.12–1.85; p = 0.276). Our analysis illustrates the feasibility of evaluating outcomes of patients who have been cared for in additional, emergency ICU beds, whilst demonstrating comparable outcomes for adults cared for in pediatric and adult units.

Cardiac Dysfunction and Serum Ferritin Level as Early Prognostic Markers in Children with Sepsis.

2020 ◽  
Author(s):  
Nagwa Mohamed Sabry Abdelsalam Mahmoud ◽  
Ahlam M. Ismail ◽  
Moustafa Ahmed El Sayed Ahmed Abu Elela ◽  
Islam nashaat roshdy Ahmed
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Cardiac Dysfunction ◽  
Leukocyte Count ◽  
Pediatric Intensive Care ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Inotropic Score

Abstract Objective: This study aimed to evaluate the association of Cardiac dysfunction assessed by Echocardiogram study, ferritin, c-reactive protein, and leukocyte count with unfavorable outcomes in pediatric sepsis within the pediatric intensive care unit.Methods: A prospective cohort study was carried out from September 2019 to April 2020, with 40 patients admitted to a pediatric intensive care unit(PICU) at Minia University Children and Maternal hospital, aged between 28 days and 15 years. Inclusion criteria where patients diagnosed with sepsis, need for mechanical ventilation for quite 48h, and vasoactive drugs. Serum levels of C-reactive protein, ferritin, and leukocyte count were collected within 24 h of admission (D1), and 72 h (D3) after admission to PICU. Patients underwent echocardiography study to figure out the ejection fraction of the ventricle on D1 and D3. The outcomes measured through length of stay at hospital and at the pediatric intensive care unit, mechanical ventilation(MV) duration, free hours of VM, duration of use of inotropic agents, maximum inotropic score, and mortality.Results: Patients with elevated ferritin levels on D1 had less ventilator-free time and higher maximum inotropic score. Patients with cardiac dysfunction by echocardiogram on D1 had longer hospital stay pediatric intensive care unit, stay longer duration of mechanical ventilation higher maximum inotropic score, and fewer ventilator-free hoursConclusion: Cardiac dysfunction by echocardiography study and serum ferritin value was significantly related to unfavorable outcomes in pediatric patients requiring admission to PICU with sepsis.

scholarly journals As-needed endotracheal suctioning protocol vs a routine endotracheal suctioning in Pediatric Intensive Care Unit: A randomized controlled trial

2018 ◽  
Vol 49 (2) ◽  
pp. 148-153
Author(s):  
Gloria Lucía Lema Zuluaga ◽  
Mauricio Fenández Laverde ◽  
Ana Marverin Correa Varela ◽  
John Jairo Zuleta Tobón
Keyword(s):  
Intensive Care Unit ◽  
Randomized Controlled Trial ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Controlled Trial ◽  
Intervention Group ◽  
Pediatric Intensive Care ◽  
Control Group ◽  
Endotracheal Suctioning ◽  
Randomized Controlled

Objective: To compare two endotracheal suctioning protocols according to morbidity, days of mechanical ventilation, length of stay in the Pediatric Intensive Care Unit (PICU), incidence of VentilatorAssociated Pneumonia (VAP) and mortality. Methods: A Pragmatic randomized controlled trial performed at University Hospital Pablo Tobón Uribe, Medellin-Colombia. Fortyfive children underwent an as-needed endotracheal suctioning protocol and forty five underwent a routine endotracheal suctioning protocol. Composite primary end point was the presence of hypoxemia, arrhythmias, accidental extubation and heart arrest. A logistic function trough generalized estimating equations (GEE) were used to calculate the Relative Risk for the main outcome. Results: Characteristics of patients were similar between groups. The composite primary end point was found in 22 (47%) of intervention group and 25 (55%) children of control group (RR= 0.84; 95% CI: 0.56-1.25), as well in 35 (5.8%) of 606 endotracheal suctioning performed to intervention group and 48(7.4%) of 649 performed to control group (OR= 0.80; 95% CI: 0.5-1.3). Conclusions: There were no differences between an as-needed and a routine endotracheal suctioning protocol. Trial Registration: ClinicalTrials.gov identifier: NCT01069185

scholarly journals Invasive Candida Infections in a Pediatric Intensive Care Unit in Turkey: Evaluation of an 11-Year Period

2019 ◽  
Vol 09 (01) ◽  
pp. 021-026
Author(s):  
Nagehan Aslan ◽  
Dincer Yildizdas ◽  
Derya Alabaz ◽  
Ozden Ozgur Horoz ◽  
Ahmet Yontem ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Candida Albicans ◽  
Intensive Care ◽  
Mortality Rate ◽  
Pediatric Intensive Care Unit ◽  
Candida Species ◽  
Pediatric Intensive Care ◽  
Significant Difference ◽  
Candida Infections

AbstractThe aim of this study was to evaluate the Candida species, predisposing factors, antifungal treatment approaches, and clinical outcomes of invasive Candida infections (ICIs) in a tertiary pediatric intensive care unit (PICU). A retrospective study was performed from January 2008 to January 2019 including 102 children with ICIs who were admitted to a university hospital in southeastern Turkey. Positive blood cultures were detected in 43 (42.1%) patients, and positive urine cultures were detected in 59 (57.8%). According to our results, Candida albicans (42.2%) was the most common species for all isolates followed by C. parapsilosis (17.6%). In our patient population, non-albicans Candida species were dominant (57.8%) in all isolates. The most common facilitating factor in our study was the use of mechanical ventilator support (87.3%). The mortality rate of our patients with ICIs was 13.7%. Candida albicans was found to have the highest mortality rate among all Candida species (30.7%). When we compared patients with C. albicans and those with non-albicans Candida species in terms of risk factors, we detected a significant difference between the two groups for total parenteral nutrition use (p = 0.027). Fluconazole was the most preferred (58.8%) treatment option in our PICU for ICIs. Our results showed an increased trend in micafungin use in recent years. ICIs are a significant problem due to the high mortality and morbidity rates in critically ill pediatric patients in PICUs. In recent years, an increase in Candida infections caused by non-albicans Candida species has been reported. Multicenter prospective studies are needed to determine the risk factors for ICIs.

scholarly journals Predicting Candida Infection in Pediatric Intensive Care Unit using Candida Score in a Low-Resource Setting

2021 ◽  
Vol 8 ◽  
pp. 2333794X2199915
Author(s):  
Dicky Ari Risandy ◽  
Desy Rusmawatiningtyas ◽  
Firdian Makrufardi ◽  
Elisabeth Siti Herini ◽  
Nurnaningsih
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Candida Infection ◽  
Control Group ◽  
Case Group ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Candida Score

Candida infection was previously thought to be rare in intensive care. With the increased use of broad-spectrum antibiotics, the incidence of candida infection increased significantly. Case-control study was done in patients ≤18 years of age treated for 3 days or more in Pediatric Intensive Care Unit (PICU) Dr. Sardjito General Hospital, Yogyakarta from January 2014 to December 2016. Overall, 43 children were included in this study as a case group with positive candida culture and 43 children as a control group with no candida culture. Cut off point of candida score is ≥3 from our subjects. The area under curve (AUC) value for cut off ≥3 was moderate (0,72). Candida score ≥3 has an odd ratio (OR) 6.8 (95% CI 2.4-18.6) with P < .05. All of confounding factors in candida infection have no association with P > .05. Candida score can be used as predictor of candida infection in PICU.

scholarly journals The Clinical Effects of Psychological Nursing in the Pediatric Intensive Care Unit

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Yang Yi
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Statistical Significance ◽  
Compliance Rate ◽  
Pediatric Intensive Care ◽  
Care Quality ◽  
Control Group ◽  
Clinical Effects ◽  
Observation Group

Objective: To explore the effects of psychological nursing in the pediatric intensive care unit. Methods: 110 cases of intensive care of children from January 2014 to January 2015 were selected and randomly divided into the observation group (n=55) and the control group (n=55). The children of the control group were given usual nursing care, the patients of the observation group were given psychological nursing. On two groups of patients before and after the intervention of the SAS scores and SDS scores compliance parents care quality satisfaction are compared. Results: Before intervention, theobservation group of patients and the control group of patients with SAS scores and SDS scores difference no statistical significance (P > 0.05), and after the intervention, the observation group patients' scores of SAS and SDS were significantly better than the control group, and the observation group below the control group (P < 0.05). The observation group of compliance rate was 96.36%, and the control group of compliance rate was 69.09%, it below the observation (P<0.05). Parents care quality satisfaction of observation group was obviously better than that of control group with that difference is statistically significant (P<0.05). Conclusion: psychological nursing measures used in pediatric intensive care unit has certain feasibility and is worth popularizing clinically.

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