Radiation Exposure in Pediatric Intensive Care Unit Patients: How Much Is Too Much?

We aimed to determine median cumulative radiation exposure in pediatric intensive care unit (PICU) patients, proportion of patients with high radiation exposure (above annual average radiation per person of 6.2 mSv), and determine risk factors for high exposure. This was a retrospective chart review of PICU patients up to 18 years of age admitted to a large community hospital over 2 years. Radiologic studies and radiation exposure were determined for each patient, and total hospital radiation exposure was classified as high (>6.2 mSv) or not (≤6.2 mSv). Median radiation exposure per patient was 0.2 mSv (interquartile range = 2.1) and 11.7% of patients received >6.2 mSv radiation during their hospitalization. Factors associated with high radiation exposure included admission for trauma or surgery, number of computed tomography scans, age, and PICU length of stay (all P < .0001). We concluded that subsets of PICU patients are at risk of high radiation exposure. Policies and protocols may help minimize radiation exposure among PICU patients.

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Severe Food Protein Induced Enterocolitis Syndrome (FPIES) in the Pediatric Intensive Care Unit (PICU): A Retrospective Chart Review

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2014.12.1080 ◽

2015 ◽

Vol 135 (2) ◽

pp. AB47

Author(s):

Tamar Weinberger ◽

Elizabeth Feuille ◽

Anna H. Nowak-Wegrzyn ◽

Cecilia Thompson

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Chart Review ◽

Pediatric Intensive Care ◽

Retrospective Chart Review ◽

Food Protein

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Impact of a Drug Shortage on Medication Errors and Clinical Outcomes in the Pediatric Intensive Care Unit

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-20.6.453 ◽

2015 ◽

Vol 20 (6) ◽

pp. 453-461 ◽

Cited By ~ 3

Author(s):

Kaitlin M. Hughes ◽

Elizabeth S. Goswami ◽

Jennifer L. Morris

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Adverse Events ◽

Pediatric Intensive Care Unit ◽

Clinical Pharmacist ◽

Pediatric Intensive Care ◽

Retrospective Chart Review ◽

Prescribing Errors ◽

Drug Shortage

OBJECTIVES: The purpose of this study was to assess the rate of prescribing errors, resulting adverse events, and patient outcomes associated with sedation and analgesia in the pediatric intensive care unit (PICU) before and during a national shortage of fentanyl and injectable benzodiazepines. METHODS: A retrospective chart review was performed of patients admitted to the PICU with at least 1 prescribed order for a sedative or analgesic agent during the time periods of January to February of 2011 and 2012. Initial orders for sedative and analgesic agents were identified and investigated for appropriateness of dose and were assessed for error-associated adverse events. Orders were stratified by timing in regard to clinical pharmacist on-site availability. Demographic and outcome information, including unintended extubations, ventilator days, and PICU length of stay, were gathered. RESULTS: One hundred sixty-nine orders representing 72 patients and 179 orders representing 75 patients in 2011 and 2012, respectively, were included in analysis. No differences were found in the rate of prescribing errors in 2011 and 2012 (33 errors in 169 orders vs. 39 errors in 179 orders, respectively, p=0.603). No differences were found in rates of prescribing errors in regard to clinical pharmacist on-site availability. A significant increase was seen in unintended extubations per 100 ventilator days, with 0.15 in 2011 vs. 1.13 in 2012, respectively (p<0.001). A significant decrease was seen in ventilator days per patient (p<0.001) and PICU length of stay per patient (p=0.019). CONCLUSIONS: There were no differences in rates of prescribing errors before versus during the fentanyl and benzodiazepine shortage.

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Hyperoxemia among Pediatric Intensive Care Unit Patients Receiving Oxygen Therapy

Journal of Pediatric Intensive Care ◽

10.1055/s-0041-1740586 ◽

2021 ◽

Author(s):

Azadeh R. Fayazi ◽

Matteo Sesia ◽

Kanwaljeet J. S. Anand

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Oxygen Therapy ◽

Oxygen Toxicity ◽

Pediatric Intensive Care ◽

Retrospective Chart Review ◽

Organ Injury ◽

Arterial Blood Gas ◽

Arterial Blood

AbstractSupratherapeutic oxygen levels consistently cause oxygen toxicity in the lungs and other organs. The prevalence and severity of hyperoxemia among pediatric intensive care unit (PICU) patients remain unknown. This was the first study to examine the prevalence and duration of hyperoxemia in PICU patients receiving oxygen therapy. This is a retrospective chart review. This was performed in a setting of 36-bed PICU in a quaternary-care children's hospital. All the patients were children aged <18 years, admitted to the PICU for ≥24 hours, receiving oxygen therapy for ≥12 hours who had at least one arterial blood gas during this time.There was no intervention. Of 5,251 patients admitted to the PICU, 614 were included in the study. On average, these patients received oxygen therapy for 91% of their time in the PICU and remained hyperoxemic, as measured by pulse oximetry, for 65% of their time on oxygen therapy. Patients on oxygen therapy remained hyperoxemic for a median of 38 hours per patient and only 1.1% of patients did not experience any hyperoxemia. Most of the time (87.5%) patients received oxygen therapy through a fraction of inspired oxygen (FiO2)-adjustable device. Mean FiO2 on noninvasive support was 0.56 and on invasive support was 0.37. Mean partial pressure of oxygen (PaO2) on oxygen therapy was 108.7 torr and 3,037 (42.1%) of PaO2 measurements were >100 torr. Despite relatively low FiO2, PICU patients receiving oxygen therapy are commonly exposed to prolonged hyperoxemia, which may contribute to ongoing organ injury.

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Frequency of and Risk Factors for Acute Kidney Injury Associated With Vancomycin Use in the Pediatric Intensive Care Unit

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-21.6.486 ◽

2016 ◽

Vol 21 (6) ◽

pp. 486-493 ◽

Cited By ~ 3

Author(s):

Sarah Bonazza ◽

Lauren C. Bresee ◽

Timothy Kraft ◽

B. Catherine Ross ◽

Deonne Dersch-Mills

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Kidney Injury ◽

Pediatric Intensive Care ◽

Retrospective Chart Review ◽

Primary Objective ◽

Vancomycin Trough

BACKGROUND: Published information evaluating frequency of and risk factors for vancomycin-induced acute kidney injury (AKI) in the pediatric intensive care unit (PICU) population is conflicting. OBJECTIVES: The primary objective was to describe the proportion of our PICU patients who developed AKI with intravenous (IV) vancomycin. The secondary objective was to describe the associated potential risk factors. METHODS: Pediatric patients (0–18 years) who received their first IV vancomycin dose in the PICU were evaluated in this retrospective chart review. AKI was defined based on Pediatric-Modified RIFLE (pRIFLE) criteria. Patient demographics, vancomycin trough concentrations, concomitant nephrotoxins, and estimated creatinine clearance changes were analyzed. RESULTS: Of 265 patients included, the primary outcome of AKI (defined by meeting any pRIFLE criteria) occurred in 62 (23.4%) patients (48 category R, 11 category I, 3 category F). Patients who received vancomycin treatment for = 5 days were more likely to develop AKI (unadjusted odds ratio [uOR]: 2.52; 95% confidence interval [CI]: 1.11–5.73), as were patients with a maximum vancomycin trough level = 20 mg/L (OR: 2.99; 95% CI: 1.54–5.78) and patients on 1 (uOR: 2.29; 95% CI: 1.12–4.66) or more concurrent nephrotoxin (uOR: 3.11; 95% CI: 1.43–6.77). Among nephrotoxins, patients receiving furosemide concomitantly with vancomycin were more likely to develop AKI (uOR: 3.47; 95% CI: 1.92–6.27). After adjustment, only furosemide was a significant predictor of risk of AKI/AKI (adjusted OR: 3.52; 95% CI: 1.88–6.62). The study was limited by its retrospective and observational design, and confounding variables. CONCLUSIONS: Patients who were receiving vancomycin with concurrent furosemide were at highest risk of developing AKI.

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Community-associated methicillin-resistant Staphylococcus aureus infections in a pediatric intensive care unit

The Journal of Infection in Developing Countries ◽

10.3855/jidc.1565 ◽

2011 ◽

Vol 5 (08) ◽

pp. 587-591 ◽

Cited By ~ 4

Author(s):

Khaled Menif ◽

Asma Bouziri ◽

Ammar Khaldi ◽

Asma Hamdi ◽

Sarra Belhadj ◽

...

Keyword(s):

Intensive Care Unit ◽

Staphylococcus Aureus ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Methicillin Resistant Staphylococcus Aureus ◽

Pediatric Intensive Care ◽

Retrospective Chart Review ◽

Pulmonary Involvement ◽

Methicillin Resistant ◽

Mrsa Infection

Introduction: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection is an increasing problem worldwide. In developing countries, there is little data on CA-MRSA infection in children. This study reviewed the clinical features and outcomes of children admitted in a Tunisian pediatric intensive care unit with severe CA-MRSA infections. Methodology: Retrospective chart review of patients coded for CA-MRSA over 10 years. Results: There were 14 (0.32% of all admissions) patients identified with severe CA-MRSA infections. The median age was three months (range, 0.5-156 months). All patients had pulmonary involvement. Six children (42.8%) developed septic shock. Two (14.3%) patients had multifocal infection with deep venous thrombosis. Two (14.3%) patients died. Conclusions: Severe CA-MRSA pneumonia dominated presentation. The mortality of CA-MRSA infection in our series is lower than that previously reported.

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