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 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 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 THE USE OF 2% CHLORHEXIDINE GLUCONATE (CHG) AS A DAILY BATHING TO REDUCE BACTEREMIA IN CHILDREN WITH CRITICAL ILLNESS AT PICU/NICU

2016 ◽  
Vol 2 (1) ◽  
pp. 1
Author(s):  
Nopi Nur Khasanah
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Nosocomial Infection ◽  
Critically Ill ◽  
Pediatric Intensive Care ◽  
Central Venous Catheters ◽  
Chlorhexidine Gluconate ◽  
Critically Ill Children ◽  
Central Venous

Background: Bacteremia frequently occurs because of nosocomial infection that actually could be preventable. In children who are hospitalized ussually have a higher risk to experience it. Especially in children with critical illness at Pediatric Intensive Care Unit (PICU) at which the state of children to get an indication of central venous catheters (CVC). Objective: To analyze the use of 2% Chlorhexidine Gluconate (CHG) as a daily bathing treatment to reduce bacteremia in critically ill children in the PICU/NICU. Discussion: The study of the use 2% CHG as a daily bathing treatment for critically ill patients admitted to the intensive care unit has been carried out. However, only performed in adult patients. Developing research conducted in children, this study recommends the use of 2% CHG as a daily bathing treatment can be used in selected patients in the NICU when there is an effort by other measures, but still failed to reduce the incidence of CLABSI. Conclusions: Implementation of recommendations will involve approval by the appropriate organizational structure in charge of monitoring the evolution of the practice. Need staff whom known the instructions on the use of CHG to develop procedures daily bathing with 2% CHG in intensive care and decrease the incidence of bacteremia,.Keywords: Chlorhexidine Gluconate, Daily Bathing, Bacteremia in children, PICU/NICU.

A Report of 7-Year Experience on Pediatric Continuous Renal Replacement Therapy

2017 ◽  
Vol 34 (11-12) ◽  
pp. 985-989 ◽  
Author(s):  
Ayse Filiz Yetimakman ◽  
Selman Kesici ◽  
Murat Tanyildiz ◽  
Umut Selda Bayrakci ◽  
Benan Bayrakci
Keyword(s):  
Critically Ill ◽  
Metabolic Diseases ◽  
Fluid Overload ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Standardized Mortality Ratio ◽  
Inborn Errors ◽  
Fluid Removal ◽  
Continuous Renal Replacement Therapies ◽  
Organ Failures

Background: Continuous renal replacement therapies (CRRTs) either as continuous venovenous hemofiltration (CVVH) or hemodiafiltration (CVVHD) are used frequently in critically ill children. Many clinical variables and technical issues are known to affect the result. The factors that could be modified to increase the survival of renal replacement are sought. As a contribution, we present the data on 104 patients who underwent CRRT within a 7-year period. Materials and Method: A total of 104 patients admitted between 2009 and 2016 were included in the study. The demographic information, admittance pediatric risk of mortality (PRISM) scores, indication for CRRT, presence of fluid overload, CRRT modality, durations of CRRT, and pediatric intensive care unit (PICU) stay were compared between survivors and nonsurvivors. Results: The overall rate of survival was 51%. Patients with fluid overload had significantly increased rate of death, CRRT duration, and PICU stay. Multiorgan dysfunction syndrome as the indication for CRRT was significantly related to decreased survival when compared to acute renal failure and acute attacks of metabolic diseases. The CRRT modality was not different between survivors and nonsurvivors. Standardized mortality ratio of the group was calculated to be 0.8. Conclusion: The CRRT in critically ill patients is successful in achieving fluid removal and correction of metabolic imbalances caused by organ failures or attacks of inborn errors of metabolism. It has a positive effect on expected mortality in high-risk PICU patients. To affect the outcome, follow-up should be focused on starting therapy in early stages of fluid overload. Prospective studies defining relative importance of risk factors causing mortality can assist in building up guidelines to affect the outcome.

scholarly journals Use of body composition and phase angle analysis for the assessment of nutritional status and clinical outcomes in critically ill children

2021 ◽  
Author(s):  
Zi-Hong Xiong ◽  
Xue-Mei Zheng ◽  
Guo-Ying Zhang ◽  
Meng-Jun Wu ◽  
Yi Qu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nutritional Status ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Phase Angle ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Duration Time

Abstract BackgroundMalnutrition is highly prevalent in critically ill children in the pediatric intensive care unit .We aimed to investigate the efficiency of bioelectrical impedance analysis (BIA) measurements and phase angle (PhA) analysis for the assessment of nutritional risk and clinical outcomes in critically ill children.MethodsThis single-center observational study included patients admitted to the Pediatric Intensive Care Unit (PICU) of Chengdu Women’s and Children’s Central Hospital. All patients underwent anthropometric measurement in the first 24 h of admission and underwent BIA measurements within 3 days after the admission. The patients were classified into different groups based on body mass index (BMI) for age. Electronic hospital medical records were reviewed to collect clinical data for each patient. All the obtained data were analyzed by the statistics method.ResultsThere were 204 patients enrolled in our study, of which 32.4% were diagnosed with malnutrition. We found that BMI, arm muscle circumference, fat mass, and %body fat were lower in the group with poorer nutritional status (P < 0.05). Evident differences in the score of the Pediatric Risk of Mortality and the duration of mechanical ventilation (MV) among the three groups with different nutritional statuses were observed (P < 0.05). Patients in the severely malnourished group had the longest duration of MV. In the MV groups, there were significant differences (P < 0.05) in albumin level, PhA, and extracellular water/total body water (ECW/TBW ratio). The ECW/TBW ratio and the time for PICU stay had a weak degree of correlation (Pearson correlation coefficient = 0.375). PhA showed a weak degree of correlation with the duration time of medical ventilation (coefficient of correlation = 0.398).ConclusionBIA can be considered an alternative way to assess nutritional status in critically ill children. ECW/TBW ratio and PhA were correlated with PICU stay and duration time of medical ventilation, respectively.

scholarly journals Urinary CXCL10 is Associated with Acute Kidney Injury and Sepsis, and Predicts Mortality in Critically Ill Children

2020 ◽  
Author(s):  
Hui Huang ◽  
Huiting Zhou ◽  
Wenwen Wang ◽  
Xiaomei Dai ◽  
Wenjing Li ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Inflammatory Mediator ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Surviving Sepsis Campaign ◽  
Predictive Values ◽  
Specific Setting ◽  
Potential Indicator

Abstract Background: Acute kidney injury (AKI) biomarkers are often susceptible to confounding factors, limiting their utility as a specific biomarker, in the prediction of AKI, especially in heterogeneous population. The urinary CXC motif chemokine 10 (uCXCL10), as an inflammatory mediator, has been proposed to be a biomarker for AKI in a specific setting. Whether uCXCL10 is associated with AKI and predicts AKI in critically ill patients remains unclear. The aims of the study were to investigate clinical variables potentially associated with uCXCL10 levels and determine the associations of uCXCL10 with AKI, sepsis and PICU mortality in critically ill children, as well as its predictive values of aforementioned issues. Methods: Urinary CXCL10 levels were serially measured in a heterogeneous group of children during the first week after pediatric intensive care unit (PICU) admission. AKI diagnosis was based on the criteria of Kidney Disease: Improving Global Outcomes with serum creatinine and urine output. Sepsis was diagnosed according to surviving sepsis campaign international guidelines for children. Mortality was defined as all-cause death occurring during the PICU stay.Results: Among 342 critically ill children, 52 (15.2%) developed AKI during the first week after PICU admission, and 132 (38.6%) were diagnosed as sepsis and 30 (12.3%) died during PICU stay. Both the initial and peak values of uCXCL10 remained independently associated with AKI with adjusted odds ratios (AORs) of 1.791 (P = 0.010) and 2.002 (P = 0.002), sepsis with AORs of 1.679 (P = 0.003) and 1.752 (P = 0.002), septic AKI with AORs of 3.281 (P <0.001) and 3.172 (P <0.001), and PICU mortality with AORs of 2.779 (P = 0.001) and 3.965 (P <0.001), respectively. The AUCs of the initial uCXCL10 for predicting AKI, sepsis, septic AKI, and PICU mortality were 0.63 (0.53-0.72), 0.62 (0.56-0.68), 0.75 (0.64-0.87), and 0.77 (0.68-0.86), respectively. The AUCs for prediction by using peak uCXCL10 were as follows: AKI 0.65 (0.56-0.75), sepsis 0.63 (0.57-0.69), septic AKI 0.76 (0.65-0.87), and PICU mortality 0.84 (0.76-0.91).Conclusions: Urinary CXCL10 is independently associated with AKI and sepsis, and may be a potential indicator of septic AKI and PICU mortality in critically ill children.

A Systematic Review of CrossFit® Workouts and Dietary and Supplementation Interventions to Guide Nutritional Strategies and Future Research in CrossFit®

2020 ◽  
pp. 1-19
Author(s):  
Ricardo Augusto Silva de Souza ◽  
André Guedes da Silva ◽  
Magda Ferreira de Souza ◽  
Liliana Kataryne Ferreira Souza ◽  
Hamilton Roschel ◽  
...  
Keyword(s):  
Systematic Review ◽  
Muscle Fatigue ◽  
High Intensity ◽  
Scientific Evidence ◽  
Metabolic Stress ◽  
Optimal Recovery ◽  
Future Research ◽  
Nutritional Recommendations ◽  
And Performance ◽  
Nutritional Strategies

CrossFit® is a high-intensity functional training method consisting of daily workouts called “workouts of the day.” No nutritional recommendations exist for CrossFit® that are supported by scientific evidence regarding the energetic demands of this type of activity or dietary and supplement interventions. This systematic review performed in accordance with PRISMA guidelines aimed to identify studies that determined (a) the physiological and metabolic demands of CrossFit® and (b) the effects of nutritional strategies on CrossFit® performance to guide nutritional recommendations for optimal recovery, adaptations, and performance for CrossFit® athletes and direct future research in this emerging area. Three databases were searched for studies that investigated physiological responses to CrossFit® and dietary or supplementation interventions on CrossFit® performance. Various physiological measures revealed the intense nature of all CrossFit® workouts of the day, reflected in substantial muscle fatigue and damage. Dietary and supplementation studies provided an unclear insight into effective strategies to improve performance and enhance adaptations and recovery due to methodological shortcomings across studies. This systematic review showed that CrossFit® is a high-intensity sport with fairly homogenous anaerobic and aerobic characteristics, resulting in substantial metabolic stress, leading to metabolite accumulation (e.g., lactate and hydrogen ions) and increased markers of muscle damage and muscle fatigue. Limited interventional data exist on dietary and supplementation strategies to optimize CrossFit® performance, and most are moderate to very low quality with some critical methodological limitations, precluding solid conclusions on their efficacy. High-quality work is needed to confirm the ideal dietary and supplemental strategies for optimal performance and recovery for CrossFit® athletes and is an exciting avenue for further research.

The need to know: experiences of critically ill patients

2000 ◽  
Vol 9 (3) ◽  
pp. 192-198 ◽  
Author(s):  
JE Hupcey ◽  
HE Zimmerman
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Critically Ill ◽  
Nursing Staff ◽  
Critically Ill Patients ◽  
Second Phase ◽  
The Past ◽  
Intensive Care Unit Nurses ◽  
Vivid Memories

BACKGROUND: Critically ill patients vary in their memories of their experience in the intensive care unit. Some have little recall and need to learn about their critical illness. Others have more vivid memories of their experiences, some of which were extremely unpleasant. Patients' not knowing what was happening may have exacerbated the unpleasant experiences. OBJECTIVES: To elicit the experience of knowing for critically ill patients and to explore the differences in perceptions between patients who were intubated and those who were not intubated during the illness. METHODS: Grounded theory was used to explore the meaning of knowing and not knowing and the process by which knowing occurs. Unstructured interviews were done with 14 patients. RESULTS: Knowing had 2 phases: the need to know (1) during and (2) after the critical illness. The first phase had 3 facets: needing information, needing to be oriented, and having confusing perceptions. The second phase had 2 facets: needing information about what had happened and piecing together events. Many experiences with knowing during and after a critical illness were similar for both intubated and nonintubated patients. The main difference was the intensity of the experience in some categories. CONCLUSIONS: Critically ill patients have a strong need to know throughout and after their time in the intensive care unit. Nurses must address this need for constant reorientation to the past and present in these patients. In addition, adequate nursing staff must be available for these patients.

scholarly journals Assessment of delirium in children admitted into the Intensive Care Unit: psCAM-ICU Tool

2020 ◽  
Vol 38 (2) ◽  
pp. 140-148
Author(s):  
Ángela María Henao Castaño ◽  
Edwar Yamith Pinzon Casas
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Pediatric Intensive Care ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Primary Diagnosis ◽  
Critically Ill Children ◽  
Associated Risk Factors ◽  
Prolonged Hospital

Background: Delirium has been identified as a risk factor for the mortality of critically ill patients, generating great social and economic impacts, since patients require more days of mechanical ventilation and a prolonged hospital stay in the intensive care unit (ICU), thus increasing medical costs. Objective: To describe the prevalence and characteristics of delirium episodes in a sample of 6-month to 5-year-old children who are critically ill. Methods: Cohort study at a Pediatric Intensive Care Unit (PICU) in Bogotá (Colombia). Participants were assessed by the Preschool Confusion Assessment Method for the ICU (psCAM-ICU) within the first twenty-four hours of hospitalization. Results: One quarter of the participants (25.8%) presented some type of delirium. Among them, two sub-types of delirium were observed: 62.5% of the cases were hypoactive and 37.5% hyperactive. Moreover, from them, six were male (75%) and 2 female (25%). Primary diagnosis was respiratory tract infection in 62.55% of the patients, while respiratory failure was diagnosed in the remaining 37.5%. Conclusions: The implementation of delirium monitoring tools in critically ill children provides a better understanding of the clinical manifestation of this phenomenon and associated risk factors in order to contribute to the design of efficient intervention strategies.

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