scholarly journals A clinical prediction model to identify patients at high risk of hemodynamic instability in the pediatric intensive care unit

Critical Care ◽  
2017 ◽  
Vol 21 (1) ◽  
Author(s):  
Cristhian Potes ◽  
Bryan Conroy ◽  
Minnan Xu-Wilson ◽  
Christopher Newth ◽  
David Inwald ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Prediction Model ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Hemodynamic Instability ◽  
Clinical Prediction ◽  
Clinical Prediction Model

scholarly journals Failure to Validate a Multivariable Clinical Prediction Model to Identify Pediatric Intensive Care Unit Patients at High Risk for Candidemia

2015 ◽  
Vol 5 (4) ◽  
pp. 458-461 ◽  
Author(s):  
Brian T. Fisher ◽  
Rachael K. Ross ◽  
Emmanuel Roilides ◽  
Debra L. Palazzi ◽  
Mark J. Abzug ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Case Control Study ◽  
Prediction Rule ◽  
Pediatric Intensive Care ◽  
Clinical Prediction Rule ◽  
Clinical Prediction ◽  
Clinical Prediction Model ◽  
Control Study

Abstract We attempted to validate a previously derived clinical prediction rule for candidemia in the pediatric intensive care unit. This multicenter case control study did not identify significant association of candidemia with most of the previously identified predictors. Additional study in larger cohorts with other predictor variables is needed.

Admission to a Pediatric Intensive Care Unit for Bacterial Meningitis: Review of 168 Cases

1995 ◽  
Vol 10 (5) ◽  
pp. 253-260 ◽  
Author(s):  
Marisa Tucci ◽  
Marc H. Lebel ◽  
Marie Gauthier ◽  
Catherine A. Farrell ◽  
Jacques Lacroix
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bacterial Meningitis ◽  
Pediatric Intensive Care Unit ◽  
Hormone Secretion ◽  
Pediatric Intensive Care ◽  
Hemodynamic Instability ◽  
Haemophilus Influenzae Type ◽  
Altered Level ◽  
Neurological Sequelae

We performed a retrospective analysis of the charts of 168 patients (1 week to 17 years of age) admitted to a pediatric intensive care unit (PICU) with bacterial meningitis over an 11-year period (1980–1990) to delineate clinical characteristics and outcome. The four major reasons for PICU admission were an altered level of consciousness (70%), hemodynamic instability (33%), seizures (13%), and apnea (7%). Many children had more than one reason for admission to the PICU. The pathogens identified included Haemophilus influenzae type b in 71 (42%) patients, Neisseria meningitidis in 33 (20%), Streptococcus pneumoniae (SP) in 23 (14%), Group B Streptococcus (GBS) in 18 (11%), Escherichia coli in 7 (4%), and others in 7 (4%). Overall mortality was 13% (22 of 168); most deaths (12/22) occurred within 24 hours of admission. The highest mortality rate was associated with GBS meningitis (39%). Average duration of stay in the PICU was 2.9 days. Complications in the PICU included seizures (32%), hemodynamic instability (23%), hyponatremia (21%), syndrome of inappropriate antidiuretic hormone secretion (13%), disseminated intravascular coagulation (12%), and hypernatremia (6%). Ninety-five percent (138/146) of the survivors were evaluated between 1 month and 1 year after discharge: 79% had no significant neurological sequelae, 14% had mild sequelae, and 7% remained with major neurological sequelae. Moderate or severe hearing deficits were detected in 13% of those evaluated (13 of 102). Patients with SP and GBS meningitis had the highest incidence of complications, sequelae, and mortality. The majority of deaths due to bacterial meningitis, in a PICU, occur early, seem unavoidable, and result from neurological or hemodynamic dysfunction. The fact that the majority of survivors have a normal outcome despite a complicated course favors provision of close surveillance and aggressive management in a PICU setting.

Identifying children at high risk for psychological sequelae after pediatric intensive care unit hospitalization*

2004 ◽  
Vol 5 (4) ◽  
pp. 358-363 ◽  
Author(s):  
Janet E. Rennick ◽  
Isabelle Morin ◽  
Doris Kim ◽  
C. Celeste Johnston ◽  
Geoffrey Dougherty ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Psychological Sequelae

Difference Between the Measured and Ordered Dose of Catecholamine Infusions

1995 ◽  
Vol 29 (11) ◽  
pp. 1095-1100 ◽  
Author(s):  
Elizabeth M Allen ◽  
Don H Van Boerum ◽  
Alice F Olsen ◽  
J Michael Dean
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Critically Ill Patients ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Hemodynamic Instability ◽  
Drug Preparation ◽  
Catecholamine Concentration

Objective: To measure the actual concentrations of dopamine, dobutamine, and epinephrine in infusates prepared for patients, and to compare these concentrations with those of the dopamine HCl, dobutamine, and epinephrine HCl infusates that had been prescribed to evaluate drug preparation accuracy. Design: Prospective, unblind study. Setting: Pediatric intensive care unit in a tertiary-care teaching hospital. Participants: All dopamine, dobutamine, and epinephrine infusions ordered for patients during the 2-month study period were eligible for inclusion in the study. Measurements: Daily samples of dopamine, dobutamine, and epinephrine infusates that were prepared for 41 pediatric patients were obtained; the infusate catecholamine concentration was measured by HPLC and compared with the ordered concentration. The concentration then was multiplied by the rate of infusion to determine the catecholamine dose. Main Results: There were significant differences between the measured doses of dopamine, dobutamine, and epinephrine and the dopamine HCl, dobutamine, and epinephrine HCl doses (p = 0.0001, p = 0.039, and p = 0.0009, respectively) that had been ordered because of preparation inaccuracies. Failure to account for the HCl salt in the stock drug accounted for some, but not all, of the inaccuracy of the dopamine HCl and epinephrine HCl infusates. There was a wide interday variability in the measured catecholamine dosage in patients receiving the same dose for 3 days or more. Conclusions: There are daily fluctuations in the preparation of dopamine, dobutamine, and epinephrine infusates that could alter the amount of drug actually delivered to critically ill patients and potentially contribute to their hemodynamic instability.

PROPER: Development of an Early Pediatric Intensive Care Unit Readmission Risk Prediction Tool

2016 ◽  
Vol 33 (1) ◽  
pp. 29-36 ◽  
Author(s):  
Harsheen Kaur ◽  
James M. Naessens ◽  
Andrew C. Hanson ◽  
Karen Fryer ◽  
Michael E. Nemergut ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prediction Model ◽  
Pediatric Intensive Care Unit ◽  
Risk Prediction ◽  
Pediatric Population ◽  
Cerebral Performance Category ◽  
Pediatric Intensive Care ◽  
Risk Prediction Model ◽  
Retrospective Case

Objective: No risk prediction model is currently available to measure patient’s probability for readmission to the pediatric intensive care unit (PICU). This retrospective case–control study was designed to assess the applicability of an adult risk prediction score (Stability and Workload Index for Transfer [SWIFT]) and to create a pediatric version (PRediction Of PICU Early Readmissions [PROPER]). Design: Eighty-six unplanned early (<48 hours) PICU readmissions from January 07, 2007, to June 30, 2014, were compared with 170 random controls. Patient- and disease-specific data and PICU workload factors were compared across the 2 groups. Factors statistically significant on multivariate analysis were included in the creation of the risk prediction model. The SWIFT scores were calculated for cases and controls and compared for validation. Results: Readmitted patients were younger, weighed less, and were more likely to be admitted from the emergency department. There were no differences in gender, race, or admission Pediatric Index of Mortality scores. A higher proportion of patients in the readmission group had a Pediatric Cerebral Performance Category in the moderate to severe disability category. Cases and controls did not differ with respect to staff workload at discharge or discharge day of the week; there was a much higher proportion of patients on supplemental oxygen in the readmission group. Only 2 of 5 categories in the SWIFT model were significantly different, and although the median SWIFT score was significantly higher in the readmissions group, the model discriminated poorly between cases and controls (area under the curve: 0.613). A 7-category PROPER score was created based on a multiple logistic regression model. Sensitivity of this model (score ≥12) for the detection of readmission was 81% with a positive predictive value of 0.50. Conclusion: We have created a preliminary model for predicting patients at risk of early readmissions to the PICU from the hospital floor. The SWIFT score is not applicable for predicting the risk for pediatric population.

scholarly journals NEUROlogical Prognosis After Cardiac Arrest in Kids (NEUROPACK) study: protocol for a prospective multicentre clinical prediction model derivation and validation study in children after cardiac arrest

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e037517
Author(s):  
Barnaby Robert Scholefield ◽  
James Martin ◽  
Kate Penny-Thomas ◽  
Sarah Evans ◽  
Mirjam Kool ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Prediction Model ◽  
Neurodevelopmental Outcome ◽  
Paediatric Intensive Care ◽  
Ethical Review ◽  
Clinical Prediction ◽  
Clinical Prediction Model ◽  
Paediatric Cardiac Arrest

IntroductionCurrently, we are unable to accurately predict mortality or neurological morbidity following resuscitation after paediatric out of hospital (OHCA) or in-hospital (IHCA) cardiac arrest. A clinical prediction model may improve communication with parents and families and risk stratification of patients for appropriate postcardiac arrest care. This study aims to the derive and validate a clinical prediction model to predict, within 1 hour of admission to the paediatric intensive care unit (PICU), neurodevelopmental outcome at 3 months after paediatric cardiac arrest.Methods and analysisA prospective study of children (age: >24 hours and <16 years), admitted to 1 of the 24 participating PICUs in the UK and Ireland, following an OHCA or IHCA. Patients are included if requiring more than 1 min of cardiopulmonary resuscitation and mechanical ventilation at PICU admission Children who had cardiac arrests in PICU or neonatal intensive care unit will be excluded. Candidate variables will be identified from data submitted to the Paediatric Intensive Care Audit Network registry. Primary outcome is neurodevelopmental status, assessed at 3 months by telephone interview using the Vineland Adaptive Behavioural Score II questionnaire. A clinical prediction model will be derived using logistic regression with model performance and accuracy assessment. External validation will be performed using the Therapeutic Hypothermia After Paediatric Cardiac Arrest trial dataset. We aim to identify 370 patients, with successful consent and follow-up of 150 patients. Patient inclusion started 1 January 2018 and inclusion will continue over 18 months.Ethics and disseminationEthical review of this protocol was completed by 27 September 2017 at the Wales Research Ethics Committee 5, 17/WA/0306. The results of this study will be published in peer-reviewed journals and presented in conferences.Trial registration numberNCT03574025.

Factors Related to Parent Attendance at a Follow-Up Meeting With an Intensivist After a Child’s Death in the Pediatric Intensive Care Unit

2017 ◽  
Vol 79 (4) ◽  
pp. 436-445
Author(s):  
Markita L. Suttle ◽  
Cynthia A. Gerhardt ◽  
Marci Z. Fults
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Pediatric Intensive Care Unit ◽  
Emotional Support ◽  
Pediatric Intensive Care ◽  
Bereaved Parents ◽  
Specific Subset ◽  
Child's Death

Parents who experience the death of a child are at high risk for psychopathology. Because a large percentage of pediatric deaths occur in the pediatric intensive care unit each year, a follow-up meeting between bereaved parents and intensivists could provide essential emotional support, although some parents may not attend. The aim of this study was to explore demographic and medical factors that may distinguish between bereaved parents who attend a follow-up meeting with their child’s pediatric intensivist and those who do not. Our analysis revealed that parents of children who died of trauma were less likely to attend a follow-up meeting with an intensivist. It is possible that symptoms of posttraumatic stress play a role in these findings. Enhanced efforts to identify other interventions for this specific subset of bereaved parents may be necessary.

An Outbreak of Gentamicin-ResistantEnterobacter cloacaeInfections in a Pediatric Intensive Care Unit

1983 ◽  
Vol 4 (3) ◽  
pp. 148-152 ◽  
Author(s):  
Edwin L. Anderson ◽  
J. Patrick Hieber
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Patients ◽  
Medical Center ◽  
Newborn Infants ◽  
Pediatric Intensive Care ◽  
Enterobacter Cloacae ◽  
Surgical Unit

AbstractThe intensive care unit at Children's Medical Center in Dallas is a medical-surgical unit that cares for pediatric patients of all ages. In 1978 an outbreak of infections occurred that was caused by a gentamicin-resistant strain ofEnterobacter cloacae. Thirty of the 34 patients involved in the outbreak were neonates. Six patients developed bacteremia, five of them neonates. The neonates who became infected were significantly smaller (> 1500 g) and more premature (< 35 weeks) than control patients. Neonates with bacteremia had a significantly higher incidence of congenital anomalies. In a multi-specialty pediatric intensive care unit newborn infants were the group of patients at high risk for nosocomial infection.

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