scholarly journals Association between the use of balanced fluids and outcomes in critically ill children: a before and after study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Matthew F. Barhight ◽  
Delphine Nelson ◽  
Thomas Moran ◽  
Jessica Christiano ◽  
L. Nelson Sanchez-Pinto
Keyword(s):  
Clinical Outcomes ◽  
Critically Ill ◽  
Standard Care ◽  
Kidney Injury ◽  
Hospital Length Of Stay ◽  
Critically Ill Children ◽  
Post Intervention ◽  
Before And After ◽  
Secondary Outcomes ◽  
Electrolyte Abnormalities

Abstract Background Hyperchloremia and chloride load have been associated with worse clinical outcomes in critically ill patients. We sought to evaluate the electrolyte profile and clinical outcomes associated with a unit-wide transition from saline to balanced fluids for resuscitation and maintenance fluids in a pediatric intensive care unit (PICU). Methods A before and after analysis of all patients admitted to the PICU in a large, urban, academic hospital between August 2018 and March 2020. The transition from the use of saline to the use of balanced fluids for both resuscitation and maintenance fluid as standard care occurred in June 2019. The primary outcome was day 3 acute kidney injury (AKI). The secondary outcomes included mortality, ventilator-free days (VFDs), need for renal replacement therapy (RRT), hospital length of stay (LOS), and electrolyte abnormalities. Results Overall, 2863 patients (47% female) with a day 3 AKI rate of 12.9% (n = 130) and a mortality rate of 2.8% (n = 79) were included. After adjusting for confounders (age, PRISM III, mechanical ventilation, and immunocompromised state, septic shock), there were no significant differences in the odds of day 3 AKI (pre 13%, post 12.5%; adjusted odds ratio [aOR] 0.96, 95%CI 0.65–1.42). There were no differences in the secondary outcomes. The post-intervention period had fewer patients with hyperchloremia (pre 15.5% vs. post 10.4%, p =  < 0.0001) and hyperkalemia (pre 3.2% vs. post 1.4%, p = 0.02) and more patients with hypochloremia (pre 9.5% vs. post 14.4%, p =  < 0.0001) and hypokalemia (pre 38.2% vs. post 47.2%, p =  < 0.0001). In reference to the normochloremic cohort, the hypochloremic cohort had an increase in day 3 AKI, need for RRT, hyperchloremia, and hyperkalemia, and a decrease in hypokalemia; and the hyperchloremic cohort had an increase in VFD and a decrease in hospital LOS. Conclusions Following a unit-wide implementation of balanced fluids as standard care, there were no differences in rates of day 3 AKI or other clinical outcomes. However, there were lower rates of hyperkalemia and hyperchloremia and higher rates of hypokalemia and hypochloremia. Further evaluation of the effect of balanced fluids and the clinical significance of electrolyte abnormalities in critically ill children is needed.

scholarly journals Piperacillin/Tazobactam and Antibiotic-Associated Acute Kidney Injury in Critically Ill Children

2019 ◽  
Vol 30 (11) ◽  
pp. 2243-2251 ◽  
Author(s):  
Emily L. Joyce ◽  
Sandra L. Kane-Gill ◽  
Priyanka Priyanka ◽  
Dana Y. Fuhrman ◽  
John A. Kellum
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Primary Outcome ◽  
Pediatric Patients ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Lengths Of Stay ◽  
Medication Exposure ◽  
Secondary Outcomes

BackgroundThere continues to be uncertainty about whether piperacillin/tazobactam (TZP) increases the risk of AKI in critically ill pediatric patients. We sought to compare rates of AKI among critically ill children treated with TZP or cefepime, an alternative frequently used in intensive care units, with and without vancomycin.MethodsWe conducted a retrospective cohort study assessing the risk of AKI in pediatric intensive care unit patients after exposure to vancomycin, TZP, and cefepime, alone or in combination, within 48 hours of admission. The primary outcome was development of stage 2 or 3 AKI or an increase in AKI stage from 2 to 3 within the 6 days after the 48-hour exposure window. Secondary outcomes included lengths of stay, need for RRT, and mortality.ResultsOf 5686 patients included, 494 (8.7%) developed stage 2 or 3 AKI. The adjusted odds of developing AKI after medication exposure were 1.56 for TZP (95% confidence interval [95% CI], 1.23 to 1.99), 1.13 for cefepime (95% CI, 0.79 to 1.64), and 0.86 for vancomycin (95% CI, 0.69 to 1.07). The adjusted odds of developing AKI for vancomycin plus TZP versus vancomycin plus cefepime was 1.38 (95% CI, 0.85 to 2.24).ConclusionsObservational data in critically ill children show that TZP use is associated with increased odds of AKI. A weaker, nonsignificant association between vancomycin plus TZP and AKI compared with vancomycin plus cefepime, creates some uncertainty about the nature of the association between TZP and AKI. However, cefepime is an alternative not associated with AKI.

scholarly journals 1506. Outcomes of Standardized Neonatal Cephalexin Dosing

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S548-S548
Author(s):  
Melena J Robertson ◽  
Van Tran ◽  
Andrew M Nuibe
Keyword(s):  
Clinical Outcomes ◽  
Kidney Injury ◽  
Optimal Dose ◽  
Intervention Period ◽  
Post Intervention ◽  
Post Intervention Period ◽  
Stewardship Program ◽  
Optimal Dosing ◽  
Before And After ◽  
Tract Infections

Abstract Background The optimal dosing of cephalexin in infants ≤90 days old is not well known. Our Antimicrobial Stewardship Program (ASP) standardized cephalexin dosing for inpatients ≥30 days old using available literature and released an antimicrobial dosing guideline in September 2016. Recommended antimicrobial dosing for inpatients <30 days old followed in November 2017. We reviewed the indications, cephalexin dosing, and clinical outcomes of patients before and after the release of our ASP’s cephalexin dosing guidelines. Methods Webi Universe was queried for cephalexin orders for inpatients ≤ 90 days old at the Inova Children’s Hospital from January 2016 to November 2018. Manual chart review extracted clinical points of interest and ensured that inclusion criteria were met. For patients <30 days old, the pre-intervention period was January 2016 to October 2017 and the post-intervention period was November 2017 to October 2018. For patients ≥30 days old the pre-intervention period was January 2016 to August 2016 and the post-intervention period was September 2016 to October 2018. Aggregate data from the two pre-intervention and two post-intervention periods were pooled, respectively. Results 41 patients were identified: 25 in the pre-intervention period and 16 in the post-intervention period. The median age of patients in the pre-intervention period was 16 days compared with 31 days in the post-intervention period (P = 0.02). No patients had acute kidney injury requiring cephalexin renal dosing. Skin and soft-tissue infections (18) and urinary tract infections (10) were the most common infections in both periods. 24% of patients received the recommended cephalexin dose in the pre-intervention period compared with 63% in the post-intervention period (P = 0.02). Logistic regression controlling for pathogens and area of care showed that patient age predicted the use of recommended cephalexin dosing (OR 1.1, 95% CI: 1.01–1.21). There were no deaths or recrudescent infections. Conclusion Our ASP’s interventions improved adherence to standardized cephalexin dosing in inpatients ≤90 days old without any adverse clinical outcomes. Patients ≥30 days old were more likely to receive recommended cephalexin dosing. Opportunities remain to best define the optimal dose of cephalexin in infants ≤90 days old. Disclosures All authors: No reported disclosures.

Evaluation of Delirium in Critically Ill Patients Prescribed Melatonin or Ramelteon

2021 ◽  
pp. 106002802110020
Author(s):  
Natasha Romero ◽  
Kevin M. Dube ◽  
Kenneth E. Lupi ◽  
Jeremy R. DeGrado
Keyword(s):  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Receptor Agonist ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Melatonin Receptor ◽  
Observational Cohort ◽  
Impaired Sleep ◽  
Retrospective Observational Cohort Study

Background: An impaired sleep-wake cycle may be one factor that affects the development of delirium in critically ill patients. Several small studies suggest that exogenous melatonin or ramelteon may decrease the incidence and/or duration of delirium. Objective: To compare the effect of prophylactic administration of melatonin, ramelteon, or no melatonin receptor agonist on the development of delirium in the intensive care unit (ICU). Methods: This was a single-center, retrospective, observational cohort study of nondelirious patients in the ICU who received melatonin, ramelteon, or no melatonin receptor agonist. The primary end point was the incidence of delirium. Secondary end points included assessments of daily level of sedation and daily utilization of antipsychotic, sedative, and opioid agents. Results: No difference was observed in the incidence of delirium among the melatonin, ramelteon, and placebo cohorts (18.7% vs 14.3% vs 13.8%; P = 0.77). A difference was observed in the rate of agitation and sedation among the 3 groups, with the greatest observed in the melatonin cohort. Additionally, there was a difference in the use of propofol, dexmedetomidine, and opioids. Overall, there was no difference in clinical outcomes, including duration of mechanical ventilation and ICU or hospital length of stay. Conclusion and Relevance: Therapy with melatonin, ramelteon, and no melatonin receptor agonist resulted in similar rates of delirium in a mixed ICU population. Despite significant differences in agitation, sedation, and medication utilization, there was no differences in the clinical outcomes evaluated.

Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury

2009 ◽  
Vol 24 (1) ◽  
pp. 129-140 ◽  
Author(s):  
Sean M. Bagshaw ◽  
Shigehiko Uchino ◽  
Rinaldo Bellomo ◽  
Hiroshi Morimatsu ◽  
Stanislao Morgera ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury

OR007: Nutrition Support Guidelines in Critically Ill Children with Acute Kidney Injury

2015 ◽  
Vol 34 ◽  
pp. S2
Author(s):  
J.C. Silva ◽  
U.G. Kyle ◽  
M. Treviño ◽  
J.L. Lusk ◽  
G. Dardon ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Kidney Injury ◽  
Nutrition Support ◽  
Critically Ill Children ◽  
Support Guidelines
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