scholarly journals Pediatric Organ Dysfunction Information Update Mandate (PODIUM) Contemporary Organ Dysfunction Criteria: Executive Summary

PEDIATRICS ◽  
2022 ◽  
Vol 149 (Supplement_1) ◽  
pp. S1-S12 ◽  
Author(s):  
Melania M. Bembea ◽  
Michael Agus ◽  
Ayse Akcan-Arikan ◽  
Peta Alexander ◽  
Rajit Basu ◽  
...  
Keyword(s):  
Critically Ill ◽  
Organ Dysfunction ◽  
Outcome Data ◽  
Multiple Organ ◽  
Critically Ill Children ◽  
Multiple Organ Dysfunction ◽  
Medical Subject Headings ◽  
Executive Summary ◽  
Immune System Dysfunction ◽  
Information Update

Prior criteria for organ dysfunction in critically ill children were based mainly on expert opinion. We convened the Pediatric Organ Dysfunction Information Update Mandate (PODIUM) expert panel to summarize data characterizing single and multiple organ dysfunction and to derive contemporary criteria for pediatric organ dysfunction. The panel was composed of 88 members representing 47 institutions and 7 countries. We conducted systematic reviews of the literature to derive evidence-based criteria for single organ dysfunction for neurologic, cardiovascular, respiratory, gastrointestinal, acute liver, renal, hematologic, coagulation, endocrine, endothelial, and immune system dysfunction. We searched PubMed and Embase from January 1992 to January 2020. Study identification was accomplished using a combination of medical subject headings terms and keywords related to concepts of pediatric organ dysfunction. Electronic searches were performed by medical librarians. Studies were eligible for inclusion if the authors reported original data collected in critically ill children; evaluated performance characteristics of scoring tools or clinical assessments for organ dysfunction; and assessed a patient-centered, clinically meaningful outcome. Data were abstracted from each included study into an electronic data extraction form. Risk of bias was assessed using the Quality in Prognosis Studies tool. Consensus was achieved for a final set of 43 criteria for pediatric organ dysfunction through iterative voting and discussion. Although the PODIUM criteria for organ dysfunction were limited by available evidence and will require validation, they provide a contemporary foundation for researchers to identify and study single and multiple organ dysfunction in critically ill children.

scholarly journals Derivation and Validation of Novel Phenotypes of Multiple Organ Dysfunction Syndrome in Critically Ill Children

2020 ◽  
Vol 3 (8) ◽  
pp. e209271
Author(s):  
L. Nelson Sanchez-Pinto ◽  
Emily K. Stroup ◽  
Tricia Pendergrast ◽  
Neethi Pinto ◽  
Yuan Luo
Keyword(s):  
Critically Ill ◽  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Multiple Organ ◽  
Critically Ill Children ◽  
Multiple Organ Dysfunction

scholarly journals Daily estimation of the severity of multiple organ dysfunction syndrome in critically ill children

2010 ◽  
Vol 182 (11) ◽  
pp. 1181-1187 ◽  
Author(s):  
S. Leteurtre ◽  
A. Duhamel ◽  
B. Grandbastien ◽  
F. Proulx ◽  
J. Cotting ◽  
...  
Keyword(s):  
Critically Ill ◽  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Multiple Organ ◽  
Critically Ill Children ◽  
Multiple Organ Dysfunction

scholarly journals Scoring Systems for Organ Dysfunction and Multiple Organ Dysfunction: The PODIUM Consensus Conference

PEDIATRICS ◽  
2022 ◽  
Vol 149 (Supplement_1) ◽  
pp. S23-S31
Author(s):  
Luregn J. Schlapbach ◽  
Scott L. Weiss ◽  
Melania M. Bembea ◽  
Joseph A. Carcillo ◽  
Francis Leclerc ◽  
...  
Keyword(s):  
Critically Ill ◽  
Organ Dysfunction ◽  
Data Extraction ◽  
Severity Of Illness ◽  
Scoring Systems ◽  
Multiple Organ ◽  
Consensus Conference ◽  
Critically Ill Children ◽  
Multiple Organ Dysfunction ◽  
Scoring Tools

CONTEXT Multiple scores exist to characterize organ dysfunction in children. OBJECTIVE To review the literature on multiple organ dysfunction (MOD) scoring systems to estimate severity of illness and to characterize the performance characteristics of currently used scoring tools and clinical assessments for organ dysfunction in critically ill children. DATA SOURCES Electronic searches of PubMed and Embase were conducted from January 1992 to January 2020. STUDY SELECTION Studies were included if they evaluated critically ill children with MOD, evaluated the performance characteristics of scoring tools for MOD, and assessed outcomes related to mortality, functional status, organ-specific outcomes, or other patient-centered outcomes. DATA EXTRACTION Data were abstracted into a standard data extraction form by a task force member. RESULTS Of 1152 unique abstracts screened, 156 full text studies were assessed including a total of 54 eligible studies. The most commonly reported scores were the Pediatric Logistic Organ Dysfunction Score (PELOD), pediatric Sequential Organ Failure Assessment score (pSOFA), Pediatric Index of Mortality (PIM), PRISM, and counts of organ dysfunction using the International Pediatric Sepsis Definition Consensus Conference. Cut-offs for specific organ dysfunction criteria, diagnostic elements included, and use of counts versus weighting varied substantially. LIMITATIONS While scores demonstrated an increase in mortality associated with the severity and number of organ dysfunctions, the performance ranged widely. CONCLUSIONS The multitude of scores on organ dysfunction to assess severity of illness indicates a need for unified and data-driven organ dysfunction criteria, derived and validated in large, heterogenous international databases of critically ill children.

scholarly journals Efficacy and safety of plasma hemodiafiltration (PHDF) in pediatric patients with multiple organ dysfunction syndrome with shock and DIC: a preliminary study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Hiroyuki Nagafuchi ◽  
Hiroyuki Shimizu ◽  
Kaori Yamada ◽  
Kenta Shono ◽  
Tetsuya Ogawa
Keyword(s):  
Mortality Rate ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Multiple Organ Dysfunction Syndrome ◽  
Venous Pressure ◽  
Multiple Organ ◽  
Critically Ill Children ◽  
Multiple Organ Dysfunction ◽  
Circulating Blood Volume ◽  
Logistic Organ Dysfunction

Abstract Background Multiple organ dysfunction syndrome is the leading cause of death in pediatric intensive care units and can be very critical when combined with shock and disseminated intravascular coagulation (DIC). Currently, there is no effective treatment. We developed a new hemodiafiltration (HDF) method called plasma HDF (PHDF) that uses fresh frozen plasma as replacement fluid and investigated the safety and efficacy of this treatment. Methods We enrolled critically ill children with (1) a Pediatric Logistic Organ Dysfunction 2 (PELOD-2) score ≥ 14, (2) a Japanese Ministry of Health and Welfare (JMHW) DIC score ≥ 7, (3) a vasoactive inotropic score (VIS) ≥ 10, and (4) a serum total protein concentration ≤ 5.0 g/dL. PHDF was performed for 5 h and then switched to continuous HDF. The primary endpoint was the 28-day mortality rate. Secondary endpoints included assessment of vital signs, blood test data, and fluid balance from PHDF start to day 7. Results Nine patients (four males and five females) between 3 days and 40 months of age, weighing 2.1–13 kg, met the inclusion criteria. Although the median PMR was 0.94 (0.71–0.96), the 28-day mortality rate was 22.2% (2/9). One hour after the start of PHDF, there was an increase in mean arterial pressure and central venous pressure and a decrease in heart rate; by day 7, there was a significant decrease in the PELOD-2 score, the JMHW DIC score, and the VIS. Hypoproteinemia also improved the day after PHDF. Water balance was able to remain negative after day 2. Conclusions PHDF was found to be effective in the treatment of DIC and circulatory failure by supplementing coagulation and antithrombotic factors as well as by raising colloid osmotic pressure to increase circulating blood volume. PHDF has been shown to be a safe and useful treatment for critically ill children and has the potential to improve 28-day survival.

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