scholarly journals Immune System Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

PEDIATRICS ◽  
2022 ◽  
Vol 149 (Supplement_1) ◽  
pp. S91-S98
Author(s):  
Mark W. Hall ◽  
Joseph A. Carcillo ◽  
Timothy Cornell
Keyword(s):  
Immune System ◽  
Critically Ill ◽  
Lymphocyte Count ◽  
Task Force ◽  
Ex Vivo ◽  
Data Extraction ◽  
Case Series ◽  
Adverse Outcomes ◽  
Critically Ill Children ◽  
Immune System Dysfunction

CONTEXT Immune system dysfunction is poorly represented in pediatric organ dysfunction definitions. OBJECTIVE To evaluate evidence for criteria that define immune system dysfunction in critically ill children and associations with adverse outcomes and develop consensus criteria for the diagnosis of immune system dysfunction in critically ill children. DATA SOURCES We conducted electronic searches of PubMed and Embase from January 1992 to January 2020, using medical subject heading terms and text words to define immune system dysfunction and outcomes of interest. STUDY SELECTION Studies of critically ill children with an abnormality in leukocyte numbers or function that is currently measurable in the clinical laboratory in which researchers assessed patient-centered outcomes were included. Studies of adults or premature infants, animal studies, reviews and commentaries, case series (≤10 subjects), and studies not published in English with inability to determine eligibility criteria were excluded. DATA EXTRACTION Data were abstracted from eligible studies into a standard data extraction form along with risk of bias assessment by a task force member. RESULTS We identified the following criteria for immune system dysfunction: (1) peripheral absolute neutrophil count <500 cells/μL, (2) peripheral absolute lymphocyte count <1000 cells/μL, (3) reduction in CD4+ lymphocyte count or percentage of total lymphocytes below age-specific thresholds, (4) monocyte HLA-DR expression <30%, or (5) reduction in ex vivo whole blood lipopolysaccharide-induced TNFα production capacity below manufacturer-provided thresholds. LIMITATIONS Many measures of immune system function are currently limited to the research environment. CONCLUSIONS We present consensus criteria for the diagnosis of immune system dysfunction in critically ill children.

scholarly journals Gastrointestinal Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

PEDIATRICS ◽  
2022 ◽  
Vol 149 (Supplement_1) ◽  
pp. S53-S58
Author(s):  
Katri V. Typpo ◽  
Sharon Y. Irving ◽  
Jose M. Prince ◽  
Nazima Pathan ◽  
Ann-Marie Brown
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Task Force ◽  
Data Extraction ◽  
Case Series ◽  
Current Evidence ◽  
Abdominal Radiograph ◽  
Critically Ill Children ◽  
Gastrointestinal Dysfunction ◽  
Plain Abdominal Radiograph

CONTEXT Prior criteria to define pediatric multiple organ dysfunction syndrome (MODS) did not include gastrointestinal dysfunction. OBJECTIVES Our objective was to evaluate current evidence and to develop consensus criteria for gastrointestinal dysfunction in critically ill children. DATA SOURCES Electronic searches of PubMed and EMBASE were conducted from January 1992 to January 2020, using medical subject heading terms and text words to define gastrointestinal dysfunction, pediatric critical illness, and outcomes. STUDY SELECTION Studies were included if they evaluated critically ill children with gastrointestinal dysfunction, performance characteristics of assessment/scoring tools to screen for gastrointestinal dysfunction, and assessed outcomes related to mortality, functional status, organ-specific outcomes, or other patient-centered outcomes. Studies of adults or premature infants, animal studies, reviews/commentaries, case series with sample size ≤10, and non-English language studies with inability to determine eligibility criteria were excluded. DATA EXTRACTION Data were abstracted from each eligible study into a standard data extraction form along with risk of bias assessment by a task force member. RESULTS The systematic review supports the following criteria for severe gastrointestinal dysfunction: 1a) bowel perforation, 1b) pneumatosis intestinalis, or 1c) bowel ischemia, present on plain abdominal radiograph, computed tomography (CT) scan, magnetic resonance imaging (MRI), or gross surgical inspection, or 2) rectal sloughing of gut mucosa. LIMITATIONS The validity of the consensus criteria for gastrointestinal dysfunction are limited by the quantity and quality of current evidence. CONCLUSIONS Understanding the role of gastrointestinal dysfunction in the pathophysiology and outcomes of MODS is important in pediatric critical illness.

scholarly journals Acute Neurologic Dysfunction in Critically Ill Children: The PODIUM Consensus Conference

PEDIATRICS ◽  
2022 ◽  
Vol 149 (Supplement_1) ◽  
pp. S32-S38
Author(s):  
Mark S. Wainwright ◽  
Kristin Guilliams ◽  
Sujatha Kannan ◽  
Dennis W. Simon ◽  
Robert C. Tasker ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Critically Ill ◽  
Task Force ◽  
Data Extraction ◽  
Adult Population ◽  
Case Series ◽  
Consensus Conference ◽  
Critically Ill Children ◽  
Coma Scale ◽  
Neurologic Dysfunction

CONTEXT Acute neurologic dysfunction is common in critically ill children and contributes to outcomes and end of life decision-making. OBJECTIVE To develop consensus criteria for neurologic dysfunction in critically ill children by evaluating the evidence supporting such criteria and their association with outcomes. DATA SOURCES Electronic searches of PubMed and Embase were conducted from January 1992 to January 2020, by using a combination of medical subject heading terms and text words to define concepts of neurologic dysfunction, pediatric critical illness, and outcomes of interest. STUDY SELECTION Studies were included if the researchers evaluated critically ill children with neurologic injury, evaluated the performance characteristics of assessment and scoring tools to screen for neurologic dysfunction, and assessed outcomes related to mortality, functional status, organ-specific outcomes, or other patient-centered outcomes. Studies with an adult population or premature infants (≤36 weeks' gestational age), animal studies, reviews or commentaries, case series with sample size ≤10, and studies not published in English with an inability to determine eligibility criteria were excluded. DATA EXTRACTION Data were abstracted from each study meeting inclusion criteria into a standard data extraction form by task force members. DATA SYNTHESIS The systematic review supported the following criteria for neurologic dysfunction as any 1 of the following: (1) Glasgow Coma Scale score ≤8; (2) Glasgow Coma Scale motor score ≤4; (3) Cornell Assessment of Pediatric Delirium score ≥9; or (4) electroencephalography revealing attenuation, suppression, or electrographic seizures. CONCLUSIONS We present consensus criteria for neurologic dysfunction in critically ill children.

scholarly journals Renal Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

PEDIATRICS ◽  
2022 ◽  
Vol 149 (Supplement_1) ◽  
pp. S66-S73
Author(s):  
Julie C. Fitzgerald ◽  
Rajit K. Basu ◽  
Dana Y. Fuhrman ◽  
Stephen M. Gorga ◽  
Amanda B. Hassinger ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Renal Dysfunction ◽  
Critically Ill ◽  
Urine Output ◽  
Data Extraction ◽  
Case Series ◽  
Adverse Outcomes ◽  
Assessment Tools ◽  
Current Evidence ◽  
Critically Ill Children

CONTEXT Renal dysfunction is associated with poor outcomes in critically ill children. OBJECTIVE To evaluate the current evidence for criteria defining renal dysfunction in critically ill children and association with adverse outcomes. To develop contemporary consensus criteria for renal dysfunction in critically ill children. DATA SOURCES PubMed and Embase were searched from January 1992 to January 2020. STUDY SELECTION Included studies evaluated critically ill children with renal dysfunction, performance characteristics of assessment tools for renal dysfunction, and outcomes related to mortality, functional status, or organ-specific or other patient-centered outcomes. Studies with adults or premature infants (≤36 weeks' gestational age), animal studies, reviews, case series, and studies not published in English with inability to determine eligibility criteria were excluded. DATA EXTRACTION Data were extracted from included studies into a standard data extraction form by task force members. RESULTS The systematic review supported the following criteria for renal dysfunction: (1) urine output <0.5 mL/kg per hour for ≥6 hours and serum creatinine increase of 1.5 to 1.9 times baseline or ≥0.3 mg/dL, or (2) urine output <0.5 mL/kg per hour for ≥12 hours, or (3) serum creatinine increase ≥2 times baseline, or (4) estimated glomerular filtration rate <35 mL/minute/1.73 m2, or (5) initiation of renal replacement therapy, or (6) fluid overload ≥20%. Data also support criteria for persistent renal dysfunction and for high risk of renal dysfunction. LIMITATIONS All included studies were observational and many were retrospective. CONCLUSIONS We present consensus criteria for renal dysfunction in critically ill children.

scholarly journals Coagulation Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

PEDIATRICS ◽  
2022 ◽  
Vol 149 (Supplement_1) ◽  
pp. S79-S83
Author(s):  
E. Vincent S. Faustino ◽  
Oliver Karam ◽  
Robert I. Parker ◽  
Sheila J. Hanson ◽  
Leonardo R. Brandão ◽  
...  
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Limit Of Detection ◽  
Task Force ◽  
Data Extraction ◽  
Adverse Outcomes ◽  
Current Evidence ◽  
Critically Ill Children ◽  
Upper Limit ◽  
Coagulation Dysfunction

CONTEXT Previous criteria for coagulation dysfunction in critically ill children were based mainly on expert opinion. OBJECTIVE To evaluate current evidence regarding coagulation tests associated with adverse outcomes in children to inform criteria for coagulation dysfunction during critical illness. DATA SOURCES Electronic searches of PubMed and Embase were conducted from January 1992 to January 2020 by using a combination of medical subject heading terms and text words to define concepts of coagulation dysfunction, pediatric critical illness, and outcomes of interest. STUDY SELECTION Studies were included if critically ill children with coagulation dysfunction were evaluated, if performance characteristics of assessment and/or scoring tools to screen for coagulation dysfunction were evaluated, and if outcomes related to mortality or functional status, organ-specific outcomes, or other patient-centered outcomes were assessed. DATA EXTRACTION Data were abstracted from each eligible study into a standard data extraction form, along with risk of bias assessment, by a task force member. RESULTS The systematic review supports the presence of at least 2 of the following criteria reflecting coagulation dysfunction in the absence of liver dysfunction: platelet count <100 000 cells per μL, international normalized ratio >1.5, fibrinogen level <150 mg/dL, and D-dimer value above 10 times the upper limit of normal, or above the assay’s upper limit of detection if this limit is below 10 times the upper limit of normal. LIMITATIONS The proposed criteria for coagulation dysfunction are limited by the available evidence and will require future validation. CONCLUSIONS Validation of the proposed criteria and identified scientific priorities will enhance our understanding of coagulation dysfunction in critically ill children.

scholarly journals Respiratory Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

PEDIATRICS ◽  
2022 ◽  
Vol 149 (Supplement_1) ◽  
pp. S48-S52
Author(s):  
Nadir Yehya ◽  
Robinder G. Khemani ◽  
Simon Erickson ◽  
Lincoln S. Smith ◽  
Courtney M. Rowan ◽  
...  
Keyword(s):  
Critically Ill ◽  
Data Extraction ◽  
Case Series ◽  
Consensus Conference ◽  
Small Sample ◽  
Critically Ill Children ◽  
Evidence Based ◽  
Sample Sizes ◽  
Eligibility Criteria ◽  
Respiratory Dysfunction

CONTEXT Respiratory dysfunction is a component of every organ failure scoring system developed, reflecting the significance of the lung in multiple organ dysfunction syndrome. However, existing systems do not reflect current practice and are not consistently evidence based. OBJECTIVE We aimed to review the literature to identify the components of respiratory failure associated with outcomes in children, with the purpose of developing an operational and evidence-based definition of respiratory dysfunction. DATA SOURCES Electronic searches of PubMed and Embase were conducted from 1992 to January 2020 by using a combination of medical subject heading terms and text words to define respiratory dysfunction, critical illness, and outcomes. STUDY SELECTION We included studies of critically ill children with respiratory dysfunction that evaluated the performance of metrics of respiratory dysfunction and their association with patient-centered outcomes. Studies in adults, studies in premature infants (≤36 weeks’ gestational age), animal studies, reviews and commentaries, case series with sample sizes ≤10, and studies not published in English in which we were unable to determine eligibility criteria were excluded. DATA EXTRACTION Data were abstracted into a standard data extraction form. RESULTS We provided binary (no or yes) and graded (no, nonsevere, or severe) definitions of respiratory dysfunction, prioritizing oxygenation and respiratory support. The proposed criteria were approved by 82% of members in the first round, with a score of 8 of 9 (interquartile range 7–8). LIMITATIONS Exclusion of non-English publications, heterogeneity across the pediatric age range, small sample sizes, and incomplete handling of confounders are limitations. CONCLUSIONS We propose definitions for respiratory dysfunction in critically ill children after an exhaustive literature review.

scholarly journals Hematologic Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

PEDIATRICS ◽  
2022 ◽  
Vol 149 (Supplement_1) ◽  
pp. S74-S78
Author(s):  
Jennifer A. Muszynski ◽  
Jill M. Cholette ◽  
Marie E. Steiner ◽  
Marisa Tucci ◽  
Allan Doctor ◽  
...  
Keyword(s):  
Platelet Count ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
English Language ◽  
Data Extraction ◽  
Case Series ◽  
Hemoglobin Concentration ◽  
Consensus Conference ◽  
Data Sources ◽  
Critically Ill Children

CONTEXT Studies of organ dysfunction in children are limited by a lack of consensus around organ dysfunction criteria. OBJECTIVES To derive evidence-informed, consensus-based criteria for hematologic dysfunction in critically ill children. DATA SOURCES Data sources included PubMed and Embase from January 1992 to January 2020. STUDY SELECTION Studies were included if they evaluated assessment/scoring tools to screen for hematologic dysfunction and assessed outcomes of mortality, functional status, organ-specific outcomes, or other patient-centered outcomes. Studies of adults or premature infants, animal studies, reviews/commentaries, small case series, and non-English language studies with inability to determine eligibility were excluded. DATA EXTRACTION Data were abstracted from each eligible study into a standard data extraction form along with risk of bias assessment. RESULTS Twenty-nine studies were included. The systematic review supports the following criteria for hematologic dysfunction: thrombocytopenia (platelet count <100000 cells/µL in patients without hematologic or oncologic diagnosis, platelet count <30000 cells/µL in patients with hematologic or oncologic diagnoses, or platelet count decreased ≥50% from baseline; or leukocyte count <3000 cells/µL; or hemoglobin concentration between 5 and 7 g/dL (nonsevere) or <5 g/dL (severe). LIMITATIONS Most studies evaluated pre-specified thresholds of cytopenias. No studies addressed associations between the etiology or progression of cytopenias overtime with outcomes, and no studies evaluated cellular function. CONCLUSIONS Hematologic dysfunction, as defined by cytopenia, is a risk factor for poor outcome in critically ill children, although specific threshold values associated with increased mortality are poorly defined by the current literature.

scholarly journals Thymosin alpha 1 mitigates cytokine storm in blood cells from COVID-19 patients

2020 ◽  
Author(s):  
Claudia Matteucci ◽  
Antonella Minutolo ◽  
Emanuela Balestrieri ◽  
Vita Petrone ◽  
Marialaura Fanelli ◽  
...  
Keyword(s):  
Immune System ◽  
Blood Cells ◽  
Ex Vivo ◽  
Cell Subset ◽  
Adverse Outcomes ◽  
Cytokine Signaling ◽  
Cytokine Storm ◽  
Thymosin Alpha 1

Abstract COVID-19 is characterized by immune-mediated lung injury and complex alterations of the immune system, such as lymphopenia and cytokine storm, that have been associated with adverse outcomes underlining a fundamental role of host response in SARS-CoV-2 infection and the pathogenesis of the disease. Thymosin alpha 1 (Tα1) is one of the molecules used in the management of COVID-19, since it is known to restore the homeostasis of the immune system during infections and cancer. Here we captured the interconnected biological processes regulated by Tα1 in CD8+ T cells under inflammatory conditions. Genes associated with cytokine signaling and production were found up-regulated in blood cells from COVID-19 patients and the ex-vivo treatment with Tα1 mitigated cytokines expression and inhibited lymphocytes activation in CD8+ T cell subset specifically, suggesting the potential role of Tα1 in modulating the immune response homeostasis and the cytokine storm in vivo.

scholarly journals Early Supplemental Parenteral Nutrition in Critically Ill Children: An Update

2019 ◽  
Vol 8 (6) ◽  
pp. 830 ◽  
Author(s):  
An Jacobs ◽  
Ines Verlinden ◽  
Ilse Vanhorebeek ◽  
Greet Van den Berghe
Keyword(s):  
Parenteral Nutrition ◽  
Critically Ill ◽  
Controlled Trial ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Optimal Dose ◽  
Adverse Outcomes ◽  
Critically Ill Children ◽  
Clinical Practices ◽  
Supplemental Parenteral Nutrition

In critically ill children admitted to pediatric intensive care units (PICUs), enteral nutrition (EN) is often delayed due to gastrointestinal dysfunction or interrupted. Since a macronutrient deficit in these patients has been associated with adverse outcomes in observational studies, supplemental parenteral nutrition (PN) in PICUs has long been widely advised to meeting nutritional requirements. However, uncertainty of timing of initiation, optimal dose and composition of PN has led to a wide variation in previous guidelines and current clinical practices. The PEPaNIC (Early versus Late Parenteral Nutrition in the Pediatric ICU) randomized controlled trial recently showed that withholding PN in the first week in PICUs reduced incidence of new infections and accelerated recovery as compared with providing supplemental PN early (within 24 hours after PICU admission), irrespective of diagnosis, severity of illness, risk of malnutrition or age. The early withholding of amino acids in particular, which are powerful suppressors of intracellular quality control by autophagy, statistically explained this outcome benefit. Importantly, two years after PICU admission, not providing supplemental PN early in PICUs did not negatively affect mortality, growth or health status, and significantly improved neurocognitive development. These findings have an important impact on the recently issued guidelines for PN administration to critically ill children. In this review, we summarize the most recent literature that provides evidence on the implications for clinical practice with regard to the use of early supplemental PN in critically ill children.

scholarly journals Quetiapine as treatment for delirium in critically ill children: A case series

2015 ◽  
Vol 02 (03) ◽  
pp. 121-126 ◽  
Author(s):  
Robert Witcher ◽  
Elena Mendez-Rico ◽  
Gabrielle Silver ◽  
Chani Traube
Keyword(s):  
Critically Ill ◽  
Case Series ◽  
Critically Ill Children

scholarly journals Endocrine Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

PEDIATRICS ◽  
2022 ◽  
Vol 149 (Supplement_1) ◽  
pp. S84-S90
Author(s):  
Vijay Srinivasan ◽  
Jan Hau Lee ◽  
Kusum Menon ◽  
Jerry J. Zimmerman ◽  
Melania M. Bembea ◽  
...  
Keyword(s):  
Critically Ill ◽  
Thyroid Function ◽  
Glucose Homeostasis ◽  
Data Extraction ◽  
Serum Cortisol ◽  
Cortisol Concentration ◽  
Critically Ill Children ◽  
Endocrine Dysfunction ◽  
Adrenal Axis ◽  
Serum Cortisol Concentration

CONTEXT Endocrine dysfunction is common in critically ill children and is manifested by abnormalities in glucose, thyroid hormone, and cortisol metabolism. OBJECTIVE To develop consensus criteria for endocrine dysfunction in critically ill children by assessing the association of various biomarkers with clinical and functional outcomes. DATA SOURCES PubMed and Embase were searched from January 1992 to January 2020. STUDY SELECTION We included studies in which researchers evaluated critically ill children with abnormalities in glucose homeostasis, thyroid function and adrenal function, performance characteristics of assessment and/or scoring tools to screen for endocrine dysfunction, and outcomes related to mortality, organ-specific status, and patient-centered outcomes. Studies of adults, premature infants or animals, reviews and/or commentaries, case series with sample size ≤10, and non–English-language studies were excluded. DATA EXTRACTION Data extraction and risk-of-bias assessment for each eligible study were performed by 2 independent reviewers. RESULTS The systematic review supports the following criteria for abnormal glucose homeostasis (blood glucose [BG] concentrations >150 mg/dL [>8.3 mmol/L] and BG concentrations <50 mg/dL [<2.8 mmol/L]), abnormal thyroid function (serum total thyroxine [T4] <4.2 μg/dL [<54 nmol/L]), and abnormal adrenal function (peak serum cortisol concentration <18 μg/dL [500 nmol/L]) and/or an increment in serum cortisol concentration of <9 μg/dL (250 nmol/L) after adrenocorticotropic hormone stimulation. LIMITATIONS These included variable sampling for BG measurements, limited reporting of free T4 levels, and inconsistent interpretation of adrenal axis testing. CONCLUSIONS We present consensus criteria for endocrine dysfunction in critically ill children that include specific measures of BG, T4, and adrenal axis testing.

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