scholarly journals Influence of nutritional status on clinical outcomes in critically ill children

2018 ◽  
Vol 5 (2) ◽  
pp. 462 ◽  
Author(s):  
Chaitra K. M. ◽  
Bhavya G. ◽  
Harish S. ◽  
Shruthi Patel ◽  
Syeda Kausar Anjum
Keyword(s):  
Nutritional Status ◽  
Hospital Stay ◽  
Critically Ill ◽  
Tertiary Care ◽  
Metabolic Stress ◽  
Normal Weight ◽  
Critically Ill Children ◽  
Obese Children ◽  
Significant Difference ◽  
Prolonged Hospital

Background: Critically-ill children have a state of metabolic stress. The nutritional needs of these patients can be increased. Their nutritional status at admission and its possible deterioration during hospitalization can be a predictor of worse outcome. The objective of this study was to study the influence of nutritional status on outcomes like mortality, duration of mechanical ventilation and duration PICU stay and hospital stay, in critically ill children.Methods: This was a prospective comparative study conducted on 60 critically ill children aged 1 month to 18 years admitted to PICU of tertiary care, teaching hospital, Bangalore, Karnataka over a study period of 12 months. Patients were divided into 4 categories based on Body mass index (BMI) as per WHO growth charts into: underweight, normal, overweight and obese and outcomes was analysed.Results: In the present study 60 children were studied. Subjects were classified as underweight (23.33%), normal weight (45%), overweight/obese (31.67%) based on BMI Z-score at admission. The odds of prolonged hospital stay were higher in underweight and overweight/obese children (OR-2.85, p-0.12 and OR-3.92, p-0.03 respectively). Underweight and overweight/ obese children had higher odds for prolonged PICU stay. (OR-6, p-0.02 and OR-2.13, p-0.36 respectively). Underweight children required prolonged ventilator support (OR-2, p-0.03). There was no significant difference among the group.Conclusions: There is a high prevalence of malnourishment in critically ill children compared to general population and they are prone for poor outcome. Malnourished children must be identified at admission and optimal therapies, nutritional strategies aimed at preventing further nutritional deterioration should be made.

scholarly journals Study of role of oral probiotics in patients on ventilator in paediatric Intensive Care Unit at tertiary care center

2020 ◽  
Vol 7 (5) ◽  
pp. 988
Author(s):  
Prashant Chawan ◽  
Aswathy Rajan
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Stay ◽  
Critically Ill ◽  
Tertiary Care ◽  
Control Group ◽  
Case Group ◽  
Age Group ◽  
Duration Of Hospital Stay ◽  
Significant Difference ◽  
And Control

Background: The normal intestinal microbiota of critically ill patients is altered and replaced by pathogens. Any significant insult to the gut or alteration to its microbiota plays a role in promoting systemic inflammation and infection in the critically ill population. Probiotics may affect other body sites in addition to the GI tract , and they can have applications in a variety of populations, including healthy individuals, children, elderly, immunocompromised and genetically predisposed individuals. These studies the effect of probiotics in pediatric population on mechanical ventilation in a tertiary care hospital.Methods: Present study was conducted in a PICU of a tertiary care teaching hospital in children aged 12 years or less admitted to PICU and who were likely to need mechanical ventilation for more than 48 h were recruited.Results: In present study 25 patients were recruited in each group i.e. case (probiotics) group and control group. Most common age group among case group was 6-8 years (44 %), while 9-12 years (36 %) was most common age group in control group. Mean age was comparable in both groups (7.6±3.5 years in case group and 7.9±4.1 years in control group). In both groups septic shock and pneumonia were most common diagnosis followed by admission due to miscellaneous cause. In both groups mechanical ventilation was used due to respiratory failure and shock. Outcome was compared in both groups. Authors noted a statistically significant difference in duration of ICU stay, duration of hospital stay and duration of mechanical ventilation, between case 7 control group (p<0.05). In terms of overall mortality, authors did not noted any significant difference among groups.Conclusions: Authors noted a statistically significant difference in duration of ICU stay, duration of hospital stay and duration of mechanical ventilation, between case and control group (p<0.05).   

Prevalence, Correlates and Management of Hyperglycemia in Diabetic Non-critically Ill Patients at a Tertiary Care Center in Lebanon

2019 ◽  
Vol 15 (2) ◽  
pp. 133-140 ◽  
Author(s):  
Ghada El Khoury ◽  
Hanine Mansour ◽  
Wissam K. Kabbara ◽  
Nibal Chamoun ◽  
Nadim Atallah ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Center ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Diabetic Patients

Background: Diabetes Mellitus is a chronic metabolic disease that affects 387 million people around the world. Episodes of hyperglycemia in hospitalized diabetic patients are associated with poor clinical outcomes and increased morbidity and mortality. Therefore, prevention of hyperglycemia is critical to decrease the length of hospital stay and to reduce complications and readmissions. Objective: The study aims to examine the prevalence of hyperglycemia and assess the correlates and management of hyperglycemia in diabetic non-critically ill patients. Methods: The study was conducted on the medical wards of a tertiary care teaching hospital in Lebanon. A retrospective chart review was conducted from January 2014 until September 2015. Diabetic patients admitted to Internal Medicine floors were identified. Descriptive analysis was first carried out, followed by a multivariable analysis to study the correlates of hyperglycemia occurrence. Results: A total of 235 medical charts were reviewed. Seventy percent of participants suffered from hyperglycemia during their hospital stay. The identified significant positive correlates for inpatient hyperglycemia, were the use of insulin sliding scale alone (OR=16.438 ± 6.765-39.941, p=0.001) and the low frequency of glucose monitoring. Measuring glucose every 8 hours (OR= 3.583 ± 1.506-8.524, p=0.004) and/or every 12 hours (OR=7.647 ± 0.704-79.231, p=0.0095) was associated with hyperglycemia. The major factor perceived by nurses as a barrier to successful hyperglycemia management was the lack of knowledge about appropriate insulin use (87.5%). Conclusion: Considerable mismanagement of hyperglycemia in diabetic non-critically ill patients exists; indicating a compelling need for the development and implementation of protocol-driven insulin order forms a comprehensive education plan on the appropriate use of insulin.

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 Asthma prevalence and the impact of nutritional status on prescribed asthma medications in children

2020 ◽  
Vol 73 (9-10) ◽  
pp. 265-270
Author(s):  
Vesna Petrovic ◽  
Vesna Vujic-Aleksic ◽  
Tanja Rozek-Mitrovic ◽  
Aleksandra Hristov
Keyword(s):  
Nutritional Status ◽  
Normal Weight ◽  
Asthma Prevalence ◽  
Obese Children ◽  
Primary Health Center ◽  
Cross Sectional ◽  
Asthma Symptoms ◽  
Children With Asthma ◽  
Nutritional Status Of Children ◽  
The Impact

Introduction. Asthma and obesity are the most common chronic health disorders in children. Although heredity plays a significant role in their development, environmental factors and early exposure have contributed to the increasing incidence of both disorders in recent decades. The aim of the study was to estimate asthma prevalence in schoolchildren in Indjija, Srem District, Serbia, and to investigate differences in nutritional status of children with asthma as well as differences between their nutritional status and prescribed asthma medications. Material and Methods. A cross-sectional retrospective cohort study was conducted at the Primary Health Center in Indjija. Of all the medical records of children aged 6 - 14 years, a cohort of children with asthma was formed. The retrospective study evaluated their nutritional status and the prescribed asthma medications. Results. The prevalence of asthma in children aged 6 - 14 was 6.9%. Children with asthma were significantly more overweight and obese (40.5%) than children without asthma. Boys accounted for 63.7% of children with asthma, with a statistically significant gender difference. Abnormal nutritional status was found in 44.3% of children with asthma and boys with asthma were significantly more obese (23%) compared to girls (7.8%). Overweight and obese children with asthma were not prescribed significantly more medications to relieve asthma symptoms than normal-weight children. Conclusion. The prevalence of asthma among schoolchildren in Indjija was 6.9%. Children with asthma were more likely to be overweight and obese than children without asthma, whereas boys with asthma were significantly more obese than girls. No significant differences were found between their nutritional status and prescribed asthma medications.

Abstract MP25: Expression Of Urinary Somatic And Soluble N-domain Isoforms Of Angiotensin Converting Enzyme And Association With Different Nutritional Status And Cardiovascular Risk Profile

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Nayara A Cruz ◽  
Lilian C Oliveira ◽  
Fernanda B Fernandes ◽  
Dulce E Casarini
Keyword(s):  
Cardiovascular Risk ◽  
Nutritional Status ◽  
Angiotensin Converting Enzyme ◽  
Children And Adolescents ◽  
Risk Profile ◽  
Normal Weight ◽  
Converting Enzyme ◽  
Cardiovascular Risk Profile ◽  
Obese Children ◽  
High Cardiovascular Risk

Angiotensin converting enzyme (ACE) plays a dominant role in renal and cardiovascular diseases, obesity and diabetes. The somatic ACE (130-190 kDa) is composed of two homologous N- and C- domains. Two soluble N-domain isoforms have been described in human urine with 65 and 90KDa. Studies have supported that N-domain ACE with 90KDa is a biomarker for hypertension, pre-eclampsia and inflammation. We analyzed the expression of somatic and soluble N-domain ACE isoforms in urine of children and adolescents with different nutritional status and cardiovascular risk profile. The volunteers aged from 6 to 19 years were classified into four groups according to their BMI percentile; underweight (n=51), normal weight (n = 53), overweight (n=53) and obese (n=49). Waist-height-ratio (WHtR) was used to assess cardiovascular risk profile dividing the participants into normal risk (n=105) and high risk (n=101). The urines were concentrated 10-fold and dialyzed with Tris-HCl pH 8 and pure water. Then, we performed western blot analysis using 50μg of lyophilized urinary protein, using the ACE polyclonal antibody Y1. Protein detection was performed by chemiluminescent and analysis in Image Lab software utilizing total protein stain for normalization. ACE expression is augmented in obese children when compared with normal weight children ( 0.09 vs 0.53 arbitrary units, p=0,04 ). The higher cardiovascular risk group also presented increased expression of ACE ( 0.27 vs 0.09 arbitrary units, p=0.046 ). The 90KDa N-domain isoform is frequently found in the high cardiovascular risk children ( p= 0.02 ). According to Spearman correlation test, the expression of 90 kDa N-domain ACE correlates positively with waist circumference, WHtR, BMI percentile and Z-score of BMI. Increased ACE expression in obese children contributes to higher cardiovascular risk once this enzyme biosynthesizes Angiotensin II which promotes blood pressure increase, sympathetic nervous system activation and release of glucocorticoids from adrenal gland. ACE expression is also augmented in children with high cardiovascular risk. Presence of 90 KDa N-domain ACE in urine of children and adolescents is a biomarker of poor prognostic for cardiovascular disease in childhood obesity.

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.

scholarly journals In-line filtration of intravenous infusion may reduce organ dysfunction of adult critical patients

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Elke Schmitt ◽  
Patrick Meybohm ◽  
Eva Herrmann ◽  
Karin Ammersbach ◽  
Raphaela Endres ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Kidney Injury ◽  
Adult Patients ◽  
Brain Inflammation ◽  
Critically Ill Children ◽  
Respiratory Dysfunction ◽  
Time Period ◽  
Fine Filter

Abstract Background The potential harmful effects of particle-contaminated infusions for critically ill adult patients are yet unclear. So far, only significant improved outcome in critically ill children and new-borns was demonstrated when using in-line filters, but for adult patients, evidence is still missing. Methods This single-centre, retrospective controlled cohort study assessed the effect of in-line filtration of intravenous fluids with finer 0.2 or 1.2 μm vs 5.0 μm filters in critically ill adult patients. From a total of n = 3215 adult patients, n = 3012 patients were selected by propensity score matching (adjusting for sex, age, and surgery group) and assigned to either a fine filter cohort (with 0.2/1.2 μm filters, n = 1506, time period from February 2013 to January 2014) or a control filter cohort (with 5.0 μm filters, n = 1506, time period from April 2014 to March 2015). The cohorts were compared regarding the occurrence of severe vasoplegia, organ dysfunctions (lung, kidney, and brain), inflammation, in-hospital complications (myocardial infarction, ischemic stroke, pneumonia, and sepsis), in-hospital mortality, and length of ICU and hospital stay. Results Comparing fine filter vs control filter cohort, respiratory dysfunction (Horowitz index 206 (119–290) vs 191 (104.75–280); P = 0.04), pneumonia (11.4% vs 14.4%; P = 0.02), sepsis (9.6% vs 12.2%; P = 0.03), interleukin-6 (471.5 (258.8–1062.8) ng/l vs 540.5 (284.5–1147.5) ng/l; P = 0.01), and length of ICU (1.2 (0.6–4.9) vs 1.7 (0.8–6.9) days; P <  0.01) and hospital stay (14.0 (9.2–22.2) vs 14.8 (10.0–26.8) days; P = 0.01) were reduced. Rate of severe vasoplegia (21.0% vs 19.6%; P > 0.20) and acute kidney injury (11.8% vs 13.7%; P = 0.11) was not significantly different between the cohorts. Conclusions In-line filtration with finer 0.2 and 1.2 μm filters may be associated with less organ dysfunction and less inflammation in critically ill adult patients. Trial registration The study was registered at ClinicalTrials.gov (number: NCT02281604).

Peritoneal dialysis in critically ill children in resource-limited setting: A prospective cohort study

2020 ◽  
pp. 089686082097589
Author(s):  
Pallavi Choudhary ◽  
Virendra Kumar ◽  
Abhijeet Saha ◽  
Archana Thakur
Keyword(s):  
Mechanical Ventilation ◽  
Peritoneal Dialysis ◽  
Renal Impairment ◽  
Critically Ill ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Renal Outcome ◽  
Severe Dengue ◽  
Critically Ill Children

Background: Peritoneal dialysis (PD) is easily available and simple lifesaving procedure in children with renal impairment. There is paucity of reports on efficacy of PD in critically ill children in presence of shock and those requiring mechanical ventilation. Methods: In this prospective observational study, efficacy and outcome of PD were evaluated in 50 critically ill children aged 1 month to 14 years admitted in pediatric intensive care unit of a tertiary care teaching hospital in India. Results: Indication of PD was acute kidney injury (AKI) in 66% of patients followed by chronic kidney disease with acute deterioration due to infectious complications in 34%. Bacterial sepsis was the most common cause of AKI (22%), others being malaria (14%) and severe dengue (12%). At initiation of PD, 26% of patients were in shock and 46% were mechanically ventilated. PD was effective and improvement in pH, bicarbonate, and lactate started within hours, with consistent improvement in estimated glomerular filtration rate by 24 h, which continued till the end of procedure, including the subgroup of patients with shock and mechanical ventilation. Total complications were seen in 14% and of which peritonitis was present in 4.0% of patients. Mortality was seen in 14% (7/50) of patients. Shock at initiation of PD (odds ratio (OR), 5.03; 95% confidence interval (CI), 0.95–26.69; p < 0.04) and requirement of mechanical ventilation (OR, 9.17; 95% CI, 1.01–83.10; p < 0.02) were associated with mortality. Conclusions: Acute PD in critically ill children with renal impairment is a lifesaving procedure. Treatment of shock with resuscitative measures and respiratory failure with mechanical ventilation, along with PD, resulted in favorable renal outcome.

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.

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