Hypomagnesemia as a predictor of mortality in critically ill pediatric patients in picu using prism score

Background: Magnesium is the fourth most abundant cation in the human body and the second most abundant intracellular cation after potassium. A potential relationship between low magnesium levels and increased mortality has been suggested in the literature. The objectives were to detect prevalence of hypomagnesemia in critically ill children, its association with sepsis and to correlate this with mortality.Methods: This study was an observational study done on 100 children who met the inclusion criteria, admitted to the PICU of Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India. Patients under the study were managed and treated according to their clinical status and supportive traditional treatment.Results: Prevalence of hypomagnesemia in critically ill pediatric patients was 53%. In this study, majority of the cases admitted to PICU were dengue (19%) and bronchopneumonia (15%) which were significantly associated with hypomagnesemia as p value was less than 0.05. As regard prognosis, Mg had an AUC of 0.576 for prediction of mortality whereas the AUC for PRISM score was 0.811. Logistic regression analysis showed that hypomagnesemia is a significant predictor for mortality among critically ill children (p value=0.028) and OR=3.180 (0.854-7.965).Conclusions: Present study has found high prevalence of hypomagnesemia in critically ill patients. Hypomagnesemia was associated with a higher mortality rate in critically ill patients and commonly associated with infections and respiratory diseases. Hypomagnesemia indicated poor outcome and higher mortality rates in critically ill patients.

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Hypoalbuminemia as a Predictor of Adverse Outcome in Critically Ill Children: A Prospective Cohort Study

10.21203/rs.3.rs-430440/v1 ◽

2021 ◽

Author(s):

Abeer Yehia El-shamy ◽

Ahmed Anwar Khattab ◽

Alyaa Ahdy Adbel-Aziz

Keyword(s):

Cohort Study ◽

High Risk ◽

Critically Ill ◽

Prospective Cohort ◽

Poor Prognosis ◽

Pediatric Patients ◽

Albumin Level ◽

Critically Ill Children ◽

P Value ◽

Risk Of Mortality

Abstract Background hypoalbuminemia is a common finding in critically ill patients associated with a high risk of mortality, but there is lack of data on its role in pediatric patients. The aim of this study is to investigate the effect of low albumin levels in pediatric patients on poor prognosis and high risk of mortality in the pediatric intensive care unit (PICU). Methods This was a prospective cohort study conducted at the PICU at El-Bagour hospital from November 2018 to November 2020. The aim was to evaluate low albumin level as a predictor of poor prognosis and clinical outcome in 150 critically ill children aged one month up to 18 years. ROC curve was used to assess the discriminatory ability of scoring systems for patients’ mortality. Results 148 patients were included in the final analysis where the incidence of hypoalbuminemia in the 1st 48-h postadmission was 44.6% with an overall mean serum albumin level of 3.34 ± 0.78. Hypoalbuminemia was an independent factor of mortality prediction. Moreover, we found children with hypoalbuminemia had higher mortality rate (p-value < 0.001), higher PICU stays (p-value = 0.016), lower galscow coma score (GSC) (p-value = 0.0017), and more need of mechanical ventilation (p-value < 0.001). Conclusion hypoalbuminemia may be used as a significant predictor of mortality and risk assessment in critically ill children.

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Epidemiology of Blood Culture Utilization in a Cohort of Critically Ill Children

Journal of Pediatric Intensive Care ◽

10.1055/s-0038-1676993 ◽

2019 ◽

Vol 08 (03) ◽

pp. 144-147

Author(s):

Christine Anh-Thu Tran ◽

Jenna Verena Zschaebitz ◽

Michael Campbell Spaeder

Keyword(s):

Decision Making ◽

Blood Culture ◽

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Critically Ill ◽

Clinical Status ◽

Blood Cultures ◽

Systemic Inflammatory Response ◽

Critically Ill Children ◽

Culture Acquisition

AbstractBlood culture acquisition is integral in the assessment of patients with sepsis, though there exists a lack of clarity relating to clinical states that warrant acquisition. We investigated the clinical status of critically ill children in the timeframe proximate to acquisition of blood cultures. The associated rates of systemic inflammatory response syndrome (72%) and sepsis (57%) with blood culture acquisition were relatively low suggesting a potential overutilization of blood cultures. Efforts are needed to improve decision making at the time that acquisition of blood cultures is under consideration and promote percutaneous blood draws over indwelling lines.

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Pediatric Multi-Organ Dysfunction Syndrome: Analysis by an Untargeted “Shotgun” Lipidomic Approach Reveals Low-Abundance Plasma Phospholipids and Dynamic Recovery over 8-Day Period, a Single-Center Observational Study

Nutrients ◽

10.3390/nu13030774 ◽

2021 ◽

Vol 13 (3) ◽

pp. 774

Author(s):

Mara L. Leimanis-Laurens ◽

Karen Ferguson ◽

Emily Wolfrum ◽

Brian Boville ◽

Dominic Sanfilippo ◽

...

Keyword(s):

Mass Spectrometry ◽

Intensive Care ◽

Critically Ill ◽

Organ Dysfunction ◽

Lipid Profiles ◽

Critically Ill Children ◽

P Value ◽

Time Points ◽

Logistic Organ Dysfunction ◽

Multi Organ Dysfunction Syndrome

Lipids are molecules involved in metabolism and inflammation. This study investigates the plasma lipidome for markers of severity and nutritional status in critically ill children. Children with multi-organ dysfunction syndrome (MODS) (n = 24) are analyzed at three time-points and cross-referenced to sedation controls (n = 4) for a total of N = 28. Eight of the patients with MODS, needed veno-arterial extracorporeal membrane oxygenation (VA ECMO) support to survive. Blood plasma lipid profiles are quantified by nano-electrospray (nESI), direct infusion high resolution/accurate mass spectrometry (MS), and tandem mass spectrometry (MS/MS), and compared to nutritional profiles and pediatric logistic organ dysfunction (PELOD) scores. Our results show that PELOD scores were not significantly different between MODS and ECMO cases across time-points (p = 0.66). Lipid profiling provides stratification between sedation controls and all MODS patients for total lysophosphatidylserine (lysoPS) (p-value = 0.004), total phosphatidylserine (PS) (p-value = 0.015), and total ether-linked phosphatidylethanolamine (ether-PE) (p-value = 0.03) after adjusting for sex and age. Nutrition intake over time did not correlate with changes in lipid profiles, as measured by caloric and protein intake. Lipid measurement in the intensive care environment shows dynamic changes over an 8-day pediatric intensive care unit (PICU) course, suggesting novel metabolic indicators for defining critically ill children.

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Pediatric Diabetic Ketoacidosis and Hypoglycemia

10.2310/em.4413 ◽

2020 ◽

Author(s):

Rachel J Williams ◽

Samantha L. Wood

Keyword(s):

Emergency Department ◽

Key Words ◽

Diabetic Ketoacidosis ◽

Critically Ill ◽

Cerebral Edema ◽

Critically Ill Patients ◽

Pediatric Patients ◽

Serum Glucose ◽

Neurologic Function ◽

Threat To Life

Abnormalities of serum glucose in pediatric patients are commonly encountered in the emergency department and represent an acute threat to life and neurologic function. Rapidly identifying and aggressively treating hyperglycemia with diabetic ketoacidosis and hypoglycemia are critical to ensure the best possible outcome. This review will guide the emergency provider in the identification, resuscitation, workup, and disposition of these critically ill patients. This review contains 6 figures, 13 tables, and 50 reviews. Key Words: Cerebral edema, diabetic ketoacidosis, hyperglycemia, hypoglycemia

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ASSOCIATION OF ACID-BASE PARAMETERS WITH LACTATE LEVEL IN CRITICALLY ILL PATIENTS WITH METABOLIC ACIDOSIS

INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY ◽

10.24293/ijcpml.v24i2.1313 ◽

2018 ◽

Vol 24 (2) ◽

pp. 141

Author(s):

Donaliazarti Donaliazarti ◽

Rismawati Yaswir ◽

Hanifah Maani ◽

Efrida Efrida

Keyword(s):

Metabolic Acidosis ◽

Critically Ill ◽

Critically Ill Patients ◽

Lactate Level ◽

Linear Regression Analysis ◽

P Value ◽

Acid Base Balance ◽

Acid Base ◽

Base Parameters ◽

Base Balance

Metabolic acidosis is prevalent among critically ill patients and the common cause of metabolic acidosis in ICU is lactic acidosis. However, not all ICUs can provide lactate measurement. The traditional method that uses Henderson-Hasselbach equation (completed with BE and AG) and alternative method consisting of Stewart and its modification (BDEgap and SIG), are acid-base balance parameters commonly used by clinicians to determine metabolic acidosis in critically ill patients. The objective of this study was to discover the association between acid-base parameters (BE, AGobserved, AGcalculated, SIG, BDEgap) with lactate level in critically ill patients with metabolic acidosis. This was an analytical study with a cross-sectional design. Eighty-four critically ill patients hospitalized in the ICU department Dr. M. Djamil Padang Hospital were recruited in this study from January to September 2016. Blood gas analysis and lactate measurement were performed by potentiometric and amperometric method while electrolytes and albumin measurement were done by ISE and colorimetric method (BCG). Linear regression analysis was used to evaluate the association between acid-base parameters with lactate level based on p-value less than 0.05. Fourty five (54%) were females and thirty-nine (46%) were males with participant’s ages ranged from 18 to 81 years old. Postoperative was the most reason for ICU admission (88%). Linear regression analysis showed that p-value for BE, AGobserved, AGcalculated, SIG and BDEgap were 119; 0.967; 0.001; 0.001; 0.689, respectively. Acid-base balance parameters which were mostly associated with lactate level in critically ill patients with metabolic acidosis were AGcalculated and SIG.

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Early Versus Late Use of Dexamethasone in Critically Ill Patients With COVID-19: A Multicenter, Prospective Cohort Study

10.21203/rs.3.rs-349677/v1 ◽

2021 ◽

Author(s):

Khalid Al Sulaiman ◽

Alaa Alhubaishi ◽

Ohoud Al Juhani ◽

Khalid Eljaaly ◽

Omar Al Harbi ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Early Initiation ◽

P Value ◽

Icu Mortality ◽

Icu Admission ◽

Icu Length Of Stay ◽

Beta Coefficient ◽

Multicenter Prospective Cohort Study

Abstract Background: Corticosteroids, especially dexamethasone, showed a survival benefit in critically ill COVID 19 patients. However, it is unclear whether the timing of dexamethasone initiation is associated with positive outcomes. The aim of this study is to evaluate the timing of dexamethasone initiation and 30-day ICU mortality in critically ill patients with COVID19. Methods: A multicenter, non-interventional, prospective study for all adult COVID19 admitted to intensive care units (ICUs) who received systemic dexamethasone between March 01 to December 31, 2020. Patients were divided into two groups based on the timing for dexamethasone initiation (early vs. late). Early use defined as the initiation of dexamethasone within three days of ICU admission. Multivariate logistic and generalized linear regression were used. We considered a P value of < 0.05 statistically significant. Results: A total of 475 patients were included in the study; dexamethasone was initiated early within three days of ICU admission in 433 patients. Early initiation of dexamethasone was associated with lower 30-day ICU mortality (OR [95%CI]: 0.43 [0.23, 0.81], p-value = 0.01), and acute kidney injury during ICU stay, (OR [95%CI]: 0.45 [0.21, 0.94], p-value = 0.03). Additionally, among survivors, early initiation was associated with shorter MV duration (beta coefficient [95% CI]: -0.94 [-1.477, -0.395], p-value = 0.0001), ICU length of stay (LOS) (beta coefficient [95%CI]: -0.73 [-0.9971, -0.469], p-value = 0.0001), and hospital LOS (beta coefficient [95%CI]: -0.68 [-0.913, -0.452], p-value = 0.0001). Conclusion: Early initiation of dexamethasone within three days of ICU admission in COVID-19 critically ill patients was associated with a mortality benefit. Additionally, it was associated with shorter MV duration, hospital, and ICU LOS.

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Effect of Permissive Underfeeding with Intensive Insulin Therapy on MCP-1, sICAM-1, and TF in Critically Ill Patients

Nutrients ◽

10.3390/nu11050987 ◽

2019 ◽

Vol 11 (5) ◽

pp. 987

Author(s):

Ahmad Aljada ◽

Ghada Fahad AlGwaiz ◽

Demah AlAyadhi ◽

Emad Masuadi ◽

Mahmoud Zahra ◽

...

Keyword(s):

Insulin Therapy ◽

Critically Ill ◽

Intensive Insulin Therapy ◽

Inflammatory Mediators ◽

Critically Ill Patients ◽

Caloric Intake ◽

Intercellular Adhesion Molecule ◽

P Value ◽

Permissive Underfeeding ◽

Significant Difference

Purpose: This study examined the effect of permissive underfeeding compared to target feeding and intensive insulin therapy (IIT) compared to conventional insulin therapy (CIT) on the inflammatory mediators monocyte chemoattractant protein 1 (MCP-1), soluble intercellular adhesion molecule 1 (sICAM-1), and tissue factor (TF) in critically ill patients. Methodology: This was a substudy of a 2 × 2 factorial design randomized controlled trial in which intensive care unit (ICU) patients were randomized into permissive underfeeding compared to target feeding groups and into IIT compared to CIT groups (ISRCTN96294863). In this substudy, we included 91 patients with almost equal numbers across randomization groups. Blood samples were collected at baseline and at days 3, 5, and 7 of an ICU stay. Linear mixed models were used to assess the differences in MCP-1, sICAM-1, and TF across randomization groups over time. Results: Baseline characteristics were balanced across randomization groups. Daily caloric intake was significantly higher in the target feeding than in the permissive underfeeding groups (P-value < 0.01), and the daily insulin dose was significantly higher in the IIT than in the CIT groups (P-value < 0.01). MCP-1, sICAM-1, and TF did not show any significant difference between the randomization groups, while there was a time effect for MCP-1. Baseline sequential organ failure assessment (SOFA) score and platelets had a significant effect on sICAM-1 (P-value < 0.01). For TF, there was a significant association with age (P-value < 0.01). Conclusions: Although it has been previously demonstrated that insulin inhibits MCP-1, sICAM-1 in critically ill patients, and TF in non-critically ill patients, our study demonstrated that IIT in critically ill patients did not affect these inflammatory mediators. Similarly, caloric intake had a negligible effect on the inflammatory mediators studied.

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An Alternative Approach to Treatment of Hypophosphatemia in Nonsurgical Critically Ill Patients in Countries With Limited Resources

Dose-Response ◽

10.1177/1559325819850421 ◽

2019 ◽

Vol 17 (2) ◽

pp. 155932581985042

Author(s):

Tijana Kovačević ◽

Peđja Kovačević ◽

Boris Tomić ◽

Saša Dragić ◽

Danica Momčičević

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Phosphate Buffer ◽

Dose Range ◽

Clinical Status ◽

Serum Phosphate ◽

Serum Phosphate Level ◽

Alternative Approach ◽

Medical Intensive Care ◽

A Prospective Study

Background: Hypophosphatemia can complicate and prolong the treatment of critically ill patients, and it is even thought to be related to mortality rate. Objectives: The aim of this study is to determine whether using extemporary prepared phosphate buffer in pharmacy would help correct serum phosphate in critically ill patients. Methods: A prospective study was conducted at the medical intensive care unit over a period of 1 year and included 50 patients who were diagnosed with hypophosphatemia. Phosphate buffer was prepared at the pharmacy, and the dose range was recommended by a clinical pharmacist. Results: Patients were administered phosphate buffer via the nasogastric tube, and the doses chosen by the physicians depended on serum phosphate level and the severity of the patients’ clinical status. Serum phosphate levels were successfully corrected in all treated patients. The most frequently used dose was 60 mmoL/d, and in most patients 1-day therapy was sufficient. No adverse effects were observed. Conclusion: The phosphate buffer is an adequate alternative for the treatment of hypophosphatemia of nonsurgically critically ill patients. One-day therapy with the 60 mmoL phosphate dose divided into 3 single doses resulted in normalization of serum phosphate values in most patients.

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Dialysis Therapies in Critically Ill Children

AACN Advanced Critical Care ◽

10.4037/15597768-1992-3007 ◽

1992 ◽

Vol 3 (3) ◽

pp. 605-613

Author(s):

Will Hendrix

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Critically Ill ◽

Pediatric Patients ◽

Treatment Options ◽

Critically Ill Children ◽

Small Children ◽

Care Nurse ◽

Renal Replacement Therapies ◽

In Infants And Children

Technologic advances provide renal replacement therapies to critically ill pediatric patients. Having multiplied rapidly, the options for intervention and treatment of acute renal failure in infants and small children are numerous. Thus, the need for the dialysis nurse and the critical care nurse to maintain, expand, and develop a new baseline of knowledge is a constant challenge. This article explores the management and treatment options for acute renal failure in infants and children

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