scholarly journals LESS IS MORE? – A PILOT RCT OF FLUID STRATEGY IN CRITICALLY ILL CHILDREN WITH ACUTE RESPIRATORY TRACT INFECTION

2018 ◽  
Author(s):  
Sarah A. Ingelse ◽  
Vincent G. Geukers ◽  
Monique E. Dijsselhof ◽  
Joris Lemson ◽  
Reinout A. Bem ◽  
...  
Keyword(s):  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Critically Ill ◽  
Fluid Intake ◽  
Fluid Overload ◽  
Acute Respiratory Tract Infection ◽  
Critically Ill Children ◽  
Conservative Group ◽  
Pilot Rct

Abstract Background: Fluid overload is common in critically ill children and is associated with adverse outcome. Therefore, restricting fluid intake may be beneficial. This study aims to pilot the feasibility of a RCT comparing a conservative to a standard, more liberal, strategy of fluid management in mechanically ventilated (MV) pediatric patients with acute respiratory tract infection (ARTI). Methods: This is a pilot RCT and feasibility study in a single, tertiary referral pediatic intensive care unit. Twenty-three children receiving MV for ARTI, without ongoing hemodynamic support, admitted to the PICU of the Emma Children’s Hospital/Amsterdam UMC between 2016-2018 were included. Patients were randomized to a conservative (<70% of normal intake) or standard (>85% of normal intake) fluid strategy, which was kept throughout the period of MV. Results: Primary endpoints were adherence to fluid strategy and safety parameters such as calorie and protein intake. Secondary outcomes were cumulative fluid intake (CFI) and cumulative fluid balance (CFB) on day 3. In the conservative group, in 75% of the MV days patients reached their target fluid intake. Median calorie intake over all MV days was 67.8 [53.1-75.2] kcal/kg/day and 1.6 [1.3-1.7] gr protein/kg/day (no difference between groups). No adverse effects on hemodynamics or electrolyte imbalances were noted. Mean CFI on day 3 was 262.3 (±58.9) ml/kg in the conservative group vs. 360.5 (±52.6) ml/kg in the standard fluid group (p<0.001), which did not result in a lower CFB. Conclusions: A conservative fluid strategy in MV children with ARTI seems feasible, without limiting metabolic needs. However, in our study a conservative fluid strategy surprisingly did not reduce the degree of fluid overload. This pilot study aids the design and sample size calculation of a future larger multicenter RCT, in which we need to redefine the target fluid strategy, possibly by even further fluid restriction and early initiation of active diuresis. Trial registration: ClinicalTrials.gov, NCT02989051. Registered 12 December 2016 - Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/NCT02989051

scholarly journals Less Is More? – a Feasibility Study of Fluid Strategy in Critically Ill Children With Acute Respiratory Tract Infection

2019 ◽  
Author(s):  
Sarah Anne Ingelse ◽  
Vincent G. Geukers ◽  
Monique E. Dijsselhof ◽  
Joris Lemson ◽  
Reinout A. Bem ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Tract Infection ◽  
Protein Intake ◽  
Fluid Intake ◽  
Fluid Overload ◽  
Acute Respiratory Tract Infection ◽  
Critically Ill Children ◽  
Standard Group ◽  
Mechanically Ventilated ◽  
Conservative Group

Abstract Background: Fluid overload is common in critically ill children and is associated with adverse outcome. Therefore, restricting fluid intake may be beneficial. This study aims to study the feasibility of a randomized controlled trial (RCT) comparing a conservative to a standard, more liberal, strategy of fluid management in mechanically ventilated pediatric patients with acute respiratory tract infection (ARTI). Methods: This is a feasibility study in a single, tertiary referral pediatic intensive care unit (PICU). Twenty-three children receiving mechanical ventilation for ARTI, without ongoing hemodynamic support, admitted to the PICU of the Emma Children’s Hospital/Amsterdam UMC between 2016-2018 were included. Patients were randomized to a conservative (<70% of normal intake) or standard (>85% of normal intake) fluid strategy, which was kept throughout the period of mechanical ventilation. Results: Primary endpoints were adherence to fluid strategy and safety parameters such as calorie and protein intake. Secondary outcomes were cumulative fluid intake (CFI) and cumulative fluid balance (CFB) on day 3. In the conservative group, in 75% of the mechanical ventilation days patients achieved their target fluid intake. Median [25th-75th percentiles] calorie intake over all mechanical ventilation days was 67.9 [51.5-74.0] kcal/kg/day in the conservative versus 67.2 [58.0-75.2] kcal/kg/day in the standard group (p=0.878). Protein intake was 1.6 [1.3-1.8] gr protein/kg in the conservative and 1.5 [1.2-1.7] gr protein/kg in the standard group (p=0.598). No adverse effects on hemodynamics or electrolyte imbalances were noted. Mean CFI on day 3 was 262.3 (sd±58.9) ml/kg in the conservative group vs. 360.5 (sd±52.6) ml/kg in the standard fluid group (p<0.001), which did not result in a lower CFB. Conclusions: A conservative fluid strategy in mechanically ventilated children with ARTI seems feasible, without limiting metabolic needs. However, in our study a conservative fluid strategy surprisingly did not reduce the degree of fluid overload. This study aids the design and sample size calculation of a future larger multicenter RCT, in which we need to redefine the target fluid strategy, possibly by even further fluid restriction and early initiation of active diuresis.

Effect of vitamin A supplementation on diarrhoea and acute respiratory tract infection in children

1994 ◽  
Vol 10 (1) ◽  
pp. 57-61 ◽  
Author(s):  
R. Biswas ◽  
A. B. Biswas ◽  
B. Manna ◽  
S. K. Bhattacharya ◽  
R. Dey ◽  
...  
Keyword(s):  
Tract Infection ◽  
Vitamin A ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Acute Respiratory Tract Infection ◽  
Vitamin A Supplementation

scholarly journals Respiratory syncytial virus genotypes NA1, ON1, and BA9 are prevalent in Thailand, 2012–2015

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e3970 ◽  
Author(s):  
Ilada Thongpan ◽  
John Mauleekoonphairoj ◽  
Preeyaporn Vichiwattana ◽  
Sumeth Korkong ◽  
Rujipat Wasitthankasem ◽  
...  
Keyword(s):  
Respiratory Syncytial Virus ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Acute Respiratory Tract Infection ◽  
Glycosylation Site ◽  
Predicted Amino Acid Sequence ◽  
Glycoprotein Gene ◽  
Virus Genotypes ◽  
Syncytial Virus

Respiratory syncytial virus (RSV) causes acute lower respiratory tract infection in infants and young children worldwide. To investigate the RSV burden in Thailand over four consecutive years (January 2012 to December 2015), we screened 3,306 samples obtained from children ≤5 years old with acute respiratory tract infection using semi-nested reverse-transcription polymerase chain reaction (RT-PCR). In all, 8.4% (277/3,306) of the specimens tested positive for RSV, most of which appeared in the rainy months of July to November. We then genotyped RSV by sequencing the G glycoprotein gene and performed phylogenetic analysis to determine the RSV antigenic subgroup. The majority (57.4%, 159/277) of the RSV belonged to subgroup A (RSV-A), of which NA1 genotype was the most common in 2012 while ON1 genotype became prevalent the following year. Among samples tested positive for RSV-B subgroup B (RSV-B) (42.6%, 118/277), most were genotype BA9 (92.6%, 87/94) with some BA10 and BA-C. Predicted amino acid sequence from the partial G region showed highly conserved N-linked glycosylation site at residue N237 among all RSV-A ON1 strains (68/68), and at residues N296 (86/87) and N310 (87/87) among RSV-B BA9 strains. Positive selection of key residues combined with notable sequence variations on the G gene contributed to the continued circulation of this rapidly evolving virus.

scholarly journals A study on association between respiratory tract infection and serum 25 (OH) vitamin D level in children

2020 ◽  
Vol 7 (11) ◽  
pp. 2198
Author(s):  
Rajesh Kumar Sah ◽  
Hemant Kumar
Keyword(s):  
Vitamin D ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Serum Vitamin ◽  
Acute Respiratory Tract Infection ◽  
Control Group ◽  
Medical College ◽  
Serum Vitamin D ◽  
25 Oh Vitamin D

Background: Acute respiratory tract infection are a major cause of global morbidity and mortality. Observational studies report consistent independent association between low serum concentration of 25-hydroxy-vitamin D and susceptibility to acute respiratory tract infection. This study was done to assess serum vitamin D level in children and correlation with respiratory tract infection.Methods: The present study was undertaken in department of paediatrics medicine, Patna Medical College and Hospital in patients attending out-patients department (OPD) as well as admitted in in-patients department (IPD). Assessment of serum 25(OH) Vitamin D was done by the enzyme immunoassay kit at Patna Medical College and Hospital.Results: The mean serum vitamin D level in cases was (20.52±5.64 ng/ml) where as in control group was (26.46±4.52 ng/ml) with a statically significant p value of <0.0001, hence cases are associated with vitamin D deficiency.Conclusions: The finding in this study showed significantly decreased mean serum vitamin D level in cases than that of control which implies that vitamin D deficiency predisposes to respiratory tract infection in children.

Human respiratory syncytial virus load normalized by cell quantification as predictor of acute respiratory tract infection

2018 ◽  
Vol 90 (5) ◽  
pp. 861-866 ◽  
Author(s):  
Miriam Gómez‐Novo ◽  
José A. Boga ◽  
Marta E. Álvarez‐Argüelles ◽  
Susana Rojo‐Alba ◽  
Ana Fernández ◽  
...  
Keyword(s):  
Respiratory Syncytial Virus ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Acute Respiratory Tract Infection ◽  
Human Respiratory Syncytial Virus ◽  
Virus Load ◽  
Cell Quantification ◽  
Syncytial Virus
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