scholarly journals A prospective observational study on critically ill children with diaphragmatic dysfunction: clinical outcomes and risk factors

2020 ◽  
Author(s):  
Yang Xue ◽  
Chun-Feng Yang ◽  
Yu Ao ◽  
Ji Qi ◽  
Fei-Yong Jia
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Treatment Time ◽  
Negative Impact ◽  
Extubation Failure ◽  
Critically Ill Children ◽  
Diaphragmatic Dysfunction ◽  
Factors Associated

Abstract Background Diaphragmatic dysfunction (DD) has a great negative impact on clinical outcomes, and it is a well-recognized complication in adult patients with critical illness. However, DD is largely unexplored in the critically ill pediatric population. The aim of this study was to identify risk factors associated with DD, and to investigate the effects of DD on clinical outcomes among critically ill children. Methods Diaphragmatic function was assessed by diaphragm ultrasound. According to the result of diaphragmatic ultrasound, all enrolled subjects were categorized into the DD group (n=24) and the non-DD group (n=46). Collection of sample characteristics in both groups include age, sex, height, weight, primary diagnosis, complications, laboratory findings, medications, ventilatory time and clinical outcomes. Results The incidence of DD in this PICU was 34.3%. The level of CRP at discharge (P=0.003) in the DD group was higher than the non-DD group, and duration of elevated C-reactive protein (CRP) (P<0.001), sedative days (P=0.008) and ventilatory treatment time (P<0.001) in the DD group was significantly longer than the non-DD group. Ventilatory treatment time and duration of elevated CRP were independently risk factors associated with DD. Patients in the DD group had longer PICU length of stay, higher rate of weaning or extubation failure and higher mortality. Conclusion DD is associated with poorer clinical outcomes in critically ill childern, which include a longer PICU length of stay, higher rate of weaning or extubation failure and a higher mortality. The ventilatory treatment time and duration of elevated CRP are main risk factors of DD in critically ill children.

scholarly journals Clinical outcomes and risk factors in critically ill children with diaphragmatic dysfunction: an prospective observational study

2020 ◽  
Author(s):  
Yang Xue ◽  
Chun-Feng Yang ◽  
Yu Ao ◽  
Ji Qi ◽  
Fei-Yong Jia
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Treatment Time ◽  
Negative Impact ◽  
Extubation Failure ◽  
Critically Ill Children ◽  
Diaphragmatic Dysfunction ◽  
Factors Associated

Abstract Background: Diaphragmatic dysfunction (DD) has a great negative impact on clinical outcomes, and it is a well-recognized complication in adult patients with critical illness. However, DD is largely unexplored in the critically ill pediatric population. The aim of this study was to identify risk factors associated with DD, and to investigate the effects of DD on clinical outcomes among critically ill children.Methods: Diaphragmatic function was assessed by diaphragm ultrasound. According to the result of diaphragmatic ultrasound, all enrolled subjects were categorized into the DD group ( n=24 ) and the non-DD group ( n=46 ). Collection of sample characteristics in both groups include age, sex, height, weight, primary diagnosis, complications, laboratory findings, medications, ventilatory time and clinical outcomes.Results: The incidence of DD in this PICU was 34.3%. The level of CRP at discharge (P=0.003) in the DD group was higher than the non-DD group, and duration of elevated C-reactive protein (CRP) (P<0.001), sedative days (P=0.008) and ventilatory treatment time (P<0.001) in the DD group was significantly longer than the non-DD group. Ventilatory treatment time and duration of elevated CRP were independently risk factors associated with DD. Patients in the DD group had longer PICU length of stay, higher rate of weaning or extubation failure and higher mortality. Conclusion: DD is associated with poorer clinical outcomes in critically ill childern, which include a longer PICU length of stay, higher rate of weaning or extubation failure and a higher mortality. The ventilatory treatment time and duration of elevated CRP are main risk factors of DD in critically ill children.

Clinical Features and Risk Factors Associated with Mortality in Critically ill Children Requiring Continuous Renal Replacement Therapy

2020 ◽  
Author(s):  
Muhterem Duyu ◽  
Ceren Turkozkan
Keyword(s):  
Risk Factors ◽  
Respiratory Failure ◽  
Renal Replacement Therapy ◽  
Renal Disease ◽  
Continuous Renal Replacement Therapy ◽  
Critically Ill ◽  
Odds Ratio ◽  
Critically Ill Children ◽  
Factors Associated ◽  
High Lactate

Abstract Background: The aims of this study were to describe the epidemiology and demographic characteristics of critically ill children requiring continuous renal replacement therapy (CRRT) at our pediatric intensive care unit (PICU) and to explore risk factors associated with mortality. Methods: A retrospective cohort of 121 critically ill children who received CRRT from May 2015 to May 2020 in the PICU of a tertiary healthcare institution was evalauted. The demographic information, admission diagnosis, indication for CRRT, clinical variables at the initiation of CRRT, time related variables and the laboratory results at initiation of CRRT were compared between survivors and non-survivors.Results: The most common diagnoses were renal disease (30.6%), hemato-oncological disease (12.4%), and sepsis (11.6%). The overall mortality was 29.8%. When compared according to diagnosis at admission, we found that patients with hemato-oncologic disease (73.3%) and those with pneumonia/respiratory failure (72.7%) had the highest mortality, while patients with renal disease had the lowest mortality (5.4%). The most common CRRT indications were: electrolyte or acid base imbalance (38.8%), acute kidney injury (29.8%) and fluid overload (14.9%). There was no relationship between mortality and indication for CRRT. The time interval between PICU admission and CRRT initiation was also unassociated with mortality (p=0.146). In patients diagnosed with sepsis, time until the initiation of CRRT was significantly shorter in survivors compared to non-survivors (p=0.004). Based on multivariate logistic regression, presence of comorbidity (odds ratio: 5.71; %95 CI: 1.16-27.97), being diagnosed with pneumonia/respiratory failure at admission (odds ratio: 16.16; %95 CI: 1.56-167.01), and high lactate level at the initiation of CRRT (odds ratio: 1.43; %95 CI: 1.17-1.79) were independently associated with mortality.Conclusions: In the context of the population studied mortality rate was lower than previously reported. In critically ill children requiring CRRT, mortality seems to be related to underlying disease, presence of comorbidity, and high lactate levels at CRRT initiation. We also found that early initiation of CRRT in sepsis can reduce mortality.

PP272-SUN: Risk Factors Associated With Underfeeding in Critically Ill Children

2014 ◽  
Vol 33 ◽  
pp. S121
Author(s):  
U.G. Kyle ◽  
J.C. Silva ◽  
L.A. Lucas ◽  
G. Dardon ◽  
N. Maldonado ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Critically Ill Children ◽  
Factors Associated

Effect of Red Blood Cell Transfusions on Clinical Outcomes in Critically Ill Children

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3851-3851
Author(s):  
Irina B. Pateva ◽  
Steven L Shein ◽  
MaryAnn O'Riordan ◽  
Sanjay P Ahuja
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Blood Cell ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Age Groups ◽  
Critically Ill Children ◽  
Age Group ◽  
Vasoactive Agents ◽  
The Impact

Abstract Introduction: The association of packed Red Blood Cell (pRBC) transfusions with worse outcomes in critically ill adults is well documented. The impact of pRBC transfusions on clinical outcomes in critically ill children, however, has not been well studied. Associations of pRBCs with outcomes such as mortality and length of stay need to be studied in large clinical databases. This will lead to improvement of our knowledge and generation of guidelines for transfusions in children hospitalized in the Pediatric Intensive Care Units (PICU). Methods: With IRB approval, the Pediatric Health Information System (PHIS) database was queried for children ≤ 18 years admitted to the PICU, receiving pRBC transfusions between January 2011 and December 2015. The PHIS is a database that captures de-identified patient information from 45 pediatric hospitals in the US. The patients of this study were stratified by age groups: less than 1 month of age; 1 month to < 3years; 3 to <10 years; 10 to < 15 years and 15 to 18 years. Patients with underlying hematological or oncological diagnoses and who had undergone HSCT were excluded from the study. Information regarding major comorbidities such as mechanical ventilation, sepsis, use of vasoactive agents, acute kidney injury (AKI) and post-operative state were extracted. Patients who received pRBCs and who did not receive pRBCs were included in the analyses. The primary outcomes were Length of Stay (LOS) and mortality. Multiple linear and logistic regression analyses were performed to define the association between pRBC transfusions and outcomes and to control for sepsis, mechanical ventilation, vasoactive medications, post-operative state and AKI. Data are shown as median (IQR). Results: Of the 393,384 patients who met the inclusion criteria, 43,569 (11%) had transfusions, with 97.2% of the patients receiving only 1 transfusion. The median (IQR) overall length of stay was 5.0 days (2, 10) and the overall mortality was 3.1%. The median (IQR) LOS for those who received pRBCs was 13 days (6, 29) compared to 4.0 days (2, 8) for those who did not. Mortality for those who received pRBCs was 10.1% compared to 2.2% for those who did not. The highest rate of pRBC transfusion was noted in the patients less than 1 month old (22%). The highest unadjusted mortality for patients who received pRBCs was also in the same age group- 7%. The associations between transfusion of pRBCs and outcomes are summarized in Table 1. Of the 393,384 patients, 19,686 (5.0 %) had sepsis; 143,085 (36.4%) were on mechanical ventilation; 141,123 (35.9%) were on vasoactive agents and 14,243 (3.6%) had AKI. After adjusting for sepsis, mechanical ventilation, use of vasoactive agents, post-op state and AKI, pRBC transfusions were associated with significantly increased LOS for all age groups. The highest increase in LOS was noted for the infants younger than 1 month of age - by 11.6 days (p<0.001). The mortality was also increased in patients who received PRBCs, when adjusted for other comorbidites, the highest risk was for patients in the age group of 15 to 18 years old: OR 2.50 (95% CI 2.14- 2.93). Conclusions: In this large, multicenter database study, we identified an association of increased mortality and LOS in critically ill children who received pRBC transfusions. More studies are needed to further investigate the impact of blood transfusions on clinical outcomes in the pediatric population. Disclosures No relevant conflicts of interest to declare.

Risk Factors for Nosocomial Infections in a Critically Ill Pediatric Population: A 25-Month Prospective Cohort Study

2000 ◽  
Vol 21 (5) ◽  
pp. 340-342 ◽  
Author(s):  
Alfredo E. Gilio ◽  
Adalberto Stape ◽  
Crésio R. Pereira ◽  
Maria Fátima S. Cardoso ◽  
Claudia V. Silva ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Critically Ill ◽  
Nosocomial Infections ◽  
Pediatric Population ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Utilization Ratio

We studied risk factors for nosocomial infections among 500 critically ill children who were admitted to a pediatric intensive care unit from August 1994 through August 1996 and who were prospectively followed until death, transfer, or discharge. Age, gender, postoperative state, length of stay, device-utilization ratio, pediatric risk of mortality score, and total parenteral nutrition were the risk factors studied. Through multivariate analysis, we identified three independent risk factors for nosocomial infection: device-utilization ratio (odds ratio [OR], 1.6; 95% confidence interval [CI95], 1.10-2.34), total parenteral nutrition (OR, 2.5; CI95, 1.05-5.81) and length of stay (OR, 1.7; CI95, 1.31-2.21).

scholarly journals Phosphate disturbance in critically ill children: Incidence, associated risk factors and clinical outcomes

2017 ◽  
Vol 21 ◽  
pp. 118-123 ◽  
Author(s):  
Ahmed Nabih El Shazly ◽  
Doaa Refaey Soliman ◽  
Effat Hussien Assar ◽  
Eman Gamal Behiry ◽  
Ibrahim Abd El Naby Gad Ahmed
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Children ◽  
Associated Risk Factors

414: RISK FACTORS ASSOCIATED WITH MALNUTRITION IN CRITICALLY ILL CHILDREN ADMITTED TO THE PICU

2018 ◽  
Vol 46 (1) ◽  
pp. 190-190
Author(s):  
Andrea Marroquín ◽  
Karla Abela ◽  
Kyle Schmucker ◽  
Yash Desai ◽  
Tonita Fontenot ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Critically Ill Children ◽  
Factors Associated
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