Analysis of Prolonged Pediatric Intensive Care Stay in Children with Diabetic Ketoacidosis

Background: Diabetic ketoacidosis is one of most serious complication of diabetes requiring intensive care management. We aim to analyze various factors responsible for prolonged duration of stay in pediatric intensive care unit in a child with Diabetic Ketoacidosis. Materials and Methods: This was a hospital based prospective observational study conducted in Nobel Medical College and Teaching Hospital among children with Diabetic ketoacidosis over the period of one year. A total of 22 cases with Diabetic ketoacidosis aged 1 month to 18 years were included and clinical profile, laboratory reports including blood gas analysis were documented. Results: Among cases of Diabetic ketoacidosis, 4 (18%) cases were of mild Diabetic ketoacidosis, 4 cases (18%) were of moderate Diabetic ketoacidosis and 14 cases (64%) were of severe Diabetic ketoacidosis. Mean duration of Intensive care stay in new cases of Diabetic ketoacidosis was 69.46 hours which was significantly higher compared to old cases (30.66 hours) suggested by p value < 0.0001. In 15 cases (68%), acidosis resolved in less than 48-55 hours, whereas 7 cases (32%) required more than 48-55 hours for resolution of acidosis, hence required longer Intensive care stay. Cases who required prolonged Pediatric Intensive care stay, sepsis was contributing factor in 3 cases (42.85%), one case (14.28%) has associated muscular dystrophy and 3 cases (42.85%) had hyperchloremia at the end of 48 hours. Conclusion: Presence of sepsis and Hyperchloremia are important reasons for prolonged stay in Intensive Care Unit in Diabetic ketoacidosis patients. Other associated chronic illness can also prolong intensive care stay in Diabetic ketoacidosis patients.

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Validity of venous blood gas analysis for diagnosis of acid-base imbalance in children admitted to pediatric intensive care unit

World Journal of Pediatrics ◽

10.1007/s12519-008-0022-x ◽

2008 ◽

Vol 4 (2) ◽

pp. 114-117 ◽

Cited By ~ 21

Author(s):

Nemat Bilan ◽

Afshin G. Behbahan ◽

A. J. Khosroshahi

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Venous Blood ◽

Pediatric Intensive Care ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Blood Gas ◽

Acid Base ◽

Venous Blood Gas ◽

Venous Blood Gas Analysis

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Respiratory Modalities in Preventing Reintubation in a Pediatric Intensive Care Unit

Global Pediatric Health ◽

10.1177/2333794x21991531 ◽

2021 ◽

Vol 8 ◽

pp. 2333794X2199153

Author(s):

Ameer Al-Hadidi ◽

Morta Lapkus ◽

Patrick Karabon ◽

Begum Akay ◽

Paras Khandhar

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Noninvasive Positive Pressure Ventilation ◽

Pediatric Intensive Care ◽

Nasal Cannula ◽

Respiratory Support ◽

Positive Pressure ◽

P Value

Post-extubation respiratory failure requiring reintubation in a Pediatric Intensive Care Unit (PICU) results in significant morbidity. Data in the pediatric population comparing various therapeutic respiratory modalities for avoiding reintubation is lacking. Our objective was to compare therapeutic respiratory modalities following extubation from mechanical ventilation. About 491 children admitted to a single-center PICU requiring mechanical ventilation from January 2010 through December 2017 were retrospectively reviewed. Therapeutic respiratory support assisted in avoiding reintubation in the majority of patients initially extubated to room air or nasal cannula with high-flow nasal cannula (80%) or noninvasive positive pressure ventilation (100%). Patients requiring therapeutic respiratory support had longer PICU LOS (10.92 vs 6.91 days, P-value = .0357) and hospital LOS (16.43 vs 10.20 days, P-value = .0250). Therapeutic respiratory support following extubation can assist in avoiding reintubation. Those who required therapeutic respiratory support experienced a significantly longer PICU and hospital LOS. Further prospective clinical trials are warranted.

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A STUDY ON ETIOLOGY, CLINICAL FEATURES, MANAGEMENT AND OUTCOME OF ACUTE LIVER FAILURE IN PAEDIATRIC INTENSIVE CARE UNIT OF BURDWAN MEDICAL COLLEGE

10.36106/ijsr/5133342 ◽

2021 ◽

pp. 54-55

Author(s):

Sankar narayan mishra ◽

Kaustav nayek ◽

Tamal kayal ◽

Debarshi Jana

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Liver Failure ◽

Acute Liver Failure ◽

Pediatric Intensive Care Unit ◽

Clinical Features ◽

Paediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Medical College ◽

Bacterial Peritonitis

Introduction: In the present study, etiology, important clinical features, management and outcome of acute liver failure in children admitted in Pediatric Intensive Care Unit (PICU) of BURDWAN MEDICALCOLLEGE, WB are studied. Aims and objectives:To study different clinical features among those children having acute liver failure. I. To study the management and outcome of those children with acute liver failure in the Pediatric Intensive Care Unit. Material and methods: Pediatric Intensive Care Unit of BURDWAN MEDICALCOLLEGE, WB. 1 Year [December 2019 to November 2020]. Patients from 3months of age to 12years of age are eligible for enrolment if they meet the following criteria. Conclusion: Present study showed that cerebral edema was signicantly associated with mortality whereas AKI and spontaneous bacterial peritonitis were not signicantly related with mortality. Mean TSB and Prothrobin Time were higher but mean serum albumin was lower in those cases that had died.

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Be cautious during the interpretation of arterial blood gas analysis performed outside the intensive care unit

Acta Biochimica Polonica ◽

10.18388/abp.2020_5178 ◽

2020 ◽

Author(s):

Lukasz Krzych ◽

Olga Wojnarowicz ◽

Paweł Ignacy ◽

Julia Dorniak

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Point Of Care ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Blood Gas ◽

Acid Base Balance ◽

Arterial Blood Gas ◽

Arterial Blood ◽

The Impact

Introduction. Reliable results of an arterial blood gas (ABG) analysis are crucial for the implementation of appropriate diagnostics and therapy. We aimed to investigate the differences (Δ) between ABG parameters obtained from point-of-care testing (POCT) and central laboratory (CL) measurements, taking into account the turnaround time (TAT). Materials and methods. A number of 208 paired samples were collected from 54 intensive care unit (ICU) patients. Analyses were performed using Siemens RAPIDPoint 500 Blood Gas System on the samples just after blood retrieval at the ICU and after delivery to the CL. Results. The median TAT was 56 minutes (IQR 39-74). Differences were found for all ABG parameters. Median Δs for acid-base balance ere: ΔpH=0.006 (IQR –0.0070–0.0195), ΔBEef=–0.9 (IQR –2.0–0.4) and HCO3–act=–1.05 (IQR –2.25–0.35). For ventilatory parameters they were: ΔpO2=–8.3 mmHg (IQR –20.9–0.8) and ΔpCO2=–2.2 mmHg (IQR –4.2––0.4). For electrolytes balance the differences were: ΔNa+=1.55 mM/L (IQR 0.10–2.85), ΔK+=–0.120 mM/L (IQR –0.295–0.135) and ΔCl–=1.0 mM/L (IQR –1.0–3.0). Although the Δs might have caused misdiagnosis in 51 samples, Bland-Altman analysis revealed that only for pO2 the difference was of clinical significance (mean: –10.1 mmHg, ±1.96SD –58.5; +38.3). There was an important correlation between TAT and ΔpH (R=0.45, p<0.01) with the safest time delay for proper assessment being less than 39 minutes. Conclusions. Differences between POCT and CL results in ABG analysis may be clinically important and cause misdiagnosis, especially for pO2. POCT should be advised for ABG analysis due to the impact of TAT, which seems to be the most important for the analysis of pH.

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Predictors of mortality in children with acute kidney injury in intensive care unit

Paediatrica Indonesiana ◽

10.14238/pi59.2.2019.92-7 ◽

2019 ◽

Vol 59 (2) ◽

pp. 92-7

Author(s):

Umi Rakhmawati ◽

Indah K. Murni ◽

Desy Rusmawatiningtyas

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Protective Factor ◽

Kidney Injury ◽

Pediatric Intensive Care ◽

P Value ◽

Middle Income ◽

Predictors Of Mortality ◽

Middle Income Countries

Background Acute kidney injury (AKI) can increase the morbidity and mortality in children admitted to the pediatric intensive care unit (PICU). Previous published studies have mostly been conducted in high-income countries. Evaluations of possible predictors of mortality in children with AKI in low- and middle-income countries have been limited, particularly in Indonesia. Objective To assess possible predictors of mortality in children with AKI in the PICU. Methods We conducted a retrospective cohort study at Dr. Sardjito Hospital, Yogyakarta, Indonesia. All children with AKI admitted to PICU for more than 24 hours from 2010 to 2016 were eligible and consecutively recruited into the study. Logistic regression analysis was used to identify independent predictors. Results Of the 152 children with AKI recruited, 119 died. In order to get a P value of <0.25, multivariate analysis is run to degree AKI, ventilator utilization, primary infection disease, MOF and age.Multivariate analysis showed that ventilator use, severe AKI, and infection were independently associated with mortality in children with AKI, with odds ratios (OR) of 19.2 (95%CI 6.2 to 59.7; P<0.001), 8.6 (95%CI 2.7 to 27.6; P<0.001), and 0.2 (95%CI 0.1 to 0.8; P=0.02), respectively. Conclusion The use of mechanical ventilation and the presence of severe AKI are associated with mortality in children with AKI admitted to the PICU. Interestingly, the presence of infection might be a protective factor from mortality in such patients.

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Effect of Potassium Infusions on Serum Levels in Children during Treatment of Diabetic Ketoacidosis

Journal of Pediatric Intensive Care ◽

10.1055/s-0039-1700981 ◽

2020 ◽

Vol 09 (02) ◽

pp. 113-118 ◽

Cited By ~ 1

Author(s):

Sangita Basnet ◽

Rawan Musaitif ◽

Aayush Khanal ◽

Kimberly Powell ◽

Giovanna Caprirolo ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Retrospective Study ◽

Diabetic Ketoacidosis ◽

Treatment Period ◽

Pediatric Intensive Care ◽

Serum Levels ◽

K Value ◽

Data Points ◽

Low K

AbstractA retrospective study was done to determine the effect of potassium (K+) infusions on serum levels in children admitted to the pediatric intensive care unit (PICU) with diabetic ketoacidosis (DKA). Eighty-two percent of 92 cases studied received 40 mEq/L K+ infusion over the treatment period of median 13.0 (interquartile range [IQR]: 7–18) hours. The median K+ value at the end of this period was 3.9 (IQR: 3.4–4.2) mEq/L. There were 31 data points of low K+ values (<3.5 mEq/L) and 4 high values (>5.5 mEq/L) during this treatment period. The K+ infusions of 40 mEq/L may be sufficient to normalize serum K+ when treating DKA.

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