scholarly journals Early Supplemental Parenteral Nutrition in Critically Ill Children: An Update

2019 ◽  
Vol 8 (6) ◽  
pp. 830 ◽  
Author(s):  
An Jacobs ◽  
Ines Verlinden ◽  
Ilse Vanhorebeek ◽  
Greet Van den Berghe
Keyword(s):  
Parenteral Nutrition ◽  
Critically Ill ◽  
Controlled Trial ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Optimal Dose ◽  
Adverse Outcomes ◽  
Critically Ill Children ◽  
Clinical Practices ◽  
Supplemental Parenteral Nutrition

In critically ill children admitted to pediatric intensive care units (PICUs), enteral nutrition (EN) is often delayed due to gastrointestinal dysfunction or interrupted. Since a macronutrient deficit in these patients has been associated with adverse outcomes in observational studies, supplemental parenteral nutrition (PN) in PICUs has long been widely advised to meeting nutritional requirements. However, uncertainty of timing of initiation, optimal dose and composition of PN has led to a wide variation in previous guidelines and current clinical practices. The PEPaNIC (Early versus Late Parenteral Nutrition in the Pediatric ICU) randomized controlled trial recently showed that withholding PN in the first week in PICUs reduced incidence of new infections and accelerated recovery as compared with providing supplemental PN early (within 24 hours after PICU admission), irrespective of diagnosis, severity of illness, risk of malnutrition or age. The early withholding of amino acids in particular, which are powerful suppressors of intracellular quality control by autophagy, statistically explained this outcome benefit. Importantly, two years after PICU admission, not providing supplemental PN early in PICUs did not negatively affect mortality, growth or health status, and significantly improved neurocognitive development. These findings have an important impact on the recently issued guidelines for PN administration to critically ill children. In this review, we summarize the most recent literature that provides evidence on the implications for clinical practice with regard to the use of early supplemental PN in critically ill children.

Mobilization Therapy in the Pediatric Intensive Care Unit: A Multidisciplinary Quality Improvement Initiative

2018 ◽  
Vol 27 (3) ◽  
pp. 194-203 ◽  
Author(s):  
Blair R. L. Colwell ◽  
Cydni N. Williams ◽  
Serena P. Kelly ◽  
Laura M. Ibsen
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Tertiary Care ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Improvement Project

Background Mobilization is safe and associated with improved outcomes in critically ill adults, but little is known about mobilization of critically ill children. Objective To implement a standardized mobilization therapy protocol in a pediatric intensive care unit and improve mobilization of patients. Methods A goal-directed mobilization protocol was instituted as a quality improvement project in a 20-bed cardiac and medical-surgical pediatric intensive care unit within an academic tertiary care center. The mobilization goal was based on age and severity of illness. Data on severity of illness, ordered activity limitations, baseline functioning, mobilization level, complications of mobilization, and mobilization barriers were collected. Goal mobilization was defined as a ratio of mobilization level to severity of illness of 1 or greater. Results In 9 months, 567 patient encounters were analyzed, 294 (52%) of which achieved goal mobilization. The mean ratio of mobilization level to severity of illness improved slightly but nonsignificantly. Encounters that met mobilization goals were in younger (P = .04) and more ill (P < .001) patients and were less likely to have barriers (P < .001) than encounters not meeting the goals. Complication rate was 2.5%, with no difference between groups (P = .18). No serious adverse events occurred. Conclusions A multidisciplinary, multiprofessional, goal-directed mobilization protocol achieved goal mobilization in more than 50% of patients in this pediatric intensive care unit. Undermobilized patients were older, less ill, and more likely to have mobilization barriers at the patient and provider level.

scholarly journals Post-extubation Airway Obstruction in Children: Are Steroids the Key to Prevention?

2021 ◽  
Author(s):  
Kaitlin Verdone ◽  
Christopher Watson
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Airway Obstruction ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Optimal Dose ◽  
Extubation Failure ◽  
Cost Of Care ◽  
Critically Ill Children

Reintubation in the pediatric intensive care unit (PICU) increases morbidity, mortality, and the overall cost of care. Post-extubation airway obstruction (PEAO) is a potentially predictable cause of extubation failure and may be prevented by the use of corticosteroids. Defining which patients are most at risk for the development of POAE as well as the optimal dose and timing of corticosteroids for prevention is critical. We review the current literature regarding the use of corticosteroids surrounding extubation in the PICU and discuss the implications that a clear algorithm for identification and treatment of these patients would have in the care of critically ill children.

Gastric Feeding in Critically Ill Children: A Randomized Controlled Trial

2003 ◽  
Vol 12 (5) ◽  
pp. 461-468 ◽  
Author(s):  
Desley Horn ◽  
Wendy Chaboyer
Keyword(s):  
Randomized Controlled Trial ◽  
Intensive Care ◽  
Critically Ill ◽  
Controlled Trial ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Pharmacological Agents ◽  
Feeding Groups ◽  
Randomized Controlled ◽  
Gastric Feeding

• Background Provision of enteral nutrition via the gastric route is a common nursing procedure in pediatric intensive care units. Little research, however, has focused on children’s tolerance of different types of gastric feeding regimens. • Objectives To examine the relationship between 2 gastric feeding regimens, continuous and intermittent, and children’s tolerance as measured by the number of stools and prevalences of diarrhea and vomiting. • Methods A randomized controlled trial was conducted in an Australian pediatric intensive care unit; 45 children were randomly assigned to either the continuous or the intermittent gastric feeding groups. Participants remained in the assigned feeding group for the duration of the study, and values of variables used to monitor patients’ tolerance were recorded. • Results Both feeding groups were similar with respect to Pediatric Index Mortality score, age, weight, sex, diagnosis, and use of pharmacological agents known to affect the gastrointestinal tract. Additionally, the 2 groups did not differ in study duration or the daily volume of administered enteral formula per kilogram of body weight. The number of stools per day and the prevalences of diarrhea and vomiting did not differ significantly between the 2 groups. • Discussion Continuous and intermittent gastric feeding regimens have similar outcomes with respect to the number of stools per day and the prevalence of diarrhea and vomiting in pediatric intensive care patients. Further gastric feeding studies and the development of enteral feeding guidelines for critically ill children are needed.

Performance of Pediatric Risk of Mortality Score Among Critically Ill Children With Heart Disease

2017 ◽  
Vol 8 (4) ◽  
pp. 427-434 ◽  
Author(s):  
Rebecca A. Russell ◽  
Mallikarjuna Rettiganti ◽  
Nancy Brundage ◽  
Howard E. Jeffries ◽  
Punkaj Gupta
Keyword(s):  
Cardiac Surgery ◽  
Heart Disease ◽  
Critically Ill ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Medical Patients ◽  
Entire Cohort ◽  
C Statistic ◽  
Risk Of Mortality

Objective: To evaluate the performance of the Pediatric Risk of Mortality 3 (PRISM-3) score in critically ill children with heart disease. Methods: Patients <18 years of age admitted with cardiac diagnoses (cardiac medical and cardiac surgical) to one of the participating pediatric intensive care units in the Virtual Pediatric Systems, LLC, database were included. Performance of PRISM-3 was evaluated with discrimination and calibration measures among both cardiac surgical and cardiac medical patients. Results: The study population consisted of 87,993 patients, of which 49% were cardiac medical patients (n = 43,545) and 51% were cardiac surgical patients (n = 44,448). The ability of PRISM-3 to distinguish survivors from nonsurvivors was acceptable for the entire cohort (c-statistic 0.86). However, PRISM-3 did not perform as well when stratified by varied severity of illness categories. Pediatric Risk of Mortality 3 underpredicted mortality among patients with lower severity of illness categories (quintiles 1-4) whereas it overpredicted mortality among patients with greatest severity of illness category (fifth quintile). When stratified by Society of Thoracic Surgeons–European Association for Cardiothoracic Surgery (STS-EACTS) categories, PRISM-3 overpredicted mortality among the STS-EACTS mortality categories 1, 2, and 3 and underpredicted mortality among the STS-EACTS mortality categories 4 and 5. Pediatric Risk of Mortality 3 overpredicted mortality among centers with high cardiac surgery volume whereas it underpredicted mortality among centers with low cardiac surgery volume. Conclusion: Data from this large multicenter study do not support the use of PRISM-3 in cardiac surgical or cardiac medical patients. In this study, the ability of PRISM-3 to distinguish survivors from nonsurvivors was fair at best, and the accuracy with which it predicted death was poor.

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).

SPO2/FIO2 RATIO AND TRIAGE SCORE IN PREDICTING OUTCOME OF CRITICALLY ILL CHILDREN

2021 ◽  
pp. 103-105
Author(s):  
Rohini D ◽  
Meghashree N ◽  
Mahendar Reddy M ◽  
Pranam G.M
Keyword(s):  
Critically Ill ◽  
Scoring System ◽  
Rapid Assessment ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Research Centre ◽  
Critically Ill Children ◽  
College Hospital ◽  
Non Invasive ◽  
Predicting Outcome

Introduction: Non-invasive nature of pulse oximetry allows much affordable, rapid assessment of degree of hypoxemia and helps in identication of the patients at risk. Mortality in a pediatric intensive care unit (PICU) depends on the severity of illness. A good scoring system for identifying the severity of illness can help to prioritize care. Triage is sorting out of patients, the main objective of which is early patient assessment to obviate harmful delay in the management. Aims And Objectives: To predict the outcome of critically ill children in pediatric ICU by using the Triage scoring system and Spo2/Fio2(SF) ratio. Materials And Methods: A hospital based prospective observational study done at Navodaya Medical College Hospital & Research Centre during January 2020 to June 2021 for a period of 18 months. A total of 125 children were studied. Data is described in terms of mean (+SD), frequencies (number of cases) and percentages. Statistical analysis was done using SPSS software version 26. Results: Out of 125 children studied, 8 died. Except temperature, all other variables showed signicant association with mortality (p <0.001). Mortality was 0%, 4.88%, 28.57%, 75%, 25% and 50% for scores of 0, 1, 2, 3, 4 and 5 respectively. Children of score 3 or more had signicant high mortality. Among the 113 subjects who survived, mean SpO2/FiO2 ratio is 340 and among 12 subjects who died, SpO2/FiO2 ratio is 184. SpO2/FiO2 ratio is less among the children who died and can predict mortality. Conclusions: Many deaths in under ve children occurring in hospitals can be prevented if triage is followed, if any sick children are identied soon on their arrival and treatment is started immediately. SpO2/FiO2 ratio is a non-invasive and reliable tool for hypoxemia screening and predicting outcome among patients admitted to the ED.

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