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.

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 &lt; .001) patients and were less likely to have barriers (P &lt; .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.

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.

scholarly journals ANI scoring system – In differentiating alcoholic and non-alcoholic liver disease

2021 ◽  
Vol 12 (11) ◽  
pp. 104-107
Author(s):  
Anitha G ◽  
Sivakumar J ◽  
Kalavathy Ponniraivan
Keyword(s):  
Liver Disease ◽  
Liver Biopsy ◽  
Alcoholic Liver Disease ◽  
Scoring System ◽  
Research Centre ◽  
College Hospital ◽  
Alcoholic Fatty Liver ◽  
Medical College ◽  
Non Invasive ◽  
Invasive Method

Background: Alcoholic liver disease/non-alcoholic liver disease Index – ANI scoring system was constructed for clinically diagnosing the etiology of liver diseases, avoiding the risks of liver biopsy. Aims and Objectives: This study aims to test the reliability of ANI scoring system as a non-invasive method to distinguish alcoholic liver disease (ALD) from non-alcoholic fatty liver disease (NAFLD). Materials and Methods: This retrospective study was conducted on 177 (114 men and 58 women) treated as inpatients in Trichy SRM Medical College Hospital and Research Centre, Trichy, in the period of December 1, 2015–August 1, 2016. About 40 patients with etiology of viral, autoimmune, and biliary lithiasis were excluded. A total of 137 patients (98 men and 39 women) were classified into two groups, ALD (70) and NAFLD (67) based on diagnosis. Parameters of ANI – AST, ALT, MCV, BMI, and sex were recorded. ANI was calculated by online calculator. Results: ANI was significantly higher in patients with ALD than NAFLD (P<0.01). The cutoff value of ANI is –0.11. Conclusion: On the basis of the results, ANI scoring system may be used in clinically distinguishing ALD from NAFLD, avoiding the risks of liver biopsy.

A Report of 7-Year Experience on Pediatric Continuous Renal Replacement Therapy

2017 ◽  
Vol 34 (11-12) ◽  
pp. 985-989 ◽  
Author(s):  
Ayse Filiz Yetimakman ◽  
Selman Kesici ◽  
Murat Tanyildiz ◽  
Umut Selda Bayrakci ◽  
Benan Bayrakci
Keyword(s):  
Critically Ill ◽  
Metabolic Diseases ◽  
Fluid Overload ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Standardized Mortality Ratio ◽  
Inborn Errors ◽  
Fluid Removal ◽  
Continuous Renal Replacement Therapies ◽  
Organ Failures

Background: Continuous renal replacement therapies (CRRTs) either as continuous venovenous hemofiltration (CVVH) or hemodiafiltration (CVVHD) are used frequently in critically ill children. Many clinical variables and technical issues are known to affect the result. The factors that could be modified to increase the survival of renal replacement are sought. As a contribution, we present the data on 104 patients who underwent CRRT within a 7-year period. Materials and Method: A total of 104 patients admitted between 2009 and 2016 were included in the study. The demographic information, admittance pediatric risk of mortality (PRISM) scores, indication for CRRT, presence of fluid overload, CRRT modality, durations of CRRT, and pediatric intensive care unit (PICU) stay were compared between survivors and nonsurvivors. Results: The overall rate of survival was 51%. Patients with fluid overload had significantly increased rate of death, CRRT duration, and PICU stay. Multiorgan dysfunction syndrome as the indication for CRRT was significantly related to decreased survival when compared to acute renal failure and acute attacks of metabolic diseases. The CRRT modality was not different between survivors and nonsurvivors. Standardized mortality ratio of the group was calculated to be 0.8. Conclusion: The CRRT in critically ill patients is successful in achieving fluid removal and correction of metabolic imbalances caused by organ failures or attacks of inborn errors of metabolism. It has a positive effect on expected mortality in high-risk PICU patients. To affect the outcome, follow-up should be focused on starting therapy in early stages of fluid overload. Prospective studies defining relative importance of risk factors causing mortality can assist in building up guidelines to affect the outcome.

scholarly journals Risk Factors Associated with Mechanical Ventilation in Critical Bronchiolitis

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 1035
Author(s):  
Rachel K. Marlow ◽  
Sydney Brouillette ◽  
Vannessa Williams ◽  
Ariann Lenihan ◽  
Nichole Nemec ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Medical Center ◽  
Invasive Mechanical Ventilation ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Respiratory Support ◽  
Non Invasive ◽  
Lengths Of Stay

The American Academy of Pediatrics (AAP) recommends supportive care for the management of bronchiolitis. However, patients admitted to the intensive care unit with severe (critical) bronchiolitis define a unique group with varying needs for both non-invasive and invasive respiratory support. Currently, no guidance exists to help clinicians discern who will progress to invasive mechanical support. Here, we sought to identify key clinical features that distinguish pediatric patients with critical bronchiolitis requiring invasive mechanical ventilation from those that did not. We conducted a retrospective cohort study at a tertiary pediatric medical center. Children ≤2 years old admitted to the pediatric intensive care unit (PICU) from January 2015 to December 2019 with acute bronchiolitis were studied. Patients were divided into non-invasive respiratory support (NRS) and invasive mechanical ventilation (IMV) groups; the IMV group was further subdivided depending on timing of intubation relative to PICU admission. Of the 573 qualifying patients, 133 (23%) required invasive mechanical ventilation. Median age and weight were lower in the IMV group, while incidence of prematurity and pre-existing neurologic or genetic conditions were higher compared to the NRS group. Multi-microbial pneumonias were diagnosed more commonly in the IMV group, in turn associated with higher severity of illness scores, longer PICU lengths of stay, and more antibiotic usage. Within the IMV group, those intubated earlier had a shorter duration of mechanical ventilation and PICU length of stay, associated with lower pathogen load and, in turn, shorter antibiotic duration. Taken together, our data reveal that critically ill patients with bronchiolitis who require mechanical ventilation possess high risk features, including younger age, history of prematurity, neurologic or genetic co-morbidities, and a propensity for multi-microbial infections.

scholarly journals Use of body composition and phase angle analysis for the assessment of nutritional status and clinical outcomes in critically ill children

2021 ◽  
Author(s):  
Zi-Hong Xiong ◽  
Xue-Mei Zheng ◽  
Guo-Ying Zhang ◽  
Meng-Jun Wu ◽  
Yi Qu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nutritional Status ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Phase Angle ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Duration Time

Abstract BackgroundMalnutrition is highly prevalent in critically ill children in the pediatric intensive care unit .We aimed to investigate the efficiency of bioelectrical impedance analysis (BIA) measurements and phase angle (PhA) analysis for the assessment of nutritional risk and clinical outcomes in critically ill children.MethodsThis single-center observational study included patients admitted to the Pediatric Intensive Care Unit (PICU) of Chengdu Women’s and Children’s Central Hospital. All patients underwent anthropometric measurement in the first 24 h of admission and underwent BIA measurements within 3 days after the admission. The patients were classified into different groups based on body mass index (BMI) for age. Electronic hospital medical records were reviewed to collect clinical data for each patient. All the obtained data were analyzed by the statistics method.ResultsThere were 204 patients enrolled in our study, of which 32.4% were diagnosed with malnutrition. We found that BMI, arm muscle circumference, fat mass, and %body fat were lower in the group with poorer nutritional status (P < 0.05). Evident differences in the score of the Pediatric Risk of Mortality and the duration of mechanical ventilation (MV) among the three groups with different nutritional statuses were observed (P < 0.05). Patients in the severely malnourished group had the longest duration of MV. In the MV groups, there were significant differences (P < 0.05) in albumin level, PhA, and extracellular water/total body water (ECW/TBW ratio). The ECW/TBW ratio and the time for PICU stay had a weak degree of correlation (Pearson correlation coefficient = 0.375). PhA showed a weak degree of correlation with the duration time of medical ventilation (coefficient of correlation = 0.398).ConclusionBIA can be considered an alternative way to assess nutritional status in critically ill children. ECW/TBW ratio and PhA were correlated with PICU stay and duration time of medical ventilation, respectively.

scholarly journals Urinary CXCL10 is Associated with Acute Kidney Injury and Sepsis, and Predicts Mortality in Critically Ill Children

2020 ◽  
Author(s):  
Hui Huang ◽  
Huiting Zhou ◽  
Wenwen Wang ◽  
Xiaomei Dai ◽  
Wenjing Li ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Inflammatory Mediator ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Surviving Sepsis Campaign ◽  
Predictive Values ◽  
Specific Setting ◽  
Potential Indicator

Abstract Background: Acute kidney injury (AKI) biomarkers are often susceptible to confounding factors, limiting their utility as a specific biomarker, in the prediction of AKI, especially in heterogeneous population. The urinary CXC motif chemokine 10 (uCXCL10), as an inflammatory mediator, has been proposed to be a biomarker for AKI in a specific setting. Whether uCXCL10 is associated with AKI and predicts AKI in critically ill patients remains unclear. The aims of the study were to investigate clinical variables potentially associated with uCXCL10 levels and determine the associations of uCXCL10 with AKI, sepsis and PICU mortality in critically ill children, as well as its predictive values of aforementioned issues. Methods: Urinary CXCL10 levels were serially measured in a heterogeneous group of children during the first week after pediatric intensive care unit (PICU) admission. AKI diagnosis was based on the criteria of Kidney Disease: Improving Global Outcomes with serum creatinine and urine output. Sepsis was diagnosed according to surviving sepsis campaign international guidelines for children. Mortality was defined as all-cause death occurring during the PICU stay.Results: Among 342 critically ill children, 52 (15.2%) developed AKI during the first week after PICU admission, and 132 (38.6%) were diagnosed as sepsis and 30 (12.3%) died during PICU stay. Both the initial and peak values of uCXCL10 remained independently associated with AKI with adjusted odds ratios (AORs) of 1.791 (P = 0.010) and 2.002 (P = 0.002), sepsis with AORs of 1.679 (P = 0.003) and 1.752 (P = 0.002), septic AKI with AORs of 3.281 (P <0.001) and 3.172 (P <0.001), and PICU mortality with AORs of 2.779 (P = 0.001) and 3.965 (P <0.001), respectively. The AUCs of the initial uCXCL10 for predicting AKI, sepsis, septic AKI, and PICU mortality were 0.63 (0.53-0.72), 0.62 (0.56-0.68), 0.75 (0.64-0.87), and 0.77 (0.68-0.86), respectively. The AUCs for prediction by using peak uCXCL10 were as follows: AKI 0.65 (0.56-0.75), sepsis 0.63 (0.57-0.69), septic AKI 0.76 (0.65-0.87), and PICU mortality 0.84 (0.76-0.91).Conclusions: Urinary CXCL10 is independently associated with AKI and sepsis, and may be a potential indicator of septic AKI and PICU mortality in critically ill children.

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