scholarly journals Dexmedetomidine to treat opioid withdrawal in infants following prolonged sedation in the pediatric ICU

2006 ◽  
Vol 2 (4) ◽  
pp. 201 ◽  
Author(s):  
Joseph D. Tobias, MD
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Care Center ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Signs And Symptoms ◽  
Opioid Withdrawal ◽  
Loading Dose

This retrospective study aims to report on the use of dexmedetomidine to treat opioid withdrawal following sedation during mechanical ventilation in a cohort of infants. Seven infants in the pediatric intensive care unit of a tertiary care center, ranging in age from three to 24 months (12.4 ± 8.2 months) and in weight from 4.6 to 15.4 kgs (9.9 ± 4.2 kgs), had received a continuous fentanyl infusion, supplemented with intermittent doses of midazolam for sedation, during mechanical ventilation. Withdrawal was documented by a Finnegan score ³ 12. Dexmedetomidine was administered as a loading dose of 0.5 mg/kg/hr, followed by an infusion of 0.5 mg/kg/hr.Dexmedetomidine effectively controlled the signs and symptoms of withdrawal in the seven patients. Subsequent Finnegan scores were £ 7 at all times (median 4, range 1 to 7). Two patients required a repeat of the loading dose and an increase of the infusion to 0.7 mg/kg/hr. These two patients had received higher doses of fentanyl than the other five patients (8.5 ± 0.7 versus 4.6 ± 0.5 mg/kg/hr, p < 0.0005). No adverse hemodynamic or respiratory effects related to dexmedetomidine were noted.This report involves the largest cohort of patients to receive dexmedetomidine in the treatment of withdrawal following opioid and benzodiazepine sedation during mechanical ventilation. We conclude that dexmedetomidine offers a viable option for such issues in the pediatric intensive care unit (PICU) setting.

Outcome and Incidence of Hypomagnesemia in Children Admitted in Pediatric Intensive Care Unit of a Tertiary Care Hospital

2021 ◽  
Vol 15 (5) ◽  
pp. 1169-1173
Author(s):  
R. Farrukh ◽  
S. Masood ◽  
I. Shakoor ◽  
A. Naseer ◽  
S. Sultana ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Severe Acute Malnutrition ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Magnesium Level ◽  
Acute Malnutrition ◽  
Care Hospital

Background: Magnesium deficiency is common in serious diseases and is often associated with mechanical ventilation, mortality, and long-term intensive care. Awareness of hypomagnesaemia is essential because little data is available and may have prognostic and therapeutic implications. Aim: This study was conducted to calculate the incidence of hypomagnesaemia at PICU admission and to relate it to length of PICU stay, duration of mechanical ventilation, and outcome of hospital stay or discharge. Place and Duration: In the Pediatric Intensive Care Unit (PICU), Abbasi Shaheed Hospital, Karachi for one-year duration from April 2020 to April 2021. Methods: This is a prospective observational study involving 200 children aged 1 month to 12 years admitted to the PICU. All qualified children underwent an interview and clinical examination. Blood was collected during admission to calculate serum magnesium level. The patients were grouped into three groups: normomagnesemia, hypomagnesaemia and hypermagnesemia, and the data were analyzed. Results: 200 children were included in the inclusion study. Males constituted 57.0%and females 43.0%. The ratio of men to women was 1.2: 1. Most of the respondents were 5 years old. Most of the respondents were in the ICU with neurological symptoms (36.5%), followed by respiratory diseases (27%). Of the 200 patients, 138 (69%) had a mean magnesium level of 1.9 mg / dL. 51(25.5%) patients had hypomagnesaemia. The average magnesium level was 1.3 mg / dL. 11 (5.5%) patients had hypermagnesemia with a mean magnesium content of 2.7 mg / dl. The lowest measured magnesium level was 1 mg / dl and the highest was 4.2 mg / dl. There was no statistically significant association between hypomagnesaemia and gender, age, disease acceptance category, and sepsis. ≤ 27.4% of children under 5 years of age had severe acute malnutrition in the hypomagnesaemia group. Among those with normal magnesium levels, 24% had severe acute malnutrition and 27.3% had severe acute malnutrition among those with hypermagnesemia. In the study, overall mortality was 25% (50 out of 200). Mortality among people with hypomagnesaemia was 29.40%. Among those with normal magnesium levels, 21.2% died and 18.2% in the hypermagnesemia group. Conclusion: Patients with hypomagnesaemia have prolonged PICU stay, other related electrolyte disturbances and increased mortality. Therefore, in severe ill patients, magnesium levels are monitored. Keywords: Children, Hypomagnesaemia, Intensive Care Unit, Mortality, Outcome, ICU

DOZ047.61: Elective tracheostomy in critically ill children: to do or not to do? Ten year experience from an academic center in Pakistan

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
S Ishaque ◽  
F Karim ◽  
S H Qazi ◽  
Q Abbas
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Prolonged Mechanical Ventilation ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Elective Tracheostomy

Abstract Background Tracheostomy is one of the oldest and most commonly performed procedures among critically ill patients. The advantages of an elective tracheostomy in pediatric intensive care unit are improved patient comfort, lesser need for sedative drugs, early weaning from mechanical ventilation support eventually leading to reduced cost of care. Objective This study describes the frequency, indications, complications, and outcome of elective pediatric tracheostomies in critically ill children from a single pediatric intensive care unit of a tertiary care center. Design This is a retrospective cohort study of patients undergoing tracheostomy. Setting This is a pediatric intensive care unit (PICU) of a tertiary-care hospital. Patients All patients underwent tracheostomy in our PICU over the ten-year period. Main Results A total of 48 children underwent a tracheostomy, corresponding to a 1.5% of the total PICU admissions during the study period. 34/48 (71%) patients were male. A 25% of our patients undergoing a tracheostomy had an underlying CNS condition, followed closely by a respiratory problem (11/48 patients).The main indication for tracheostomy in children was prolonged mechanical ventilation secondary to respiratory 35/48 (73%), that included upper airway obstruction, foreign body aspiration or pneumonia and neurological or neuromuscular illness (6.3%) including traumatic brain injury, meningitis/encephalitis, Gullain Barre’ syndrome, and neurodegenerative disorders. Two patients died from tracheostomy-related complications, making it an overall mortality rate of 4%. Conclusion Tracheostomy in children is a relatively frequent procedure at our hospital. The commonest indication was prolonged mechanical ventilation. Early tracheostomy is associated with better patient outcomes in terms of morbidity and length of stay.

scholarly journals Respiratory Modalities in Preventing Reintubation in a Pediatric Intensive Care Unit

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.

scholarly journals 1134. Antibiotic Indications and Appropriateness in the Pediatric Intensive Care Unit: A 10 Center Point Prevalence Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S403-S404
Author(s):  
Kathleen Chiotos ◽  
Jennifer Blumenthal ◽  
Juri Boguniewicz ◽  
Debra Palazzi ◽  
Emily Berkman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Antibiotic Use ◽  
Empiric Therapy ◽  
Point Prevalence ◽  
Prevalence Study ◽  
Point Prevalence Study

Abstract Background Antibiotics are prescribed in up to 80% of pediatric intensive care unit (PICU) patients, but multicenter studies systematically evaluating antibiotic indications and appropriateness in this high-utilizing population are lacking. Methods A multicenter point prevalence study was conducted at 10 geographically diverse tertiary care US children’s hospitals. All PICU patients < 21 years of age who were receiving systemic antibiotics at 8:00 AM on each study day were included. Study days occurred in February and March 2019. Data were abstracted by critical care and/or infectious diseases trained clinicians using standardized data collection forms and definitions of antibiotic appropriateness. Results 408 of 732 PICU patients (56%) received 618 antibiotics on the two study days. Empiric therapy for suspected bacterial infections without sepsis was the most common indication for antibiotics (22%), followed by treatment of community-acquired pneumonia and empiric therapy for septic shock (12% each, Figure 1). Overall, 194 antibiotic orders (32%) were classified as inappropriate and 158 patients (39%) received at least one inappropriate antibiotic. Vancomycin, cefepime, and ceftriaxone were the antibiotics most often inappropriately prescribed (Figure 2). Antibiotics prescribed inappropriately for the top 5 indications shown in Figure 1 accounted for 77% of all inappropriate antibiotic use. Prolonged ( >4 days) empiric therapy and prolonged ( >24 hours) post-operative prophylaxis were the most common reasons antibiotics prescribed for these indications were classified as inappropriate. Pneumonia and ventilator-associated infections were the most common infections for which antibiotics were prescribed inappropriately (46%). Reasons for inappropriate antibiotic use included lack of evidence supporting a bacterial infection (no radiographic infiltrate or significant increase in respiratory support) and use of unnecessarily broad antibiotics (Table 1). Conclusion Inappropriate antibiotic use is common in the PICU, particularly for pneumonia. Studies focused on defining optimal treatment strategies, as well as improved diagnostic approaches to curtail prolonged courses of empiric therapy, should be prioritized. Disclosures All authors: No reported disclosures.

Sign in / Sign up

Export Citation Format

Share Document