Frequency of Electrolyte Disorders and Its Effect On Mortality Among Children Admitted In Pediatric Intensive Care Unit

Objective: To determine the frequency of electrolyte disorders, i.e., serum sodium and potassium and to evaluate its effect on mortality rate among children admitted at the pediatric intensive care unit. Study Design and Setting: This was a descriptive cross sectional study conducted at Pediatric Intensive care unit of Civil Hospital Karachi from April to December 2017 Methodology: Informed consent was obtained from 150 parents of the children who fulfill the inclusion criteria. Laboratory data (serum sodium and serum potassium) were recorded during the stay in the pediatric intensive care unit. Data was analyzed using SPSS version 20. Mean ± S.D was calculated for quantitative variables. Frequency and percentage were calculated for gender, electrolyte disorders and mortality. Effect modifiers were controlled by stratification of age, gender and electrolyte disorders (Hypernatremia, Hyponatremia, Hyperkalemia, and Hypokalemia). Post-stratification, Chi-squared test was applied. P-value = 0.05 was taken as significant. Results: Out of 150 patients, electrolyte disorders in terms of serum sodium and potassium, were found in 86(57.3%) children. Mortality in children with electrolyte disorders was found to be 46(53.5%) which was significantly higher (P<0.001) than patients without electrolyte disorders 40(46.5%). Hypernatremia was found in 48(32%), hyponatremia 24(16%), hyperkalemia 21(14%) and hypokalemia in 42(28%) patients.In comparison; of electrolyte disorders with mortality; significant association was found in hypernatremia (P<0.001), and hyperkalemia (P<0.001). Conclusion: The most common electrolyte abnormalities were hypernatremia and hypokalemia. Mortality was significantly higher in subjects with electrolyte disorders, especially hypernatremia and hyperkalemia

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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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Mean difference of Electrolyte Level measured in Arterial Blood gases and measured in Laboratory in Children presenting in Pediatric Intensive Care Unit

Journal of Sheikh Zayed Medical College ◽

10.47883/jszmc.v12i02.63 ◽

2021 ◽

pp. 3-6

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Blood Gases ◽

P Value ◽

Arterial Blood Gases ◽

K Value ◽

Electrolyte Level ◽

Arterial Blood

Background: Electrolytes are measured in arterial and venous blood by arterial blood gas analyzer and the auto-analyzers respectively. Objective: To determine the mean difference in electrolyte level in arterial blood gases (ABGs) level versus laboratory serum electrolyte level in the children admitted in the pediatric intensive care unit. Methodology: This cross-sectional study was conducted at department of Pediatrics, the Children’s Hospital and Institute of Child Health, Lahore from 1st December 2015 to 31st May 2016. Total of 125 children fulfilling inclusion criteria were enrolled in the study from pediatric intensive care unit. The ABGs (whole blood) electrolytes were obtained immediately after collection, using ABGs analyzer. Serum electrolytes were analyzed in the central laboratory of the institution. Reports were assessed and levels of sodium and potassium was noted from reports of ABGs and laboratory. Results: Mean NA+ value on ABGs and from laboratory was 134.66 and 132.26 (p= 0.01). Mean K+ value from on ABGs and from laboratory was 4.51 and 4.28. (p= 0.071). In age group 1-5 and 6-10 years, K+ level was high in ABGs value (p-value=0.065 & p-value=0.073). However, in age group 11-15 years K+ level was significantly higher in ABGs value as that of laboratory value (p-value=0.014). The same trend was observed in male and female children that mean NA+ and K+ value with ABGs was significantly higher as compared to that of laboratory value. Conclusion: NA+ and K+ in arterial blood gases level were different from laboratory serum electrolyte level in children admitted to pediatric intensive care unit. Clinician should be aware of differences so that potential misdiagnosis does not occur and unnecessary treatment or investigation can’t be performed.

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Dialyzable Leukocyte Extract (Transferon™) Administration in Sepsis: Experience from a Single Referral Pediatric Intensive Care Unit

BioMed Research International ◽

10.1155/2019/8980506 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10 ◽

Cited By ~ 4

Author(s):

Maria Isabel Castrejón Vázquez ◽

Aldo Arturo Reséndiz-Albor ◽

Mario A. Ynga-Durand ◽

Ivonne Maciel Arciniega Martínez ◽

Vanessa Ivonne Orellana-Villazon ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Laboratory Data ◽

Pediatric Intensive Care ◽

Control Group ◽

Immunomodulatory Agents ◽

Reactive Protein ◽

Significant Difference ◽

Pediatric Sepsis

Immunomodulatory agents have been proposed as therapeutic candidates to improve outcomes in sepsis. Transferon™, a dialyzable leukocyte extract (DLE), has been supported in Mexico as an immunomodulatory adjuvant in anti-infectious therapy. Here we present a retrospective study describing the experience of a referral pediatric intensive care unit (PICU) with Transferon™ in sepsis. We studied clinical and laboratory data from 123 patients with sepsis (15 in the DLE group and 108 in the control group) that were admitted to PICU during the period between January 2010 and December 2016. Transferon™ DLE use was associated with lower C reactive protein (CRP), increase in total lymphocyte counts (TLC), and decrease in total neutrophil count (TNC) 72 hours after Transferon™ DLE administration. The control group did not present any significant difference in CRP values and had lower TLC after 72 hours of admission. There was no difference in PICU length of stay between control and Transferon™ DLE group. Transferon™ DLE administration was associated with a higher survival rate at the end of PICU stay. This study shows a possible immunomodulatory effect of Transferon™ on pediatric sepsis patients.

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Faktor Risiko Kegagalan Ventilasi non Invasif di Pediatric Intensive Care Unit (PICU) RSUD Dr. Moewardi

Sari Pediatri ◽

10.14238/sp21.3.2019.177-82 ◽

2019 ◽

Vol 21 (3) ◽

pp. 177

Author(s):

Leksmana Hidayatullah ◽

Sri Martuti ◽

Pudjiastuti Pudjiastuti

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

P Value ◽

Invasive Ventilation ◽

Cross Sectional ◽

Non Invasive ◽

Non Invasive Ventilation

Latar belakang. Ventilasi non invasif (non invasive ventilation = NIV) dapat menjadi alternatif ventilasi selain intubasi endotrakeal, belum banyak didapatkan penelitian mengenai NIV di negara berkembang. Karakteristik awal pasien mempunyai peranan sebagai faktor risiko kegagalan NIV, tetapi masih didapatkan hasil yang beragam.Tujuan. Menganalisis faktor risiko kegagalan terapi NIV berdasarkan karakteristik awal pasien di Pediatric Intensive Care Unit Rumah Sakit Umum Daerah Dr. Moewardi.Metode. Penelitian analitik dengan desain cross sectional dengan besar sampel 25 anak, dilakukan pengambilan data melalui rekam medik dengan periode november 2016 sampai mei 2018.Hasil. Didapatkan hasil, sebanyak 10 dari 25 pasien (40%) gagal NIV, 22 pasien (88%) sebagai lini pertama sedangkan sebagai penyapihan ventilator sebanyak 3 pasien (12%). Analisis multivariat dengan menggunakan regresi logistik menunjukkan jalur nutrisi enteral (P value 0,028 ;OR 10,64 (1,29-87,56)CI 95%) dapat menjadi prediktor kegagalan penggunaan NIV.Kesimpulan. Pemberian Nutrisi secara enteral pada saat awal penggunaan NIV dapat dijadikan prediktor kegagalan.

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Hexosylceramides and glycerophosphatidylcholine GPC(36:1) increase in Multi-Organ Dysfunction Syndrome patients with Pediatric Intensive Care Unit Admission over 8-day hospitalization

10.1101/2021.02.11.21251596 ◽

2021 ◽

Author(s):

Mara L. Leimanis-Laurens ◽

Emily Wolfrum ◽

Karen Ferguson ◽

Jocelyn R. Grunwell ◽

Dominic Sanfilippo ◽

...

Keyword(s):

Mass Spectrometry ◽

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Organ Dysfunction ◽

Plasma Lipid ◽

Pediatric Intensive Care ◽

P Value ◽

Time Points ◽

Multi Organ Dysfunction Syndrome

AbstractGlycero- and sphingo-lipids are important in plasma membrane structure, caloric storage and signaling. An un-targeted lipidomics approach for a cohort of critically ill pediatric intensive care unit (PICU) patients, undergoing multi-organ dysfunction syndrome (MODS) was compared to sedation controls. After IRB approval, patients meeting criteria for MODS were screened, consented (n=24), and blood samples were collected from the PICU at HDVCH, Michigan; eight patients needed veno-arterial extracorporeal membrane oxygenation (VA ECMO). Sedation controls were presenting for routine sedation (n=4). Plasma lipid profiles were determined by nano-electrospray (nESI) direct infusion high resolution/accurate mass spectrometry (MS) and tandem mass spectrometry (MS/MS). Biostatistics analysis was performed using R v 3.6.0. 61 patient samples over 3 time points revealed a ceramide metabolite, hexosylceramide (Hex-Cer) was high across all time points (mean 1.63% - 3.19%; vs. controls 0.22%). Fourteen species statistically differentiated from sedation controls (P-value ≤0.05); sphingomyelin (SM) [SM(d18:1/23:0), SM(d18:1/22:0), SM(d18:1/23:1), SM(d18:1/21:0), SM(d18:1/24:0)]; and glycerophosphotidylcholine (GPC) [GPC(36:01), GPC(18:00), GPC(O:34:02), GPC(18:02), GPC(38:05), GPC(O:34:03), GPC(16:00), GPC(40:05), GPC(O:36:03)]. Hex-Cer has been shown to be involved in viral infection and may be at play during acute illness. GPC(36:01) was elevated in all MODS patients at all time points and is associated with inflammation and brain injury.

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Electrolytes Profile of Critically Ill Patients Admitted To Pediatric Intensive Care Unit (PICU) Dr. Soetomo General Hospital

Indonesian Journal of Anesthesiology and Reanimation ◽

10.20473/ijar.v2i12020.1-7 ◽

2020 ◽

Vol 2 (1) ◽

pp. 1

Author(s):

Amalia Citra Octavia ◽

Arina Setyaningtyas ◽

Pesta Parulian Maurid Edwar

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

General Hospital ◽

Critically Ill ◽

Pediatric Intensive Care Unit ◽

Critically Ill Patients ◽

Pediatric Intensive Care ◽

Main Diagnosis ◽

Electrolyte Disorders ◽

Serum Chloride

Introduction: Fluid and electrolyte disorders can be affected by various conditions or diseases. Electrolyte disorders are often found in pediatric patients with critically ill conditions and are associated with increased morbidity also mortality that requires extra care in the Pediatric Intensive Care Unit (PICU). Objective: To describe the electrolyte profile of critically ill patients with electrolyte disorders admitted to the Pediatric Intensive Care Unit (PICU) Dr. Soetomo General Hospital. Materials and Methods: The study was conducted prospectively with a descriptive method in patients with electrolyte disorders aged 1 month – 18 years old admitted to PICU Dr. Soetomo General Hospital, Surabaya in a period from August to November 2018. Data on patient age, gender, electrolyte profile (sodium, potassium, calcium, chloride), and origin before PICU admission were recorded. Results and Discussion: From 37 patients with electrolyte disorders showed that patients were dominated by the male in 56.8% (n=21), in the age group of infants or 1-12 months old in 45.9% (n=17). Common main diagnosis in most patients were digestive system disorders in 27% (n=10), followed by central nervous system, respiratory system, kidney and cardiovascular disorders, and the origin before PICU admission were from Emergency Room (ER) in 62.2% (n=23). There were found 97 incidences of electrolyte disorders. Most frequent electrolyte disorders were hypocalcemia in 59.5% (n=22), hypokalemia in 54.1% (n=20), hyponatremia in 40.5% (n=15) and the least was hypochloremia in 35.1% (n=13). Mean serum sodium level was 138.18 ± 12.071, serum potassium level was 3.608 ± 1.2247, serum calcium level was 8.057 ± 1.9473 and serum chloride level was 101.45 ± 13.266. Conclusions: Critically ill patients admitted in PICU tend to experience low electrolyte levels.

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Hexosylceramides and Glycerophosphatidylcholine GPC(36:1) Increase in Multi-Organ Dysfunction Syndrome Patients with Pediatric Intensive Care Unit Admission over 8-Day Hospitalization

Journal of Personalized Medicine ◽

10.3390/jpm11050339 ◽

2021 ◽

Vol 11 (5) ◽

pp. 339

Author(s):

Mara Leimanis-Laurens ◽

Emily Wolfrum ◽

Karen Ferguson ◽

Jocelyn R. Grunwell ◽

Dominic Sanfilippo ◽

...

Keyword(s):

Mass Spectrometry ◽

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Organ Dysfunction ◽

Plasma Lipid ◽

Pediatric Intensive Care ◽

P Value ◽

Time Points ◽

Multi Organ Dysfunction Syndrome

Glycero- and sphingo-lipids are important in plasma membrane structure, caloric storage and signaling. An un-targeted lipidomics approach for a cohort of critically ill pediatric intensive care unit (PICU) patients undergoing multi-organ dysfunction syndrome (MODS) was compared to sedation controls. After IRB approval, patients meeting the criteria for MODS were screened, consented (n = 24), and blood samples were collected from the PICU at HDVCH, Michigan; eight patients needed veno-arterial extracorporeal membrane oxygenation (VA ECMO). Sedation controls were presenting for routine sedation (n = 4). Plasma lipid profiles were determined by nano-electrospray (nESI) direct infusion high resolution/accurate mass spectrometry (MS) and tandem mass spectrometry (MS/MS). Biostatistics analysis was performed using R v 3.6.0. Sixty-one patient samples over three time points revealed a ceramide metabolite, hexosylceramide (Hex-Cer) was high across all time points (mean 1.63–3.19%; vs. controls 0.22%). Fourteen species statistically differentiated from sedation controls (p-value ≤ 0.05); sphingomyelin (SM) [SM(d18:1/23:0), SM(d18:1/22:0), SM(d18:1/23:1), SM(d18:1/21:0), SM(d18:1/24:0)]; and glycerophosphotidylcholine (GPC) [GPC(36:01), GPC(18:00), GPC(O:34:02), GPC(18:02), GPC(38:05), GPC(O:34:03), GPC(16:00), GPC(40:05), GPC(O:36:03)]. Hex-Cer has been shown to be involved in viral infection and may be at play during acute illness. GPC(36:01) was elevated in all MODS patients at all time points and is associated with inflammation and brain injury.

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Prediction Of Mortality By Pediatric Risk Of Mortality (PRISM) III Score In NGMC Pediatric Intensive Care Unit

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v17i1.25305 ◽

2019 ◽

Vol 17 (1) ◽

pp. 5-9

Author(s):

Roma Bora

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Analytical Study ◽

Pediatric Intensive Care ◽

P Value ◽

Prediction Of Mortality ◽

Risk Of Mortality ◽

Prediction Of Prognosis ◽

Developed World

Background: The pediatric risk of mortality (PRISM) III score helps in predicting prognosis. It is being used in most of the pediatric intensive care units of developed world and few of developing ones. We have undertaken this study to evaluate efficacy of PRISM III score in prediction of mortality. Material and Methods: Prospective hospital based analytical study conducted from May 2018 to April 2019 in patients admitted to pediatric intensive care unit (PICU) of NGMC, Nepal. The pediatric risk of mortality score (PRISM) III which includes 14 parameters (physiological and laboratory) was recorded within 24 hours of admission. A total of 480 patients were included. The final outcome was recorded as death or discharge. Result: It was observed that mortality increased with increasing PRISM III score approaching almost 100% by PRISM III score of 25 and more. The variables that were found to be risk factors for death were readmission, diseases of hepatobiliary system, mechanical ventilation (MV) and use of vasoactive drugs with p value of <0.001. PRISM III score offers a good discriminative power with 0.866 (95% CI) area under the ROC curve. Conclusion: The pediatric risk of mortality score was found to be a useful tool for prediction of prognosis.

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