scholarly journals Predicting Successful Extubation Rate Using Modified Spontaneous Breathing Trial in PICUs

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Nagwa Mohamed Sabry Mahmoud
Keyword(s):  
Critically Ill ◽  
Spontaneous Breathing ◽  
Spontaneous Breathing Trial ◽  
Pediatric Intensive Care ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Critically Ill Children ◽  
Cross Sectional ◽  
Total Period ◽  
Successful Extubation

Background: Extubation readiness is assessed by spontaneous breathing trials (SBTs); however, there is a lack of universally agreed protocols for their accurate performance and reporting in pediatric intensive care units (PICUs). Objectives: We aimed to evaluate extubating bundles, including modified SBT, in predicting successful extubation in critically-ill children with planned extubation. Method: This prospective cross-sectional study was based on the collection of data from 150 critically-ill children admitted to the PICU at Minia University Hospital. From January 2019 to June 2020, those children admitted to the PCIU and subjected to mechanical ventilation (MV), and extubation were enrolled. When the clinical team decided a child was ready for extubation based on the extubating bundle, a modified SBT (10 min) was used. It was started with switching to the CPAP\PS mode, followed by PS zero, and maintaining the original PEEP for 3 min. Finally, PS was kept at 5 - 8 cm H2O, and the original PEEP was maintained for the remaining 7 min (total period of 10 min). Results: The extubation bundle with modified SBT could predict extubation success with 89% sensitivity and 89.9% positive predictive value (PPV). There were no significant differences in age, weight, gender, and length of intubation between children with failed SBT and those who were successfully extubated. In 41 cases, SBT failure occurred in 3 ‐ 5 min, while nine cases showed failure in 6 ‐ 10 min. Conclusions: Extubation bundle with modified SBT before elective extubation is indicated for children. Guidelines for extubation among critically-ill children are needed to reduce unnecessary exposure to mechanical ventilation's adverse effects. Further multicenter research is required to enhance outcomes and decline the burden of these patients.

Device associated healthcare associated infections in a pediatric intensive care unit of a Tertiary Care Hospital, Pakistan.

2021 ◽  
Vol 28 (03) ◽  
pp. 338-343
Author(s):  
Shah Ali Ahmed ◽  
Anwarul Haque ◽  
Qalab Abbas ◽  
Humaira Jurair ◽  
Zohra Qamar ud Din ◽  
...  
Keyword(s):  
Intensive Care ◽  
Blood Stream Infection ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Blood Stream ◽  
Central Line ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Care Hospital ◽  
Cross Sectional

Objective: To determine the frequency of Ventilator associated Pneumonia (VAP), Central Line Associated Blood Stream Infection (CLABSI) and Catheter Associated Urinary Tract infection (CAUTI) by using standardized criteria established by Center of disease control and prevention. Study Design: Cross-sectional study. Setting: PICU of Aga Khan University Hospital (AKUH). Period: (August 2015 to January 2016). Material & Methods: Data was collected on a pre-coded proforma. Data was entered and analyzed through SPSS. Results: 156 patients were enrolled. 102 (65.4%) were male. Mean age was 57.59 months. Mean length of stay was 5.6 days. Patient and Device days were 546 and 958 respectively. Device utilization ratio was 0.56. Four Device associated infections (DAI) were identified during study period with a DAI Rate of 4.17 per 1000 device days. All DAI were CLABSIs. Enterococcus was the most frequent bacterial isolate. Conclusion: DAI are highly prevalent in low resource countries, especially in intensive care areas including PICUs. In our setup, CLABSI are increasing while VAP and CAUTI are decreasing.

scholarly journals Gastrointestinal complications in critically ill children: Experience from a resource-limited country

2021 ◽  
Vol 37 (3) ◽  
Author(s):  
Sidra Ishaque ◽  
Marium Shakir ◽  
Asma Ladak ◽  
Anwar Ul Haque
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
University Hospital ◽  
Critically Ill Children ◽  
Ethical Review ◽  
Gastrointestinal Complications ◽  
Resource Limited

Objectives: To determine the frequency and predictors of outcome of gastrointestinal complications (GIC) in critically ill children. Methods: This descriptive study was prospectively conducted in The Pediatric Intensive Care Unit (PICU), The Aga Khan University Hospital (AKUH), Karachi, from September 2015 to January 2017. After obtaining approval from the Ethical Review Committee of AKUH and informed consent from the parents, all children (aged one month to 18 years), of either gender, admitted to the Pediatric Intensive Care Unit (PICU) during the study period were included. The frequency of the defined GIC: vomiting, high gastric residue volume (GRV), diarrhea, constipation, and gastrointestinal bleed were recorded daily for the first week of the PICU stay. The data was collected by the primary investigator on a predesigned data collection form with inclusion of variables and predictors in light of existing literature and local expertise. The questionnaire was shared with the Pediatric Critical Care Medicine faculty and a consensus was sought on the elements to be incorporated. Results: GIC developed within the first 48 hours of admission in 78 (41%) patients. Of the patients who developed GIC, 37 (47.4%) patients developed high GRV: 31 (39.7%) patients developed constipation, 18 (23.1%) patients developed vomiting, 14 (17.9%) patients developed abdominal distension. With regards to prevalence by occurrence, 32/78 (41%) of patients presented with two GI complications, followed by 21 patients (27%) who presented with a single GIC. Only 11 patients (14%) presented with more than three complications. Median length of stay was higher in patients with GIC (8 days) than with those who did not develop GIC (4 days). The frequency of gastrointestinal complications was significantly higher in children receiving mechanical ventilation, on sedatives and relaxants and those with multiorgan dysfunction syndrome (MODS) and inotropes Conclusion: GI complications are a frequent occurrence in the PICU and are associated with worse clinical outcomes. The use of sedative drugs and the presence of shock with MODS were amongst the important contributing factors. doi: https://doi.org/10.12669/pjms.37.3.3493 How to cite this:Ishaque S, Shakir M, Ladak A, Anwar-Ul-Haque. Gastrointestinal complications in critically ill children: Experience from a resource-limited country. Pak J Med Sci. 2021;37(3):---------. doi: https://doi.org/10.12669/pjms.37.3.3493 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Acute kidney injury and mortality in critically ill children

2014 ◽  
Vol 54 (5) ◽  
pp. 251
Author(s):  
Putri Amelia ◽  
Munar Lubis ◽  
Ema Mutiara ◽  
Yunnie Trisnawati
Keyword(s):  
Acute Kidney Injury ◽  
Mortality Rate ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Kidney Injury ◽  
Cross Sectional Study ◽  
Critically Ill Children ◽  
Cross Sectional ◽  
Logistic Organ Dysfunction ◽  
Stage Renal Disease

Background Mortality from acute kidney injury (AKI) can be ashigh as 60% in critically ill children. This high mortality rate isinfluenced by the severity of primary diseases, organ dysfunction,and the stage of acute kidney injury.Objective To assess for an as sedation between AKI and mortalityin critically ill children hospitalized in the pediatric intensive careunit (PICU).Methods A cross-sectional study was conducted from Aprilto July 2012. All patients aged 1 month to 18 years who werehospitalized in the PICU for more than 24 hours were included.Urine output and serum creatinine levels were evaluated daily.Patients were categorized according to the pediatric risk, injury,failure, loss, and end stage renal disease (pRIFLE) criteria. Chisquare, Fisher's exact, Mann-\X'hitney U, and Kruskal-Wallis testswere used to assess for an association between AKI, mortality,pediatric logistic organ dysfunction (PELOD) score, and lengthof PICU stay. AP value of < 0.05 was considered as statisticallysignificant.Results During the study period, 57 children were admitted,consisting of 25 (43.9%) females and 32 (56.1 %) males, witha median age of 43 months. The prevalance of AKI was 31.5%(18/57) and classified into stages: risk 13/18, injury 3/18, andfailure 2/18. The mortality rate for AKI was 16. 7%. There was noassociation between AKI and mortality (P=0.592). The PELODscores were found to be similar among patients (SD 11.3 2 vs. SD12.23; P=0.830), and there was no association between AKI andlength of PICU stay (P=0.819).Conclusion There is no association between AKI and mortalityin critically ill children admitted in PICU.

scholarly journals PELOD score, serum procalcitonin, and lactate levels in pediatric sepsis

2016 ◽  
Vol 55 (6) ◽  
pp. 293
Author(s):  
Jufitriani Ismy ◽  
Munar Lubis ◽  
Erna Mutiara ◽  
Gema Nazri Yani ◽  
Yunnie Trisnawati
Keyword(s):  
Critically Ill ◽  
Positive Culture ◽  
Cross Sectional Study ◽  
Critically Ill Children ◽  
Sectional Study ◽  
Cross Sectional ◽  
Lactate Levels ◽  
Pediatric Sepsis ◽  
Age Range ◽  
Pelod Score

Background Sepsis remains a major cause of morbidity andmortality among critically ill children in the pediatric intensivecare unit (PICU). Procalcitonin and lactate have been used asbiomarkers of sepsis, as they have been correlated with diseaseseverity, organ failure and death. The Pediatric Logistic OrganDysfunction (PELOD) score is a tool to assess the severity oforgan dysfunction in critically ill children.Objective To investigate the correlation between PELOD scoreand procalcitonin and lactate levels in pediatric sepsis.Methods A cross-sectional study was conducted in childrenwith sepsis who were admitted to the PICU from April to July2012. Sepsis was defined as systemic inflammatory responsesyndrome (SIRS), as a result of suspected or proven infection.Proven infection was defined as positive culture findings (blood,􀁘􀁕􀁌􀁑􀁈􀀃 􀁒􀁕􀀃 􀁒􀁗􀁋􀁈􀁕􀀃 􀁖􀁓􀁈􀁆􀁌􀁐􀁈􀁑􀁖􀀌􀀃 􀁄􀁑􀁇􀀒􀁒􀁕􀀃 􀁖􀁈􀁕􀁘􀁐􀀃 􀁓􀁕􀁒􀁆􀁄􀁏􀁆􀁌􀁗􀁒􀁑􀁌􀁑􀀃 􀂕􀀕􀀃 􀁑􀁊􀀒mL. Spearman’s test was used to assess for correlations betweenPELOD scores and procalcitonin as well as lactate levels.Results Thirty-two patients were analyzed, consisting of 18 malesand 14 females with an age range of 1-432 months (median 21months). There was no statistically significant correlation betweenprocalcitonin level and PELOD score (r=- 0.186, 95%CI -0.502to 0.174, P=0.308) nor between lactate level(r=-0.069, 95%CI-0.408 to 0.287, P=0.709) and PELOD score.Conclusion Serum procalcitonin and lactate levels are notcorrelated with PELOD scores in children with sepsis.

Clinical Severity as a Predictor of Nursing Workload in Pediatric Intensive Care Units: A Cross-Sectional Study

2019 ◽  
Vol 13 (4) ◽  
pp. 175-184
Author(s):  
Alexandra-Stavroula Nieri ◽  
Eleni Spithouraki ◽  
Petros Galanis ◽  
Daphne Kaitelidou ◽  
Vasiliki Matziou ◽  
...  
Keyword(s):  
Intensive Care ◽  
Elective Surgery ◽  
Pediatric Intensive Care ◽  
Cross Sectional Study ◽  
Clinical Severity ◽  
Critically Ill Children ◽  
Nursing Workload ◽  
Sectional Study ◽  
Cross Sectional ◽  
Logistic Organ Dysfunction

BackgroundIncreased nursing workload (NW) is associated with increased incidence of adverse events. In adult ICUs, one of the factors that increase NW is the severity of illness; however, this has not been adequately investigated in pediatric intensive care unit (PICU).AimTo explore potential association between clinical severity of critically ill children and NW in PICU.MethodsA descriptive, correlational, cross-sectional study design was employed. Data were collected from three PICUs of Athens, Greece, during November 2015 to March 2016, using a sample of 58 pediatric patients. The Pediatric-Nursing Activities Score (P-NAS) and the Therapeutic Intervention Scoring System 28 (TISS-28) were used to measure NW and the Pediatric Logistic Organ Dysfunction (PELOD) to assess clinical severity. Demographic and clinical variables of the children were also investigated. Multiple linear regressions were used to identify NW predictive factors, at 5% significance level.ResultsParticipants' median age (interquartile range [IQR]) was 38.5 (7.0–127.0) months and 50% of them were male. PELOD score was significantly correlated with NW scores on the first day of hospitalization in PICU (P-NAS: ρ = .319, p = .020, TISS-28: ρ = .547, p < .0001) and with NW during total PICU stay (TISS-28: ρ = .483, p < .001). The PELOD (β = .694, p = .052) and the elective surgery (β = −13.12, p = .01) were predictors of the P-NAS on the first day of hospitalization, and the PELOD (β = .563, p = .029) and the emergency surgery (β = 16.09, p = .01) were predictors of the P-NAS during total PICU stay. The PELOD (β = .509, p = .001) was a predictor factor of the TISS-28 score on the first day of PICU hospitalization and the PELOD (β = .371, p = .003) and the age (β = .036, p = .005) were predictors of the TISS-28 score during total PICU stay.ConclusionsThe clinical severity is a predictive factor of NW required in PICUs.

Prothrombin Complex Concentrate Utilization in Children's Hospitals

2021 ◽  
Author(s):  
Jeffrey E. Lutmer ◽  
Christian Mpody ◽  
Eric A. Sribnick ◽  
Takaharu Karube ◽  
Joseph D. Tobias
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Health Information System ◽  
Bleeding Risk ◽  
Cross Sectional Study ◽  
Critically Ill Children ◽  
Children's Hospitals ◽  
Cross Sectional ◽  
Medical Coding ◽  
Children’S Hospitals

AbstractProthrombin complex concentrates (PCCs) are used to manage bleeding in critically ill children. We performed a repeat cross-sectional study using the Pediatric Health Information System registry to describe PCC utilization in the U.S. children's hospitals over time and determine the relationship between PCC use and specific risk factors for bleeding. We included children < 18 years who received three-factor or four-factor PCC during hospital admission between January 2015 and December 2020 to describe the association between PCC therapy, anticoagulation therapies, and inherited or acquired bleeding diatheses. PCC use steadily increased over the 6-year study period (from 1.3 to 4.6 per 10,000 encounters). Patients exhibited a high degree of critical illness, with 85.0% requiring intensive care unit admission and a mortality rate of 25.8%. PCCs were used in a primarily emergent or urgent fashion (32.6 and 39.3%, respectively) and more frequently in surgical cases (79.0% surgical vs. 21.0% medical). Coding analysis suggested a low rate of chronic anticoagulant use which was supported by review of concomitant anticoagulant medications. PCC use is increasing in critically ill children and does not correlate with specific anticoagulant therapy use or other bleeding risk factors. These findings suggest PCC use is not limited to vitamin K antagonist reversal. Indications, efficacy, and safety of PCC therapy in children require further study.

scholarly journals The Influence of Albumin Level in Critically Ill Children to Length of Stay and Mortality in Paediatric Intensive Care Unit

2019 ◽  
Vol 7 (20) ◽  
pp. 3455-3458
Author(s):  
Gema Nazri Yanni ◽  
Munar Lubis ◽  
Muhammad Ali
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Critically Ill ◽  
Average Length ◽  
Pediatric Intensive Care ◽  
Albumin Level ◽  
Critically Ill Children ◽  
Albumin Concentration ◽  
Cross Sectional

BACKGROUND: The use of albumin in the critical care setting is a very controversial issue. Low serum albumin concentration in critical illness is associated with a poor outcome. AIM: We aimed to evaluate the influence of albumin level in critically ill children to the length of stay and mortality in the Pediatric Intensive Care Unit (PICU) Haji Adam Malik General Hospital, Medan, Indonesia. METHODS: The study used an observational method with a cross-sectional design. The population of the study was all patients with major postoperative surgery and critically ill that admitted to the PICU at Haji Adam Malik Hospital from the period of June 2008 to September 2008. The albumin level of the subjects was determined on the first day admitted. RESULTS: The group with hypoalbuminemia (< 3 g/dL) was given albumin supplementation according to a protocol in the PICU. The group with hypoalbuminemia have an average length of stay 7.6 days (9.7%) and mortality of 12 subjects (36.4%). The group with normal albumin level have 4.7 days (5.0%) and mortality 13 subjects (37.1%). There was no significant effect of albumin level to mortality. CONCLUSION: Albumin level did not affect the length of stay and mortality in PICU.

STUDY OF HISTOPATHOLOGY IN PATIENTS WITH HODGKIN AND NON - HODGKIN LYMPHOMA

2016 ◽  
pp. 59-65 ◽  
Author(s):  
Van Mao Nguyen
Keyword(s):  
Lymph Node ◽  
Hodgkin Lymphoma ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Cross Sectional ◽  
Histopathological Classification ◽  
Non Hodgkin Lymphoma ◽  
Key Words Lymphoma ◽  
Malignant Grade

Background: Lymphoma is one of the most ten common cancers in the world as well as in Vietnam which has been ever increasing. It was divided into 2 main groups Hodgkin and non – Hodgkin lymphoma in which non-Hodgkin lymphoma appeared more frequency, worse prognosis and different therapy. Objectives: - To describe some common characteristics in patients with non – Hodgkin lymphoma; - To determine the proportion between Hodgkin and non- Hodgkin lymphoma, histopathological classification of classical Hodgkin by modified Rye 1966 and non-Hodgkin lymphoma by Working Formulation (WF) of US national oncology institute 1982. Materials and Method: This cross-sectional study was conducted on 65 patients with Hodgkin and non- Hodgkin lymphoma diagnosed definitely by histopathology at Hue Central Hospital and Hue University Hospital. Results:. The ratio of male/female for the non-Hodgkin lymphoma was 1.14/1, the most frequent range of age was 51-60 accounting for 35%, not common under 40 years. Non - Hodgkin lymphoma appeared at lymph node was the most common (51.7%), at the extranodal site was rather high 48.3%. The non - Hodgkin lymphoma proportion was predominant 92.3% comparing to the Hodgkin lymphoma only 7.7%; The most WF type was WF7 (53.3%), following the WF6 18,3% and WF5 11,7%; The intermediate malignancy grade of non- Hodgkin lymphoma was the highest proportion accouting for 85%, then the low and the high one 8.3% and 6.7% respectively. Conclusion: The histopathological classification and the malignant grade of lymphoma for Hodgkin and non - Hodgkin lymphoma played a practical role for the prognosis and the treatment orientation, also a fundamental one for the modern classification of non - Hodgkin lymphoma nowadays. Key words: lymphoma, Hodgkin lymphoma, non-Hodgkin lymphoma, classication, grade, histopathology, lymph node

Hepatitis A Seroprevalence Among Patients with Chronic Hepatitis B Infection: A Cross-Sectional Study in Iran During 2016-2017

2020 ◽  
Vol 20 (5) ◽  
pp. 748-751
Author(s):  
Seyed Ali Dehghan Manshadi ◽  
Neda Alijani ◽  
Mohammadreza Salehi ◽  
Omid Dadras ◽  
SeyedAhmad SeyedAlinaghi ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis B ◽  
Chronic Hepatitis B ◽  
Hepatitis A ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Cross Sectional ◽  
Reasonable Approach ◽  
The Difference ◽  
Prevention Method

Introduction: The aim of this study was to determine the prevalence of exposure to hepatitis A by means of serologic markers in chronic hepatitis B patients, with the secondary aim of finding the best prevention method for hepatitis A infection in susceptible groups of our setting. Methods: During the period between 2016 and 2017, we recruited 403 hepatitis B patients aged more than 14 years and regularly attending the infectious diseases clinic at a referral university hospital, Tehran, Iran. A blood sample was collected from all the patients and tested for hepatitis A IgG. The data was analyzed by SPSS v.19. Results: Although none of the patients had previously received hepatitis A vaccine, the results for serologic level of hepatitis A IgG, demonstrated positive results in 379 (94%) cases. The mean age of patients with negative and positive IgG was 29.17 and 42.46 years, respectively; the difference was statistically significant (P≤0.001). The majority of seronegative patients were young adults aged < 25 years and 25 to 35 years (P <0.001). Conclusion: Seroprevalence of hepatitis A in chronic HBV patients in Iran is high. As HBV infected patients younger than 35 years could be seronagative for HAV infection, evaluation of these patients for HAV infection and vaccination of seronegative patients would be a reasonable approach.

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