scholarly journals Successful Treatment of Severely Hypotensive Pediatric Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) with the Guidance of Invasive Hemodynamic Monitoring: A Report of Three Cases

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Amir Saeed ◽  
Nima Mehdizadegan
Keyword(s):  
Hemodynamic Monitoring ◽  
Pediatric Patients ◽  
Treatment Plan ◽  
Case Series ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Invasive Hemodynamic Monitoring ◽  
Severe Hypotension ◽  
Pediatric Sepsis ◽  
Inflammatory Syndrome

Introduction: Since the beginning of the coronavirus disease 2019 (COVID-19) outbreak, it was assumed that infection rate in pediatric patients is lower than in adults and that infection is less severe in children than adult patients. Recently, there have been several reports and case series presenting critically-ill children with COVID-19, but still, severe hypotension is rare in pediatric patients with COVID-19. Case Presentation: We describe three pediatric cases with COVID-19 who presented with multi-system organ failure and severe hypotension treated with the guidance of the parameters of an invasive continuous hemodynamic monitoring device. We also compare their parameters with few articles on pediatric sepsis parameters. Conclusions: Although we usually start the treatment of hypotensive pediatric patients with hydration and epinephrine as an inotrope, in our cases, we required a different treatment plan according to the hemodynamic monitoring parameters, which indicates the value of the utilization of these devices in pediatric intensive care units

scholarly journals Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Alberto García-Salido ◽  
◽  
Juan Carlos de Carlos Vicente ◽  
Sylvia Belda Hofheinz ◽  
Joan Balcells Ramírez ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Gastrointestinal Symptoms ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Vasoactive Drugs ◽  
Pediatric Intensive Care Units ◽  
Neutrophil Lymphocyte Ratio ◽  
Inflammatory Syndrome ◽  
To Receive

Abstract Background Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. Methods A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. Results Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5–11.8) vs 3.4 years (IQR 0.4–9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5–8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. Conclusions MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients.

scholarly journals A Conscious Sedation Protocol for Videolaryngostroboscopy in Pediatric Patients

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Samantha Anne ◽  
Lawrence M. Borland ◽  
Laura Haibeck ◽  
Joseph E. Dohar
Keyword(s):  
Outcome Measures ◽  
Pediatric Patients ◽  
Conscious Sedation ◽  
Treatment Plan ◽  
Tertiary Care ◽  
Case Series ◽  
Diagnostic Information ◽  
Secondary Outcome ◽  
Sedation Protocol

Objective. To determine best sedation protocol for videolaryngostroboscopy in children unable to tolerate non-sedated evaluation.Materials and Methods.Consecutive case series of 10 children with voice disturbances, unable to tolerate nonsedated videolaryngostroboscopy at an academic tertiary care children’s hospital. Flexible fiberoptic videolaryngostroboscopy was performed and interpreted by pediatric otolaryngologist and speech and language pathologist. Sedation was administered with newly described protocol that allowed functional portion of evaluation.Main Outcome Measures: ability to follow commands and tolerate flexible fiberoptic videolaryngostroboscopy.Secondary Outcome Measures: total phonation time, complications, need for subsequent videolaryngostroboscopic attempts, clinical outcomes, and follow-up.Results. 10 children underwent procedure under conscious sedation. 9/10 children were able to perform simple tasks and maintain adequate phonation time to complete stroboscopic exam. 1/10 patients failed to complete exam because of crying during entire exam. Mean exam time was 2 minutes 52 seconds (SD 86 seconds), phonation time is 1 minute 44 seconds (SD 60 seconds), and number of tasks completed was 10.5 (SD 8.6).Conclusions. Conscious sedation for videolaryngostroboscopy can be safely and effectively performed in children unable to comply with nonsedated examination. Such studies provide valuable diagnostic information to make a diagnosis and to devise a treatment plan.

scholarly journals Serie de Casos: Intoxicación por Amlodipino

2020 ◽  
Vol 12 (2) ◽  
pp. 145-150
Author(s):  
Carlos Fernando Ordoñez Troya ◽  
Giovanni Paolo González Pazmiño ◽  
Lupe Nataly Mora Robles ◽  
María Eduarda Clavijo Izquierdo
Keyword(s):  
Laboratory Tests ◽  
Pediatric Patients ◽  
Clinical Course ◽  
Case Reports ◽  
Treatment Plan ◽  
Low Frequency ◽  
Pediatric Intensive Care ◽  
Evidence Based ◽  
Support Measures

BACKGROUND: Drug poisoning is an important cause of morbidity and mortality in pediatric patients. However, amlodipine poisoning, a widely used dihydropyridine calcium chanel blocker, is not fully documented in Ecuador. Treatment consists of classic measures for shock management and specific measures for this type of intoxication. CASE REPORTS: We present two case reports, both of teenage patients admitted into the pediatric intensive care unit for suicide attempt by taking amlodipine and some other drugs. EVOLUTION: During hospital stay, they presented a different evolutionary course. In both cases vasoactive drugs were needed, dosage was modified according to clinical course. Also in both patients, calcium gluconate was administered along with other support measures described in this paper. Finally, both patients presented a good outcome and were discharged after psychological and psychiatric assessment and follow up. CONCLUSION: The low frequency of amlodipine poisoning and the lack of evidence-based knowledge, constitute it as a diagnostic and therapeutic challenge. Based on our experience, we highlight the importance of early suspicion and prioritizing the use of vasopressors over fluid resuscitation. Additionally, we recommend documenting the exact dose of intake and inquiring about consumption of other drugs to properly classify the severity of the poisoning and stablish the treatment plan. Finally, constant clinical monitoring and support of laboratory tests will guide the conduct.

scholarly journals Piperacillin/Tazobactam and Antibiotic-Associated Acute Kidney Injury in Critically Ill Children

2019 ◽  
Vol 30 (11) ◽  
pp. 2243-2251 ◽  
Author(s):  
Emily L. Joyce ◽  
Sandra L. Kane-Gill ◽  
Priyanka Priyanka ◽  
Dana Y. Fuhrman ◽  
John A. Kellum
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Primary Outcome ◽  
Pediatric Patients ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Lengths Of Stay ◽  
Medication Exposure ◽  
Secondary Outcomes

BackgroundThere continues to be uncertainty about whether piperacillin/tazobactam (TZP) increases the risk of AKI in critically ill pediatric patients. We sought to compare rates of AKI among critically ill children treated with TZP or cefepime, an alternative frequently used in intensive care units, with and without vancomycin.MethodsWe conducted a retrospective cohort study assessing the risk of AKI in pediatric intensive care unit patients after exposure to vancomycin, TZP, and cefepime, alone or in combination, within 48 hours of admission. The primary outcome was development of stage 2 or 3 AKI or an increase in AKI stage from 2 to 3 within the 6 days after the 48-hour exposure window. Secondary outcomes included lengths of stay, need for RRT, and mortality.ResultsOf 5686 patients included, 494 (8.7%) developed stage 2 or 3 AKI. The adjusted odds of developing AKI after medication exposure were 1.56 for TZP (95% confidence interval [95% CI], 1.23 to 1.99), 1.13 for cefepime (95% CI, 0.79 to 1.64), and 0.86 for vancomycin (95% CI, 0.69 to 1.07). The adjusted odds of developing AKI for vancomycin plus TZP versus vancomycin plus cefepime was 1.38 (95% CI, 0.85 to 2.24).ConclusionsObservational data in critically ill children show that TZP use is associated with increased odds of AKI. A weaker, nonsignificant association between vancomycin plus TZP and AKI compared with vancomycin plus cefepime, creates some uncertainty about the nature of the association between TZP and AKI. However, cefepime is an alternative not associated with AKI.

scholarly journals Multisystem Inflammatory Syndrome in Children During the Coronavirus 2019 Pandemic: A Case Series

2020 ◽  
Vol 9 (3) ◽  
pp. 393-398 ◽  
Author(s):  
Kathleen Chiotos ◽  
Hamid Bassiri ◽  
Edward M Behrens ◽  
Allison M Blatz ◽  
Joyce Chang ◽  
...  
Keyword(s):  
Critically Ill ◽  
Mucous Membrane ◽  
Case Series ◽  
Critically Ill Children ◽  
Membrane Changes ◽  
Inflammatory Syndrome

Abstract We present a series of 6 critically ill children with multisystem inflammatory syndrome in children. Key findings of this syndrome include fever, diarrhea, shock, and variable presence of rash, conjunctivitis, extremity edema, and mucous membrane changes.

Etiology of Fever and Opportunities for Reduction of Antibiotic Use in a Pediatric Intensive Care Unit

2001 ◽  
Vol 22 (08) ◽  
pp. 499-504 ◽  
Author(s):  
Philip Toltzis ◽  
Bonnie Rosolowski ◽  
Ann Salvator
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Tertiary Care ◽  
Case Series ◽  
Pediatric Intensive Care ◽  
Antibiotic Use ◽  
Critically Ill Children ◽  
Axillary Temperature ◽  
Prospective Case Series

Abstract Objective: To determine the cause of fever in critically ill children and to identify opportunities for reducing antibiotic use in this population. Design: Prospective case series. Setting: A tertiary-care medical-surgical pediatric intensive care unit (PICU). Patients: Children admitted to the PICU who experienced fever (axillary temperature &gt;38.3°C). Measurements: Consecutive children who were febrile at any point in their PICU stay were investigated over two winter seasons. Etiology of the fever was determined by physical examination and routine microbiology and radiographic tests. Three subgroups were reviewed to approximate the number of antibiotic-days that could have been reduced; namely, those with an indeterminate source, those with a documented viral infection, and those receiving a prolonged course of antibiotics. A set of standards reflecting common antibiotic use then was applied to these three patient groups. Results: Of 211 subjects, the majority (83.3%) had either a definitive or suspected focus for their fever, and nearly all of these patients were judged to have an infectious etiology. The study population received a total of 2,036 antibiotic-days. Despite the high incidence of infectious causes of fever in our subjects, however, approximately 15% of total antibiotic-days could have been reduced by applying common-use standards. Conclusions: Fever in the PICU was usually of defined focus and infectious in origin. However, among febrile patients in the PICU, substantial opportunity exists for reduction of antibiotic use. Trials determining the safety of antibiotic reduction in this population should be pursued vigorously.

scholarly journals Comparison of three non-invasive hemodynamic monitoring methods in critically ill children

PLoS ONE ◽  
2018 ◽  
Vol 13 (6) ◽  
pp. e0199203 ◽  
Author(s):  
Chanapai Chaiyakulsil ◽  
Marut Chantra ◽  
Poomiporn Katanyuwong ◽  
Anant Khositseth ◽  
Nattachai Anantasit
Keyword(s):  
Critically Ill ◽  
Hemodynamic Monitoring ◽  
Critically Ill Children ◽  
Monitoring Methods ◽  
Non Invasive ◽  
Invasive Hemodynamic Monitoring

scholarly journals Multiple organ dysfunction in children admitted at pediatric intensive care unit of the Children Hospital, Multan.

2020 ◽  
Vol 27 (11) ◽  
pp. 2345-2349
Author(s):  
Huma Iqbal ◽  
Asim Khurshid ◽  
Ayesha Fayyaz
Keyword(s):  
Intensive Care ◽  
Organ Dysfunction ◽  
Rural Areas ◽  
Maternal Education ◽  
Case Series ◽  
Pediatric Intensive Care ◽  
Multiple Organ ◽  
Critically Ill Children ◽  
Multiple Organ Dysfunction ◽  
Residential Status

Objectives: Multiple organ dysfunction syndrome (MODS) is commonly encountered by pediatricians in Pediatric Intensive care Units (PICUs) among critically ill children. This study was done to find out the frequency of MODS in children admitted at PICU. Study Design: Case series. Setting: Department of Pediatrics Medicine, The Children’s hospital and the Institute of Child Health, Multan. Period: From May to November 2019. Material & Methods: Variables recorded for each case included age, gender, residential status, maternal education, height, weight and BMI. Venous blood sample was sent to the hospital pathology laboratory for baseline investigations to diagnose MODS. Results: Of these 101 study cases, majority, 61 (60.4 %) were male, 51 (50.5 %) belonged to rural areas, 74 (73.3%) from middle income families and 72 (71.3%) mothers of admitted children were illiterate. Overall mean age was 3.62 ± 1.95 years while mean body mass index was 24.85 ± 2.20 kg/m.2 Mean duration of PICU stay was 4.31 ± 3.39 day and 69 (68.3 %) had duration of PICU stay up to 5 days. Of these 101 study cases, multiple organ dysfunction was noted in 33 (32.7%). Conclusion: High Frequency of MOD was observed among children admitted to PICU. MODS was found to have association with male gender, residential status as rural, maternal education status as illiterate, obesity and duration of PICU of more than 5 days.

scholarly journals Impact of Acute Kidney Injury on Critically Ill Children and Neonates

2021 ◽  
Vol 9 ◽  
Author(s):  
Bassil Leghrouz ◽  
Ahmad Kaddourah
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Critically Ill ◽  
Pediatric Patients ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Clinical Syndrome ◽  
Morbidity And Mortality ◽  
Critically Ill Children ◽  
Critically Ill Neonates

Acute kidney injury (AKI) is a clinical syndrome that manifests as an abrupt impairment of kidney function. AKI is common in critically ill pediatric patients admitted to the pediatric intensive care units. AKI is a deleterious complication in critically ill children as it is associated with increased morbidity and mortality. This review provides an overview of the incidence, morbidity, and mortality of AKI in critically ill children in general and specific cohorts such as post-cardiac surgeries, sepsis, critically ill neonates, and post stem cell transplantation.

scholarly journals The Platelet-to-lymphocyte ratio, PELOD-2 score, and mortality rate in pediatric sepsis

2021 ◽  
Vol 61 (4) ◽  
pp. 186-91
Author(s):  
Novie Homenta Rampengan ◽  
Gregory Joey ◽  
Ferry Kurniawan ◽  
Jeanette I. Ch. Manoppo ◽  
Ari Lukas Runtunuwu
Keyword(s):  
Mortality Rate ◽  
Organ Dysfunction ◽  
Pediatric Patients ◽  
Pediatric Intensive Care ◽  
Scoring Systems ◽  
Platelet To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Logistic Organ Dysfunction ◽  
Increased Risk ◽  
Pediatric Sepsis

Background Sepsis is life-threatening organ dysfunction caused by a regulated immune response to infection. Sepsis remains the most common cause of death in infants and children worldwide. The Pediatric Logistic Organ Dysfunction (PELOD-2) score, one of the most widely used scoring systems in pediatric sepsis patients, has been shown to be accurate in predicting mortality. The platelet-to-lymphocyte ratio (PLR) is a new clinical indicator of inflammation in a variety of diseases including sepsis. Objective To investigate the relationship between PLR, PELOD-2 score, and clinical outcomes in pediatric patients with sepsis. Methods This retrospective cohort study was conducted in the Pediatric Intensive Care Unit (PICU), Prof R.D. Kandou Hospital, Manado, North Sulawesi, from February to August 2020. Subjects’ PELOD-2 score and PLR were recorded once within the first 24 hours of PICU admission. We analyzed patients’ PELOD-2 score, PLR, and mortality rate, with 95% confidence interval (CI) for each value. Results Of 96 children with sepsis admitted to the PICU during the study period, 87 patients (46 boys; 52.9%) met the inclusion criteria. In total, 50 (57.47%) patients were non-survivors. Mean PLR values among survivors [77.54 (SD 50.08)] was significantly lower compared to the values among non-survivors [157.13 (SD 67.38)]; as well as the PELOD-2 score in the survivors group [12 (SD 1.32)] was significantly lower than its value in the non-survivors [14.65 (SD 2.09)]. Spearman’s analysis showed a moderately positive correlation between PLR and PELOD-2 score (r=0.444; 95%CI 0.44 to 1; P<0.01). Biserial point correlation analysis revealed a significant association between PLR and mortality rate (rpb=0.566; P<0.0001),with elevated PLR related to an increased risk of mortality. Conclusion There are positive correlations between PLR, PELOD-2 score, and mortality rate in pediatric patients with sepsis. Higher PLR and PELOD-2 score are associated with higher mortality.

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