scholarly journals Ketamine Prolonged Infusions in the Pediatric Intensive Care Unit: a Tertiary-Care Single-Center Analysis

2021 ◽  
Vol 26 (1) ◽  
pp. 73-80
Author(s):  
Francesca Sperotto ◽  
Irene Giaretta ◽  
Maria C. Mondardini ◽  
Federico Pece ◽  
Marco Daverio ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Adverse Events ◽  
Care Center ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Analgesic Agent ◽  
Epileptic Patients ◽  
Prolonged Sedation ◽  
Infusion Duration

OBJECTIVE Ketamine is commonly used as an anesthetic and analgesic agent for procedural sedation, but there is little evidence on its current use as a prolonged continuous infusion in the PICU. We sought to analyze the use of ketamine as a prolonged infusion in critically ill children, its indications, dosages, efficacy, and safety. METHODS We retrospectively reviewed the clinical charts of patients receiving ketamine for ≥24 hours in the period 2017–2018 in our tertiary care center. Data on concomitant treatments pre and 24 hours post ketamine introduction and adverse events were also collected. RESULTS Of the 60 patients included, 78% received ketamine as an adjuvant of analgosedation, 18% as an adjuvant of bronchospasm therapy, and 4% as an antiepileptic treatment. The median infusion duration was 103 hours (interquartile range [IQR], 58–159; range, 24–287), with median dosages between 15 (IQR, 10–20; range, 5–47) and 30 (IQR, 20–50; range, 10–100) mcg/kg/min. At 24 hours of ketamine infusion, dosages/kg/hr of opioids significantly decreased (p < 0.001), and 81% of patients had no increases in dosages of concomitant analgosedation. For 27% of patients with bronchospasm, the salbutamol infusions were lowered at 24 hours after ketamine introduction. Electroencephalograms of epileptic patients (n = 2) showed resolution of status epilepticus after ketamine administration. Adverse events most likely related to ketamine were hypertension (n = 1), hypersalivation (n = 1), and delirium (n = 1). CONCLUSIONS Ketamine can be considered a worthy strategy for the analgosedation of difficult-to-sedate patients. Its use for prolonged sedation allows the sparing of opioids. Its efficacy in patients with bronchospasm or status epilepticus still needs to be investigated.

scholarly journals A OBSERVATIONAL STUDY CLINICAL, EPIDEMIOLOGICALAND ETIOLOGICAL PROFILE IN PEDIATRIC STATUS EPILEPTICUS IN A TERTIARY CARE CENTER IN WEST BENGAL

2020 ◽  
pp. 3-5
Author(s):  
Dipanjan Halder ◽  
Neha Karar ◽  
Sabyasachi Som ◽  
Debarshi Jana
Keyword(s):  
Status Epilepticus ◽  
West Bengal ◽  
Economic Status ◽  
Care Center ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Lower Class ◽  
Age Group ◽  
Tertiary Care Center ◽  
Pediatric Age Group

INTRODUCTION: Status epilepticus (SE) is a medical and neurological emergency. The objectives of the study were to determine the clinical, etiological and epidemiological profile of SE in pediatric age group admitted to pediatric intensive care unit (PICU) in a tertiary care center at West Bengal. MATERIAL AND METHOD: An observational descriptive study, 108 children with age more than 28 days and upto 12 years presenting with SE were included in Department of Pediatric Medicine, R.G.Kar Medical College and Hospital, Kolkata from January 2016 to January 2017. RESULTS AND DISCUSSION: Test of proportion showed that the proportion of the patients in the age group 5-10 years (54.6%) were significantly higher than other age group (Z= 2.75; p=0.006). 11(10.2%) patient was with age<1 year. Acute Symptomatic (38.9%) was the commonest among the etiologies followed by Idiopathic (31.5%) which were significantly higher than other etiologies (Z=4.36;p<0.001). CONCLUSION: Patients with younger age are more vulnerable to develop SE. Most of the children belonged to lower class socio-economic status. Acute symptomatic is the most common etiology followed by idiopathic.Convulsive SE with generalized tonic clonic type of convulsion is the most common variety.

scholarly journals Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Novel Coronavirus (SARS-CoV-2) Infection: A Report on Two Cases

2021 ◽  
Vol 16 (1) ◽  
pp. 76-79
Author(s):  
Nurun Nahar Fatema Begum ◽  
Abdullah Al Amin ◽  
Maksuda Begum ◽  
Md Ferdousur Rahman Sarker ◽  
Nazmul Islam Bhuiyan ◽  
...  
Keyword(s):  
Critically Ill ◽  
Troponin I ◽  
Care Center ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Military Hospital ◽  
Healthy Children ◽  
Novel Coronavirus ◽  
Inflammatory Syndrome

We report two critically ill children (aged 5–8 years), presented with features of multisystem inflammatory syndrome in children (MIS-C) from January 1 to February 2, 2021 at a tertiary-care center (Combined Military Hospital) in Dhaka, Bangladesh. Both of the previously healthy children tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Clinical presentations were similar in both with fever, gastrointestinal complaints, respiratory distress, rash, headache and myalgia. Laboratory values were high levels of C-reactive protein, D-dimers, B-type natriuretic peptide (Pro-BNP), troponin I and low albumin levels in both patients. Evaluations for other infectious diseases werenegative. Both the patients were critically ill, requiring admission to the pediatric intensive care unit (P-ICU) due to circulatory shock and needed inotropes. One of the patients had respiratory failure and required mechanical ventilation. Both patients received steroids, Intravenous Immunoglobulin (IVIG), Remdesivir, Tocilizumab. MIS-C is a recently recognized pediatric illness spectrum in association with SARS-CoV-2 infection. As for manifestations of COVID-19 infection and its consequences in children is myriad and knowledge about MIS-C is evolving, reporting is essential for better understanding of clinical clues of MIS-C and finding out a panacea through experience sharing. JAFMC Bangladesh. Vol 15, No 1 (June) 2020: 76-79

Utilizing serum bicarbonate instead of venous pH to transition from intravenous to subcutaneous insulin shortens the duration of insulin infusion in pediatric diabetic ketoacidosis

2019 ◽  
Vol 32 (1) ◽  
pp. 11-17
Author(s):  
Jennifer Gauntt ◽  
Priya Vaidyanathan ◽  
Sonali Basu
Keyword(s):  
Adverse Events ◽  
Diabetic Ketoacidosis ◽  
Insulin Infusion ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Regular Insulin ◽  
Serum Bicarbonate ◽  
Transition Group ◽  
Serum Bicarbonate Level ◽  
Transition Criteria

Abstract Background Standard therapy of diabetic ketoacidosis (DKA) in pediatrics involves intravenous (IV) infusion of regular insulin until correction of acidosis, followed by transition to subcutaneous (SC) insulin. It is unclear what laboratory marker best indicates correction of acidosis. We hypothesized that an institutional protocol change to determine correction of acidosis based on serum bicarbonate level instead of venous pH would shorten the duration of insulin infusion and decrease the number of pediatric intensive care unit (PICU) therapies without an increase in adverse events. Methods We conducted a retrospective (pre/post) analysis of records for patients admitted with DKA to the PICU of a large tertiary care children’s hospital before and after a transition-criteria protocol change. Outcomes were compared between patients in the pH transition group (transition when venous pH≥7.3) and the bicarbonate transition group (transition when serum bicarbonate ≥15 mmol/L). Results We evaluated 274 patient records (n=142 pH transition group, n=132 bicarbonate transition group). Duration of insulin infusion was shorter in the bicarbonate transition group (18.5 vs. 15.4 h, p=0.008). PICU length of stay was 3.2 h shorter in the bicarbonate transition group (26.0 vs. 22.8 h, p=0.04). There was no difference in the number of adverse events between the groups. Conclusions Transitioning patients from IV to SC insulin based on serum bicarbonate instead of venous pH led to a shorter duration of insulin infusion with a reduction in the number of PICU therapies without an increase in the number of adverse events.

scholarly journals Accidental tramadol ingestion in children admitted in tertiary care centre

2019 ◽  
Vol 8 (12) ◽  
pp. 2661
Author(s):  
Vadlakonda Sruthi ◽  
Annaladasu Narendra
Keyword(s):  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Ventilatory Support ◽  
Case Series ◽  
Pediatric Intensive Care ◽  
Hemodynamic Instability ◽  
Tertiary Care Centre ◽  
Medical College ◽  
History Of

Background: Tramadol use has been increasing in the adult and pediatric population. Practitioners must be alert because Tramadol misuse can lead to severe intoxication in which respiratory failure and seizures are frequent. Overdoses can lead to death. We report 47 pediatric cases with history of accidental tramadol exposure in children.Methods: An observational, retrospective, single center case -series of children with a history of accidental tramadol exposure in children admitted in pediatric intensive care unit of tertiary care center, Niloufer Hospital (Osmania Medical College) Hyderabad, Telangana India.Results: Of 47 children, 22 (47%) are male and 25 (53%) were female. At presentation 11 (23%) had loss of consciousness, 14 (29%) seizures, 17 (36%) hypotonia was noted. Pupils were miotic in 22 (47%) mydriatic in 2 (4.2%) normal in rest of children. Hemodynamic instability noted in 13 (27.6%). Serotonin syndrome (tachycardia, hyperthermia, hypertension, hyper reflex, clonus) was noted on 5 (10.6%) children. Respiratory depression was seen in 4 (8%) children who needed ventilatory support. Antidote Naloxone was given in 7 children. No adverse reaction was noted with Naloxone. All 47 children were successfully discharged.Conclusions: Overdoses can lead to death and practitioners must be alert because of the increasing use of tramadol in the adult and pediatric population. The handling of the tramadol should be explained to parents and general population and naloxone could be efficient when opioid toxicity signs are present.

Peritoneal dialysis in critically ill children in resource-limited setting: A prospective cohort study

2020 ◽  
pp. 089686082097589
Author(s):  
Pallavi Choudhary ◽  
Virendra Kumar ◽  
Abhijeet Saha ◽  
Archana Thakur
Keyword(s):  
Mechanical Ventilation ◽  
Peritoneal Dialysis ◽  
Renal Impairment ◽  
Critically Ill ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Renal Outcome ◽  
Severe Dengue ◽  
Critically Ill Children

Background: Peritoneal dialysis (PD) is easily available and simple lifesaving procedure in children with renal impairment. There is paucity of reports on efficacy of PD in critically ill children in presence of shock and those requiring mechanical ventilation. Methods: In this prospective observational study, efficacy and outcome of PD were evaluated in 50 critically ill children aged 1 month to 14 years admitted in pediatric intensive care unit of a tertiary care teaching hospital in India. Results: Indication of PD was acute kidney injury (AKI) in 66% of patients followed by chronic kidney disease with acute deterioration due to infectious complications in 34%. Bacterial sepsis was the most common cause of AKI (22%), others being malaria (14%) and severe dengue (12%). At initiation of PD, 26% of patients were in shock and 46% were mechanically ventilated. PD was effective and improvement in pH, bicarbonate, and lactate started within hours, with consistent improvement in estimated glomerular filtration rate by 24 h, which continued till the end of procedure, including the subgroup of patients with shock and mechanical ventilation. Total complications were seen in 14% and of which peritonitis was present in 4.0% of patients. Mortality was seen in 14% (7/50) of patients. Shock at initiation of PD (odds ratio (OR), 5.03; 95% confidence interval (CI), 0.95–26.69; p < 0.04) and requirement of mechanical ventilation (OR, 9.17; 95% CI, 1.01–83.10; p < 0.02) were associated with mortality. Conclusions: Acute PD in critically ill children with renal impairment is a lifesaving procedure. Treatment of shock with resuscitative measures and respiratory failure with mechanical ventilation, along with PD, resulted in favorable renal outcome.

scholarly journals Transfusion-related adverse events at the tertiary care center in North India: An institutional hemovigilance effort

2011 ◽  
Vol 5 (2) ◽  
pp. 164 ◽  
Author(s):  
Neelam Marwaha ◽  
Pallab Roy ◽  
Prasun Bhattacharya ◽  
HariKrishan Dhawan ◽  
RR Sharma
Keyword(s):  
Adverse Events ◽  
Care Center ◽  
Tertiary Care ◽  
North India ◽  
Tertiary Care Center

scholarly journals Secondary overtriage of pediatric neurosurgical trauma at a Level I pediatric trauma center

2018 ◽  
Vol 22 (4) ◽  
pp. 375-383 ◽  
Author(s):  
Charles E. Mackel ◽  
Brent C. Morel ◽  
Jesse L. Winer ◽  
Hannah G. Park ◽  
Megan Sweeney ◽  
...  
Keyword(s):  
Brain Injuries ◽  
Care Center ◽  
Tertiary Care ◽  
Pediatric Trauma ◽  
Pediatric Intensive Care ◽  
Ct Scans ◽  
Loss Of Consciousness ◽  
Skull Fractures ◽  
Level I ◽  
Neurosurgical Intervention

OBJECTIVEThe authors reviewed the transfer requests for isolated pediatric traumatic brain injuries (TBIs) at a Level I/II facility with the goal of identifying clinical and radiographic traits associated with potentially avoidable transfers that could be safely managed in a non–tertiary care setting.METHODSThe authors conducted a retrospective study of patients < 18 years of age classified as having TBI and transferred to their Level I tertiary care center over a 12-year period. The primary outcome of interest was identifying potentially avoidable transfers, defined as transfers of patients not requiring any neurosurgical intervention and discharged 1 hospital day after admission.RESULTSOverall, 70.8% of pediatric patients with isolated TBI did not require neurosurgical intervention or monitoring, indicating an avoidable transfer. Potentially avoidable transfers were associated with outside hospital imaging that was negative (86%) or showed isolated, nondisplaced skull fractures (86%) compared to patients with cranial pathology (53.8%, p < 0.001) as well as age ≤ 6 years (81% [negative imaging/isolated, nondisplaced fractures] vs 54% [positive cranial pathology], p < 0.001). The presence of headaches, nonfocal deficits, and loss of consciousness were associated with necessary transfer (p < 0.05). Patients with potentially avoidable transfers underwent frequent repeat CT studies (19.1%) and admissions to the pediatric intensive care unit (55.9%) but at a lower rate than those whose transfers were necessary (p < 0.001). Neurosurgical interventions occurred in 11% of patients with cranial pathology, which accounted for 17.9% of necessary transfers and 5.2% of all transfers.CONCLUSIONSIn the authors’ region, potentially up to 70% of interfacility transfers for pediatric brain trauma in the absence of other systemic injuries warranting surgical intervention may not require neurosurgical intervention and could be managed locally. No patients transferred with isolated, nondisplaced skull fractures or negative CT scans required neurosurgical intervention, and 86% were discharged the day after admission. In contrast, 11% of patients with CT scans indicative of cranial pathology required neurosurgical intervention. Age > 6 years, loss of consciousness, and nonfocal deficits were associated with a greater likelihood of needing a transfer. Further studies are required to clarify which patients can be managed at local institutions, but referring centers should practice overcaution given the potential risks.

P2853Contemporary reporting of acute complications from implantable cardioverter defibrillator surgery

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Hassan ◽  
D Birnie ◽  
P Nery ◽  
G Nair ◽  
D Davis ◽  
...  
Keyword(s):  
Adverse Events ◽  
Pulse Generator ◽  
De Novo ◽  
Care Center ◽  
Tertiary Care ◽  
Adverse Outcomes ◽  
Physician Remuneration ◽  
Major Adverse Events ◽  
Lead Dislodgement

Abstract Background Defibrillator placement carries an inherent risk to the patient. Traditionally, major adverse events defined as cardiac arrest, tamponnade, pneumothorax, infection requiring re-operation, MI and CVA within 30 days are reported to occur between 3 and 4%. Minor complications such as heamatomae or lead dislodgement are reported between 8 and 13%. Novel lead technologies, protocolised programming and reduced use of Heparin bridging have been reported to reduce adverse outcomes. However, patients are still typically monitored in hospital for 24 hours to mitigate these risks. There is little evidence that discharge delay is effective yet incurs significant additional costs. Purpose We sought to evaluate the frequency and timing of adverse events relating to defibrillator surgery (ICD and CRT-D) at a large Canadian tertiary care center (UOHI). Methods We retrospectively reviewed all patients who received a defibrillator placed from 1st April 2013 to 31st March 2018 inclusive. Patient comorbidities were extracted from the hospital electronic medical record (EMR) system. Device related information and complications were extracted from UOHI PaceartTM system and EMR and cross referenced with physician remuneration databases. Results A total of 2221 procedures were performed on 2153 patients (78% male, mean age 65 years). The majority (60%) of defibrillator implants were de novo, with 884 (40%) pulse generator replacements/ upgrades and 868 (39%) defibrillators had CRT capability. Patients were routinely discharged within 24 hours of ICD surgery. Post-operative follow up ≥30 days was complete in 97% patients. Major adverse events occurred within 30 days in 9 patients (0.4%); 9 (100%) were infection requiring re-operation. An additional 32 patients (1.5%) required repeat interventions or readmission within 30 days of implant, most commonly due to lead dislodgement. Only 2 patients required readmission within 24 hours of surgery (0.1%). All procedure-related adverse events during clinical follow up (≤5 years) were 131 (5.9%) occurring in 122 patients. There were no apparent predictors of adverse events in this cohort. Conclusion(s) Contemporary risks to patients undergoing defibrillator surgery are considerably lower than that reported in 2010. The risk of infection appears constant despite increased antibiosis. Patients receiving an ICD or CRT-D can safely be discharged within 24 hours if no complications are apparent. Acknowledgement/Funding None

Sign in / Sign up

Export Citation Format

Share Document