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.

Peritoneal Dialysis with Rigid Catheters in Children with Acute Kidney Injury: A Single-Centre Experience

2022 ◽  
Author(s):  
Manasi Garg ◽  
Lalitha A. V. ◽  
Anil Vasudevan
Keyword(s):  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Critically Ill ◽  
Dengue Infection ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Renal Outcome ◽  
Critically Ill Children ◽  
Care Hospital ◽  
Major Life

AbstractPeritoneal dialysis (PD) is a simple and preferred modality of dialysis for children with acute kidney injury (AKI) in resource poor countries. The aim of the study is to evaluate the utility and safety of acute PD using rigid catheter in critically ill children admitted to pediatric intensive care unit (PICU) with emphasis on short-term patient and renal outcome and complications. In this retrospective study, outcome and complications of PD using rigid catheter were evaluated in 113 critically ill children admitted in PICU of a tertiary care hospital from 2014 to 2019. The most common causes for AKI were sepsis (39.8%), dengue infection (16.8%), and hemolytic uremic syndrome (13.2%). In 113 patients, 122 PD catheters were inserted, and the median duration of PD was 60 (IQR: 36–89) hours. At the initiation of PD, 64 (56.6%) patients were critically ill requiring mechanical ventilation and inotropes, 26 (23%) had disseminated intravascular coagulation, and 42 (37%) had multiorgan dysfunction syndrome. PD was effective and there was a significant improvement in urea and creatinine, and one-third patients (n = 38; 33.6%) had complete renal recovery at the end of PD. Total complications were seen in 67% children but majority of them were metabolic (39.8%). Total catheter related complications were seen in 21.2% and peritonitis was seen in 4.4%. Catheter removal due to complications was required in 8.8% children. Overall, among children on PD, 53.7% survived. Acute PD with rigid catheters can be performed bedside in absence of soft catheters and significant clearance can be obtained without major life-threatening complications.

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 Renal angina index predicts fluid overload in critically ill children: an observational cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Stephen M. Gorga ◽  
Erin F. Carlton ◽  
Joseph G. Kohne ◽  
Ryan P. Barbaro ◽  
Rajit K. Basu
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Fluid Overload ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Poor Outcomes ◽  
Renal Angina Index ◽  
Renal Angina

Abstract Background Fluid overload and acute kidney injury are common and associated with poor outcomes among critically ill children. The prodrome of renal angina stratifies patients by risk for severe acute kidney injury, but the predictive discrimination for fluid overload is unknown. Methods Post-hoc analysis of patients admitted to a tertiary care pediatric intensive care unit (PICU). The primary outcome was the performance of renal angina fulfillment on day of ICU admission to predict fluid overload ≥15% on Day 3. Results 77/139 children (55%) fulfilled renal angina (RA+). After adjusting for covariates, RA+ was associated with increased odds of fluid overload on Day 3 (adjusted odds ratio (aOR) 5.1, 95% CI 1.23–21.2, p = 0.025, versus RA-). RA- resulted in a 90% negative predictive value for fluid overload on Day 3. Median fluid overload was significantly higher in RA+ patients with severe acute kidney injury compared to RA+ patients without severe acute kidney injury (% fluid overload on Day 3: 8.8% vs. 0.73%, p = 0.002). Conclusion Among critically ill children, fulfillment of renal angina was associated with increased odds of fluid overload versus the absence of renal angina and a higher fluid overload among patients who developed acute kidney injury. Renal angina directed risk classification may identify patients at highest risk for fluid accumulation. Expanded study in larger populations is warranted.

scholarly journals Profile and outcome of acute kidney injury in critically ill children admitted to pediatric intensive care unit

2018 ◽  
Vol 5 (6) ◽  
pp. 2148
Author(s):  
Urmila Chauhan ◽  
Yogesh Phirke ◽  
Sandeep Golhar ◽  
Abhishek Madhura
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Serum Creatinine ◽  
Critically Ill ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Nephrotoxic Drugs

Background: Acute kidney injury (AKI) is defined as an abrupt onset of renal dysfunction resulting from injurious endogenous or exogenous processes characterized by a decrease in glomerular filtration rate (GFR) and an increase in serum creatinine. AKI is common in critically ill children and early diagnosis is important for better outcome in these children.Methods: This was a prospective observational study. Critically ill infants and children of either sex and in age group between >28 days to 12 years admitted to pediatric intensive care unit (PICU) were included. Serum creatinine and estimated creatinine clearance (eCC) were used to and patients classified as AKI on pRIFLE criteria either at admission or subsequently during the hospital stay. AKI cases were further classified into risk, injury or failure category on the day of development of AKI and the maximum pRIFLE stage reached during PICU stay was noted. Detailed data regarding the treatment received and use of nephrotoxic drugs, inotropic support, mechanical ventilation, dialysis and total length of stay in PICU in all was noted. Outcome of the subjects were observed for survival or mortality.Results: Total 343 subjects were enrolled in the study. During the study 27.1% patients developed AKI according to pRIFLE staging. In AKI category 60.21% reached maximum risk category, 21.5% reached maximum injury category, 18.28% reached maximum failure category. Amongst AKI subjects 64.52% had infectious etiology. Multiorgan dysfunction, encephalopathy, shock, metabolic acidosis, hypertension, mechanical ventilation and nephrotoxic drugs administration were more associated with AKI and was statistically significant.Conclusions: Pediatric modification of RIFLE criteria is sensitive index to detect AKI at earliest in critically ill children for early intervention leading to better outcome.

scholarly journals Urinary CXCL10 is Associated with Acute Kidney Injury and Sepsis, and Predicts Mortality in Critically Ill Children

2020 ◽  
Author(s):  
Hui Huang ◽  
Huiting Zhou ◽  
Wenwen Wang ◽  
Xiaomei Dai ◽  
Wenjing Li ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Inflammatory Mediator ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Surviving Sepsis Campaign ◽  
Predictive Values ◽  
Specific Setting ◽  
Potential Indicator

Abstract Background: Acute kidney injury (AKI) biomarkers are often susceptible to confounding factors, limiting their utility as a specific biomarker, in the prediction of AKI, especially in heterogeneous population. The urinary CXC motif chemokine 10 (uCXCL10), as an inflammatory mediator, has been proposed to be a biomarker for AKI in a specific setting. Whether uCXCL10 is associated with AKI and predicts AKI in critically ill patients remains unclear. The aims of the study were to investigate clinical variables potentially associated with uCXCL10 levels and determine the associations of uCXCL10 with AKI, sepsis and PICU mortality in critically ill children, as well as its predictive values of aforementioned issues. Methods: Urinary CXCL10 levels were serially measured in a heterogeneous group of children during the first week after pediatric intensive care unit (PICU) admission. AKI diagnosis was based on the criteria of Kidney Disease: Improving Global Outcomes with serum creatinine and urine output. Sepsis was diagnosed according to surviving sepsis campaign international guidelines for children. Mortality was defined as all-cause death occurring during the PICU stay.Results: Among 342 critically ill children, 52 (15.2%) developed AKI during the first week after PICU admission, and 132 (38.6%) were diagnosed as sepsis and 30 (12.3%) died during PICU stay. Both the initial and peak values of uCXCL10 remained independently associated with AKI with adjusted odds ratios (AORs) of 1.791 (P = 0.010) and 2.002 (P = 0.002), sepsis with AORs of 1.679 (P = 0.003) and 1.752 (P = 0.002), septic AKI with AORs of 3.281 (P <0.001) and 3.172 (P <0.001), and PICU mortality with AORs of 2.779 (P = 0.001) and 3.965 (P <0.001), respectively. The AUCs of the initial uCXCL10 for predicting AKI, sepsis, septic AKI, and PICU mortality were 0.63 (0.53-0.72), 0.62 (0.56-0.68), 0.75 (0.64-0.87), and 0.77 (0.68-0.86), respectively. The AUCs for prediction by using peak uCXCL10 were as follows: AKI 0.65 (0.56-0.75), sepsis 0.63 (0.57-0.69), septic AKI 0.76 (0.65-0.87), and PICU mortality 0.84 (0.76-0.91).Conclusions: Urinary CXCL10 is independently associated with AKI and sepsis, and may be a potential indicator of septic AKI and PICU mortality in critically ill children.

scholarly journals Finding the Dose for Ceftolozane-Tazobactam in Critically Ill Children with and without Acute Kidney Injury

Antibiotics ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 887
Author(s):  
Laura Butragueño-Laiseca ◽  
Iñaki F. Troconiz ◽  
Santiago Grau ◽  
Nuria Campillo ◽  
Xandra García ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Renal Impairment ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Severe Renal Impairment ◽  
Kidney Injury ◽  
Volume Of Distribution ◽  
Critically Ill Children ◽  
Multi Drug Resistance ◽  
Time Curve

Background: Ceftolozane-tazobactam is a new antibiotic against multidrug-resistant pathogens such as Pseudomonas aeruginosas. Ceftolozane-tazobactam dosage is still uncertain in children, especially in those with renal impairment or undergoing continuous renal replacement therapy (CRRT). Methods: Evaluation of different ceftolozane-tazobactam dosing regimens in three critically ill children. Ceftolozane pharmacokinetics (PK) were characterized by obtaining the patient’s specific parameters by Bayesian estimation based on a population PK model. The clearance (CL) in patient C undergoing CRRT was estimated using the prefilter, postfilter, and ultrafiltrate concentrations simultaneously. Variables such as blood, dialysate, replacement, and ultrafiltrate flow rates, and hematocrit were integrated in the model. All PK analyses were performed using NONMEM v.7.4. Results: Patient A (8 months of age, 8.7 kg) with normal renal function received 40 mg/kg every 6 h: renal clearance (CLR) was 0.88 L/h; volume of distribution (Vd) Vd1 = 3.45 L, Vd2 = 0.942 L; terminal halflife (t1/2,β) = 3.51 h, dosing interval area under the drug concentration vs. time curve at steady-state (AUCτ,SS) 397.73 mg × h × L−1. Patient B (19 months of age, 11 kg) with eGFR of 22 mL/min/1.73 m2 received 36 mg/kg every 8 h: CLR = 0.27 L/h; Vd1 = 1.13 L; Vd2 = 1.36; t1/2,β = 6.62 h; AUCSS 1481.48 mg × h × L−1. Patient C (9 months of age, 5.8 kg), with severe renal impairment undergoing CRRT received 30 mg/kg every 8 h: renal replacement therapy clearance (CLRRT) 0.39 L/h; Vd1 = 0.74 L; Vd2= 1.17; t 1/2,β = 3.51 h; AUCτ,SS 448.72 mg × h × L−1. No adverse effects attributable to antibiotic treatment were observed. Conclusions: Our results suggest that a dose of 35 mg/kg every 8 h can be appropriate in critically ill septic children with multi-drug resistance Pseudomonas aeruginosa infections. A lower dose of 10 mg/kg every 8 h could be considered for children with severe AKI. For patients with CRRT and a high effluent rate, a dose of 30 mg/kg every 8 h can be considered.

scholarly journals A study on symptoms of children mechanically ventilated in a paediatric intensive care unit of a minimum resource setting in tertiary care centre

2019 ◽  
Vol 6 (2) ◽  
pp. 574
Author(s):  
Korisipati Ankireddy ◽  
Aruna Jyothi K.
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critically Ill ◽  
Tertiary Care ◽  
Limited Resource ◽  
Critically Ill Children ◽  
Invasive Ventilation ◽  
Ventilator Support ◽  
Mechanically Ventilated

Background: Mechanical ventilation, a lifesaving intervention in a critical care unit is under continuous evolution in modern era. Despite this, the management of children with invasive ventilation in developing countries with limited resources is challenging. The study analyses the clinical profile, indications, complications and duration of ventilator care in limited resource settings. Methods: A retrospective study of critically ill children mechanically ventilated in an intensive care unit of a tertiary care government hospital.   Results: A total of 120 children required invasive ventilation during the study period of 1 year. Infants constituted the majority (70%), and males (65%) were marginally more than female children (35%). Respiratory failure was the most common indication for invasive ventilation (55%). The major underlying etiology for invasive ventilation was bronchopneumonia associated with septic shock (30%); and the same also required a prolonged duration of ventilation of >72 hours (35%). Prolonged ventilator support of >72 hours predisposed to more complications as well as a prolonged hospital stay of >2 weeks and above, which was statistically significant. Upper lobe atelectasis (50%) and ventilator associated pneumonia (25%) were the major complications. The mortality rate of present study population was 40% as opposed to the overall mortality of 10%.   Conclusions: Present study highlights that critically ill children can be managed with mechanical ventilation even in limited resource settings. The child should be assessed clinically regarding the tolerance to extubation every day, to minimise the complications associated with prolonged ventilator support.

scholarly journals Paediatric RIFLE and AKIN Classification for Detection and Outcome of Acute Kidney Injury in Critically Sick Children. Which is Better? A Prospective Cohort Study

2018 ◽  
Vol 38 (1) ◽  
pp. 31-37
Author(s):  
Pareshkumar A Thakkar ◽  
Neha Pandey ◽  
Kalpita S Shringarpure
Keyword(s):  
Acute Kidney Injury ◽  
Cohort Study ◽  
Critically Ill ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Critically Ill Children ◽  
Schwartz Formula ◽  
Sick Children

Introduction: Acute Kidney Injury (AKI) is becoming increasingly common in both developed and developing countries with significant morbidity and mortality. However, the precise incidence of AKI in children is not well known due to lack of uniformity in various definitions of AKI. This study was carried out to compare incidence of AKI using two different definitions-pRIFLE and AKIN.Material and Methods: This was a prospective cohort study conducted in the paediatric ICU of a tertiary care government hospital attached to a Medical College of Central Gujarat, India. Total 115 critically ill paediatric patients aged one month to 12 years were included in the study. Serum Creatinine (SCr) levels were tested and Glomerular filtration rate (GFR) was calculated using the Schwartz formula at 0, 6, 12, 24 and 48 hours of admission. Patients were assessed for AKI using AKIN and pRIFLE classification.Results: Incidence of AKI was 80% and 66.9% in critically ill children, as classified by pRIFLE and AKIN classification respectively. Paediatric RIFLE labelled 15 more patients as AKI which were classified as non-AKI by AKIN criteria. There was moderate agreement in between the two classifications to diagnose stages of AKI (Kappa 0.474, CI- 0.359 to 0.589). With increasing grades of AKI, mortality was higher using pRIFLE staging; unlike the AKIN staging wherein this was not observed.Conclusion: The pRIFLE criteria detects a greater number of cases of AKI compared to AKIN criteria. Based on severity staging, pRIFLE is more consistent with adverse outcome of patients with AKI compared to AKIN classification. Overall mortality is significant high in patients with AKI compared to patients without AKI using any of the classifications.  

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.

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