scholarly journals Incidence of Ventilator-Associated Pneumonia in Critically Ill Children Undergoing Mechanical Ventilation in Pediatric Intensive Care Unit

Children ◽  
2017 ◽  
Vol 4 (7) ◽  
pp. 56 ◽  
Author(s):  
Ali Amanati ◽  
Abdollah Karimi ◽  
Alireza Fahimzad ◽  
Ahmad Reza Shamshiri ◽  
Fatemeh Fallah ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Ventilator Associated Pneumonia

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 Use of body composition and phase angle analysis for the assessment of nutritional status and clinical outcomes in critically ill children

2021 ◽  
Author(s):  
Zi-Hong Xiong ◽  
Xue-Mei Zheng ◽  
Guo-Ying Zhang ◽  
Meng-Jun Wu ◽  
Yi Qu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nutritional Status ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Phase Angle ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Duration Time

Abstract BackgroundMalnutrition is highly prevalent in critically ill children in the pediatric intensive care unit .We aimed to investigate the efficiency of bioelectrical impedance analysis (BIA) measurements and phase angle (PhA) analysis for the assessment of nutritional risk and clinical outcomes in critically ill children.MethodsThis single-center observational study included patients admitted to the Pediatric Intensive Care Unit (PICU) of Chengdu Women’s and Children’s Central Hospital. All patients underwent anthropometric measurement in the first 24 h of admission and underwent BIA measurements within 3 days after the admission. The patients were classified into different groups based on body mass index (BMI) for age. Electronic hospital medical records were reviewed to collect clinical data for each patient. All the obtained data were analyzed by the statistics method.ResultsThere were 204 patients enrolled in our study, of which 32.4% were diagnosed with malnutrition. We found that BMI, arm muscle circumference, fat mass, and %body fat were lower in the group with poorer nutritional status (P < 0.05). Evident differences in the score of the Pediatric Risk of Mortality and the duration of mechanical ventilation (MV) among the three groups with different nutritional statuses were observed (P < 0.05). Patients in the severely malnourished group had the longest duration of MV. In the MV groups, there were significant differences (P < 0.05) in albumin level, PhA, and extracellular water/total body water (ECW/TBW ratio). The ECW/TBW ratio and the time for PICU stay had a weak degree of correlation (Pearson correlation coefficient = 0.375). PhA showed a weak degree of correlation with the duration time of medical ventilation (coefficient of correlation = 0.398).ConclusionBIA can be considered an alternative way to assess nutritional status in critically ill children. ECW/TBW ratio and PhA were correlated with PICU stay and duration time of medical ventilation, respectively.

scholarly journals SAT-724 Endocrine Disruption by Phthalate Exposure in the Pediatric Intensive Care Unit

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
An Jacobs ◽  
Adrian Covaci ◽  
Govindan Malarvannan ◽  
Giulia Poma ◽  
Inge Derese ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Total Cortisol ◽  
Free Cortisol ◽  
Metabolite Concentrations ◽  
Dehp Exposure

Abstract Aim: Pediatric intensive care relies on plastic indwelling medical devices softened by phthalates. Phthalates leach into the circulation and concerns about toxicity were raised. Exceeding a certain threshold of di(2-ethylhexyl)phthalate (DEHP) exposure in the pediatric intensive care unit (PICU) has been associated with an attention deficit 4 years later (1). Moreover, DEHP and its metabolites have endocrine disrupting properties. Critically ill children reveal the non-thyroidal illness syndrome (2) and unexplained relatively low cortisol (3). Whether DEHP exposure in PICU has endocrine disruptive effects is unknown. We investigated whether DEHP exposure in the PICU, exceeding the previously identified “toxic” threshold for attention, is independently associated with thyroid- and HPA-axis alterations upon PICU discharge. Methods: In this preplanned secondary analysis of the PEPaNIC RCT (N=1440) (4), plasma DEHP metabolite concentrations (MEHP, 5OH-MEHP, 5cx-MEPP, 5oxo-MEHP) were quantified for all patients with a last PICU day sample (N=920). Minimal DEHP exposure was defined as the product of the total DEHP metabolite concentrations on the last PICU day and duration of PICU stay, with 0.551 µmol/L.days identified as “toxic” threshold (1). Serum TSH, total T4, total T3 and rT3 concentrations were quantified for patients with an available last day sample (N=913). For patients with a last day plasma sample and who did not receive corticosteroids (N=391), plasma ACTH, total cortisol, albumin and CBG concentrations were quantified and free cortisol calculated. Multivariable linear regression analyses, adjusted for baseline risk factors and for duration of PICU stay, assessed whether exceeding the previously determined threshold of toxic DEHP exposure was independently associated with the hormone levels on the last PICU day. Main results: Median total DEHP metabolite concentration was 0.101 (IQR 0.049 - 0.279) µmol/L on the last PICU day. Minimal DEHP exposure was 0.337 (IQR 0.161 - 0.880) µmol/l.days, and 328 patients (35.7%) exceeded the toxic threshold. Exceeding this threshold was independently associated with lower total T4 (P=0.002), total T3 (P=0.02) and total cortisol (P=0.001), and higher rT3 (P=0.01) concentrations on the last PICU day, but not with TSH, ACTH or free cortisol. Conclusion: Critically ill children had DHEP metabolites in plasma upon PICU discharge and more than a third were exposed to toxic levels. Toxic DEHP exposure was an independent contributor to the severity of the non-thyroidal illness phenotype and to lower cortisol upon PICU discharge. Future research should assess whether such endocrine-disruptive impact of DHEP exposure in the PICU plays a role in the long-term developmental legacy of critical illness in children. 1 Verstraete et al Intensive Care Med 2016 2 Jacobs et al Thyroid 2019 3 Jacobs et al Intensive Care Med 2019 4 Fivez et al N Engl J Med 2016

Risk Factors for Ventilator-Associated Pneumonia in Infants and Children: a Cross-sectional Cohort Study

2014 ◽  
Vol 23 (6) ◽  
pp. 469-476 ◽  
Author(s):  
Denise Miyuki Kusahara ◽  
Camila da Cruz Enz ◽  
Ariane Ferreira Machado Avelar ◽  
Maria Angélica Sorgini Peterlini ◽  
Mavilde da Luz Gonçalves Pedreira
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Odds Ratio ◽  
Pediatric Intensive Care ◽  
Ventilator Associated Pneumonia ◽  
Vasoactive Drugs ◽  
Cross Sectional

Background The epidemiology of ventilator-associated pneumonia is well described for adults, but little information is available on risk factors for this disease in children. Objective To identify predisposing factors for ventilator-associated pneumonia in children. Methods A cross-sectional prospective cohort study of 96 patients in a 9-bed pediatric intensive care unit was performed. Variables examined were demographic characteristics, inpatient care, medications, nutrition, invasive procedures, and characteristics of mechanical ventilation. Data were analyzed by using Pearson χ2 analysis, Fisher exact and Mann-Whitney tests, odds ratios, and forward stepwise logistic regression. Results Occurrence of ventilator-associated pneumonia correlated positively with use of nasoenteral tubes (odds ratio, 5.278; P &lt; .001), intermittent administration of nutritional formula (odds ratio, 6.632; P = .005), emergency reintubation (odds ratio, 2.700; P = .02), use of vasoactive drugs (odds ratio, 5.108; P = .009), duration of mechanical ventilation (P &lt; .001), and length of stay in the pediatric intensive care unit (P &lt; .001) and in the hospital (P = .01). Conclusion Use of vasoactive drugs, presence of a nasoenteral tube, and duration of stay in the pediatric intensive care unit were independent risk factors for ventilator-associated pneumonia.

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