Duration Of Pediatric Intensive Care Unit Research Articles

Clinical Profile, Intensive Care Needs, and Short-Term Outcome of Toxic Shock Syndrome Among Children:A 10-Year Single-Centre Experience from North India.

ObjectiveTo describe the clinical and laboratory profile, management, intensive care needs, and outcome of children with toxic shock syndrome (TSS) admitted to the pediatric intensive care unit (PICU) of a tertiary care center in North India.MethodsThis retrospective study was conducted in the PICU of a tertiary care hospital in North India over a period of 10 y (January 2011–December 2020) including children < 12 y with TSS (n = 63).ResultsThe median (interquartile range, IQR) age was 5 (2–9) y, 58.7% were boys, and Pediatric Risk of Mortality III (PRISM-III) score was 15 (12–17). The primary focus of infection was identified in 60.3% children, 44.5% had skin and soft tissue infections, and 17.5% (n = 11) had growth of Staphylococcus aureus. Common manifestations were shock (100%), rash (95.2%), thrombocytopenia (79.4%), transaminitis (66.7%), coagulopathy (58.7%), and acute kidney injury (AKI) (52.4%); and involvement of gastrointestinal (61.9%), mucus membrane (55.5%), respiratory (47.6%), musculoskeletal (41.3%), and central nervous system (CNS) (31.7%). The treatment included fluid resuscitation (100%), vasoactive drugs (92.1%), clindamycin (96.8%), intravenous immunoglobulin (IVIG) (92.1%), blood products (74.6%), mechanical ventilation (58.7%), and renal replacement therapy (31.7%). The mortality was 27% (n = 17). The duration of PICU and hopsital stay was 5 (4–10) and 7 (4–11) d, respectively. Higher proportion of nonsurvivors had CNS involvement, transaminitis, thrombocytopenia, coagulopathy, and AKI; required mechanical ventilation and blood products; and had higher vasoactive–inotropic score.ConclusionTSS is not uncommon in children in Indian setup. The management includes early recognition, intensive care, antibiotics, source control, and adjunctive therapy (IVIG and clindamycin). Multiorgan dysfunction and need for organ supportive therapies predicted mortality.

Clinical Features, Intensive Care Needs, and Outcome of Carbamazepine Poisoning in Children.

Carbamazepine is commonly used antiseizure medication with a narrow therapeutic range. The data on carbamazepine poisoning in children from India is limited. In this retrospective study, the authors reported 10 children with carbamazepine poisoning admitted to pediatric intensive care unit (PICU) of a tertiary care teaching hospital in North India over a period of 8 y (2013 to 2020). The median age was 5.5 (4.3-6) y and 60% cases were males. All had accidental ingestion and the dose ingested was 96 (80-103) mg/kg. The common clinical features were drowsiness (100%), tachycardia (80%), vomiting (60%), seizures (60%), respiratory failure (60%), and dystonia (50%). At admission, 60% children had coma. The treatment included gastric lavage (70%), single-dose-activated charcoal (60%), multidose-activated charcoal (30%), mechanical ventilation (60%), and dialysis (20%). The duration of PICU and hospital stay was 36 (22-45) h and 48 (48-60) h, respectively. There was no mortality.

Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2—Case Series of a Pediatric Intensive Care Unit in Portugal

AbstractPediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PIMS-TS) is a novel condition with persistent fever, inflammation, and single or multiorgan dysfunction. We aimed to describe the characteristics of children more severely affected and our clinical approach. We retrospectively collected clinical, treatment, and early outcomes data during a 3-month period in a pediatric intensive care unit (PICU) of a tertiary university hospital in Portugal. Twelve children who fulfilled the Royal College of Pediatrics and Child Health case definition were hospitalized, seven needed PICU admission. Median age was 13 years and three were overweight, with no other comorbidity. All had positive immunoglobulin G antibodies for SARS-CoV-2. All presented with prolonged fever, asthenia, hypotension, and shock. Other prominent symptoms were abdominal complaints and rash. All patients had leukocytosis, neutrophilia, and marked elevation of inflammatory markers. Cardiac involvement was observed in all patients with elevated levels of troponin and B-type natriuretic peptide along with left ventricular hypokinesis. Depressed left ventricular function was observed in four patients. All patients received broad-spectrum antibiotics, intravenous immunoglobulin, methylprednisolone, low-dose aspirin, and vasoactive medications. Four patients received prophylactic enoxaparin. All patients needed supplementary oxygen; however, high-flow oxygen therapy and noninvasive ventilatory support with positive end-expiratory pressure were required in three and two patients, respectively. Five patients required invasive mechanical ventilation. The mean duration of PICU stay was 7.1 days. The median Pediatric Risk of Mortality-III score was 9 and no mortality was observed. PIMS-TS demands a prompt and multidisciplinary approach. Risk factors, best clinical pathway, and long-term complications are still unknown.

Comparison of urine albumin creatinine ratio with the pediatric index of mortality 2 score for prediction of pediatric intensive care unit outcomes

BackgroundPredicting morbidity and mortality in a pediatric intensive care unit (PICU) is of extreme importance to make precise decisions for better outcomes.AimWe compared the urine albumin creatinine ratio (ACR) with the established PICU score, pediatric index of mortality 2 (PIM 2) for predicting PICU outcomes.MethodsThis cross-sectional study enrolled 67 patients admitted to PICU with systemic inflammatory response syndrome. Urine ACR was estimated on admission, and PIM 2 score was calculated. ACR was compared with PIM 2 for PICU outcome measures: the need for inotropes, development of multiple organ dysfunction syndrome (MODS), duration of PICU stay, and survival.ResultsMicroalbuminuria was found in 77.6% of patients with a median ACR of 80 mg/g. ACR showed a significant association with the need for inotropes (p < 0.001), MODS (p = 0.001), and significant correlation to PICU stay (p 0.001, rho = 0.361). The area under the receiver operating characteristic curve for ACR (0.798) was comparable to that of PIM 2 (0.896). The cutoff value of ACR derived to predict mortality was 110 mg/g. The study subjects were divided into 2 groups: below cutoff and above the cutoff. Outcome variables, inotrope use, MODS, mortality, and PICU stay compared between these subgroups, were statistically significant.ConclusionACR is a good predictor of PICU outcomes and is comparable to PIM 2 for mortality prediction.

Morbidity and Mortality Pattern of Patients Admitted into Paediatric Intensive Care Unit of Tertiary Level Hospital of Nepal

Introduction: The paediatric intensive care unit (PICU) takes care of critically ill paediatric patients. Regular evaluation of the outcomes of patients admitted to PICU is important to assess the effectiveness of various interventions. This study aimed to find the morbidity and mortality pattern of patients admitted to PICU of tertiary level Paediatric hospital of Nepal.&#x0D; Methods: We conducted a retrospective, cross sectional observational study using the records of all the patients admitted to PICU of a tertiary level hospital from January 2017 to August 2017. We collected data on age, sex, geographical distribution, duration of PICU stay and the morbidity and mortality outcomes. Outcome is classified as transfer to ward, leave against medical advice (LAMA) and death. Data were analysed descriptively using SPSS version 23.&#x0D; Results: Out of 358 patients admitted to PICU, the mean age was 1.83 years. Majority were infants (54.5%) with male:female ratio of 1.8:1. The major causes of PICU admission were respiratory disease (27.7%) followed by CNS disease (19.6%) and infections (17.3%). The average length of stay was 6.27 days. Overall mortality was 22.7%.&#x0D; Conclusion: Respiratory infections were the primary cause of PICU admission and overall mortality rate was high at 22.7%. However, mortality rate was even worse for patients with multi-system involvement. We need prospective studies to examine the underlying reasons for mortality among patients with multi-system involvement.

Outcome and risk factors of pediatric hemato-oncology patients admitted in pediatric intensive care unit

Purpose : To evaluate the risk factors for mortality and prognostic factors in pediatric hemato-oncology patients admitted to the pediatric intensive care unit (PICU). Methods : We retrospectively reviewed the medical records of pediatric hemato-oncology patients admitted at the PICU of the Asan Medical Center between September 2005 and July 2008. Patients admitted at the PICU for perioperative or terminal care were excluded. Results : Total 88 patients were analyzed. Overall ICU mortality rate was 34.1%. Mean age at PICU admission was 7.0± 5.7 years and mean duration of PICU stay was 18.1±22.2 days. Hematologic diseases contributed to 77.3% of all the primary diagnoses, and the primary cause of admission was respiratory failure (39.8%). The factors related to increased mortality were C-reactive protein level (P<0.01), ventilation or dialysis requirement (P<0.01), and hematopoietic stem cell transplantation (P<0.05). In all, 3 scoring systems were investigated [Number of Organ System Failures (OSF number), the Pediatric Risk of Mortality III (PRISM III) score, and the Sequential Organ Failure Assessment (SOFA) score]; higher score correlated with worse outcome (P<0.01). The Oncological Pediatric Risk of Mortality (O-PRISM) scores of the 21 patients who had received hematopoietic stem cell transplantation were higher among the non-survivors, but not statistically significant (P=0.203). Conclusion : The PRISM III and SOFA scores obtained within 24 hours of PICU admission were found to be useful as early mortality predictors. The highest OSF number during the PICU stay was closely related to poor outcome. (Korean J Pediatr 2009;52:1153-1160)