Pediatric Surgical Intensive Care Unit Research Articles

Pediatric trauma patients with isolated grade III blunt splenic injuries may be safely managed without intensive care unit admission

BackgroundNon-operative management is the standard of care for pediatric blunt splenic injury. The American Pediatric Surgical Association recommends intensive care unit monitoring only for grade IV/V blunt splenic injury; however, variation remains regarding this practice. We hypothesized that pediatric trauma patients with near-isolated grade III blunt splenic injuries admitted to a non-intensive care unit setting would have similar outcomes to those admitted to the intensive care unit. MethodsThe 2017 to 2019 Trauma Quality Improvement Program database was queried for blunt pediatric trauma patients (≤16 years) with near-isolated grade III blunt splenic injuries. Patients with systolic blood pressure <90 mmHg or heart rate >90 were excluded. Pediatric trauma patients admitted to the intensive care unit were compared to non-intensive care unit admissions. The primary outcome was splenectomy. Bivariate analyses were performed. ResultsOf 461 pediatric trauma patients with near-isolated grade III blunt splenic injuries, 186 (40.3%) were admitted to the intensive care unit. Intensive care unit patients were older than their non-intensive care unit counterparts (15 vs 14 years, P = .03). Intensive care unit and non-intensive care unit patients had a similar rate of splenectomy (0.5% vs 0.7%, P = .80) and time to surgery (19.7 vs 19.8 hours, P = .98). Patients admitted to the intensive care unit had a longer length of stay (4 vs 3 days, P < .001). There were no significant complications or deaths in either group. ConclusionThis national analysis demonstrated that hemodynamically stable pediatric trauma patients with near-isolated grade III blunt splenic injuries admitted to the floor or intensive care unit had a similar rate of splenectomy without complications or deaths. This aligns with American Pediatric Surgical Association recommendations that pediatric trauma patients with grade III blunt splenic injuries be managed in non-intensive care unit settings. Widespread adoption is warranted and should lead to decreased healthcare expenditures.

Nutritional and clinical factors associated with acute kidney injury development in critically ill children.

Acute kidney injury (AKI) is common in the pediatric intensive care unit (ICU) and is associated with poorer clinical outcomes. There is scarce data to support an association between nutritional status and nutrient delivery in critically ill pediatric patients. Therefore, the present study aimed to identify the nutritional and clinical factors associated with the development of AKI during pediatric ICU stay. This prospective study included critically ill pediatric patients aged < 15years who were admitted to the medical and surgical pediatric ICU. Clinical, laboratory, nutritional status, nutritional therapy parameters, and AKI data were recorded. Adjusted logistic regression was applied and expressed as odds ratio (OR) and 95% confidence interval (95%CI). P-value < 0.05 was considered significant. We enrolled 108 patients with a median age of 9months (interquartile range/IQR 2.4-62.5), and 43.5% developed AKI. Sepsis/septic shock (OR 8.00; 95% CI 2.06-32.51, p = 0.003), higher severity of illness (OR 1.89; 95% CI 1.24-2.90, p = 0.003), hypoalbuminemia (OR 4.11; 95% CI 1.61-10.46, p = 0.006), edema (OR 3.42, 95% CI 1.10-10.67, p = 0.034), fluid overload (OR 3.52, 95% CI 1.56-7.96, p = 0.003), need for mechanical ventilation (OR 3.62, 95% CI 1.45-9.04, p = 0.006) and adequate protein intake (OR 0.79, 95% CI 0.63-1.00, p = 0.048) were associated with development of AKI. Hypoalbuminemia, need for mechanical ventilation, fluid overload, severity of illness, sepsis/septic shock, and edema were risk factors for AKI in pediatric ICU. Furthermore, adequate protein intake is associated with AKI during pediatric ICU stay, making it important to implement nutritional assessment and nutritional therapy protocols for critically ill pediatric patients.

Spectrum of World Health Organization global priority pathogens in hospitalized children - A single center experience

Objectives: To study the spectrum of World Health Organization (WHO) global priority pathogens in hospitalized children at our center. Material and Methods: This cross-sectional study was conducted between April 2021 to September 2022 in the Department of Pediatrics at Sri Aurobindo Institute of Medical Sciences and Post Graduate Institute (SAMC), Indore. All children admitted to the Pediatric and Adolescent Medicine Department; Ward, Pediatric Intensive Care Unit, Neonatal Intensive Care Unit, and Pediatric Surgical intensive Care Unit and with culture (Blood, urine, cerebrospinal fluid, and other body fluids/tissue) having grown at least one of the WHO priority pathogens, were studied. Results: In this study period, 100 children had positive cultures. We found that urine specimens had the most bacterial isolations 35 (35%), followed by blood 24 (24%). Escherichia coli was the most often isolated organism [25 (25%)], followed by Staphylococcus aureus [18 (18%)]. About 80% of E. coli and 70.59% of Klebsiella spp. were resistant to third-generation cephalosporins due to extended-spectrum beta-lactamase (ESBL), while 50% of S. aureus were Methicillin-resistant. In all, over half of the Enterobacteriaceae were resistant to carbapenem (49.21%) or third generation cephalosporins (55.56%) due to ESBL. Pseudomonas aeruginosa carbapenem resistance was found in 11.11% cases. Conclusion: In this study, WHO priority list pathogens, Enterobacteriaceae, methicillin-resistant S. aureus, Klebsiella species, and E. coli all show significant antimicrobial resistance (AMR). On the other hand, AMR trends for Acinetobacter baumanni, P. aeruginosa, and S. aureus (vancomycin resistant) are lower than the estimations provided by the WHO globally.

The impact of the COVID-19 pandemic on a surgical PICU in China that did not admit COVID-19 patients

BackgroundThe unprecedented COVID-19 pandemic has been spreading for a long time. However, it is unclear whether the pandemic influenced admission in a surgical pediatric intensive care unit (PICU) that never received COVID-19 patients during the early outbreak in China. MethodsA retrospective study was conducted in a surgical PICU in a tertiary hospital in Chengdu, China. We sought to describe the trend in admission numbers from January 2018 to April 2021. We explored the impact of the COVID-19 outbreak on PICU admission characteristics by including all patients younger than 18 years admitted to the PICU between January 23 and April 8 in 2020 and those admitted in the same time periods in prepandemic years (2018 and 2019) and in 2021. ResultsThe percentage of patients admitted to the PICU from the Chengdu region increased from 34.2 percent in 2019 to 40.4 percent in 2020, whereas that from other provinces decreased from 11.7 percent in 2019 to 5.8 percent in 2020 (P = 0.012). The median length of stay (LOS) in the PICU was significantly longer in the 2020 cohort (4.0 days) than in the 2019 cohort (2.0 days) (P < 0.001); the median hospital LOS was also significantly longer in the former (12.0 days) than in the latter (8.0 days) (P < 0.001). Hospital outcomes (P = 0.005) and primary diagnosis distributions (P = 0.025) between the 2020 and 2019 cohorts were both statistically significant. ConclusionsIn a surgical PICU that never received COVID-19 patients, the onset of the 2020 major outbreak was accompanied by changes in the composition of the regional sources of patients, longer PICU and hospital stays, increased proportions of unauthorized discharges, and changes in the distribution of primary diseases for admission. These findings have yet to be strengthened by additional studies involving similar healthcare backgrounds.

Assessment of the effect of two regimens of milrinone infusion in paediatric patients with pulmonary artery hypertension undergoing corrective cardiac procedure: A prospective observational study.

The aim of the study was to compare the effect of two different regimens of milrinone in pediatric patients with pulmonary artery hypertension (PAH) undergoing corrective procedure. This randomized prospective study included 100 pediatric patients undergoing corrective cardiac surgeries. Group E: Milrinone was started as infusion 0.5 μg/kg/min without a loading dose after induction of anesthesia and continued as infusion 0.5-0.75 μg/kg/min in the pediatric cardiac surgical intensive care unit (PSICU). Group L: Milrinone was started as a loading dose 50 μg/kg over 10 min before weaning from cardiopulmonary bypass (CPB) followed by infusion 0.5-0.75 μg/kg/min in the PSICU. We compared heart rate, mean arterial blood pressure, central venous pressure, cardiac index (CI), mean pulmonary arterial pressure (MPAP), serum lactate level, urine output, vasoactive inotropic score, mechanical ventilation duration, and intensive care unit (ICU)- and hospital length of stay between the groups. There was an increase in mean arterial blood pressure, CI, and urine output in Group E compared to Group L (P < 0.05). MPAP, serum lactate level, and requirement of inotropes and vasopressors were lower in Group E compared to Group L (P < 0.05). Mechanical ventilation duration, ICU, and hospital length of stay were shorter in Group E than Group L (P < 0.05). Early use of milrinone in patients with PAH undergoing corrective cardiac surgeries improved CI and mean arterial pressure, decreased MPAP, improved urine output, decreased serum lactate level, and decreased requirement of inotropes and vasopressors after weaning from CPB compared to the milrinone bolus group.

Bedside Chest Ultrasound in Postoperative Pediatric Cardiac Surgery Patients: Comparison With Bedside Chest Radiography

The primary objective was to study the degree of agreement between the chest ultrasound (CUS) studies and chest x-ray (CXR) studies in postoperative pediatric cardiac surgical patients regarding the diagnosis of thoracic abnormalities, and also to compare the diagnostic performance of CUS in reference to CXR for the detection of thoracic abnormalities. The secondary objective was to compare the necessity for interventions done on the basis of CUS and CXR findings in the postoperative setting. A prospective observational study. At a postoperative pediatric cardiac surgical intensive care unit in a tertiary-care center. One hundred sixty patients between the age of 2 months to 18 years undergoing elective cardiac surgery for various congenital heart diseases. After obtaining permission from the institutional ethics committee, 160 pediatric cardiac surgical patients were studied prospectively in the postoperative period. On the day of surgery (postoperative day [POD] 0), bedside CXR was done in the immediate postoperative period. After bedside CXR, CUS examination was performed and then interpreted by the principal investigator. The CXR was interpreted by the surgical team. Provisional diagnosis was made by the principal investigator and surgical team. Any intervention required was decided based on CXR or CUS findings or both. The procedure was repeated in the morning of POD 1. The degree of agreement between CUS studies and CXR studies in detecting abnormalities was evaluated by Cohen's kappa (k) statistics. The diagnostic performance of CUS was compared with that of CXR using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy. Overall, kappa analysis (k) showed substantial agreement between the findings of the CUS and CXR studies (k=0.749). The diagnostic performance of CUS, as compared with CXR, was found to have a sensitivity of 96.9%, specificity of 84.75%, PPV of 73.4%, NPV of 98.43%, and diagnostic accuracy of 88.44%. In 94 abnormal findings, the interventions were done based on CUS or CXR findings or both. Overall, there was a substantial agreement (k=0.787) between CUS and CXR regarding the necessity for interventions. The degree of agreement between CUS and CXR studies was substantial for atelectasis, interstitial edema, and diaphragmatic weakness. The degree of agreement between CUS and CXR studies was almost perfect for pneumothorax and fair for pleural effusion. More CUS studies detected intrathoracic pathologies than CXR studies. The CUS also detected abnormalities earlier than CXR and was found to be useful for the early institution of intervention therapy in patients with interstitial edema and atelectasis. It would be reasonable to conclude that CUS may be considered in some instances as an alternative to CXR.

The Bacteriological and Clinical Outcomes of Ventilator-associated Pneumonia Post-cardiac Surgery in the Pediatric Surgical Intensive Care Unit

Abstract Background: Ventilator-associated pneumonia (VAP) is a serious nosocomial infection that threatens pediatric patients who have undergone cardiac surgery. The aim of this study is to analyze the bacteriological profile and antibiotic resistance pattern of the organisms grown from pediatric patients diagnosed as VAP after cardiac surgery and also to study the bacteriological and clinical outcomes of the patients. Patients and Methods: This prospective observational study was conducted in a tertiary care teaching institution in children aged younger than 14 years who had undergone cardiac surgery and were diagnosed to have VAP and on mechanical ventilation (MV). The clinical and the bacteriological profile of patients with VAP, the systemic antibiotics used, the resistance pattern to the antibiotics, and, finally, the bacteriological and clinical outcomes were analyzed. Results: Among the 98 patients with VAP, 55% were early onset (&lt;4 days of MV) and 45% were late onset (&gt;4 days of MV) VAP. Among the most common pathogens causing VAP, Klebsiella and Escherichia coli contributed to 18% each of the total VAP. Twenty percent of VAP were polymicrobial in origin. About 63% of organisms were resistant to Augmentin, and 11% of the organisms were multidrug resistant (MDR). Conclusion: This study not only showed the pattern of early and late onset VAP but also revealed the bacteriological profile and the resistance pattern of the local microbial flora causing VAP, guiding us in a more efficient management of VAP in children.

Incidence of Medical Adhesive–Related Skin Injuries and Associated Factors After Pediatric Congenital Heart Surgery

PURPOSE: The aim of this study was to identify the incidence, characteristics, and factors associated with medical adhesive–related skin injuries (MARSI). DESIGN: Prospective cohort study. SUBJECTS AND SETTINGS: The sample comprised 136 children in the postoperative period after congenital heart surgery. The study setting was in a 31-bed pediatric surgical intensive care unit (ICU) of a university hospital in Sao Paulo, Brazil. METHODS: Patients were followed from admission, with daily skin assessments, until the onset of MARSI or ICU discharge. Outcomes were compared by Fisher's exact test, Pearson's χ2 test, Mann-Whitney test, Brunner-Munzel test, and Welch 2-sample t test. RESULTS: The incidence of MARSI was 60.3%, with 85 injuries in 82 patients. The highest occurrence was on postoperative day 2 (27 wounds; 31.8%). The most frequent medical adhesive associated with MARSI was transparent film dressing (n = 74; 86.6%). Factors associated with MARSI were age (P = .000), number of devices inserted (P = .000), Braden Q Scale score (P = .005), duration of surgery (P = .021), cardiopulmonary bypass duration (P = .000), duration of mechanical ventilation (P = .000), and length of ICU stay (P = .000). Children who developed MARSI received more blood components (P = .039), vasopressors (P = .000), and corticosteroids (P = 0.000); required longer sedation (P = .000); and had more edema (P = .001). CONCLUSION: This high incidence indicates the need for greater awareness and prompt action in response to MARSI. Polyurethane transparent film without concurrent use of a skin barrier product should be avoided.

Incidence of pressure injuries and risk factors in a paediatric surgical intensive care unit: a prospective cohort study.

The aim of the study was to evaluate the incidence of, and risk factors for, the occurrence of pressure injuries (PIs) in a paediatric surgical intensive care unit (ICU). This is a prospective cohort study of 153 children in the postoperative period. Patients were assessed daily by physical examination and data were collected. All independent variables were included in a logistic regression. The mean age of the cohort was 2 years, and the incidence of PI was 15.7%. According to the Braden Q Scale, 58.2% of patients were at high risk of developing PI; 79.3% of PIs were related to immobility and 69.0% were at stage 1. Risk factors were ICU length of stay and the number of medical devices used. The incidence of PI was high because patients were mostly at a considerable risk of developing a PI. PI was associated with several factors, especially length of ICU stay and number of devices, both of which are indirect indicators of the severity of patient condition and healthcare costs.

Audit of paediatric surgical intensive care unit admissions in north Jordan

An audit was carried out over a 12-month period at a district general hospital in the north of Jordan. The study aimed to establish the reasons for and outcome of paediatric intensive care unit admissions. Of the 854 admissions, 107 were paediatric surgical cases. The causes of trauma were: road traffic accident (42 cases), burns (35) and falls (18). The remaining 12 cases were either post-operative admissions (7 cases) or acute admissions (5 cases). A total of 31 patients died and 8 children were left with significant disability or brain death. We conclude that trauma is a significant cause of disability, morbidity and mortality in children in our area. Society as a whole needs to look at the causes of childhood trauma and identify ways of reducing it.

Evaluation of dynamic/thiol disulphide balance and ischaemia modified albumin in children with trauma

Trauma is the most common cause of death in childhood. Tissue damage, ischaemia-reperfusion injury and inflammatory response are mainly responsible for increasing free oxygen radicals. In this study, we aimed to investigate the use of thiol-disulphide and ischaemia-modified albumin levels as a diagnostic laboratory parameter in trauma children. Of 202 children, 101 were hospitalised in the paediatric surgical intensive care unit with trauma, and 101 were healthy children. Levels of native thiol (-SH), total thiol (SH + SS), dynamic disulphide (SS), dynamic disulphide (SS)/total thiol (SH + SS), albumin and ischaemic modified albumin (IMA) were measured from the sera of patients and healthy volunteers. For statistical analyses, SPSS 17.0 was used. Mann-Whitney U and paired correlation tests were used where appropriate. P<.05 was considered significant. The mean age of the patients in the trauma group (boys: 61 girls: 40) was 7.88years and the control group was 8.00years. In the trauma group, 86 children were exposed to blunt trauma, 15 children had penetrating trauma and 54 patients had multiple trauma. Surgical procedures were performed on 17 patients. In the trauma group, native thiol, total thiol, dynamic disulphide/total thiol, albumin and IMA levels were significantly lower than that of the control (P<.001), and their dynamic disulphide (P=.001) was higher compared with the control. There was no difference thiol-disulphide parameters in trauma groups sub-division as surgery (n=17) vs follow-up (n=84) groups or multiple trauma (n=54) vs isolated organ trauma (n=47) groups or penetrating (n=15) or blunt trauma (n=86) groups. Thiol-disulphide balance and IMA levels show changes in favour of oxidative stress in children with trauma; however, it cannot be used as a laboratory marker that helps to show the system and organ affected by the trauma and to decide the surgical intervention.

Are Nutritional Guidelines Followed in the Pediatric Intensive Care Unit?

Background: French (2014) and American (2017) pediatric guidelines recommend starting enteral nutrition (EN) early in pediatric intensive care. The aims of this study were to compare the applicability of the guidelines in the pediatric intensive care unit (PICU) and to identify risk factors of non-application of the guidelines.Methods: This retrospective, single-center study was conducted in a medical–surgical PICU between 2014 and 2016. All patients from 1 month to 18 years old with a length of stay >48 h and an exclusive EN at least 1 day during the PICU stay were included. The outcome variable was application of the 2014 and 2017 guidelines, defined by energy intakes ≥90% of the recommended intake at least 1 day as defined by both guidelines. The risk factors of non-application were studied comparing “optimal EN” vs. “non-optimal EN” groups for both guidelines.Results: In total, 416 children were included (mortality rate, 8%). Malnutrition occurred in 36% of cases. The mean energy intake was 34 ± 30.3 kcal kg−1 day−1. The 2014 and 2017 guidelines were applied in 183 (44%) and 296 (71%) patients, respectively (p < 0.05). Following the 2017 guidelines, enteral energy intakes were considered as “satisfactory enteral intake” for 335 patients (81%). Hemodynamic failure was a risk factor of the non-application of both guidelines.Conclusion: In our PICU, the received energy intake approached the level of intake recommended by the American 2017 guidelines, which used the predictive Schofield equations and seem more useful and applicable than the higher recommendations of the 2014 guidelines. Multicenter studies to validate the pediatric guidelines seem necessary.

Nosocomial infections in a pediatric surgical intensive care unit: An unicentric cross-sectional study

Introduction. Nosocomial infections are a common complication in patients hospitalized in intensive care units. The aims of this research were to examine the incidence of nosocomial infections in patients admitted to the pediatric surgical intensive care unit, the impact of hospital length of stay and type of surgical disease on the incidence of nosocomial infections, the frequency of microorganisms causing nosocomial infections and their antibiotic susceptibility profile. Material and Methods. Data on 50 subjects were extracted from the database. The following data were taken from the medical histories of the examinees: age, sex, diagnosis, number of days at the hospital before admission to the intensive care unit, number of days in the intensive care unit, levels of C-reactive protein, applied antimicrobial drugs, isolated microorganisms and their susceptibility to antibiotics. Results. The incidence of nosocomial infections in the study period was 52%. Patients who developed nosocomial infection remained longer in the intensive care unit than those who did not develop it (p = 0.003). Patients with the diagnosis of acute abdomen had a statistically significantly higher incidence of nosocomial infections compared to other patients (p = 0.001). Gram-negative bacteria were the most commonly isolated pathogens (46.8%). Acinetobacter baumanii proved to be the most resistant species in this study, since 80% of the strains did not show sensitivity to any of the tested antibiotics. Conclusion. Nosocomial infections are present in slightly more than half of the patients treated at the pediatric surgical intensive care unit. Patients who developed nosocomial infections stayed longer in the pediatric surgical intensive care unit, which had negative consequences for their health and treatment costs.

Milky Lungs: Ultrasonographic Findings in Pediatric Acute Respiratory Distress Syndrome

Diagnosis and following up the dynamics of Pediatric Acute Respiratory Distress Syndrome demand a more feasible, non-invasive and bedside tool, such as lung ultrasound, for monitoring the damaged lungs. We report on a 6-month-old child admitted in our Pediatric Surgical Intensive Care Unit with a clinical presentation of ileus and concomitant community acquired pneumonia. Lung ultrasound (LUS) examinations according to the BLUE Protocol were done several times during the hospital stay. A-lines were seen at admission in the upper segments, but 2–3 B-lines were present in the posterolateral segments bilaterally. Later on, separated and coalescent B-lines were seen. White lung parenchyma or milky lungs with a thickened pleural line were seen, while the worst gas exchange according to the results of Arterial Blood Gases (ABGs) has been detected. According to the findings, as many B-lines will be detected, as the severeness of lung damage and gas exchange impairement. The improvement of the gas exchange with the disappearance of the coalescent B-lines was seen later on, after ventilating the child in a prone position. Bedsides, LUS is a feasible and non-invasive point of care method that could be used for diagnosing Pediatric Acute Respiratory Distress Syndrome (PARDS) but in guiding therapy of the damaged lungs, also. The finding of diffuse, coalescent and homogenous B-lines interpreted as “Milky lungs” is consistent with the diagnosis of PARDS.

Mean platelet volume dynamics as a prognostic indicator in pediatric surgical intensive care unit: a descriptive observational study

BackgroundPlatelet size and activity have a close correlation. The mean platelet volume (MPV) is related to the disease severity and prognosis, especially in critically ill patients.ObjectiveTo study the relation between MPV changes and postoperative morbidities and mortality in pediatric surgical intensive care unit (PSICU).Methods and materialWe enrolled in this descriptive observational study one hundred PSICU children aged from 1 month to 18 years and stayed for > 48 h for peri-operative or post-trauma management. The 1ry outcome was the association between percentage change in MPV (ΔMPV) value and mortality. We recorded MPV, ΔMPV, and platelet count as a baseline, at day 0, 1st, 2nd, 3rd, 5th, and 7th days and then once weekly until patients were discharged, died, or reached a maximum of 90 days in ICU stay.Statistical analysis usedWe used statistical package for the social science (SPSS) version 22. Non-parametric Mann-Whitney test made comparisons between quantitative variables. Repeated measures analysis of variance (ANOVA), non-parametric Friedman, and Wilcoxon signed-rank tests made the comparison within the same patients. We used receiver operating characteristic (ROC) curves for the detection of sensitivity and specificity.ResultsPatients who developed ICU complications showed higher ΔMPV compared with non-complicated cases, and this was statistically significant on days 2, 3, 5, and 7 of ICU stay. ROC curve analysis showed a sensitivity of 57.2% and 73% on days 2 and 3 and a specificity of 76.6% and 71% on days 2 and 3, respectively.ConclusionsMPV dynamics have a prognostic role and worth a value in predicting several complications in PSICU.

Central‐line‐associated bloodstream infections in a surgical paediatric intensive care unit: Risk factors and prevention with chlorhexidine bathing

The aims of the study are to evaluate the impact of a 4% chlorhexidine (CHG4%) bathing on the occurrence of central-line-associated bloodstream infection (CLABSI) and to identify risk factors (RFs) for CLABSI in our population. This is a retrospective monocentric cohort study in the paediatric surgical intensive care unit at the Necker Enfants Malades Hospital, Paris, France. All hospitalised patients with central venous catheters (CVCs) in 2015 were included. CHG4% bathing was prescribed in CLABSI high-risk patients, defined by the presence of exposition factors (EFs): constitutive or acquired immunosuppression, presence of an invasive medical device (IMD) and the carriage of Staphylococcus aureus. The overall 2015 CLABSI incidence rate was compared with 2014 CLABSI incidence rate (before CHG4% bathing). In all, 775 patients were analysed. Some 182 had at least one EF, and 49 received CHG4%. The incidence rates of CLABSI in 2014 and 2015 were, respectively, 6.1 and 2.3/1000 days CVC (P < 0.01). The presence of at least one EF was associated with the CLABSI's occurrence: odds ratio = 15.13 (95% confidence interval: 4.26-53.71; P < 0.0001), particularly acquired immunosuppression, IMD and S. aureus colonisation. Other RFs were age <1 year and carrying duration >16 days. This study showed a significant reduction in incidence of CLABSI after introduction of a targeted CHG4% bathing protocol. Presence of IMD, S. aureus colonisation, immunosuppression, age <1 year and carrying duration >16 days were CLABSI RFs. Regarding the literature, the presence of IMD seems to be underestimated in CLABSI prevention.

The Role of Thiol–Disulfide and Ischemia-Modified Albumin in the Differential Diagnosis of Ovarian Pathologies in Children

Introduction: The aim of this study was to evaluate the association between ovarian pathologies and oxidative stress in children via the new method of thiol/disulfide homeostasis. Materials and Methods: The study was conducted in our clinic and included 24 cases of ovarian cysts (OCs) followed by us and 23 cases of operated OC or torsion and monitored by pediatric surgical intensive care unit. The control group consisted of 24 girls who admitted to the pediatric surgery outpatient clinic because of not-incarcerated inguinal hernia. Serum native thiol, total thiol, dynamic disulfide, albumin, and ischemia-modified albumin (IMA) levels of the patients and healthy volunteers were evaluated. Results: Native thiol (P = 0.41), total thiol (P = 0.57), dynamic disulfide (P = 0.98), albumin (P = 0.54), and IMA (P = 0.98) levels of the patients with OC were found similar with the ovarian torsion (OT) group. However, there were statistically significant differences in native thiol (P

Influence of implementing a protocol for an intravenously administered ammonia scavenger on the management of acute hyperammonemia in a pediatric intensive care unit.

The purpose of the study was to evaluate the influence of establishing a protocol for the use of combined sodium benzoate and sodium phenylacetate (SBSP) (Ammonul®) to treat acute hyperammonemia. This was a retrospective, single-center study in a 24-bed medical and surgical pediatric intensive care unit (PICU) in a tertiary care teaching maternal-child hospital in Canada. Inclusion criteria were age < 18 years, PICU admission between 1 January 2000 and 30 June 2016, and SBSP treatment. An SBSP delivery protocol was implemented in our hospital on 30 August 2008 in order to improve management of acute hyperammonemia. Patients were assigned to one of the two groups, without or with protocol, depending on date of admission. SBSP was ordered 34 times during the study period, and 23 orders were considered for analysis (14 with and 9 without protocol). Patient characteristics were similar between groups. The median time from diagnosis to prescription was significantly shorter in the protocol group [40 min (21-82) vs 100 min (70-150), p = 0.03)] but the median time from diagnosis to administration of the treatment was equivalent [144 min (90-220) vs 195 (143-274), (p = 0.2)]. Other clinical outcomes did not differ. This study is the first to compare two SBSP delivery strategies in the treatment of acute hyperammonemia in this PICU setting. Implementation of a delivery protocol shortened the time from diagnosis of hyperammonemia to prescription of SBSP and helped us identify other parameters that can be improved to optimize treatment delivery.

Influence of implementing a protocol for an intravenously administered ammonia scavenger on the management of acute hyperammonemia in a pediatric intensive care unit

The purpose of the study was to evaluate the influence of establishing a protocol for the use of combined sodium benzoate and sodium phenylacetate (SBSP) (Ammonul®) to treat acute hyperammonemia. This was a retrospective, single-center study in a 24-bed medical and surgical pediatric intensive care unit (PICU) in a tertiary care teaching maternal–child hospital in Canada. Inclusion criteria were age < 18 years, PICU admission between 1 January 2000 and 30 June 2016, and SBSP treatment. An SBSP delivery protocol was implemented in our hospital on 30 August 2008 in order to improve management of acute hyperammonemia. Patients were assigned to one of the two groups, without or with protocol, depending on date of admission. SBSP was ordered 34 times during the study period, and 23 orders were considered for analysis (14 with and 9 without protocol). Patient characteristics were similar between groups. The median time from diagnosis to prescription was significantly shorter in the protocol group [40 min (21–82) vs 100 min (70–150), p = 0.03)] but the median time from diagnosis to administration of the treatment was equivalent [144 min (90–220) vs 195 (143–274), (p = 0.2)]. Other clinical outcomes did not differ. This study is the first to compare two SBSP delivery strategies in the treatment of acute hyperammonemia in this PICU setting. Implementation of a delivery protocol shortened the time from diagnosis of hyperammonemia to prescription of SBSP and helped us identify other parameters that can be improved to optimize treatment delivery.

Brain Death in Children: Incidence, Donation Rates, and the Occurrence of Central Diabetes Insipidus.

Brain death is currently defined as the loss of full brain function including the brainstem. The diagnosis and its subsequent management in the pediatric population are still controversial. The aim of this study was to define the demographic characteristics, clinical features and outcomes of patients with brain death and determine the incidence of brain death, donation rates and occurrence of central diabetes insipidus accompanying brain death in children. This retrospective study was conducted at a twelve-bed tertiary-care combined medical and surgical pediatric intensive care unit of the Ondokuz Mayis University Medical School, Samsun, Turkey. In 37 of 341 deaths (10.8%), a diagnosis of brain death was identified. The primary insult causing brain death was post-cardiorespiratory arrest in 8 (21.6%), head trauma in 8 (21.6%), and drowning in 4 (18.9%). In all patients, transcranial Doppler ultrasound was utilised as an ancillary test and test was repeated until it was consistent with brain death. In 33 (89%) patients, central diabetes insipidus was determined at or near the time brain death was confirmed. The four patients not diagnosed with CDI had acute renal failure, and renal replacement treatment was carried out. The consent rate for organ donation was 18.9%, and 16.7% of potential donors proceeded to actual donation. In the current study the consent rate for organ donation is relatively low compared to the rest of the world. The prevalence of central diabetes insipidus in this pedaitric brain death population is higher than reports in the literature, and acute renal failure accounted for the lack of central diabetes insipidus in four patients with brain death. Further studies are needed to explain normouria in brain-dead patients.