Journal of Pediatric Intensive Care - Volume 1, issue 4

Authors: Choong, Karen | Tran, Nga | Clark, Heather | Cupido, Cynthia | Corsi, Daniel J.

Article Type: Research Article

Abstract: Immobility increases morbidity, while early mobilization improves outcomes in adults. Rehabilitation practices in critically ill children, and the degree to which they are immobilized, are currently not well understood. The objective of this retrospective cohort study was to evaluate acute rehabilitation practices and potential barriers to mobilization in a tertiary care pediatric critical care unit (PCCU). Children aged less than 18 yr with a greater than 24 h length of stay were eligible. Outcomes of interest were physical therapy (PT) practice patterns, predictors of immobility, and adverse sequelae attributable to immobility. Interventions were classified as non-mobility and mobility types of …PT. Ninety-one patients were included, 46.2% (42/91) were males. The mean age was 6.4 ± 6.4 yrs. Thirty-six of ninety-one (39.6%) patients received some form of PT while in PCCU. The mean proportion of PCCU days during which PT occurred was 20% (SD 28.8), and 3% (3/91) of patients received PT daily. Sixteen patients (17.6%) received exclusively non-mobility PT, 20 (22.0%) received some form of mobility, and six (6.6%) received both non-mobility and mobility PT. Increased severity of illness, mechanical ventilation, baseline disability and young age were identified barriers to mobilization. Immobilization is common in critically ill children. PT was often delayed until the patient was stabilized, and when performed was focused on respiratory function. Mobility PT was reserved for less sick, older, and non-mechanically ventilated patients. Future research is necessary to evaluate the significance of immobility and its impact on clinical outcomes in this population. Show more

Keywords: Pediatric critical care, physical therapy, rehabilitation, mobilization

DOI: 10.3233/PIC-12031

Citation: Journal of Pediatric Intensive Care, vol. 1, no. 4, pp. 183-192, 2012

Authors: Pons-Ódena, Martí | de la Fuente, Alexandre Escribá | Cambra Lasaosa, Francisco José | Segura Matute, Susana | Palomeque Rico, Antonio | Modesto, Vicent

Article Type: Research Article

Abstract: OBJECTIVE: To study patients diagnosed with bronchiolitis receiving ventilatory support with non-invasive ventilation (NIV) according to a chronologic classification: initial support (i-NIV), rescue post-extubation (r-NIV) and elective post-extubation (e-NIV); and to identify predictive factors of failure for each group. Prospective observational study (January 2004-December 2009), including all the patients with bronchiolitis admitted to pediatric intensive care unit and receiving ventilatory support with NIV. Clinical data collected at 0 (pre-NIV), 1, 2, 8, 12, 24 h of treatment were analyzed. Need for intubation was considered as NIV failure. NIV was successful in 65.8% of 152 cases included. Success rates were as …follows: i-NIV (52.2%); r-NIV (72.2%); and e-NIV (90.9%) (Anova P  < 0.000). Bi-level modes had higher efficacy (73%) than continuous positive airway pressure (61.5%) (Fisher’s-test P  = 0.049). Predictive factors of success in i-NIV group were inspired fraction of oxygen (FiO2 ) at 2 h, P  = 0.003, higher pulse oximeter saturation (SpO2 )/FiO2 values at 2 h (P  = 0.009), and SpO2 /FiO2 - 12 h (P  = 0.05), lower heart rate (HR) at 12 h (P  = 0.01), lower partial pressure of carbon dioxide (PCO2 ) previous to NIV (P = 0.009) and HR decrease-12 h (P  = 0.008), In e-NIV: respiratory rate (RR)-1 h (P  = 0.02), RR decrease-1 h (P  = 0.006) and higher SpO2 /FiO2 - 24 h (P  = 0.01); in r-NIV: SpO2 /FiO2 - 12 h (P  = 0.04), lower HR-2 h (P = 0.03) and HR-8 h (P  = 0.01). Multivariate analysis identified the groups as an independent variable (P  = 0.04) but didn’t show any significant value in any of the analyzed groups. Separate evaluation is advisable for i-NIV, r-NIV and e-NIV. Show more

Keywords: Non-invasive ventilation, interface, bronchiolitis, failure predictive factors, extubation, children

DOI: 10.3233/PIC-12032

Citation: Journal of Pediatric Intensive Care, vol. 1, no. 4, pp. 193-200, 2012

Authors: Caprotta, Gustavo | Tiszler, Martin | Chávez, Ximena | Frydman, Judith

Article Type: Research Article

Abstract: The indications for and timing of tracheostomy in children have changed significantly over recent years, and no consensus has been gathered in that regard. The purpose of this study is to present a series of critically ill patients who required a tracheostomy. All critically ill patients required a tracheostomy between 1 June 2009 and 31 March 2012. It is a retrospective, observational, descriptive study. A total of 18 patients underwent tracheostomy during the period under study. The most common indication was neuromuscular compromise. The average duration of mechanical ventilation before placement of a tracheostomy was 23.8 days (0–58 days). The …complications observed were minor, and no patients died from tracheostomy-related causes. All parents were trained in airway management and cardiopulmonary resuscitation. There were no serious tracheostomy-related complications in critically ill pediatric patients. The procedure was effective in the management of patients with respiratory failure, patients with neuromuscular compromise and children with upper airway obstruction. Show more

Keywords: Tracheostomy, intensive care unit, pediatrics

DOI: 10.3233/PIC-12033

Citation: Journal of Pediatric Intensive Care, vol. 1, no. 4, pp. 201-205, 2012

Authors: Witt, Russell G. | Raff, Gary W. | Van Gundy, Jeff | Si, Ming-Sing

Article Type: Research Article

Abstract: A Down syndrome female born at 35 wk estimated gestational age with non-immune hydrops fetalis associated with a complete atrioventricular septal defect and large patent ductus arteriosus with hypoxemia, severe anasarca and hypotension was treated successfully with extracorporeal life support for severe cardiopulmonary failure leading to eventual hospital discharge and elective repair of her cardiac defect. The case demonstrates that extracorporeal life support may be an effective therapy when initiated early in patients with non-immune hydrops fetalis associated with significant cardiac abnormalities.

Keywords: Cardiac anatomy, pathologic anatomy, congenital heart disease, septal defect, extracorporeal membrane oxygenation

DOI: 10.3233/PIC-12034

Citation: Journal of Pediatric Intensive Care, vol. 1, no. 4, pp. 207-210, 2012

Authors: Badugu, Srinivasarao | Elder, Melissa | Smith, Tara

Article Type: Research Article

Abstract: Macrophage activation syndrome (MAS) is a rare and life threatening complication of rheumatic diseases. It is seen most frequently in association with systemic onset juvenile idiopathic arthritis and less commonly in other rheumatic diseases of childhood including systemic lupus erythematosus. Recognition of MAS in patients with rheumatic diseases is often challenging as it may mimic the clinical features of the underlying disease. Sometimes MAS can be the mode of initial presentation adding to the diagnostic complexity. We describe two cases of MAS in association with systemic onset juvenile idiopathic arthritis who presented with a clinical picture suggestive of septic shock. …The Internal Review Board at Shands Children’s Hospital and the University of Florida waived the need for approval for these case reports. Show more

Keywords: Systemic onset juvenile idiopathic arthritis, macrophage activation syndrome, rheumatic disease

DOI: 10.3233/PIC-12035

Citation: Journal of Pediatric Intensive Care, vol. 1, no. 4, pp. 211-216, 2012

Authors: Badugu, Srinivasarao | Bennett, Jeffrey | Slamon, Nicholas

Article Type: Research Article

Abstract: Missile embolization is a rare phenomenon with most cases reported in the literature as a consequence of direct or indirect vascular trauma. Despite their characterization as toys, traumatic injuries from pellet guns are associated with significant rates of morbidity related to their vascular and neurological complications. We present a 9-year-old boy who was shot in the chest with a pellet gun and suffered a femoral arterial occlusion and a delayed stroke in the middle cerebral arterial distribution.

Keywords: Projectile, embolus, stroke

DOI: 10.3233/PIC-12036

Citation: Journal of Pediatric Intensive Care, vol. 1, no. 4, pp. 217-220, 2012

Authors: Tran, Kim A. | Fraser, Douglas D. | Hawrylyshyn, Krista | Norozi, Kambiz

Article Type: Research Article

Abstract: Our aim is to report the consequences of epinephrine toxicity leading to cardiac failure in a child and the successful management with dopamine and milrinone. A previously healthy 13-year-old girl undergoing a left tympanomastoidectomy was inadvertently administered 10 mL of 1:1000 epinephrine subcutaneously (0.175 mg/kg) on the left post auricular region in lieu of lidocaine. She developed sudden supraventricular tachycardia, hypertension and flash pulmonary edema. She was initially treated with propofol, nitrogycerin and increased peak end-expiratory pressure. Within 4 h, she remained tachycardic, but was hypotensive with an increased central venous pressure. Electrocardiogram and echocardiogram investigations showed ST changes indicative …of myocardial ischemia and globally reduced function, respectively. Dopamine infusion was administered, together with milrinone, resulting in a gradual improvement of cardiac function within 3 days. She was transitioned to enalapril and discharged home. This case highlights the clinical features of high dose epinephrine toxicity secondary to iatrogenic subcutaneous overdose followed by hypotension and pulmonary edema as a possible late effect of epinephrine and the successful management of secondary cardiac failure with administration of dopamine, milrinone and enalapril. Show more

Keywords: Epinephrine, drug toxicity, dopamine, milrinone, myocardial ischemia, pulmonary edema

DOI: 10.3233/PIC-12037

Citation: Journal of Pediatric Intensive Care, vol. 1, no. 4, pp. 221-225, 2012

Authors: Ramsey, Valerie

Article Type: Other

DOI: 10.3233/PIC-12038

Citation: Journal of Pediatric Intensive Care, vol. 1, no. 4, pp. 227-227, 2012

Authors: Khan, Sujoy

Article Type: Other

DOI: 10.3233/PIC-12039

Citation: Journal of Pediatric Intensive Care, vol. 1, no. 4, pp. 229-230, 2012

Article Type: Other

Citation: Journal of Pediatric Intensive Care, vol. 1, no. 4, pp. 231-233, 2012

Article Type: Other

Citation: Journal of Pediatric Intensive Care, vol. 1, no. 4, pp. 235-236, 2012