Journal of Pediatric Intensive Care - Volume 2, issue 2
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Journal of Pediatric Intensive Care is an English multidisciplinary peer-reviewed international journal publishing articles in the field of pediatric intensive care.
Journal of Pediatric Intensive Care is written for the entire intensive care team: pediatric intensivist, pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are followed in neonatal and pediatric intensive care units.
Journal of Pediatric Intensive Care provides an in-depth update on new subjects, and current comprehensive coverage of the latest techniques in intensive care in childhood.
Journal of Pediatric Intensive Care encourages submissions from all authors throughout the world.
The following articles will be considered for publication: editorials, original and review articles, short report, rapid communications, letters to the editor, and book reviews. The aim of the journal is to share and disseminate knowledge between all disciplines that work in the field of pediatric intensive care.
Abstract: Delirium is a neuropsychiatric disorder characterized by acute disturbances in attention, consciousness, cognitive processing, perception, and the sleep-wake cycle. The few studies investigating treatment of delirium in critically ill children and adolescents have used differing diagnostic criteria, and have not employed control groups or procedures to blind observations. The objective of this study was to examine the efficacy of olanzapine for the treatment of delirium in the pediatric intensive care unit (ICU) using methodological procedures to reduce bias and allow greater generalization. Psychiatric records of 59 patients admitted to the pediatric ICU or cardiothoracic ICU over a 4 yr period…with the diagnosis of delirium were examined. The delirium rating scale was used to assess delirium severity at the time of initial psychiatric evaluation and five days later. Raters were blinded to medication administration. Patients who were diagnosed with delirium, but did not receive olanzapine, or any other antipsychotic medication, served as the control group. Greater improvement of delirium symptoms was found for the olanzapine group (n = 31) than the control group (n = 28) (F (1,40) = 4.86, r = 0.33, 95% confidence interval = 0.020–0.58). This finding remained statistically significant after controlling for initial delirium severity (F (1, 20) = 28.62, r = 0.77, 95% confidence interval = 0.50–0.90). This study demonstrates patients with delirium administered olanzapine had greater reduction of delirium symptom severity than controls. It supplements the existing literature by using a study design that reduces expectancy effects and allows examination of the natural history of delirium symptoms without medication administration.
Keywords: Olanzapine, antipsychotics, neuroleptics, delirium, pediatric intensive care
Abstract: Data regarding in-hospital pediatric cardiopulmonary resuscitation (CPR) are limited because of retrospective study designs and inconsistent definitions. There are no Indian studies on pediatric CPR. Accordingly, we conducted this retrospective study to determine the outcome of in-hospital CPR and assess which variables predict outcome. Consecutive in-hospital CPR events in children aged 1-mo to 14-yr during a 1 yr period were described prospectively using Utstein guidelines. Variables affecting outcome were evaluated by univariate and multivariate analysis. A total of 427 patients were enrolled and received CPR. The indication for CPR was primary respiratory failure in 213 (50%) and clinical cardiac arrest…in 191 (44%). The most common underlying etiology was neurological illness (26%). Sustained return of spontaneous circulation was attained in 112 (26%). Fifty-three (12%) patients were alive at 24 h, of which only 8 (1.87%) were alive at discharge. Of those patients who survived to discharge, all were alive after 6 mo. Multivariate logistic regression analysis showed that CPR during night hours (adjusted odds ratio [aOR]: 3.73), CPR of more than 10 min duration (aOR: 27.04) and cardiac arrest as an indication of CPR (aOR: 2.56) were independently associated with poor immediate outcome. Factors associated with death within 24 h were CPR during night hours (aOR: 3.17), age > 1 yr (aOR: 5.52) and cardiac arrest (aOR: 4.93). Good neurological outcome was found in seven out of eight (87.5%) patients at follow up. We conclude that pediatric cardiac arrest in a tertiary hospital in India has a poor outcome even after survival beyond 24 h; however, neurological outcome is generally good among survivors.
Keywords: Cardiopulmonary resuscitation, in hospital, Utstein guidelines
Abstract: No studies have evaluated the outcomes of a bowel regimen (BR) in critically ill children receiving enteral nutrition. In fall 2010, a comprehensive feeding protocol and BR protocol were initiated in our institution. Six age-based BR protocols were developed, each of which included a four-step approach. This retrospective study evaluated children <18 years of age who received the BR between July 18, 2010 and April 31, 2012. The primary objective was to determine the percentage of patients requiring BR escalation beyond the initial step in the protocol (Step 1). Secondary objectives included the number of patients with a protocol deviation…and the frequency of adverse events. Fifty-four patients were included. The majority were male with a median age of 0.25-year-old (range 0.08–15 yr). Forty-three (79.6%) patients received opioid continuous infusions. The BR was initiated on pediatric intensive care unit day 1 (range 1–25 d). Thirty patients (55.6%) required escalation beyond “Step 1”. All patients who received “Step 2” and “Step 3” had a protocol deviation. Opioid duration was significantly associated with protocol escalation (odds ratio, 0.83; 95% confidence interval 0.689–0.997; P = 0.047). This pilot study is the first to describe the outcomes of the implementation of a four-step BR in critically ill children. Future studies should focus on the optimal regimen to alleviate constipation in critically ill children.
Abstract: In this article, we report a case of a previously healthy 11-year-old male who presented to our university hospital with a mediastinal mass, a left and right pleural effusion, and a small pericardial effusion of 5 mm, detected on computed tomography scan and echocardiography. On assessment, he had all the clinical features of superior vena cava syndrome and tamponade, including muffled heart sounds, tachycardia, and pulsus paradoxus. The patient developed increasing respiratory distress requiring tracheal intubation and mechanical ventilation, and despite drainage of his larger pleural effusion, continued to experience symptoms of respiratory distress. Finally, the small pericardial effusion was…confirmed on echocardiography and drained after a clinical diagnosis of cardiac tamponade, leading to dramatic improvement in the patient's cardiovascular status. Curiously, on pericardiocentesis, much less fluid was obtained than expected for his presenting symptoms and clinical course.
Abstract: A 10-year-old girl presented with severe diabetic ketoacidosis and a hemoglobin A1c of 17.9%. On hospital day 2, after acidosis had improved, it worsened and she developed excruciating abdominal pain. Her serum triglycerides and lipase levels were found to be extremely high and ultrasound analysis of the pancreas was consistent with acute pancreatitis. She was diagnosed with acute pancreatitis secondary to hypertriglyceridemia. The pancreatitis resolved completely and 2 mo later her hemoglobin A1c was 8.2% and the serum triglycerides were normal. Severe hypertriglyceridemia from insulin deficiency causing pancreatitis in new onset type 1 diabetes mellitus is a rare but serious…complication of diabetic ketoacidosis in children.
Abstract: Vein of Galen arterio-venous malformation is a rare congenital anomaly, which presents in the neonatal period. High output heart failure in the absence of an underlying structural heart defect points towards the condition and is an important contributing factor for morbidity and mortality. We describe a case of a term newborn who presented with respiratory distress and cardiomegaly. The characteristic echocardiographic findings of high output cardiac failure were found and eventually led to the diagnosis of an underlying vein of Galen arterio-venous malformation. The relevant literature is discussed.
Keywords: Vein of Galen arterio-venous malformation, echocardiography, neonate
Abstract: We present the cases of a 1-month-old infant diagnosed as having malignant migrating partial epilepsy of infancy and a 2-month-old infant with Ohtahara syndrome, who both presented with severe refractory status epilepticus and were treated with potassium bromide when all other antiepileptic drugs failed. Appropriate augmentation of the dosage of potassium bromide led to reduction in the frequency and duration of seizures in both patients. There was a notable reduction in the occurrence of epileptic seizures in both cases, with no apparent side effects. Potassium bromide was of significant benefit for seizure reduction in two infants with intractable seizures. It…could be used safely and within a short period. Potassium bromide should be considered as a relatively safe therapeutic option for infants and children with severe intractable seizures when other antiepileptic drugs fail to control the seizures.
Keywords: Bromides, refractory status epilepticus, pediatric intensive care unit, antiepileptic drugs, seizure control, side effects
Abstract: Neurogenic pulmonary edema (NPE) and neurogenic stunned myocardium are known complications of acute neuropathology, but these conditions have only rarely been reported with ventriculoperitoneal shunt malfunction. Furthermore, shunt malfunction presenting with NPE has not been described in a pediatric patient. A case of acute shunt malfunction and NPE followed by a complicated cardiopulmonary clinical course is reviewed.