Journal of Pediatric Intensive Care - Volume 3, issue 3
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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: Hematopoietic stem cell transplantation (HSCT) is being used to treat numerous malignant and non-malignant medical conditions in pediatric patients, but frequently is associated with severe medical complications. We review the outcomes of HSCT patients who developed complications requiring pediatric intensive care unit (PICU) care. The earliest reported patient cohorts, who were transplanted prior to 1990, had high PICU mortality rates, exceeding 80%. Patients transplanted from the 1980s–1990s varied more widely in mortality rates, with mortalities of 56–88% reported for mechanically ventilated patients and rates of 44–50% reported for studies including both mechanically ventilated and non-mechanically ventilated patients in PICU. The…patient group transplanted from the 1990s to the early 2000s had reported mortalities of 46–60%. For patients transplanted after 2000, mortality rates were reported ranging from 37–69%. Two centers reported a significant improvement in mortality over time at their centers, although other institutions did not find similar changes. Factors associated with increased mortality included the need for mechanical ventilation, pulmonary pathology as a cause for intubation, severity of lung disease, multiorgan failure, and severe graft versus host disease. The Pediatric Risk of Mortality scoring system has not been consistently predictive of mortality; the modified Oncological Pediatric Risk of Mortality system was more predictive of mortality in several studies. Overall, the mortality of pediatric HSCT patients requiring PICU care has decreased, but remains substantial. Further study is needed to define clinical factors that affect outcome, so that treatments might be modified to improve survival.
Keywords: Hematopoietic stem cell transplant, intensive care, bone marrow transplant, mechanical ventilation, pediatric, sepsis, mortality
Abstract: Hematopoietic cell transplantation is a potentially curative therapeutic modality for a wide range of pediatric malignant and nonmalignant diseases. Hematopoietic cell transplantation has evolved over time to include more indications for transplantation and broad-spectrum treatment and supportive care strategies. This review will address the process of transplantation, donor and stem cell sources, complications, and transplantable diseases.
Abstract: Children undergoing hematopoietic stem cell transplant often require intensive care support due to their underlying disease, sepsis, infection, hemorrhage, respiratory failure and organ dysfunction. The majority of children requiring intensive care support have an allogeneic donor. These children carry a higher likelihood of graft versus host disease complicating their medical management. Understanding the process of graft versus host disease is important in the shared care of these children between pediatric intensive care physicians and the bone marrow transplant team.
Abstract: Pediatric hematopoietic stem cell transplant recipients are at risk for acquiring a variety of lower respiratory tract infections (LRTI), which result in frequent pediatric intensive care unit admission with high mortality. Recent advances in conditioning regimens, opportunistic infection prophylaxis, diagnostic tools, and treatment modalities have broadly impacted our understanding of LRTI among these vulnerable patients. In this review, the most common bacteria, viruses, and fungi causing LRTI in pediatric hematopoietic stem cell transplant patients are discussed.
Keywords: Pediatric, bone marrow transplant, hematopoietic stem cell transplant, intensive care unit, critical care, pulmonary, lower respiratory tract, infection, pneumonia, immunocompromise
Abstract: Noninfectious pulmonary complications of hematopoietic stem cell transplant are currently more prevalent than infectious complications. Unfortunately, the pathophysiology basis is not completely understood. However, there is a string association with graft-versus-host disease for many of them. Therefore, an important component of their pathophysiology is likely an allo-immune response. There is much research that needs to be conducted to improve the less than optimal outcomes for these disorders.
Keywords: Hematopoietic cell transplant, pulmonary complications, graft versus host disease
Abstract: Non-infectious lung injury following hematopoietic stem cell transplant may be driven by either immune or non-immune pathways of inflammation. Common alloimmune lung complications include idiopathic pneumonia syndrome (IPS), transfusion related lung injury, diffuse alveolar hemorrhage, and peri-engraftment respiratory distress syndrome, with both diffuse alveolar hemorrhage and peri-engraftment respiratory distress syndrome existing as subsets of IPS when infection is absent. This review will discuss the definitions, risk factors, and pathogeneses of IPS and highlight the diagnostic work-up and novel approaches to treatment.
Abstract: Acute kidney injury is common after pediatric hematopoietic stem cell transplant with a reported incidence of 21–55% in the first 3 mo after transplant. Acute kidney injury is associated with decreased survival and the development of chronic kidney disease in this patient population. In this review, current definitions of acute kidney injury are discussed. The epidemiology and risk factors for acute kidney injury in this patient population are described, and current hypotheses on the pathophysiology are reviewed. Current and emerging ideas about changes to management strategies to mitigate acute kidney injury are presented, and areas for further research are proposed.
Abstract: Acute neurologic complications in pediatric hematopoietic stem cell transplant (HSCT) patients cause significant morbidity and mortality. To conduct a comprehensive review of the existing literature reporting acute neurologic complications of the central nervous system among children undergoing HSCT. Comprehensive literature review from 2000 to 2014 using Medline. A total of 566 pediatric articles were reviewed and data from 66 studies selected. A brief overview of morbidity and mortality in pediatric HSCT patients is provided followed by a summary of findings related to acute neurologic complications. Acute central nervous system complications in pediatric HSCT patients are varied and are the result…of multiple causes including infection, drug-related toxicity, immune suppression, vascular injury and neoplasms.
Abstract: Hepatic veno-occlusive disease (VOD), or sinusoidal obstruction syndrome, is a potentially fatal complication, which occurs in 7–27% of children undergoing hematopoietic stem cell transplantation. In this article, we review commonly accepted diagnostic criteria, atypical diagnostic features as well as preventative and treatment measures associated with VOD. Reversal of portal venous flow by Doppler ultrasound is often a late finding; many patients with anicteric VOD may never develop hyperbilirubinemia, and yet perish from severe VOD. Transjugular liver biopsy is usually not available and/or is often avoided. Prophylactic therapies with ursodeoxycholic acid, heparin and defibrotide are discussed. Supportive care with fluid restriction…and diuretic therapy, analgesia, blood and platelet transfusions, paracentesis as well as other pulmonary and renal therapies remain imperative to superior outcomes. Specific therapy with thrombolytics such as defibrotide and recombinant tissue plasminogen activator is discussed and a classification of severity of VOD is proposed.