Journal of Pediatric Intensive Care - Volume 3, issue 4

Authors: Weiss, Scott L. | Fitzgerald, Julie C.

Article Type: Other

DOI: 10.3233/PIC-14109

Citation: Journal of Pediatric Intensive Care, vol. 3, no. 4, pp. 201-203, 2014

Authors: Murthy, Srinivas | Kissoon, Niranjan

Article Type: Research Article

Abstract: Viral infections are major causes of morbidity and mortality among children worldwide. All children, regardless of geographic region, socio-economic status, or age, are vulnerable to severe viral infections. They often require specialized care that ideally necessitates admission to an intensive care unit. This article will review the major viral syndromes and pathogens that affect children, focusing on the current evidence for their acute management in the intensive care unit.

Keywords: Bronchiolitis, encephalitis, intensive care, pediatric, pneumonia, virus

DOI: 10.3233/PIC-14103

Citation: Journal of Pediatric Intensive Care, vol. 3, no. 4, pp. 205-216, 2014

Authors: Siefkes, Heather | Hamele, Mitchell | Ampofo, Krow | Poss, W. Bradley

Article Type: Research Article

Abstract: Seasonal influenza is a leading cause of morbidity and mortality worldwide annually while pandemic influenza, a unique entity, poses distinct challenges. The pediatric population is the primary vector for epidemics and the main focus of this article. While primary prevention with universal influenza vaccination is the best protection against significant illness, the antigenic shift and drift unique to influenza viruses leave a large population at risk even with universal vaccination. Early in an epidemic various diagnostic tests are available and discussed here. However, once an epidemic is established, testing is no longer necessary for diagnosis. Groups with particular vulnerability to …serious illness include those <6 mo of age, children with underlying neuromuscular disease, pulmonary disorders, or other comorbid conditions. Early treatment with neuraminidase inhibitors is recommended for those with influenza infection requiring hospitalization. Respiratory failure and need for mechanical ventilation are the leading indications for intensive care unit admission among children. Complications of influenza such as pneumonia, empyema, myocarditis and neurologic involvement increase risk for intensive care unit admission and will be discussed as will the use of extracorporeal membrane support. An overview of the epidemiology of influenza with an emphasis on risk factors for critical illness and poor patient outcomes in the pediatric population as well as treatment strategies for critically ill children will be presented. Additionally, we will address some of the unique challenges posed by pandemic influenza and mitigation strategies. Show more

Keywords: Critical illness, influenza, pandemic, surge capacity

DOI: 10.3233/PIC-14104

Citation: Journal of Pediatric Intensive Care, vol. 3, no. 4, pp. 217-226, 2014

Authors: Chiotos, Kathleen | Balamuth, Fran | Scott, Halden F.

Article Type: Research Article

Abstract: Bacterial sepsis is a leading cause of pediatric morbidity and mortality worldwide. Early diagnosis, a coordinated and aggressive approach to initial resuscitation, and timely and appropriate antibiotic therapy are paramount to improving outcomes of these dangerous infections. The basic tenants of initial and ongoing resuscitation include rapid isotonic intravenous fluid boluses with reassessment for physiologic response, empiric broad-spectrum antibiotics directed to cover suspected sources of infection, source control, vasoactive infusions, supportive critical care and monitoring of response to therapy. In addition to resuscitation of bacterial sepsis, this article will review approaches to empiric antibiotic choice in septic shock, and detail …definitive management of infections caused by several specific organisms, including Staphylococcus aureus, group A Streptococcus, Pseudomonas aeruginosa, Mycobacterium tuberculosis, and Clostridium difficile. Lastly, management of several common pediatric infections, including community acquired bacterial pneumonia and bacterial meningitis, will be reviewed. Show more

Keywords: Anti-bacterial agents, bacteremia, pediatric, resuscitation, septic shock, sepsis

DOI: 10.3233/PIC-14105

Citation: Journal of Pediatric Intensive Care, vol. 3, no. 4, pp. 227-242, 2014

Authors: Demirkol, Demet | Carcillo, Joseph

Article Type: Research Article

Abstract: Hemophagocytic lymphohistiocytosis (HLH) or macrophage activation syndrome (MAS) is a frequently fatal disease, which can result in end-organ damage and death. This condition shares features with sepsis and systemic inflammatory response syndrome. Making a diagnosis of HLH can be challenging since most of the clinical and laboratory features of HLH are quite nonspecific. Timely diagnosis is critical to start therapy before damage by hypercytokinemia becomes irreversible. The treatment for patients with suspected acquired HLH/sepsis/systemic inflammatory response syndrome/multi organ dysfunction syndrome/ MAS overlap syndrome should be guided primarily by the severity of signs and symptoms, age of the patient, and underlying …conditions. It is critical that the risks of treatment or non-treatment be weighed according to the clinical presentation of each patient. In this article, the authors discuss the diagnostic similarities between sepsis/HLH/MAS and management of the critically ill child with sepsis/HLH/MAS overlap syndrome. Show more

Keywords: Hemophagocytic lymphohistiocytosis, macrophage activation syndrome, sepsis, multiple organ dysfunction syndrome, hyperferritinemia, hypercytokinemia

DOI: 10.3233/PIC-14106

Citation: Journal of Pediatric Intensive Care, vol. 3, no. 4, pp. 243-254, 2014

Authors: Muszynski, Jennifer A. | Frazier, W. Joshua | Hall, Mark W.

Article Type: Research Article

Abstract: Primary goals of sepsis therapy include early, appropriate antimicrobial therapy and prompt recognition and reversal of shock. Despite these measures, however, sepsis remains an important source of pediatric morbidity and mortality. Here we review rationale and existing evidence in support of adjunctive sepsis therapies including extracorporeal support, immunomodulation, and mitochondria-targeted therapies. While each of these therapeutic modalities shows promise, additional studies are urgently needed to identify the right patients, the right timing, and the right context for these interventions.

Keywords: Sepsis, extra corporeal membrane oxygenation, renal dialysis, immunomodulation, mitochondria

DOI: 10.3233/PIC-14112

Citation: Journal of Pediatric Intensive Care, vol. 3, no. 4, pp. 255-267, 2014

Authors: Chiotos, Kathleen | Fisher, Brian T. | Zaoutis, Theoklis

Article Type: Research Article

Abstract: Invasive candidiasis (IC) are the most common invasive fungal infections in pediatric intensive care unit patients due to commonly present risk factors including central venous catheters, antibiotic exposure, recent surgery, total parenteral nutrition, and prior colonization with Candida species. These infections are economically costly and have been associated with an attributable mortality of approximately 10%. As a result, investigators have attempted to identify cohorts of pediatric intensive care unit patients at highest risk of development of IC who may benefit from prophylactic, early empiric, or pre-emptive therapy. This review article will consider these prediction models and therapeutic approaches. Additionally, the …management of confirmed IC, including anti-fungal therapeutic options, evaluation for disseminated disease, and management of central venous catheters, will be reviewed. Show more

Keywords: Candida, candidiasis, anti-fungal agent, pediatrics, pediatric intensive care unit

DOI: 10.3233/PIC-14108

Citation: Journal of Pediatric Intensive Care, vol. 3, no. 4, pp. 269-279, 2014

Authors: Guzman-Cottrill, Judith A. | Kirby, Aileen

Article Type: Research Article

Abstract: Healthcare-associated infections cause significant morbidity and mortality in pediatric intensive care unit (PICU) patients. Critically ill children frequently require the placement of invasive devices, such as central venous catheters, urinary catheters, and endotracheal tubes. Each device increases a patient's risk of acquiring infection. In this review, the diagnosis and management of common healthcare-associated infections in the PICU is discussed. This review also examines several infection prevention strategies used in the PICU.

Keywords: Healthcare-associated infection, central line-associated bloodstream infection, ventilator-associated pneumonia, catheter-associated urinary tract infection, hospital-onset respiratory virus infection

DOI: 10.3233/PIC-14110

Citation: Journal of Pediatric Intensive Care, vol. 3, no. 4, pp. 281-289, 2014

Authors: Chaparro, Juan D. | Leake, John A.D.

Article Type: Research Article

Abstract: Parasitic diseases, previously thought to be the domain of developing nations only, are being increasingly recognized as a significant source of morbidity/mortality in developed and developing nations alike. While many parasites cause long-term low-level disease, some parasitic diseases can have severe manifestations necessitating intensive care unit admission. In this review, we focus on severe malaria (including cerebral malaria), neurocysticercosis, Strongyloides hyperinfection syndrome, American trypanosomiasis (Chagas disease), baylisascariasis and amoebic meningoencephalitis.

Keywords: American trypanosomiasis, amoebic meningoencephalitis, baylisascariasis, Chagas disease, hyperinfection syndrome, neurocysticercosis, pediatric parasitic disease, parasitic disease, severe malaria, strongyloidiasis

DOI: 10.3233/PIC-14111

Citation: Journal of Pediatric Intensive Care, vol. 3, no. 4, pp. 291-304, 2014

Authors: Vella, Laura | Fisher, Brian T.

Article Type: Research Article

Abstract: The diagnosis and management of infectious diseases in the immunocompromised patient can be challenging, especially when that patient is critically ill. In the diagnostic approach to the immunocompromised patient, clinicians will need to integrate the risks particular to the immunodeficiency with the risks associated with hospital-associated exposures. The potential infectious diagnoses are expanded in the immunocompromised patients, most notably to include diseases due to opportunistic infections, such as fungi, latent viruses, and opportunistic Gram-positive and Gram-negative bacteria. In addition, prior hospital and antibiotic exposure increases the likelihood that these patients will have infections due to resistant organisms. When an infection …is diagnosed, the approach to treatment in the immunocompromised patient is also dependent on the degree and type of immunodeficiency, and optimal treatment strategies are often not well studied. This review focuses on general principles that can be used in the diagnosis and management of immunocompromised, critically ill patients with suspected or proven infection and highlights in detail the approach to infections of the blood stream and respiratory tract. Show more

Keywords: Immunocompromised, infections, pediatric intensive care unit

DOI: 10.3233/PIC-14113

Citation: Journal of Pediatric Intensive Care, vol. 3, no. 4, pp. 305-313, 2014