Pediatric Critical Care

to other interventions and prophylactically in the hope of reducing blood loss. Treatment regimens vary widely, in terms of both first and cumulative dose. Data on chest tube blood loss and two markers of coagulation were pooled and analyzed, and significant improvements were demonstrated. Mortality was 4.4% for the entire cohort but 20% of patients on extracorporeal membrane oxygenation suffered significant thromboembolic complications.

Objective: To identify and evaluate the quality of evidence supporting prophylactic use of treatments for stress ulcers and upper gastrointestinal bleeding. Stress ulcers, erosions of the stomach and duodenum, and upper gastrointestinal bleeding are well-known complications of critical illness in children admitted to the pediatric intensive care unit.

Las cuestiones éticas tienen un interés creciente en la medicina actual, y la pediatría no es una excepción. En la medicina intensiva, la relevancia de estas consideraciones es aún mayor. Un problema frecuente, que se ha puesto de manifiesto en diversos trabajos, es la confusión terminológica en las diversas expresiones de uso común en bioética, lo que probablemente se traduce en muchos casos en una falta de claridad conceptual.

Las cuestiones éticas tienen un interés creciente en la medicina actual, y la pediatría no es una excepción. En la medicina intensiva, la relevancia de estas consideraciones es aún mayor. Un problema frecuente, que se ha puesto de manifiesto en diversos trabajos, es la confusión terminológica en las diversas expresiones de uso común en bioética, lo que probablemente se traduce en muchos casos en una falta de claridad conceptual.En un intento de aportar algo de claridad y de facilitar la comprensión de los conceptos y las ideas relevantes en bioética, el Grupo de Ética de la Sociedad Española de Cuidados Intensivos Pediátricos ha elaborado este glosario de términos y expresiones frecuentes en bioética.Todos los miembros del grupo somos intensivistas pediátricos en activo, por lo que, en la selección y definición de estos términos, hemos tenido en cuenta la problemática ética que se plantea en nuestra actividad asistencial diaria, aunque, por supuesto, ha sido fundamental el análisis y la reflexión sobre las ideas y opiniones expuestas en diferentes obras de los autores más relevantes.Ethical issues are of increasing interest in current medicine, and pediatrics is no exception. In critical care, the relevance of these considerations becomes even greater.Commonly used expressions in bioethics, frequently lead to terminological confusion and misunderstandings, as reported by several publications, revealing a lack of clear concepts in many cases.As an attempt to clarify or facilitate the comprehension of the most relevant terms in this field, the Spanish Society of Pediatric Intensive Care has prepared a Glossary of the most commonly used terms and expressions.

Objective: Enteral feeding is widely used in ventilated patients admitted to pediatric intensive care units. Although studies in adult patients have shown that the site of feeding (stomach vs. small intestine) may be associated with aspiration pneumonia, there are no such reports in critically ill pediatric patients. We hypothesized that in intubated pediatric patients, there was no difference in the frequency of aspiration between nasogastric and postpyloric enteral feeding.

The Citadel ABSTRACT. Described here is behavioral theory, research, and treatment of physical child abuse. A brief history is presented, along with incidence data. Some research has shown successful behavioral assessment and treatment in child abuse; many more issues remain open for additional success with this treatment refractory societal problem. These issues are explored, along with speculation as to why there has not been more research in an area of such vital social importance.

Education recently released new standards for supervision and duty hours for residency programs. These new standards, which will affect over 100,000 residents, take effect in July 2011. In response to these new guidelines, the Society of Critical Care Medicine convened a task force to develop a white paper on the impact of changes in resident duty hours on the critical care workforce and staffing of intensive care units.

Objective: To evaluate the impact of syringe size on start-up delay and the time to reach 50% and 90% of target flow rates, using two commercially available syringe infusion pumps at infusion rates of <1 mL/hr. Design: Two syringes (Terumo) of different size (10-mL and 50-mL), using two syringe infusion pumps (Pump A, Terumo Terufusion Infusion Pump TE-331; and Pump B, Braun Perfusor Compact S) were studied. Effective fluid delivery was measured at 0.4 mL/hr, 0.8 mL/hr, and 1.0 mL/hr for the initial 60 mins, using the gravimetric method. Instant flow was calculated as volume difference for every 1-min interval per minute. Start-up delay was defined as time in minutes of 0 flow from the start of infusion. Syringe placement, bubble removal, infusion line priming, and positioning were standardized for all measurements, using new syringes and infusion lines. Each experiment was repeated six times. Statistical analysis was performed, using a nonparametric test (Mann-Whitney U test).

Las cuestiones éticas tienen un interés creciente en la medicina actual, y la pediatría no es una excepción. En la medicina intensiva, la relevancia de estas consideraciones es aún mayor. Un problema frecuente, que se ha puesto de manifiesto en diversos trabajos, es la confusión terminológica en las diversas expresiones de uso común en bioética, lo que probablemente se traduce en muchos casos en una falta de claridad conceptual.

Background: Communication skills and relational abilities are essential core competencies that are associated with improved health outcomes, better patient adherence, fewer malpractice claims, and enhanced satisfaction with care. Yet, corresponding educational opportunities are sorely underrepresented and undervalued.

Objective: Inotrope score has been proposed as a marker of illness severity after pediatric cardiac surgery despite a lack of data to support its use as such. The goal of this study was to determine the association between inotropic/vasoactive support and clinical outcome in infants after cardiac surgery.

Mean Arterial Pressure (MAP)-Central venous pressure (CVP) (MM of Hg) Term Newborn 120 to 180 55 Up To 1 year 120 to 180 60 Up To 2 years 120 t0 160 65 Up To 7 years 100 t0 140 65 Up To 15 years 90 to 140 65 ABSTRACT Severe sepsis and septic shock are complications of infection leading to high morbidity and mortality. Hemodynamic outcomes are considered surrogate markers for survival-an ultimate goal of treatment strategies. The goal of vasoactive agents is to improve arterial blood pressure (age related norms) without associated adverse effects. Early initiation of a vasoactive agent in fl uid-refractory septic shock has a signifi cant role in the outcome; initiation within an hour of presentation is recommended and is associated with favorable outcomes. The choice of the correct vasoactive agent in a given scenario has a pivotal role on the desired outcome as well as the duration to achieve it. Cardiac dysfunction is a well recognized complication of septic shock, occurring in about 60% of the patients. So ionotropes may play a role in septic shock patients with associated myocardial dysfunction and signs of organ hypoperfusion despite achieving adequate preload and mean arterial pressure. In children presentation of septic shock is more complex, predominantly vasoconstricted with low cardiac output. Sometimes they can have deranged myocardial contractility and SVR problems requiring combination of inotropes and vasopressors. Hence the choice of inotrope remains empirical. Vasoactive therapy should be guided by clinical end points.

The primary purpose of this article is to critically examine the state of the medical ethics literature and discourse around the concept of futility in pediatric intensive or critical care. The secondary purpose is to identify the conceptualization of futility by different authors, the tensions that exist in the discourse around futility, and the variables that exist in cases when futility is thought to occur. Identification of concepts, tensions, and variables will help to identify the social structure around issues of futility in pediatric intensive care. Seventeen articles were included for summative content analysis. Four conceptions of futility were found: unclear, against medical standards, a subjective value judgment, and not a unilateral conception. The major tensions that emerged, in order, were that futility is based in relationships and responsibility, is goal oriented, and based in beliefs and values. The most reported variable was conflict between parents and careproviders, followed by mechanical ventilation, neurologic devastation, terminal illness, uncertainty , and aggressive treatment. Given that the main variable found was conflict, the main tension was relational, and no consensus on futility was found, it appears that unless there is investigation into the mechanisms of conflict and relational tensions

Objective: Previous publications using nonconcurrent series of patients indicate improved survival for patients with hypoplastic left heart syndrome (HLHS) undergoing stage I palliation with a right ventricle to pulmonary artery conduit (NW-RVPA) vs. a modified Blalock-Taussig shunt (NW-BT). We compared postoperative outcomes in a concurrent series of patients with HLHS undergoing an NW-BT procedure vs. NW-RVPA procedure.

Objective: To explore whether the carbon dioxide-bicarbonate (PCO 2 -HCO 3 ) buffering system in blood and cerebrospinal fluid (CSF) in diabetic ketoacidosis should influence the approach to ventilation in patients at risk of cerebral edema.

Background: The extent of neuroendocrine dysfunction (NED) has not been well defined in critically ill children and likely varies significantly from that in adults. We sought to define the prevalence of neuroendocrine dysfunction in a group of children in a multidisciplinary pediatric intensive care unit and determine the relationship of neuroendocrine dysfunction with severity of illness and presence of sepsis.

Background: The term "humanization" indicates the process by which people try to make something more human and civilized, more in line with what is believed to be the human nature. The humanization of care is an important and not yet a well-defined issue which includes a wide range of aspects related to the approach to the patient and care modalities. In pediatrics, the humanization concept is even vaguer due to the dual involvement of both the child and his/her family and by the existence of multiple proposed models. Objective: The present study aims to analyze the main existing humanization models regarding pediatric care, and the tools for assessing its grade. Results: The main Humanization care programs have been elaborated and developed both in America (Brazil, USA) and Europe. The North American and European models specifically concern pediatric care, while the model developed in Brazil is part of a broader program aimed at all age groups. The first emphasis is on the importance of the family in child care, the second emphasis is on the child's right to be a leader, to be heard and to be able to express its opinion on the program's own care. Several tools have been created and used to evaluate humanization of care programs and related aspects. None, however, had been mutually compared. Conclusions: The major models of humanization care and the related assessment tools here reviewed highlight the urgent need for a more unifying approach, which may help in realizing health care programs closer to the young patient's and his/her family needs.

Microcirculation is a network of small blood vessels of <100 μm diameter. It includes arterioles, capillaries and venules.Its main function is to regulate the blood fl ow and distribution of fl ow to various organ systems. Dysfunction of microcirculatory systemis one of the important pathophysiologic process in sepsis evolution. In septic shock, microcirculatory dysfunction is due to endothelial dysfunction, coagulation abnormalities, tissue infl ammation, hemorheologic abnormalities, functional shunting and leukocyte-endothelium interactions. Various biomarkers are surrogate markers of measuring microcirculatory dysfunction, however, direct visualization of capillaries using video microscopic techniques is the gold standard. Therapeutic intervention for managing septic shock are mainly titrated on microcirculatory parameters and do not corelate directly with improvement at microcirculatory levels. More data is needed on practical bedside monitoring of microcirculation and titrating the therapy based on that.

A cute lung injury (ALI) and its more severe form, acute respiratory distress syndrome (ARDS), are life-threatening conditions of acute pulmonary inflammation and hypoxia, frequently resulting in respiratory failure. ALI/ARDS are associated with high mortality ranging from 33% to 65% in adults (1, 2) and 18% to 35% in children (3-6). Mechanical ventilator management can impact outcomes in ALI/ARDS, and minimizing ventilator-induced lung injury can decrease mortality 8). In adults, there have been several large (ϳ800 -1000 patients), randomized, clinical trials with ALI/ ARDS assessing ventilator management strategies and adjunctive therapies.

Background: Communication skills and relational abilities are essential core competencies that are associated with improved health outcomes, better patient adherence, fewer malpractice claims, and enhanced satisfaction with care. Yet, corresponding educational opportunities are sorely underrepresented and undervalued.

Mechanical ventilation (MV) and respiratory care provide support to the patient who cannot maintain viable oxygenation, ventilation, and/or protective airway reflexes. Support is initiated when the patient cannot maintain a safe level of homeostasis. Support is withdrawn when the patient is able to breathe without artificial assistance. The level and duration of support depend on the cause of the respiratory system’s failure and the patient’s response to therapy. Mechanical ventilation (MV) and respiratory care provide support to the patient who cannot maintain viable oxygenation, ventilation, and/or protective airway reflexes. Support is initiated when the patient cannot maintain a safe level of homeostasis. Support is withdrawn when the patient is able to breathe without artificial assistance. The level and duration of support depend on the cause of the respiratory system’s failure and the patient’s response to therapy.

Background: Mechanical ventilation is lifesaving in children with respiratory failure. However, its unnecessary prolongation once a child is capable of sustaining spontaneous effective ventilation is associated with significant complications. Objective: To identify the factors that lead to higher chance of extubation failure in mechanically ventilated children. Materials and Methods: A prospective, observational study was conducted over a period of 1 year. Children admitted to pediatric intensive care unit of a tertiary care hospital of Northern India aged 1 month-17 years, needing mechanical ventilation were included in the study. Predefined criteria were used to decide the timing of extubation. Relevant details were recorded to study various patient-related parameters and their association with extubation outcome. Results: Mean age of the study group was 50 months with a male:female ratio of 3:1. Extubation failure rate was 14.5%. Extubation failure was significantly higher in patients ventilated for >7 days (p=0.01), those with the pediatric risk of mortality score >10 at admission (p=0.009), in addition to peak inspiratory pressure >16 cm H 2 O (p=0.009) and FiO 2 ≥0.35 (p=0.01) before extubation. Accidental extubation was also associated with higher extubation failure (p<0.001). Conclusion: Our study demonstrates that even though sicker patients requiring ventilation for longer duration are more prone to failed extubations, protocol based, and planned extubations lead to better extubation success.

Introduction : Early and late neurologic complications of congenital chikungunya fever has been underreported in published literature. We describe the acute clinical manifestations and long term neurodevelopmental outcomes of congenital chikungunya in a recent case series. Objective: To describe clinical manifestations of congenital chikungunya and its neurodevelopmental outcomes at 18 months follow up. Methods : Medical records of the neonates born to mothers with chikungunya admitted in Sir Gangaram Hospital, New Delhi during August to November 2016 were reviewed. All exposed neonates were observed for signs and symptoms of chikungunya and managed as per departmental protocol. Newborns with positive cord blood or postnatal RT-PCR were defi ned to have congenital chikungunya. These infants were evaluated for developmental disabilities at 18 months of age by ages and stages questionnaire (ASQ-3). Results: Seventeen neonates were considered to be "exposed" being delivered to chikungunya positive mothers. Of them, nine (52.9%) were labelled as infected on basis of positive cord blood RT-PCR. Eight neonates became symptomatic with development of typical chikungunya rash in 6 (66.6%), fever in 5 (55.5%), encephalopathy in 8 (100%), and seizure in 4(50%) neonates with one mortality(11%). MRI-brain was abnormal in six encephalopathic (75%) neonates. Based on parental response of ASQ-3 questionnaire, neurodevelopment was learnt to be normal in six infants (75%) and two (25%) had delay in motor and communication skills. Conclusion: Although few babies developed developmental delay, signifi cant proportion of them recovered by 18 months of age inspite of severe neurotropic manifestation of congenital chikungunya.

Pediatrics is the specialty of medical science concerned with the physical, mental, and social health of children from birth to young adulthood. Pediatric care encompasses a broad spectrum of health services ranging from preventive health care to the diagnosis and treatment of acute and chronic diseases.
https://clinicalcasereports.conferenceseries.com/call-for-abstracts.php Pediatrics is a discipline that deals with biological, social, and environmental influences on the developing child and with the impact of disease and dysfunction on development. Children differ from adults anatomically, physiologically, immunologically, psychologically, developmentally, and metabolically.

To determine energy dose and number of biphasic direct current shocks for pediatric ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). Observation of preshock and postshock rhythms, energy doses, and number of shocks. Pediatric hospital. Shockable ventricular dysrhythmias. None. Forty-eight patients with VF or pulseless VT received external shock at 1.7 ± 0.8 (mean ± SD) J/kg. Return of spontaneous circulation (ROSC) occurred in 23 (48%) patients with 2.0 ± 1.0 J/kg, but 25 (52%) patients remained in VF after 1.5 ± 0.7 J/kg (p = .05). In 24 non-responding patients, additional 1-8 shocks (final dose, 2.8 ± 1.2 J/kg) achieved ROSC in 14 (58%) with 2.6 ± 1.1 J/kg but not in 10 (42%) with 3.2 ± 1.2 J/kg (not significant). Overall, 37 (77%) patients achieved ROSC with 2.2 ± 1.1 J/kg (range, 0.5-5.0 J/kg). Eight patients without ROSC recovered with cardiopulmonary bypass and internal direct current shock. At 13 subsequent episodes of VF or VT among eight patients, f...

Objective: The aims of this study were to document the incidence of impaired cerebral autoregulation in children with traumatic brain injury using transcranial Doppler ultrasonography and to examine the relationship between autoregulatory capacity and outcome in children following traumatic brain injury.

Pulmonary alveolar Proteinosis (PAP) is a rare disease whereby the alveolar sacs are filled with a lipoproteinaceous material. The accumulation of this material hinders gas exchange, resulting in a variety of presentations involving all age groups. Symptoms range in severity from mild cough and dyspnea in most patients, to respiratory distress and failure to thrive in infants and young children. Depending on the etiology, PAP cases are classified as being hereditary, secondary, or autoimmune. Despite the different mechanisms underlying these, a unifying pathophysiological concept for PAP exists. Diagnosis is often difficult, and takes time to establish, given the vague nature ofthe presenting symptoms ofthis disease. High resolution computed tomography (HRCT) remains the preferred radiological diagnostic tool. Diagnosis is confirmed by lung biopsy and bronchoalveolar fluid lavage. Management encompasses whole lung lavage (WLL), exogenous GM-CSF therapy, supportive respiratory measur...

Introduction: First 28 days of life is the most vulnerable period after birth as the newborns are prone for acquiring some preventable and other non-preventable diseases at this age. Developing countries like India contribute to nearly 1/3rd of neonatal mortality which are majorly seen during delivery and could be prevented.Thus, these neonatal diseases prove to be a major burden on an economy of the developing countries like ours. Poor maternal health, not so suffi cient management of pregnancy related complications and scarcity of neonatal careare few of the identifi ed risk factors for neonatal morbidities. Newborn disease pattern is a very insightful pointer of accessibility, utility and value of maternal & child health services in our society 1. Objectives : To assess the various morbidity patterns in patients presenting to neonatal intensive care unit of tertiary care centre, Moradabad. Material and Methods: The present study was conducted in Teerthanker Mahaveer Medical College and Research Centre, Moradabad between May 2017 to April 2018. Total 100 newborns presenting with conditions requiring admission to the NICU were included in the study. Results: The maximum number of cases (78%) presented within the fi rst three days of life, with male preponderance (78%). The study revealed a large number (94%) of these neonates were being delivered at hospitals and thus were referred in time for better care, preterm delivery rates (45%) were comparable to term deliveries (55%),Of the 47% patients presenting with sepsis 57% had early onset sepsis and 43% patients had late onset sepsis. HIE (I/II/III) and low birth weight constituted other major groups responsible for neonatal morbidity. Amongst the maternal risk factors for sepsis 38% mothers had leaking per vaginum. Conclusion: Present study concluded that early care and intervention is needed during fi rst 72hrs of life to prevent and manage most neonatal morbidities.

Improper complimentary feeding poses an infant to nutritional defi ciencies. These various nutritional defi ciencies are found to affect our immune system and can predispose to life threatening events. These life threatening nutritional conditions are often missed in emergency room. Infantile Tremor Syndrome is one such rare condition which is often missed. It is characterised by tetradof tremors, skin pigmentation, anaemia, developmental delay. 1-3 It is most commonly found in Indian subcontinent. 2 Various theories have been propounded for etiology of ITS namely malnutrition, vitamin B12 defi ciency, magnesium defi ciency, degenerative conditions and infections. 4 This study was conducted to delineate various presentation of infantile tremor syndrome as nutritional emergency. Material and Methods Children who were admitted to PICU who had clinical tetrad of ITS admitted between January 2017 To August 2018 at tertiary care hospital, Bagalkot were analysed.