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Abstract Body

Children with congenital heart disease are at high risk of thrombotic complications.

The aim of this study was to evaluate the effectiveness of realized prophylactic measures.

Material and methods. 433 pediatric and neonatal cardiosurgical patients were included. For the purpose of antithrombotic prevention was used heparin that added into all washing solutions of monitoring lines and parenteral nutrition (2U/ml).

Daily clinical evaluation incuded the assessing ischemic changes in the extremities, neurological status, functional status of systemic pulmonary anastomoses, etc. The laboratory tests included prothrombin time (PT), activated partial thromboplastin time (aPPT), fibrinogen level (FG), international normalized ratio (INR).

The tests were performed before surgery and on the 3^rd, 7^th and 14^th PO.

Results. 36 patients (8.314%) had thrombosis in the postoperative period. 28 patients had venous thrombosis, 6 patients had the Blalock-Taussig shunt thrombosis, and 2 patients had arterial thrombosis. The mortality rate was higher in the group with registered thrombosis than in the group without thrombosis (p=0.01).

The implementation of antithrombotic prophylaxis resulted in an increase in the average values of PT, aPPT, FG on the 7^th and 14^th days and subsequent stages of evaluating the basic parameters of the coagulation profile.

Conclusion. The cardiosurgical patients are unique due to due to frequently use invasive manipulations, and necessity controlled anticoagulation perioperatively. The dosage regimen for children and neonatal patients should be based on age-associated antithrombotic drug standards and requires an integral approach to evaluating the effectiveness of preventive and therapeutic measures especially among the patients with single ventricle physiology.

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Background and aims: Multidrug-resistance infections are a growing concern. Ceftolozane-tazobactam is a relatively new antibiotic against multidrug-resistant pathogens as Pseudomonas aureginosas (PA). Ceftolozane-tazobactam dosage is still uncertain in children, especially in renal impairment or CRRT. The target free time above the MIC (fT>MIC) (PA susceptibility breakpoint is 4 µg/ml) should be at least 40% of the dosing interval but 100% is desirable in critically ill patients.

Methods: Ceftolozane pharmacokinetics (PK) in 3 patients with PA infections was characterized obtaining the patient’s specific parameters by Bayesian estimation based on the population PK model developed by Larson et al. The elimination clearance (CL) in patient 1 undergoing CRRT was estimated using the prefilter, postfilter and ultrafiltrate concentrations simultaneously. Variables such blood, dialysate, replacement and ultrafiltrate flow rates and hematocrit, were integrated in the model. All the analyses were performed using NONMEM v.7.4.

Results: Patient 1 (9 moa, 5.8 kg), with severe renal impairment undergoing CRRT received 30 mg/kg every 8h. Patient 2 (8 moa, 8.7 kg) with normal renal function received 40 mg/kg every 6h. Patient 3 (19 moa, 11kg) with eGFR 22 ml/min/1.73m² received 36 mg/kg every 8h. Patients’ PK is described in Table 1. No adverse effects were found related to the treatment.

Conclusions: All plasma free-drug concentrations remained well above the MIC during the entire interval (100%fT>MIC). Patient 1 and 2 PK are appropriate according to existing studies. However, patient 3 PK reveals that a lower total dose might be utilized in patients with renal impairment.

Abstract Body

Background

Comfort and tolerance to non-invasive ventilation (NIV) are factors that can influence the success or failure of this technique. The objective of this study was to assess the comfort level of children with acute respiratory failure (ARF) undergoing NIV.

Methods

An observational prospective study was performed; included children with ARF treated with NIV, from December-2019 to March-2020 in a Pediatric Intensive Care Unit (PICU). Comfort and tolerance to NIV were serially evaluated using the COMFORT scale (range from 8 to 40 points).

Results

During the study period, 26 children subjected to NIV in a total of 28 ARF episodes were included, with each episode treated as an independent event. The medians age and weight were 5.8 months [range 1.5-23.3] and 7 Kg [range 4.5-11.5], respectively; 53.6% were male. Main diagnoses were bronchiolitis (57.1%), acute bronchitis and pneumonia (35.7%). Bi-level pressure was used in 78.5%; two patients were intubated (7.7%). Sedation was administered in 13 patients (46.4%). The mean COMFORT score on the first day was 19 points [CI95% 17-20], indicating that the children were comfortable (adequate sedation or comfort range: 17-26). An increase in patient comfort was observed with a gradual decrease in the scores (figure 1). An inverse association between age and comfort score at 24 hours was identified (r: -0.498; p=0.017). No statistical relation was found between COMFORT score and NIV modality.

Conclusions

COMFORT score results indicated that NIV was well tolerated by children. Younger age was associated with less comfort.

Abstract Body

Septic critically ill children are subject to changes in pharmacokinetics leading to high risk of inadequate antibiotics (ATB) exposure. Therapeutic drug monitoring (TDM) is a growing strategy that improves the likelihood to reach pharmacodynamic (PD) target. It is commonplace for very few ATB and yet casually used for any antibiotic at the physician’s discretion.

We conducted a 6 month monocentric prospective study of children receiving ATB to review situations that prompted physicians to perform TDM and how it was applied. Blood samples were collected during routine laboratory tests and antibiotics were quantified using LC-MS/MS or HPLC-UV.

From june to december 2019, 209 children (median age 2,4 years) admitted to our unit recieved ATB. TDM was performed in 27.8% patients, who had more organ dysfunctions (3 vs 1, p<0.05) were more often immunosuppressed (64% vs 29%, p<0.05) and had longer antibiotic therapy, accounting for 210 assays. Median time to results was 3 days and 52.7% didn’t reached PD targets. 53.3% of the 75 off-target concentrations available in due time led to dosing adjustments. Control concentrations better achieved PD targets in case of adjustment (70% vs 20%, p 0.013). Initial pharmacological evaluation using EUCAST breakpoints were not consistent with remote analysis based on real MIC in 19%.

TDM is feasable and effective to improve ATB exposure in critically ill children. It requires timely avalaible ATB blood concentration and MIC. It is necessary to define clinically relevant PD targets, to select patients who should benefit from TDM and how it should be managed.

Abstract Body

Introduction : IRRT in infant and in patients with acute circulatory faillure (ACF) remains a challenge for the intensivist. It is the connection in the dialysis that affected the hemodynamics stutus because of the vasoplegia and the blood spoliation in the circuit. The isovolumic priming is one of the crucial measures to optimize the hemodynamics in pediatric resuscitation using blood, isotonic saline or Albumin

Our study aim to show the contribution of the isovolumic connection in IRRT in pediatrics population.

Material and method : In this prospective observational study from july 2017 to september 2019 including all patients admitted to hemodialysis unit for emergency renal replacement therapy.

Results :Forty seven patients collected with median age of 84 (4-180) months, median weight of 20 kg (6,7-50) and sex ratio of 3,3.

The isovolumic connection was performed in 32 patients (68,1%), using blood priming in 13 cases (40,6%) and isotonic saline priming in 19 cases (59,4%)

Indications of IRRT was : Multiple Organe Failure (7), tumoral lysis (7), severe acidosis (5), acutization of chronic renal failure (4), dehydratation (3), oncological disease (3), atypical hemolytic uremic syndrome (2), poisoning (2), hemolytic uremic syndrome (1), metabolic disease (1).

We reported hypotension in 3 cases, bradycardia in 2 cases and the necessity to interrupt it in 2 cases

Conclusion : the use of IRRT with an isovolumic connection remains a good alternative to the CRRT.

Abstract Body

Background:
Drug preparation and administration in paediatric intensive care units is both complex and time-consuming. Direct IV medication errors have been reported in up to 41% of cases during simulated in-hospital paediatric resuscitations. We developed a mobile device application called “Ped-drug” as a step-by-step guide for the preparation of intravenous drugs.

Objective: The aim of our study was to determine whether the use of “Ped-drug” reduces drug prescription time (TDP) and errors when compared with conventional prescription methods.

Methods:

We performed a randomized controlled crossover trial with 2 parallel groups, comparing “Ped-drug” with a conventional calculation method for the preparation of direct intravenously administered emergency medications during standardized, simulation-based, paediatric resuscitation scenarios with a high fidelity manikin. Each group was asked to prescribe 5 drugs. Outcomes were the elapsed time in minutes, in each allocation group, from the oral order by the major physician to the end of the written prescription by the resident, in addition to the medication dosage error rate.

Results:

Nineteen residents were randomized into 2 groups. Mean TDP while using Ped-drug was 9min30s versus 10min34s for the conventional prescription methods group(p=0.683).

Medication errors were reduced from 60% to 14% (p =0.01) using application.

Conclusion: In this study medication errors especially dosage errors were dramatically reduced.However,time reduction wasn't stastically significant.

Abstract Body

BACKGROUND AND AIMS:

Point of Care Ultrasound (POCUS) is established in many pediatric and neonatal critical care units as an essential diagnostic and therapeutic tool. There is a lack of consistent evidence that supports this tool in transport medicine. We present a descriptive study of POCUS in the interfacility transport of critical pediatric and neonatal patients.

METHODS:

Descriptive study of clinical ultrasounds performed by a pediatric and neonatal advanced life support unit between november 2019 and february 2020. Images were captured with linear and phased array transducers.

RESULTS:

In the study period 26 ultrasounds were performed on 23 patients. The median age was 85 days (range: 4 hours - 6 years). We performed 10 evaluations of cardiac function (38.46%), 6 studies for suspected pneumothorax (23.08%), 4 pulmonary evaluations (15.38%), 2 controls after pneumothorax drainage (11.54%) , 2 central nervous system studies (7.69%) and 2 studies to rule out pleural effusion (7.69). The median time invested in performing the ultrasound was 5 minutes (range 3-10). Management was modified in 11 patients (42.31%) including 3 pneumothorax drains, 3 increases in hemodynamic support (volume and / or vasoactive drugs), 3 optimizations of respiratory support after ruling out pneumothorax, and avoiding volume expansion in two patients by detecting signs of hypervolemia.

CONCLUSIONS: This study shows a high percentage of critical patients who benefit from POCUS during interhospital transport. In our study, patients with respiratory, hemodynamic or neurological compromise are the most benefited from its use.