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Background and aims: NE is routinely using for the management of patients with vasoplegia in our pediatric intensive care unit (PICU), and echocardiography using for hemodynamic monitoring effects.

Our study aimed to investigate relationship between NE effects and SVI in ventilated patients with vasoplegia

Methods: In this prospective observational study conducted in our PICU from January 2014 to December 2017; we investigated 42 mechanically ventilated children. All patient presented at least one episode of hypotension with vasoplegia defined by diastolic pressure (DAP<= 40 mmHg) and preserved left ventricular (LV) function using TTE. Preload dependency was evaluating in all patients (defined by ΔVpeak_ao ≥ 12%). all receiving NE at baseline at (0,96±1,15 μg/kg/min)

Intervention: We performed sixty increase or introduce NE (INE) dose (1,21±1,38 μg/kg/min) during this study.

Results: INE dose significantly increased SAP [93,1±14,2 to 104,0±15,5 mmHg ; (p<0,0001)], DAP [38,2±1,8 to 45,9±4,9 mmHg ; (p<0,0001)], MAP [60,1 ± 9,3 to 70,1 ± 10,4 mmHg ; (p<0,0001)], stork volume (SV) [21,2±13,5 to 25,9±16,5 ; (p<0,0001)], SVI [31,1 ± 10,1 to 37,9 ±13,1 ml/m2 ; (p<0,0001)], cardiac output (CO) [3.62 ± 1.18 to 4.23 ± 1.42 L/min ; (p<0,0001)] and cardiac index (CI) [3.62 ± 1.18 to 4.23 ± 1.42 L/min/m2 ; (p<0,0001)] in 61,5% cases. Before INE DVpeak_ao in responders (89,2%), was significantly higher than that in non-responders [17,3±4,0 vs. 11,5±3,8 ; (p<0,0001)]. After INE, the DVpeak_ao decrease significantly in responders than that in non-responders [10,7±0,6 vs 9,6±1,1 (p=0,037)].

Conclusion: This study showed that NE could induce increase in SVI and reduce preload dependency in ventilated patients with vasoplegia.

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Objective: There is some evidence supporting the manipulation of DA patency in newborns affected by pulmonary hypertension, but choosing the appropriate timing for PDA closure is still a challenge. Aim of our study was to evaluate the haemodynamic effects of PDA closure during vv-ECMO support.
Methods: We evaluated newborns affected by severe acute respiratory failure due to pulmonary hypertension on vv-ECMO, admitted to our ICU between 2017 and 2018. We collected haemodynamic parameters (MAP, HR, SpO2, NIRS, urinary output), blood gas analysis, biochemical data, respiratory and inotropic support at 24 hours pre and 48 hours post-PDA closure.
Results: We analyzed 7 newborns, with mean gestational age of 36.4 weeks and mean body weight of 2.9 kg. 5 out of 7 patients were congenital diaphragmatic hernias, 1 meconium aspiration syndrome and 1 hydrops. In 3 cases we obtained pharmacological PDA closure, while 4 patients underwent surgery. Comparing post vs pre-PDA closure parameters, we found a significant reduction (p< 0.05) in lactate levels (14±7.8 vs 20.5±13 mg/dl) and epinephrine dose (0.05±0.1 vs 0.08±0.1 mcg/kg/min). We also detected a trend in increasing of MAP (58.7±11.8 vs 53.3±15.2 mmHg) and decreasing of milrinone (0.4±0.33 vs 0.44±0.32 mcg/kg/min) and iNO (9.3±6.1 vs 12.2±6.9 ppm) support, but with no statistical significance.
Conclusions: During the early phase of severe pulmonary hypertension, PDA ensures the unloading of right ventricle and a better systemic perfusion. After lowering of pulmonary vascular resistances, instead, PDA closure leads to an improvement of systemic perfusion indexes (lactates) and a reduction of inotropic drugs.

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Background and aims: Echocardiography is noninvasive tool that helps intensivist in the assessment and management of the acute circulatory failure (ACF) in children to improve the hemodynamic status

The aim is to describe how echocardiography improve hemodynamic management in children with shock in ICU.

Methods: A prospective study conducted in our PICU including all children presented ACF. Each patient had hemodynamic Assessment and management of shock using Echocardiography by Intensivist which consists on optimization of cardiac output (CO) (= Heart Rate “HR”x Stroke Volume “SV”).

Results: Management of ACF in 145 children, increased CO [(2,91±1,56) vs. (2,55±1,33) l / min; p<0,0001] and SV [(25,7±15,5) vs. (21,7±13,4) ml; p<0,0001] and decreased HR [(122,6±26,2) vs. (127,5±26,5) b/min; p0,0001].

Gain of SV [(20,0±5,6) %; p<0,0001] result to volume expansion (20,0 ± 5,6 ml/kg) in hypovolemic patients, norepinephrine (NE) increasing dose [(1,33±1,68) vs. (1,27±1,70) μg/kg/min ; p = 0,024] in vasoplegic patients with preload dependency and dobutamine increasing dose [(7.48 4.10) vs. (4.06 4.92) (μg/kg/min); P0,0001] in patients with cardiogenic shock. Pericardiocentesis were necessary in 2 cases.

Conclusion: In our study, Echocardiography is an incountournabl tool in the evaluation and management of shock in children in ICU.

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Background

Queens' Medical Centre (QMC), Nottingham, is a large tertiary hospital in the middle of the UK. For two years paediatric wards have been using High Flow Nasal Cannula Treatment (HFNCT) on the general wards.

Aim

Evaluate the use of HFNCT on the wards and identify risk factors for escalation of respiratory support.

Methods

Data collection: children who commenced HFNCT on the paediatric wards from October to March 2019. Demographic and physiological data were collected. Heart rate, respiratory rate, FiO2, saturation, pH, CO2 were taken prior to commencing HFNCT and 2 hours, 4 hours, and 6 hours post. The primary outcome was to identify predictive factors for escalation of support (CPAP, BiPAP or invasive ventilation).

Results

Total of 49 patients included with a mean age of 16 months. Most of the patients were being treated for bronchiolitis (n=33). The average duration of HFNCT was 53 hours with 3.47 bed days. 36.7% required escalation: 30% required NIV and 6% invasive ventilation.

Analysis was performed comparing the change in vitals and gases from baseline to 2 hours, 4 hours, and 6 hours post commencing HFCNT; in the group which remained on the wards and those that were admitted to PCCU. The only statistically significant difference was the change in respiratory rate at 2 hours (p value of 0.04).

Conclusion

HFNCT is safe, effective and can be managed on paediatric wards, freeing up critical care beds. Further data collection however is required to identify features that indicate patients require escalation of care.

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Aims & Objectives

In adults, receiving non-invasive ventilation (NIV) for acute adult respiratory distress syndrome is a risk factor for increased length of ventilation (LOV) and increased mortality. This relationship is yet unknown for children with bronchiolitis. We compared LOV and length of stay (LOS) in paediatric intensive care in two groups of infants with bronchiolitis: those who failed NIV and those who never received NIV.

Methods

LOV and LOS at the Evelina Children’s Hospital were compared between infants who failed NIV at the Royal Alexandra Children’s Hospital and those infants who received standard oxygen therapy or no therapy at other hospitals. 231 patients under the age of 2 from 2017 and 2018 were included, of which 24 had failed NIV. LOV and LOS data was transformed logarithmically to parametric distribution and compared via independent samples t-test.

Results

Mean LOV in NIV-failures was 101.97 hours (=4.24 days), whilst mean LOV in non-NIV patients was 117.4 hours (=4.89 days). Mean LOS in NIV- failures was 137.07 hours (=5.71 days) while mean LOS in non-NIV patients was 153.63 hours (=6.40 days). There was no statistically significant difference in either length of ventilation nor length of stay in the two groups.

Conclusions

This indicates that infants who trialled and failed NIV did not have worse outcomes, as measured by LOV and LOS, compared to patients who were directly ventilated and transferred without NIV trial. This suggests that NIV trial is safe, even if children need to ultimately be invasively ventilated.

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We conducted a single center retrospective chart study in a tertiary and quaternary referral PICU, reference center for sickle cell disease (SCD), regional reference center for emerging infectious diseases.

All SCD patients with suspected COVID-19 admitted in our PICU between March 1, 2020 and April 15, 2020 were included.

We analyzed the files of 12 SCD children with suspected COVID-19. Four patients had confirmed COVID-19 on nasal swab. Tthey presented with high fever and inflammation, thoracic vaso-occlusive crisis, respiratory distress with clinical and radiological acute chest syndrome (ACS).

All four patients received usual supportive care (fluids, antibiotics, pain medication including morphine, excluding NSAID). None of them received anti-viral therapy.

Automated erythrocytapheresis was performed in all COVID-19 cases, 3 patients also received simple red blood cell transfusion.

One patient with very high inflammation and elevated plasma IL-6 level was treated with an injection of Tociluzimab.

Respiratory distress recquired continuous non-invasive ventilation (NIV) for a median duration of 5.5 days. They stayed in PICU for a median duration of 6 days and in hospital for 8 days.

Two COVID-19 patients had CT-scans, which showed images similar to those previously described for non SCD patients affected with COVID-19 (ground glass opacities with halo sign) and lower lobes consolidations consistent with ACS classical description. One patient developed segmentary pulmonary thrombosis on day one in PICU (day 13 of COVID-19).

All patients had a favorable outcome.

Conclusions: COVID-19 can trigger severe ACS in SCD patients. Future studies are mandatory to determine the best therapeutic options for these patients.