- Pierre Tissieres, France
- Martin Kneyber, Netherlands
Session Webcast
THE COMPARISON OF THE CARDIAC INDEX VALUES MEASURED BY CRITICAL CARE ECHOCARDIOGRAPHY WITH THE VALUES MEASURED BY PICCO IN THE PEDIATRIC INTENSIVE CARE UNIT
- Nagehan Aslan, Turkey
- Nagehan Aslan, Turkey
- Özden Horoz,
- Dincer R. Yildizdas, Turkey
- Yasemin Çoban, Turkey
- Fadli Demir,
- Sevcan Erdem,
- Yasar Sertdemir, Turkey
Abstract
Background
Pulse index Contour Cardiac Output (PiCCO) monitoring is an invasive, hemodynamics monitor and provides continuous cardiac output (CO) and cardiac index (CI), preload, systemic vascular resistance index measurements. Use of critical care echocardiography by the pediatric intensivists has been increased. Cardiac output and CI can be measured with echocardiography.
Objectives
In this study we aimed to compare the CO and CI values which were measured by pediatric intensivists with critical-care echocardiography and measured by PiCCO monitor in critically ill pediatric patients.
Methods
A total of 49 echocardiographic measurements were performed and recorded from 15 patients with diagnosis of septic shock, cardiogenic shock, acute respiratory distress syndrome, pulmonary edema. Echocardiographic measurements were performed by two pediatric intensive care fellows. The distance of left ventricle outflow tract (LVOT) in parasternal longer axis and LVOT-Velocity Time Integral (LVOT-VTI) measurement was performed in the apical five chamber image. Cardiac output_echocardiography (CO_echo) and CI_echocardiography (CI_echo) was calculated with these measurements. PiCCO monitoring was performed.
Results
Cardiac output (CO_picco) and CI (CI_picco) measured by PiCCO simultaneously with echocardiographic measurements were recorded another researcher who blind to echocardiographic measurements. We detected strong positive correlation between CO_echo and CO_picco measurements (p<0.001, r=0.985) and a strong positive correlation between CI_echo and CI_picco measurements (p<0.001, r=0.943).
Conclusion
According to our study results we suggested that echocardiographic CO measurements which will be performed by an experienced pediatric intensive care team with critical care echocardiography may be as valuable as PiCCO measurements in the management of the fluid and vasoactive-inotropic treatment of critically ill pediatric patients.
Video on Demand
0.9% SALINE VERSUS PLASMA-LYTE AS INITIAL FLUID IN CHILDREN WITH DIABETIC KETOACIDOSIS- A DOUBLE BLIND RANDOMIZED CONTROLLED TRIAL
- Vijai Williams, India
- Vijai Williams, India
- Muralidharan Jayashree, India
- Karthi Nallasamy,
- Devi Dayal,
- Amit Rawat,
Abstract
Background
Acute kidney injury (AKI) is commonly encountered during management of Diabetic Ketoacidosis (DKA). Although adult data has shown reduced incidence of hyperchloremia and AKI with Plasma-Lyte, no study has evaluated its role in pediatric DKA.
Objectives
To compare 0.9% saline with Plasma-Lyte as initial fluid in pediatric DKA with respect to incidence of new/progressive AKI, defined as a composite outcome of creatinine (defined by KDIGO), estimated creatinine clearance (defined by p-RIFLE) and NGAL levels.
Methods
Children (>1month-12 years) with DKA, were randomized to receive either Plasma-Lyte (n= 34) or 0.9% saline (n= 32) in a double blind, parallel arm, investigator initiated, randomized controlled trial. Children with cerebral edema, chronic kidney disease or who had received pre-referral fluids and/or insulin were excluded.
Results
The incidence of new/progressive AKI was similar in both [Plasma-Lyte 3(8.8%) vs. 0.9% saline 1(3.1%);unadjusted risk ratio (95% CI)-3.0(0.29,30.44);p-0.332]. The median(IQR) time to resolution of DKA in Plasma-Lyte and 0.9% saline was 14.5(12,20) hours and 16(8,20) hours respectively. Time to resolution of AKI were similar in both [Plasma-Lyte 22.1 versus 0.9% Saline18.8 hours (adjusted HR-0.22; 95% CI: 0.02-2.30;p=0.21)]. The change in pH, chloride, bicarbonate, sodium, anion gap and effective osmolality between both groups was similar. Length of hospital stay was also similar in both [Plasma-Lyte 9(8,12) versus 0.9% Saline-10(8.25,11) days;p=0.396]
Conclusion
The incidence of new/progressive AKI and resolution of AKI were similar in 0.9% Saline and Plasma-Lyte. 0.9% Saline was non-inferior to Plasma-Lyte in time to resolution of DKA, need for RRT, mortality and lengths of PICU and hospital stay.
Video on Demand
THE EFFECT OF USING NOISE AND LIGHT REDUCTION HOOD ON OXYGEN SATURATION, HEART RATE AND SLEEP STATE OF PRETERM INFANT
- Mujde Calikusu Incekar, Turkey
- Mujde Calikusu Incekar, Turkey
- Duygu Gozen, Turkey
- Ayhan Tastekin, Turkey
Abstract
Background
It has been reported that the noisy environment significantly reduces arterial oxygen saturation, increases heart rate and disturbing the sleep state of preterm infant. It has been reported that interventions to protect the preterm infants from the noise, especially at the 34th gestational week and below, should be performed within 48 hours after delivery.
Objectives
It was determined the effect of the noise and light reduction oxygen hood on the oxygen saturation, heart rate and sleep state of the preterm infant.
Methods
The study was conducted as a randomized controlled experimental design with 80 preterm infant with 30-34 gestational weeks between April 2017 and October 2018 in the Neonatal Intensive Care Unit (NICU) in a university hospital in Istanbul. The infant’s identify form, sound meter, photo meter, actiwatch device, and monitor were collected. Ethical committee permission, institution permission and written consent from the families were obtained. In the analysis of data, descriptive statistics, independent groups t test, repeated measures test, Mann-Whitney U test, Friedman Test, Pearson chi-square test and Fisher statistics exact test were used. Statistical significance was accepted as p <0.05.
Results
There was a significant difference in oxygen saturation between the noise and light reduction oxygen hood and the standard oxygen hood (p< 0.05); no significant difference in heart rate between groups (p> 0.05) and a significant difference in sleep duration between groups (p< 0.05).
Conclusion
It was concluded that the use of noise and light reduction oxygen hood in preterm infants is an effective intervention.
Video on Demand
DEGRADED COMPONENTS OF THE ENDOTHELIAL GLYCOCALYX ARE ASSOCIATED WITH ACIDOSIS IN CHILDREN FOLLOWING SURGERY WITH CARDIOPULMONARY BYPASS
- Michael J. Carter, United Kingdom
- Michael J. Carter, United Kingdom
- Harish Bangalore,
- Julia Harris,
- Kiran Parmar,
- Beverley Hunt,
- Shane M. Tibby,
Abstract
Background
Metabolic acidosis is highly prevalent in young children following surgery with cardiopulmonary bypass (CPB). The endothelial glycocalyx is degraded during CPB. We hypothesised that the negatively charged glycocalyx components, heparan sulfate and syndecan-1, may contribute to metabolic acidosis in these patients.
Objectives
To assess the association between glycocalyx components in plasma (syndecan-1 and heparan sulfate) and metabolic acidosis quantified using Stewart's strong ion gap (SIG).
Methods
We prospectively sampled plasma at multiple time points from baseline (pre-surgery), intraoperatively and at PICU admission in 27 children <5 years of age undergoing cardiac surgery with CPB. We measured syndecan-1 and heparan sulfate using ELISAs, and full routine biochemical and haematological data (including components of the SIG).
Results
Glycocalyx components increased from baseline to a maximum at end of CPB across the cohort (paired t-test; syndecan-1 33 ng/ml, 95% CI 15–51, versus 168, 95% CI 146–189, p<0.001; heparan sulfate 11 mcg/ml, 95% CI 9–13, versus 25, 95% CI 22–28, p<0.001). The SIG was calculable on 26 patients on admission to PICU. Multivariable linear regression yielded an association between glycocalyx components and SIG (R2=0.23). Of these, heparan sulfate was the strongest predictor (coefficient 0.20, p=0.06).
Conclusion
We provide pilot data on an association between degradation of the glycocalyx, and increased SIG in children following surgery with CPB. Further analyses, including modelling of individual participants with clinical outcome data are pending.
Video on Demand
IS DEXMEDETOMIDINE EFFECTIVE AND SAFE FOR PROLONGED SEDATION IN CRITICALLY-ILL PEDIATRIC PATIENTS? A PROSPECTIVE MULTICENTER STUDY (PROSDEX)
- Francesca Sperotto, Italy
- Francesca Sperotto, Italy
- Maria Cristina Mondardini,
- Marco Daverio, Italy
- Clara Dell'Oste,
- Francesca Vitale,
- Emanuele Rossetti,
- Stefania Ferrario,
- Maria Lapi,
- Federica Ferrero,
- Maria Pia Dusio,
- Angela Amigoni, Italy
Abstract
Background
Dexmedetomidine (DEX) is a selective-alpha-2-adrenergic-agonist recently authorized by Italian-Medicines-Agency for difficult sedation in pediatrics. Few data exist regarding prolonged infusions and no prospective study has systematically evaluated its efficacy so far.
Objectives
To evaluate DEX efficacy and safety for prolonged sedation in PICU.
Methods
Patients <18years receiving DEX≥24 hours in 9PICUs were included. Indications, dosages, efficacy and safety were systematically evaluated. Efficacy was defined as reduction of validated clinical-scores (Comfort-Behavior-Scale, CBS; Withdrawal-Assessment-Tool-1, WAT-1; Cornell-Assessment-of-Pediatric-Delirum, CAPD) and sparing of analgesics and sedatives. Every potential adverse-event (AE) was registered.
Results
A calculated sample-size of 163 patients (median-age 13months, IQR 4-71) were enrolled. Main indication was adjuvant for drug-sparing (42.3%). Seven-percent of patients received a loading-dose. Median infusion-duration was 108 hours (IQR 60-168) with dosages between 0.4 (IQR 0.3-0.5) and 0.8mcg/kg/h (IQR 0.6-1.2). Median time of infusion-weaning was 24 hours (IQR 5-48). Twenty-three patients (14.1%) received DEX as solo-sedation, 61% with other sedatives, 81% with other analgesics. After DEX-starting, CBS, WAT-1 and CAPD significantly reduced (p<0.001,p<0.001,p=0.027) as well as the dosages/kg/h of benzodiazepines, opioids, propofol and ketamine (p<0.001,p<0.001,p=0.001,p=0.027). Thirty-seven-percent of patients presented hemodynamic-AEs not-requiring intervention while 8.6% presented hemodynamic-AEs requiring intervention (79% dose-reduction). In multivariate models a loading-dose was associated with hemodynamic AEs (p=0.043) and the use of aminergic-inotropic-drugs was associated with severe hemodynamic-AEs (p=0.011).
Conclusion
DEX prolonged infusion assures comfort, allows sparing of opioids and benzodiazepines and helps to treat withdrawal-syndrome and delirium. AEs are mainly hemodynamic and easily reversible with dose-reduction. The loading-dose and the concomitant use of aminergic-inotropic-drugs are independent risk factors for hemodynamic-AEs.
Video on Demand
THE EFFECT OF PRESSURE SUPPORT ON IMPOSED WORK OF BREATHING DURING PAEDIATRIC EXTUBATION READINESS TESTING
- Jefta Van Dijk, Netherlands
- Jefta Van Dijk, Netherlands
- Robert Blokpoel, Netherlands
- Alette A. Koopman, Netherlands
- Hans Burgerhof,
- Sandra Dijkstra,
- Martin Kneyber, Netherlands
Abstract
Background
Paediatric critical care practitioners often make use of pressure support (PS) to overcome the perceived imposed work of breathing (WOBimp) during extubation readiness testing (ERT).
Objectives
Level of WOBimp during ERT with and without added PS and to study its clinical correlate
Methods
Prospective study in spontaneously breathing ventilated children < 18 years undergoing ERT. Using tracheal manometry, WOBimp was calculated by integrating the difference between positive end-expiratory pressure (PEEP) and tracheal pressure (Ptrach) over the measured expiratory tidal volume (Vt) under two conditions: continuous positive airway pressure (CPAP) with and without PS.
Results
112 patients were studied. Median PS d uring the ERT was 10 cmH2O. WOBimp was significantly higher without PS (median 0.27, IQR 0.20 – 0.50 Joules/L) than with added PS (median 0.00, IQR 0.00 – 0.11 Joules/L). Although there were statistically significant changes in spontaneous breath rate (32 (23 – 42) vs 37 (27 – 45) breaths/min, p < 0.001), higher ET-CO2 (5.89 (5.37 – 6.58) vs 6.23 (5.54 – 6.98) kPa, p < 0.001) and expiratory Vt (7.71 (6.60 – 8.82) vs 7.12 (5.83 – 8.08) mL/kg, p < 0.001) in the absence of PS, these changes appeared clinically irrelevant since the Comfort B score remained unaffected (12 (10 – 13) vs 12 (10 – 13), p = NS). Multivariate analysis showed that increases in WOBimp in the absence of PS occurred independent of endotracheal tube size.
Conclusion
Withholding PS during ERT does not lead to clinically relevant increases in WOBimp, irrespective of endotracheal tube size.