Author Of 2 Presentations
AIRWAY DRIVING PRESSURE (ΔP) AND OUTCOME IN CHILDREN WITH ACUTE HYPOXEMIC RESPIRATORY FAILURE (AHRF)
Abstract
Background
Limited adult data suggests that ΔP (PPLAT—PEEP), might better reflect the lung injury than tidal volume in ARDS.
Objectives
This study aimed to evaluate the effect of ΔP on morbidity and mortality of children with AHRF.
Methods
This retrospective study at tertiary care PICU in developing country was done on children who received invasive mechanical ventilation for AHRF (PaO2/FiO2 <300 within 24 hours after intubation), in a 2-year period. Cohort was divided to two groups based on the highest ΔP in first 24 hours.
Results
101 case out of 380 ventilated children were enrolled. In comparison to high ΔP (≥15 cm H2O) group, children in low ΔP group had significantly lower duration of ventilation [median (IQR) 5 (4-6) vs 8(6-11) days, p< 0.001] , length of PICU stay [6 (5-8) vs 12(8-15) days, p< 0.001] and higher ventilator free days at day 28 [23(20-24) vs 17(0-22) days, p<0.001]. However, there was no statistically significant difference in mortality between two groups (17% in low ΔP v/s 24% in high ΔP, p=0.38). Logistic regression model also suggested ΔP as an independent predictor of morbidity. ΔP >19 cm H2O was associated with significant mortality.. Subgroup analysis of 65 patients with ARDS, yielded similar results with respect to mortality and morbidity. The independent early mortality predictors (at 24 hours) found by multivariate analysis were Oxygenation Index >8 and cumulative fluid balance >5%.
Conclusion
ΔP <15cm H2O might be beneficial in AHRF children with significantly decreased morbidity.
MORTALITY PREDICTORS IN CHILDREN WITH DENGUE FEVER IN PEDIATRIC INTENSIVE CARE UNIT IN TERTIARY UNIT IN DEVELOPING COUNTRY
Abstract
Background
Dengue fever is often fatal disease and predicting outcome in dengue infections remains challenging. Identification of modifiable predictors related to outcome of Dengue infection may help in developing new treatment strategies and to potentially decrease in-hospital mortality.
Objectives
To study the mortality prediction parameters at admission in children with dengue fever admitted in PICU
Methods
All children (1month to 18 years) with laboratory-confirmed dengue infection were enrolled between 1 July 2016 to31 December 2018. The medical records of all the recruited patients were reviewed retrospectively. In univariate analysis, parameters significantly associated with mortality were tested for interaction with multiple logistic regression analysis. Odds ratios and 95% confidence intervals were calculated.
Results
148 patients with laboratory confirmed dengue fever were admitted in PICU. 70 patients were between 1-10years of age. 103 (69.6%) were male. Eighty patients had dengue fever with warning signs while 68 cases had severe dengue fever. In univariate analysis high admission SGOT, SGPT, Inotropic score, S. Lactate, PELOD score and presence of AKI and PRISM 12 score were independent predictor of mortality (p value 0.0001). These variables were not included in multivariate logistic regression as the Pearson correlation was more than 0.5. While other variables, need for mechanical ventilation, platelet transfusion at admission and fluid balance ≥5% after 24 hours of admission were independent predictor of mortality.
Conclusion
Indices of organ dysfunction and fluid overload may be better predictors of mortality than traditional markers like platelet count, leucocyte count and hematocrit.
Presenter of 2 Presentations
AIRWAY DRIVING PRESSURE (ΔP) AND OUTCOME IN CHILDREN WITH ACUTE HYPOXEMIC RESPIRATORY FAILURE (AHRF)
Abstract
Background
Limited adult data suggests that ΔP (PPLAT—PEEP), might better reflect the lung injury than tidal volume in ARDS.
Objectives
This study aimed to evaluate the effect of ΔP on morbidity and mortality of children with AHRF.
Methods
This retrospective study at tertiary care PICU in developing country was done on children who received invasive mechanical ventilation for AHRF (PaO2/FiO2 <300 within 24 hours after intubation), in a 2-year period. Cohort was divided to two groups based on the highest ΔP in first 24 hours.
Results
101 case out of 380 ventilated children were enrolled. In comparison to high ΔP (≥15 cm H2O) group, children in low ΔP group had significantly lower duration of ventilation [median (IQR) 5 (4-6) vs 8(6-11) days, p< 0.001] , length of PICU stay [6 (5-8) vs 12(8-15) days, p< 0.001] and higher ventilator free days at day 28 [23(20-24) vs 17(0-22) days, p<0.001]. However, there was no statistically significant difference in mortality between two groups (17% in low ΔP v/s 24% in high ΔP, p=0.38). Logistic regression model also suggested ΔP as an independent predictor of morbidity. ΔP >19 cm H2O was associated with significant mortality.. Subgroup analysis of 65 patients with ARDS, yielded similar results with respect to mortality and morbidity. The independent early mortality predictors (at 24 hours) found by multivariate analysis were Oxygenation Index >8 and cumulative fluid balance >5%.
Conclusion
ΔP <15cm H2O might be beneficial in AHRF children with significantly decreased morbidity.
MORTALITY PREDICTORS IN CHILDREN WITH DENGUE FEVER IN PEDIATRIC INTENSIVE CARE UNIT IN TERTIARY UNIT IN DEVELOPING COUNTRY
Abstract
Background
Dengue fever is often fatal disease and predicting outcome in dengue infections remains challenging. Identification of modifiable predictors related to outcome of Dengue infection may help in developing new treatment strategies and to potentially decrease in-hospital mortality.
Objectives
To study the mortality prediction parameters at admission in children with dengue fever admitted in PICU
Methods
All children (1month to 18 years) with laboratory-confirmed dengue infection were enrolled between 1 July 2016 to31 December 2018. The medical records of all the recruited patients were reviewed retrospectively. In univariate analysis, parameters significantly associated with mortality were tested for interaction with multiple logistic regression analysis. Odds ratios and 95% confidence intervals were calculated.
Results
148 patients with laboratory confirmed dengue fever were admitted in PICU. 70 patients were between 1-10years of age. 103 (69.6%) were male. Eighty patients had dengue fever with warning signs while 68 cases had severe dengue fever. In univariate analysis high admission SGOT, SGPT, Inotropic score, S. Lactate, PELOD score and presence of AKI and PRISM 12 score were independent predictor of mortality (p value 0.0001). These variables were not included in multivariate logistic regression as the Pearson correlation was more than 0.5. While other variables, need for mechanical ventilation, platelet transfusion at admission and fluid balance ≥5% after 24 hours of admission were independent predictor of mortality.
Conclusion
Indices of organ dysfunction and fluid overload may be better predictors of mortality than traditional markers like platelet count, leucocyte count and hematocrit.