Author Of 2 Presentations
TWELVE YEARS' EXPERIENCE AND EVOLUTION OF HIGH-FREQUENCY OSCILLATORY VENTILATION IN INTER-HOSPITAL PEDIATRIC TRANSPORTS.
Abstract
Background
High-frequency oscillatory ventilation (HFOV) use has become controversial. However, some severe pathologies of neonate and children still require HFOV to optimize inter-hospital transports safety.
Objectives
We report here a 12 years’ experience and evolution of children and neonates HFOV transport made by our pediatric intensive care unit transport team (PICU-TT).
Methods
This was a Monocentric retrospective observational study from January 2006 to December 2017 in the North of France. Patient under the age of 18 years-old, transported on HFOV were included.
Results
Over 12 years, we performed 128 HFOV transports, including 110 newborns and 18 children. Median age and weight were 8.5 days (1 H-9 years) and 3.3 (2.7-39) kg, respectively. Four cardiac arrests occurred and 1 patient died during transport. Survival rates at discharge was significantly higher in neonates (79%) than in pediatrics (56%) (p=0,04). In neonates, the main indications were meconium aspiration syndrome (n=20, 18%) acute respiratory distress syndrome (ARDS) (n=17, 16% ) and congenital diaphragmatic hernia (CDH) (n=16, 15%). Only CDH was associated with a higher mortality (OR = 3.7; CI 95% [1.02 ; 13]). In children ARDS was the main indication (n=15, 83%). Proportion of HFOV transport increased during the last years of the study for neonates and remains stable for older children.
Conclusion
In this study, we showed the feasibility and safety of HFOV transports made by a PICU-TT. This must encourage the PICU-TT to follow evolution of resuscitation devices and procedures to offer optimized care to severely ill children and neonates.
EVALUATION OF A 30 MG/KG AMIKACIN DAILY DOSE ON THE ACHIEVEMENT OF THE PLASMA PEAK TARGET IN CRITICALLY ILL CHILDREN
Abstract
Background
Amikacin efficacy requires a plasma peak concentration (Cmax) > 8-10 times the minimal inhibitory concentration (MIC) corresponding to a Cmax between 60-80 mg/l. The recommended 30 mg/kg dose was evaluated in critically ill adult leading to underexposure in 20% of patients but was not evaluated in critically ill children.
Objectives
We aimed to assess the incidence and factors associated with a Cmax < 60 mg/L in critically ill children treated with a 30 mg/kg dose of amikacine.
Methods
Retrospective observational multicentric study, from November 2017 to June 2018 in two pediatric intensive care unit (PICU) located within two French tertiary academic pediatric hospitals. We included all children admitted in the PICU receiving 30 mg/kg amikacin dose.
Results
We analyzed 24 children. Cmax was < 60 mg/L in 16 patients (67%). None had Cmax > 80 mg/L. Thirteen (93%) patients from the 14 having a measured MIC achieved a Cmax /MIC > 8. Higher level of uremia was significantly associated with a Cmax < 60 mg/L. We observed an occurrence or a worsening of acute kidney injury in 12 (50%) of our patients after amikacin injection. Trough concentration was > 2.5 mg/L in 40% of our patients.
Conclusion
Despite the use of a 30 mg/kg amikacin dose, Cmax were below pharmacokinetic target in 67% of our population and no Cmax was above. However, kidney function was impaired in half of our patients. This reinforces the need to monitor systematically peak and trough concentration in this vulnerable population receiving high doses of aminoglycosides.
Presenter of 2 Presentations
TWELVE YEARS' EXPERIENCE AND EVOLUTION OF HIGH-FREQUENCY OSCILLATORY VENTILATION IN INTER-HOSPITAL PEDIATRIC TRANSPORTS.
Abstract
Background
High-frequency oscillatory ventilation (HFOV) use has become controversial. However, some severe pathologies of neonate and children still require HFOV to optimize inter-hospital transports safety.
Objectives
We report here a 12 years’ experience and evolution of children and neonates HFOV transport made by our pediatric intensive care unit transport team (PICU-TT).
Methods
This was a Monocentric retrospective observational study from January 2006 to December 2017 in the North of France. Patient under the age of 18 years-old, transported on HFOV were included.
Results
Over 12 years, we performed 128 HFOV transports, including 110 newborns and 18 children. Median age and weight were 8.5 days (1 H-9 years) and 3.3 (2.7-39) kg, respectively. Four cardiac arrests occurred and 1 patient died during transport. Survival rates at discharge was significantly higher in neonates (79%) than in pediatrics (56%) (p=0,04). In neonates, the main indications were meconium aspiration syndrome (n=20, 18%) acute respiratory distress syndrome (ARDS) (n=17, 16% ) and congenital diaphragmatic hernia (CDH) (n=16, 15%). Only CDH was associated with a higher mortality (OR = 3.7; CI 95% [1.02 ; 13]). In children ARDS was the main indication (n=15, 83%). Proportion of HFOV transport increased during the last years of the study for neonates and remains stable for older children.
Conclusion
In this study, we showed the feasibility and safety of HFOV transports made by a PICU-TT. This must encourage the PICU-TT to follow evolution of resuscitation devices and procedures to offer optimized care to severely ill children and neonates.
EVALUATION OF A 30 MG/KG AMIKACIN DAILY DOSE ON THE ACHIEVEMENT OF THE PLASMA PEAK TARGET IN CRITICALLY ILL CHILDREN
Abstract
Background
Amikacin efficacy requires a plasma peak concentration (Cmax) > 8-10 times the minimal inhibitory concentration (MIC) corresponding to a Cmax between 60-80 mg/l. The recommended 30 mg/kg dose was evaluated in critically ill adult leading to underexposure in 20% of patients but was not evaluated in critically ill children.
Objectives
We aimed to assess the incidence and factors associated with a Cmax < 60 mg/L in critically ill children treated with a 30 mg/kg dose of amikacine.
Methods
Retrospective observational multicentric study, from November 2017 to June 2018 in two pediatric intensive care unit (PICU) located within two French tertiary academic pediatric hospitals. We included all children admitted in the PICU receiving 30 mg/kg amikacin dose.
Results
We analyzed 24 children. Cmax was < 60 mg/L in 16 patients (67%). None had Cmax > 80 mg/L. Thirteen (93%) patients from the 14 having a measured MIC achieved a Cmax /MIC > 8. Higher level of uremia was significantly associated with a Cmax < 60 mg/L. We observed an occurrence or a worsening of acute kidney injury in 12 (50%) of our patients after amikacin injection. Trough concentration was > 2.5 mg/L in 40% of our patients.
Conclusion
Despite the use of a 30 mg/kg amikacin dose, Cmax were below pharmacokinetic target in 67% of our population and no Cmax was above. However, kidney function was impaired in half of our patients. This reinforces the need to monitor systematically peak and trough concentration in this vulnerable population receiving high doses of aminoglycosides.
Facilitator Of
SECTION 1: ECMO CIRCUIT
SECTION 2: TROUBLESHOOTING ON ECMO
SECTION 3: ECMO CANNULATION
SECTION 4: SIMULATION SCENARIO-TEAM WORK