Author Of 5 Presentations
INCIDENCE, RISK FACTORS AND CLINICAL OUTCOME OF ACUTE KIDNEY INJURY IN CRITICALLY ILL CHILDREN: A RETROSPECTIVE COHORT STUDY
Abstract
Background
Children admitted to PICU are at risk of AKI. Few pediatric studies have focused on the identification of factors associated with the development of this condition.
Objectives
We assess the incidence rate of AKI, identify risk factors, and evaluate clinical outcome in a large sample of critically ill children.
Methods
This retrospective observational study was conducted including patients admitted to our PICU from Jan 2014 to Dec 2016. AKI was defined according to KDIGO criteria. A comparison between patients with and without AKI was carried out. Risk factors for AKI were analyzed by univariate and multivariate analysis.
Results
222 patients out of 811 (27.4%) had AKI. The most common PICU admission diagnoses in AKI cases were heart disease (38.6%) and respiratory failure (16.8%). Hypoxic-ischemic was the most frequent cause of AKI. Significant risk factors for AKI in multivariate analysis were age > 2 years (OR 2.27; 95% CI 1.06-4.90; p=0.035), inotrope exposure (OR 2.88; 95% CI 1.64-5.08 p<0.001), multiple organ dysfunction syndrome (OR 2.90; 95% CI 1.77-4.76; p<0.001), coagulopathy (OR 1.57; 95% CI 0.98-2.50, p=0.054) and thrombocytopenia (OR 2.54; 95% CI 1.34-4.79; p=0.004). AKI was associated with a longer PICU stay (median LOS of 8 days, vs. 4 days, in non-AKI patients; p <0.001). The mortality rate resulted ten-fold higher in AKI than non-AKI patients (12.6% vs.1.3%; p<0.001).
Conclusion
The incidence of AKI in critically ill children is high, with an associated increased LOS and mortality. In the PICU setting, risk factors of AKI are multiple and mainly associated with illness severity.
USE OF DEXMEDETOMIDINE FOR EEG SEDATION IN CHILDREN WITH BEHAVIOURAL DISORDERS
Abstract
Background
Electroencephalogram (EEG) is difficult to be performed in children with behavioural disorders without sedation. Dexmedetomidine, a safe highly selective α2-agonist sedative, does not affect EEG results.
Objectives
To evaluate the efficacy and safety of sedation with dexmedetomidine for EEG recordings in children with behavioural disorders.
Methods
Prospective observational study on children with behavioural disorders who had to undergo an EEG at the paediatric hospital in Padova, Italy. A bolus of dexmedetomidine (2 mcg/kg over 10 min) was administered, followed by an infusion (1-2 mcg/kg/h). The bolus could be repeated up 3 times to reach the target level of sedation assessed by the Pediatric Sedation State Scale. Vital signs (including EtCO2) were recorded before, during and after the procedure until complete recovery. EEG recording quality, and caregivers’ opinion on the quality of sedation and quality of sleep at home was assessed.
Results
For this preliminary study 13 patients were enrolled. Efficacy was 100%. Mean total dose of dexmedetomidine was 3,24±0,95 mcg/kg. Adequate sedation was achieved within 12±8,7 minutes. Time to first awakening was 24±25.5 minutes and to complete recovery 65±50 minutes. Adverse effects (hypotension, bradycardia) were reported in 6 patients and classified as “minor” requiring no intervention. EEG recording quality was good or excellent in 100% of patients. Parents referred an excellent quality of the procedure and a low incidence of sleep disorders.
Conclusion
Dexmedetomidine showed an excellent efficacy and good safety profile for EEG recording. More data are needed to confirm our preliminary findings.
THE USE OF NEUROMUSCULAR BLOCKING AGENTS IS ASSOCIATED WITH A HIGHER MORTALITY RATE IN PATIENTS ADMITTED TO PEDIATRIC INTENSIVE CARE: A MULTICENTER REPORT
Abstract
Background
Few data are available about patients receiving neuromuscular blocking agents (NMBAs) in pediatric intensive care units (PICU). Their use is often reported without clear and definite indications with conflicting data about the outcome of these patients.
Objectives
To describe the characteristics and outcome of children receiving prolonged NMBAs treatment in PICU.
Methods
Retrospective, multicenter study using a prospective electronic web-based-national-registry (Pediatric Intensive Care Unit Study Group Network-TIPNET) of patients admitted to 18 Italians’ PICUs (January 2010-October 2017). We included children (<18 years-of-age) receiving mechanical ventilation (MV) and compared patients who received NMBAs (Cur+) with children who did not receive them (Cur-).
Results
A total of 3848 patients were included, 504 (13%) Cur+. There were no significant differences about gender, comorbidities and PIM3 score between the two populations. Cur+ had a significantly lower age (20months [interquartile range (IQR) 5-65] vs 30months [IQR 8-83],p<0.001) and weight (10kg [IQR 5-18] vs 12kg [IQR 7-21]),p<0.001). They received MV more for respiratory (50%vs29%,p<0.001) and less for cardiac diseases (10%vs31%,p<0.001). Cur+ showed longer ventilation duration (6days [IQR 2-12] vs 3days [IQR 1-6],p<0.001) and a higher rate of use of high frequency oscillatory ventilation (18%vs3%,p<0.001). A logistic regression adjusted for age, gender and ventilation modality demonstrated a correlation between NMBAs use and mortality (p<0.001).
Conclusion
A non-negligible proportion of children in PICUs received NMBAs. Their use was more frequent in younger age, it is associated with prolonged use of MV and a higher mortality. Further studies are needed to clarify the specific indications, patients’ clinical features and the concomitant pharmacological management.
DEXMEDETOMIDINE FOR MRI SEDATION IN CHILDREN
Abstract
Background
Children’s poor compliance during imaging requiring prolonged immobilization, such as MRI, often requires the use of sedative drugs. Dexmedetomidine is a high selective α2-agonist sedative drug, which can be used for this purpose.
Objectives
To evaluate the effectiveness, safety and feasibility of dexmedetomidine for sedation during MRI in non-cooperative children, providing additional data on the most appropriate dosage and time of administration.
Methods
This is a prospective observational study conducted at the paediatric hospital of Padua, Italy, including uncooperative children who had to undergo a brain MRI. Dexmedetomidine iv loading dose of 2 mcg/kg in 10 minutes (up to 3 times) was administered, followed by continuous infusion at 1-2 mcg/kg/h. Level of sedation (Pediatric Sedation State Scale), vital signs (including EtCO2), adverse effects and quality of MRI were recorded.
Results
Twenty-eight children were enrolled. Efficacy was 96.4%. Mean total dose was 3.44±2 mcg/kg. Adequate sedation was achieved within 10 minutes in 71.4%, time to first awakening was 23.8±31.5 minutes and to complete recovery 92.7±57.8 minutes. Adverse effects were haemodinamic and reported in 6 patients: all of them were classified as “minor” according to SIVA score and required no intervention. No respiratory adverse events were recorded. MRI quality was excellent (76.5%) or good (23.5%).
Conclusion
Dexmedetomidine showed a high efficacy and good safety profile for MRI sedation at the dosage regimen used. More data are needed to further validate our preliminary findings.
IS DEXMEDETOMIDINE EFFECTIVE AND SAFE FOR PROLONGED SEDATION IN CRITICALLY-ILL PEDIATRIC PATIENTS? A PROSPECTIVE MULTICENTER STUDY (PROSDEX)
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.
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USE OF DEXMEDETOMIDINE FOR EEG SEDATION IN CHILDREN WITH BEHAVIOURAL DISORDERS
Abstract
Background
Electroencephalogram (EEG) is difficult to be performed in children with behavioural disorders without sedation. Dexmedetomidine, a safe highly selective α2-agonist sedative, does not affect EEG results.
Objectives
To evaluate the efficacy and safety of sedation with dexmedetomidine for EEG recordings in children with behavioural disorders.
Methods
Prospective observational study on children with behavioural disorders who had to undergo an EEG at the paediatric hospital in Padova, Italy. A bolus of dexmedetomidine (2 mcg/kg over 10 min) was administered, followed by an infusion (1-2 mcg/kg/h). The bolus could be repeated up 3 times to reach the target level of sedation assessed by the Pediatric Sedation State Scale. Vital signs (including EtCO2) were recorded before, during and after the procedure until complete recovery. EEG recording quality, and caregivers’ opinion on the quality of sedation and quality of sleep at home was assessed.
Results
For this preliminary study 13 patients were enrolled. Efficacy was 100%. Mean total dose of dexmedetomidine was 3,24±0,95 mcg/kg. Adequate sedation was achieved within 12±8,7 minutes. Time to first awakening was 24±25.5 minutes and to complete recovery 65±50 minutes. Adverse effects (hypotension, bradycardia) were reported in 6 patients and classified as “minor” requiring no intervention. EEG recording quality was good or excellent in 100% of patients. Parents referred an excellent quality of the procedure and a low incidence of sleep disorders.
Conclusion
Dexmedetomidine showed an excellent efficacy and good safety profile for EEG recording. More data are needed to confirm our preliminary findings.