Fluid balance in critically ill children with lower respiratory tract viral infection: a cohort study.

BACKGROUND: Increasing evidence has associated positive fluid balance of critically ill patients with poor outcomes. The aim of this study was to explore the pattern of daily fluid balances and their association with outcomes in critically ill children with lower respiratory tract viral infection. METHODS: A retrospective single-center study was conducted, in children supported with high-flow nasal cannula, non-invasive ventilation, or invasive ventilation. Median (interquartile range) daily fluid balances, cumulative fluid overload (FO) and peak FO variation, indexed as the % of admission body weight, over the first week of Pediatric Intensive Care Unit admission, and their association with the duration of respiratory support were assessed. RESULTS: Overall, 94 patients with a median age of 6.9 (1.9-18) months, and a respiratory support duration of 4 (2-7) days, showed a median (interquartile range) daily fluid balance of 18 (4.5-19.5) ml/kg at day 1, which decreased up to day 3 to 5.9 (- 14 to 24.9) ml/kg and increased to 13 (- 11 to 29.9) ml/kg at day 7 (p = 0.001). Median cumulative FO% was 4.6 (- 0.8 to 11) and peak FO% was 5.7 (1.9-12.4). Daily fluid balances, once patients were stratified according to the respiratory support, were significantly lower in those requiring mechanical ventilation (p = 0.003). No correlation was found between all examined fluid balances and respiratory support duration or oxygen saturation, even after subgroup analysis of patients with invasive mechanical ventilation, or respiratory comorbidities, or bacterial coinfection, or of patients under 1 year old. CONCLUSIONS: In a cohort of children with bronchiolitis, fluid balance was not associated with duration of respiratory support or other parameters of pulmonary function.

Quality of Life of Pediatric Nurses During the COVID-19 Pandemic: A Cross-sectional Study.

BACKGROUND: In a public health emergency, the psychological stress of nursing staff should be assessed, and nurses who cared for coronavirus disease 2019 (COVID-19) patients were constantly under pressure. Currently, frontline health care workers are experiencing mental health issues. The personal quality of life is directly related to the working environment, especially at this moment, when nursing could be a highly stressful and emotionally draining job. OBJECTIVES: During the COVID-19 pandemic, the primary objectives of the study were to describe the quality of life, posttraumatic stress disorder, and self-efficacy and to identify any associated factors of pediatric critical care nurses. This study is a multicenter cross-sectional study. METHODS: Data were collected between February and May 2021 from pediatric critical care nurses. The following instruments were used: the Nursing Quality of Life Scale, the Nursing Profession Self-Efficacy Scale, and the Impact of Event Scale. RESULTS: One hundred twelve nurses participated in this study with a 40% of response rate. Data suggest a better global perception of quality of life by male subjects (F = 6.65, P = .011). The nurses who cared for COVID-19 patients reported a lower quality of social life (F = 4.09, P = .045); furthermore, the nurses who had clinically vulnerable people in their families reported a worse quality of physical life (F = 4.37, P = .045). Approximately 50% of nurses reported sleep disturbances, and 37% reported symptoms of posttraumatic stress disorder, especially female nurses (F = 8.55, P = .04). CONCLUSION: According to this study, female nurses were more likely to experience posttraumatic stress disorder symptoms during the COVID-19 pandemic. Furthermore, findings also highlighted a lower quality of social life for those with clinically vulnerable relatives may be due to a self-limitation of interactions with other people. Finally, sleep disturbances were prevalent, potentially affecting nurses' mental health and performance.

Continuous Renal Replacement Therapy in Critically Ill Children in the Pediatric Intensive Care Unit: A Retrospective Analysis of Real-Life Prescriptions, Complications, and Outcomes.

Introduction: Severe acute kidney injury is a common finding in the Pediatric Intensive Care Unit (PICU), however, Continuous Renal Replacement Therapy (CRRT) is rarely applied in this setting. This study aims to describe our experience in the rate of application of CRRT, patients' clinical characteristics at admission and CRRT initiation, CRRT prescription, predictors of circuit clotting, short- and long-term outcomes. Methods: A 6-year single center retrospective study in a tertiary PICU. Results: Twenty-eight critically ill patients aged 0 to 18 years received CRRT between January 2012 and December 2017 (1.4% of all patients admitted to PICU). Complete clinical and CRRT technical information were available for 23/28 patients for a total of 101 CRRT sessions. CRRT was started, on average, 40 h (20-160) after PICU admission, mostly because of fluid overload. Continuous veno-venous hemodiafiltration and systemic heparinization were applied in 83.2 and 71.3% of sessions, respectively. Fifty-nine sessions (58.4%) were complicated by circuit clotting. At multivariate Cox-regression analysis, vascular access caliber larger than 8 Fr [HR 0.37 (0.19-0.72), p = 0.004] and regional citrate anticoagulation strategy [HR 0.14 (0.03-0.60), p = 0.008] were independent protective factors for clotting. PICU mortality rate was 42.8%, and six survivors developed chronic kidney disease (CKD), within an average follow up of 3.5 years. Conclusions: CRRT is uncommonly applied in our PICU, mostly within 2 days after admission and because of fluid overload. Larger vascular access and citrate anticoagulation are independent protective factors for circuit clotting. Patients' PICU mortality rate is high and survival often complicated by CKD development.