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1.
Pediatr Crit Care Med ; 20(7): e293-e300, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31149966

RESUMEN

OBJECTIVES: To identify the clinical findings available at the time of hospitalization from the emergency department that are associated with deterioration within 24 hours. DESIGN: A retrospective case-control study. SETTING: A pediatric hospital in Ottawa, ON, Canada. PATIENTS: Children less than 18 years old who were hospitalized via the emergency department between January 1, 2008, and December 31, 2012. Cases (n = 98) had an unplanned admission to the PICU or unexpected death on the hospital ward within 24 hours of hospitalization and controls (n = 196) did not. INTERVENTIONS: None. MAIN RESULTS: Ninety-eight children (53% boys; mean age 63.2 mo) required early unplanned admission to the PICU. Multivariable conditional logistic regression resulted in a model with five predictors reaching statistical significance: higher triage acuity score (odds ratio, 4.1; 95% CI, 1.7-10.2), tachypnea in the emergency department (odds ratio, 4.6; 95% CI, 1.8-11.8), tachycardia in the emergency department (odds ratio, 2.6; 95% CI, 1.1-6.5), PICU consultation in the emergency department (odds ratio, 8.0; 95% CI, 1.1-57.7), and admission to a ward not typical for age and/or diagnosis (odds ratio, 4.5; 95% CI, 1.7-11.6). CONCLUSIONS: We have identified risk factors that should be included as potential predictor variables in future large, prospective studies to derive and validate a weighted scoring system to identify hospitalized children at high risk of early clinical deterioration.

2.
Paediatr Child Health ; 24(3): 170-172, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31110457
3.
J Pediatr Intensive Care ; 8(2): 113-116, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31093466

RESUMEN

Little is known about severe anaphylaxis in the pediatric population. In this retrospective cohort study, we aimed to describe the characteristics of children who required admission from an outpatient setting to one of two Pediatric Intensive Care Units in Atlantic Canada with a primary diagnosis of anaphylaxis. During the 10-year study period, there were 12 admissions (58% females) for a population incidence of 2.4 per 100,000 children. Both patients who died were adolescents with a witnessed anaphylaxis event, immediately recognized as such after exposure to a known allergen, with immediate access to epinephrine that was not administered until after cardiorespiratory arrest occurred. This study highlights the high mortality associated with severe anaphylaxis and the ongoing need for education surrounding the early administration of intramuscular epinephrine.

5.
Crit Care Med ; 45(6): 989-992, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28350643

RESUMEN

OBJECTIVES: Rates of organ donation and transplantation have steadily increased in the United States and Canada over the past decade, largely attributable to a notable increase in donation after circulatory death. However, the number of patients awaiting solid organ transplantation continues to remain much higher than the number of organs transplanted each year. The objective of this study was to determine the potential to increase donation rates further by identifying gaps in the well-established donation after circulatory death process in Ontario. DESIGN: Retrospective cohort study. SETTING: Provincial organ procurement organization. PATIENTS: Patients who died in designated donation hospitals within the province of Ontario, Canada between April 1, 2013, and March 31, 2015. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 1,407 patient deaths following planned withdrawal of life-sustaining therapy, 54.0% (n = 760) were medically suitable for donation after circulatory death. In 438 cases where next of kin was approached, consent rates reached 47.5%. A total of 119 patients became actual organ donors. Only 66.2% (n = 503) of suitable patients were appropriately referred, resulting in 251 missed potential donors whose next of kin could not be approached regarding organ donation because referral occurred after initiation of withdrawal of life-sustaining therapy or not at all. CONCLUSIONS: The number of medically suitable patients who die within 2 hours of planned withdrawal of life-sustaining therapy is nearly six times higher than the number of actual organ donors, with the greatest loss of potential due to delayed referral until at the time of or after planned withdrawal of life-sustaining therapy. Intensive care teams are not meeting their ethical responsibility to recognize impending death and appropriately refer potential organ donors to the local organ procurement organization. In cases where patients had previously registered their consent decision, they were denied a healthcare right.


Asunto(s)
Cuidados Críticos/estadística & datos numéricos , Muerte , Derivación y Consulta/estadística & datos numéricos , Obtención de Tejidos y Órganos/estadística & datos numéricos , Adulto , Cuidados Críticos/organización & administración , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ontario , Estudios Retrospectivos , Factores de Tiempo , Obtención de Tejidos y Órganos/organización & administración
6.
Hosp Pediatr ; 6(10): 616-625, 2016 10.
Artículo en Inglés | MEDLINE | ID: mdl-27686826

RESUMEN

OBJECTIVE: Hospitalized children who are admitted to the inpatient ward can deteriorate and require unplanned transfer to the PICU. Studies designed to validate early warning scoring systems have focused mainly on abnormalities in vital signs in patients admitted to the inpatient ward. The objective of this study was to determine the patient and system factors that experienced clinicians think are associated with progression to critical illness in hospitalized children. METHODS: We conducted a modified Delphi study with 3 iterations, administered electronically. The expert panel consisted of 11 physician and nonphysician health care providers from hospitals in Canada and the United States. RESULTS: Consensus was reached that 21 of the 57 factors presented are associated with clinical deterioration in hospitalized children. The final list of variables includes patient characteristics, signs and symptoms in the emergency department, emergency department management, and system factors. CONCLUSIONS: We generated a list of variables that can be used in future prospective studies to determine if they are predictors of clinical deterioration on the inpatient ward.


Asunto(s)
Enfermedad Crítica , Servicio de Urgencia en Hospital , Hospitalización/estadística & datos numéricos , Medición de Riesgo/métodos , Tiempo de Tratamiento , Canadá/epidemiología , Niño , Niño Hospitalizado/estadística & datos numéricos , Enfermedad Crítica/epidemiología , Enfermedad Crítica/terapia , Técnica Delfos , Progresión de la Enfermedad , Diagnóstico Precoz , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/normas , Femenino , Humanos , Lactante , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Masculino , Estudios Prospectivos , Tiempo de Tratamiento/normas , Tiempo de Tratamiento/estadística & datos numéricos , Estados Unidos/epidemiología
7.
BMJ Clin Evid ; 20152015 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-26689353

RESUMEN

INTRODUCTION: Cardiorespiratory arrest outside hospital occurs in approximately 1/10,000 children per year in resource-rich countries, with two-thirds of arrests occurring in children under 18 months of age. Approximately 45% of cases have undetermined causes, including sudden infant death syndrome. Of the rest, 20% are caused by trauma, 10% by chronic disease, and 6% by pneumonia. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of treatments for non-submersion out-of-hospital cardiorespiratory arrest in children? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS: At this update, searching of electronic databases retrieved 192 studies. After deduplication and removal of conference abstracts, 81 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 68 studies and the further review of 13 full publications. Of the 13 full articles evaluated, three systematic reviews were added at this update. We have also added eight studies to the Comment section. We performed a GRADE evaluation for three PICO combinations. CONCLUSIONS: In this systematic overview, we categorised the efficacy for nine interventions based on information about the effectiveness and safety of airway management and ventilation (bag-mask ventilation and intubation), bystander cardiopulmonary resuscitation, direct-current cardiac shock, high dose and standard dose intravenous adrenaline (epinephrine), intravenous sodium bicarbonate, intubation versus bag-mask ventilation, targeted temperature management, and training parents to perform resuscitation.

9.
Hosp Pediatr ; 3(3): 212-8, 2013 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24313089

RESUMEN

OBJECTIVE: The goal of this study was to describe the frequency, characteristics, and outcomes of children who require early unplanned admission to the PICU within 24 hours of hospitalization from the emergency department. METHODS: This study was a retrospective audit of 24 months of prospectively collected medical emergency team records at a tertiary pediatric hospital in Canada. Our review identified 39 hospitalized children who had an activation that resulted in unplanned admission to the PICU within 24 hours of admission from the ED. RESULTS: Forty-six percent of the study subjects were infants aged < 1 year, and 64% were male. Respiratory complaints were the most common reason for hospitalization (59%). Preexisting medical conditions (51%), abnormal respiratory rates (46%), abnormal heart rates (33%), abnormal blood gas values (49%), high supplemental oxygen requirement (23%), and treatment with nebulized medications (46%), intravenous fluids (33%), and antibiotics (33%) were common. The median time to medical emergency team activation was 9.4 hours (interquartile range: 4.4-14.5). Nearly one-half (49%) of the patients required a significant intervention after admission to the PICU, with a mean length of stay of 3.4 days and a mortality rate of 50/%. CONCLUSIONS: Male subjects, infants aged < 1 year, and children with respiratory complaints accounted for a large proportion of children requiring early unplanned admission to the PICU within 24 hours of hospitalization from the ED. Further studies are required to determine which factors are associated with deterioration after hospitalization.


Asunto(s)
Enfermedad Crítica/epidemiología , Hospitalización/estadística & datos numéricos , Hospitales Pediátricos/estadística & datos numéricos , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Canadá/epidemiología , Preescolar , Progresión de la Enfermedad , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo
10.
Eur J Emerg Med ; 14(1): 60-1, 2007 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-17198333

RESUMEN

Anaphylactoid reaction to recombinant tissue plasminogen activator for the thrombolytic treatment of acute ischemic stroke is an uncommon complication. An increased risk of anaphylaxis may be found in patients concomitantly being treated with angiotensin-converting enzyme inhibitors, as illustrated by this case report describing a patient who experienced an urticaric rash, hypotension, tachycardia, orolingual angioedema, and airway obstruction following intravenous administration of alteplase. Possible pharmacologic interactions resulting in excessive serum bradykinin and subsequent systemic hypersensitivity responses are discussed.


Asunto(s)
Anafilaxia/inducido químicamente , Fibrinolíticos/efectos adversos , Accidente Cerebrovascular/terapia , Terapia Trombolítica/efectos adversos , Activador de Tejido Plasminógeno/efectos adversos , Anciano , Femenino , Humanos
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