Outcomes of extracorporeal membrane oxygenation support in pediatric hemato-oncology patients.

BACKGROUND: In this study, we reviewed the outcomes of pediatric patients with malignancies who underwent hematopoietic stem cell transplantation (HSCT) and extracorporeal membrane oxygenation (ECMO). METHODS: We retrospectively analyzed the records of pediatric hemato-oncology patients treated with chemotherapy or HSCT and who received ECMO in the pediatric intensive care unit (PICU) at Seoul National University Children's Hospital from January 2012 to December 2020. RESULTS: Over a 9-year period, 21 patients (14 males and 7 females) received ECMO at a single pediatric institute; 10 patients (48%) received veno-arterial (VA) ECMO for septic shock (n=5), acute respiratory distress syndrome (ARDS) (n=3), stress-induced myopathy (n=1), or hepatopulmonary syndrome (n=1); and 11 patients (52%) received veno-venous (VV) ECMO for ARDS due to pneumocystis pneumonia (n=1), air leak (n=3), influenza (n=1), pulmonary hemorrhage (n=1), or unknown etiology (n=5). All patients received chemotherapy; 9 received anthracycline drugs and 14 (67%) underwent HSCT. Thirteen patients (62%) were diagnosed with malignancies and 8 (38%) were diagnosed with non-malignant disease. Among the 21 patients, 6 (29%) survived ECMO in the PICU and 5 (24%) survived to hospital discharge. Among patients treated for septic shock, 3 of 5 patients (60%) who underwent ECMO and 5 of 10 patients (50%) who underwent VA ECMO survived. However, all the patients who underwent VA ECMO or VV ECMO for ARDS died. CONCLUSIONS: ECMO is a feasible treatment option for respiratory or heart failure in pediatric patients receiving chemotherapy or undergoing HSCT.

SCORING SYSTEM FOR PREDICTED SURGICAL-SITE INFECTION IN NEONATES AND PEDIATRIC INTENSIVE CARE UNIT: A PRELIMINARY STUDY.

BACKGROUND: Surgical-site infections (SSI) account for a large portion of morbidity with the rate of 500,000 cases per year from 27 million surgeries. Some researchers found that factors contributing to surgical wound infections are the number of bacteria contaminants, the bacterias virulence, the micro-environment around the surgical wound, and the immune system of the host. OBJECTIVE: To account the risk factors for surgical-site infections in neonatal and pediatric intensive care unit and apply them in a risk index for neonates and pediatrics in critical care unit. METHOD: A cohort retrospective study was initiated to investigate risk factors for SSI at Tarakan General Hospital from January 2018 to July 2019. The different factors then analyzed with chi-square test, whereas the multivariate binary logistic regression model was used to examine independent risk factors for SSI. RESULT: A total of 179 patients met the inclusion criteria. There were 66 patients in NICU and 113 in PICU. Bivariate analysis showed that SSI was associated with type of ward, operating room temperature, perioperative septicemia, length of stay, and the use of chlorhexidine bath-washing (p<0.05). Multivariate analysis identified three independent parameters correlating with the occurance of SSI: operating room temperature (odds ratio [OR] 12,510; 95% confidence interval [CI] 4,198 37,279; P<0.001); perioperative septicemia (OR 6,424; 95% CI 2,221 18,581; P=0.001); and the use of chlorhexidine bath-washing (OR 35,751; 95% CI 8,627 148,164; P<0.001). CONCLUSION: From these three independent paramaters, we recommend a prognostic scoring for SSI in post operative NICUs and PICUs patients that still need another diagnostic, validity and realibility test to improve patients outcome.

Exploring the Relationship Between Morphine Concentration and Oversedation in Children After Cardiac Surgery.

Titrating analgesic and sedative drugs in pediatric intensive care remains a challenge for caregivers due to the lack of pharmacodynamic knowledge in this population. The aim of the current study is to explore the concentration-effect relationship for morphine-associated oversedation after cardiac surgery in children aged 3 months to 3 years. Data on morphine dosing, as well as morphine plasma concentrations, were available from a previous study on the pharmacokinetics of morphine after cardiac surgery in children. Oversedation was defined as scores below 11 on the validated COMFORT-behavioral scale. Population pharmacokinetic-pharmacodynamic modeling was performed in NONMEM 7.3. The probability of oversedation as a function of morphine concentration was best described using a step function in which the EC50 was 46.3 ng/mL. At morphine concentrations below the EC50 , the probability of oversedation was 2.9% (0.4& to 18%), whereas above the EC50 percentages were 13% (1.9% to 52%) (median value [95% prediction interval from interindividual variability]). Additionally, the risk of oversedation was found to be increased during the first hours after surgery (P < .001) and was significantly lower during mechanical ventilation (P < .005). We conclude that morphine concentrations above approximately 45 ng/mL may increase the probability of oversedation in children after cardiac surgery. The clinician must evaluate, on a case-by-case basis, whether the analgesic benefits arising from dosing regimen associated with such concentrations outweigh the risks.

Comfort of the child in intensive pediatric therapy: perception of nursing professionals / El bienestar del niño en la terapia intensiva pediátrica: percepción de los profesionales de enfermería / Conforto da criança na terapia intensiva pediátrica: percepção dos profissionais de Enfermagem

ABSTRACT Objectives: o analyze the concept of comfort in a Pediatric Intensive Care Unit from the perspective of nursing professionals. Methods: descriptive research, with qualitative-quantitative approach, conducted in an Intensive Care Unit. Data collection occurred between January and May 2017; 40 nursing professionals participated in the study. The textual data obtained in the semi-structured interviews was processed in the Iramuteq 7.2 software. The Descending Hierarchical Classification and Bardin analysis were used for the discussion. Katharine Kolcaba's concepts were used as theoretical framework. Results: three categories emerged: the environment that promotes (dis)comfort; feasible actions to promote comfort; uncomfortable actions in care. Final Considerations: it was possible to identify that comfort is offered by providing measures that favor the well-being, warmth, safety and tranquility of hospitalized children. The study brings a reflection about the nursing care provided to severely ill hospitalized children.

RESUMEN Objetivos: analizar el concepto de comodidad en Unidad de Terapia Intensiva Pediátrica en la perspectiva de los profesionales de enfermería. Métodos: investigación descriptiva, con enfoque cuantitativo, desarrollada en una Unidad de Terapia Intensiva. La recolección ocurrió entre enero a mayo de 2017; participaron del estudio 40 profesionales de enfermería. A partir de los datos textuales originados por la entrevista semiestructurada, se realizó el procesamiento de los datos por el software Iramuteq 7.2. Para la discusión, se utilizó la Clasificación Jerárquica Descendente y análisis de Bardin. Se utilizaron las concepciones de Katharine Kolcaba como referencial teórico. Resultados: surgieron tres categorías, siendo ellas: el ambiente que promueve (des) comodidad; acciones viables para la promoción del confort; acciones incómodas en la prestación de la asistencia. Consideraciones Finales: fue posible identificar que el confort es ofrecido, al proporcionar medidas que favorezcan bienestar, comodidad, seguridad y tranquilidad del niño hospitalizado. El estudio trae una reflexión en cuanto a los cuidados de enfermería que se prestan al niño gravemente hospitalizado.

RESUMO Objetivos: analisar o conceito de conforto em Unidade de Terapia Intensiva Pediátrica, na perspectiva dos profissionais de enfermagem. Métodos: pesquisa descritiva, com abordagem quantiqualitativa, desenvolvida em uma Unidade de Terapia Intensiva. A coleta ocorreu entre janeiro a maio de 2017; participaram do estudo 40 profissionais de enfermagem. A partir dos dados textuais originados pela entrevista semiestruturada, foi realizado o processamento dos dados pelo software Iramuteq 7.2. Para a discussão, utilizou-se a Classificação Hierárquica Descendente e análise de Bardin. Utilizaram-se as concepções de Katharine Kolcaba como referencial teórico. Resultados: emergiram três categorias, sendo elas: o ambiente que promove (des)conforto; ações exequíveis para promoção do conforto; ações desconfortantes na prestação da assistência. Considerações Finais: foi possível identificar que o conforto é ofertado, ao proporcionar medidas que favoreçam bem-estar, aconchego, segurança e tranquilidade da criança hospitalizada. O estudo traz uma reflexão quanto aos cuidados de enfermagem que são prestados à criança gravemente hospitalizada.

Vasoactive-ventilation-renal score in predicting outcome postcardiac surgery in children.

OBJECTIVE: The objective of this study was to evaluate vasoactive-ventilation-renal (VVR) score to predict outcome postcardiac surgery in children and establish the time at which the score is best to predict outcome. MATERIALS AND METHODS: This prospective cohort included children ≤18 years recovering from cardiac surgery for congenital heart disease. Data were collected from the Intensive Care Unit (ICU) and vasoactive-inotropic score (VIS) and VVR scores calculated at admission, 24 h, and 48 h postoperatively. Outcome of interest was prolonged length of ICU stay (defined as length of stay [LOS] in the upper 25th percentile) and ICU mortality. Correlation between the outcome and scores was obtained and receiver operating characteristic (ROC) curves generated. Independent association of the scores with the outcome was also established. RESULTS: One thousand ninety-seven patients were enrolled with a median age of 24 months (range: 2 days-18 years) including 14.6% with single ventricle physiology. Pediatric ICU LOS >89 h was considered prolonged, and mortality was 2.2%. VVR score correlated better with outcome and had greater area under the curve (AUC) for ROC curve than the corresponding VIS at each study time point. The AUC of ROC curve for VVR score was greatest at 48 h for predicting both prolonged LOS (0.87) and mortality (0.92). VVR score at 48 h remains strongly associated with both prolonged LOS (odds ratio [OR] - 1.24; P = 0.000) and mortality (OR - 1.16; P = 0.000). CONCLUSION: VVR score is effective and robust bedside method to predict prolonged LOS and mortality postpediatric cardiac surgery. VVR score at 48 h was the best to predict outcome.

Quando a vida começa diferente: cuidado postural no cotidiano da equipe multiprofissional em terapia intensiva pediátrica / Cuando la vida empieza distinta: el cuidado postural en la rutina del equipo multiprofesional de cuidados intensivos pediátricos / When life begins different: postural care on daily life of the multiprofessional team in pediatric intensive care

Objetivo: Compreender as práticas da equipe multiprofissional no cuidado postural da criança cardiopata na unidade de terapia intensiva. Métodos: Trata-se de estudo descritivo de cunho qualitativo, realizado na Unidade de Terapia Intensiva cardiopediátrica de um hospital de referência de Fortaleza, Ceará, Brasil, no tratamento de doenças cardíacas e pulmonares em abril de 2016, com profissionais de saúde lotados há pelo menos seis meses na unidade atuando no manejo da criança no leito. A coleta de dados foi através da observação participante e da entrevista semiestruturada. Utilizou-se a Análise de Conteúdo para a análise das informações. A pesquisa cumpriu a Resolução 466/12 e foi iniciada após a aprovação do Comitê de Ética do referido hospital com parecer de nº 53399616.4.0000. Resultados: Emergiram as seguintes categorias de análise: "Só mais uma vez... amanhã talvez": a distância dos sujeitos nos processos de cuidado em saúde e "Oh me vira aqui... me mexe aqui": outros modos de ser profissional de saúde. Conclusão: Há que se refletir criticamente acerca das ações e interações no contexto dos serviços de saúde sobre o que, como e quando falar; o que, como e quando olhar; como se posicionar e tocar a criança. Importa compreender o que a criança transmite e tentar atender às suas necessidades como pessoa e não só como paciente.

Objetivo: Comprender las prácticas del equipo multiprofesional para el cuidado postural del niño con cardiopatía en la unidad de cuidados intensivos. Métodos: Se trata de un estudio descriptivo y cualitativo realizado en la Unidad de Cuidados Intensivos cardiopediátrico de un hospital de referencia de Fortaleza, Ceará, Brasil, para el tratamiento de enfermedades cardíacas y pulmonares en abril de 2016 con profesionales sanitarios que trabajaban desde hace por lo menos seis meses en la unidad en el manejo del niño en la cama. La recogida de datos se dio a través de la observación participante y de la entrevista semiestructurada. Para el análisis de las informaciones se utilizó el Análisis de Contenido. La investigación ha cumplido la Resolución 466/12 y se ha iniciado tras la aprobación del Comité de Ética del referido hospital con el informe de nº 53399616.4.0000.Resultados: Emergieron las siguientes categorías de análisis: "Solo una vez más….mañana tal vez": la distancia de los sujetos en los procesos del cuidado en salud y "Oye, voltéame aquí…me mueve aquí": otros modos de ser profesional sanitario. Conclusión: Hay que reflexionar críticamente sobre las acciones y interacciones en el contexto de los servicios de salud sobre el que, cómo y cuándo hablar; el que, cómo y cuándo mirar; como posicionarse y tocar el niño. Es importante comprender lo que el niño trasmite y intentar atender sus necesidades como persona y no solo como paciente.

Objective: To understand the practices of the multiprofessional team in the postural care of the cardiopath child in the intensive care unit. Methods: This is a qualitative descriptive study, carried out in the Cardiopediatric Intensive Care Unit of a reference hospital in Fortaleza, Ceará, Brasil, in the treatment of heart and lung diseases in April of 2016, with health professionals who had been working for at least six months at the unit dealing with child in bed. A semistructured interview and participants observation was used to collect data. Content Analysis was used to analyze the information. The research complied with Resolution 466/12 and it started after the approval of the Ethics Committee of said hospital with the opinion of nº 53399616.4.0000. Results: The following categories of analysis emerged: "Only once more ... maybetomorrow ": the distance of the subjects in the processes health care and "Oh turn me here ... move me here": other ways of being a health professional. Conclusion: It is necessary to reflect critically on the actions and interactions in the context of the health services on what, how and when to speak; what, how and when to look; how to stand and touch the child. It is important to understand what the child transmits and try to meet their needs as a person and not only as a patient.

A review of acute and chronic peritoneal dialysis in developing countries.

Various modalities of renal replacement therapy (RRT) are available for the management of acute kidney injury (AKI) and end-stage renal disease (ESRD). While developed countries mainly use hemodialysis as a form of RRT, peritoneal dialysis (PD) has been increasingly utilized in developing countries. Chronic PD offers various benefits including lower cost, home-based therapy, single access, less requirement of highly trained personnel and major infrastructure, higher number of patients under a single nephrologist with probably improved quality of life and freedom of activities. PD has been found to be lifesaving in the management of AKI in patients in developing countries where facilities for other forms of RRT are not readily available. The International Society of Peritoneal Dialysis has published guidelines regarding the use of PD in AKI, which has helped in ensuring uniformity. PD has also been successfully used in certain special situations of AKI due to snake bite, malaria, febrile illness, following cardiac surgery and in poisoning. Hemodialysis is the most common form of RRT used in ESRD worldwide, but some countries have begun to adopt a 'PD first' policy to reduce healthcare costs of RRT and ensure that it reaches the underserved population.