Clinical review of High Flow Nasal Cannula and Continuous Positive Airway Pressure in pediatric acute respiratory distress.

Acute Respiratory Distress Syndrome (ARDS) causes much morbidity and mortality in children. In mild to moderate ARDS, non-invasive ventilation (NIV) is the treatment of choice. Recently, there are 2 kinds of NIV used Continuous Positive Airway Pressure (CPAP) or High Flow Nasal Cannula (HFNC). Both of them can be used in various respiratory distress and have different physiological mechanisms. The effectiveness to improve the clinical parameter, morbidity, and mortality are similar between CPAP and HFNC. However, HFNC application is more tolerated in acute respiratory distress in children, with less nasal injury, lower heart rate inflicted, and better comfort index score.

The risk factors of the functional status, quality of life, and family psychological status in children with postintensive care syndrome: A cohort study.

Background: Intensive care treatment has a side effect of several impairments after hospital discharge, known as postintensive care syndrome (PICS). PICS in children must be well evaluated because PICS can affect their global development and quality of life. Our specific aims are to determine the impact of intensive care treatment and the risk factors which contribute to PICS. Methods: In this observational cohort study, we identified critically ill children treated in intensive care units (ICUs) for more than 24 h and survived. We evaluated the internal and external risk factors of the patients in the intensive care. We interviewed their parents to define the functional status and quality of life of the patients in 7 days before ICU admission and the psychological status of the family at the time of intensive care admission. The interview was repeated in 3 months after the intensive care discharge. Results: There was a significant decrease in functional status and quality of life after intensive care treatment (P < 0.001). However, none of the internal risk factors were significantly associated with PICS. Neurologic involvement in the disease was associated with the significantly reduced functional status of patients, while the severity of the disease was significantly associated with both functional status and quality of life. Our study also showed a significant psychological disorder of the family in the intensive care. Conclusion: The occurrence of PICS in children was associated with the severity of the disease, decreased the functional status and quality of life, and contributed to psychological disorders for the family.

Impact of restrictive versus liberal transfusion and clinical outcomes in critically ill children: A retrospective observational study.

Background and Aims: Critically ill children with anemia often requires blood transfusion, which can cause several complications. It is important to decide when to start the red blood cell (RBC) transfusion; however, the guidelines is still lacking. The aim of this study was to compare restrictive and liberal transfusion strategy. Methods: This is an observational retrospective study of critically-ill children who receive RBC transfusion. Subjects categorized into two groups by initial hemoglobin (Hb), that is, restrictive (Hb ≤ 7 g/dl) and liberal (Hb ≤ 9.5 g/dl) strategy. In each group, subjects categorized based on: (1) Hb increment: high (increased ≥2.5 g/dl) and low (increase <2.5 g/dl) and (2) final Hb level: low (<7.0 mg/dl), moderate (7.0-10.0 mg/dl), and high (>10.0 mg/dl). Patient with hematologic or congenital disorder, severe malnutrition, chronic infection-related anemia, and transfusion in Hb level ≥9.5 g/dl were exclude. Each patients were evaluated for the clinical outcome, which is: intensive care length of stay (IC-LOS), length of mechanical ventilation (LoMV), and mortality rate. Results: Clinical outcome and mortality rates of both transfusion strategies are similar. The mortality rates were lower in higher Hb increment and final Hb level (p = 0.04 and p = 0.01, respectively). Multivariate analysis in all groups revealed mortality rate had moderate correlation with Hb increment (odds ratio [OR] = 0.694, 95% confidence interval [CI] 0.549-0.878; p = 0.002) and moderate correlation (OR = 0.642, 95% CI 0.519-0.795; p = 0.000) with final Hb level. The similar results was found after categorization based on transfusion strategy. Conclusion: We conclude the restrictive and liberal transfusion strategy have a similar effect to IC-LOS, LoMV, and mortality rate. High Hb increment (≥2.5 g/dl) and moderate-high final Hb (≥7.0 g/dl) after transfusion reduce the mortality rate.