A study on mean anion gap over 6 hours after admission as a predictor of pediatric mortality in pediatric intensive care unit

Background:The aims of the study was to correlate change in anion gap at 0 and 6 hours of admission with mortality in pediatric intensive care unit (PICU).Methods:Fifty children up to 12 years of age, admitted in PICU were included in the study. Blood gas anion gap levels were taken at 0 and 6 hours of admission and change in anion gap was calculated. Final outcome was recorded.Results:Out of 50 patients enrolled in the study, 18 (36%) patients died and 32 (64%) survived. Mortality was higher in group with increased anion gap after 6 hours of admission as compared to survived. Change in anion gap was higher in expired patient as compared to survivors.Conclusions:Mortality was higher in group with increased anion gap after 6 hours of admission

Nasal Continuous Positive Airway Pressure in Bronchiolitis: A Randomized Controlled Trial

Objective: To evaluate the efficacy of nasal continuous positiveairway pressure (nCPAP) in decreasing respiratory distress inbronchiolitis.Design: Randomized controlled trial.Setting: Tertiary-care hospital in New Delhi, India.Participants: 72 infants (age <1y) hospitalized with a clinicaldiagnosis of bronchiolitis were randomized to receive standardcare, or nCPAP in addition to standard care, in the first hour afteradmission. 23 parents refused to give consent for participation. 2infants did not tolerate nCPAP.Intervention: The outcome was assessed after 60 minutes. IfnCPAP was not tolerated or the distress increased, the infant wasswitched to standard care. Analysis was done on intention-to-treatbasis Main outcome measures: Change in respiratory rate,Silverman-Anderson score and a Modified Pediatric Society ofNew Zealand Severity Score.Results: 14 out of 32 in nCPAP group and 5 out of 35 in standardcare group had change in respiratory rate ?10 (P=0.008). Themean (SD) change in respiratory rate [8.0 (5.8) vs 5.1 (4.0),P=0.02] in Silverman-Anderson score [0.78 (0.87) vs 0.39 (0.73),P=0.029] and in Modified Pediatric Society of New ZealandSeverity Score [2.5 (3.01) vs. 1.08 (1.3), P=0.012] weresignificantly different in the nCPAP and standard care groups,respectively.Conclusion: nCPAP helped reduce respiratory distresssignificantly compared to standard care.