Near-drowning in Pediatric Respiratory Intensive Care Unit, Siriraj Hospital.

OBJECTIVES: To study characteristics, treatment and outcome of near-drowning patients in Pediatric Respiratory Care Unit (P-RCU), Siriraj Hospital MATERIAL AND METHOD: We retrospectively reviewed hospital records of 31 near-drowning patients admitted at P-RCU Siriraj Hospital during 1990-2002. RESULTS: The average age of admitted patients was 4 years (ranged from 6 months to 13 years). Seventy percent of the patients were under 5 years of age. Male : female ratio was 2.1 : 1. Sixty-two percents of the patients were left alone when near-drowning occurred. The sites of occurrence were around their houses in 60% of cases. Bystander resuscitation was documented in 35%. Common complications were pneumonia (74.2%) and seizure (58%). Patients with poor outcome were children without spontaneous purposeful movement within 24 hours after submersion. Neurological sequelae was found in 35.5% of the cases and the mortality rate was 25.8% (3 due to severe pneumonia from prolonged intubation and aspiration, 2 due to severe brain hypoxia, 2 due to severe adult respiratory distress syndrome (ARDS) and 1 due to intracerebral hemorrhage) CONCLUSION: Due to poor outcome observed in this study, prevention of submersion injury is the most important and cost-effective measure. However, if near-drowning happens, effective immediate resuscitation is crucial for the best outcome.

Transportation of critically ill patient to Pediatric Intensive Care Unit, Siriraj Hospital.

This retrospective study was undertaken to evaluate and identify some difficulties encountered in the process of interhospital transport of pediatric critically ill patients from remote hospitals to the Pediatric Intensive care unit (PICU) of the Department of Pediatrics, Faculty of Medicine Siriraj Hospital. The study was conducted between 1st June, 2001 and 30th June, 2003. Total number of patients transferred to PICU were 36. Most patients suffered from respiratory diseases (14 cases, 38.9%) and cardiovascular diseases (8 cases, 22.2%) prior to transfer. Five patients (13.9%) had cardiac arrest and required CPR prior to the transfers. Twelve cases (30%) were transferred at the parents' request or and due to socioeconomic problems. All patients were transported by ambulance. The longest transfer duration was from a hospital in Chiangmai province (11 hours by road transfer). The majority of accompanying medical personnel were nurses (55.5%) with no experience in intensive care pediatrics. In no cases were any doctors or trained paramedics presented with the transport team. Prior to transportation, the PICU physician was phone-contacted by the referring physician. The patients' status prior to being transferred to PICU were as follows; 23 cases (63.9%) were intubated, 4 (11.1%) cases had intravenous cut down and 10 (27.8%) were infused inotropic drug. None of the patients had any record on important patient's data (e.g. vital signs, oxygen saturation) or adverse events during transport such as equipment problems and clinical deteriorations. Twenty eight patients (77.8%) stayed in PICU average length of less than 7 days. Eleven patients died (mortality rate of 30.59%). In conclusion, the major obstacle in properly transporting patients to the PICU was the lack of experience/knowledge of transport team to perform safe transfer in pediatrics during transport. The second problem was lack of documentation or record of vital signs and adverse events observed during the transfer. Organization of effective team working in pediatric transfer to PICU is inevitably needed to improve the outcome of these critically ill patients.

First fatal avian influenza A (H5N1) in Siriraj Hospital: A case report.

In Thailand the outbreak of avian flu began in late 2003. It was alerted after a six-year-old boy was referred to Sirivaj Hospital from Kanchanaburi province with symptoms of high fever, cough and shortness of breath, followed by severe hypoxemic respiratory failure. He then developed multiple organ failure and expired on the tenth day of hospitalization. The diagnosis of avian influenza A (H5N1) was established by an isolation of the virus from his nasopharyngeal and tracheal secretions. The infection appeared to have been acquired directly from infected poultry. The case confirmed to the Thai government that the outbreak of the avian flu had begun. Consequently, prevention policies and early detection strategies have been strongly enforced.

Outcome of pediatric oncologic patients in the respiratory intensive care unit: Siriraj Hospital.

OBJECTIVES: To review the characteristics and outcome of patients with childhood malignancy requiring respiratory intensive care treatment and to assess the outcome of these patients. DESIGN: Retrospective review of 22 oncological patients admitted to the pediatric respiratory intensive care unit between January 1, 1996 and December 31, 1998 (total 3 years.) RESULTS: The overall survival at discharge from the intensive care unit was 10 out of 22 (45%). The mean age of the patients was 4 years 5 months old (range 1 month to 14 years). Male:Female ratio was 1.2:1.21 patients had fever. All patients with a systemic or respiratory infective illness were neutropenic with a positive hemoculture in 17 out of 21 (81%) and 10 out of 20 (50%), respectively. The most common organisms detected were coagulase negative Staphylococcal aureus and Escherichia Coli. Sputum culture in the respiratory failure group was positive in 3 out of 7 patients, all of them grew Pseudomonas aeruginosa. Antibiotics were given to all oncological patients presenting with fever. The most common antibiotics administered were Ceftazidime, Amikacin and Imipenem. Fourteen patients needed mechanical ventilation. 11 of these 14 patients had respiratory tract infections, 1 patient had acute respiratory distress syndrome and the remainder were in a coma as a result of brain metastasis. Only 2 of them survived. The mean duration of stay in the respiratory intensive care unit was 10.9 days. CONCLUSIONS: There has been an improvement in the survival of oncology patients admitted to the intensive care unit especially for those with either a systemic or respiratory infection. Early and full intensive care treatment should be provided for these patients in order to improve the outcome.

Pulmonary involvement with massive pneumothorax in a child with Langerhams Cell Histiocytosis (LCH).

An eight-year-old boy with pulmonary LCH, who had spontaneous pneumothorax, prolonged air leak and recurrence of puneumothorax after re-expansion of the lung was described. Medical pleurodesis was successfully employed to prevent recurrence of the air leak.