Could lactate clearance be a marker of mortality in pediatric intensive care unit?

BACKGROUND: Hyperlactatemia is a common finding in critically ill patients and has significant prognostic implications. However, a single lactate measurement has not been correlated to mortality consistently. In this study, we aimed to correlate the clinical efficacy of lactate clearance for the prediction of mortality in pediatric intensive care unit patients. METHODS: This retrospective observational study was performed in the pediatric intensive care unit in patients with lactate level >3 mmol/lt. Initial, 6th h, and 24th h lactate levels were recorded and lactate clearance was calculated using these values (lactate level at admission - level 6 h later × 100/lactate level at admission). RESULTS: A total of 172 patients were included in the study. Forty-four out of 172 patients died. Median (IQR) lactate (mmol/L) at admission was low in those who survived in comparison to nonsurvivors 4.4 (3.1) vs. 5.75 (7.7) (p = 0.002). Clearance at 6th h was significantly lower in those who died (11.7%) than those who survived (36.7) (p = 0.001). 6th h lactate clearance level <20.7% predicted mortality with a sensitivity of 63.6% and specificity of 69.5% along with a positive predictive value of 41.8 and a negative predictive value of 84.8 (p = 0.004). Both lactate levels and lactate clearance values were significantly predictive factors for mortality (p < 0.05). Only a positive moderate correlation was found between the percentage of PRISM-IV % and 6th h lactate level. DISCUSSION: The present study revealed that lactate clearance is a simple and rapid risk-stratification tool holding to be a potential biomarker of managing the treatment efficacy of children in the pediatric intensive care unit.

The effect of tracheotomy on ventilator-associated pneumonia rate in children.

OBJECTIVES: Data on the relationship between tracheotomy and ventilator-associated pneumonia (VAP) in children is very limited. We planned to evaluate the effect of tracheotomy on VAP rates in children. MATERIALS AND METHODS: We evaluated patients who underwent tracheotomy during follow-up at the pediatric intensive care unit (PICU) of our hospital. Patients who were diagnosed as VAP at least once and followed by a mechanical ventilation (MV) for at least 30 days before and after tracheotomy were included in our study. The underlying diagnoses of the patients and the number of VAP diagnosis, VAP rates (VAP number x1000/day of MV) before and after tracheotomy were recorded. Logistic regression analysis was used to compare VAP rates before and following a tracheotomy. RESULTS: There were a total of 47 patients including 28 (59.6%) girls and 19 (40.4%) boys in our study. The duration of MV before tracheotomy was 74.9 ± 48.9 (31-295) days and after tracheotomy, it was 103.3 ± 102.8 (30-586) days. The number of VAP before tracheotomy was 0.9 ± 1.2 (0-8) and after tracheotomy, it was 0.6 ± 0.6 (0-3). The VAP rate before tracheotomy was 5.9 ± 6.3 (0-26.5) and the VAP rate after tracheotomy was 3.2 ± 3.8 (0-11.4). Ventilator-associated pneumonia rates were lower following tracheotomy (OR:0.91,95%CI:0.826-0.981,p = 0.017). CONCLUSION: Tracheotomy decreased the VAP rate in children receiving long-term mechanical ventilatory support.

Kawasaki disease shock syndrome: a severe form of Kawasaki disease.

Kawasaki disease is a systemic vasculitis, primarily encountered in children. Its clinical presentation is well known, and coronary artery abnormalities are classical complications. Shock is not a common form of presentation of the disease. We report a case who presented with shock due to Kawasaki disease in accordance with the recently defined 'Kawasaki disease shock syndrome'. In pediatric intensive care units, Kawasaki disease shock syndrome may be misdiagnosed as toxic shock syndrome. Intensivists and emergency room physicians should be aware of this uncommon presentation and perform an echocardiography to search for coronary involvement in case of clinical doubt.