ABSTRACT
BACKGROUND: The objective of this study was to analyze the effects of sedation administration on clinical parameters, comfort status, intubation requirements, and the pediatric intensive care unit (PICU) length of stay (LOS) in children with acute respiratory failure (ARF) receiving noninvasive ventilation (NIV). METHODS: Thirteen PICUs in Spain participated in a prospective, multicenter, observational trial from January to December 2021. Children with ARF under the age of five who were receiving NIV were included. Clinical information and comfort levels were documented at the time of NIV initiation, as well as at 3, 6, 12, 24, and 48 h. The COMFORT-behavior (COMFORT-B) scale was used to assess the patients' level of comfort. NIV failure was considered to be a requirement for endotracheal intubation. RESULTS: A total of 457 patients were included, with a median age of 3.3 months (IQR 1.3-16.1). Two hundred and thirteen children (46.6%) received sedation (sedation group); these patients had a higher heart rate, higher COMFORT-B score, and lower SpO2/FiO2 ratio than did those who did not receive sedation (non-sedation group). A significantly greater improvement in the COMFORT-B score at 3, 6, 12, and 24 h, heart rate at 6 and 12 h, and SpO2/FiO2 ratio at 6 h was observed in the sedation group. Overall, the NIV success rate was 95.6%-intubation was required in 6.1% of the sedation group and in 2.9% of the other group (p = 0.092). Multivariate analysis revealed that the PRISM III score at NIV initiation (OR 1.408; 95% CI 1.230-1.611) and respiratory rate at 3 h (OR 1.043; 95% CI 1.009-1.079) were found to be independent predictors of NIV failure. The PICU LOS was correlated with weight, PRISM III score, respiratory rate at 12 h, SpO2 at 3 h, FiO2 at 12 h, NIV failure and NIV duration. Sedation use was not found to be independently related to NIV failure or to the PICU LOS. CONCLUSIONS: Sedation use may be useful in children with ARF treated with NIV, as it seems to improve clinical parameters and comfort status but may not increase the NIV failure rate or PICU LOS, even though sedated children were more severe at technique initiation in the present sample.
Subject(s)
Intensive Care Units, Pediatric , Noninvasive Ventilation , Respiratory Insufficiency , Humans , Noninvasive Ventilation/methods , Noninvasive Ventilation/statistics & numerical data , Prospective Studies , Female , Male , Infant , Intensive Care Units, Pediatric/statistics & numerical data , Intensive Care Units, Pediatric/organization & administration , Respiratory Insufficiency/therapy , Spain , Child, Preschool , Hypnotics and Sedatives/therapeutic use , Hypnotics and Sedatives/administration & dosage , Conscious Sedation/methods , Conscious Sedation/statistics & numerical dataSubject(s)
Critical Care , Intensive Care Units , Humans , Child , Feasibility Studies , Critical Illness/therapyABSTRACT
The long-term response of two infants with anti-N-methyl-D-aspartate receptor (anti-NMDAR) post herpes simplex encephalitis treated with rituximab is reported here. Rituximab may improve the course of the disease and should be considered early as second-line treatment. Data on the long-term effect of rituximab in B cell depletion and immunoglobulins levels in infants are needed.
Subject(s)
Anti-N-Methyl-D-Aspartate Receptor Encephalitis , Encephalitis, Herpes Simplex , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/diagnosis , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/drug therapy , Encephalitis, Herpes Simplex/complications , Encephalitis, Herpes Simplex/drug therapy , Humans , Infant , Receptors, N-Methyl-D-Aspartate , Rituximab/therapeutic useABSTRACT
No disponible
Subject(s)
Humans , Infant , Child, Preschool , Child , Tachycardia, Ectopic Junctional/drug therapy , Tachycardia, Ectopic Junctional/surgery , Ivabradine , Atrioventricular NodeSubject(s)
Pneumothorax , Humans , Lung/diagnostic imaging , Pneumothorax/diagnostic imaging , UltrasonographyABSTRACT
No disponible
