ABSTRACT
OBJECTIVES: To describe the clinical features of patients admitted to the pediatric intensive care unit (PICU) with acute lower respiratory tract infection (LRTI) attributable to influenza A pH1N1 virus and compare them with those admitted with LRTI due to other viral pathogens. DESIGN: Retrospective, observational, comparative study. SETTING: PICU in a university-affiliated, tertiary-care, pediatric hospital. PATIENTS: Patients aged >1 month with acute viral LRTI admitted to the PICU who met the following criteria: 1) influenza A pH1N1 virus infection detected between June 1, 2009 and July 16, 2009; and 2) patients with LRTI due to other viral pathogens infection detected in the same period of the year 2008 plus patients with 2009 influenza A non-pH1N1 infection. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We evaluated age, weight, gender, length of hospital stay before PICU admission, length of PICU stay, underlying disease, clinical diagnosis, severity, complications, treatment, risk of death, mortality, and cause of death. We identified 30 patients with acute LRTI due to influenza A pH1N1 virus (group 1) and 62 patients with LRTI due to other viral pathogens (group 2). Relevant characteristics in group 1: 59% of patients were aged >2 yrs. Median length of PICU stay was 15 days. An underlying condition was present in 83% of the patients. None of them had bronchiolitis on PICU admission; 12 (40%) had bilateral pneumonia; 15 (50%) had acute respiratory distress syndrome; and nine (30%) had shock. Twenty-nine patients required mechanical ventilation (96.6%); only one required extracorporeal membrane oxygenation; and 19 (63%) had respiratory complications. Six (20%) children died. When both groups were compared, patients with influenza A pH1N1 infection were older; pneumonia, acute respiratory distress syndrome, and shock were more frequently seen at the time of PICU admission, although length of stay and mortality were similar. CONCLUSIONS: Patients with influenza A pH1N1 respiratory virus infection presented with more severe illness. Outcomes were similar in both groups.
Subject(s)
Hospitalization , Influenza A Virus, H1N1 Subtype , Influenza, Human/physiopathology , Intensive Care Units, Pediatric , Respiratory System/virology , Adolescent , Child , Child, Preschool , Female , Hospitals, Pediatric , Humans , Infant , Infant, Newborn , Influenza, Human/virology , Male , Retrospective StudiesABSTRACT
OBJECTIVES: To investigate the detection of hepatitis A virus ribonucleic acid in patients with acute liver failure and to assess if the results have any clinical implications for the evolution of acute liver failure in children. Hepatitis A infection, a vaccine-preventable disease, is an important cause of acute liver failure in children in Argentina. Universal vaccination in 1-yr-old children was implemented in June 2005. DESIGN: Observational study in which patients were divided into Group 1 consisting of positive hepatitis A virus ribonucleic acid and Group 2 consisting of negative hepatitis A virus ribonucleic acid. SETTING: Pediatric intensive care unit in National Pediatric Hospital "Dr. J. P. Garrahan," Buenos Aires, Argentina. PATIENTS: Thirty-three patients with the diagnosis of acute liver failure secondary to hepatitis A virus infection and admitted to the Garrahan Pediatric Hospital between September 2003 and September 2005 were enrolled in the study. Twenty of these children were admitted to the pediatric intensive care unit. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Samples for total ribonucleic acid detection and genotyping were obtained from serum and/or stools on admission. We found positive hepatitis A virus ribonucleic acid in 13 patients and negative hepatitis A virus ribonucleic acid in 20 patients. The following clinical variables were evaluated: time of evolution, hospital stay, admission to the pediatric intensive care unit, pediatric intensive care unit stay, time on mechanical ventilation, criteria for orthotopic liver transplantation, and mortality. Characterization of the isolates did not reveal differences related to genotype; all cases were IA. No statistical significance was found as to the variables. However, positive hepatitis A virus ribonucleic acid showed lower percentages of pediatric intensive care unit admissions, criteria for orthotopic liver transplantation, number of orthotopic liver transplantation, and mortality than the group of patients with negative hepatitis A virus ribonucleic acid. CONCLUSIONS: Hepatitis A virus genotyping studies did not show any particularities, all cases were IA and, thus, apparent associations between genotype and the clinical presentation of acute liver failure could not be found.
Subject(s)
Genotype , Hepatitis A virus/genetics , Hepatitis A virus/isolation & purification , Hepatitis A/diagnosis , Liver Failure, Acute/etiology , RNA/blood , Adolescent , Argentina/epidemiology , Child , Child, Preschool , Feces/virology , Female , Hepatitis A/epidemiology , Humans , Infant , Intensive Care Units, Pediatric , Liver Failure, Acute/virology , Male , ObservationSubject(s)
Clinical Protocols , Critical Illness , Enteral Nutrition , Child , Humans , Intensive Care Units, PediatricABSTRACT
OBJECTIVE: To describe the main liver support devices used for fulminant hepatic failure (FHF) and to review data on the Molecular Adsorbents Recycling System (MARS) and assess its efficiency in children. DATA SOURCE: Studies were identified through selected readings and a MEDLINE search from 1975 and 2004 using fulminant hepatic failure, acute liver failure, primary graft dysfunction, liver support, MARS, and extracorporeal liver assist device as key words. STUDY SELECTION: All original studies, including case reports, relating to the use of the MARS or albumin dialysis system were included. Additional attention was put on prognosis criteria of FHF severity in children. DATA EXTRACTION: Study design, numbers and diagnoses of patients, definite or bridging treatment, outcome measures, and complications were extracted and compiled. Results of individual trials were combined on the risk ratio scale. DATA SYNTHESIS: Nine randomized trials including 354 patients were identified. However, liver support failed to significantly affect mortality when compared with standard medical therapy. Albumin dialysis, and particularly MARS, emerges as an easily applicable technique for temporary liver support. Some well-designed studies have characterized its efficiency in a few indications, such as in intractable pruritus in chronic liver disease, in acute or chronic liver diseases, and in decompensated cirrhosis with hepatorenal syndrome. In adults and children with FHF, anecdotal reports suggest that MARS may stabilize the patient. However, no randomized controlled study has validated its use in this indication. A randomized controlled study is ongoing in adults with FHF. Such a trial seems to be unfeasible in children for several methodologic reasons. CONCLUSIONS: Although promising preliminary results suggest that MARS may have a significant position in the therapeutic arsenal for FHF, no sufficient data exist to justify its use in children. For as long as the results of the ongoing adult trial are not available, the indications of this expensive technique in children with FHF are limited.
Subject(s)
Liver Failure, Acute/therapy , Liver, Artificial , Sorption Detoxification/instrumentation , Adult , Child , Dialysis Solutions/pharmacokinetics , Equipment Design , Humans , Serum Albumin/pharmacokinetics , Treatment OutcomeSubject(s)
Congresses as Topic/organization & administration , Critical Care , Pediatrics , Child , HumansABSTRACT
OBJECTIVES: To determine risk factors of mortality in the preoperative, perioperative, and immediate postoperative period of a pediatric population that has undergone orthotopic liver transplantation for fulminant hepatic failure in a pediatric intensive care unit. DESIGN: Retrospective review of medical records. SETTING: A pediatric intensive care unit in a children's hospital. PATIENTS: Sixty patients with fulminant hepatic failure who fulfilled King's College criteria for liver transplantation. INTERVENTION: Orthotopic liver transplantation was performed according to standard techniques. Before transplantation, patients were admitted to a pediatric intensive care unit when intensive care was required, and patients were always admitted to a pediatric intensive care unit after the operation. Measurements: A total of 20 variables were studied via univariate and multivariate analysis; statistical significance was accepted when p
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Asphyxia/etiology , Immersion/adverse effectsSubject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Hepatitis, Viral, Human/mortality , Hepatitis, Viral, Human/surgery , Incidence , Liver Transplantation , PrognosisABSTRACT
Evaluamos el tratamiento de 14 pacientes en el período posoperatorio de cirugía abdominal complicada de diferentes etiologías, cuyo diagnóstico final fue síndrome de intestino corto (SIC). Fueron divididos en dos grupos: resección o exclusión intestinal menor del 50 por ciento y resección o exclusión intestinal mayor del 50 por ciento. Después del tratamiento inicial hidroelectrolítico y durante la terapeútica antiinfecciosa, el aporte nutricional se inició con nutrición parenteral (NP) en todos los pacientes, cuando las condiciones clínicas lo permitieron, se agregó nutrición enteral (NE). La NE se inició con dietas elementales (Pregestimil) en cuatro niños; en los diez restantes se administró una dieta modulable a base de caseinato de calcio, triglicéridos en cadena mediana y glucosa, comenzando con 30 calorías por 100 cc y 145 mOsm/l hasta un máximo de 90 calorías popr 100 cc y 412 mOsm/l. Fue necesario cambiar la dieta por intolerancia transitoria en cuatro pacientes del primer grupo y dos del segundo. Como alternativa utilizamos una dieta a base de proteínas de pollo con adecuada tolerancia. Los resultados fueron evaluados en base a la respuesta clínica al tratamiento nutricional, pérdidas por heces, presencia de sustencias reductoras (glucosa) y pH menor de 6. Cinco pacientes fallecieron (35,7 por ciento), todos del primer grupo. Se halló diferencia entre los dos grupos, siendo para el primero mayor el tiempo de internación, la duración de la NP, complicaciones y mortalidad. El alta nutricional fue considerada cuando la dieta modulable y la dieta elemental pudieron ser reemplazadas por una leche libre de lactosa (LK). Nuestros datos sugieren que aquellos nióos que presentan resección o exclusión intestinal y se comportan como SIC, el aspecto nutricional puede ser adecuadamente tratado con una dieta modulable que reemplace a la dieta elemental, por ser esta difícil de obtener en nuestro país y por su alto costo
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Enteral Nutrition/methods , Parenteral Nutrition/methods , Short Bowel Syndrome/diet therapy , Intestine, Small/surgery , Osmolar Concentration , Short Bowel Syndrome/classification , Short Bowel Syndrome/etiology , Treatment OutcomeABSTRACT
Evaluamos el tratamiento de 14 pacientes en el período posoperatorio de cirugía abdominal complicada de diferentes etiologías, cuyo diagnóstico final fue síndrome de intestino corto (SIC). Fueron divididos en dos grupos: resección o exclusión intestinal menor del 50 por ciento y resección o exclusión intestinal mayor del 50 por ciento. Después del tratamiento inicial hidroelectrolítico y durante la terapeútica antiinfecciosa, el aporte nutricional se inició con nutrición parenteral (NP) en todos los pacientes, cuando las condiciones clínicas lo permitieron, se agregó nutrición enteral (NE). La NE se inició con dietas elementales (Pregestimil) en cuatro niños; en los diez restantes se administró una dieta modulable a base de caseinato de calcio, triglicéridos en cadena mediana y glucosa, comenzando con 30 calorías por 100 cc y 145 mOsm/l hasta un máximo de 90 calorías popr 100 cc y 412 mOsm/l. Fue necesario cambiar la dieta por intolerancia transitoria en cuatro pacientes del primer grupo y dos del segundo. Como alternativa utilizamos una dieta a base de proteínas de pollo con adecuada tolerancia. Los resultados fueron evaluados en base a la respuesta clínica al tratamiento nutricional, pérdidas por heces, presencia de sustencias reductoras (glucosa) y pH menor de 6. Cinco pacientes fallecieron (35,7 por ciento), todos del primer grupo. Se halló diferencia entre los dos grupos, siendo para el primero mayor el tiempo de internación, la duración de la NP, complicaciones y mortalidad. El alta nutricional fue considerada cuando la dieta modulable y la dieta elemental pudieron ser reemplazadas por una leche libre de lactosa (LK). Nuestros datos sugieren que aquellos nióos que presentan resección o exclusión intestinal y se comportan como SIC, el aspecto nutricional puede ser adecuadamente tratado con una dieta modulable que reemplace a la dieta elemental, por ser esta difícil de obtener en nuestro país y por su alto costo (AU)
