Predicting Pediatric ICU Outcomes: Yet Another SOFA (Study) on the PODIUM?

How to cite this article: Solomon R. Predicting Pediatric ICU Outcomes: Yet Another SOFA (Study) on the PODIUM? Indian J Crit Care Med 2023;27(8):526-528.

Pediatric Acute Respiratory Distress Syndrome in India: Time for Collaborative Study?

How to cite this article: Solomon R. Pediatric Acute Respiratory Distress Syndrome in India: Time for Collaborative Study? Indian J Crit Care Med 2022;26(8):896-897.

Profile of Children With Tuberculosis in a Pediatric Intensive Care Unit in Mumbai.

OBJECTIVE: This study was done to analyze the profile of confirmed pediatric TB patients seen in an intensive care setting. METHODS: Data of all children admitted in our PICU with bacteriologically proven tuberculosis (smear, culture, poly-merase chain reaction, genotypic testing or Pyrosequencing) between January, 2007 and December, 2019 were retrieved. Drug resistance was classified as per World Health Organization definitions. RESULTS: 59 children (28 boys) met the inclusion criteria (median (IQR) age 8 (4,13) years). About a third (22/59) had past history of treatment with antituberculosis drugs. The indications for admission to PICU were monitoring and management of neurological status in 31 children, post procedure monitoring in 20 children and respiratory failure in 8 children. Severe ARDS was seen in 2 children. Out of 37 children with neuro-tuberculosis, 19 children had TB in additional sites, and 9 children died. Sample positivity rate for CSF culture was 66%. Drug sensitivity testing (DST) of positive culture was done in 35 cases and showed multidrug resistance in 4 children, pre-XDR (extreme drug resistance) in 10 and XDR in 5 children. CONCLUSION: Neurotuberculosis was the commonest reason for admission to PICU. Concerted efforts should be made to obtain samples for culture and drug sensitivity testing in critically ill children with tuberculosis.

Multisystem Inflammatory Syndrome in Children: Clinical Features and Management-Intensive Care Experience from a Pediatric Public Hospital in Western India.

BACKGROUND: Multisystem inflammatory syndrome (MIS) associated with severe acute respiratory syndrome coronavirus (SARS-CoV-2) (MIS-C) in children is being increasingly reported across the world. MATERIALS AND METHODS: Children fulfilling the World Health Organization criteria of MIS-C needing pediatric intensive care unit between April 15 and July 26, 2020 were studied. RESULTS: There were 21 patients with median age of 7 years [interquartile range (IQR) 1.9-12.1], of which 11 were females. SARS-CoV-2 real-time polymerase chain reaction positive in 8/21 and/or antibody positive 16/21. Fever was present in all patients, and gastrointestinal symptoms being second most frequent (16/21). One child had aplastic anemia, while the rest had no comorbidities. Nearly all presented with shock (n = 20/21) and 90% needed vasoactive drugs with a median Vasoactive Inotropic Score of 40 (IQR 20-95). Thirteen children needed ventilatory support and one needed peritoneal dialysis. Nine children had left ventricular dysfunction and five had dilatation of coronaries on echocardiography. Inflammatory markers C-reactive protein [98 mg/dL (IQR 89-119)], serum ferritin [710 mg/dL (IQR 422-1,609)], and serum interleukin-6 levels [215 ng/L (IQR 43-527)] were uniformly elevated. Eighteen children received pulse methyl-prednisolone, eleven intravenous immunoglobulins, and four tocilizumab. Eighteen children (86%) were discharged home while three died. CONCLUSION: In our cohort, MIS-C was seen in previously healthy children with fever, gastrointestinal symptoms, and shock. Early and aggressive management of shock and immune modulation with methyl-prednisolone and intravenous immunoglobulin were used. HOW TO CITE THIS ARTICLE: Shobhavat L, Solomon R, Rao S, Bhagat I, Prabhu S, Prabhu S, et al. Multisystem Inflammatory Syndrome in Children: Clinical Features and Management-Intensive Care Experience from a Pediatric Public Hospital in Western India. Indian J Crit Care Med 2020;24(11):1089-1094.

Detection of inflammation and oxidative lung injury in exhaled breath condensate of rats with acute lung injury due to Staphylococcal enterotoxin B.

The objectives were to determine if tumor necrosis factor (TNF)-α, leukotriene (LT)B4 and 8-isoprostane (IP) were present in the exhaled breath condensate (EBC) and total lung lavage (TLL) of mechanically ventilated rats, 4 and 24 h after administration of Staphylococcal entertoxin (SEB) and to find out if these mediators in the EBC correlate with the concentration in the TLL. Rats were assigned to control (n = 8); 4 h (n = 8) or 24 h (n = 8) groups after SEB. The rats were mechanically ventilated and EBC and TLL were collected for TNF-α, LTB4 and 8-IP. TNF-α was higher in the EBC of rats at 24 h after SEB when compared to control [34.5 (16-62 versus 2 (14-30) pg ml⁻¹, p < 0.05] and also in the TLL [113.5 (70-460) versus 59 (35-79) pg ml⁻¹, p < 0.04]. LTB4 was higher in the EBC of 24 h SEB rats, when compared to control [42 (28-50) versus 36 (29-37) pg ml⁻¹, p < 0.01] and also in the TLL [179 (116-232) versus 114 (80-187) pg ml⁻¹, p < 0.05). 8-IP was similar among the groups. No correlation was observed between TNF-α, LTB4 or 8-IP in the EBC compared to the TLL. TNF-α and LTB4 may be indicators of inflammation and oxidative lung injury but the EBC does not correlate with TLL concentrations.

Prolonged recovery from pediatric cardiac surgery due to disseminated cytomegalovirus infection.

Partial atrioventricular septal defect is usually followed by an uncomplicated postoperative course. We present an infant with unexplained persistent respiratory failure following partial a trioventricular septal defect repair. Extensive evaluation including bronchoalveolar lavage subsequently led to the diagnosis of disseminated cytomegalovirus. This is the first reported case to our knowledge of disseminated cytomegalovirus following surgical repair of congenital heart disease excluding orthotopic heart transplant.

Detection of tumor necrosis factor-α and interleukin-6 in exhaled breath condensate of rats with pneumonia due to staphylococcal enterotoxin B.

Exhaled breath condensate (EBC) may contain mediators of acute lung injury. The objectives were to determine if EBC could be collected in a mechanically ventilated rat, to measure tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in the EBC after staphylococcal enterotoxin B administration (SEB) and to find out if the concentrations of TNF-α and IL-6 correlated with those in lung lavage. Four hours after SEB instillation, rats were placed on mechanical ventilation and EBC was collected over 90 minutes. Lung lavage was collected and white cell count was determined. TNF-α and IL-6 were measured in the EBC and lavage. EBC was available in a sufficient quantity (250-400 µL) for the measurement of cytokines. The rats that received SEB had an inflammatory response when compared to control rats as shown by an increase in white cell count. TNF-α and IL-6 were detected in the EBC. Concentration of TNF-α correlated with that in the lavage (r = .497, P = .021), whereas IL-6 did not. EBC can be collected in rats in sufficient quantities to study acute lung injury. TNF-α and IL-6 can be measured in the EBC. Correlation between TNF-α in the EBC and lavage was demonstrated in this rat model of lung injury.