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Pediatrics
Development of a deep learning model for predicting critical events in a pediatric intensive care unit
In Kyung Lee, Bongjin Lee, June Dong Park
Acute Crit Care. 2024;39(1):186-191.   Published online February 20, 2024
DOI: https://doi.org/10.4266/acc.2023.01424
Correction in: Acute Crit Care 2024;39(2):330
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AbstractAbstract PDF
Background
Identifying critically ill patients at risk of cardiac arrest is important because it offers the opportunity for early intervention and increased survival. The aim of this study was to develop a deep learning model to predict critical events, such as cardiopulmonary resuscitation or mortality. Methods: This retrospective observational study was conducted at a tertiary university hospital. All patients younger than 18 years who were admitted to the pediatric intensive care unit from January 2010 to May 2023 were included. The main outcome was prediction performance of the deep learning model at forecasting critical events. Long short-term memory was used as a deep learning algorithm. The five-fold cross validation method was employed for model learning and testing. Results: Among the vital sign measurements collected during the study period, 11,660 measurements were used to develop the model after preprocessing; 1,060 of these data points were measurements that corresponded to critical events. The prediction performance of the model was the area under the receiver operating characteristic curve (95% confidence interval) of 0.988 (0.9751.000), and the area under the precision-recall curve was 0.862 (0.700–1.000). Conclusions: The performance of the developed model at predicting critical events was excellent. However, follow-up research is needed for external validation.
Pediatrics
Outcomes of extracorporeal membrane oxygenation support in pediatric hemato-oncology patients
Hong Yul An, Hyoung Jin Kang, June Dong Park
Acute Crit Care. 2024;39(1):108-116.   Published online January 24, 2024
DOI: https://doi.org/10.4266/acc.2023.01088
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AbstractAbstract PDFSupplementary Material
Background
In this study, we reviewed the outcomes of pediatric patients with malignancies who underwent hematopoietic stem cell transplantation (HSCT) and extracorporeal membrane oxygenation (ECMO). Methods: We retrospectively analyzed the records of pediatric hemato-oncology patients treated with chemotherapy or HSCT and who received ECMO in the pediatric intensive care unit (PICU) at Seoul National University Children’s Hospital from January 2012 to December 2020. Results: Over a 9-year period, 21 patients (14 males and 7 females) received ECMO at a single pediatric institute; 10 patients (48%) received veno-arterial (VA) ECMO for septic shock (n=5), acute respiratory distress syndrome (ARDS) (n=3), stress-induced myopathy (n=1), or hepatopulmonary syndrome (n=1); and 11 patients (52%) received veno-venous (VV) ECMO for ARDS due to pneumocystis pneumonia (n=1), air leak (n=3), influenza (n=1), pulmonary hemorrhage (n=1), or unknown etiology (n=5). All patients received chemotherapy; 9 received anthracycline drugs and 14 (67%) underwent HSCT. Thirteen patients (62%) were diagnosed with malignancies and 8 (38%) were diagnosed with non-malignant disease. Among the 21 patients, 6 (29%) survived ECMO in the PICU and 5 (24%) survived to hospital discharge. Among patients treated for septic shock, 3 of 5 patients (60%) who underwent ECMO and 5 of 10 patients (50%) who underwent VA ECMO survived. However, all the patients who underwent VA ECMO or VV ECMO for ARDS died. Conclusions: ECMO is a feasible treatment option for respiratory or heart failure in pediatric patients receiving chemotherapy or undergoing HSCT.
Pediatrics
Eleven years of experience in operating a pediatric rapid response system at a children’s hospital in South Korea
Yong Hyuk Jeon, Bongjin Lee, You Sun Kim, Won Jin Jang, June Dong Park
Acute Crit Care. 2023;38(4):498-506.   Published online November 29, 2023
DOI: https://doi.org/10.4266/acc.2023.01354
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AbstractAbstract PDFSupplementary Material
Background
Various rapid response systems have been developed to detect clinical deterioration in patients. Few studies have evaluated single-parameter systems in children compared to scoring systems. Therefore, in this study we evaluated a single-parameter system called the acute response system (ARS).
Methods
This retrospective study was performed at a tertiary children’s hospital. Patients under 18 years old admitted from January 2012 to August 2023 were enrolled. ARS parameters such as systolic blood pressure, heart rate, respiratory rate, oxygen saturation, and whether the ARS was activated were collected. We divided patients into two groups according to activation status and then compared the occurrence of critical events (cardiopulmonary resuscitation or unexpected intensive care unit admission). We evaluated the ability of ARS to predict critical events and calculated compliance. We also analyzed the correlation between each parameter that activates ARS and critical events.
Results
The critical events prediction performance of ARS has a specificity of 98.5%, a sensitivity of 24.0%, a negative predictive value of 99.6%, and a positive predictive value of 8.1%. The compliance rate was 15.6%. Statistically significant increases in the risk of critical events were observed for all abnormal criteria except low heart rate. There was no significant difference in the incidence of critical events.
Conclusions
ARS, a single parameter system, had good specificity and negative predictive value for predicting critical events; however, sensitivity and positive predictive value were not good, and medical staff compliance was poor.
Pediatric
Impact of the COVID-19 pandemic on diabetic ketoacidosis management in the pediatric intensive care unit
Fevzi Kahveci, Buse Önen Ocak, Emrah Gün, Anar Gurbanov, Hacer Uçmak, Ayşen Durak Aslan, Ayşegül Ceran, Hasan Özen, Burak Balaban, Edin Botan, Zeynep Şıklar, Merih Berberoğlu, Tanıl Kendirli
Acute Crit Care. 2023;38(3):371-379.   Published online August 31, 2023
DOI: https://doi.org/10.4266/acc.2023.00038
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AbstractAbstract PDF
Background
Diabetic ketoacidosis (DKA) is a common endocrine emergency in pediatric patients. Early presentation to health facilities, diagnosis, and good management in the pediatric intensive care unit (PICU) are crucial for better outcomes in children with DKA.
Methods
This was a single-center, retrospective cohort study conducted between February 2015 and January 2022. Patients with DKA were divided into two groups according to pandemic status and diabetes diagnosis.
Results
The study enrolled 59 patients, and their mean age was 11±5 years. Forty (68%) had newly diagnosed type 1 diabetes mellitus (T1DM), and 61% received follow-up in the pre-pandemic period. Blood glucose, blood ketone, potassium, phosphorus, and creatinine levels were significantly higher in the new-onset T1DM group compared with the previously diagnosed group (P=0.01, P=0.02, P<0.001, P=0.01, and P=0.08, respectively). In patients with newly diagnosed T1DM, length of PICU stays were longer than in those with previously diagnosed T1DM (28.5±8.9 vs. 17.3±6.7 hours, P<0.001). The pandemic group was compared with pre-pandemic group, there was a statistically significant difference in laboratory parameters of pH, HCO3, and lactate and also Pediatric Risk of Mortality (PRISM) III score. All patients survived, and there were no neurologic sequelae.
Conclusions
Patients admitted during the pandemic period were admitted with more severe DKA and had higher PRISM III scores. During the pandemic period, there was an increase in the incidence of DKA in the participating center compared to that before the pandemic.

Citations

Citations to this article as recorded by  
  • Covid 19 and diabetes in children: advances and strategies
    Zhaoyuan Wu, Jinling Wang, Rahim Ullah, Minghao Chen, Ke Huang, Guanping Dong, Junfen Fu
    Diabetology & Metabolic Syndrome.2024;[Epub]     CrossRef
Pediatrics
Characteristics and timing of mortality in children dying in pediatric intensive care: a 5-year experience
Edin Botan, Emrah Gün, Emine Kübra Şden, Cansu Yöndem, Anar Gurbanov, Burak Balaban, Fevzi Kahveci, Hasan Özen, Hacer Uçmak, Ali Genco Gençay, Tanil Kendirli
Acute Crit Care. 2022;37(4):644-653.   Published online November 11, 2022
DOI: https://doi.org/10.4266/acc.2022.00395
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AbstractAbstract PDF
Background
Pediatric intensive care units (PICUs), where children with critical illnesses are treated, require considerable manpower and technological infrastructure in order to keep children alive and free from sequelae. Methods: In this retrospective comparative cohort study, hospital records of patients aged 1 month to 18 years who died in the study PICU between January 2015 and December 2019 were reviewed. Results: A total of 2,781 critically ill children were admitted to the PICU. The mean±standard deviation age of 254 nonsurvivors was 64.34±69.48 months. The mean PICU length of stay was 17 days (range, 1–205 days), with 40 children dying early (<1 day of PICU admission). The majority of nonsurvivors (83.9%) had comorbid illnesses. Children with early mortality were more likely to have neurological findings (62.5%), hypotension (82.5%), oliguria (47.5%), acidosis (92.5%), coagulopathy (30.0%), and cardiac arrest (45.0%) and less likely to have terminal illnesses (52.5%) and chronic illnesses (75.6%). Children who died early had a higher mean age (81.8 months) and Pediatric Risk of Mortality (PRISM) III score (37). In children who died early, the first three signs during ICU admission were hypoglycemia in 68.5%, neurological symptoms in 43.5%, and acidosis in 78.3%. Sixty-seven patients needed continuous renal replacement therapy, 51 required extracorporeal membrane oxygenation support, and 10 underwent extracorporeal cardiopulmonary resuscitation. Conclusions: We found that rates of neurological findings, hypotension, oliguria, acidosis, coagulation disorder, and cardiac arrest and PRISM III scores were higher in children who died early compared to those who died later.

Citations

Citations to this article as recorded by  
  • Descriptive and Clinical Characteristics of Nonsurvivors in a Tertiary Pediatric Intensive Care Unit in Turkey: 6 Years of Experience
    Zeynep Karakaya, Merve Boyraz, Seyma Koksal Atis, Servet Yuce, Muhterem Duyu
    Journal of Pediatric Intensive Care.2023;[Epub]     CrossRef
  • Association between mortality and critical events within 48 hours of transfer to the pediatric intensive care unit
    Huan Liang, Kyle A. Carey, Priti Jani, Emily R. Gilbert, Majid Afshar, L. Nelson Sanchez-Pinto, Matthew M. Churpek, Anoop Mayampurath
    Frontiers in Pediatrics.2023;[Epub]     CrossRef
Pediatrics
Multicenter validation of a deep-learning-based pediatric early-warning system for prediction of deterioration events
Yunseob Shin, Kyung-Jae Cho, Yeha Lee, Yu Hyeon Choi, Jae Hwa Jung, Soo Yeon Kim, Yeo Hyang Kim, Young A Kim, Joongbum Cho, Seong Jong Park, Won Kyoung Jhang
Acute Crit Care. 2022;37(4):654-666.   Published online October 26, 2022
DOI: https://doi.org/10.4266/acc.2022.00976
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AbstractAbstract PDFSupplementary Material
Background
Early recognition of deterioration events is crucial to improve clinical outcomes. For this purpose, we developed a deep-learning-based pediatric early-warning system (pDEWS) and aimed to validate its clinical performance. Methods: This is a retrospective multicenter cohort study including five tertiary-care academic children’s hospitals. All pediatric patients younger than 19 years admitted to the general ward from January 2019 to December 2019 were included. Using patient electronic medical records, we evaluated the clinical performance of the pDEWS for identifying deterioration events defined as in-hospital cardiac arrest (IHCA) and unexpected general ward-to-pediatric intensive care unit transfer (UIT) within 24 hours before event occurrence. We also compared pDEWS performance to those of the modified pediatric early-warning score (PEWS) and prediction models using logistic regression (LR) and random forest (RF). Results: The study population consisted of 28,758 patients with 34 cases of IHCA and 291 cases of UIT. pDEWS showed better performance for predicting deterioration events with a larger area under the receiver operating characteristic curve, fewer false alarms, a lower mean alarm count per day, and a smaller number of cases needed to examine than the modified PEWS, LR, or RF models regardless of site, event occurrence time, age group, or sex. Conclusions: The pDEWS outperformed modified PEWS, LR, and RF models for early and accurate prediction of deterioration events regardless of clinical situation. This study demonstrated the potential of pDEWS as an efficient screening tool for efferent operation of rapid response teams.

Citations

Citations to this article as recorded by  
  • Predicting cardiac arrest after neonatal cardiac surgery
    Alexis L. Benscoter, Mark A. Law, Santiago Borasino, A. K. M. Fazlur Rahman, Jeffrey A. Alten, Mihir R. Atreya
    Intensive Care Medicine – Paediatric and Neonatal.2024;[Epub]     CrossRef
  • Volumetric regional MRI and neuropsychological predictors of motor task variability in cognitively unimpaired, Mild Cognitive Impairment, and probable Alzheimer's disease older adults
    Michael Malek-Ahmadi, Kevin Duff, Kewei Chen, Yi Su, Jace B. King, Vincent Koppelmans, Sydney Y. Schaefer
    Experimental Gerontology.2023; 173: 112087.     CrossRef
  • Predicting sepsis using deep learning across international sites: a retrospective development and validation study
    Michael Moor, Nicolas Bennett, Drago Plečko, Max Horn, Bastian Rieck, Nicolai Meinshausen, Peter Bühlmann, Karsten Borgwardt
    eClinicalMedicine.2023; 62: 102124.     CrossRef
  • A model study for the classification of high-risk groups for cardiac arrest in general ward patients using simulation techniques
    Seok Young Song, Won-Kee Choi, Sanggyu Kwak
    Medicine.2023; 102(37): e35057.     CrossRef
  • An advanced pediatric early warning system: a reliable sentinel, not annoying extra work
    Young Joo Han
    Acute and Critical Care.2022; 37(4): 667.     CrossRef
Neurosurgery
Development and internal validation of a nomogram for predicting outcomes in children with traumatic subdural hematoma
Anukoon Kaewborisutsakul, Thara Tunthanathip
Acute Crit Care. 2022;37(3):429-437.   Published online June 23, 2022
DOI: https://doi.org/10.4266/acc.2021.01795
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AbstractAbstract PDF
Background
A subdural hematoma (SDH) following a traumatic brain injury (TBI) in children can lead to unexpected death or disability. The nomogram is a clinical prediction tool used by physicians to provide prognosis advice to parents for making decisions regarding treatment. In the present study, a nomogram for predicting outcomes was developed and validated. In addition, the predictors associated with outcomes in children with traumatic SDH were determined.
Methods
In this retrospective study, 103 children with SDH after TBI were evaluated. According to the King’s Outcome Scale for Childhood Head Injury classification, the functional outcomes were assessed at hospital discharge and categorized into favorable and unfavorable. The predictors associated with the unfavorable outcomes were analyzed using binary logistic regression. Subsequently, a two-dimensional nomogram was developed for presentation of the predictive model.
Results
The predictive model with the lowest level of Akaike information criterion consisted of hypotension (odds ratio [OR], 9.4; 95% confidence interval [CI], 2.0–42.9), Glasgow coma scale scores of 3–8 (OR, 8.2; 95% CI, 1.7–38.9), fixed pupil in one eye (OR, 4.8; 95% CI, 2.6–8.8), and fixed pupils in both eyes (OR, 3.5; 95% CI, 1.6–7.1). A midline shift ≥5 mm (OR, 1.1; 95% CI, 0.62–10.73) and co-existing intraventricular hemorrhage (OR, 6.5; 95% CI, 0.003–26.1) were also included.
Conclusions
SDH in pediatric TBI can lead to mortality and disability. The predictability level of the nomogram in the present study was excellent, and external validation should be conducted to confirm the performance of the clinical prediction tool.

Citations

Citations to this article as recorded by  
  • Prognostic factors and clinical nomogram for in-hospital mortality in traumatic brain injury
    Thara Tunthanathip, Nakornchai Phuenpathom, Apisorn Jongjit
    The American Journal of Emergency Medicine.2024; 77: 194.     CrossRef
  • Development of a Clinical Nomogram for Predicting Shunt-Dependent Hydrocephalus
    Avika Trakulpanitkit, Thara Tunthanathip
    Journal of Health and Allied Sciences NU.2024;[Epub]     CrossRef
  • Prediction performance of the machine learning model in predicting mortality risk in patients with traumatic brain injuries: a systematic review and meta-analysis
    Jue Wang, Ming Jing Yin, Han Chun Wen
    BMC Medical Informatics and Decision Making.2023;[Epub]     CrossRef
  • Development and internal validation of a nomogram to predict massive blood transfusions in neurosurgical operations
    Kanisorn Sungkaro, Chin Taweesomboonyat, Anukoon Kaewborisutsakul
    Journal of Neurosciences in Rural Practice.2022; 13: 711.     CrossRef
  • Prediction of massive transfusions in neurosurgical operations using machine learning
    Chin Taweesomboonyat, Anukoon Kaewborisutsakul, Kanisorn Sungkaro
    Asian Journal of Transfusion Science.2022;[Epub]     CrossRef
Pediatrics
Hearing screening outcomes in pediatric critical care survivors: a 1-year report
Pattita Suwannatrai, Chanapai Chaiyakulsil
Acute Crit Care. 2022;37(2):209-216.   Published online March 8, 2022
DOI: https://doi.org/10.4266/acc.2021.00899
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AbstractAbstract PDF
Background
Hearing loss is a potentially serious complication that can occur after surviving a critical illness. Study on screening for hearing problems in pediatric critical care survivors beyond the neonatal period is lacking. This study aimed to identify the prevalence of abnormal hearing screening outcomes using transitory evoked otoacoustic emission (TEOAE) screening in children who survived critical illness and to find possible associating factors for abnormal hearing screening results.
Methods
This study was a single-center, prospective, observational study. All children underwent otoscopy to exclude external and middle ear abnormalities before undergoing TEOAE screening. The screening was conducted before hospital discharge. Descriptive statistics, chi-square, and logistic regression tests were used for data analysis.
Results
A total of 92 children were enrolled. Abnormal TEOAE responses were identified in 26 participants (28.3%). Children with abnormal responses were significantly younger than those with normal responses with a median age of 10.0 months and 43.5 months, respectively (P<0.001). Positive association with abnormal responses was found in children younger than 12 months of age (adjusted odds ratio [OR], 3.07; 95% confidence interval [CI], 1.06–8.90) and children with underlying genetic conditions (adjusted OR, 6.95; 95% CI, 1.49–32.54).
Conclusions
Our study demonstrates a high prevalence of abnormal TEOAE screening responses in children surviving critical illness, especially in patients younger than 12 months of age. More extensive studies should be performed to identify the prevalence and associated risk factors of hearing problems in critically ill children.

Citations

Citations to this article as recorded by  
  • Physiological and electrophysiological evaluation of the hearing system in low birth weight neonates treated with cholestin: a cohort study
    Nastaran Khosravi, Malihah Mazaheryazdi, Majid Kalani, Nasrin Khalesi, Zinat Shakeri, Saeedeh Archang, Maryam Archang
    The Egyptian Journal of Otolaryngology.2023;[Epub]     CrossRef
Pediatrics
Determining the diagnostic value of tracheal intubation by palpation and auscultation methods compared to the chest X-ray method in children
Gholamreza Masoumi, Mojtaba Mansouri, Omid Fathali
Acute Crit Care. 2022;37(2):224-229.   Published online February 3, 2022
DOI: https://doi.org/10.4266/acc.2021.00787
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AbstractAbstract PDF
Background
It is important to determine the proper location of tracheal tube for proper ventilation. In this study, we compared the diagnostic value of tracheal intubation with two methods of palpation and auscultation with chest X-ray (CXR) method in pediatric.
Methods
In this interventional study, 80 patients under 6 years of age were included. After tracheal intubation appropriate depth of tracheal tube was determined by auscultation and recorded, then by palpation depth of tracheal tube determined and tube was fixed. The length of the tube was calculated with the standard formula based on age. After surgery, CXR was taken and, according to the landmark, the distance from the end of the tube to the anterior lower tooth was recorded.
Results
Interclass correlation coefficient (ICC) between the palpation method and the standard method in the number of fixing tracheal intubation was 0.573, which shows the average and significant correlation between these two methods in determining the fixed number of tracheal intubation. ICC between the auscultation and the standard method in fixing tracheal intubation number was 0.430, which shows the average and significant agreement between these two methods in determining the fixed number of tracheal intubation. There is no significant relationship between sex and the average number of fixing tracheal intubation in all methods.
Conclusions
This study has shown that both palpation and auscultation methods are appropriate, but with a slightly higher palpation ICC, the palpation can be considered relatively better.
Pediatrics
Early postoperative arrhythmias after pediatric congenital heart disease surgery: a 5-year audit from a lower- to middle-income country
Sidra Ishaque, Saleem Akhtar, Asma Akbar Ladak, Russell Seth Martins, Muhammad Kamran Younis Memon, Alisha Raza Kazmi, Fatima Mahmood, Anwar ul Haque
Acute Crit Care. 2022;37(2):217-223.   Published online February 3, 2022
DOI: https://doi.org/10.4266/acc.2020.00990
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AbstractAbstract PDF
Background
Arrhythmias are known complication after surgery for congenital heart disease (CHD). This study aimed to identify and discuss their immediate prevalence, diagnosis and management at a tertiary care hospital in Pakistan. Methods: A retrospective study was conducted at a tertiary care hospital in Pakistan between January 2014 and December 2018. All pediatric (<18 years old) patients admitted to the intensive care unit and undergoing continuous electrocardiographic monitoring after surgery for CHD were included in this study. Data pertaining to the incidence, diagnosis, and management of postoperative arrhythmias were collected. Results: Amongst 812 children who underwent surgery for CHD, 185 (22.8%) developed arrhythmias. Junctional ectopic tachycardia (JET) was the most common arrhythmia, observed in 120 patients (64.9%), followed by complete heart block (CHB) in 33 patients (17.8%). The highest incidence of early postoperative arrhythmia was seen in patients with atrioventricular septal defects (64.3%) and transposition of the great arteries (36.4%). Patients were managed according to the Pediatric Advanced Life Support guidelines. JET resolved successfully within 24 hours in 92% of patients, while 16 (48%) patients with CHB required a permanent pacemaker. Conclusions: More than one in five pediatric patients suffered from early postoperative arrhythmias in our setting. Further research exploring predictive factors and the development of better management protocols of patients with CHB are essential for reducing the morbidity and mortality associated with postoperative arrhythmia.

Citations

Citations to this article as recorded by  
  • Prevalence and risk factors analysis of early postoperative arrhythmia after congenital heart surgery in pediatric patients
    Ketut Putu Yasa, Arinda Agung Katritama, I. Komang Adhi Parama Harta, I. Wayan Sudarma
    Journal of Arrhythmia.2024; 40(2): 356.     CrossRef
  • Improvements in Accuracy and Confidence in Rhythm Identification After Cardiac Surgery Using the AtriAmp Signals
    Diane H. Brown, Xiao Zhang, Awni M. Al-Subu, Nicholas H. Von Bergen
    Journal of Intensive Care Medicine.2023; 38(9): 809.     CrossRef
Pediatrics
Prognostic factors of pediatric hematopoietic stem cell transplantation recipients admitted to the pediatric intensive care unit
Da Hyun Kim, Eun Ju Ha, Seong Jong Park, Kyung-Nam Koh, Hyery Kim, Ho Joon Im, Won Kyoung Jhang
Acute Crit Care. 2021;36(4):380-387.   Published online November 26, 2021
DOI: https://doi.org/10.4266/acc.2020.01193
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AbstractAbstract PDF
Background
Pediatric patients who received hematopoietic stem cell transplantation (HSCT) tend to have high morbidity and mortality. While, the prognostic factors of adult patients received bone marrow transplantation were already known, there is little known in pediatric pateints. This study aimed to identify the prognostic factor for pediatric intensive care unit (PICU) mortality of critically ill pediatric patients with HSCT.
Method
Retrospectively reviewed that the medical records of patients who received HSCT and admitted to PICU between January 2010 and December 2019. Mortality was defined a patient who expired within 28 days.
Results
A total of 131 patients were included. There were 63 boys (48.1%) and median age was 11 years (interquartile range, 0–20 years). The most common HSCT type was haploidentical (38.9%) and respiratory failure (44.3%) was the most common reason for PICU admission. Twenty-eight–day mortality was 22.1% (29/131). In comparison between survivors and non-survivors, the number of HSCT received, sepsis, oncological pediatric risk of mortality-III (OPRISM-III), PRISM-III, pediatric sequential organ failure assessment (pSOFA), serum lactate, B-type natriuretic peptide (BNP) and use of mechanical ventilator (MV) and vasoactive inotropics were significant predictors (p<0.05 for all variables). In multivariate logistic regression, number of HSCT received, use of MV, OPRISM-III, PRISM-III and pSOFA were independent risk factors of PICU mortality. Moreover, three scoring systems were significant prognostic factors of 28-day mortality.
Conclusions
The number of HSCT received and use of MV were more accurate predictors in pediatric patients received HSCT.

Citations

Citations to this article as recorded by  
  • Prognostic factors and predictive scores for 6-months mortality of hematopoietic stem cell transplantation recipients admitted to the pediatric intensive care unit
    Sarah Schober, Silke Huber, Norbert Braun, Michaela Döring, Peter Lang, Michael Hofbeck, Felix Neunhoeffer, Hanna Renk
    Frontiers in Oncology.2023;[Epub]     CrossRef
  • Survival outcomes of pediatric hematopoietic stem cell transplant patients admitted to the intensive care unit: A case–control study from a tertiary care center in Saudi Arabia
    LujainTalib Aljudaibi, MohamedSalaheldin Bayoumy, HassanA Altrabolsi, AbdullahM Alzaydi, Nawaf Aldajani, Nadia Hammad, Ismail Alzahrani, Marwa Elhadidy, IbraheemF Abosoudah
    Journal of Applied Hematology.2022; 13(4): 192.     CrossRef
Pediatric
Abstract to publication conversion in pediatric critical care medicine in Pakistan
Anwarul Haque, Mohammad Shahzad, Humaira Jurair, Naveed Ur Rehman Siddiqui, Sidra Ishaque, Qalab Abbas
Acute Crit Care. 2021;36(1):62-66.   Published online February 5, 2021
DOI: https://doi.org/10.4266/acc.2020.00780
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AbstractAbstract PDF
Background
To determine the rate of conversion of abstracts presented at conferences into full-text articles published in peer-reviewed journals in the field of pediatric critical care medicine (PCCM) in a developing country.
Methods
We retrospectively reviewed PCCM abstracts from Pakistan presented at national and international pediatric and critical care conferences over 10 years (January 2010 to March 2020). Data included abstract characteristics, such as presentation (poster/oral), presenter (fellow/resident), time of meeting (month and year), type of meeting, study design and topic; and publication characteristics, such as journal name, time (month and year) and first author. The primary outcome was publication rate of PCCM abstracts presented in meetings and time (months) from presentation to publication.
Results
A total of 79 PCCM abstracts were presented in 20 meetings during the study period. There were 65 poster presentations (82.28%), of which 63 (79.74%) were presented at international critical care conferences and all presenters were PCCM fellows. In total, 64 (81%) abstracts were descriptive observational studies (retrospective: 50, 63.29%) and prospective (14, 17.72%). Only one was an interventional randomized controlled trial. The publication rate of PCCM abstracts was 63.3% (50/79) and the mean time to publication was 12.39±13.61 months. The publication rate was significantly correlated to the year of publication (P<0.001).
Conclusions
The PCCM abstract publication rate and mean time from presentation to publication was 63.3% and 12.39±13.61 months, respectively, in a developing country.

Citations

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  • From Concept to Publication
    Aaron W. Calhoun, Isabel T. Gross, Leah B. Mallory, Lindsay N. Shepard, Mark D. Adler, Tensing Maa, Marc A. Auerbach, Adam Cheng, David O. Kessler, Travis M. Whitfill, Jonathan P. Duff
    Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare.2022; 17(6): 385.     CrossRef
Case Report
Cardiology
Percutaneous bicaval dual lumen cannula for extracorporeal life support
Woojung Kim, Hye Won Kwon, Jooncheol Min, Sungkyu Cho, Jae Gun Kwak, June Dong Park, Woong-Han Kim
Acute Crit Care. 2020;35(3):207-212.   Published online September 23, 2019
DOI: https://doi.org/10.4266/acc.2019.00584
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AbstractAbstract PDF
Veno-venous extracorporeal membrane oxygenation (ECMO) is a useful mechanical device for pediatric patients with severe respiratory failure. Conventional veno-venous ECMO using double cannulation, however, is not feasible due to size limitations in pediatric patients who have small femoral vessels. Recently, percutaneous bicaval dual-lumen cannula can be inserted using single cannulation via the right internal jugular vein. Herein, we report the case of a pediatric patient with severe respiratory failure who was weaned off the ECMO successfully after treatment with bicaval dual-lumen cannulation for 5 days despite the small body size and immunocompromised condition due to chemotherapy for hemophagocytic lymphohistiocytosis.

Citations

Citations to this article as recorded by  
  • Lipid Emulsion Treatment for Drug Toxicity Caused by Nonlocal Anesthetic Drugs in Pediatric Patients
    Soo Hee Lee, Sunmin Kim, Ju-Tae Sohn
    Pediatric Emergency Care.2023; 39(1): 53.     CrossRef
  • Mechanisms underlying lipid emulsion resuscitation for drug toxicity: a narrative review
    Soo Hee Lee, Ju-Tae Sohn
    Korean Journal of Anesthesiology.2023; 76(3): 171.     CrossRef
Original Articles
Pediatric
Oxygenation Index in the First 24 Hours after the Diagnosis of Acute Respiratory Distress Syndrome as a Surrogate Metric for Risk Stratification in Children
Soo Yeon Kim, Byuhree Kim, Sun Ha Choi, Jong Deok Kim, In Suk Sol, Min Jung Kim, Yoon Hee Kim, Kyung Won Kim, Myung Hyun Sohn, Kyu-Earn Kim
Acute Crit Care. 2018;33(4):222-229.   Published online November 29, 2018
DOI: https://doi.org/10.4266/acc.2018.00136
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AbstractAbstract PDFSupplementary Material
Background
The diagnosis of pediatric acute respiratory distress syndrome (PARDS) is a pragmatic decision based on the degree of hypoxia at the time of onset. We aimed to determine whether reclassification using oxygenation metrics 24 hours after diagnosis could provide prognostic ability for outcomes in PARDS.
Methods
Two hundred and eighty-eight pediatric patients admitted between January 1, 2010 and January 30, 2017, who met the inclusion criteria for PARDS were retrospectively analyzed. Reclassification based on data measured 24 hours after diagnosis was compared with the initial classification, and changes in pressure parameters and oxygenation were investigated for their prognostic value with respect to mortality.
Results
PARDS severity varied widely in the first 24 hours; 52.4% of patients showed an improvement, 35.4% showed no change, and 12.2% either showed progression of PARDS or died. Multivariate analysis revealed that mortality risk significantly increased for the severe group, based on classification using metrics collected 24 hours after diagnosis (adjusted odds ratio, 26.84; 95% confidence interval [CI], 3.43 to 209.89; P=0.002). Compared to changes in pressure variables (peak inspiratory pressure and driving pressure), changes in oxygenation (arterial partial pressure of oxygen to fraction of inspired oxygen) over the first 24 hours showed statistically better discriminative power for mortality (area under the receiver operating characteristic curve, 0.701; 95% CI, 0.636 to 0.766; P<0.001).
Conclusions
Implementation of reclassification based on oxygenation metrics 24 hours after diagnosis effectively stratified outcomes in PARDS. Progress within the first 24 hours was significantly associated with outcomes in PARDS, and oxygenation response was the most discernable surrogate metric for mortality.

Citations

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  • A single‐center PICU present status survey of pediatric sepsis‐related acute respiratory distress syndrome
    Liang Zhou, Shaojun Li, Tian Tang, Xiu Yuan, Liping Tan
    Pediatric Pulmonology.2022; 57(9): 2003.     CrossRef
CPR/Resuscitation
Validation of Pediatric Index of Mortality 3 for Predicting Mortality among Patients Admitted to a Pediatric Intensive Care Unit
Jae Hwa Jung, In Suk Sol, Min Jung Kim, Yoon Hee Kim, Kyung Won Kim, Myung Hyun Sohn
Acute Crit Care. 2018;33(3):170-177.   Published online August 31, 2018
DOI: https://doi.org/10.4266/acc.2018.00150
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  • 13 Web of Science
  • 11 Crossref
AbstractAbstract PDF
Background
The objective of this study was to evaluate the usefulness of the newest version of the pediatric index of mortality (PIM) 3 for predicting mortality and validating PIM 3 in Korean children admitted to a single intensive care unit (ICU).
Methods
We enrolled children at least 1 month old but less than 18 years of age who were admitted to the medical ICU between March 2009 and February 2015. Performances of the pediatric risk of mortality (PRISM) III, PIM 2, and PIM 3 were evaluated by assessing the area under the receiver operating characteristic (ROC) curve, conducting the Hosmer-Lemeshow test, and calculating the standardized mortality ratio (SMR).
Results
In total, 503 children were enrolled; the areas under the ROC curve for PRISM III, PIM 2, and PIM 3 were 0.775, 0.796, and 0.826, respectively. The area under the ROC curve was significantly greater for PIM 3 than for PIM 2 (P<0.001) and PRISM III (P=0.016). There were no significant differences in the Hosmer-Lemeshow test results for PRISM III (P=0.498), PIM 2 (P=0.249), and PIM 3 (P=0.337). The SMR calculated using PIM 3 (1.11) was closer to 1 than PIM 2 (0.84).
Conclusions
PIM 3 showed better prediction of the risk of mortality than PIM 2 for the Korean pediatric population admitted in the ICU.

Citations

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    Journal of Korean Medical Science.2023;[Epub]     CrossRef
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    Frontiers in Pediatrics.2021;[Epub]     CrossRef
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ACC : Acute and Critical Care