Critical care of the pediatric patient with rheumatic disease

Shulman, Andrew I.; Punaro, Marilynn

doi:10.1097/mop.0b013e328346198f

Cited by 8 publications

(11 citation statements)

References 48 publications

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“…The prognosis related to the age, poor prior chronic health status, earlier critical care unit admission, infection, and immunosuppressive treatment [[7], [8], [9]]. Unfortunately, the available published data about children with rheumatic diseases admitted to intensive care unit is very limited [10,11]. Furthermore, we are not aware about any published data from the Middle East.…”

Section: Introductionmentioning

confidence: 99%

Outcome of children with systemic rheumatic diseases admitted to pediatric intensive care unit

Al‐Mayouf

Fallatah

AlTwajery

et al. 2019

International Journal of Pediatrics and Adolescent Medicine

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ObjectiveTo report the outcome of children with rheumatic diseases admitted to pediatric intensive care unit (PICU) in a tertiary hospital.MethodsDatabase from PICU and pediatric rheumatology section used to retrieve all candidate patients admitted to PICU from June 2000 to December 2017. Medical records of all enrolled patients reviewed for diagnosis, organ involvement, reason of PICU admission, the length of stay, and outcome.ResultsTwenty-five patients (17 female, 8 male) with total of 41 admissions identified. The median PICU stay was 13.5 days (range, 3–24). The most frequent diagnoses were systemic lupus erythematosus (SLE) (48%), followed by systemic vasculitis (16%). Most admissions were from the medical ward (68.3%), while 24.4% from the emergency room. The main reason of PICU admission was a disease flare or related complications (48.8%), followed by infection (34.2%). Fifty one percent of the admissions were due to respiratory dysfunction, 46% required non-invasive respiratory support while 38% was in need for mechanical ventilation. During PICU stay, anti-microbial agents used 90.3%, immunosuppressive treatment adjustment 75.6%, anti-hypertensive 24.4% and vasopressors 12.2%. Twelve patients (48%) fully recovered and 40% partially recovered while three patients died during their PICU stay. The causes of death were macrophage activation syndrome complicated by sepsis in two patients and advanced pulmonary hypertension in one patient.ConclusionOur data showed that children with rheumatic diseases, particularly SLE, are mostly admitted to PICU with serious disease exacerbation or severe infection. To improve the outcome, early diagnosis of critical condition and proper intervention are fundamental in reducing mortality.

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Section: Introductionmentioning

confidence: 99%

Outcome of children with systemic rheumatic diseases admitted to pediatric intensive care unit

Al‐Mayouf

Fallatah

AlTwajery

et al. 2019

International Journal of Pediatrics and Adolescent Medicine

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“…Because the 3 patients we describe who died of CVC-related bacterial sepsis manifested unusually severe and rapidly progressing multiorgan failure, we considered the possibility of MAS in the differential diagnoses ( 14 , 16 , 33 , 34 ). MAS is a well-recognized major risk factor for death in children with JIA admitted to PICU ( 33 , 34 ). A recent international study of a large cohort of So-JIA patients identified the most common clinical features as fever, organomegaly, central nervous system involvement, and hemorrhage ( 16 ).…”

Section: Possible Risk Factors For Severe Infection and Deathmentioning

confidence: 99%

Infection-Related Death among Persons with Refractory Juvenile Idiopathic Arthritis

Abinun¹,

Lane²,

Wood³

et al. 2016

Emerg. Infect. Dis.

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“…6 The main cause of mortality in pediatric patients with AIDs admitted to the ICU is severe infection. 7 However, prognosis in pediatric patients is dependent on the presence of infection as well as AIDs disease severity level during their PICU stay. Thus, a multidisciplinary approach to care is needed.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, a multidisciplinary approach to care is needed. 7 In Latin America, limited data exist on understanding the course of pediatric AIDs. This study aims to characterize the main causes of PICU admission in pediatric patients with AIDs at a tertiary health hospital in Cali, Colombia, and describe associated risk factors, complications, and outcomes among this patient population.…”

Section: Introductionmentioning

confidence: 99%

Characterization of Pediatric Patients with Rheumatological Diseases Admitted to a Single Tertiary Health Hospital's Pediatric Intensive Care Unit in Latin America

Erazo-Martínez

Ruiz-Ordóñez

Álvarez

et al. 2022

J Pediatr Intensive Care

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Most autoimmune diseases (AIDs) during childhood debut with more severe and aggressive forms, with life-threatening conditions that increase the need for intensive care therapy. This study describes the clinical, laboratory, and health outcome features of pediatric patients with AIDs admitted to the pediatric intensive care unit (PICU). This is a retrospective cross-sectional study that included the clinical records of all pediatric patients with AIDs admitted to the PICU between 2011 and 2020 in Cali, Colombia. In total, 225 PICU admissions from 136 patients were evaluated. Median age was 13 (11–15) years, and the median disease duration was 15 (5–38.5) months. Systemic lupus erythematosus was the most prevalent disease (91, 66.9%), followed by vasculitis (27, 19.8%). The leading cause of PICU admission was AID activity (95, 44.3%). C-reactive-protein levels were associated with infections (p <0.0394). Mortality occurred in 12 (8.8%) patients secondary to AID activity, primarily, diffuse alveolar hemorrhage (6, 50%). A longer disease duration was associated with mortality (p <0.00398). AID activity was the leading cause of PICU admission and mortality. Pulse steroid therapy, mechanical ventilation, and inotropic and vasopressor support were associated with nonsurvival.

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Critical care of the pediatric patient with rheumatic disease

Cited by 8 publications

References 48 publications

Outcome of children with systemic rheumatic diseases admitted to pediatric intensive care unit

Outcome of children with systemic rheumatic diseases admitted to pediatric intensive care unit

Infection-Related Death among Persons with Refractory Juvenile Idiopathic Arthritis

Characterization of Pediatric Patients with Rheumatological Diseases Admitted to a Single Tertiary Health Hospital's Pediatric Intensive Care Unit in Latin America

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