Higher-volume hypertonic saline and increased thrombotic risk in pediatric traumatic brain injury

Webster, Danielle; Lin, Fang; Falcone, Richard A.; Kaplan, Jennifer

doi:10.1016/j.jcrc.2015.07.022

Cited by 24 publications

(12 citation statements)

References 31 publications

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“…Previous pediatric studies focusing on the rate of thrombosis in critically ill children reported that the incidence in severely injured patients can be as high as 13.8% with a significantly lower incidence in nontrauma patients. [24][25][26][27][28] Compared with these previous reports, the DVT rate in our cohort was high, but no sequelae Abbreviations: 4F-PCC, four-factor prothrombin complex concentrate; FFP, fresh frozen plasma; INR, international normalized ratio; TACO, transfusion-associated circulatory overload; TRALI, transfusion-related acute lung injury. of the localized thrombotic event such as pulmonary embolism was noted.…”

Section: Discussionmentioning

confidence: 78%

Single-Center Use of Prothrombin Complex Concentrate in Pediatric Patients

Karube

Andersen

Tobias

2020

J Pediatr Intensive Care

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Coagulation disturbances frequently occur in critically ill children. Four-factor prothrombin complex concentrate (4F-PCC) may have a potential role in managing these patients while avoiding concerns associated with fresh frozen plasma. However, data on this product in critically ill children is scarce. We retrospectively identified 24 critically ill pediatric patients who received 4F-PCC. The primary indication was to correct coagulopathy and control bleeding in the trauma or surgical setting. 4F-PCC effectively decreased the international normalized ratio level, a surrogate marker of hemostasis. Further study is warranted to identify efficacy, indications, optimal dosing, and adverse effects in the critically ill pediatric patients.

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Section: Discussionmentioning

confidence: 78%

Single-Center Use of Prothrombin Complex Concentrate in Pediatric Patients

Karube

Andersen

Tobias

2020

J Pediatr Intensive Care

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“…[16] To achieve this goal, HS strategy has been designed as the optimal therapeutic modality to attenuate the postoperative intestine edema after major operation or severe trauma. [17] The present study was conducted to determine if HS intragastric injection would reduce the postoperative intestine edema so as to promote intestinal function recovery in patients undergoing major upper gastrointestinal surgery, which has not been previously reported. In a previous biological investigation, it has been demonstrated that edema's detrimental effects on intestinal function directly affect muscle function and force transmission.…”

Section: Discussionmentioning

confidence: 99%

Impact of hypertonic saline on postoperative complications for patients undergoing upper gastrointestinal surgery

et al. 2017

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The aim of this study was to explore the impact of 3% hypertonic saline (HS) intragastric administration for patients who underwent upper gastrointestinal surgery.During the postoperative period, 3% HS has been suggested as a means to improve the intestinal edema and reduce gastrointestinal complications.The medical records of 111 patients with HS intragastric administration following upper gastrointestinal surgery and 268 patients, served as control, were reviewed retrospectively. Propensity score matching was performed to adjust for selected baseline variables. Clinical outcomes, including early gastrointestinal function recovery, postoperative complications, and length of hospital stay, were compared according to the HS intragastric administration or not.HS intragastric administration was associated with prompt postoperative gastrointestinal function recovery, including first flatus (risk ratio [RR], 1.32; 95% confidence interval [CI], 0.89–1.65; P = 0.048) and feeding within 3 postoperative days (RR (95% CI), 0.57 (0.49–0.77); P = 0.036). Early ileus occurred in 25 of 108 patients with HS treatment versus 36 of 108 patients without HS treatment (RR (95% CI), 1.43 (0.63–2.15); P = 0.065). The patients with HS experienced a lower overall postoperative complication (odds ratio [OD] 0.57; 95% CI, 0.33–1.09; P = 0.063), including trend toward a decrease for infectious complications (15[13.9] vs 23[21.3]; P = 0.11; OD, 0.59; 95% CI, 0.29–1.22). There was a decreased incidence of anastomotic leakage (1[0.9] vs 7[6.5]; P = 0.033) and postoperative ileuas (5[4.6%] vs 11[10.2%]; P = 0.096) in the HS administration patients.Our study demonstrated beneficial postoperative clinical effects of HS intragastric administration in patients who had undergone upper gastrointestinal surgery, such as prompt postoperative gastrointestinal function recovery and reduced overall postoperative complications, which may be attributed to a reduced intestinal edema.

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“…HTS has not been studied as an agent to treat acute increase in ICP in ALF patients. HTS is associated with electrolyte abnormalities, hyperchloremic metabolic acidosis, worsening coagulopathy, deep venous thrombosis, and hemorrhages [25,28,29].…”

Section: Managementmentioning

confidence: 99%

Management of Acute Liver Failure: A Pediatric Perspective

Bhatt

Rao

2018

Curr Pediatr Rep

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Purpose of Review Pediatric acute liver failure is a rare, complex, rapidly progressing, and life-threatening illness. Majority of pediatric acute liver failures have unknown etiology. This review intends to discuss the current literature on the challenging aspects of management of acute liver failure. Recent Findings Collaborative multidisciplinary approach for management of patients with pediatric acute liver failure with upfront involvement of transplant hepatologist and critical care specialists can improve outcomes of this fatal disease. Extensive but systematic diagnostic evaluation can help to identify etiology and guide management. Early referral to a transplant center with prompt liver transplant, if indicated, can lead to improved survival in these patients. Summary Prompt identification and aggressive management of pediatric acute liver failure and related comorbidities can lead to increased transplant-free survival and improved post-transplant outcomes, thus decreasing mortality and morbidity associated with this potential fatal condition.

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Higher-volume hypertonic saline and increased thrombotic risk in pediatric traumatic brain injury

Cited by 24 publications

References 31 publications

Single-Center Use of Prothrombin Complex Concentrate in Pediatric Patients

Single-Center Use of Prothrombin Complex Concentrate in Pediatric Patients

Impact of hypertonic saline on postoperative complications for patients undergoing upper gastrointestinal surgery

Management of Acute Liver Failure: A Pediatric Perspective

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