Hypoxaemia and septic shock were independent risk factors for mechanical ventilation in Bangladeshi children hospitalised for diarrhoea

Chisti, Mohammod Jobayer; Shahunja, K. M.; Afroze, Farzana; Shahid, Abu S. M. S. B.; Sharifuzzaman, Md.; Ahmed, Tahmeed

doi:10.1111/apa.13836

Cited by 9 publications

(13 citation statements)

References 28 publications

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“…Chisti et al also found similar findings in under 5 diarrheal children. 27 In our study, no survival benefit was observed among children who got a blood transfusion (Table 1). In critically ill septic patients, red blood cell transfusion is associated with a dose-dependent increase in morbidity and mortality.…”

Section: Discussionmentioning

confidence: 48%

Predictor of Death in Diarrheal Children Under 5 Years of Age Having Severe Sepsis in an Urban Critical Care Ward in Bangladesh

Sarmin

Afroze

Sharifuzzaman

et al. 2019

Global Pediatric Health

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We aimed to identify clinical predictors of fatal outcome in children under 5 years of age having diarrhea and severe sepsis and treated in the Intensive Care Unit of the Dhaka Hospital of icddr,b from October 2010 through September 2011. Among 191 enrolled children, 70 (37%) died and were considered to be cases, while the remaining 121 (63%) who survived constituted the controls. The cases more often had shortness of breath (SOB), septic shock, dehydrating diarrhea compared with the controls (for all, P < .05). After adjusting for potential confounders using logistic regression analysis, the likelihood of death was higher in children who had septic shock and SOB and lower in children having dehydrating diarrhea (for all, P < .05). Thus, SOB can trigger an early alarm for sepsis recognition; otherwise, these children can end up with fatality from septic shock. In resource-poor settings, early identification of these predictors can alleviate death.

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Section: Discussionmentioning

confidence: 48%

Predictor of Death in Diarrheal Children Under 5 Years of Age Having Severe Sepsis in an Urban Critical Care Ward in Bangladesh

Sarmin

Afroze

Sharifuzzaman

et al. 2019

Global Pediatric Health

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“…23,24 Moreover, children in our study with cerebral edema more often required mechanical ventilation and received a blood transfusion, and both of these associated factors may be responsible for the higher deaths in our study children with cerebral edema. 25,26 However, mortality rates in children suffering from cerebral edema in other studies differ according to its causes, the most prominent reason being diabetic ketoacidosis, 6 neonatal seizure, 27 and fulminant hepatic failure. 28…”

Section: Discussionmentioning

confidence: 99%

Factors associated with cerebral edema in children under 5 years of age admitted in an intensive care unit and their outcome

et al. 2019

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Objective: We aimed to evaluate risk factors and outcome of cerebral edema in children with diarrhea. Methods: In this retrospective chart analysis, data of all diarrheal children under 5 years of age having convulsion and admitted in intensive care unit were retrieved from an electronic medical record system of Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh, from 1st January 2011 to 31st December 2016. Comparison of clinical and laboratory characteristics was made between children with (cases = 22) and without cerebral edema (controls = 66). Results: Cases more often had a fatal outcome than controls (36% vs 8%, p = 0.003). In logistic regression analysis, after adjusting for potential confounders, the cases were independently associated with respiratory distress (odds ratio = 5.5, confidence interval = 1.55–19.62, p = 0.008), severe sepsis (odds ratio = 4.6, confidence interval = 1.24–16.77, p = 0.022), and severe malnutrition (odds ratio = 0.16, confidence interval = 0.04–0.74, p = 0.019). A rapid drop (>0.5 mmol/L per hour) in serum sodium did not have any impact on developing cerebral edema (p = 0.090). Conclusion: Identification of simple clinical predictors may help in the early treatment of cerebral edema that may further help in reducing deaths in such children especially in resource-poor settings. However, further research with prospective design is needed to consolidate our observation.

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“…3,4 A number of children requiring admission in ICU often require mechanical ventilation (MV) mainly because of respiratory failure. 5,6 MV is a frequently used and essential life-supporting invasive technology that imitates respiratory physiological function at the time of impending or acute respiratory failure or acute neurological illness. 7,8 Although benefits of MV are indisputable in industrialized countries, the invasiveness and the nature of the procedure of MV in developing country setups are often associated with hospital-acquired infections, airway lesions, ventilator-associated pneumonia (VAP), and so on.…”

Section: Introductionmentioning

confidence: 99%

“…[11][12][13] Patients requiring MV support in the ICU had substantially higher mortality rates when compared with patients without MV support. 5,14 We need to understand the risk factors for death in children requiring MV to provide useful guidance in appropriately managing at-risk patients in order to reduce mortality associated with MV. Although a number of studies have reported risk factors for mortality in children requiring MV, 11,15,16 to our knowledge there are no published data on the risk factors of death in children also having diarrhea and requiring MV.…”

Section: Introductionmentioning

confidence: 99%

Hyperkalemia Was an Independent Risk Factor for Death While Under Mechanical Ventilation Among Children Hospitalized With Diarrhea in Bangladesh

Chowdhury

Ghosh

Shahunja

et al. 2018

Global Pediatric Health

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Objectives. We sought to evaluate the admission and hospital risk factors for death in children with diarrhea requiring mechanical ventilation (MV). Methods. This was a retrospective study. We enrolled children aged 0 to 59 months admitted with diarrhea to the intensive care unit of the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) between August 2009 and July 2013 and required MV. To evaluate the risk factors for death in MV, we compared the clinical and laboratory characteristics of the children requiring MV. We matched up to the clinical characteristics presented on admission and subsequently developed before MV during hospital stay with the survivors and deaths of children having MV. Results. Among 73 enrolled children, 58 (80%) died. Incidence of death in MV was higher among children having hyperkalemia (P ≤ .001), hypoglycemia (P ≤ .001), and metabolic acidosis (P = .06) on admission and lower in children having tracheal isolates (P ≤ .001) during hospitalization. After adjusting for covariates by using multivariate robust Poisson regression, children with hyperkalemia (incidence ratio = 1.34; P = .03; confidence interval = 1.02-1.76) on admission was the only independent risk factor for death of children with MV. Conclusion. Children with hyperkalemia on admission and subsequently requiring MV were more likely to die compared with those without hyperkalemia.

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Hypoxaemia and septic shock were independent risk factors for mechanical ventilation in Bangladeshi children hospitalised for diarrhoea

Abstract: Children under five with diarrhoea who required mechanical ventilation frequently had hypoxaemia and septic shock and were more likely to die than unventilated controls.

Cited by 9 publications

References 28 publications

Predictor of Death in Diarrheal Children Under 5 Years of Age Having Severe Sepsis in an Urban Critical Care Ward in Bangladesh

Predictor of Death in Diarrheal Children Under 5 Years of Age Having Severe Sepsis in an Urban Critical Care Ward in Bangladesh

Factors associated with cerebral edema in children under 5 years of age admitted in an intensive care unit and their outcome

Hyperkalemia Was an Independent Risk Factor for Death While Under Mechanical Ventilation Among Children Hospitalized With Diarrhea in Bangladesh

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