Impact of the use of nephrotoxic drugs in critically ill pediatric patients

Almeida, Jáder Pereira; João, Paulo Ramos David; Sylvestre, Lucimary de Castro

doi:10.5935/0103-507x.20200093

Cited by 3 publications

(6 citation statements)

References 27 publications

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“…[30] Besides that, adjusting the dose of medications according to the estimated glomerular filtration rate, maintaining a state of normovolemia, and avoiding the use of nephrotoxic drugs when possible is indicated. [31] As positive points, our study was performed in a general ICU, reference in pediatrics, with a diverse sample of neoplasms and a research protocol with specific definitions. This allows us to generalize the data to other units.…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury in children with cancer admitted in an intensive care unit

Almeida,

Luiz,

De-Oliveira

et al. 2022

Brazilian Journal of Oncology

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Objective: Evaluating the association between acute kidney injury and death in critically ill children with oncological diseases admitted in an intensive care unit (ICU). Material and Methods: Unicentric cohort study, evolving children with cancer admitted in the ICU of a pediatrics referral hospital. The patients were divided according to the presence or absence of acute kidney injury. Patients with a history of urogenital disease, nephrectomy or chronic kidney disease were excluded. The acute kidney injury was defined by the Kidney Disease Improving Global Outcomes (KDIGO) classification. The main outcome was death. Results: The sample was composed of 84 patients, in which 46.4% were diagnosed with hematologic neoplasm, 29.8% evolved with febrile neutropenia, 11.9% had a history of bone marrow transplant, and 27.3% deceased. Acute kidney injury occurred in 51.2% of the sample, 53.6% used furosemide, 38% showed fluid overload, and 8.3% had renal replacement therapy. The main variables related to kidney dysfunction were admission due to hemodynamic shock, pediatric risk of mortality score 2 ≥5%, bone marrow transplant, volume overload and multiple organ dysfunction syndrome.More advanced stages of acute kidney injury were associated with renal replacement therapy (p<0.001), longer stay in the ICU (p=0.006), and death (p=0.003). Conclusion: Children with cancer showed many risk factors of acute kidney injury, and this complication is associated with higher death rate.

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Section: Discussionmentioning

confidence: 99%

Acute kidney injury in children with cancer admitted in an intensive care unit

Almeida,

Luiz,

De-Oliveira

et al. 2022

Brazilian Journal of Oncology

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“…A gestão do DSV é adaptada individualmente, considerando fatores como a idade do paciente, gravidade dos sintomas e a presença de complicações associadas. A colaboração entre especialistas, incluindo cardiologistas pediátricos e cirurgiões cardíacos, é essencial para um cuidado abrangente 2,7,8 .…”

Section: Diagnósticounclassified

“…Quando necessário, a administração de medicamentos pode ser uma opção para controlar sintomas e melhorar a função cardíaca 2,6,7,8 . Programas de reabilitação cardíaca podem ser implementados para promover a recuperação e melhorar a qualidade de vida, especialmente após intervenções cirúrgicas.…”

Section: Cirurgia Corretivaunclassified

“…A decisão de usar fentanil em pacientes pediátricos cardiopatas é tomada de forma criteriosa pela equipe médica. Sua aplicação é abrangente, sendo empregado tanto na indução quanto na manutenção da anestesia ao longo do cateterismo cardíaco 2,6,7 .…”

Section: Agentes Anestésicos Inalatóriosunclassified

“…A diversidade dessas condições implica desafios diagnósticos e terapêuticos significativos, destacando a necessidade de abordagens personalizadas. A interação entre fatores genéticos, ambientais e fisiológicos contribui para a complexidade, exigindo uma compreensão abrangente para a prestação de cuidados eficazes e seguros a pacientes pediátricos cardiopatas 2,7,8,10 .…”

Section: Introductionunclassified

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Harmonia Cirúrgica: Cuidados Minuciosos Na Anestesia De Pacientes Pediátricos Com Cardiopatia Em Procedimentos Cirúrgicos

Coelho,

Nogueira,

Filho

et al. 2024

Braz. J. Implantol. Health Sci.

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A cirurgia em pacientes pediátricos com cardiopatia congênita apresenta desafios únicos devido à complexidade da doença cardíaca e à vulnerabilidade desses pacientes. Dessa forma, a anestesia desses pacientes requer uma abordagem cuidadosa e minuciosa para garantir a segurança e o sucesso do procedimento cirúrgico. A harmonia cirúrgica, caracterizada pela colaboração eficaz entre a equipe médica, desempenha um papel crucial nesse contexto, permitindo a coordenação adequada dos cuidados e a minimização de riscos. Objetivo: Destacar a importância da abordagem integrada e cuidadosa na administração da anestesia em pacientes pediátricos com cardiopatia submetidos a procedimentos cirúrgicos. Metodologia: Foram utilizadas as bases de dados Cochrane, Scielo e Medline, buscando artigos publicados entre os anos de 2020 e 2023, nos idiomas Português ou Inglês. Considerações Finais: A busca pela harmonia cirúrgica em procedimentos pediátricos em pacientes com cardiopatia é essencial para garantir a segurança e o sucesso do procedimento. Assim, a atenção minuciosa aos detalhes na administração da anestesia, considerando as particularidades fisiológicas e anatômicas desses pacientes, é fundamental para minimizar os riscos e garantir um resultado positivo.

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Acute Kidney Injury in Relation to Nephrotoxic Medication Use Among Critically Ill Children in the Paediatric Intensive Care Unit

Chan,

Hui,

Lok

et al. 2024

Journal of Pharmacy Practice

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Background: Critically ill children are vulnerable to acute kidney injury (AKI) and are often exposed to nephrotoxic medications. Objectives: We aimed to investigate the association between nephrotoxic medications and the risk of AKI in critically ill children admitted to our paediatric intensive care unit (PICU). Methods: Patients aged > 1 month to ≤18 years old were prospectively recruited from 6/2020 to 6/2021. The medication records from 14 days prior to PICU admission to PICU discharge were reviewed. Medication-exposure intensity was defined as the number of concomitant nephrotoxic medications. The relative risk (RR) of nephrotoxic medication exposure indices and other potential predictors for AKI development were determined. Results: Altogether 253 episodes of admissions (median [IQR] age of 4.9 [9.6] years) were enrolled. The AKI incidence was 41.9% and 69.2% of the patients were exposed to ≥1 of the 47 nephrotoxic medications. The total nephrotoxic medication dose (RR: 1.01 [1.00, 1.02]) and medication-exposure intensity (RR: 1.381 [1.101, 1.732]) were significantly associated with AKI development. The risk of AKI increased when the medication-exposure intensity was ≥4 (RR: 3.687 (1.320, 10.301)). During their PICU stay, children with AKI received a higher number ( P < .01), total dose ( P < .01) and medication exposure intensity ( P < .01) of nephrotoxic medications. Children with AKI who received nephrotoxic medications were more likely to have a persistently higher peak-to-baseline ratio ( P = .046). Conclusion: Nephrotoxic medication exposure significantly increased the risk of AKI development among critically ill children. The use of nephrotoxic medications among critically ill children at risk for AKI should be monitored frequently.

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Impact of the use of nephrotoxic drugs in critically ill pediatric patients

Cited by 3 publications

References 27 publications

Acute kidney injury in children with cancer admitted in an intensive care unit

Acute kidney injury in children with cancer admitted in an intensive care unit

Harmonia Cirúrgica: Cuidados Minuciosos Na Anestesia De Pacientes Pediátricos Com Cardiopatia Em Procedimentos Cirúrgicos

Acute Kidney Injury in Relation to Nephrotoxic Medication Use Among Critically Ill Children in the Paediatric Intensive Care Unit

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