Nonrespiratory Pediatric Logistic Organ Dysfunction-2 Score Is a Good Predictor of Mortality in Children With Acute Respiratory Failure

Leclerc, Francis; Duhamel, Alain; Deken, Valérie; Reun, C. Le; Lacroix, Jacques; Leteurtre, Stéphane; Pédiatriques, Groupe Francophone de Réanimation et d’Urgences

doi:10.1097/pcc.0000000000000184

Cited by 18 publications

(13 citation statements)

References 15 publications

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“…A daily vasoactive inotrope score (VIS) was calculated to describe the need for vasoactive support [16]. The non-respiratory Pediatric Logistic Organ Dysfunction (PELOD) 2 score was calculated daily to describe organ dysfunction [17]. The use of neuromuscular blocking agents (NMBAs) was noted as well as total daily cumulative dosage of sedatives and analgesic drugs.…”

Section: Methodsmentioning

confidence: 99%

Feasibility of an alternative, physiologic, individualized open-lung approach to high-frequency oscillatory ventilation in children

Jager

Kamp

Dijkstra

et al. 2019

Ann. Intensive Care

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BackgroundHigh-frequency oscillatory ventilation (HFOV) is a common but unproven management strategy in paediatric critical care. Oscillator settings have been traditionally guided by patient age and/or weight rather than by lung mechanics, thereby potentially negating any beneficial effects. We have adopted an open-lung HFOV strategy based on a corner frequency approach using an initial incremental–decremental mean airway pressure titration manoeuvre, a high frequency (8–15 Hz), and high power to initially target a proximal pressure amplitude (∆Pproximal) of 70–90 cm H2O, irrespective of age or weight.MethodsWe reviewed prospectively collected data on patients < 18 years of age who were managed with HFOV for acute respiratory failure. We measured metrics for oxygenation, ventilation, and haemodynamics as well as the use of sedative-analgesic medications and neuromuscular blocking agents.ResultsData from 115 non-cardiac patients were analysed, of whom 53 had moderate-to-severe paediatric acute respiratory distress syndrome (PARDS). Sixteen patients (13.9%) died. Frequencies≥ 8 Hz and high ∆Pproximal were achieved in all patients irrespective of age or PARDS severity. Patients with severe PARDS showed the greatest improvement in oxygenation. pH and PaCO2 normalized in all patients. Haemodynamic parameters, cumulative amount of fluid challenges, and daily fluid balance did not deteriorate after transitioning to HFOV in any age or PARDS severity group. We observed a transient increase neuromuscular blocking agent use after switching to HFOV, but there was no increase in the daily cumulative amount of continuous midazolam or morphine in any age or PARDS severity group. No patients experienced clinically apparent barotrauma.ConclusionsThis is the first study reporting the feasibility of an alternative, individualized, physiology-based open-lung HFOV strategy targeting high F and high ∆Pproximal. No adverse effects were observed with this strategy. Our findings warrant further systematic evaluation.

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Section: Methodsmentioning

confidence: 99%

Feasibility of an alternative, physiologic, individualized open-lung approach to high-frequency oscillatory ventilation in children

Jager

Kamp

Dijkstra

et al. 2019

Ann. Intensive Care

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“…We focused on acute respiratory failure because this diagnostic category constitutes a significant proportion of children admitted to the PICU, and these patients likely have a higher risk profile than many other populations of patients who require TI and MV. Furthermore, an overwhelming majority of children with acute respiratory failure require TI and MV [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

The number of tracheal intubation attempts matters! A prospective multi-institutional pediatric observational study

et al. 2016

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BackgroundThe impact of multiple tracheal intubation (TI) attempts on outcomes in critically ill children with acute respiratory failure is not known. The objective of our study is to determine the association between number of TI attempts and severe desaturation (SpO2 < 70 %) and adverse TI associated events (TIAEs).MethodsWe performed an analysis of a prospective multicenter TI database (National Emergency Airway Registry for Children: NEAR4KIDS). Primary exposure variable was number of TI attempts trichotomized as one, two, or ≥3 attempts. Estimates were adjusted for history of difficult airway, upper airway obstruction, and age. We included all children with initial TI performed with direct laryngoscopy for acute respiratory failure between 7/2010-3/2013. Our main outcome measures were desaturation (<80 % during TI attempt), severe desaturation (<70 %), adverse and severe TIAEs (e.g., cardiac arrest, hypotension requiring treatment).ResultsOf 3382 TIs, 2080(65 %) were for acute respiratory failure. First attempt success was achieved in 1256/2080(60 %), second attempt in 503/2080(24 %), and ≥3 attempts in 321/2080(15 %). Higher number of attempts was associated with younger age, history of difficult airway, signs of upper airway obstruction, and first provider training level. The proportion of TIs with desaturation increased with increasing number of attempts (1 attempt:16 %, 2 attempts:36 %, ≥3 attempts:56 %, p < 0.001; adjusted OR for 2 attempts: 2.9[95 % CI:2.3–3.7]; ≥3 attempts: 6.5[95 % CI: 5.0–8.5], adjusted for patient factors). Proportion of TIs with severe desaturation also increased with increasing number of attempts (1 attempt:12 %, 2 attempts:30 %, ≥3 attempts:44 %, p < 0.001); adjusted OR for 2 attempts: 3.1[95 % CI:2.4–4.0]; ≥3 attempts: 5.7[95 % CI: 4.3–7.5] ). TIAE rates increased from 10 to 29 to 38 % with increasing number of attempts (p < 0.001); adjusted OR for 2 attempts: 3.7[95 % CI:2.9–4.9] ; ≥3 attempts: 5.5[95 % CI: 4.1–7.4]. Severe TIAE rates went from 5 to 8 to 9 % (p = 0.008); adjusted OR for 2 attempts: 1.6 [95 % CI:1.1–2.4]; ≥3 attempts: 1.8[95 % CI:1.1–2.8].ConclusionsNumber of TI attempts was associated with desaturations and increased occurrence of TIAEs in critically ill children with acute respiratory failure. Thoughtful attention to initial provider as well as optimal setting/preparation is important to maximize the chance for first attempt success and to avoid desaturation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-016-0593-y) contains supplementary material, which is available to authorized users.

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“…(27, 31–33) Furthermore, hemodynamic instability is a predictor of mortality in pediatric patients with acute respiratory failure receiving mechanical ventilation. (2) Whether hemodynamic optimization before/during airway management could lead to improved outcomes remains to be determined. We also found that hospital characteristics such as non-teaching and minor teaching hospitals were associated with decreased mortality in the multivariable model.…”

Section: Discussionmentioning

confidence: 99%

“…(1–7) Even though mortality varies substantially depending on the definitions used(1, 2), mortality may exceed 40% in severe cases. (3, 4) Although there are no published incidence estimates for all pediatric patients, ICD-9-data from a study performed in 2000 estimates the annual incidence at greater than 5,000 cases each year in the United States in children between 5 and 17 years.…”

Section: Introductionmentioning

confidence: 99%

Pediatric In-Hospital Acute Respiratory Compromise: A Report From the American Heart Association’s Get With the Guidelines-Resuscitation Registry*

Andersen¹,

Vognsen

Topjian

et al. 2017

Pediatric Critical Care Medicine

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Objectives The main objectives of this study were to describe in-hospital acute respiratory compromise among children (age < 18 years), and its association with cardiac arrest and in-hospital mortality. Design Observational study using prospectively collected data. Setting United States hospitals reporting data to the Get With The Guidelines® – Resuscitation registry. Patients Pediatric patients (age < 18 years) with acute respiratory compromise. Acute respiratory compromise was defined as absent, agonal, or inadequate respiration that required emergency assisted ventilation and elicited a hospital-wide or unit-based emergency response. Interventions None. Measurements and Main Results The primary outcome was in-hospital mortality. Cardiac arrest during the event was a secondary outcome. To assess the association between patient, event, and hospital characteristics and the outcomes, we created multivariable logistic regressions models accounting for within-hospital clustering. One thousand nine hundred and fifty two patients from 151 hospitals were included. Forty percent of the events occurred on the wards, 19% in the emergency department, 25% in the intensive care unit, and 16% in other locations. Two hundred eighty patients (14.6%) died before hospital discharge. Pre-existing hypotension (odds ratio: 3.26 [95%CI: 1.89, 5.62], p < 0.001) and septicemia (odds ratio: 2.46 [95%CI: 1.52, 3.97], p < 0.001) were associated with increased mortality. The acute respiratory compromise event was temporally associated with a cardiac arrest in 182 patients (9.3%), among whom 46.2% died. One thousand two hundred and eight patients (62%) required tracheal intubation during the event. In-hospital mortality among patients requiring tracheal intubation during the event was 18.6%. Conclusion In this large, multicenter study of acute respiratory compromise, 40% occurred in ward settings, 9.3% had an associated cardiac arrest, and overall in-hospital mortality was 14.6%. Pre-event hypotension and septicemia were associated with increased mortality rate.

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Nonrespiratory Pediatric Logistic Organ Dysfunction-2 Score Is a Good Predictor of Mortality in Children With Acute Respiratory Failure

Cited by 18 publications

References 15 publications

Feasibility of an alternative, physiologic, individualized open-lung approach to high-frequency oscillatory ventilation in children

Feasibility of an alternative, physiologic, individualized open-lung approach to high-frequency oscillatory ventilation in children

The number of tracheal intubation attempts matters! A prospective multi-institutional pediatric observational study

Pediatric In-Hospital Acute Respiratory Compromise: A Report From the American Heart Association’s Get With the Guidelines-Resuscitation Registry*

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