101
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Gc VS, Franklin D, Whitty JA, Dalziel SR, Babl FE, Schlapbach LJ, Fraser JF, Craig S, Neutze J, Oakley E, Schibler A. First-line oxygen therapy with high-flow in bronchiolitis is not cost saving for the health service. Arch Dis Child 2020; 105:975-980. [PMID: 32276987 DOI: 10.1136/archdischild-2019-318427] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bronchiolitis is the most common reason for hospital admission in infants. High-flow oxygen therapy has emerged as a new treatment; however, the cost-effectiveness of using it as first-line therapy is unknown. OBJECTIVE To compare the cost of providing high-flow therapy as a first-line therapy compared with rescue therapy after failure of standard oxygen in the management of bronchiolitis. METHODS A within-trial economic evaluation from the health service perspective using data from a multicentre randomised controlled trial for hypoxic infants (≤12 months) admitted to hospital with bronchiolitis in Australia and New Zealand. Intervention costs, length of hospital and intensive care stay and associated costs were compared for infants who received first-line treatment with high-flow therapy (early high-flow, n=739) or for infants who received standard oxygen and optional rescue high-flow (rescue high-flow, n=733). Costs were applied using Australian costing sources and are reported in 2016-2017 AU$. RESULTS The incremental cost to avoid one treatment failure was AU$1778 (95% credible interval (CrI) 207 to 7096). Mean cost of bronchiolitis treatment including intervention costs and costs associated with length of stay was AU$420 (95% CrI -176 to 1002) higher per infant in the early high-flow group compared with the rescue high-flow group. There was an 8% (95% CrI 7.5 to 8.6) likelihood of the early high-flow oxygen therapy being cost saving. CONCLUSIONS The use of high-flow oxygen as initial therapy for respiratory failure in infants with bronchiolitis is unlikely to be cost saving to the health system, compared with standard oxygen therapy with rescue high-flow.
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Affiliation(s)
- Vijay S Gc
- Centre for Health Economics, University of York, York, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Donna Franklin
- Paediatric Critical Care Research Group, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia.,Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,The University of Queensland Child Health Research Centre, School of Medicine, Brisbane, Queensland, Australia.,Paediatric Research in Emergency Departments International Collaborative (PREDICT), Brisbane, Queensland, Australia.,Critical Care Research Group, Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | | | - Stuart R Dalziel
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Brisbane, Queensland, Australia.,Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.,Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Franz E Babl
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Brisbane, Queensland, Australia.,Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia.,Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,The University of Queensland Child Health Research Centre, School of Medicine, Brisbane, Queensland, Australia.,Department of Paediatrics, Bern University Hospital, University of Bern, Bern, Switzerland
| | - John F Fraser
- The University of Queensland Child Health Research Centre, School of Medicine, Brisbane, Queensland, Australia.,Paediatric Research in Emergency Departments International Collaborative (PREDICT), Brisbane, Queensland, Australia.,Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
| | - Simon Craig
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Brisbane, Queensland, Australia.,Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.,Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Jocelyn Neutze
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Brisbane, Queensland, Australia.,KidzFirst Middlemore Hospital and theUniversity of Auckland, Auckland, New Zealand
| | - Ed Oakley
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Brisbane, Queensland, Australia.,Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Andreas Schibler
- Paediatric Critical Care Research Group, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia .,Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,The University of Queensland Child Health Research Centre, School of Medicine, Brisbane, Queensland, Australia.,Paediatric Research in Emergency Departments International Collaborative (PREDICT), Brisbane, Queensland, Australia
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102
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Cruz AT, Lane RD, Balamuth F, Aronson PL, Ashby DW, Neuman MI, Souganidis ES, Alpern ER, Schlapbach LJ. Updates on pediatric sepsis. J Am Coll Emerg Physicians Open 2020; 1:981-993. [PMID: 33145549 PMCID: PMC7593454 DOI: 10.1002/emp2.12173] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 12/11/2022] Open
Abstract
Sepsis, defined as an infection with dysregulated host response leading to life-threatening organ dysfunction, continues to carry a high potential for morbidity and mortality in children. The recognition of sepsis in children in the emergency department (ED) can be challenging, related to the high prevalence of common febrile infections, poor specificity of discriminating features, and the capacity of children to compensate until advanced stages of shock. Sepsis outcomes are strongly dependent on the timeliness of recognition and treatment, which has led to the successful implementation of quality improvement programs, increasing the reliability of sepsis treatment in many US institutions. We review clinical, laboratory, and technical modalities that can be incorporated into ED practice to facilitate the recognition, treatment, and reassessment of children with suspected sepsis. The 2020 updated pediatric sepsis guidelines are reviewed and framed in the context of ED interventions, including guidelines for antibiotic administration, fluid resuscitation, and the use of vasoactive agents. Despite a large body of literature on pediatric sepsis epidemiology in recent years, the evidence base for treatment and management components remains limited, implying an urgent need for large trials in this field. In conclusion, although the burden and impact of pediatric sepsis remains substantial, progress in our understanding of the disease and its management have led to revised guidelines and the available data emphasizes the importance of local quality improvement programs.
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Affiliation(s)
- Andrea T. Cruz
- Sections of Emergency Medicine and Infectious DiseaseDepartment of PediatricsBaylor College of MedicineHoustonTexasUSA
| | - Roni D. Lane
- Division of Pediatric Emergency Medicinethe University of Utah Primary Children's HospitalSalt Lake CityUtahUSA
| | - Fran Balamuth
- Division of Emergency MedicineDepartment of PediatricsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Paul L. Aronson
- Section of Pediatric Emergency MedicineDepartments of Pediatrics and Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - David W. Ashby
- Sections of Emergency Medicine and Infectious DiseaseDepartment of PediatricsBaylor College of MedicineHoustonTexasUSA
| | - Mark I. Neuman
- Division of Emergency MedicineDepartment of PediatricsBoston Children's HospitalBostonMassachusettsUSA
| | - Ellie S. Souganidis
- Sections of Emergency Medicine and Infectious DiseaseDepartment of PediatricsBaylor College of MedicineHoustonTexasUSA
| | - Elizabeth R. Alpern
- Division of Emergency MedicineDepartment of PediatricsAnn & Robert H. Lurie Children's HospitalFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Luregn J. Schlapbach
- Department of Intensive Care Medicine and Neonatologyand Children's Research CenterUniversity Children's Hospital of ZurichUniversity of ZurichZurichSwitzerland
- Paediatric Critical Care Research GroupThe University of Queensland and Queensland Children's HospitalBrisbaneQueenslandAustralia
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103
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Asner SA, Agyeman PKA, Gradoux E, Posfay-Barbe KM, Heininger U, Giannoni E, Crisinel PA, Stocker M, Bernhard-Stirnemann S, Niederer-Loher A, Kahlert CR, Hasters P, Relly C, Baer W, Aebi C, Schlapbach LJ, Berger C. Burden of Streptococcus pneumoniae Sepsis in Children After Introduction of Pneumococcal Conjugate Vaccines: A Prospective Population-based Cohort Study. Clin Infect Dis 2020; 69:1574-1580. [PMID: 30601988 DOI: 10.1093/cid/ciy1139] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 12/31/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Population-based studies assessing the impact of pneumococcal conjugate vaccines (PCV) on burden of pneumococcal sepsis in children are lacking. We aimed to assess this burden following introduction of PCV-13 in a nationwide cohort study. METHODS The Swiss Pediatric Sepsis Study (September 2011 to December 2015) prospectively recruited children <17 years of age with blood culture-proven sepsis due to Streptococcus pneumoniae, meeting criteria for systemic inflammatory response syndrome. Infection with vaccine serotype in children up to date with PCV immunization was defined as vaccine failure. Main outcomes were admission to pediatric intensive care unit (PICU) and length of hospital stay (LOS). RESULTS Children with pneumococcal sepsis (n = 117) accounted for a crude incidence of 2.0 per 100 000 children (95% confidence interval [CI] 1.7-2.4) and 25% of community-acquired sepsis episodes. Case fatality rate was 8%. Forty-two (36%) patients required PICU admission. Children with meningitis (29; 25%) were more often infected by serotypes not included in PCV (69% vs 31%; P < .001). Sixteen (26%) of 62 children up to date with PCV immunization presented with vaccine failure, including 11 infected with serotype 3. In multivariable analyses, children with meningitis (odds ratio [OR] 6.8; 95% CI 2.4-19.3; P < .001) or infected with serotype 3 (OR 2.8; 95% CI 1.1-7.3; P = .04) were more often admitted to PICU. Children infected with serotype 3 had longer LOS (β coefficient 0.2, 95% CI .1-1.1; P = .01). CONCLUSIONS The incidence of pneumococcal sepsis in children shortly after introduction of PCV-13 remained substantial. Meningitis mostly due to non-vaccine serotypes and disease caused by serotype 3 represented significant predictors of severity.
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Affiliation(s)
- Sandra A Asner
- Pediatric Infectious Diseases and Vaccinology Unit, Department Mother-Woman-Child, Switzerland.,Infectious Diseases Service, Department of Internal Medicine, Lausanne University Hospital, Switzerland
| | - Philipp K A Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, Switzerland
| | - Eugénie Gradoux
- Pediatric Infectious Diseases and Vaccinology Unit, Department Mother-Woman-Child, Switzerland
| | - Klara M Posfay-Barbe
- Pediatric Infectious Diseases Unit, Children's Hospital of Geneva, University Hospitals of Geneva, Switzerland
| | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University Children's Hospital Basel, Switzerland
| | - Eric Giannoni
- Infectious Diseases Service, Department of Internal Medicine, Lausanne University Hospital, Switzerland.,Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital, Switzerland
| | - Pierre A Crisinel
- Pediatric Infectious Diseases and Vaccinology Unit, Department Mother-Woman-Child, Switzerland
| | - Martin Stocker
- Department of Pediatrics, Children's Hospital Lucerne, Switzerland
| | | | | | | | - Paul Hasters
- Department of Neonatology, University Hospital Zurich, Switzerland
| | - Christa Relly
- Division of Infectious Diseases and Children's Research Center, University Children's Hospital Zurich, Switzerland
| | | | - Christoph Aebi
- Department of Pediatrics, Inselspital, Bern University Hospital, Switzerland
| | - Luregn J Schlapbach
- Department of Pediatrics, Inselspital, Bern University Hospital, Switzerland.,Faculty of Medicine, Child Health Research Centre, The University of Queensland, Brisbane, Australia.,Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Australia.,Intensive Care Unit, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia
| | - Christoph Berger
- Division of Infectious Diseases and Children's Research Center, University Children's Hospital Zurich, Switzerland
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104
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Schlapbach LJ, Kissoon N, Alhawsawi A, Aljuaid MH, Daniels R, Gorordo-Delsol LA, Machado F, Malik I, Nsutebu EF, Finfer S, Reinhart K. World Sepsis Day: a global agenda to target a leading cause of morbidity and mortality. Am J Physiol Lung Cell Mol Physiol 2020; 319:L518-L522. [PMID: 32812788 DOI: 10.1152/ajplung.00369.2020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Luregn J Schlapbach
- Child Health Research Centre, The University of Queensland and Queensland Children's Hospital, Brisbane, Queensland, Australia.,Department of Intensive Care Medicine and Neonatology, and Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Niranjan Kissoon
- Children's and Women's Global Health, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Maha H Aljuaid
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ron Daniels
- Department of Critical Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | | | - Imrana Malik
- Department of Critical Care, The University of Texas, Anderson Cancer Center, Houston, Texas
| | - Emmanuel Fru Nsutebu
- Infectious Diseases Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Simon Finfer
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Konrad Reinhart
- Department of Anesthesia and Surgical Intensive Care Medicine, Charité Universitätsmedizin, Berlin, Germany
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105
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Balamuth F, Schlapbach LJ. Paediatric patient stratification in the emergency department. Lancet Child Adolesc Health 2020; 4:557-558. [PMID: 32710836 PMCID: PMC7375780 DOI: 10.1016/s2352-4642(20)30208-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 11/21/2022]
Affiliation(s)
- Fran Balamuth
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland and Queensland Children's Hospital, Brisbane, QLD, Australia; Department of Intensive Care Medicine and Neonatology, and Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland.
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106
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Namachivayam SP, Carlin JB, Millar J, Alexander J, Edmunds S, Ganeshalingham A, Lew J, Erickson S, Butt W, Schlapbach LJ, Ganu S, Festa M, Egan JR, Williams G, Young J. Gestational Age and Risk of Mortality in Term-Born Critically Ill Neonates Admitted to PICUs in Australia and New Zealand. Crit Care Med 2020; 48:e648-e656. [PMID: 32697505 DOI: 10.1097/ccm.0000000000004409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Gestational age at birth is declining, probably because more deliveries are being induced. Gestational age is an important modifiable risk factor for neonatal mortality and morbidity. We aimed to investigate the association between gestational age and mortality in hospital for term-born neonates (≥ 37 wk') admitted to PICUs in Australia and New Zealand. DESIGN Observational multicenter cohort study. SETTING PICUs in Australia and New Zealand. PATIENTS Term-born neonates (≥ 37 wk) admitted to PICUs. INTERVENTIONS None MEASUREMENTS AND MAIN RESULTS:: We studied 5,073 infants born with a gestational age greater than or equal to 37 weeks and were less than 28 days old when admitted to a PICU in Australia or New Zealand between 2007 and 2016. The association between gestational age and mortality was estimated using a multivariable logistic regression model, adjusting for age, sex, indigenous status, Pediatric Index of Mortality version 2, and site. The median gestational age was 39.1 weeks (interquartile range, 38.2-40 wk) and mortality in hospital was 6.6%. Risk of mortality declined log-linearly with gestational age. The adjusted analysis showed a 20% (95% CI, 11-28%) relative reduction in mortality for each extra week of gestation beyond 37 weeks. The effect of gestation was stronger among those who received extracorporeal life support: each extra week of gestation was associated with a 44% (95% CI, 25-57%) relative reduction in mortality. Longer gestation was also associated with reduced length of stay in hospital: each week increase in gestation, the average length of stay decreased by 4% (95% CI, 2-6%). CONCLUSIONS Among neonates born at "term" who are admitted to a PICU, increasing gestational age at birth is associated with a substantial reduction in the risk of dying in hospital. The maturational influence on outcome was more strongly noted in the sickest neonates, such as those requiring extracorporeal life support. This information is important in view of the increasing proportion of planned births in both high- and low-/middle-income countries.
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Affiliation(s)
- Siva P Namachivayam
- Pediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Registry, Centre for Outcomes and Resource Evaluation, Australian and New Zealand Intensive Care Society, Camberwell, VIC, Australia
- Pediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand
- Pediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, QLD, Australia
- Pediatric Critical Care Research Group, Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
- Pediatric Intensive Care Unit and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- Pediatric Intensive Care Unit, Women's and Children's Hospital, Adelaide, SA, Australia
- Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
- Pediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Pediatric Intensive Care Unit, The Sydney Children's Hospital, Sydney, NSW, Australia
| | - John B Carlin
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Johnny Millar
- Australian and New Zealand Intensive Care Registry, Centre for Outcomes and Resource Evaluation, Australian and New Zealand Intensive Care Society, Camberwell, VIC, Australia
| | - Janet Alexander
- Australian and New Zealand Intensive Care Registry, Centre for Outcomes and Resource Evaluation, Australian and New Zealand Intensive Care Society, Camberwell, VIC, Australia
| | - Sarah Edmunds
- Pediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand
| | | | - Jamie Lew
- Pediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia
| | - Simon Erickson
- Pediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia
| | - Warwick Butt
- Pediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Registry, Centre for Outcomes and Resource Evaluation, Australian and New Zealand Intensive Care Society, Camberwell, VIC, Australia
- Pediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand
- Pediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, QLD, Australia
- Pediatric Critical Care Research Group, Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
- Pediatric Intensive Care Unit and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- Pediatric Intensive Care Unit, Women's and Children's Hospital, Adelaide, SA, Australia
- Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
- Pediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Pediatric Intensive Care Unit, The Sydney Children's Hospital, Sydney, NSW, Australia
| | - Luregn J Schlapbach
- Pediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Registry, Centre for Outcomes and Resource Evaluation, Australian and New Zealand Intensive Care Society, Camberwell, VIC, Australia
- Pediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand
- Pediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, QLD, Australia
- Pediatric Critical Care Research Group, Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
- Pediatric Intensive Care Unit and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- Pediatric Intensive Care Unit, Women's and Children's Hospital, Adelaide, SA, Australia
- Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
- Pediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Pediatric Intensive Care Unit, The Sydney Children's Hospital, Sydney, NSW, Australia
| | - Subodh Ganu
- Pediatric Intensive Care Unit, Women's and Children's Hospital, Adelaide, SA, Australia
- Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
| | - Marino Festa
- Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
| | - Jonathan R Egan
- Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
| | - Gary Williams
- Pediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Janelle Young
- Pediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
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107
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Lunke S, Eggers S, Wilson M, Patel C, Barnett CP, Pinner J, Sandaradura SA, Buckley MF, Krzesinski EI, de Silva MG, Brett GR, Boggs K, Mowat D, Kirk EP, Adès LC, Akesson LS, Amor DJ, Ayres S, Baxendale A, Borrie S, Bray A, Brown NJ, Chan CY, Chong B, Cliffe C, Delatycki MB, Edwards M, Elakis G, Fahey MC, Fennell A, Fowles L, Gallacher L, Higgins M, Howell KB, Hunt L, Hunter MF, Jones KJ, King S, Kumble S, Lang S, Le Moing M, Ma A, Phelan D, Quinn MCJ, Richards A, Richmond CM, Riseley J, Rodgers J, Sachdev R, Sadedin S, Schlapbach LJ, Smith J, Springer A, Tan NB, Tan TY, Temple SL, Theda C, Vasudevan A, White SM, Yeung A, Zhu Y, Martyn M, Best S, Roscioli T, Christodoulou J, Stark Z. Feasibility of Ultra-Rapid Exome Sequencing in Critically Ill Infants and Children With Suspected Monogenic Conditions in the Australian Public Health Care System. JAMA 2020; 323:2503-2511. [PMID: 32573669 PMCID: PMC7312414 DOI: 10.1001/jama.2020.7671] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Widespread adoption of rapid genomic testing in pediatric critical care requires robust clinical and laboratory pathways that provide equitable and consistent service across health care systems. OBJECTIVE To prospectively evaluate the performance of a multicenter network for ultra-rapid genomic diagnosis in a public health care system. DESIGN, SETTING, AND PARTICIPANTS Descriptive feasibility study of critically ill pediatric patients with suspected monogenic conditions treated at 12 Australian hospitals between March 2018 and February 2019, with data collected to May 2019. A formal implementation strategy emphasizing communication and feedback, standardized processes, coordination, distributed leadership, and collective learning was used to facilitate adoption. EXPOSURES Ultra-rapid exome sequencing. MAIN OUTCOMES AND MEASURES The primary outcome was time from sample receipt to ultra-rapid exome sequencing report. The secondary outcomes were the molecular diagnostic yield, the change in clinical management after the ultra-rapid exome sequencing report, the time from hospital admission to the laboratory report, and the proportion of laboratory reports returned prior to death or hospital discharge. RESULTS The study population included 108 patients with a median age of 28 days (range, 0 days to 17 years); 34% were female; and 57% were from neonatal intensive care units, 33% were from pediatric intensive care units, and 9% were from other hospital wards. The mean time from sample receipt to ultra-rapid exome sequencing report was 3.3 days (95% CI, 3.2-3.5 days) and the median time was 3 days (range, 2-7 days). The mean time from hospital admission to ultra-rapid exome sequencing report was 17.5 days (95% CI, 14.6-21.1 days) and 93 reports (86%) were issued prior to death or hospital discharge. A molecular diagnosis was established in 55 patients (51%). Eleven diagnoses (20%) resulted from using the following approaches to augment standard exome sequencing analysis: mitochondrial genome sequencing analysis, exome sequencing-based copy number analysis, use of international databases to identify novel gene-disease associations, and additional phenotyping and RNA analysis. In 42 of 55 patients (76%) with a molecular diagnosis and 6 of 53 patients (11%) without a molecular diagnosis, the ultra-rapid exome sequencing result was considered as having influenced clinical management. Targeted treatments were initiated in 12 patients (11%), treatment was redirected toward palliative care in 14 patients (13%), and surveillance for specific complications was initiated in 19 patients (18%). CONCLUSIONS AND RELEVANCE This study suggests feasibility of ultra-rapid genomic testing in critically ill pediatric patients with suspected monogenic conditions in the Australian public health care system. However, further research is needed to understand the clinical value of such testing, and the generalizability of the findings to other health care settings.
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Affiliation(s)
| | - Sebastian Lunke
- Australian Genomics Health Alliance, Parkville, Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Stefanie Eggers
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Meredith Wilson
- Sydney Children's Hospitals Network-Westmead, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Chirag Patel
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Jason Pinner
- Sydney Children's Hospitals Network-Randwick, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Sarah A Sandaradura
- Sydney Children's Hospitals Network-Westmead, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Michael F Buckley
- NSW Health Pathology Randwick Genomics Laboratory, Sydney, Australia
| | - Emma I Krzesinski
- Monash Genetics, Monash Health, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Michelle G de Silva
- Australian Genomics Health Alliance, Parkville, Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Gemma R Brett
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Kirsten Boggs
- Australian Genomics Health Alliance, Parkville, Australia
- Sydney Children's Hospitals Network-Westmead, Sydney, Australia
- Sydney Children's Hospitals Network-Randwick, Sydney, Australia
| | - David Mowat
- Sydney Children's Hospitals Network-Randwick, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Edwin P Kirk
- Sydney Children's Hospitals Network-Randwick, Sydney, Australia
- University of New South Wales, Sydney, Australia
- NSW Health Pathology Randwick Genomics Laboratory, Sydney, Australia
| | - Lesley C Adès
- Sydney Children's Hospitals Network-Westmead, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Lauren S Akesson
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Monash Genetics, Monash Health, Melbourne, Australia
| | - David J Amor
- University of Melbourne, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Samantha Ayres
- Australian Genomics Health Alliance, Parkville, Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Anne Baxendale
- Women's and Children's Hospital, North Adelaide, Australia
| | - Sarah Borrie
- Women's and Children's Hospital, North Adelaide, Australia
| | - Alessandra Bray
- Australian Genomics Health Alliance, Parkville, Australia
- Sydney Children's Hospitals Network-Westmead, Sydney, Australia
- Sydney Children's Hospitals Network-Randwick, Sydney, Australia
| | - Natasha J Brown
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Cheng Yee Chan
- NSW Health Pathology Randwick Genomics Laboratory, Sydney, Australia
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Belinda Chong
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Corrina Cliffe
- NSW Health Pathology Randwick Genomics Laboratory, Sydney, Australia
| | - Martin B Delatycki
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Matthew Edwards
- Hunter Genetics, Newcastle, Australia
- Department of Paediatrics, School of Medicine, University of Western Sydney, Sydney, Australia
| | - George Elakis
- NSW Health Pathology Randwick Genomics Laboratory, Sydney, Australia
| | - Michael C Fahey
- Monash Genetics, Monash Health, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Andrew Fennell
- Monash Genetics, Monash Health, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Lindsay Fowles
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Lyndon Gallacher
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Megan Higgins
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Australia
| | - Katherine B Howell
- University of Melbourne, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Lauren Hunt
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Australia
| | - Matthew F Hunter
- Monash Genetics, Monash Health, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Kristi J Jones
- Sydney Children's Hospitals Network-Westmead, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Sarah King
- Australian Genomics Health Alliance, Parkville, Australia
- Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide
| | - Smitha Kumble
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Sarah Lang
- NSW Health Pathology Randwick Genomics Laboratory, Sydney, Australia
| | - Maelle Le Moing
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Alan Ma
- Sydney Children's Hospitals Network-Westmead, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Dean Phelan
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Michael C J Quinn
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Anna Richards
- NSW Health Pathology Randwick Genomics Laboratory, Sydney, Australia
| | - Christopher M Richmond
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jessica Riseley
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jonathan Rodgers
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Rani Sachdev
- Sydney Children's Hospitals Network-Randwick, Sydney, Australia
| | - Simon Sadedin
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, Child Health Research Centre, the University of Queensland and Queensland Children's Hospital, Brisbane, Australia
| | - Janine Smith
- Sydney Children's Hospitals Network-Westmead, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Amanda Springer
- Monash Genetics, Monash Health, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Natalie B Tan
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Tiong Y Tan
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Suzanna L Temple
- NSW Health Pathology Randwick Genomics Laboratory, Sydney, Australia
| | - Christiane Theda
- University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Royal Women's Hospital, Melbourne, Australia
| | | | - Susan M White
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Alison Yeung
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- Monash Genetics, Monash Health, Melbourne, Australia
| | - Ying Zhu
- NSW Health Pathology Randwick Genomics Laboratory, Sydney, Australia
| | - Melissa Martyn
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne Genomics Health Alliance, Melbourne, Australia
| | - Stephanie Best
- Australian Genomics Health Alliance, Parkville, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney
| | - Tony Roscioli
- University of New South Wales, Sydney, Australia
- NSW Health Pathology Randwick Genomics Laboratory, Sydney, Australia
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - John Christodoulou
- Australian Genomics Health Alliance, Parkville, Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- University of Sydney, Sydney, Australia
| | - Zornitza Stark
- Australian Genomics Health Alliance, Parkville, Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
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108
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Schlapbach LJ, Trück J, Roger T. Editorial: The Immunology of Sepsis-Understanding Host Susceptibility, Pathogenesis of Disease, and Avenues for Future Treatment. Front Immunol 2020; 11:1263. [PMID: 32655563 PMCID: PMC7324471 DOI: 10.3389/fimmu.2020.01263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 05/19/2020] [Indexed: 12/29/2022] Open
Affiliation(s)
- Luregn J Schlapbach
- Paediatric Critical Care Research Group, Paediatric Intensive Care Unit, Child Health Research Centre, Queensland Children's Hospital, The University of Queensland, Brisbane, QLD, Australia.,University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Johannes Trück
- University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Thierry Roger
- Lausanne University Hospital and University of Lausanne, Epalinges, Switzerland
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109
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Babl FE, Franklin D, Schlapbach LJ, Oakley E, Dalziel S, Whitty JA, Neutze J, Furyk J, Craig S, Fraser JF, Jones M, Schibler A. Enteral hydration in high-flow therapy for infants with bronchiolitis: Secondary analysis of a randomised trial. J Paediatr Child Health 2020; 56:950-955. [PMID: 32043304 DOI: 10.1111/jpc.14799] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/22/2019] [Accepted: 01/05/2020] [Indexed: 11/29/2022]
Abstract
AIM Nasal high-flow oxygen therapy is increasingly used in infants for supportive respiratory therapy in bronchiolitis. It is unclear whether enteral hydration is safe in children receiving high-flow. METHODS We performed a planned secondary analysis of a multi-centre, randomised controlled trial of infants aged <12 months with bronchiolitis and an oxygen requirement. Children were assigned to treatment with either high-flow or standard-oxygen therapy with optional rescue high-flow. We assessed adverse events based on how children on high-flow were hydrated: intravenously (IV), via bolus or continuous nasogastric tube (NGT) or orally. RESULTS A total of 505 patients on high-flow via primary study assignment (n = 408), primary treatment (n = 10) or as rescue therapy (n = 87) were assessed. While on high flow, 15 of 505 (3.0%) received only IV fluids, 360 (71.3%) received only enteral fluids and 93 (18.4%) received both IV and enteral fluids. The route was unknown in 37 (7.3%). Of the 453 high-flow infants hydrated enterally patients could receive one or more methods of hydration; 80 (15.8%) received NGT bolus, 217 (43.0%) NGT continuous, 118 (23.4%) both bolus and continuous, 32 (6.3%) received only oral hydration and 171 (33.9%) a mix of NGT and oral hydration. None of the patients receiving oral or NGT hydration on high-flow sustained pulmonary aspiration (0%; 95% confidence interval N/A); one patient had a pneumothorax (0.2%; 95% confidence interval 0.0-0.7%). CONCLUSIONS The vast majority of children with hypoxic respiratory failure in bronchiolitis can be safely hydrated enterally during the period when they receive high-flow.
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Affiliation(s)
- Franz E Babl
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Donna Franklin
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.,Pediatric Critical Care Research Group, Queensland Children's Hospital and The University of Queensland, Brisbane, Queensland, Australia.,Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Critical Care Research Group, Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Luregn J Schlapbach
- Pediatric Critical Care Research Group, Queensland Children's Hospital and The University of Queensland, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Critical Care Research Group, Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Ed Oakley
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Stuart Dalziel
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.,Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jennifer A Whitty
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Jocelyn Neutze
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.,Emergency Department, KidzFirst Middlemore Hospital, Auckland, New Zealand
| | - Jeremy Furyk
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.,College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia
| | - Simon Craig
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.,Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.,Paediatric Emergency Department, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
| | - John F Fraser
- Pediatric Critical Care Research Group, Queensland Children's Hospital and The University of Queensland, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Mark Jones
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Andreas Schibler
- Pediatric Critical Care Research Group, Queensland Children's Hospital and The University of Queensland, Brisbane, Queensland, Australia.,Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
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110
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Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP, Nadel S, Schlapbach LJ, Tasker RC, Argent AC, Brierley J, Carcillo J, Carrol ED, Carroll CL, Cheifetz IM, Choong K, Cies JJ, Cruz AT, De Luca D, Deep A, Faust SN, De Oliveira CF, Hall MW, Ishimine P, Javouhey E, Joosten KFM, Joshi P, Karam O, Kneyber MCJ, Lemson J, MacLaren G, Mehta NM, Møller MH, Newth CJL, Nguyen TC, Nishisaki A, Nunnally ME, Parker MM, Paul RM, Randolph AG, Ranjit S, Romer LH, Scott HF, Tume LN, Verger JT, Williams EA, Wolf J, Wong HR, Zimmerman JJ, Kissoon N, Tissieres P. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med 2020; 21:e52-e106. [PMID: 32032273 DOI: 10.1097/pcc.0000000000002198] [Citation(s) in RCA: 458] [Impact Index Per Article: 114.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction. DESIGN A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. METHODS The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. RESULTS The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 52 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 49 research priorities were identified. CONCLUSIONS A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research.
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Affiliation(s)
- Scott L Weiss
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Mark J Peters
- Great Ormond Street Hospital for Children, London, United Kingdom
| | - Waleed Alhazzani
- Department of Medicine, Division of Critical Care, and Department of Health Research Methods and Impact, McMaster University, Hamilton, ON, Canada
| | - Michael S D Agus
- Department of Pediatrics (to Dr. Agus), Department of Anesthesiology, Critical Care and Pain (to Drs. Mehta and Randolph), Boston Children's Hospital and Harvard Medical School, Boston, MA
| | | | | | | | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, The University of Queensland and Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Robert C Tasker
- Department of Pediatrics (to Dr. Agus), Department of Anesthesiology, Critical Care and Pain (to Drs. Mehta and Randolph), Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Andrew C Argent
- Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - Joe Brierley
- Great Ormond Street Hospital for Children, London, United Kingdom
| | | | | | | | | | - Karen Choong
- Department of Medicine, Division of Critical Care, and Department of Health Research Methods and Impact, McMaster University, Hamilton, ON, Canada
| | - Jeffry J Cies
- St. Christopher's Hospital for Children, Philadelphia, PA
| | | | - Daniele De Luca
- Paris South University Hospitals-Assistance Publique Hopitaux de Paris, Paris, France.,Physiopathology and Therapeutic Innovation Unit-INSERM U999, South Paris-Saclay University, Paris, France
| | - Akash Deep
- King's College Hospital, London, United Kingdom
| | - Saul N Faust
- University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
| | | | - Mark W Hall
- Nationwide Children's Hospital, Columbus, OH
| | | | | | | | - Poonam Joshi
- All India Institute of Medical Sciences, New Delhi, India
| | - Oliver Karam
- Children's Hospital of Richmond at VCU, Richmond, VA
| | | | - Joris Lemson
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Graeme MacLaren
- National University Health System, Singapore, and Royal Children's Hospital, Melbourne, VIC, Australia
| | - Nilesh M Mehta
- Department of Pediatrics (to Dr. Agus), Department of Anesthesiology, Critical Care and Pain (to Drs. Mehta and Randolph), Boston Children's Hospital and Harvard Medical School, Boston, MA
| | | | | | | | - Akira Nishisaki
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | | | | | - Adrienne G Randolph
- Department of Pediatrics (to Dr. Agus), Department of Anesthesiology, Critical Care and Pain (to Drs. Mehta and Randolph), Boston Children's Hospital and Harvard Medical School, Boston, MA
| | | | | | | | - Lyvonne N Tume
- University of the West of England, Bristol, United Kingdom
| | - Judy T Verger
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.,College of Nursing, University of Iowa, Iowa City, IA
| | | | - Joshua Wolf
- St. Jude Children's Research Hospital, Memphis, TN
| | | | | | - Niranjan Kissoon
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Pierre Tissieres
- Paris South University Hospitals-Assistance Publique Hopitaux de Paris, Paris, France.,Institute of Integrative Biology of the Cell-CNRS, CEA, Univ Paris Sud, Gif-sur-Yvette, France
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111
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Zandstra J, van de Geer A, Tanck MWT, van Stijn-Bringas Dimitriades D, Aarts CEM, Dietz SM, van Bruggen R, Schweintzger NA, Zenz W, Emonts M, Zavadska D, Pokorn M, Usuf E, Moll HA, Schlapbach LJ, Carrol ED, Paulus S, Tsolia M, Fink C, Yeung S, Shimizu C, Tremoulet A, Galassini R, Wright VJ, Martinón-Torres F, Herberg J, Burns J, Levin M, Kuijpers TW. Biomarkers for the Discrimination of Acute Kawasaki Disease From Infections in Childhood. Front Pediatr 2020; 8:355. [PMID: 32775314 PMCID: PMC7388698 DOI: 10.3389/fped.2020.00355] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/28/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Kawasaki disease (KD) is a vasculitis of early childhood mimicking several infectious diseases. Differentiation between KD and infectious diseases is essential as KD's most important complication-the development of coronary artery aneurysms (CAA)-can be largely avoided by timely treatment with intravenous immunoglobulins (IVIG). Currently, KD diagnosis is only based on clinical criteria. The aim of this study was to evaluate whether routine C-reactive protein (CRP) and additional inflammatory parameters myeloid-related protein 8/14 (MRP8/14 or S100A8/9) and human neutrophil-derived elastase (HNE) could distinguish KD from infectious diseases. Methods and Results: The cross-sectional study included KD patients and children with proven infections as well as febrile controls. Patients were recruited between July 2006 and December 2018 in Europe and USA. MRP8/14, CRP, and HNE were assessed for their discriminatory ability by multiple logistic regression analysis with backward selection and receiver operator characteristic (ROC) curves. In the discovery cohort, the combination of MRP8/14+CRP discriminated KD patients (n = 48) from patients with infection (n = 105), with area under the ROC curve (AUC) of 0.88. The HNE values did not improve discrimination. The first validation cohort confirmed the predictive value of MRP8/14+CRP to discriminate acute KD patients (n = 26) from those with infections (n = 150), with an AUC of 0.78. The second validation cohort of acute KD patients (n = 25) and febrile controls (n = 50) showed an AUC of 0.72, which improved to 0.84 when HNE was included. Conclusion: When used in combination, the plasma markers MRP8/14, CRP, and HNE may assist in the discrimination of KD from both proven and suspected infection.
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Affiliation(s)
- Judith Zandstra
- Sanquin Research and Landsteiner Laboratory, Department of Immunopathology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Annemarie van de Geer
- Sanquin Research and Landsteiner Laboratory, Department of Blood Cell Research, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Michael W T Tanck
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Diana van Stijn-Bringas Dimitriades
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Cathelijn E M Aarts
- Sanquin Research and Landsteiner Laboratory, Department of Blood Cell Research, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Sanne M Dietz
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Robin van Bruggen
- Sanquin Research and Landsteiner Laboratory, Department of Blood Cell Research, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Nina A Schweintzger
- Department of General Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Werner Zenz
- Department of General Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Marieke Emonts
- Pediatric Infectious Diseases and Immunology Department, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Dace Zavadska
- Department of Pediatrics, Riga Stradins University, Riga, Latvia
| | - Marko Pokorn
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Effua Usuf
- Medical Research Council Unit the Gambia (MRCG) at LSHTM, Serrekunda, Gambia
| | - Henriette A Moll
- Department of General Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Luregn J Schlapbach
- Pediatric Intensive Care Unit, Lady Cilento Children's Hospital, Pediatric Critical Care Research Group, Brisbane, QLD, Australia
| | - Enitan D Carrol
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool Institute of Infection and Global Health, Liverpool, United Kingdom
| | - Stephane Paulus
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool Institute of Infection and Global Health, Liverpool, United Kingdom
| | - Maria Tsolia
- Second Department of Pediatrics, P. & A. Kyriakou Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Colin Fink
- Micropathology Ltd., University of Warwick, Warwick, United Kingdom
| | - Shunmay Yeung
- Department of Clinical Research, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Section of Paediatric Infectious Diseases, Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Chisato Shimizu
- Kawasaki Disease Research Center, Rady's Children's Hospital-San Diego, University of California, San Diego, San Diego, CA, United States
| | - Adriana Tremoulet
- Kawasaki Disease Research Center, Rady's Children's Hospital-San Diego, University of California, San Diego, San Diego, CA, United States
| | - Rachel Galassini
- Section of Paediatric Infectious Diseases, Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Victoria J Wright
- Section of Paediatric Infectious Diseases, Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago, University of Santiago, Santiago de Compostela, Spain
| | - Jethro Herberg
- Section of Paediatric Infectious Diseases, Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Jane Burns
- Kawasaki Disease Research Center, Rady's Children's Hospital-San Diego, University of California, San Diego, San Diego, CA, United States
| | - Michael Levin
- Section of Paediatric Infectious Diseases, Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Taco W Kuijpers
- Sanquin Research and Landsteiner Laboratory, Department of Blood Cell Research, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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112
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Affiliation(s)
- Eric Giannoni
- Department Mother-Woman-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Luregn J Schlapbach
- Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.,Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, QLD, Australia.,Pediatric and Neonatal Intensive Care Unit, Children's Research Center, University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland
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113
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Schlapbach LJ, Chiletti R, Straney L, Festa M, Alexander D, Butt W, MacLaren G. Defining benefit threshold for extracorporeal membrane oxygenation in children with sepsis-a binational multicenter cohort study. Crit Care 2019; 23:429. [PMID: 31888705 PMCID: PMC6937937 DOI: 10.1186/s13054-019-2685-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/26/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND The surviving sepsis campaign recommends consideration for extracorporeal membrane oxygenation (ECMO) in refractory septic shock. We aimed to define the benefit threshold of ECMO in pediatric septic shock. METHODS Retrospective binational multicenter cohort study of all ICUs contributing to the Australian and New Zealand Paediatric Intensive Care Registry. We included patients < 16 years admitted to ICU with sepsis and septic shock between 2002 and 2016. Sepsis-specific risk-adjusted models to establish ECMO benefit thresholds with mortality as the primary outcome were performed. Models were based on clinical variables available early after admission to ICU. Multivariate analyses were performed to identify predictors of survival in children treated with ECMO. RESULTS Five thousand sixty-two children with sepsis and septic shock met eligibility criteria, of which 80 (1.6%) were treated with veno-arterial ECMO. A model based on 12 clinical variables predicted mortality with an AUROC of 0.879 (95% CI 0.864-0.895). The benefit threshold was calculated as 47.1% predicted risk of mortality. The observed mortality for children treated with ECMO below the threshold was 41.8% (23 deaths), compared to a predicted mortality of 30.0% as per the baseline model (16.5 deaths; standardized mortality rate 1.40, 95% CI 0.89-2.09). Among patients above the benefit threshold, the observed mortality was 52.0% (13 deaths) compared to 68.2% as per the baseline model (16.5 deaths; standardized mortality rate 0.61, 95% CI 0.39-0.92). Multivariable analyses identified lower lactate, the absence of cardiac arrest prior to ECMO, and the central cannulation (OR 0.31, 95% CI 0.10-0.98, p = 0.046) as significant predictors of survival for those treated with VA-ECMO. CONCLUSIONS This binational study demonstrates that a rapidly available sepsis mortality prediction model can define thresholds for survival benefit in children with septic shock considered for ECMO. Survival on ECMO was associated with central cannulation. Our findings suggest that a fully powered RCT on ECMO in sepsis is unlikely to be feasible.
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Affiliation(s)
- Luregn J Schlapbach
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Australia. .,Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, 4101, Australia. .,Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Roberto Chiletti
- University of Melbourne, Melbourne, Australia.,Paediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia
| | - Lahn Straney
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Marino Festa
- Paediatric Intensive Care Unit, Children's Hospital Westmead, Sydney, Australia.,Kids Critical Care Research Group, Kids Research, Sydney Children's Hospitals Network, Sydney, Australia
| | - Daniel Alexander
- Paediatric Intensive Care Unit, Perth Children's Hospital, Perth, Australia
| | - Warwick Butt
- Paediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia
| | - Graeme MacLaren
- Paediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia.,Cardiothoracic Intensive Care Unit, National University Health System, Singapore, Singapore
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114
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Franklin D, Shellshear D, Babl FE, Schlapbach LJ, Oakley E, Borland ML, Hoeppner T, George S, Craig S, Neutze J, Williams A, Acworth J, McCay H, Wallace A, Mattes J, Gangathimn V, Wildman M, Fraser JF, Moloney S, Gavranich J, Waugh J, Hobbins S, Fahy R, Grew S, Gannon B, Gibbons K, Dalziel S, Schibler A. Multicentre, randomised trial to investigate early nasal high-flow therapy in paediatric acute hypoxaemic respiratory failure: a protocol for a randomised controlled trial-a Paediatric Acute respiratory Intervention Study (PARIS 2). BMJ Open 2019; 9:e030516. [PMID: 31857300 PMCID: PMC6937038 DOI: 10.1136/bmjopen-2019-030516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Acute hypoxaemic respiratory failure (AHRF) in children is the most frequent reason for non-elective hospital admission. During the initial phase, AHRF is a clinical syndrome defined for the purpose of this study by an oxygen requirement and caused by pneumonia, lower respiratory tract infections, asthma or bronchiolitis. Up to 20% of these children with AHRF can rapidly deteriorate requiring non-invasive or invasive ventilation. Nasal high-flow (NHF) therapy has been used by clinicians for oxygen therapy outside intensive care settings to prevent escalation of care. A recent randomised trial in infants with bronchiolitis has shown that NHF therapy reduces the need to escalate therapy. No similar data is available in the older children presenting with AHRF. In this study we aim to investigate in children aged 1 to 4 years presenting with AHRF if early NHF therapy compared with standard-oxygen therapy reduces hospital length of stay and if this is cost-effective compared with standard treatment. METHODS AND ANALYSIS The study design is an open-labelled randomised multicentre trial comparing early NHF and standard-oxygen therapy and will be stratified by sites and into obstructive and non-obstructive groups. Children aged 1 to 4 years (n=1512) presenting with AHRF to one of the participating emergency departments will be randomly allocated to NHF or standard-oxygen therapy once the eligibility criteria have been met (oxygen requirement with transcutaneous saturation <92%/90% (dependant on hospital standard threshold), diagnosis of AHRF, admission to hospital and tachypnoea ≥35 breaths/min). Children in the standard-oxygen group can receive rescue NHF therapy if escalation is required. The primary outcome is hospital length of stay. Secondary outcomes will include length of oxygen therapy, proportion of intensive care admissions, healthcare resource utilisation and associated costs. Analyses will be conducted on an intention-to-treat basis. ETHICS AND DISSEMINATION Ethics approval has been obtained in Australia (HREC/15/QRCH/159) and New Zealand (HDEC 17/NTA/135). The trial commenced recruitment in December 2017. The study findings will be submitted for publication in a peer-reviewed journal and presented at relevant conferences. Authorship of all publications will be decided by mutual consensus of the research team. TRIAL REGISTRATION NUMBER ACTRN12618000210279.
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Affiliation(s)
- Donna Franklin
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- School of Medicine, The University Of Queensland, St Lucia, Queensland, Australia
- Mater Medical Research Institute, South Brisbane, Queensland, Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
| | - Deborah Shellshear
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Franz E Babl
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Royal Childrens Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Melbourne, Victoria, Australia
| | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- School of Medicine, The University Of Queensland, St Lucia, Queensland, Australia
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Ed Oakley
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Royal Childrens Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Melbourne, Victoria, Australia
| | - Meredith L Borland
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia
- University of Western Australia, School of Medicine, Divisions of Emergency Medicine and Paediatrics, Crawley, Western Australia, Australia
| | - Tobias Hoeppner
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia
| | - Shane George
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- School of Medicine, The University Of Queensland, St Lucia, Queensland, Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Simon Craig
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Monash Medical Centre Clayton, Clayton, Victoria, Australia
- Department of Medicine, School of Clinical Science, Monash University, Clayton, Victoria, Australia
| | - Jocelyn Neutze
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- KidzFirst Middlemore Emergency Department, Middlemore Hospital, Auckland, New Zealand
- University of Auckland, Auckland, New Zealand
| | - Amanda Williams
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Royal Childrens Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jason Acworth
- School of Medicine, The University Of Queensland, St Lucia, Queensland, Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Hamish McCay
- Paediatrics, Waikato Hospital, Hamilton, New Zealand
| | - Alex Wallace
- Paediatrics, Waikato Hospital, Hamilton, New Zealand
| | - Joerg Mattes
- Paediatrics, John Hunter Children's Hospital, Hunter Region Mail Centre, New South Wales, Australia
- University of Newcastle, Priority Research Centre GrowUpWell, Callaghan, New South Wales, Australia
| | - Vinay Gangathimn
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Townsville General Hospital, Townsville, Queensland, Australia
| | - Mark Wildman
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Townsville General Hospital, Townsville, Queensland, Australia
| | - John F Fraser
- Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Queensland, Australia
| | - Susan Moloney
- Paediatric Department, Gold Coast University Hospital, Southport, Queensland, Australia
| | - John Gavranich
- Paediatrics, Ipswich Hospital, Ipswich, Queensland, Australia
| | - John Waugh
- Paediatrics, Caboolture Hospital, Caboolture, Queensland, Australia
| | - Sue Hobbins
- Paediatrics, Prince Charles Hospital, Chermside, Queensland, Australia
| | - Rose Fahy
- Paediatrics, Prince Charles Hospital, Chermside, Queensland, Australia
| | - Simon Grew
- Paediatrics, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Brenda Gannon
- The University of Queensland, Centre for Business and Economics of Health, St Lucia Qld, Queensland, Australia
| | - Kristen Gibbons
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Mater Medical Research Institute, South Brisbane, Queensland, Australia
| | - Stuart Dalziel
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- University of Auckland, Auckland, New Zealand
- Starship Children's Health, Emergency Department, Newmarket, New Zealand
- Department of Surgery and Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Andreas Schibler
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- School of Medicine, The University Of Queensland, St Lucia, Queensland, Australia
- Mater Medical Research Institute, South Brisbane, Queensland, Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
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115
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Wang X, Nijman R, Camuzeaux S, Sands C, Jackson H, Kaforou M, Emonts M, Herberg JA, Maconochie I, Carrol ED, Paulus SC, Zenz W, Van der Flier M, de Groot R, Martinon-Torres F, Schlapbach LJ, Pollard AJ, Fink C, Kuijpers TT, Anderson S, Lewis MR, Levin M, McClure M. Plasma lipid profiles discriminate bacterial from viral infection in febrile children. Sci Rep 2019; 9:17714. [PMID: 31776453 PMCID: PMC6881435 DOI: 10.1038/s41598-019-53721-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/03/2019] [Indexed: 11/16/2022] Open
Abstract
Fever is the most common reason that children present to Emergency Departments. Clinical signs and symptoms suggestive of bacterial infection are often non-specific, and there is no definitive test for the accurate diagnosis of infection. The 'omics' approaches to identifying biomarkers from the host-response to bacterial infection are promising. In this study, lipidomic analysis was carried out with plasma samples obtained from febrile children with confirmed bacterial infection (n = 20) and confirmed viral infection (n = 20). We show for the first time that bacterial and viral infection produces distinct profile in the host lipidome. Some species of glycerophosphoinositol, sphingomyelin, lysophosphatidylcholine and cholesterol sulfate were higher in the confirmed virus infected group, while some species of fatty acids, glycerophosphocholine, glycerophosphoserine, lactosylceramide and bilirubin were lower in the confirmed virus infected group when compared with confirmed bacterial infected group. A combination of three lipids achieved an area under the receiver operating characteristic (ROC) curve of 0.911 (95% CI 0.81 to 0.98). This pilot study demonstrates the potential of metabolic biomarkers to assist clinicians in distinguishing bacterial from viral infection in febrile children, to facilitate effective clinical management and to the limit inappropriate use of antibiotics.
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Affiliation(s)
- Xinzhu Wang
- Department of Infectious Disease, Imperial College London, London, W2 1PG, United Kingdom
| | - Ruud Nijman
- Department of Infectious Disease, Imperial College London, London, W2 1PG, United Kingdom
| | - Stephane Camuzeaux
- National Phenome Centre and Imperial Clinical Phenotyping Centre, Department of Metabolism, Digestion and Reproduction, IRDB Building, Du Cane Road, Imperial College London, London, W12 0NN, United Kingdom
| | - Caroline Sands
- National Phenome Centre and Imperial Clinical Phenotyping Centre, Department of Metabolism, Digestion and Reproduction, IRDB Building, Du Cane Road, Imperial College London, London, W12 0NN, United Kingdom
| | - Heather Jackson
- Department of Infectious Disease, Imperial College London, London, W2 1PG, United Kingdom
| | - Myrsini Kaforou
- Department of Infectious Disease, Imperial College London, London, W2 1PG, United Kingdom
| | - Marieke Emonts
- Great North Children's Hospital, Paediatric Immunology, Infectious Diseases & Allergy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
- NIHR Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, NE4 5PL, United Kingdom
| | - Jethro A Herberg
- Department of Infectious Disease, Imperial College London, London, W2 1PG, United Kingdom
| | - Ian Maconochie
- Department of Paediatric Emergency Medicine, St Mary's Hospital, Imperial College NHS Healthcare Trust, London, W2 1NY, United Kingdom
| | - Enitan D Carrol
- Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, United Kingdom
- Department of Infectious Diseases, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP, United Kingdom
- Liverpool Health Partners, Liverpool, L3 5TF, United Kingdom
| | - Stephane C Paulus
- Department of Infectious Diseases, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP, United Kingdom
- Liverpool Health Partners, Liverpool, L3 5TF, United Kingdom
| | - Werner Zenz
- Department of General Paediatrics, Medical University of Graz, Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria
| | - Michiel Van der Flier
- Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, 3508 AB, The Netherlands
- Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital, and Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, 6500 HB, The Netherlands
| | - Ronald de Groot
- Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital, and Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, 6500 HB, The Netherlands
| | - Federico Martinon-Torres
- Genetic, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago and Universidad de Santiago de Compostela (USC), Galicia, Spain
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Galicia, 15706, Spain
| | - Luregn J Schlapbach
- Paediatirc Criticial Care Research Group, Child Health Research Centre, The University of Queensland and Paediatric Intensive Care Research Group, Queensland Children's Hospital, Brisbane, Australia
| | - Andrew J Pollard
- Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, OX3 9DU, United Kingdom
| | - Colin Fink
- Micropathology Ltd, University of Warwick, Warwick, CV4 7EZ, United Kingdom
| | - Taco T Kuijpers
- Division of Pediatric Hematology, Immunology and Infectious diseases, Emma Children's Hospital Academic Medical Center, Amsterdam, 1105 AZ, The Netherlands
| | - Suzanne Anderson
- Medical Research Council Unit at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Matthew R Lewis
- National Phenome Centre and Imperial Clinical Phenotyping Centre, Department of Metabolism, Digestion and Reproduction, IRDB Building, Du Cane Road, Imperial College London, London, W12 0NN, United Kingdom
| | - Michael Levin
- Department of Infectious Disease, Imperial College London, London, W2 1PG, United Kingdom
| | - Myra McClure
- Department of Infectious Disease, Imperial College London, London, W2 1PG, United Kingdom.
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116
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Achten NB, Klingenberg C, Benitz WE, Stocker M, Schlapbach LJ, Giannoni E, Bokelaar R, Driessen GJA, Brodin P, Uthaya S, van Rossum AMC, Plötz FB. Association of Use of the Neonatal Early-Onset Sepsis Calculator With Reduction in Antibiotic Therapy and Safety: A Systematic Review and Meta-analysis. JAMA Pediatr 2019; 173:1032-1040. [PMID: 31479103 PMCID: PMC6724419 DOI: 10.1001/jamapediatrics.2019.2825] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE The neonatal early-onset sepsis (EOS) calculator is a clinical risk stratification tool increasingly used to guide the use of empirical antibiotics for newborns. Evidence on the effectiveness and safety of the EOS calculator is essential to inform clinicians considering implementation. OBJECTIVE To assess the association between management of neonatal EOS guided by the neonatal EOS calculator (compared with conventional management strategies) and reduction in antibiotic therapy for newborns. DATA SOURCES Electronic searches in MEDLINE, Embase, Web of Science, and Google Scholar were conducted from 2011 (introduction of the EOS calculator model) through January 31, 2019. STUDY SELECTION All studies with original data that compared management guided by the EOS calculator with conventional management strategies for allocating antibiotic therapy to newborns suspected to have EOS were included. DATA EXTRACTION AND SYNTHESIS Following PRISMA-P guidelines, relevant data were extracted from full-text articles and supplements. CHARMS (Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies) and GRADE (Grades of Recommendation, Assessment, Development and Evaluation) tools were used to assess the risk of bias and quality of evidence. Meta-analysis using a random-effects model was conducted for studies with separate cohorts for EOS calculator and conventional management strategies. MAIN OUTCOMES AND MEASURES The difference in percentage of newborns treated with empirical antibiotics for suspected or proven EOS between management guided by the EOS calculator and conventional management strategies. Safety-related outcomes involved missed cases of EOS, readmissions, treatment delay, morbidity, and mortality. RESULTS Thirteen relevant studies analyzing a total of 175 752 newborns were included. All studies found a substantially lower relative risk (range, 3%-60%) for empirical antibiotic therapy, favoring the EOS calculator. Meta-analysis revealed a relative risk of antibiotic use of 56% (95% CI, 53%-59%) in before-after studies including newborns regardless of exposure to chorioamnionitis. Evidence on safety was limited, but proportions of missed cases of EOS were comparable between management guided by the EOS calculator (5 of 18 [28%]) and conventional management strategies (8 of 28 [29%]) (pooled odds ratio, 0.96; 95% CI, 0.26-3.52; P = .95). CONCLUSIONS AND RELEVANCE Use of the neonatal EOS calculator is associated with a substantial reduction in the use of empirical antibiotics for suspected EOS. Available evidence regarding safety of the use of the EOS calculator is limited, but shows no indication of inferiority compared with conventional management strategies.
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Affiliation(s)
- Niek B. Achten
- Department of Pediatrics, Tergooi Hospital, Blaricum, the Netherlands,Faculty of Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Claus Klingenberg
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway,Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | | | - Martin Stocker
- Department of Pediatrics, Children’s Hospital Lucerne, Lucerne, Switzerland
| | - Luregn J. Schlapbach
- Paediatric Critical Care Research Group, Child Health Research Centre, University of Queensland, Brisbane, Australia,Paediatric Intensive Care Unit, Queensland Children’s Hospital, Brisbane, Australia,Department of Pediatrics, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eric Giannoni
- Department Woman-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Robin Bokelaar
- Department of Pediatrics, Tergooi Hospital, Blaricum, the Netherlands
| | - Gertjan J. A. Driessen
- Department of Pediatrics, Juliana Children’s Hospital, Haga Teaching Hospital, The Hague, the Netherlands
| | - Petter Brodin
- Science for Life Laboratory, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Sabita Uthaya
- Section of Neonatal Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Annemarie M. C. van Rossum
- Department of Pediatrics, Erasmus University Medical Centre-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Frans B. Plötz
- Department of Pediatrics, Tergooi Hospital, Blaricum, the Netherlands
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117
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Schlapbach LJ, Berger C, Aebi C, Agyeman PKA. SIRS in the Time of Sepsis-3: What About the Children? Chest 2019; 153:1512. [PMID: 29884267 DOI: 10.1016/j.chest.2018.02.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Luregn J Schlapbach
- Faculty of Medicine, Mater Research Institute, University of Queensland, Brisbane, Australia; Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, Australia; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Children's Health Queensland, Brisbane, Australia; Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Christoph Aebi
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp K A Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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118
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Schlapbach LJ, Horton SB, Long DA, Beca J, Erickson S, Festa M, d’Udekem Y, Alphonso N, Winlaw D, Johnson K, Delzoppo C, van Loon K, Gannon B, Fooken J, Blumenthal A, Young P, Jones M, Butt W, Schibler A. Study protocol: NITric oxide during cardiopulmonary bypass to improve Recovery in Infants with Congenital heart defects (NITRIC trial): a randomised controlled trial. BMJ Open 2019; 9:e026664. [PMID: 31420383 PMCID: PMC6701583 DOI: 10.1136/bmjopen-2018-026664] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Congenital heart disease (CHD) is a major cause of infant mortality. Many infants with CHD require corrective surgery with most operations requiring cardiopulmonary bypass (CPB). CPB triggers a systemic inflammatory response which is associated with low cardiac output syndrome (LCOS), postoperative morbidity and mortality. Delivery of nitric oxide (NO) into CPB circuits can provide myocardial protection and reduce bypass-induced inflammation, leading to less LCOS and improved recovery. We hypothesised that using NO during CPB increases ventilator-free days (VFD) (the number of days patients spend alive and free from invasive mechanical ventilation up until day 28) compared with standard care. Here, we describe the NITRIC trial protocol. METHODS AND ANALYSIS The NITRIC trial is a randomised, double-blind, controlled, parallel-group, two-sided superiority trial to be conducted in six paediatric cardiac surgical centres. One thousand three-hundred and twenty infants <2 years of age undergoing cardiac surgery with CPB will be randomly assigned to NO at 20 ppm administered into the CPB oxygenator for the duration of CPB or standard care (no NO) in a 1:1 ratio with stratification by age (<6 and ≥6 weeks), single ventricle physiology (Y/N) and study centre. The primary outcome will be VFD to day 28. Secondary outcomes include a composite of LCOS, need for extracorporeal membrane oxygenation or death within 28 days of surgery; length of stay in intensive care and in hospital; and, healthcare costs. Analyses will be conducted on an intention-to-treat basis. Preplanned secondary analyses will investigate the impact of NO on host inflammatory profiles postsurgery. ETHICS AND DISSEMINATION The study has ethical approval (HREC/17/QRCH/43, dated 26 April 2017), is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12617000821392) and commenced recruitment in July 2017. The primary manuscript will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ACTRN12617000821392.
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Affiliation(s)
- Luregn J Schlapbach
- Paediatric Critical Care Research Group, Child Health Research Institute, The University of Queensland, Brisbane, Queensland, Australia
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Children’s Health Queensland, Brisbane, Queensland, Australia
| | - Stephen Brian Horton
- Cardiac Surgical Unit, Royal Children’s Hospital, Melbourne, Victoria, Australia
- Faculty of Medicine, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Debbie Amanda Long
- Paediatric Critical Care Research Group, Child Health Research Institute, The University of Queensland, Brisbane, Queensland, Australia
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Children’s Health Queensland, Brisbane, Queensland, Australia
| | - John Beca
- Paediatric Intensive Care Unit, Starship Children’s Hospital, Auckland, New Zealand
| | - Simon Erickson
- Paediatric Critical Care, Perth Children’s Hospital, Western Australia and The University of Western Australia, Crawley, Western Australia, Australia
| | - Marino Festa
- Kids Critical Care Research, Paediatric Intensive Care Unit, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- Sydney Children’s Hospital Network, Sydney, New South Wales, Australia
| | - Yves d’Udekem
- Department of Cardiac Surgery, Royal Children’s Hospital, Melbourne, Victoria, Australia
- Heart Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- School of Medicine, Children’s Health Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
| | - Nelson Alphonso
- Cardiac Surgery, Queensland Children’s Hospital, Brisbane, Queensland, Australia
| | - David Winlaw
- Heart Centre for Children, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
- Sydney Children’s Hospital Network and Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kerry Johnson
- Paediatric Critical Care Research Group, Child Health Research Institute, The University of Queensland, Brisbane, Queensland, Australia
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Children’s Health Queensland, Brisbane, Queensland, Australia
| | - Carmel Delzoppo
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Paediatric Intensive Care Unit, Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia
| | - Kim van Loon
- Division of Anaesthetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B Gannon
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Jonas Fooken
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Antje Blumenthal
- The Infection and Inflammation Group, The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia
| | - Paul Young
- The Intensive Care Research Programme, Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Mark Jones
- School of Public Health, Bond University, Gold Coast, Brisbane, Australia
| | - Warwick Butt
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Paediatric Intensive Care Unit, Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia
| | - Andreas Schibler
- Paediatric Critical Care Research Group, Child Health Research Institute, The University of Queensland, Brisbane, Queensland, Australia
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Children’s Health Queensland, Brisbane, Queensland, Australia
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119
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McKenna R, Joseph L, Sargent P, May M, Tozer S, Bialasiewicz S, Heney C, Schlapbach LJ, Clark JE. Paediatric intensive care admissions during the 2015-2016 Queensland human parechovirus outbreak. J Paediatr Child Health 2019; 55:968-974. [PMID: 30677199 DOI: 10.1111/jpc.14336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/15/2018] [Accepted: 11/18/2018] [Indexed: 01/06/2023]
Abstract
AIM The human parechovirus (HPeV) has emerged as a pathogen causing sepsis-like presentations in young infants, but there is a lack of data on HPeV presentations requiring intensive care support. We aimed to characterise the clinical presentation, disease severity, management and outcome of a population-based cohort of children with microbiologically confirmed HPeV infection requiring admission to paediatric intensive care units (PICUs) in Queensland, Australia during a recent outbreak. METHODS This was a multicentre retrospective study of children admitted to PICU between 1 January 2015 and 31 December 2016 with confirmed HPeV infection. RESULTS Thirty infants (median age 20 days) with HPeV genotype 3 were admitted to PICU, representing 16% of all children with HPeV admitted to hospital and 6.4% of non-elective PICU admissions in children <1 year of age. Children requiring PICU admission were younger than children admitted to hospital (P = 0.001). Apnoea, haemodynamic instability with tachycardia and seizures represented the main reasons for PICU admission. Eleven children (37%) required mechanical ventilation for a median duration of 62 h, 22 (73%) received fluid boluses and 7 (23%) were treated with vasoactive agents for a median duration of 53 h. Median length of stay was 2.62 days. A total of 24 children (80%) fulfilled sepsis criteria, 14 (47%) severe sepsis and 7 (23%) septic shock criteria. Eight (27%) had abnormal brain magnetic resonance imaging. No patient died. CONCLUSIONS We confirm that HPeV infection is an important cause of sepsis-like syndrome in infants with substantial associated morbidity. Optimal management and long-term outcomes require further investigation.
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Affiliation(s)
- Ronan McKenna
- Children's Critical Care Unit, Children's Research Collaborative Gold Coast University Hospital, Gold Coast, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Lindsay Joseph
- Department of Paediatrics, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Philip Sargent
- Children's Critical Care Unit, Children's Research Collaborative Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Meryta May
- Infection Management and Prevention Services, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Sarah Tozer
- Children's Health Queensland, Queensland Paediatric Infectious Diseases Laboratory, Brisbane, Queensland, Australia.,Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Seweryn Bialasiewicz
- Children's Health Queensland, Queensland Paediatric Infectious Diseases Laboratory, Brisbane, Queensland, Australia.,Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Claire Heney
- Department of Microbiology, Pathology Queensland, Brisbane, Queensland, Australia
| | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia.,Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Julia E Clark
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Infection Management and Prevention Services, Queensland Children's Hospital, Brisbane, Queensland, Australia
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120
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Affiliation(s)
| | - Kelly Thompson
- The George Institute for Global HealthUniversity of New South Wales Sydney NSW
| | - Simon R Finfer
- The George Institute for Global HealthUniversity of New South Wales Sydney NSW
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121
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Moynihan KM, Alexander PMA, Schlapbach LJ, Millar J, Jacobe S, Ravindranathan H, Croston EJ, Staffa SJ, Burns JP, Gelbart B. Epidemiology of childhood death in Australian and New Zealand intensive care units. Intensive Care Med 2019; 45:1262-1271. [DOI: 10.1007/s00134-019-05675-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/19/2019] [Indexed: 11/30/2022]
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122
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Schults JA, Long D, Pearson K, Takashima M, Baveas T, Schlapbach LJ, Macfarlane F, Ullman AJ. Insertion, management, and complications associated with arterial catheters in paediatric intensive care: A clinical audit. Aust Crit Care 2019; 33:326-332. [PMID: 31201037 DOI: 10.1016/j.aucc.2019.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 04/25/2019] [Accepted: 05/02/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Peripheral arterial catheters (PAC) are used for haemodynamic monitoring and blood sampling in paediatric critical care. Limited data are available regarding PAC insertion and management practices, and how they relate to device function and failure. This information is necessary to inform future interventional research. OBJECTIVES The primary objective of this study was to describe PAC insertion and management practices, and associated complications. Secondary objectives were to determine patient and clinical characteristics associated with risk of PAC successful insertion and failure. METHODS A prospective, observational study was conducted in the anaesthetic department and paediatric intensive care unit of a tertiary paediatric facility. Data were collected on PAC insertion, PAC management and PAC removal. Standard incidence and prevalence were calculated per 1,000 device days. Risk factors for multiple insertions and PAC failure were identified using Cox regression. RESULTS A total of 100 catheters in 89 children were examined capturing 472 device days. PACs were primarily inserted for blood sampling (78%) in the radial artery (78%) using ultrasound guidance (67%), with 31% inserted on first attempt. Heparin saline solution was used in 82% of devices. Median catheter dwell was 50.6 hours (IQR 24.0 - 158.0), with PAC failure occurring in 19 devices (20%), at a rate of 40.2 per 1000 catheter days (95% CI 25.7 - 63.1). Arm board immobilisation (HR 2.9; 95% CI 1.02-8.02; p = 0.05), higher PIM3 score (HR 1.06; 95% CI 1.03-1.09; p < 0.01) was associated with an increased the risk of PAC failure, and non-2% chlorhexidine antisepsis was associated with a decrease in PAC failure (HR 0.32; 95% CI 0.11-0.96; p = 0.04), in univariate analysis. CONCLUSIONS PAC insertion is challenging, and failure is common. Prospective clinical trial data is needed to identify high risk patient groups and to develop interventions which optimise practices, thereby reducing failure.
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Affiliation(s)
- Jessica A Schults
- Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Heath Institute Queensland, Griffith University, Queensland, Australia.
| | - Debbie Long
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia; Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Australia
| | - Kylie Pearson
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia; Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Australia
| | - Mari Takashima
- School of Nursing and Midwifery, Griffith University, Queensland, Australia; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Heath Institute Queensland, Griffith University, Queensland, Australia
| | - Thimitra Baveas
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia
| | - Luregn J Schlapbach
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia; Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Australia
| | - Fiona Macfarlane
- Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Queensland, Australia
| | - Amanda J Ullman
- School of Nursing and Midwifery, Griffith University, Queensland, Australia; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Heath Institute Queensland, Griffith University, Queensland, Australia
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123
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Borghini L, Png E, Binder A, Wright VJ, Pinnock E, de Groot R, Hazelzet J, Emonts M, Van der Flier M, Schlapbach LJ, Anderson S, Secka F, Salas A, Fink C, Carrol ED, Pollard AJ, Coin LJ, Kuijpers TW, Martinon-Torres F, Zenz W, Levin M, Hibberd ML, Davila S. Identification of regulatory variants associated with genetic susceptibility to meningococcal disease. Sci Rep 2019; 9:6966. [PMID: 31061469 PMCID: PMC6502852 DOI: 10.1038/s41598-019-43292-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 04/17/2019] [Indexed: 12/30/2022] Open
Abstract
Non-coding genetic variants play an important role in driving susceptibility to complex diseases but their characterization remains challenging. Here, we employed a novel approach to interrogate the genetic risk of such polymorphisms in a more systematic way by targeting specific regulatory regions relevant for the phenotype studied. We applied this method to meningococcal disease susceptibility, using the DNA binding pattern of RELA – a NF-kB subunit, master regulator of the response to infection – under bacterial stimuli in nasopharyngeal epithelial cells. We designed a custom panel to cover these RELA binding sites and used it for targeted sequencing in cases and controls. Variant calling and association analysis were performed followed by validation of candidate polymorphisms by genotyping in three independent cohorts. We identified two new polymorphisms, rs4823231 and rs11913168, showing signs of association with meningococcal disease susceptibility. In addition, using our genomic data as well as publicly available resources, we found evidences for these SNPs to have potential regulatory effects on ATXN10 and LIF genes respectively. The variants and related candidate genes are relevant for infectious diseases and may have important contribution for meningococcal disease pathology. Finally, we described a novel genetic association approach that could be applied to other phenotypes.
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Affiliation(s)
- Lisa Borghini
- Human Genetics, Genome Institute of Singapore, Singapore, Singapore. .,Infectious diseases, Genome Institute of Singapore, Singapore, Singapore.
| | - Eileen Png
- Infectious diseases, Genome Institute of Singapore, Singapore, Singapore
| | - Alexander Binder
- Department of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Victoria J Wright
- Section for Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London, UK
| | - Ellie Pinnock
- Micropathology Ltd, University of Warwick, Warwick, UK
| | - Ronald de Groot
- Department of Pediatrics and Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Hazelzet
- Department of Pediatrics, Erasmus Medical Center-Sophia Children's hospital, University Medical Center, Rotterdam, The Netherlands
| | - Marieke Emonts
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.,Paediatric Infectious Diseases and Immunology Department, Newcastle upon Tyne Hospitals Foundation Trust, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
| | - Michiel Van der Flier
- Department of Pediatrics and Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Luregn J Schlapbach
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, Australia.,Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, Australia.,Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Fatou Secka
- Medical Research Council Unit Gambia, Banjul, The Gambia
| | - Antonio Salas
- Unidade de Xenética, Departamento de Anatomía Patolóxica e Ciencias Forenses, Instituto de Ciencias Forenses, Facultade de Medicina, Universidade de Santiago de Compostela, and GenPoB Research Group, Instituto de Investigaciones Sanitarias (IDIS), Hospital Clínico Universitario de Santiago, Galicia, Spain
| | - Colin Fink
- Micropathology Ltd, University of Warwick, Warwick, UK
| | - Enitan D Carrol
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Lachlan J Coin
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland, 4072, Australia
| | - Taco W Kuijpers
- Division of Pediatric Hematology, Immunology and Infectious diseases, Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands
| | - Federico Martinon-Torres
- Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.,GENVIP Research Group (www.genvip.org), Instituto de Investigación Sanitaria de Santiago, Galicia, Spain
| | - Werner Zenz
- Department of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Michael Levin
- Section for Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London, UK
| | - Martin L Hibberd
- Infectious diseases, Genome Institute of Singapore, Singapore, Singapore.,Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Sonia Davila
- Human Genetics, Genome Institute of Singapore, Singapore, Singapore. .,SingHealth Duke-NUS Institute of Precision Medicine (PRISM), Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore.
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124
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Affiliation(s)
- Luregn J Schlapbach
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Scott L Weiss
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia.,Pediatric Sepsis Program at the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joshua Wolf
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis
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125
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Schlapbach LJ, Gelbart B, Festa M, Kanthimathinathan HK, Peters MJ. Global paediatric critical care research: mind the gaps. Intensive Care Med 2019; 45:753-754. [PMID: 30840117 DOI: 10.1007/s00134-019-05571-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Luregn J Schlapbach
- Paediatric Critical Care Research Group, Child Health Research Center, Faculty of Medicine, The University of Queensland, Brisbane, Australia. .,Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, 4101, Australia.
| | - Ben Gelbart
- University of Melbourne, Melbourne, Australia.,Paediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia
| | - Marino Festa
- Paediatric Intensive Care Unit, Children's Hospital Westmead, Sydney, Australia.,Kids Critical Care Research Group, Kids Research, Sydney Children's Hospitals Network, Sydney, Australia
| | | | | | - M J Peters
- Respiratory, Critical Care and Anaesthesia Unit, University College London Great Ormond Street, Institute of Child Health, London, UK.,Paediatric Intensive Care Unit, Great Ormond St Hospital NHS Foundation Trust, London, UK
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126
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George S, Humphreys S, Williams T, Gelbart B, Chavan A, Rasmussen K, Ganeshalingham A, Erickson S, Ganu SS, Singhal N, Foster K, Gannon B, Gibbons K, Schlapbach LJ, Festa M, Dalziel S, Schibler A. Transnasal Humidified Rapid Insufflation Ventilatory Exchange in children requiring emergent intubation (Kids THRIVE): a protocol for a randomised controlled trial. BMJ Open 2019; 9:e025997. [PMID: 30787094 PMCID: PMC6398737 DOI: 10.1136/bmjopen-2018-025997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Emergency intubation of children with abnormal respiratory or cardiac physiology is a high-risk procedure and associated with a high incidence of adverse events including hypoxemia. Successful emergency intubation is dependent on inter-related patient and operator factors. Preoxygenation has been used to maximise oxygen reserves in the patient and to prolong the safe apnoeic time during the intubation phase. Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) prolongs the safe apnoeic window for a safe intubation during elective intubation. We designed a clinical trial to test the hypothesis that THRIVE reduces the frequency of adverse and hypoxemic events during emergency intubation in children and to test the hypothesis that this treatment is cost-effective compared with standard care. METHODS AND ANALYSIS The Kids THRIVE trial is a multicentre randomised controlled trial performed in participating emergency departments and paediatric intensive care units. 960 infants and children aged 0-16 years requiring emergency intubation for all reasons will be enrolled and allocated to THRIVE or control in a 1:1 allocation with stratification by site, age (<1, 1-7 and >7 years) and operator (junior and senior). Children allocated to THRIVE will receive weight appropriate transnasal flow rates with 100% oxygen, whereas children in the control arm will not receive any transnasal oxygen insufflation. The primary outcomes are defined as follows: (1) hypoxemic event during the intubation phase defined as SpO2 <90% (patient-dependent variable) and (2) first intubation attempt success without hypoxemia (operator-dependent variable). Analyses will be conducted on an intention-to-treat basis. ETHICS AND DISSEMINATION Ethics approval for the protocol and consent process has been obtained (HREC/16/QRCH/81). The trial has been actively recruiting since May 2017. The study findings will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ACTRN12617000147381.
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Affiliation(s)
- Shane George
- Children’s Critical Care Service, Gold Coast University Hospital, Southport, Queensland, Australia
- School of Medicine, Griffith University, Southport, Queensland, Australia
- Paediatric Critical Care Research Group (PCCRG), Queensland Children’s Hospital and The University of Queensland, Brisbane, Queensland, Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Paediatric Study Group, Australia and New Zealand Intensive Care Society (ANZICS PSG), Melbourne, Victoria, Australia
| | - Susan Humphreys
- Paediatric Critical Care Research Group (PCCRG), Queensland Children’s Hospital and The University of Queensland, Brisbane, Queensland, Australia
| | - Tara Williams
- Paediatric Critical Care Research Group (PCCRG), Queensland Children’s Hospital and The University of Queensland, Brisbane, Queensland, Australia
| | - Ben Gelbart
- Paediatric Intensive Care Unit, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Arjun Chavan
- Paediatric Intensive Care Unit, The Townsville Hospital, Townsville, Queensland, Australia
| | - Katie Rasmussen
- Critical Care Division, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- Paediatric Emergency Research Unit, Centre for Children’s Health Research, Children’s Health Queensland, Brisbane, Queensland, Australia
| | | | - Simon Erickson
- Paediatric Critical Care, Perth Children’s Hospital, Perth, Western Australia, Australia
| | - Subodh Suhas Ganu
- Department of Paediatric Critical Care Medicine, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia
| | - Nitesh Singhal
- Paediatric Intensive Care Unit, Royal Alexandra Hospital for Children, Westmead, New South Wales, Australia
| | - Kelly Foster
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Paediatric Emergency Research Unit, Centre for Children’s Health Research, Children’s Health Queensland, Brisbane, Queensland, Australia
| | - Brenda Gannon
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Kristen Gibbons
- Paediatric Critical Care Research Group (PCCRG), Queensland Children’s Hospital and The University of Queensland, Brisbane, Queensland, Australia
| | - Luregn J Schlapbach
- Paediatric Critical Care Research Group (PCCRG), Queensland Children’s Hospital and The University of Queensland, Brisbane, Queensland, Australia
| | - Marino Festa
- Paediatric Study Group, Australia and New Zealand Intensive Care Society (ANZICS PSG), Melbourne, Victoria, Australia
- Paediatric Intensive Care Unit, Royal Alexandra Hospital for Children, Westmead, New South Wales, Australia
| | - Stuart Dalziel
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Starship Children’s Hospital, Auckland, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Andreas Schibler
- Paediatric Critical Care Research Group (PCCRG), Queensland Children’s Hospital and The University of Queensland, Brisbane, Queensland, Australia
- Paediatric Study Group, Australia and New Zealand Intensive Care Society (ANZICS PSG), Melbourne, Victoria, Australia
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Franklin D, Babl FE, Gibbons K, Pham TMT, Hasan N, Schlapbach LJ, Oakley E, Craig S, Furyk J, Neutze J, Moloney S, Gavranich J, Shirkhedkar P, Kapoor V, Grew S, Fraser JF, Dalziel S, Schibler A. Nasal High Flow in Room Air for Hypoxemic Bronchiolitis Infants. Front Pediatr 2019; 7:426. [PMID: 31709201 PMCID: PMC6823186 DOI: 10.3389/fped.2019.00426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/04/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Bronchiolitis is the most common reason for hospital admission in infants, with one third requiring oxygen therapy due to hypoxemia. It is unknown what proportion of hypoxemic infants with bronchiolitis can be managed with nasal high-flow in room air and their resulting outcomes. Objectives and Settings: To assess the effect of nasal high-flow in room air in a subgroup of infants with bronchiolitis allocated to high-flow therapy in a recent multicenter randomized controlled trial. Patients and Interventions: Infants allocated to the high-flow arm of the trial were initially treated with room air high-flow if saturations were ≥85%. Subsequently, if oxygen saturations did not increase to ≥92%, oxygen was added and FiO2 was titrated to increase the oxygen saturations. In this planned sub-study, infants treated during their entire hospital stay with high-flow room air only were compared to infants receiving either standard-oxygen or high-flow with oxygen. Baseline characteristics, hospital length of stay and length of oxygen therapy were compared. Findings: In the per protocol analysis 64 (10%) of 630 infants commenced on high-flow room air remained in room air only during the entire stay in hospital. These infants on high-flow room air were on average older and presented with moderate hypoxemia at presentation to hospital. Their length of respiratory support and length of stay was also significantly shorter. No pre-enrolment factors could be identified in a multivariable analysis. Conclusions: In a small sub-group of hypoxemic infants with bronchiolitis hypoxemia can be reversed with the application of high-flow in room air only. Trial registration: ACTRN12615001305516.
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Affiliation(s)
- Donna Franklin
- Paediatric Critical Care Research Group, Queensland Children's Hospital, The University of Queensland, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia.,Critical Care Research Group, Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, QLD, Australia.,Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC, Australia
| | - Franz E Babl
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC, Australia.,Royal Children's Hospital, Emergency Department, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Kristen Gibbons
- Paediatric Critical Care Research Group, Queensland Children's Hospital, The University of Queensland, Brisbane, QLD, Australia.,Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Trang M T Pham
- Paediatric Critical Care Research Group, Queensland Children's Hospital, The University of Queensland, Brisbane, QLD, Australia.,Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Nadia Hasan
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, Queensland Children's Hospital, The University of Queensland, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Ed Oakley
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC, Australia.,Royal Children's Hospital, Emergency Department, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Simon Craig
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC, Australia.,Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia.,Monash Medical Centre, Emergency Department, Melbourne, VIC, Australia
| | - Jeremy Furyk
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC, Australia.,College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.,The Townsville Hospital, Emergency Department, Townsville, QLD, Australia
| | - Jocelyn Neutze
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC, Australia.,KidzFirst Middlemore Hospital, Auckland, New Zealand.,University of Auckland, Auckland, New Zealand
| | - Susan Moloney
- Department of Paediatrics, Gold Coast University Hospital, Southport, QLD, Australia.,School of Medicine, Griffith University, Gold Coast, QLD, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - John Gavranich
- Paediatric Department, Ipswich General Hospital, Ipswich, QLD, Australia
| | | | - Vishal Kapoor
- Paediatric Critical Care Research Group, Queensland Children's Hospital, The University of Queensland, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Simon Grew
- Paediatric Department, Redcliffe Hospital, Redcliffe, QLD, Australia
| | - John F Fraser
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Critical Care Research Group, Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Stuart Dalziel
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC, Australia.,Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Andreas Schibler
- Paediatric Critical Care Research Group, Queensland Children's Hospital, The University of Queensland, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia.,Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC, Australia
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128
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Harley A, Latour JM, Schlapbach LJ. The Role of Parental Concerns in the Recognition of Sepsis in Children: A Literature Review. Front Pediatr 2019; 7:161. [PMID: 31131264 PMCID: PMC6509218 DOI: 10.3389/fped.2019.00161] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 04/08/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Sepsis is a time critical disease and outcomes strongly depend on time to initiation of appropriate treatment in hospital. A range of studies have assessed sepsis recognition in hospital settings, whereas little is known about sepsis recognition in the community. The decision-making of parents in seeking medical care may substantially impact survival of children with sepsis. An improved understanding of the parental perspective in recognizing sepsis is urgently needed to inform the design of education campaigns and consideration of using parental concerns as a trigger in sepsis screening tools. Aim: To review the literature on parental concerns in the diagnosis of sepsis in children. Methods: A literature review on parental concerns in pediatric sepsis was performed accessing publications in PubMed, CINAHL and Medline published between 1990 and 2018. In addition, we compared guidelines and online institutional sepsis recognition tools and assessed whether parental concerns were used for screening. Results: Out of 188 articles reviewed, 11 met the criteria. One article was found prospectively assessing the diagnostic performance of parental concern in children evaluated for infection, indicating high positive (16.4) and negative likelihood ratio (0.23) for sepsis/meningitis in presence of parental concerns. The role of parental concern was listed as a sign assisting recognition of sepsis in four studies reporting original data, and six reviews commented on parental concern listed as a factor upon diagnosis of sepsis. When comparing selected examples of institutional sepsis pathways available online, parental concern was variably listed as a criterion to prompt evaluation for sepsis. Conclusions: Despite some guidelines emphasizing the role of parental concern in recognizing sepsis, there is a paucity of data in the field. An improved understanding of whether parental concerns adds diagnostic value to sepsis recognition at acceptable sensitivity and specificity is urgently needed. Future prospective studies should assess whether including parental concerns in sepsis screening tools benefits the assessment resulting in early diagnosis and treatment of children with sepsis.
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Affiliation(s)
- Amanda Harley
- Paediatric Critical Care Research Group, Child Health Research Centre and Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Paediatric Intensive Care Unit, Queensland Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia.,School of Nursing, The University of Queensland, Brisbane, QLD, Australia
| | - Jos M Latour
- Faculty of Health and Human Sciences, School of Nursing and Midwifery, University of Plymouth, Plymouth, United Kingdom
| | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, Child Health Research Centre and Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Paediatric Intensive Care Unit, Queensland Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia.,Department of Paediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
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129
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Jansen MA, Schlapbach LJ, Irving H. Evaluation of a paediatric clinical ethics service. J Paediatr Child Health 2018; 54:1199-1205. [PMID: 29746009 DOI: 10.1111/jpc.13933] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 02/22/2018] [Accepted: 03/19/2018] [Indexed: 11/29/2022]
Abstract
AIM To evaluate a paediatric clinical ethics service incorporating both normative and empirical analysis. METHODS Section 1: Review of consensus guidelines to identify emerging standards for clinical ethics services (CES) and evaluation of the service in relation to these. Section 2: Description of service activity data. Section 3: Feedback from clinical staff involved in clinical ethics consultations was collected using a web-based survey. RESULTS Four guideline documents were reviewed, and clear emerging consensus standards were identified. Our service fulfils identified knowledge and skill core competencies and at least partially fulfils all of the identified service-level standards. Clinicians report that clinical ethics consultation decreases their moral distress. CONCLUSIONS There is emerging consensus for staff competencies and service-level standards for CES. The role of CES in staff well-being needs to be explored. Collaborative, multi-modal research to develop standards and evaluate CES is needed.
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Affiliation(s)
- Melanie A Jansen
- Centre for Children's Health Ethics and Law, Children's Health Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Luregn J Schlapbach
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.,Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helen Irving
- Centre for Children's Health Ethics and Law, Children's Health Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Oncology Services Group, Children's Health Queensland, Brisbane, Queensland, Australia
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130
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Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med 2018; 6:223-230. [PMID: 29508706 DOI: 10.1016/s2213-2600(18)30063-8] [Citation(s) in RCA: 471] [Impact Index Per Article: 78.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 11/16/2022]
Abstract
The incidence of sepsis is highest in neonates and children, yet the global burden of sepsis in these age groups has not been assessed. We reviewed available evidence from observational epidemiological studies to estimate the global burden and mortality of sepsis in neonates and children. We did a systematic review and meta-analysis of studies reporting population-based sepsis incidence in neonates and children, published between 1979 and 2016. Our search yielded 1270 studies, 23 of which met the inclusion criteria; 16 were from high-income countries and seven from middle-income countries. 15 studies from 12 countries reported complete data and were included in the meta-analysis. We found an aggregate estimate of 48 (95% CI 27-86) sepsis cases and 22 (14-33) severe sepsis cases in children per 100 000 person-years. Mortality ranged from 1% to 5% for sepsis and 9% to 20% for severe sepsis. The population-level estimate for neonatal sepsis was 2202 (95% CI 1099-4360) per 100 000 livebirths, with mortality between 11% and 19%. Extrapolating these figures on a global scale, we estimate an incidence of 3·0 million cases of sepsis in neonates and 1·2 million cases in children. Although these results confirm that sepsis is a common and frequently fatal condition affecting neonates and children globally, few population-based data are available from low-income settings and the lack of standardisation of diagnostic criteria and definition of sepsis in the reviewed studies are obstacles to the accurate estimation of global burden. Robust epidemiological monitoring to define global sepsis incidence and mortality in children is urgently needed.
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Affiliation(s)
| | - David M Goldfarb
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany
| | - Luregn J Schlapbach
- Faculty of Medicine and Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia; Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Konrad Reinhart
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Department for Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Niranjan Kissoon
- University of British Columbia and British Columbia Children's Hospital, Vancouver, BC, Canada.
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131
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Giannoni E, Agyeman PKA, Stocker M, Posfay-Barbe KM, Heininger U, Spycher BD, Bernhard-Stirnemann S, Niederer-Loher A, Kahlert CR, Donas A, Leone A, Hasters P, Relly C, Riedel T, Kuehni C, Aebi C, Berger C, Schlapbach LJ. Neonatal Sepsis of Early Onset, and Hospital-Acquired and Community-Acquired Late Onset: A Prospective Population-Based Cohort Study. J Pediatr 2018; 201:106-114.e4. [PMID: 30054165 DOI: 10.1016/j.jpeds.2018.05.048] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/09/2018] [Accepted: 05/30/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess the epidemiology of blood culture-proven early- (EOS) and late-onset neonatal sepsis (LOS). STUDY DESIGN All newborn infants admitted to tertiary care neonatal intensive care units in Switzerland and presenting with blood culture-proven sepsis between September 2011 and December 2015 were included in the study. We defined EOS as infection occurring <3 days after birth, and LOS as infection ≥3 days after birth. Infants with LOS were classified as having community-acquired LOS if onset of infection was ≤48 hours after admission, and hospital-acquired LOS, if onset was >48 hours after admission. Incidence was estimated based on the number of livebirths in Switzerland and adjusted for the proportion of admissions at centers participating in the study. RESULTS We identified 444 episodes of blood culture-proven sepsis in 429 infants; 20% of cases were EOS, 62% hospital-acquired LOS, and 18% community-acquired LOS. The estimated national incidence of EOS, hospital-acquired LOS, and community-acquired LOS was 0.28 (95% CI 0.23-0.35), 0.86 (0.76-0.97), and 0.28 (0.23-0.34) per 1000 livebirths. Compared with EOS, hospital-acquired LOS occurred in infants of lower gestational age and was more frequently associated with comorbidities. Community-acquired LOS was more common in term infants and in male infants. Mortality was 18%, 12%, and 0% in EOS, hospital-acquired LOS, and community-acquired LOS, and was higher in preterm infants, in infants with septic shock, and in those requiring mechanical ventilation. CONCLUSIONS We report a high burden of sepsis in neonates with considerable mortality and morbidity. EOS, hospital-acquired LOS, and community-acquired LOS affect specific patient subgroups and have distinct clinical presentation, pathogens and outcomes.
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Affiliation(s)
- Eric Giannoni
- Clinic of Neonatology, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland; Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.
| | - Philipp K A Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Stocker
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Klara M Posfay-Barbe
- Pediatric Infectious Diseases Unit, Children's Hospital of Geneva, University Hospitals of Geneva, Geneva, Switzerland
| | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Ben D Spycher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | | | | | - Alex Donas
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Antonio Leone
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Paul Hasters
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Christa Relly
- Division of Infectious Diseases, and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Thomas Riedel
- Department of Pediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Claudia Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Christoph Aebi
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases, and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Luregn J Schlapbach
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Faculty of Medicine, The University of Queensland, Brisbane, Australia; Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Brisbane, Australia; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Children's Health Queensland, Brisbane, Australia
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132
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Pandya NR, Alphonso N, Tu Q, Venugopal P, Schlapbach LJ. Prolonged Postoperative Vasoplegia in Pediatric Patients on Chronic Angiotensin II Blocker Treatment. Front Cardiovasc Med 2018; 5:121. [PMID: 30234130 PMCID: PMC6131193 DOI: 10.3389/fcvm.2018.00121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/16/2018] [Indexed: 11/18/2022] Open
Abstract
Prolonged postoperative vasoplegia is known to occur following cardiac surgery in patients on chronic angiotensin II receptor blocker (ARB) treatment in adults. The perioperative management of these drugs in the pediatric population is not well described and here we would like to highlight this fact. While ARBs are increasingly used in children and adolescents with hypertension, there is lack of data to guide optimal pre-surgical management in the pediatric age group. We report two cases of prolonged vasoplegia following cardiopulmonary bypass occurring in adolescent patients on chronic ARB therapy and the importance of cessation of these drugs preoperatively.
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Affiliation(s)
- Nischal R Pandya
- Pediatric Cardiac Surgery, Lady Cilento Children's Hospital, Brisbane, QLD, Australia.,Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Nelson Alphonso
- Pediatric Cardiac Surgery, Lady Cilento Children's Hospital, Brisbane, QLD, Australia.,Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Quyen Tu
- Pediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia.,Pediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, QLD, Australia
| | - Prem Venugopal
- Pediatric Cardiac Surgery, Lady Cilento Children's Hospital, Brisbane, QLD, Australia.,Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Luregn J Schlapbach
- Pediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia.,Pediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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133
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Dierig A, Berger C, Agyeman PKA, Bernhard-Stirnemann S, Giannoni E, Stocker M, Posfay-Barbe KM, Niederer-Loher A, Kahlert CR, Donas A, Hasters P, Relly C, Riedel T, Aebi C, Schlapbach LJ, Heininger U. Time-to-Positivity of Blood Cultures in Children With Sepsis. Front Pediatr 2018; 6:222. [PMID: 30135859 PMCID: PMC6092514 DOI: 10.3389/fped.2018.00222] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 07/18/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Blood cultures are essential for the diagnosis and further appropriate treatment in children with suspected sepsis. In most hospitals, children will be empirically treated or closely monitored for at least 48 h awaiting results of blood cultures. Several studies have challenged the optimal duration of empiric treatment in the era of continuously monitored blood culture systems. The aim of our study was to investigate time-to-positivity (TTP) of blood cultures in children with proven sepsis. Methods: The Swiss Pediatric Sepsis Study prospectively enrolled children 0-16 years of age with blood culture positive sepsis between September 2011 and October 2015. TTP was prospectively assessed in six participating academic pediatric hospitals by fully automated blood culture systems. Results: In 521 (93%) of 562 bacteremia episodes (493 children, median age 103 days, range 0 days-16.9 years) a valid TTP was available. Median TTP was 12 h (IQR 8-17 h, range 0-109 h). By 24, 36, and 48 h, 460 (88%), 498 (96%), and 510 (98%) blood cultures, respectively, were positive. TTP was independent of age, sex, presence of comorbidities, site of infection and severity of infection. Median TTP in all age groups combined was shortest for group B streptococcus (8.7 h) and longest for coagulase-negative staphylococci (16.2 h). Conclusion: Growth of bacteria in blood cultures is detectable within 24 h in 9 of 10 children with blood culture-proven sepsis. Therefore, a strict rule to observe or treat all children with suspected sepsis for at least 48 h is not justified.
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Affiliation(s)
- Alexa Dierig
- Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Philipp K. A. Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Eric Giannoni
- Department Mother-Woman-Child, Service of Neonatology, Lausanne University Hospital, Lausanne, Switzerland
- Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Martin Stocker
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Klara M. Posfay-Barbe
- Pediatric Infectious Diseases Unit, Children's Hospital of Geneva, University Hospitals of Geneva, Geneva, Switzerland
| | | | | | - Alex Donas
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Paul Hasters
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Christa Relly
- Division of Infectious Diseases and Hospital Epidemiology, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Thomas Riedel
- Department of Pediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Christoph Aebi
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luregn J. Schlapbach
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
- Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia
| | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
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134
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Schlapbach LJ, Ostrowski JA, MacLaren G. The excess burden of severe sepsis in Indigenous Australian children: can anything be done? Med J Aust 2018; 207:45-46. [PMID: 28659119 DOI: 10.5694/mja17.00464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 06/29/2017] [Indexed: 01/08/2023]
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135
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Perumal G, Marathe SP, Schlapbach LJ, Morwood J, Venugopal P, Alphonso N. Postoperative catecholamine resistance following fetal methamphetamine exposure. Asian Cardiovasc Thorac Ann 2018; 27:30-32. [PMID: 29933705 DOI: 10.1177/0218492318784740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Methamphetamine and its related compounds are among the most widely abused recreational drugs worldwide. While a myriad of clinical complications of methamphetamine use have been described, there is a paucity of literature regarding the effects of maternal abuse during pregnancy on neonatal hearts. In this report, we describe a neonate who underwent Norwood-type palliation and subsequently developed catecholamine-resistant cardiogenic shock, likely related to methamphetamine exposure, which recovered after a period of venoarterial extracorporeal membrane oxygenation support.
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Affiliation(s)
- Gopinath Perumal
- 1 Queensland Paediatric Cardiac Services, Lady Cilento Children's Hospital, Brisbane, Australia.,2 Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Supreet P Marathe
- 1 Queensland Paediatric Cardiac Services, Lady Cilento Children's Hospital, Brisbane, Australia.,2 Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Luregn J Schlapbach
- 3 Burns, Trauma and Critical Care Research Centre of the University of Queensland, Brisbane, Australia.,4 Paediatric Critical Care Research Group, Mater Research, University of Queensland, Brisbane, Australia.,5 Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jim Morwood
- 1 Queensland Paediatric Cardiac Services, Lady Cilento Children's Hospital, Brisbane, Australia.,2 Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Prem Venugopal
- 1 Queensland Paediatric Cardiac Services, Lady Cilento Children's Hospital, Brisbane, Australia.,2 Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Nelson Alphonso
- 1 Queensland Paediatric Cardiac Services, Lady Cilento Children's Hospital, Brisbane, Australia.,2 Faculty of Medicine, University of Queensland, Brisbane, Australia
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136
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Boeddha NP, Schlapbach LJ, Driessen GJ, Herberg JA, Rivero-Calle I, Cebey-López M, Klobassa DS, Philipsen R, de Groot R, Inwald DP, Nadel S, Paulus S, Pinnock E, Secka F, Anderson ST, Agbeko RS, Berger C, Fink CG, Carrol ED, Zenz W, Levin M, van der Flier M, Martinón-Torres F, Hazelzet JA, Emonts M. Mortality and morbidity in community-acquired sepsis in European pediatric intensive care units: a prospective cohort study from the European Childhood Life-threatening Infectious Disease Study (EUCLIDS). Crit Care 2018; 22:143. [PMID: 29855385 PMCID: PMC5984383 DOI: 10.1186/s13054-018-2052-7] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/29/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Sepsis is one of the main reasons for non-elective admission to pediatric intensive care units (PICUs), but little is known about determinants influencing outcome. We characterized children admitted with community-acquired sepsis to European PICUs and studied risk factors for mortality and disability. METHODS Data were collected within the collaborative Seventh Framework Programme (FP7)-funded EUCLIDS study, which is a prospective multicenter cohort study aiming to evaluate genetic determinants of susceptibility and/or severity in sepsis. This report includes 795 children admitted with community-acquired sepsis to 52 PICUs from seven European countries between July 2012 and January 2016. The primary outcome measure was in-hospital death. Secondary outcome measures were PICU-free days censured at day 28, hospital length of stay, and disability. Independent predictors were identified by multivariate regression analysis. RESULTS Patients most commonly presented clinically with sepsis without a source (n = 278, 35%), meningitis/encephalitis (n = 182, 23%), or pneumonia (n = 149, 19%). Of 428 (54%) patients with confirmed bacterial infection, Neisseria meningitidis (n = 131, 31%) and Streptococcus pneumoniae (n = 78, 18%) were the main pathogens. Mortality was 6% (51/795), increasing to 10% in the presence of septic shock (45/466). Of the survivors, 31% were discharged with disability, including 24% of previously healthy children who survived with disability. Mortality and disability were independently associated with S. pneumoniae infections (mortality OR 4.1, 95% CI 1.1-16.0, P = 0.04; disability OR 5.4, 95% CI 1.8-15.8, P < 0.01) and illness severity as measured by Pediatric Index of Mortality (PIM2) score (mortality OR 2.8, 95% CI 1.3-6.1, P < 0.01; disability OR 3.4, 95% CI 1.8-6.4, P < 0.001). CONCLUSIONS Despite widespread immunization campaigns, invasive bacterial disease remains responsible for substantial morbidity and mortality in critically ill children in high-income countries. Almost one third of sepsis survivors admitted to the PICU were discharged with some disability. More research is required to delineate the long-term outcome of pediatric sepsis and to identify interventional targets. Our findings emphasize the importance of improved early sepsis-recognition programs to address the high burden of disease.
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Affiliation(s)
- Navin P. Boeddha
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
- Department of Pediatrics, Division of Pediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Luregn J. Schlapbach
- Faculty of Medicine, The University of Queensland, St Lucia Queensland, Brisbane, 4072 Australia
- Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Aubigny Place, Raymond Terrace, Brisbane, Australia
- Paediatric Intensive Care Unit, Lady Cilento Children’s Hospital, Children’s Health Queensland, 501 Stanley St, Brisbane, Australia
- Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 8, 3010 Bern, Switzerland
| | - Gertjan J. Driessen
- Department of Pediatrics, Division of Pediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
- Department of Paediatrics, Juliana Children’s Hospital/Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 AA The Hague, The Netherlands
| | - Jethro A. Herberg
- Section of Pediatrics, Imperial College London, Level 2, Faculty Building South Kensington Campus, London, SW7 2AZ UK
| | - Irene Rivero-Calle
- Translational Pediatrics and Infectious Diseases Section- Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Travesía da Choupana, 15706 Santiago de Compostela, Spain
- Genetics- Vaccines- Infectious Diseases and Pediatrics research group GENVIP, Health Research Institute of Santiago IDIS/SERGAS, Travesía da Choupana, 15706 Santiago de Compostela, Spain
| | - Miriam Cebey-López
- Genetics- Vaccines- Infectious Diseases and Pediatrics research group GENVIP, Health Research Institute of Santiago IDIS/SERGAS, Travesía da Choupana, 15706 Santiago de Compostela, Spain
| | - Daniela S. Klobassa
- Department of General Paediatrics, Medical University of Graz, Auenbruggerplatz 34/2, A-8036 Graz, Austria
| | - Ria Philipsen
- Radboudumc Technology Center Clinical Studies, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Ronald de Groot
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - David P. Inwald
- Department of Paediatrics, Faculty of Medicine, Imperial College London, South Kensington Campus, London, SW7 2AZ UK
- St Mary’s Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY UK
| | - Simon Nadel
- Department of Paediatrics, Faculty of Medicine, Imperial College London, South Kensington Campus, London, SW7 2AZ UK
- St Mary’s Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY UK
| | - Stéphane Paulus
- Division of Paediatric Infectious Diseases, Alder Hey Children’s NHS Foundation Trust, Eaton Rd, Liverpool, L12 2AP UK
- Institute of Infection & Global Health, University of Liverpool, 8 West Derby St, Liverpool, L7 3EA UK
| | - Eleanor Pinnock
- Micropathology Ltd, University of Warwick Science Park, Venture Centre, Sir William Lyons Road, Coventry, CV4 7EZ UK
| | - Fatou Secka
- Medical research Council Unit, Atlantic Boulevard, Fajara, P. O. Box 273, Banjul, The Gambia
| | - Suzanne T. Anderson
- Medical research Council Unit, Atlantic Boulevard, Fajara, P. O. Box 273, Banjul, The Gambia
| | - Rachel S. Agbeko
- Department of Paediatric Intensive Care, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP UK
- Institute of Cellular Medicine, Newcastle University, 4th Floor, William Leech Building, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, and Children’s Research Center, University Children’s Hospital Zurich, Steinwiesenstrasse 75, 8032 Zurich, Switzerland
| | - Colin G. Fink
- Micropathology Ltd, University of Warwick Science Park, Venture Centre, Sir William Lyons Road, Coventry, CV4 7EZ UK
| | - Enitan D. Carrol
- Institute of Infection & Global Health, University of Liverpool, 8 West Derby St, Liverpool, L7 3EA UK
| | - Werner Zenz
- Department of General Paediatrics, Medical University of Graz, Auenbruggerplatz 34/2, A-8036 Graz, Austria
| | - Michael Levin
- Section of Pediatrics, Imperial College London, Level 2, Faculty Building South Kensington Campus, London, SW7 2AZ UK
| | - Michiel van der Flier
- Radboudumc Technology Center Clinical Studies, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Pediatric Infectious Diseases and Immunology Amalia Children’s Hospital, and Radboudumc Expertise Center for Immunodeficiency and Autoinflammation (REIA), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases Section- Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Travesía da Choupana, 15706 Santiago de Compostela, Spain
- Genetics- Vaccines- Infectious Diseases and Pediatrics research group GENVIP, Health Research Institute of Santiago IDIS/SERGAS, Travesía da Choupana, 15706 Santiago de Compostela, Spain
| | - Jan A. Hazelzet
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Marieke Emonts
- Institute of Cellular Medicine, Newcastle University, 4th Floor, William Leech Building, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
- Paediatric Infectious Diseases and Immunology Department, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP UK
- NIHR Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Westgate Rd, Newcastle upon Tyne, NE4 5PL UK
| | - on behalf of the EUCLIDS consortium
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
- Department of Pediatrics, Division of Pediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
- Faculty of Medicine, The University of Queensland, St Lucia Queensland, Brisbane, 4072 Australia
- Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Aubigny Place, Raymond Terrace, Brisbane, Australia
- Paediatric Intensive Care Unit, Lady Cilento Children’s Hospital, Children’s Health Queensland, 501 Stanley St, Brisbane, Australia
- Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 8, 3010 Bern, Switzerland
- Department of Paediatrics, Juliana Children’s Hospital/Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 AA The Hague, The Netherlands
- Section of Pediatrics, Imperial College London, Level 2, Faculty Building South Kensington Campus, London, SW7 2AZ UK
- Translational Pediatrics and Infectious Diseases Section- Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Travesía da Choupana, 15706 Santiago de Compostela, Spain
- Genetics- Vaccines- Infectious Diseases and Pediatrics research group GENVIP, Health Research Institute of Santiago IDIS/SERGAS, Travesía da Choupana, 15706 Santiago de Compostela, Spain
- Department of General Paediatrics, Medical University of Graz, Auenbruggerplatz 34/2, A-8036 Graz, Austria
- Radboudumc Technology Center Clinical Studies, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Paediatrics, Faculty of Medicine, Imperial College London, South Kensington Campus, London, SW7 2AZ UK
- St Mary’s Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY UK
- Division of Paediatric Infectious Diseases, Alder Hey Children’s NHS Foundation Trust, Eaton Rd, Liverpool, L12 2AP UK
- Institute of Infection & Global Health, University of Liverpool, 8 West Derby St, Liverpool, L7 3EA UK
- Micropathology Ltd, University of Warwick Science Park, Venture Centre, Sir William Lyons Road, Coventry, CV4 7EZ UK
- Medical research Council Unit, Atlantic Boulevard, Fajara, P. O. Box 273, Banjul, The Gambia
- Department of Paediatric Intensive Care, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP UK
- Institute of Cellular Medicine, Newcastle University, 4th Floor, William Leech Building, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
- Division of Infectious Diseases and Hospital Epidemiology, and Children’s Research Center, University Children’s Hospital Zurich, Steinwiesenstrasse 75, 8032 Zurich, Switzerland
- Pediatric Infectious Diseases and Immunology Amalia Children’s Hospital, and Radboudumc Expertise Center for Immunodeficiency and Autoinflammation (REIA), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
- Paediatric Infectious Diseases and Immunology Department, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP UK
- NIHR Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Westgate Rd, Newcastle upon Tyne, NE4 5PL UK
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Martinón-Torres F, Salas A, Rivero-Calle I, Cebey-López M, Pardo-Seco J, Herberg JA, Boeddha NP, Klobassa DS, Secka F, Paulus S, de Groot R, Schlapbach LJ, Driessen GJ, Anderson ST, Emonts M, Zenz W, Carrol ED, Van der Flier M, Levin M. Life-threatening infections in children in Europe (the EUCLIDS Project): a prospective cohort study. Lancet Child Adolesc Health 2018; 2:404-414. [PMID: 30169282 DOI: 10.1016/s2352-4642(18)30113-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Sepsis and severe focal infections represent a substantial disease burden in children admitted to hospital. We aimed to understand the burden of disease and outcomes in children with life-threatening bacterial infections in Europe. METHODS The European Union Childhood Life-threatening Infectious Disease Study (EUCLIDS) was a prospective, multicentre, cohort study done in six countries in Europe. Patients aged 1 month to 18 years with sepsis (or suspected sepsis) or severe focal infections, admitted to 98 participating hospitals in the UK, Austria, Germany, Lithuania, Spain, and the Netherlands were prospectively recruited between July 1, 2012, and Dec 31, 2015. To assess disease burden and outcomes, we collected demographic and clinical data using a secured web-based platform and obtained microbiological data using locally available clinical diagnostic procedures. FINDINGS 2844 patients were recruited and included in the analysis. 1512 (53·2%) of 2841 patients were male and median age was 39·1 months (IQR 12·4-93·9). 1229 (43·2%) patients had sepsis and 1615 (56·8%) had severe focal infections. Patients diagnosed with sepsis had a median age of 27·6 months (IQR 9·0-80·2), whereas those diagnosed with severe focal infections had a median age of 46·5 months (15·8-100·4; p<0·0001). Of 2844 patients in the entire cohort, the main clinical syndromes were pneumonia (511 [18·0%] patients), CNS infection (469 [16·5%]), and skin and soft tissue infection (247 [8·7%]). The causal microorganism was identified in 1359 (47·8%) children, with the most prevalent ones being Neisseria meningitidis (in 259 [9·1%] patients), followed by Staphylococcus aureus (in 222 [7·8%]), Streptococcus pneumoniae (in 219 [7·7%]), and group A streptococcus (in 162 [5·7%]). 1070 (37·6%) patients required admission to a paediatric intensive care unit. Of 2469 patients with outcome data, 57 (2·2%) deaths occurred: seven were in patients with severe focal infections and 50 in those with sepsis. INTERPRETATION Mortality in children admitted to hospital for sepsis or severe focal infections is low in Europe. The disease burden is mainly in children younger than 5 years and is largely due to vaccine-preventable meningococcal and pneumococcal infections. Despite the availability and application of clinical procedures for microbiological diagnosis, the causative organism remained unidentified in approximately 50% of patients. FUNDING European Union's Seventh Framework programme.
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Affiliation(s)
- Federico Martinón-Torres
- Pediatrics Department, Translational Pediatrics and Infectious Diseases Section, Santiago de Compostela, Spain; Genetics- Vaccines- Infectious Diseases and Pediatrics research group GENVIP, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain.
| | - Antonio Salas
- Genetics- Vaccines- Infectious Diseases and Pediatrics research group GENVIP, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain; Unidade de Xenética, Departamento de Anatomía Patolóxica e Ciencias Forenses, Instituto de Ciencias Forenses, Facultade de Medicina, Universidade de Santiago de Compostela, Galicia, Spain; GenPoB Research Group, Instituto de Investigaciones Sanitarias (IDIS), Hospital Clínico Universitario de Santiago (SERGAS), Galicia, Spain
| | - Irene Rivero-Calle
- Pediatrics Department, Translational Pediatrics and Infectious Diseases Section, Santiago de Compostela, Spain; Genetics- Vaccines- Infectious Diseases and Pediatrics research group GENVIP, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | - Miriam Cebey-López
- Genetics- Vaccines- Infectious Diseases and Pediatrics research group GENVIP, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | - Jacobo Pardo-Seco
- Genetics- Vaccines- Infectious Diseases and Pediatrics research group GENVIP, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | | | - Navin P Boeddha
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Daniela S Klobassa
- Medical University of Graz, Department of General Pediatrics, Graz, Austria
| | - Fatou Secka
- Medical Research Council Unit The Gambia, Fajara, The Gambia
| | - Stephane Paulus
- Department of Clinical Infection Microbiology and Immunology, University of Liverpool Institute of Infection and Global Health, Liverpool, UK
| | - Ronald de Groot
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology and Laboratory of Infectious Diseases, Radboud Institute of Molecular Life Sciences, Radboudumc Nijmegen, the Netherlands
| | - Luregn J Schlapbach
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, QLD, Australia; Paediatric Critical Care Research Group, Mater Research, University of Queensland, Brisbane, QLD, Australia
| | - Gertjan J Driessen
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | - Marieke Emonts
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; Paediatric Infectious Diseases and Immunology Department, Newcastle upon Tyne Hospitals Foundation Trust, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Werner Zenz
- Medical University of Graz, Department of General Pediatrics, Graz, Austria
| | - Enitan D Carrol
- Department of Clinical Infection Microbiology and Immunology, University of Liverpool Institute of Infection and Global Health, Liverpool, UK
| | - Michiel Van der Flier
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology and Laboratory of Infectious Diseases, Radboud Institute of Molecular Life Sciences, Radboudumc Nijmegen, the Netherlands
| | - Michael Levin
- Section of Paediatrics, Imperial College London, London, UK
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138
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Kawasaki T, Shime N, Straney L, Bellomo R, MacLaren G, Pilcher D, Schlapbach LJ. Paediatric sequential organ failure assessment score (pSOFA): a plea for the world-wide collaboration for consensus. Intensive Care Med 2018; 44:995-997. [PMID: 29704146 DOI: 10.1007/s00134-018-5188-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Tatsuya Kawasaki
- Department of Pediatric Critical Care, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, Shizuoka, 420-8660, Japan.
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Lahn Straney
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rinaldo Bellomo
- University of Melbourne, Melbourne, Australia
- Intensive Care, Austin Health, Melbourne, Australia
| | - Graeme MacLaren
- Cardiothoracic Intensive Care Unit, National University Health System, Singapore, Singapore
- Paediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia
| | - David Pilcher
- The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation (CORE), ANZICS House, Levers Terrace, Carlton South, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care, The Alfred Hospital, Commercial Road, Prahran, VIC, Australia
| | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, Mater Research Institute and Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, Australia
- Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
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139
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Affiliation(s)
- Luregn J Schlapbach
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Niranjan Kissoon
- University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Children's Hospital, Vancouver, British Columbia, Canada
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140
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Franklin D, Babl FE, Schlapbach LJ, Oakley E, Craig S, Neutze J, Furyk J, Fraser JF, Jones M, Whitty JA, Dalziel SR, Schibler A. A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis. N Engl J Med 2018; 378:1121-1131. [PMID: 29562151 DOI: 10.1056/nejmoa1714855] [Citation(s) in RCA: 239] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND High-flow oxygen therapy through a nasal cannula has been increasingly used in infants with bronchiolitis, despite limited high-quality evidence of its efficacy. The efficacy of high-flow oxygen therapy through a nasal cannula in settings other than intensive care units (ICUs) is unclear. METHODS In this multicenter, randomized, controlled trial, we assigned infants younger than 12 months of age who had bronchiolitis and a need for supplemental oxygen therapy to receive either high-flow oxygen therapy (high-flow group) or standard oxygen therapy (standard-therapy group). Infants in the standard-therapy group could receive rescue high-flow oxygen therapy if their condition met criteria for treatment failure. The primary outcome was escalation of care due to treatment failure (defined as meeting ≥3 of 4 clinical criteria: persistent tachycardia, tachypnea, hypoxemia, and medical review triggered by a hospital early-warning tool). Secondary outcomes included duration of hospital stay, duration of oxygen therapy, and rates of transfer to a tertiary hospital, ICU admission, intubation, and adverse events. RESULTS The analyses included 1472 patients. The percentage of infants receiving escalation of care was 12% (87 of 739 infants) in the high-flow group, as compared with 23% (167 of 733) in the standard-therapy group (risk difference, -11 percentage points; 95% confidence interval, -15 to -7; P<0.001). No significant differences were observed in the duration of hospital stay or the duration of oxygen therapy. In each group, one case of pneumothorax (<1% of infants) occurred. Among the 167 infants in the standard-therapy group who had treatment failure, 102 (61%) had a response to high-flow rescue therapy. CONCLUSIONS Among infants with bronchiolitis who were treated outside an ICU, those who received high-flow oxygen therapy had significantly lower rates of escalation of care due to treatment failure than those in the group that received standard oxygen therapy. (Funded by the National Health and Medical Research Council and others; Australian and New Zealand Clinical Trials Registry number, ACTRN12613000388718 .).
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Affiliation(s)
- Donna Franklin
- From the Pediatric Critical Care Research Group, Centre for Children's Health Research, Lady Cilento Children's Hospital, and Mater Research Institute (D.F., L.J.S., A.S.), the Schools of Medicine (D.F., L.J.S., J.F.F., A.S.) and Public Health (M.J.), University of Queensland, and the Critical Care Research Group, Adult Intensive Care Service, Prince Charles Hospital (D.F., J.F.F.), Brisbane, the Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC (D.F., F.E.B., E.O., S.C., J.N., J.F., S.R.D., A.S.), Royal Children's Hospital, the Emergency Department, Murdoch Children's Research Institute, and the Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, VIC (F.E.B., E.O.), the Department of Medicine, School of Clinical Sciences, Monash University, and the Paediatric Emergency Department, Monash Medical Centre, Monash Health, Clayton, VIC (S.C.), and the College of Medicine and Dentistry, James Cook University, and the Emergency Department, Townsville Hospital, Townsville, QLD (J.F.) - all in Australia; the Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland (L.J.S.); KidzFirst Middlemore Hospital and the University of Auckland (J.N.) and the Children's Emergency Department, Starship Children's Hospital, and Liggins Institute, University of Auckland (S.R.D.), Auckland, New Zealand; and Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (J.A.W.)
| | - Franz E Babl
- From the Pediatric Critical Care Research Group, Centre for Children's Health Research, Lady Cilento Children's Hospital, and Mater Research Institute (D.F., L.J.S., A.S.), the Schools of Medicine (D.F., L.J.S., J.F.F., A.S.) and Public Health (M.J.), University of Queensland, and the Critical Care Research Group, Adult Intensive Care Service, Prince Charles Hospital (D.F., J.F.F.), Brisbane, the Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC (D.F., F.E.B., E.O., S.C., J.N., J.F., S.R.D., A.S.), Royal Children's Hospital, the Emergency Department, Murdoch Children's Research Institute, and the Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, VIC (F.E.B., E.O.), the Department of Medicine, School of Clinical Sciences, Monash University, and the Paediatric Emergency Department, Monash Medical Centre, Monash Health, Clayton, VIC (S.C.), and the College of Medicine and Dentistry, James Cook University, and the Emergency Department, Townsville Hospital, Townsville, QLD (J.F.) - all in Australia; the Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland (L.J.S.); KidzFirst Middlemore Hospital and the University of Auckland (J.N.) and the Children's Emergency Department, Starship Children's Hospital, and Liggins Institute, University of Auckland (S.R.D.), Auckland, New Zealand; and Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (J.A.W.)
| | - Luregn J Schlapbach
- From the Pediatric Critical Care Research Group, Centre for Children's Health Research, Lady Cilento Children's Hospital, and Mater Research Institute (D.F., L.J.S., A.S.), the Schools of Medicine (D.F., L.J.S., J.F.F., A.S.) and Public Health (M.J.), University of Queensland, and the Critical Care Research Group, Adult Intensive Care Service, Prince Charles Hospital (D.F., J.F.F.), Brisbane, the Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC (D.F., F.E.B., E.O., S.C., J.N., J.F., S.R.D., A.S.), Royal Children's Hospital, the Emergency Department, Murdoch Children's Research Institute, and the Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, VIC (F.E.B., E.O.), the Department of Medicine, School of Clinical Sciences, Monash University, and the Paediatric Emergency Department, Monash Medical Centre, Monash Health, Clayton, VIC (S.C.), and the College of Medicine and Dentistry, James Cook University, and the Emergency Department, Townsville Hospital, Townsville, QLD (J.F.) - all in Australia; the Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland (L.J.S.); KidzFirst Middlemore Hospital and the University of Auckland (J.N.) and the Children's Emergency Department, Starship Children's Hospital, and Liggins Institute, University of Auckland (S.R.D.), Auckland, New Zealand; and Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (J.A.W.)
| | - Ed Oakley
- From the Pediatric Critical Care Research Group, Centre for Children's Health Research, Lady Cilento Children's Hospital, and Mater Research Institute (D.F., L.J.S., A.S.), the Schools of Medicine (D.F., L.J.S., J.F.F., A.S.) and Public Health (M.J.), University of Queensland, and the Critical Care Research Group, Adult Intensive Care Service, Prince Charles Hospital (D.F., J.F.F.), Brisbane, the Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC (D.F., F.E.B., E.O., S.C., J.N., J.F., S.R.D., A.S.), Royal Children's Hospital, the Emergency Department, Murdoch Children's Research Institute, and the Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, VIC (F.E.B., E.O.), the Department of Medicine, School of Clinical Sciences, Monash University, and the Paediatric Emergency Department, Monash Medical Centre, Monash Health, Clayton, VIC (S.C.), and the College of Medicine and Dentistry, James Cook University, and the Emergency Department, Townsville Hospital, Townsville, QLD (J.F.) - all in Australia; the Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland (L.J.S.); KidzFirst Middlemore Hospital and the University of Auckland (J.N.) and the Children's Emergency Department, Starship Children's Hospital, and Liggins Institute, University of Auckland (S.R.D.), Auckland, New Zealand; and Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (J.A.W.)
| | - Simon Craig
- From the Pediatric Critical Care Research Group, Centre for Children's Health Research, Lady Cilento Children's Hospital, and Mater Research Institute (D.F., L.J.S., A.S.), the Schools of Medicine (D.F., L.J.S., J.F.F., A.S.) and Public Health (M.J.), University of Queensland, and the Critical Care Research Group, Adult Intensive Care Service, Prince Charles Hospital (D.F., J.F.F.), Brisbane, the Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC (D.F., F.E.B., E.O., S.C., J.N., J.F., S.R.D., A.S.), Royal Children's Hospital, the Emergency Department, Murdoch Children's Research Institute, and the Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, VIC (F.E.B., E.O.), the Department of Medicine, School of Clinical Sciences, Monash University, and the Paediatric Emergency Department, Monash Medical Centre, Monash Health, Clayton, VIC (S.C.), and the College of Medicine and Dentistry, James Cook University, and the Emergency Department, Townsville Hospital, Townsville, QLD (J.F.) - all in Australia; the Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland (L.J.S.); KidzFirst Middlemore Hospital and the University of Auckland (J.N.) and the Children's Emergency Department, Starship Children's Hospital, and Liggins Institute, University of Auckland (S.R.D.), Auckland, New Zealand; and Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (J.A.W.)
| | - Jocelyn Neutze
- From the Pediatric Critical Care Research Group, Centre for Children's Health Research, Lady Cilento Children's Hospital, and Mater Research Institute (D.F., L.J.S., A.S.), the Schools of Medicine (D.F., L.J.S., J.F.F., A.S.) and Public Health (M.J.), University of Queensland, and the Critical Care Research Group, Adult Intensive Care Service, Prince Charles Hospital (D.F., J.F.F.), Brisbane, the Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC (D.F., F.E.B., E.O., S.C., J.N., J.F., S.R.D., A.S.), Royal Children's Hospital, the Emergency Department, Murdoch Children's Research Institute, and the Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, VIC (F.E.B., E.O.), the Department of Medicine, School of Clinical Sciences, Monash University, and the Paediatric Emergency Department, Monash Medical Centre, Monash Health, Clayton, VIC (S.C.), and the College of Medicine and Dentistry, James Cook University, and the Emergency Department, Townsville Hospital, Townsville, QLD (J.F.) - all in Australia; the Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland (L.J.S.); KidzFirst Middlemore Hospital and the University of Auckland (J.N.) and the Children's Emergency Department, Starship Children's Hospital, and Liggins Institute, University of Auckland (S.R.D.), Auckland, New Zealand; and Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (J.A.W.)
| | - Jeremy Furyk
- From the Pediatric Critical Care Research Group, Centre for Children's Health Research, Lady Cilento Children's Hospital, and Mater Research Institute (D.F., L.J.S., A.S.), the Schools of Medicine (D.F., L.J.S., J.F.F., A.S.) and Public Health (M.J.), University of Queensland, and the Critical Care Research Group, Adult Intensive Care Service, Prince Charles Hospital (D.F., J.F.F.), Brisbane, the Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC (D.F., F.E.B., E.O., S.C., J.N., J.F., S.R.D., A.S.), Royal Children's Hospital, the Emergency Department, Murdoch Children's Research Institute, and the Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, VIC (F.E.B., E.O.), the Department of Medicine, School of Clinical Sciences, Monash University, and the Paediatric Emergency Department, Monash Medical Centre, Monash Health, Clayton, VIC (S.C.), and the College of Medicine and Dentistry, James Cook University, and the Emergency Department, Townsville Hospital, Townsville, QLD (J.F.) - all in Australia; the Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland (L.J.S.); KidzFirst Middlemore Hospital and the University of Auckland (J.N.) and the Children's Emergency Department, Starship Children's Hospital, and Liggins Institute, University of Auckland (S.R.D.), Auckland, New Zealand; and Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (J.A.W.)
| | - John F Fraser
- From the Pediatric Critical Care Research Group, Centre for Children's Health Research, Lady Cilento Children's Hospital, and Mater Research Institute (D.F., L.J.S., A.S.), the Schools of Medicine (D.F., L.J.S., J.F.F., A.S.) and Public Health (M.J.), University of Queensland, and the Critical Care Research Group, Adult Intensive Care Service, Prince Charles Hospital (D.F., J.F.F.), Brisbane, the Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC (D.F., F.E.B., E.O., S.C., J.N., J.F., S.R.D., A.S.), Royal Children's Hospital, the Emergency Department, Murdoch Children's Research Institute, and the Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, VIC (F.E.B., E.O.), the Department of Medicine, School of Clinical Sciences, Monash University, and the Paediatric Emergency Department, Monash Medical Centre, Monash Health, Clayton, VIC (S.C.), and the College of Medicine and Dentistry, James Cook University, and the Emergency Department, Townsville Hospital, Townsville, QLD (J.F.) - all in Australia; the Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland (L.J.S.); KidzFirst Middlemore Hospital and the University of Auckland (J.N.) and the Children's Emergency Department, Starship Children's Hospital, and Liggins Institute, University of Auckland (S.R.D.), Auckland, New Zealand; and Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (J.A.W.)
| | - Mark Jones
- From the Pediatric Critical Care Research Group, Centre for Children's Health Research, Lady Cilento Children's Hospital, and Mater Research Institute (D.F., L.J.S., A.S.), the Schools of Medicine (D.F., L.J.S., J.F.F., A.S.) and Public Health (M.J.), University of Queensland, and the Critical Care Research Group, Adult Intensive Care Service, Prince Charles Hospital (D.F., J.F.F.), Brisbane, the Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC (D.F., F.E.B., E.O., S.C., J.N., J.F., S.R.D., A.S.), Royal Children's Hospital, the Emergency Department, Murdoch Children's Research Institute, and the Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, VIC (F.E.B., E.O.), the Department of Medicine, School of Clinical Sciences, Monash University, and the Paediatric Emergency Department, Monash Medical Centre, Monash Health, Clayton, VIC (S.C.), and the College of Medicine and Dentistry, James Cook University, and the Emergency Department, Townsville Hospital, Townsville, QLD (J.F.) - all in Australia; the Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland (L.J.S.); KidzFirst Middlemore Hospital and the University of Auckland (J.N.) and the Children's Emergency Department, Starship Children's Hospital, and Liggins Institute, University of Auckland (S.R.D.), Auckland, New Zealand; and Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (J.A.W.)
| | - Jennifer A Whitty
- From the Pediatric Critical Care Research Group, Centre for Children's Health Research, Lady Cilento Children's Hospital, and Mater Research Institute (D.F., L.J.S., A.S.), the Schools of Medicine (D.F., L.J.S., J.F.F., A.S.) and Public Health (M.J.), University of Queensland, and the Critical Care Research Group, Adult Intensive Care Service, Prince Charles Hospital (D.F., J.F.F.), Brisbane, the Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC (D.F., F.E.B., E.O., S.C., J.N., J.F., S.R.D., A.S.), Royal Children's Hospital, the Emergency Department, Murdoch Children's Research Institute, and the Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, VIC (F.E.B., E.O.), the Department of Medicine, School of Clinical Sciences, Monash University, and the Paediatric Emergency Department, Monash Medical Centre, Monash Health, Clayton, VIC (S.C.), and the College of Medicine and Dentistry, James Cook University, and the Emergency Department, Townsville Hospital, Townsville, QLD (J.F.) - all in Australia; the Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland (L.J.S.); KidzFirst Middlemore Hospital and the University of Auckland (J.N.) and the Children's Emergency Department, Starship Children's Hospital, and Liggins Institute, University of Auckland (S.R.D.), Auckland, New Zealand; and Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (J.A.W.)
| | - Stuart R Dalziel
- From the Pediatric Critical Care Research Group, Centre for Children's Health Research, Lady Cilento Children's Hospital, and Mater Research Institute (D.F., L.J.S., A.S.), the Schools of Medicine (D.F., L.J.S., J.F.F., A.S.) and Public Health (M.J.), University of Queensland, and the Critical Care Research Group, Adult Intensive Care Service, Prince Charles Hospital (D.F., J.F.F.), Brisbane, the Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC (D.F., F.E.B., E.O., S.C., J.N., J.F., S.R.D., A.S.), Royal Children's Hospital, the Emergency Department, Murdoch Children's Research Institute, and the Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, VIC (F.E.B., E.O.), the Department of Medicine, School of Clinical Sciences, Monash University, and the Paediatric Emergency Department, Monash Medical Centre, Monash Health, Clayton, VIC (S.C.), and the College of Medicine and Dentistry, James Cook University, and the Emergency Department, Townsville Hospital, Townsville, QLD (J.F.) - all in Australia; the Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland (L.J.S.); KidzFirst Middlemore Hospital and the University of Auckland (J.N.) and the Children's Emergency Department, Starship Children's Hospital, and Liggins Institute, University of Auckland (S.R.D.), Auckland, New Zealand; and Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (J.A.W.)
| | - Andreas Schibler
- From the Pediatric Critical Care Research Group, Centre for Children's Health Research, Lady Cilento Children's Hospital, and Mater Research Institute (D.F., L.J.S., A.S.), the Schools of Medicine (D.F., L.J.S., J.F.F., A.S.) and Public Health (M.J.), University of Queensland, and the Critical Care Research Group, Adult Intensive Care Service, Prince Charles Hospital (D.F., J.F.F.), Brisbane, the Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC (D.F., F.E.B., E.O., S.C., J.N., J.F., S.R.D., A.S.), Royal Children's Hospital, the Emergency Department, Murdoch Children's Research Institute, and the Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, VIC (F.E.B., E.O.), the Department of Medicine, School of Clinical Sciences, Monash University, and the Paediatric Emergency Department, Monash Medical Centre, Monash Health, Clayton, VIC (S.C.), and the College of Medicine and Dentistry, James Cook University, and the Emergency Department, Townsville Hospital, Townsville, QLD (J.F.) - all in Australia; the Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland (L.J.S.); KidzFirst Middlemore Hospital and the University of Auckland (J.N.) and the Children's Emergency Department, Starship Children's Hospital, and Liggins Institute, University of Auckland (S.R.D.), Auckland, New Zealand; and Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (J.A.W.)
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141
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Leclerc F, Duhamel A, Leteurtre S, Straney L, Bellomo R, MacLaren G, Pilcher D, Schlapbach LJ. Which organ dysfunction scores to use in children with infection? Intensive Care Med 2018; 44:697-698. [PMID: 29569156 DOI: 10.1007/s00134-018-5123-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Francis Leclerc
- Service de réanimation pédiatrique, CHU Lille, 59000, Lille, France. .,EA 2694 Santé publique, épidémiologie et qualité des soins, Univ. Lille, 59000, Lille, France.
| | - Alain Duhamel
- EA 2694 Santé publique, épidémiologie et qualité des soins, Univ. Lille, 59000, Lille, France.,Département de biostatistiques, CHU Lille, 59000, Lille, France
| | - Stéphane Leteurtre
- Service de réanimation pédiatrique, CHU Lille, 59000, Lille, France.,EA 2694 Santé publique, épidémiologie et qualité des soins, Univ. Lille, 59000, Lille, France
| | - Lahn Straney
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rinaldo Bellomo
- University of Melbourne, Melbourne, Australia.,Intensive Care, Austin Health, Melbourne, Australia
| | - Graeme MacLaren
- Cardiothoracic Intensive Care Unit, National University Health System, Singapore, Singapore.,Paediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia
| | - David Pilcher
- The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation (CORE), ANZICS House, Levers Terrace, Carlton South, Melbourne, Australia.,School of Public Health and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.,Department of Intensive Care, The Alfred Hospital, Commercial Road, Prahran, VIC, Australia
| | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Brisbane, Australia.,Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
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142
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Schlapbach LJ, Straney L, Bellomo R, MacLaren G, Pilcher D. Prognostic accuracy of age-adapted SOFA, SIRS, PELOD-2, and qSOFA for in-hospital mortality among children with suspected infection admitted to the intensive care unit. Intensive Care Med 2018; 44:179-188. [PMID: 29256116 PMCID: PMC5816088 DOI: 10.1007/s00134-017-5021-8] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/06/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE The Sepsis-3 consensus task force defined sepsis as life-threatening organ dysfunction caused by dysregulated host response to infection. However, the clinical criteria for this definition were neither designed for nor validated in children. We validated the performance of SIRS, age-adapted SOFA, quick SOFA and PELOD-2 scores as predictors of outcome in children. METHODS We performed a multicentre binational cohort study of patients < 18 years admitted with infection to ICUs in Australia and New Zealand. The primary outcome was ICU mortality. SIRS, age-adapted SOFA, quick SOFA and PELOD-2 scores were compared using crude and adjusted area under the receiver operating characteristic curve (AUROC) analysis. RESULTS Of 2594 paediatric ICU admissions due to infection, 151 (5.8%) children died, and 949/2594 (36.6%) patients died or experienced an ICU length of stay ≥ 3 days. A ≥ 2-point increase in the individual score was associated with a crude mortality increase from 3.1 to 6.8% for SIRS, from 1.9 to 7.6% for age-adapted SOFA, from 1.7 to 7.3% for PELOD-2, and from 3.9 to 8.1% for qSOFA (p < 0.001). The discrimination of outcomes was significantly higher for SOFA (adjusted AUROC 0.829; 0.791-0.868) and PELOD-2 (0.816; 0.777-0.854) than for qSOFA (0.739; 0.695-0.784) and SIRS (0.710; 0.664-0.756). CONCLUSIONS SIRS criteria lack specificity to identify children with infection at substantially higher risk of mortality. We demonstrate that adapting Sepsis-3 to age-specific criteria performs better than Sepsis-2-based criteria. Our findings support the translation of Sepsis-3 into paediatric-specific sepsis definitions and highlight the importance of robust paediatric organ dysfunction characterization.
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Affiliation(s)
- Luregn J Schlapbach
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.
- Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Brisbane, Australia.
- Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Children's Health Queensland, Brisbane, Australia.
- Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
| | - Lahn Straney
- Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Rinaldo Bellomo
- University of Melbourne, Melbourne, Australia
- Intensive Care, Austin Health, Melbourne, Australia
| | - Graeme MacLaren
- University of Melbourne, Melbourne, Australia
- Cardiothoracic Intensive Care Unit, National University Health System, Singapore, Singapore
- Paediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia
| | - David Pilcher
- The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation (CORE), ANZICS House, Levers Terrace, Carlton South, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care, The Alfred Hospital, Commercial Road, Prahran, VIC, Australia
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143
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Ostrowski JA, MacLaren G, Alexander J, Stewart P, Gune S, Francis JR, Ganu S, Festa M, Erickson SJ, Straney L, Schlapbach LJ. The burden of invasive infections in critically ill Indigenous children in Australia. Med J Aust 2017; 206:78-84. [PMID: 28152345 DOI: 10.5694/mja16.00595] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/08/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To describe the incidence and mortality of invasive infections in Indigenous children admitted to paediatric and general intensive care units (ICUs) in Australia. DESIGN Retrospective multi-centre cohort study of Australian and New Zealand Paediatric Intensive Care Registry data. PARTICIPANTS All children under 16 years of age admitted to an ICU in Australia, 1 January 2002 - 31 December 2013. Indigenous children were defined as those identified as Aboriginal and/or Torres Strait Islander in a mandatory admissions dataset. MAIN OUTCOMES Population-based ICU mortality and admission rates. RESULTS Invasive infections accounted for 23.0% of non-elective ICU admissions of Indigenous children (726 of 3150), resulting in an admission rate of 47.6 per 100 000 children per year. Staphylococcus aureus was the leading pathogen identified in children with sepsis/septic shock (incidence, 4.42 per 100 000 Indigenous children per year; 0.57 per 100 000 non-Indigenous children per year; incidence rate ratio 7.7; 95% CI, 5.8-10.1; P < 0.001). While crude and risk-adjusted ICU mortality related to invasive infections was not significantly different for Indigenous and non-Indigenous children (odds ratio, 0.75; 95% CI, 0.53-1.07; P = 0.12), the estimated population-based age-standardised mortality rate for invasive infections was significantly higher for Indigenous children (2.67 per 100 000 per year v 1.04 per 100 000 per year; crude incidence rate ratio, 2.65; 95% CI, 1.88-3.64; P < 0.001). CONCLUSIONS The ICU admission rate for severe infections was several times higher for Indigenous than for non-Indigenous children, particularly for S. aureus infections. While ICU case fatality rates were similar, the population-based mortality was more than twice as high for Indigenous children. Our study highlights an important area of inequality in health care for Indigenous children in a high income country that needs urgent attention.
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Affiliation(s)
| | | | - Janet Alexander
- Australian and New Zealand Paediatric Intensive Care Registry (CORE), Brisbane, QLD
| | | | | | | | - Subodh Ganu
- Women's and Children's Hospital Adelaide, Adelaide, SA
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144
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Affiliation(s)
- Ulf Kessler
- Department of Pediatric Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Surgery, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
| | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
- Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, QLD, Australia
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Klimek
- Department of Pediatric Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan M Jakob
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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145
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Stocker M, van Herk W, El Helou S, Dutta S, Fontana MS, Schuerman FABA, van den Tooren-de Groot RK, Wieringa JW, Janota J, van der Meer-Kappelle LH, Moonen R, Sie SD, de Vries E, Donker AE, Zimmerman U, Schlapbach LJ, de Mol AC, Hoffman-Haringsma A, Roy M, Tomaske M, Kornelisse RF, van Gijsel J, Visser EG, Willemsen SP, van Rossum AMC. Procalcitonin-guided decision making for duration of antibiotic therapy in neonates with suspected early-onset sepsis: a multicentre, randomised controlled trial (NeoPIns). Lancet 2017; 390:871-881. [PMID: 28711318 DOI: 10.1016/s0140-6736(17)31444-7] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/15/2017] [Accepted: 03/28/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Up to 7% of term and late-preterm neonates in high-income countries receive antibiotics during the first 3 days of life because of suspected early-onset sepsis. The prevalence of culture-proven early-onset sepsis is 0·1% or less in high-income countries, suggesting substantial overtreatment. We assess whether procalcitonin-guided decision making for suspected early-onset sepsis can safely reduce the duration of antibiotic treatment. METHODS We did this randomised controlled intervention trial in Dutch (n=11), Swiss (n=4), Canadian (n=2), and Czech (n=1) hospitals. Neonates of gestational age 34 weeks or older, with suspected early-onset sepsis requiring antibiotic treatment were stratified into four risk categories by their treating physicians and randomly assigned [1:1] using a computer-generated list stratified per centre to procalcitonin-guided decision making or standard care-based antibiotic treatment. Neonates who underwent surgery within the first week of life or had major congenital malformations that would have required hospital admission were excluded. Only principal investigators were masked for group assignment. Co-primary outcomes were non-inferiority for re-infection or death in the first month of life (margin 2·0%) and superiority for duration of antibiotic therapy. Intention-to-treat and per-protocol analyses were done. This trial was registered with ClinicalTrials.gov, number NCT00854932. FINDINGS Between May 21, 2009, and Feb 14, 2015, we screened 2440 neonates with suspected early-onset sepsis. 622 infants were excluded due to lack of parental consent, 93 were ineligible for reasons unknown (68), congenital malformation (22), or surgery in the first week of life (3). 14 neonates were excluded as 100% data monitoring or retrieval was not feasible, and one neonate was excluded because their procalcitonin measurements could not be taken. 1710 neonates were enrolled and randomly assigned to either procalcitonin-guided therapy (n=866) or standard therapy (n=844). 1408 neonates underwent per-protocol analysis (745 in the procalcitonin group and 663 standard group). For the procalcitonin group, the duration of antibiotic therapy was reduced (intention to treat: 55·1 vs 65·0 h, p<0·0001; per protocol: 51·8 vs 64·0 h; p<0·0001). No sepsis-related deaths occurred, and 9 (<1%) of 1710 neonates had possible re-infection. The risk difference for non-inferiority was 0·1% (95% CI -4·6 to 4·8) in the intention-to-treat analysis (5 [0·6%] of 866 neonates in the procalcitonin group vs 4 [0·5%] of 844 neonates in the standard group) and 0·1% (-5·2 to 5·3) in the per-protocol analysis (5 [0·7%] of 745 neonates in the procalcitonin group vs 4 [0·6%] of 663 neonates in the standard group). INTERPRETATION Procalcitonin-guided decision making was superior to standard care in reducing antibiotic therapy in neonates with suspected early-onset sepsis. Non-inferiority for re-infection or death could not be shown due to the low occurrence of re-infections and absence of study-related death. FUNDING The Thrasher Foundation, the NutsOhra Foundation, the Sophia Foundation for Scientific research.
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Affiliation(s)
- Martin Stocker
- Department of Paediatrics, Neonatal and Paediatric Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Wendy van Herk
- Department of Paediatrics, Division of Paediatric Infectious Diseases & Immunology, Erasmus MC University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands.
| | - Salhab El Helou
- Division of Neonatology, McMaster University Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Sourabh Dutta
- Division of Neonatology, McMaster University Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Matteo S Fontana
- Department of Paediatrics, Neonatal and Paediatric Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | | | | | | | - Jan Janota
- Department of Neonatology, Thomayer Hospital, Prague, Czech Republic; Institute of Pathological Physiology, First Medical Faculty, Charles University in Prague, Czech Republic
| | | | - Rob Moonen
- Department of Neonatology, Atrium Medical Centre, Heerlen, Netherlands
| | - Sintha D Sie
- Department of Neonatology, VU University Medical Centre, Amsterdam, Netherlands
| | - Esther de Vries
- Department of Paediatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | - Albertine E Donker
- Department of Paediatrics, Maxima Medical Centre, Veldhoven, Netherlands
| | - Urs Zimmerman
- Department of Paediatrics, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Luregn J Schlapbach
- Department of Paediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland; Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, QLD, Australia; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, QLD, Australia
| | - Amerik C de Mol
- Department of Neonatology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | | | - Madan Roy
- Department of Neonatology, St. Josephs Healthcare, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Maren Tomaske
- Department of Paediatrics, Stadtspital Triemli, Zürich, Switzerland
| | - René F Kornelisse
- Division of Neonatology, Erasmus MC University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Juliette van Gijsel
- Julius Training General Practitioner, University Medical Centre Utrecht, Netherlands
| | - Eline G Visser
- Department of Paediatrics, Division of Paediatric Infectious Diseases & Immunology, Erasmus MC University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Sten P Willemsen
- Department of Biostatistics, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Annemarie M C van Rossum
- Department of Paediatrics, Division of Paediatric Infectious Diseases & Immunology, Erasmus MC University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands
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146
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Mattke AC, Prabhu S, Clark J, Labrom R, Burns H, Schlapbach LJ. Lemierre's syndrome, necrotizing pneumonia and staphylococcal septic shock treated with extracorporeal life support. SAGE Open Med Case Rep 2017; 5:2050313X17722726. [PMID: 28835825 PMCID: PMC5542080 DOI: 10.1177/2050313x17722726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 06/27/2017] [Indexed: 11/25/2022] Open
Abstract
Objectives: Lemierre’s syndrome cause by methicillin-sensitive Staphylococcus aureus is rare, but can lead to necrotizing pneumonia and septicaemia. When treating such patient with extracorporeal life support source control can be both challenging and controversial. Methods: In this report we present a 12 year old male who presented with Lemierre’s syndrome from which he developed septic shock and severe necrotizing pneumonia. He also showed multiple pulmonary embolisms from the internal jugular vein thrombi, resulting in acute respiratory distress syndrome. Results: The patient was treated with extracorporeal life support. Subsequent computed tomography revealed multiple abscesses throughout his lungs and around vertebral bodies C1 and C2, for which source control with drainage of the cervical abscesses was achieved while on extracorporeal life support. The necrotizing pneumonia gradually improved, and partial pneumectomy was avoided. He was successfully separated from extracorporeal life support and respiratory support and recovered from his illness. Follow-up imaging showed almost complete resolution of the pulmonary abscesses. Osteomyelitis of C1/C2 and severe muscle wasting required a prolonged hospital stay. Conclusion: This case highlights the challenges of supporting patients suffering from disseminated staphylococcal sepsis with extracorporeal life support and the key role of source control and demonstrates the value of using extracorporeal life support in necrotizing pneumonia.
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Affiliation(s)
- Adrian C Mattke
- Queensland Paediatric Cardiac Services, Lady Cilento Children's Hospital (LCCH), South Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Paediatric Critical Care Research Group, Mater Medical Research Institute, QLD, Australia.,Paediatric Intensive Care Unit, Lady Cilento Children's Hospital (LCCH), South Brisbane, QLD, Australia.,Department of Critical Care Medicine, Lady Cilento Children's Hospital (LCCH), South Brisbane, QLD, Australia
| | - Sudesh Prabhu
- Queensland Paediatric Cardiac Services, Lady Cilento Children's Hospital (LCCH), South Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Paediatric Critical Care Research Group, Mater Medical Research Institute, QLD, Australia
| | - Julia Clark
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Paediatric Infection Management Service, Lady Cilento Children's Hospital (LCCH), South Brisbane, QLD, Australia
| | - Robert Labrom
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Orthopaedic Surgery, Lady Cilento Children's Hospital (LCCH), South Brisbane, QLD, Australia
| | - Hanna Burns
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Otolaryngology, Head and Neck Surgery, Lady Cilento Children's Hospital (LCCH), South Brisbane, QLD, Australia
| | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, Mater Medical Research Institute, QLD, Australia.,Paediatric Intensive Care Unit, Lady Cilento Children's Hospital (LCCH), South Brisbane, QLD, Australia.,Department of Pediatrics, Inselspital, University of Bern, Bern, Switzerland
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147
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Affiliation(s)
- Luregn J Schlapbach
- Pediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, Australia.,Pediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, Australia.,Department of Pediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Graeme MacLaren
- Pediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, Australia.,Cardiothoracic Intensive Care Unit, National University Health System, Singapore
| | - Lahn Straney
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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148
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Schlapbach LJ, Straney L, Gelbart B, Alexander J, Franklin D, Beca J, Whitty JA, Ganu S, Wilkins B, Slater A, Croston E, Erickson S, Schibler A. Burden of disease and change in practice in critically ill infants with bronchiolitis. Eur Respir J 2017; 49:49/6/1601648. [DOI: 10.1183/13993003.01648-2016] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 03/03/2017] [Indexed: 11/05/2022]
Abstract
Bronchiolitis represents the most common cause of non-elective admission to paediatric intensive care units (ICUs).We assessed changes in admission rate, respiratory support, and outcomes of infants <24 months with bronchiolitis admitted to ICU between 2002 and 2014 in Australia and New Zealand.During the study period, bronchiolitis was responsible for 9628 (27.6%) of 34 829 non-elective ICU admissions. The estimated population-based ICU admission rate due to bronchiolitis increased by 11.76 per 100 000 each year (95% CI 8.11–15.41). The proportion of bronchiolitis patients requiring intubation decreased from 36.8% in 2002, to 10.8% in 2014 (adjusted OR 0.35, 95% CI 0.27–0.46), whilst a dramatic increase in high-flow nasal cannula therapy use to 72.6% was observed (p<0.001). We observed considerable variability in practice between units, with six-fold differences in risk-adjusted intubation rates that were not explained by ICU type, size, or major patient factors. Annual direct hospitalisation costs due to severe bronchiolitis increased to over USD30 million in 2014.We observed an increasing healthcare burden due to severe bronchiolitis, with a major change in practice in the management from invasive to non-invasive support that suggests thresholds to admittance of bronchiolitis patients to ICU have changed. Future studies should assess strategies for management of bronchiolitis outside ICUs.
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149
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Affiliation(s)
- Luregn J Schlapbach
- Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, Australia.,Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, Australia.,Department of Pediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Etienne Javouhey
- Pediatric Emergency and Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils Lyon, Bron, France.,University of Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Nicolaas J G Jansen
- Chairman of the Section Infection, Inflammation and Sepsis of ESPNIC, Pediatric Intensive Care Unit, Wilhelmina Children's Hospital, University Medical Center Utrecht, KG.01.319.0, P.O. Box 85090, 3508 AB, Utrecht, The Netherlands. .,Child Health, Science for Life, Research Group, University Medical Center Utrecht, Utrecht, The Netherlands.
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150
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Affiliation(s)
- Luregn J Schlapbach
- Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia2Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia3Department of Pediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Graeme MacLaren
- Paediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia5Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia6Cardiothoracic Intensive Care Unit, National University Health System, Singapore
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