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Peros T, Ray S, Peters MJ. Authors Reply to "False reassurance about prompt reduction of hypertension in Paediatric Intensive Care". Anaesth Crit Care Pain Med 2023; 42:101205. [PMID: 36905821 DOI: 10.1016/j.accpm.2023.101205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023]
Affiliation(s)
- Thomas Peros
- Great Ormond Street Hospital - Paediatric Intensive Care Unit, United Kingdom; Amsterdam University Medical Centre - Paediatric Intensive Care Unit, The Netherlands.
| | - Samiran Ray
- Great Ormond Street Hospital - Paediatric Intensive Care Unit, United Kingdom
| | - Mark J Peters
- Great Ormond Street Hospital - Paediatric Intensive Care Unit, United Kingdom
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Peros T, Ricciardi F, Booth J, Ray S, Peters MJ. Evaluation of blood pressure trajectories and outcome in critically ill children with initial hypertension on admission to Paediatric Intensive Care. Anaesth Crit Care Pain Med 2022; 41:101149. [PMID: 36075563 DOI: 10.1016/j.accpm.2022.101149] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/07/2022] [Accepted: 08/15/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Hypertension on paediatric intensive care (PICU) is associated with adverse outcomes. Management is complex; hypertension often represents a physiological adaptive response and exposure to hypertension could lead to altered pressure-flow autoregulation. International treatment consensus is to avoid rapid blood pressure (BP) reduction. Our aim was to examine if the rate and magnitude of BP reduction in hypertensive patients was correlated with harm. PATIENTS AND METHODS We performed a single centre, retrospective, observational study in a quaternary PICU analysing the first 24 h post admission high resolution BP profiles of children with admission BP above the 95th centile. Individual BP profiles were analysed regarding both time spent and magnitude below a threshold; 75% of the admission BP in the first 24 h. Outcomes were organ support-free days at day 28, change in serum creatinine and PICU mortality. MAIN FINDINGS Of 3069 admissions in a 36-month period (2016-2018), 21.7% had initial hypertension on admission to PICU. A total of 3,259,111 BP measurements (99.4% invasive) were available. Pre-existing hypertension was documented in 4.9% of patients. Both time spent and magnitude below threshold BP was poorly correlated with duration of required organ support and risk of death after adjusting for PIM score, pre-existing hypertension and raised intracranial pressure. We did find an association with a rise in serum creatinine on both uni- and multivariable analysis. CONCLUSIONS The risk of harm due to early and significant reduction of raised blood pressure in critically ill children appears to be limited.
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Affiliation(s)
- Thomas Peros
- Great Ormond Street Hospital - Paediatric Intensive Care Unit, London, United Kingdom; Amsterdam University Medical Centre - Paediatric Intensive Care Unit, Amsterdam, the Netherlands.
| | - Federico Ricciardi
- University College London - Department of Statistical Science, London, United Kingdom
| | - John Booth
- Great Ormond Street Hospital - Digital Research Informatics and Virtual Environments Unit, London, United Kingdom
| | - Samiran Ray
- Great Ormond Street Hospital - Paediatric Intensive Care Unit, London, United Kingdom; UCL Great Ormond Street Institute of Child Health - Infection, Immunity and Inflammation Research & Teaching Department, London, United Kingdom
| | - Mark J Peters
- Great Ormond Street Hospital - Paediatric Intensive Care Unit, London, United Kingdom; UCL Great Ormond Street Institute of Child Health - Infection, Immunity and Inflammation Research & Teaching Department, London, United Kingdom
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Peters MJ, Macharia W, Molyneux E. A COASTal view: where prior beliefs and uncertainty collide. Intensive Care Med 2021; 47:591-593. [PMID: 33904949 DOI: 10.1007/s00134-021-06406-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Mark J Peters
- Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK. .,Respiratory Critical Care and Anaesthesia Unit, University College London, Great Ormond Street Hospital Institute of Child Health, NIHR Biomedical Research Centre, London, WC1N 1EH, UK.
| | - William Macharia
- Department of Paediatric and Child Health, Aga Khan University, 3rd Parklands Avenue, Box 30270, Nairobi, 00100, Kenya
| | - Elizabeth Molyneux
- Department of Paediatric and Child Health, College of Medicine, Box 360, Blantyre, Malawi
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Singh Y, Villaescusa JU, da Cruz EM, Tibby SM, Bottari G, Saxena R, Guillén M, Herce JL, Di Nardo M, Cecchetti C, Brierley J, de Boode W, Lemson J. Recommendations for hemodynamic monitoring for critically ill children-expert consensus statement issued by the cardiovascular dynamics section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Crit Care 2020; 24:620. [PMID: 33092621 PMCID: PMC7579971 DOI: 10.1186/s13054-020-03326-2] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cardiovascular instability is common in critically ill children. There is a scarcity of published high-quality studies to develop meaningful evidence-based hemodynamic monitoring guidelines and hence, with the exception of management of shock, currently there are no published guidelines for hemodynamic monitoring in children. The European Society of Paediatric and Neonatal Intensive Care (ESPNIC) Cardiovascular Dynamics section aimed to provide expert consensus recommendations on hemodynamic monitoring in critically ill children. METHODS Creation of a panel of experts in cardiovascular hemodynamic assessment and hemodynamic monitoring and review of relevant literature-a literature search was performed, and recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. The AGREE statement was followed to prepare this document. RESULTS Of 100 suggested recommendations across 12 subgroups concerning hemodynamic monitoring in critically ill children, 72 reached "strong agreement," 20 "weak agreement," and 2 had "no agreement." Six statements were considered as redundant after rephrasing of statements following the first round of voting. The agreed 72 recommendations were then coalesced into 36 detailing four key areas of hemodynamic monitoring in the main manuscript. Due to a lack of published evidence to develop evidence-based guidelines, most of the recommendations are based upon expert consensus. CONCLUSIONS These expert consensus-based recommendations may be used to guide clinical practice for hemodynamic monitoring in critically ill children, and they may serve as a basis for highlighting gaps in the knowledge base to guide further research in hemodynamic monitoring.
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Affiliation(s)
- Yogen Singh
- Department of Pediatrics - Neonatology and Pediatric Cardiology, Cambridge University Hospitals and University of Cambridge School of Clinical Medicine, Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Javier Urbano Villaescusa
- Department of Pediatric Intensive Care, Gregorio Marañón Hospital University Hospital, Madrid, Spain
| | - Eduardo M da Cruz
- Department of Pediatrics, Children's Hospital Colorado, Section of Cardiac Intensive Care, The Heart Institute, Pittsburgh, USA
| | - Shane M Tibby
- Department of Pediatric Intensive Care, Evelina London Children's Hospital, London, UK
| | - Gabriella Bottari
- Department of Pediatric Intensive Care, Ospedale Pediatrico Bambino Gesù-IRCC, Rome, Italy
| | - Rohit Saxena
- Department of Pediatric and Cardiac Intensive Care, Great Ormond Street Hospital for Children and UCL Institute for Child Health, London, UK
| | - Marga Guillén
- Department of Pediatric Intensive Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Jesus Lopez Herce
- Department of Pediatric Intensive Care, Gregorio Marañón Hospital University Hospital, Madrid, Spain
| | - Matteo Di Nardo
- Department of Pediatric Intensive Care, Ospedale Pediatrico Bambino Gesù-IRCC, Rome, Italy
| | - Corrado Cecchetti
- Department of Pediatric Intensive Care, Ospedale Pediatrico Bambino Gesù-IRCC, Rome, Italy
| | - Joe Brierley
- Department of Pediatric and Cardiac Intensive Care, Great Ormond Street Hospital for Children and UCL Institute for Child Health, London, UK
| | - Willem de Boode
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Joris Lemson
- Department of Intensive Care Medicine, Radboud University Medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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