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Imberti S, Comoretto R, Ceschia G, Longo G, Benetti E, Amigoni A, Daverio M. Impact of the first 24 h of continuous kidney replacement therapy on hemodynamics, ventilation, and analgo-sedation in critically ill children. Pediatr Nephrol 2024; 39:879-887. [PMID: 37723304 DOI: 10.1007/s00467-023-06155-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/25/2023] [Accepted: 08/17/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND In a group of children admitted to the paediatric intensive care unit (PICU) receiving continuous kidney replacement therapy (CKRT), we aim to evaluate the data about their hemodynamic, ventilation and analgo-sedation profile in the first 24 h of treatment and possible associations with mortality. METHODS Retrospective cohort study of children admitted to the PICU of the University Hospital of Padova undergoing CKRT between January 2011 and March 2021. Data was collected at baseline (T0), after 1 h (T1) and 24 h (T24) of CKRT treatment. The differences in outcome measures were compared between these time points, and between survivors and non-survivors. RESULTS Sixty-nine patients received CKRT, of whom 38 (55%) died during the PICU stay. Overall, the vasoactive inotropic score and the adrenaline dose increased at T1 compared to T0 (p = 0.012 and p = 0.022, respectively). Compared to T0, at T24 patients showed an improvement in the following ventilatory parameters: Oxygenation Index (p = 0.005), Oxygenation Saturation Index (p = 0.013) PaO2/FiO2 ratio (p = 0.005), SpO2/FiO2 ratio (p = 0.002) and Mean Airway Pressure (p = 0.016). These improvements remained significant in survivors (p = 0.01, p = 0.027, p = 0.01 and p = 0.015, respectively) but not in non-survivors. No changes in analgo-sedative drugs have been described. CONCLUSIONS CKRT showed a significant impact on hemodynamics and ventilation in the first 24 h of treatment. We observed a significant rise in the inotropic/vasoactive support required after 1 h of treatment in the overall population, and an improvement in the ventilation parameters at 24 h only in survivors.
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Affiliation(s)
- Simona Imberti
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Rosanna Comoretto
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Giovanni Ceschia
- Department of Women's and Children's Health, University of Padua, Padua, Italy
- Pediatric Nephrology, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Germana Longo
- Pediatric Nephrology, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Elisa Benetti
- Pediatric Nephrology, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Marco Daverio
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy.
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Cortina G, Daverio M, Demirkol D, Chanchlani R, Deep A. Continuous renal replacement therapy in neonates and children: what does the pediatrician need to know? An overview from the Critical Care Nephrology Section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Eur J Pediatr 2024; 183:529-541. [PMID: 37975941 PMCID: PMC10912166 DOI: 10.1007/s00431-023-05318-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/13/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023]
Abstract
Continuous renal replacement therapy (CRRT) is the preferred method for renal support in critically ill and hemodynamically unstable children in the pediatric intensive care unit (PICU) as it allows for gentle removal of fluids and solutes. The most frequent indications for CRRT include acute kidney injury (AKI) and fluid overload (FO) as well as non-renal indications such as removal of toxic metabolites in acute liver failure, inborn errors of metabolism, and intoxications and removal of inflammatory mediators in sepsis. AKI and/or FO are common in critically ill children and their presence is associated with worse outcomes. Therefore, early recognition of AKI and FO is important and timely transfer of patients who might require CRRT to a center with institutional expertise should be considered. Although CRRT has been increasingly used in the critical care setting, due to the lack of standardized recommendations, wide practice variations exist regarding the main aspects of CRRT application in critically ill children. Conclusion: In this review, from the Critical Care Nephrology section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC), we summarize the key aspects of CRRT delivery and highlight the importance of adequate follow up among AKI survivors which might be of relevance for the general pediatric community. What is Known: • CRRT is the preferred method of renal support in critically ill and hemodynamically unstable children in the PICU as it allows for gentle removal of fluids and solutes. • Although CRRT has become an important and integral part of modern pediatric critical care, wide practice variations exist in all aspects of CRRT. What is New: • Given the lack of literature on guidance for a general pediatrician on when to refer a child for CRRT, we recommend timely transfer to a center with institutional expertise in CRRT, as both worsening AKI and FO have been associated with increased mortality. • Adequate follow-up of PICU patients with AKI and CRRT is highlighted as recent findings demonstrate that these children are at increased risk for adverse long-term outcomes.
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Affiliation(s)
- Gerard Cortina
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Marco Daverio
- Pediatric Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Demet Demirkol
- Pediatric Intensive Care Unit, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Akash Deep
- Pediatric Intensive Care Unit, Kings College London, London, UK.
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Sperotto F, Ramelet AS, Daverio M, Mondardini MC, von Borell F, Brenner S, Tibboel D, Ista E, Pokorna P, Amigoni A. Assessment and management of iatrogenic withdrawal syndrome and delirium in pediatric intensive care units across Europe: An ESPNIC survey. Pharmacotherapy 2023; 43:804-815. [PMID: 37203273 DOI: 10.1002/phar.2831] [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: 01/31/2023] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Analgesia and sedation are essential for the care of children in the pediatric intensive care unit (PICU); however, when prolonged, they may be associated with iatrogenic withdrawal syndrome (IWS) and delirium. We sought to evaluate current practices on IWS and delirium assessment and management (including non-pharmacologic strategies as early mobilization) and to investigate associations between the presence of an analgosedation protocol and IWS and delirium monitoring, analgosedation weaning, and early mobilization. METHODS We conducted a multicenter cross-sectional survey-based study collecting data from one experienced physician or nurse per PICU in Europe from January to April 2021. We then investigated differences among PICUs that did or did not follow an analgosedation protocol. RESULTS Among 357 PICUs, 215 (60%) responded across 27 countries. IWS was systematically monitored with a validated scale in 62% of PICUs, mostly using the Withdrawal Assessment Tool-1 (53%). The main first-line treatment for IWS was a rescue bolus with interruption of weaning (41%). Delirium was systematically monitored in 58% of PICUs, mostly with the Cornell Assessment of Pediatric Delirium scale (48%) and the Sophia Observation Scale for Pediatric Delirium (34%). The main reported first-line treatment for delirium was dexmedetomidine (45%) or antipsychotic drugs (40%). Seventy-one percent of PICUs reported to follow an analgosedation protocol. Multivariate analyses adjusted for PICU characteristics showed that PICUs using a protocol were significantly more likely to systematically monitor IWS (odds ratio [OR] 1.92, 95% confidence interval [CI] 1.01-3.67) and delirium (OR 2.00, 95% CI 1.07-3.72), use a protocol for analgosedation weaning (OR 6.38, 95% CI 3.20-12.71) and promote mobilization (OR 3.38, 95% CI 1.63-7.03). CONCLUSIONS Monitoring and management of IWS and delirium are highly variable among European PICUs. The use of an analgosedation protocol was associated with an increased likelihood of monitoring IWS and delirium, performing a structured analgosedation weaning and promoting mobilization. Education on this topic and interprofessional collaborations are highly needed to help reduce the burden of analgosedation-associated adverse outcomes.
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Affiliation(s)
- Francesca Sperotto
- Cardiovascular Critical Care Unit, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anne-Sylvie Ramelet
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine University of Lausanne, Lausanne, Switzerland
| | - Marco Daverio
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Maria Cristina Mondardini
- Pediatric Anesthesia and Intensive Care Unit, Department of Woman's and Child's Health, IRCCS University Hospital of Bologna Policlinico S.Orsola, Bologna, Italy
| | - Florian von Borell
- Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Sebastian Brenner
- Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Dick Tibboel
- Intensive Care and Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Erwin Ista
- Department of Neonatal & Pediatric Intensive Care, Division Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Paula Pokorna
- Department of Neonatal & Pediatric Intensive Care, Division Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
- Institute of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- Department of Physiology and Pharmacology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
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Marchetto L, Comoretto R, Gregori D, Da Dalt L, Amigoni A, Daverio M. Sepsis Prognostic Scores Accuracy in Predicting Adverse Outcomes in Children With Sepsis Admitted to the Pediatric Intensive Care Unit From the Emergency Department: A 10-Year Single-Center Experience. Pediatr Emerg Care 2023; 39:378-384. [PMID: 37256281 DOI: 10.1097/pec.0000000000002938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/01/2023]
Abstract
OBJECTIVE To compare the performance of several prognostic scores calculated in the first 24 hours of admission (day 1) in predicting mortality and morbidity among critically ill children with sepsis presenting to the pediatric emergency department (PED) and then admitted to the pediatric intensive care unit (PICU). METHODS Single-center, retrospective cohort study in children with a diagnosis of sepsis visiting the PED and then admitted to the PICU from January 1, 2010 to December 31, 2019. Sepsis organ dysfunction scores-pediatric Sequential Organ Failure Assessment (pSOFA) (Schlapbach, Matics, Shime), quickSOFA, quickSOFA-L, Pediatric Logistic Organ Dysfunction (PELOD)-2, quickPELOD-2, and Pediatric Multiple Organ Dysfunction score-were calculated during the first 24 hours of admission (day 1) and their performance compared with systemic inflammatory response syndrome (SIRS) and severe sepsis-International Consensus Conference on Pediatric Sepsis(ICCPS)-derived criteria-using the area under the receiver operating characteristic curve. Primary outcome was PICU mortality. Secondary outcomes were: a composite of death and new disability (ie, change from baseline Pediatric Overall Performance Category score ≥1); prolonged PICU length of stay (>5 d); prolonged invasive mechanical ventilation (MV) (>3 d). RESULTS Among 60 patients with sepsis, 4 (6.7%) died, 7 (11.7%) developed new disability, 26 (43.3%) experienced prolonged length of stay, and 21 (35%) prolonged invasive MV. The prognostic ability in mortality discrimination was significantly higher for organ dysfunction scores, with PELOD-2 showing the best performance (area under the receiver operating characteristic curve, 0.924; 95% confidence interval, 0.837-1.000), significantly better than SIRS 3 criteria (0.924 vs 0.509, P = 0.009), SIRS 4 criteria (0.924 vs 0.509, P < 0.001), and severe sepsis (0.924 vs 0.527, P < 0.001). Among secondary outcomes, PELOD-2 performed significantly better than SIRS criteria and severe sepsis to predict prolonged duration of invasive MV, whereas better than severe sepsis to predict "poor outcome" (mortality or new disability). CONCLUSIONS Day 1 organ dysfunction scores performed better in predicting mortality and morbidity outcomes than ICCPS-derived criteria. The PELOD-2 was the organ dysfunction score with the best performance for all outcomes.
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Affiliation(s)
| | | | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - Liviana Da Dalt
- Pediatric Emergency Department, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Angela Amigoni
- From the Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Marco Daverio
- From the Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
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Daverio M, Belda Hofheinz S, Vida V, Scattolin F, López Fernández E, García Torres E, Tajuelo-Llopis I, Izquierdo-Blasco J, Pàmies-Catalán A, Di Nardo M, De Piero ME, Balcells J, Amigoni A. Pediatric COVID-19 extracorporeal membrane oxygenation transport during the pandemic. Perfusion 2023:2676591231176243. [PMID: 37173806 PMCID: PMC10185475 DOI: 10.1177/02676591231176243] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
INTRODUCTION ExtraCorporeal Membrane Oxygenation (ECMO) in pediatric patients with COVID-19 has a survival rate similar to adults. Occasionally, patients may need to be cannulated by an ECMO team in a referring hospital and transported to an ECMO center. The ECMO transport of a COVID-19 patient has additional risks than normal pediatric ECMO transport for the possible COVID-19 transmissibility to the ECMO team and the reduction of the ECMO team performance due to the need of wearing full personal protective equipment. Since pediatric data on ECMO transport of COVID-19 patients are lacking, we explored the outcomes of the pediatric COVID-19 ECMO transports collected in the EuroECMO COVID_Neo/Ped Survey. METHODS We reported five European consecutive ECMO transports of COVID-19 pediatric patients collected in the EuroECMO COVID_Neo/Ped Survey including 52 European neonatal and/or pediatric ECMO centers and endorsed by the EuroELSO from March 2020 till September 2021. RESULTS The ECMO transports were performed for two indications, pediatric ARDS and myocarditis associated to the multisystem inflammatory syndrome related to COVID-19. Cannulation strategies differed among patients according to the age of the patients, transport distance varied between 8 and 390 km with a total transport duration between 5 to 15 h. In all five cases, the ECMO transports were successfully performed without major adverse events. One patient reported a harlequin syndrome and another patient a cannula displacement both without major clinical consequences. Hospital survival was 60% with one patient reporting neurological sequelae. No ECMO team member developed COVID-19 symptoms after the transport. CONCLUSION Five transports of pediatric patients with COVID-19 supported with ECMO were reported in the EuroECMO COVID_Neo/Ped Survey. All transports were performed by an experienced multidisciplinary ECMO team and were feasible and safe for both the patient and the ECMO team. Further experiences are needed to better characterize these transports and draw insightful conclusions.
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Affiliation(s)
- Marco Daverio
- Pediatric Intensive Care Unit, University Hospital of
Padova, Padova, Italy
- Department of Woman’s and Child’s
Health, University Hospital of
Padova, Padova, Italy
| | - Sylvia Belda Hofheinz
- ECMO Transport Team, Hospital 12 de Octubre, Madrid, Spain
- School of Medicine, Complutense University of
Madrid, Madrid, Spain
- Mother-Child Health and Development
Network (Red SAMID) of Carlos III Health Institute, 12 de Octubre Health Research
Institute, Madrid, Spain
| | - Vladimiro Vida
- Department of Woman’s and Child’s
Health, University Hospital of
Padova, Padova, Italy
- Pediatric and Congenital Cardiac
Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public
Health, University of Padova Medical
School, Padova, Italy
| | - Fabio Scattolin
- Department of Woman’s and Child’s
Health, University Hospital of
Padova, Padova, Italy
- Pediatric and Congenital Cardiac
Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public
Health, University of Padova Medical
School, Padova, Italy
| | | | | | | | - Jaume Izquierdo-Blasco
- Pediatric Critical Care Department, Hospital Universitari Vall
d'Hebron, Barcelona, Spain
| | - Antoni Pàmies-Catalán
- Pediatric Cardiac Surgery
Department, Hospital Universitari Vall
d'Hebron, Barcelona, Spain
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Children’s Hospital Bambino
Gesù, IRCCS, Rome, Italy
| | - Maria Elena De Piero
- Department of Anesthesiology and
Intensive Care, San Giovanni Bosco
Hospital, ASL Città di Torino, Turin, Italy
| | - Joan Balcells
- Pediatric Critical Care Department, Hospital Universitari Vall
d'Hebron, Barcelona, Spain
- Universitat Autònoma de
Barcelona, Barcelona, Spain
| | - Angela Amigoni
- Pediatric Intensive Care Unit, University Hospital of
Padova, Padova, Italy
- Department of Woman’s and Child’s
Health, University Hospital of
Padova, Padova, Italy
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Paolin C, Zanetto L, Frison S, Boscolo Mela F, Tessari A, Amigoni A, Daverio M, Bonardi CM. Apneas requiring respiratory support in young infants with COVID-19: a case series and literature review. Eur J Pediatr 2023; 182:2089-2094. [PMID: 36912961 PMCID: PMC10009862 DOI: 10.1007/s00431-023-04856-x] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 01/26/2023] [Accepted: 02/01/2023] [Indexed: 03/14/2023]
Abstract
The objective of this study is to describe the clinical features of young infants with apneas as a clinical sign of COVID-19. We reported the cases of 4 infants who needed respiratory support in our PICU for a severe course of COVID-19 complicated with recurrent apneas. Moreover, we conducted a review of the literature about COVID-19 and apneas in infants ≤ 2 months of corrected age. A total of 17 young infants were included. Overall, in most of the cases (88%), apnea was an initial symptom of COVID-19, and in two cases, it recurred after 3-4 weeks. Regarding neurological workup, most children underwent a cranial ultrasound, while a minority underwent electroencephalography registration, neuroimaging, and lumbar punctures. One child showed signs of encephalopathy on electroencephalogram, with further neurological workup resulting normal. SARS-CoV-2 was never found in the cerebrospinal fluid. Ten children required intensive care unit admission, with five of them needing intubation and three non-invasive ventilation. A less invasive respiratory support was sufficient for the remaining children. Eight children were treated with caffeine. All patients had a complete recovery. Conclusion: Young infants with recurrent apneas during COVID-19 usually need respiratory support and undergo a wide clinical work-up. They usually show complete recovery even when admitted to the intensive care unit. Further studies are needed to better define diagnostic and therapeutic strategies for these patients. What is Known: • Although the course of COVID-19 in infants is usually mild, some of them may develop a more severe disease needing intensive care support. Apneas may be a clinical sign in COVID-19. What is New: • Infants with apneas during COVID-19 may require intensive care support, but they usually show a benign course of the disease and full recovery.
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Affiliation(s)
- Chiara Paolin
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Lorenzo Zanetto
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Sara Frison
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Federica Boscolo Mela
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Anna Tessari
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Marco Daverio
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy.
| | - Claudia Maria Bonardi
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
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Mondardini MC, Sperotto F, Daverio M, Amigoni A. Analgesia and sedation in critically ill pediatric patients: an update from the recent guidelines and point of view. Eur J Pediatr 2023; 182:2013-2026. [PMID: 36892607 DOI: 10.1007/s00431-023-04905-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/14/2023] [Accepted: 02/26/2023] [Indexed: 03/10/2023]
Abstract
In the last decades, the advancement of knowledge in analgesia and sedation for critically ill pediatric patients has been conspicuous and relevant. Many recommendations have changed to ensure patients' comfort during their intensive care unit (ICU) stay and prevent and treat sedation-related complications, as well as improve functional recovery and clinical outcomes. The key aspects of the analgosedation management in pediatrics have been recently reviewed in two consensus-based documents. However, there remains a lot to be researched and understood. With this narrative review and authors' point of view, we aimed to summarize the new insights presented in these two documents to facilitate their interpretation and application in clinical practice, as well as to outline research priorities in the field. Conclusion: With this narrative review and authors' point of view, we aimed to summarize the new insights presented in these two documents to facilitate their interpretation and application in clinical practice, as well as to outline research priorities in the field. What is Known: • Critically ill pediatric patients receiving intensive care required analgesia and sedation to attenuate painful and stressful stimuli. •Optimal management of analgosedation is a challenge often burdened with complications such as tolerance, iatrogenic withdrawal syndrome, delirium, and possible adverse outcomes. What is New: •The new insights on the analgosedation treatment for critically ill pediatric patients delineated in the recent guidelines are summarized to identify strategies for changes in clinical practice. •Research gaps and potential for quality improvement projects are also highlighted.
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Affiliation(s)
- Maria Cristina Mondardini
- Pediatric Anesthesia and Intensive Care Unit, Department of Woman's and Child's Health, IRCCS University Hospital of Bologna Policlinico S. Orsola, Bologna, Italy
| | - Francesca Sperotto
- Cardiovascular Critical Care Unit, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco Daverio
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy.
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Sperotto F, Daverio M, Amigoni A, Gregori D, Dorste A, Allan C, Thiagarajan RR. Trends in In-Hospital Cardiac Arrest and Mortality Among Children With Cardiac Disease in the Intensive Care Unit: A Systematic Review and Meta-analysis. JAMA Netw Open 2023; 6:e2256178. [PMID: 36763356 PMCID: PMC9918886 DOI: 10.1001/jamanetworkopen.2022.56178] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
IMPORTANCE Data on trends in incidence and mortality for in-hospital cardiac arrest (IHCA) in children with cardiac disease in the intensive care unit (ICU) are lacking. Additionally, there is limited information on factors associated with IHCA and mortality in this population. OBJECTIVE To investigate incidence, trends, and factors associated with IHCA and mortality in children with cardiac disease in the ICU. DATA SOURCES A systematic review was conducted using PubMed, Web of Science, EMBASE, and CINAHL, from inception to September 2021. STUDY SELECTION Observational studies on IHCA in pediatric ICU patients with cardiac disease were selected (age cutoffs in studies varied from age ≤18 y to age ≤21 y). DATA EXTRACTION AND SYNTHESIS Quality of studies was assessed using the National Institutes of Health Quality Assessment Tools. Data on incidence, mortality, and factors associated with IHCA or mortality were extracted by 2 independent observers. Random-effects meta-analysis was used to compute pooled proportions and pooled ORs. Metaregression, adjusted for type of study and diagnostic category, was used to evaluate trends in incidence and mortality. MAIN OUTCOMES AND MEASURES Primary outcomes were incidence of IHCA and in-hospital mortality. Secondary outcomes were proportions of patients who underwent extracorporeal membrane oxygenation (ECMO) cardiopulmonary resuscitation (ECPR) and those who did not achieve return of spontaneous circulation (ROSC). RESULTS Of the 2574 studies identified, 25 were included in the systematic review (131 724 patients) and 18 in the meta-analysis. Five percent (95% CI, 4%-6%) of children with cardiac disease in the ICU experienced IHCA. The pooled in-hospital mortality among children who experienced IHCA was 51% (95% CI, 42%-59%). Thirty-nine percent (95% CI, 29%-51%) did not achieve ROSC; in centers with ECMO, 22% (95% CI, 14%-33%) underwent ECPR, whereas 22% (95% CI, 12%-38%) were unable to be resuscitated. Both incidence of IHCA and associated in-hospital mortality decreased significantly in the last 20 years (both P for trend < .001), whereas the proportion of patients not achieving ROSC did not significantly change (P for trend = .90). Neonatal age, prematurity, comorbidities, univentricular physiology, arrhythmias, prearrest mechanical ventilation or ECMO, and higher surgical complexity were associated with increased incidence of IHCA and mortality odds. CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis found that 5% of children with cardiac disease in the ICU experienced IHCA. Decreasing trends in IHCA incidence and mortality suggest that education on preventive interventions, use of ECMO, and post-arrest care may have been effective; however, there remains a crucial need for developing resuscitation strategies specific to children with cardiac disease.
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Affiliation(s)
- Francesca Sperotto
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marco Daverio
- Pediatric Intensive Care Unit, Department of Women’s and Children’s Health, University of Padova, Padova, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Department of Women’s and Children’s Health, University of Padova, Padova, Italy
| | - Dario Gregori
- Laboratories of Epidemiological Methods and Biostatistics, Department of Environmental Medicine and Public Health, University of Padova, Italy
| | - Anna Dorste
- Boston Children’s Hospital Library, Boston Children’s Hospital, Boston, Massachusetts
| | - Catherine Allan
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ravi R. Thiagarajan
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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Tessari A, Sperotto F, Pece F, Pettenuzzo G, Porcellato N, Poletto E, Mondardini MC, Pettenazzo A, Daverio M, Amigoni A. Is ketamine infusion effective and safe as an adjuvant of sedation in the PICU? Results from the Ketamine Infusion Sedation Study (KISS). Pharmacotherapy 2022. [PMID: 36567489 DOI: 10.1002/phar.2754] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/08/2022] [Accepted: 10/11/2022] [Indexed: 12/27/2022]
Abstract
STUDY OBJECTIVE We aimed to evaluate the efficacy and safety of ketamine in ensuring comfort and sparing conventional drugs when used as an adjuvant for analgesia and sedation in the Pediatric Intensive Care Unit (PICU) as a continuous infusion (≥12 h). DESIGN Observational prospective study. SETTING Tertiary-care-center PICU. PATIENTS All consecutive patients <18 years who received ketamine for ≥12 h between January 2019 and July 2021. INTERVENTIONS ketamine infusion for ≥12 h. MEASUREMENTS AND MAIN RESULTS Seventy-seven patients (median age 16 months, Interquartile Range (IQR) 7-43) were enrolled. Twenty-six percent of patients (n = 20) were paralyzed, while 74% (n = 57) were not. The median infusion duration was 90 h (IQR 39-193), with doses between 15 (IQR 15-20) and 30 μg/kg/min (IQR 20-50). At 24 h of ketamine infusion, values of COMFORT-B-Scale (CBS) were significantly lower compared with values pre-ketamine (p < 0.001). Simultaneously, doses/kg/h of opioids and benzodiazepines significantly decreased at 24 h (p < 0.001 and p = 0.002, respectively), while doses/kg/h of propofol (p = 0.500) and dexmedetomidine (p = 0.072) did not significantly change. Seventy-four percent of non-paralyzed patients (42/57) had a decrease in CBS ≥2 points with no increase of concomitant analgosedation drugs. Among paralyzed patients (n = 20), 13 (65%) had no increase of concomitant analgosedation within 24 h after ketamine initiation. Overall, 55/77 (71%) of patients responded to ketamine. The mean and maximum ketamine infusion dosages were significantly higher in the non-responders (p = 0.021 and 0.028, respectively). Eleven patients had adverse events potentially related to ketamine (hypersalivation, systemic hypertension, dystonia/dyskinesia, tachycardia, and agitation) and six patients required intervention (dose reduction, suspension, or pharmacologic therapy). None of the patients developed delirium during ketamine infusion. CONCLUSIONS Ketamine used as a continuous infusion in the PICU might represent a valid strategy to ensure comfort and spare opioids and benzodiazepines in difficult-to-sedate PICU patients. Adverse events are minor and easily reversible. Future study will be needed to investigate long-term outcomes.
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Affiliation(s)
- Anna Tessari
- Pediatric Intensive Care Unit, Department of Women and Children's Health, University Hospital of Padua, Padua, Italy
| | - Francesca Sperotto
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Federico Pece
- Pediatric Intensive Care Unit, San Bortolo Hospital, Vicenza, Italy
| | - Giulia Pettenuzzo
- Pediatric Intensive Care Unit, Department of Women and Children's Health, University Hospital of Padua, Padua, Italy
| | - Nicola Porcellato
- Pediatric Intensive Care Unit, Department of Women and Children's Health, University Hospital of Padua, Padua, Italy
| | - Elisa Poletto
- Pediatric Intensive Care Unit, San Bortolo Hospital, Vicenza, Italy
| | | | - Andrea Pettenazzo
- Pediatric Intensive Care Unit, Department of Women and Children's Health, University Hospital of Padua, Padua, Italy
| | - Marco Daverio
- Pediatric Intensive Care Unit, Department of Women and Children's Health, University Hospital of Padua, Padua, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Department of Women and Children's Health, University Hospital of Padua, Padua, Italy
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10
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Daverio M, Cortina G, Jones A, Ricci Z, Demirkol D, Raymakers-Janssen P, Lion F, Camilo C, Stojanovic V, Grazioli S, Zaoral T, Masjosthusmann K, Vankessel I, Deep A. Continuous Kidney Replacement Therapy Practices in Pediatric Intensive Care Units Across Europe. JAMA Netw Open 2022; 5:e2246901. [PMID: 36520438 PMCID: PMC9856326 DOI: 10.1001/jamanetworkopen.2022.46901] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Continuous kidney replacement therapy (CKRT) is the preferred method of kidney support for children with critical illness in pediatric intensive care units (PICUs). However, there are no data on the current CKRT management practices in European PICUs. OBJECTIVE To describe current CKRT practices across European PICUs. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional survey of PICUs in 20 European countries was conducted by the Critical Care Nephrology Section of the European Society of Pediatric and Neonatal Intensive Care from April 1, 2020, to May 31, 2022. Participants included intensivists and nurses working in European PICUs. The survey was developed in English and distributed using SurveyMonkey. One response from each PICU that provided CKRT was included in the analysis. Data were analyzed from June 1 to June 30, 2022. MAIN OUTCOME AND MEASURES Demographic characteristics of European PICUs along with organizational and delivery aspects of CKRT (including prescription, liberation from CKRT, and training and education) were assessed. RESULTS Of 283 survey responses received, 161 were included in the analysis (response rate, 76%). The attending PICU consultant (70%) and the PICU team (77%) were mainly responsible for CKRT prescription, whereas the PICU nurses were responsible for circuit setup (49%) and bedside machine running (67%). Sixty-one percent of permanent nurses received training to use CKRT, with no need for certification or recertification in 36% of PICUs. Continuous venovenous hemodiafiltration was the preferred dialytic modality (51%). Circuit priming was performed with normal saline (67%) and blood priming in children weighing less than 10 kg (56%). Median (IQR) CKRT dose was 35 (30-50) mL/kg/h in neonates and 30 (30-40) mL/kg/h in children aged 1 month to 18 years. Forty-one percent of PICUs used regional unfractionated heparin infusion, whereas 35% used citrate-based regional anticoagulation. Filters were changed for filter clotting (53%) and increased transmembrane pressure (47%). For routine circuit changes, 72 hours was the cutoff in 62% of PICUs. Some PICUs (34%) monitored fluid removal goals every 4 hours, with variation from 12 hours (17%) to 24 hours (13%). Fluid removal goals ranged from 1 to 3 mL/kg/h. Liberation from CKRT was performed with a diuretic bolus followed by an infusion (32%) or a diuretic bolus alone (19%). CONCLUSIONS AND RELEVANCE This survey study found a wide variation in current CKRT practice, including organizational aspects, education and training, prescription, and liberation from CKRT, in European PICUs. This finding calls for concerted efforts on the part of the pediatric critical care and nephrology communities to streamline CKRT education and training, research, and guidelines to reduce variation in practice.
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Affiliation(s)
- Marco Daverio
- Pediatric Intensive Care Unit, Department of Woman’s and Child’s Health, University Hospital of Padua, Padua, Italy
| | - Gerard Cortina
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrew Jones
- Children’s Acute Transport Service, Great Ormond Street Hospital for Children, National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Zaccaria Ricci
- Pediatric Intensive Care Unit, Meyer Children’s Hospital, Florence, Italy
| | - Demet Demirkol
- Pediatric Intensive Care Medicine, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Paulien Raymakers-Janssen
- Department of Pediatric Intensive Care, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
| | - Francois Lion
- Department of Cardiothoracic Surgery, Centre Hospitalier Universitaire of Martinique, Fort-de-France, Martinique
| | - Cristina Camilo
- Pediatric Intensive Care Unit, Pediatric Department, Hospital de Santa Maria–North Lisbon University Hospital Center, Lisbon, Portugal
| | - Vesna Stojanovic
- Institute for Child and Youth Health Care of Vojvodina Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Serge Grazioli
- Division of Neonatal and Pediatric Intensive Care, Department of Pediatrics, Gynecology and Obstetrics, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Tomas Zaoral
- Pediatric Intensive Care Unit, Department of Pediatrics, University Hospital of Ostrava, Faculty of Medicine Ostrava, Ostrava, Czech Republic
| | - Katja Masjosthusmann
- Department of General Pediatrics, University Children’s Hospital Muenster, Muenster, Germany
| | - Inge Vankessel
- Department of Pediatric Intensive Care, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Utrecht, the Netherlands
| | - Akash Deep
- Paediatric Intensive Care Unit, King’s College Hospital, NHS Foundation Trust, Denmark Hill, London, United Kingdom
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, United Kingdom
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11
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Corazza F, Stritoni V, Martinolli F, Daverio M, Binotti M, Genoni G, Ingrassia PL, De Luca M, Palmas G, Maccora I, Frigo AC, Da Dalt L, Bressan S. Adherence to guideline recommendations in the management of pediatric cardiac arrest: a multicentre observational simulation-based study. Eur J Emerg Med 2022; 29:271-278. [PMID: 35404331 PMCID: PMC10878464 DOI: 10.1097/mej.0000000000000923] [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: 12/30/2021] [Accepted: 02/24/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND IMPORTANCE Pediatric cardiac arrest is a rare emergency with associated high mortality. Its management is challenging and deviations from guidelines can affect clinical outcomes. OBJECTIVES To evaluate the adherence to guideline recommendations in the management of a pediatric cardiac arrest scenario by teams of pediatric residents. Secondarily, the association between the use of the Pediatric Advanced Life Support-2015 (PALS-2015) pocket card, and the teams' adherence to international guidelines, were explored. DESIGN, SETTINGS AND PARTICIPANTS Multicentre observational simulation-based study at three Italian University Hospitals in 2018, including PALS-2015 certified pediatric residents in their 3rd-5th year of residency program, divided in teams of three. INTERVENTION OR EXPOSURE Each team conducted a standard nonshockable pediatric cardiac arrest scenario and independently decided whether to use the PALS-2015 pocket card. OUTCOME MEASURE AND ANALYSIS The primary outcome was the overall number and frequency of individual deviations from the PALS-2015 guidelines, measured by the novel c-DEV15plus score (range 0-15). Secondarily, the performance on the validated Clinical Performance Tool for asystole scenarios, the time to perform resuscitation tasks and cardiopulmonary resuscitation (CPR) quality metrics were compared between the teams that used and did not use the PALS-2015 pocket card. MAIN RESULTS Twenty-seven teams (81 residents) were included. Overall, the median number of deviations per scenario was 7 out of 15 [interquartile range (IQR), 6-8]. The most frequent deviations were delays in positioning of a CPR board (92.6%), calling for adrenaline (92.6%), calling for help (88.9%) and incorrect/delayed administration of adrenaline (88.9%). The median Clinical Performance Tool score was 9 out of 13 (IQR, 7-10). The comparison between teams that used ( n = 13) and did not use ( n = 14) the PALS-2015 pocket card showed only significantly higher Clinical Performance Tool scores in the former group [9 (IQR 9-10) vs. 7 (IQR 6-8); P = 0.002]. CONCLUSIONS Deviations from guidelines, although measured by means of a nonvalidated tool, were frequent in the management of a pediatric cardiac arrest scenario by pediatric residents. The use of the PALS-2015 pocket card was associated with better Clinical Performance Tool scores but was not associated with less deviations or shorter times to resuscitation tasks.
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Affiliation(s)
- Francesco Corazza
- Department of Woman’s and Child’s Health, Division of Paediatric Emergency Medicine, University of Padua
| | - Valentina Stritoni
- Department of Woman’s and Child’s Health, Paediatric Intensive Care Unit, University of Padua, Padua
| | - Francesco Martinolli
- Department of Woman’s and Child’s Health, Division of Paediatric Emergency Medicine, University of Padua
| | - Marco Daverio
- Department of Woman’s and Child’s Health, Paediatric Intensive Care Unit, University of Padua, Padua
| | - Marco Binotti
- Neonatal and Paediatric Intensive Care Unit, Maggiore della Carità University Hospital, University of Piemonte Orientale, Novara, Italy
| | - Giulia Genoni
- Neonatal and Paediatric Intensive Care Unit, Maggiore della Carità University Hospital, University of Piemonte Orientale, Novara, Italy
| | - Pier Luigi Ingrassia
- Centro di Simulazione (CeSi), Centro Professionale Sociosanitario di Lugano, Lugano, Switzerland
| | - Marco De Luca
- Paediatric Simulation Centre, Meyer Children’s University Hospital
| | - Giordano Palmas
- Department of Health Sciences, University of Florence and Meyer Children’s University Hospital, Florence
| | - Ilaria Maccora
- Department of Health Sciences, University of Florence and Meyer Children’s University Hospital, Florence
| | - Anna Chiara Frigo
- Department of Cardiac, Biostatistics, Epidemiology and Public Health Unit, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Liviana Da Dalt
- Department of Woman’s and Child’s Health, Division of Paediatric Emergency Medicine, University of Padua
| | - Silvia Bressan
- Department of Woman’s and Child’s Health, Division of Paediatric Emergency Medicine, University of Padua
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12
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Daverio M, von Borell F, Ramelet AS, Sperotto F, Pokorna P, Brenner S, Mondardini MC, Tibboel D, Amigoni A, Ista E. Correction to: Pain and sedation management and monitoring in pediatric intensive care units across Europe: an ESPNIC survey. Crit Care 2022; 26:139. [PMID: 35578288 PMCID: PMC9109403 DOI: 10.1186/s13054-022-03992-4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Marco Daverio
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Florian von Borell
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.,Department of Pediatric and Adolescent Medicine, University Hospital Dresden, Dresden, Germany
| | - Anne-Sylvie Ramelet
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland. .,Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.
| | - Francesca Sperotto
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy.,Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paula Pokorna
- Institute of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.,Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.,Intensive Care and Department of Paediatric Surgery, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Physiology and Pharmacology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Sebastian Brenner
- Department of Pediatric and Adolescent Medicine, University Hospital Dresden, Dresden, Germany
| | - Maria Cristina Mondardini
- Pediatric Anesthesia and Intensive Care Unit, Department of Woman's and Child's Health, IRCCS University Hospital of Bologna Policlinico S.Orsola, Bologna, Italy.,Department of Woman's and Child's Health, IRCCS University Hospital of Bologna Policlinico S.Orsola, Bologna, Italy
| | - Dick Tibboel
- Pediatric Intensive Care Unit, Department of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Erwin Ista
- Pediatric Intensive Care Unit, Department of Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
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13
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Cavicchiolo ME, Daverio M, Battajon N, Frigo AC, Lago P. A Single Dose of Oral Sucrose Is Enough to Control Pain During Venipuncture: A Randomized Controlled Trial. Front Pain Res 2022; 3:888076. [PMID: 35634454 PMCID: PMC9131008 DOI: 10.3389/fpain.2022.888076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
Sucrose is effective in reducing pain during minor procedures in neonates. We evaluated whether a second dose of sucrose was more effective than a single dose during venipuncture. We performed a randomised, double-blind, controlled trial at the NICU of Padua Hospital (August 2016-October 2017). We randomised 72 preterm infants undergoing venipuncture for routine test to a control group, which received a single standard dose of sucrose 2′ before the procedure and a placebo 30″ after the venipuncture, and an experimental group in which they received two doses of 24% sucrose 2′ before and 30″ after the venipuncture. No difference in pain perception was found between the groups at 30″, 60″ and 120″. In conclusion, we do not recommend a second dose of sucrose during venipuncture in prematures.
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Affiliation(s)
- Maria Elena Cavicchiolo
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padua, Padua, Italy
- *Correspondence: Maria Elena Cavicchiolo
| | - Marco Daverio
- Paediatric Intensive Care Unit, Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | - Nadia Battajon
- Neonatal Intensive Care Unit, Azienda Unità Locale Socio Sanitaria (ULSS) 2 Marca Trevigiana, Treviso, Italy
| | - Anna Chiara Frigo
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Paola Lago
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University of Padua, Padua, Italy
- Neonatal Intensive Care Unit, Azienda Unità Locale Socio Sanitaria (ULSS) 2 Marca Trevigiana, Treviso, Italy
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14
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Poletto E, Cavagnero F, Pettenazzo M, Visentin D, Zanatta L, Zoppelletto F, Pettenazzo A, Daverio M, Bonardi CM. Corrigendum on: Ventilation weaning and extubation readiness in children in pediatric intensive care unit: A review. Front Pediatr 2022; 10:1044681. [PMID: 36313866 PMCID: PMC9616164 DOI: 10.3389/fped.2022.1044681] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/26/2022] [Indexed: 12/02/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fped.2022.867739.].
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Affiliation(s)
- Elisa Poletto
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Francesca Cavagnero
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Marco Pettenazzo
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Davide Visentin
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Laura Zanatta
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Fabrizio Zoppelletto
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Andrea Pettenazzo
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Marco Daverio
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Claudia Maria Bonardi
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
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15
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Fazio PC, Daverio M, Masola M, D'Angelo I, Frison S, Zaggia C, Simeone S, Pucciarelli G, Gregori D, Comoretto R, Amigoni A. Italian Version of the Cornell Assessment of Pediatric Delirium: Evaluation of the Scale Reliability and Ability to Detect Delirium Compared to Pediatric Intensive Care Unit Physicians Clinical Evaluation. Front Pediatr 2022; 10:894589. [PMID: 35664881 PMCID: PMC9157792 DOI: 10.3389/fped.2022.894589] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/11/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Delirium is an acute brain dysfunction associated with increased length of hospitalization, mortality, and high healthcare costs especially in patients admitted to the pediatric intensive care unit (PICU). The Cornell Assessment of Pediatric Delirium (CAPD) is a screening tool for evaluating delirium in pediatric patients. This tool has already been used and validated in other languages but not in Italian. OBJECTIVES To test the reliability of the Italian version of the CAPD to screen PICU patients for delirium and to assess the agreement between CAPD score and PICU physician clinical evaluation of delirium. METHODS Prospective double-blinded observational cohort study of patients admitted to a tertiary academic center PICU for at least 48 h from January 2020 to August 2021. We evaluated intra- and inter-rater agreement using the Intraclass Correlation Coefficient (ICC). The ability of the scale to detect delirium was evaluated by comparing the nurses' CAPD assessments with the clinical evaluation of a PICU physician with expertise in analgosedation using the area under the ROC curve (AUC). MEASUREMENTS AND MAIN RESULTS Seventy patients were included in the study. The prevalence of pediatric delirium was 54% (38/70) when reported by a positive CAPD score and 21% (15/70) when diagnosed by the PICU physician. The CAPD showed high agreement levels both for the intra-rater (ICC 1 0.98, 95% CI: 0.97-0.99) and the inter-rater (ICC 2 0.93, 95% CI: 0.89-0.96) assessments. In patients with suspected delirium according to the CAPD scale, the observed sensitivity and specificity of the scale were 0.93 (95% CI: 0.68-1.00) and 0.56 (95% CI: 0.42-0.70), respectively. The AUC observed was 0.75 (95% CI: 0.66-0.8490). CONCLUSION The Italian version of the CAPD seems a reliable tool for the identification of patients at high risk of developing delirium in pediatric critical care settings. Compared to the clinical evaluation of the PICU physician, the use of the CAPD scale avoids a possible underestimation of delirium in the pediatric population.
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Affiliation(s)
- Paola Claudia Fazio
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padua, Italy
| | - Marco Daverio
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padua, Italy.,Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | - Maristella Masola
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padua, Italy
| | - Igor D'Angelo
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padua, Italy
| | - Sara Frison
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padua, Italy
| | - Cristina Zaggia
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padua, Italy
| | - Silvio Simeone
- Department of Clinical and Experimental Medicine, University "Magna Graecia," Catanzaro, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Rosanna Comoretto
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padua, Italy
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16
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Mondardini MC, Daverio M, Caramelli F, Conti G, Zaggia C, Lazzarini R, Muscheri L, Azzolina D, Gregori D, Sperotto F, Amigoni A. Dexmedetomidine for prevention of opioid/benzodiazepine withdrawal syndrome in pediatric intensive care unit: Interim analysis of a randomized controlled trial. Pharmacotherapy 2021; 42:145-153. [PMID: 34882826 DOI: 10.1002/phar.2654] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 11/09/2022]
Abstract
STUDY OBJECTIVE Withdrawal syndrome (WS) may be a critical drawback of opioid/benzodiazepine weaning in children. The most effective intervention to reduce WS prevalence is yet to be determined. Dexmedetomidine (DEX) was estimated to be effective in reducing WS-related symptoms, but no randomized trial has been conducted to prove its efficacy so far. We aimed to evaluate the efficacy and safety of DEX in reducing the occurrence of WS. DESIGN AND SETTING This was an adaptive randomized double-blind placebo-controlled trial conducted at three Italian Pediatric Intensive Care Units (PICUs). PATIENTS It included children admitted to PICU, undergoing at least five days of opioids/benzodiazepines continuous infusion, and ready to start the analgosedation weaning. INTERVENTION Twenty-four hours before the start of weaning, an infusion of DEX/placebo was started. WS symptoms were monitored using the Withdrawal-Assessment-Tool-version-1 (WAT-1). In case of WS symptoms (WAT-1 ≥ 3) an opioid/benzodiazepine bolus was given and the DEX/placebo infusion-rate was increased. MEASUREMENTS The primary outcome measure was the prevalence of WS. Secondary outcomes were the trend of WAT-1 over time, number of rescue doses, length of weaning and PICU-stay, and onset of adverse events (AEs). MAIN RESULTS Forty-five patients were enrolled, of whom 5 dropped-out and 40 entered the interim analysis. There were no significant baseline differences between groups. WS prevalence did not significantly differ between groups (77.8% DEX vs 90.9% placebo, p = 0.381). By generalized linear mixed modeling, the WAT-1 trend showed a significant increase per unit of time in the DEX arm (estimate 0.27, CI 0.07-0.47, p = 0.009) compared to placebo. Most frequent AEs were hemodynamic, and all of them happened in the DEX arm. CONCLUSIONS A continuous infusion of DEX, started 24 h before the analgosedation weaning and increased based on WS signs, was not able to significantly modify the prevalence of WS in children who received at least five days of opioids/benzodiazepines treatment compared to placebo.
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Affiliation(s)
- Maria Cristina Mondardini
- Pediatric Anesthesia and Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Bologna IRCCS S. Orsola Polyclinic, Bologna, Italy
| | - Marco Daverio
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University-Hospital, Padua, Italy
| | - Fabio Caramelli
- Pediatric Anesthesia and Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Bologna IRCCS S. Orsola Polyclinic, Bologna, Italy
| | - Giorgio Conti
- Pediatric Intensive Care Unit and Pediatric Trauma Center, Department of Anesthesia and Intensive Care, Catholic University of Rome, A Gemelli Polyclinic, Rome, Italy
| | - Cristina Zaggia
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University-Hospital, Padua, Italy
| | - Rossella Lazzarini
- Pediatric Anesthesia and Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Bologna IRCCS S. Orsola Polyclinic, Bologna, Italy
| | - Lidia Muscheri
- Pediatric Intensive Care Unit and Pediatric Trauma Center, Department of Anesthesia and Intensive Care, Catholic University of Rome, A Gemelli Polyclinic, Rome, Italy
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University-Hospital of Padua, Padua, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University-Hospital of Padua, Padua, Italy
| | - Francesca Sperotto
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University-Hospital, Padua, Italy.,Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University-Hospital, Padua, Italy
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17
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Sperotto F, Giaretta I, Mondardini MC, Pece F, Daverio M, Amigoni A. Ketamine Prolonged Infusions in the Pediatric Intensive Care Unit: a Tertiary-Care Single-Center Analysis. J Pediatr Pharmacol Ther 2021; 26:73-80. [PMID: 33424503 DOI: 10.5863/1551-6776-26.1.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/09/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Ketamine is commonly used as an anesthetic and analgesic agent for procedural sedation, but there is little evidence on its current use as a prolonged continuous infusion in the PICU. We sought to analyze the use of ketamine as a prolonged infusion in critically ill children, its indications, dosages, efficacy, and safety. METHODS We retrospectively reviewed the clinical charts of patients receiving ketamine for ≥24 hours in the period 2017-2018 in our tertiary care center. Data on concomitant treatments pre and 24 hours post ketamine introduction and adverse events were also collected. RESULTS Of the 60 patients included, 78% received ketamine as an adjuvant of analgosedation, 18% as an adjuvant of bronchospasm therapy, and 4% as an antiepileptic treatment. The median infusion duration was 103 hours (interquartile range [IQR], 58-159; range, 24-287), with median dosages between 15 (IQR, 10-20; range, 5-47) and 30 (IQR, 20-50; range, 10-100) mcg/kg/min. At 24 hours of ketamine infusion, dosages/kg/hr of opioids significantly decreased (p < 0.001), and 81% of patients had no increases in dosages of concomitant analgosedation. For 27% of patients with bronchospasm, the salbutamol infusions were lowered at 24 hours after ketamine introduction. Electroencephalograms of epileptic patients (n = 2) showed resolution of status epilepticus after ketamine administration. Adverse events most likely related to ketamine were hypertension (n = 1), hypersalivation (n = 1), and delirium (n = 1). CONCLUSIONS Ketamine can be considered a worthy strategy for the analgosedation of difficult-to-sedate patients. Its use for prolonged sedation allows the sparing of opioids. Its efficacy in patients with bronchospasm or status epilepticus still needs to be investigated.
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18
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Corazza F, Snijders D, Arpone M, Stritoni V, Martinolli F, Daverio M, Losi MG, Soldi L, Tesauri F, Da Dalt L, Bressan S. Development and Usability of a Novel Interactive Tablet App (PediAppRREST) to Support the Management of Pediatric Cardiac Arrest: Pilot High-Fidelity Simulation-Based Study. JMIR Mhealth Uhealth 2020; 8:e19070. [PMID: 32788142 PMCID: PMC7563631 DOI: 10.2196/19070] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/26/2020] [Accepted: 07/26/2020] [Indexed: 01/22/2023] Open
Abstract
Background Pediatric cardiac arrest (PCA), although rare, is associated with high mortality. Deviations from international management guidelines are frequent and associated with poorer outcomes. Different strategies/devices have been developed to improve the management of cardiac arrest, including cognitive aids. However, there is very limited experience on the usefulness of interactive cognitive aids in the format of an app in PCA. No app has so far been tested for its usability and effectiveness in guiding the management of PCA. Objective To develop a new audiovisual interactive app for tablets, named PediAppRREST, to support the management of PCA and to test its usability in a high-fidelity simulation-based setting. Methods A research team at the University of Padova (Italy) and human–machine interface designers, as well as app developers, from an Italian company (RE:Lab S.r.l.) developed the app between March and October 2019, by applying an iterative design approach (ie, design–prototyping–evaluation iterative loops). In October–November 2019, a single-center nonrandomized controlled simulation–based pilot study was conducted including 48 pediatric residents divided into teams of 3. The same nonshockable PCA scenario was managed by 11 teams with and 5 without the app. The app user’s experience and interaction patterns were documented through video recording of scenarios, debriefing sessions, and questionnaires. App usability was evaluated with the User Experience Questionnaire (UEQ) (scores range from –3 to +3 for each scale) and open-ended questions, whereas participants’ workload was measured using the NASA Raw-Task Load Index (NASA RTLX). Results Users’ difficulties in interacting with the app during the simulations were identified using a structured framework. The app usability, in terms of mean UEQ scores, was as follows: attractiveness 1.71 (SD 1.43), perspicuity 1.75 (SD 0.88), efficiency 1.93 (SD 0.93), dependability 1.57 (SD 1.10), stimulation 1.60 (SD 1.33), and novelty 2.21 (SD 0.74). Team leaders’ perceived workload was comparable (P=.57) between the 2 groups; median NASA RTLX score was 67.5 (interquartile range [IQR] 65.0-81.7) for the control group and 66.7 (IQR 54.2-76.7) for the intervention group. A preliminary evaluation of the effectiveness of the app in reducing deviations from guidelines showed that median time to epinephrine administration was significantly longer in the group that used the app compared with the control group (254 seconds versus 165 seconds; P=.015). Conclusions The PediAppRREST app received a good usability evaluation and did not appear to increase team leaders’ workload. Based on the feedback collected from the participants and the preliminary results of the evaluation of its effects on the management of the simulated scenario, the app has been further refined. The effectiveness of the new version of the app in reducing deviations from guidelines recommendations in the management of PCA and its impact on time to critical actions will be evaluated in an upcoming multicenter simulation-based randomized controlled trial.
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Affiliation(s)
- Francesco Corazza
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Deborah Snijders
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Marta Arpone
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Valentina Stritoni
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Francesco Martinolli
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Marco Daverio
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | | | | | | | - Liviana Da Dalt
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Silvia Bressan
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
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19
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Daverio M, Amigoni A, Cavicchiolo ME. Testing for Novel Coronavirus Antibodies: A Necessary Adjunct. J Infect Dis 2020; 222:517-518. [PMID: 32442248 PMCID: PMC7313906 DOI: 10.1093/infdis/jiaa283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/20/2020] [Indexed: 12/04/2022] Open
Affiliation(s)
- Marco Daverio
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Italy
| | - Maria Elena Cavicchiolo
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Italy
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20
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Donà D, Barbieri E, Daverio M, Lundin R, Giaquinto C, Zaoutis T, Sharland M. Correction to: Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review. Antimicrob Resist Infect Control 2020; 9:59. [PMID: 32381059 PMCID: PMC7206826 DOI: 10.1186/s13756-020-00720-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)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- D Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141, Padua, Italy.,Pediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George's University of London, London, UK.,Fondazione Penta ONLUS, Padua, Italy
| | - E Barbieri
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141, Padua, Italy.
| | - M Daverio
- Pediatric intensive care unit, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - R Lundin
- Fondazione Penta ONLUS, Padua, Italy
| | - C Giaquinto
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141, Padua, Italy.,Fondazione Penta ONLUS, Padua, Italy
| | - T Zaoutis
- Fondazione Penta ONLUS, Padua, Italy.,Division of Infectious Diseases and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M Sharland
- Pediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George's University of London, London, UK.,Fondazione Penta ONLUS, Padua, Italy
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21
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Donà D, Barbieri E, Daverio M, Lundin R, Giaquinto C, Zaoutis T, Sharland M. Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review. Antimicrob Resist Infect Control 2020; 9:3. [PMID: 31911831 PMCID: PMC6942341 DOI: 10.1186/s13756-019-0659-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [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] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/26/2019] [Indexed: 02/07/2023] Open
Abstract
Background Antibiotics are the most common medicines prescribed to children in hospitals and the community, with a high proportion of potentially inappropriate use. Antibiotic misuse increases the risk of toxicity, raises healthcare costs, and selection of resistance. The primary aim of this systematic review is to summarize the current state of evidence of the implementation and outcomes of pediatric antimicrobial stewardship programs (ASPs) globally. Methods MEDLINE, Embase and Cochrane Library databases were systematically searched to identify studies reporting on ASP in children aged 0-18 years and conducted in outpatient or in-hospital settings. Three investigators independently reviewed identified articles for inclusion and extracted relevant data. Results Of the 41,916 studies screened, 113 were eligible for inclusion in this study. Most of the studies originated in the USA (52.2%), while a minority were conducted in Europe (24.7%) or Asia (17.7%). Seventy-four (65.5%) studies used a before-and-after design, and sixteen (14.1%) were randomized trials. The majority (81.4%) described in-hospital ASPs with half of interventions in mixed pediatric wards and ten (8.8%) in emergency departments. Only sixteen (14.1%) studies focused on the costs of ASPs. Almost all the studies (79.6%) showed a significant reduction in inappropriate prescriptions. Compliance after ASP implementation increased. Sixteen of the included studies quantified cost savings related to the intervention with most of the decreases due to lower rates of drug administration. Seven studies showed an increased susceptibility of the bacteria analysed with a decrease in extended spectrum beta-lactamase producers E. coli and K. pneumoniae; a reduction in the rate of P. aeruginosa carbapenem resistance subsequent to an observed reduction in the rate of antimicrobial days of therapy; and, in two studies set in outpatient setting, an increase in erythromycin-sensitive S. pyogenes following a reduction in the use of macrolides. Conclusions Pediatric ASPs have a significant impact on the reduction of targeted and empiric antibiotic use, healthcare costs, and antimicrobial resistance in both inpatient and outpatient settings. Pediatric ASPs are now widely implemented in the USA, but considerable further adaptation is required to facilitate their uptake in Europe, Asia, Latin America and Africa.
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Affiliation(s)
- D. Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141 Padua, Italy
- Pediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
- Fondazione Penta ONLUS, Padua, Italy
| | - E. Barbieri
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141 Padua, Italy
| | - M. Daverio
- Pediatric intensive care unit, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - R. Lundin
- Fondazione Penta ONLUS, Padua, Italy
| | - C. Giaquinto
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141 Padua, Italy
- Fondazione Penta ONLUS, Padua, Italy
| | - T. Zaoutis
- Fondazione Penta ONLUS, Padua, Italy
- Division of Infectious Diseases and the Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - M. Sharland
- Pediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
- Fondazione Penta ONLUS, Padua, Italy
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22
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Mondardini MC, Sperotto F, Daverio M, Caramelli F, Gregori D, Caligiuri MF, Vitale F, Cecini MT, Piastra M, Mancino A, Pettenazzo A, Conti G, Amigoni A. Efficacy and safety of dexmedetomidine for prevention of withdrawal syndrome in the pediatric intensive care unit: protocol for an adaptive, multicenter, randomized, double-blind, placebo-controlled, non-profit clinical trial. Trials 2019; 20:710. [PMID: 31829274 PMCID: PMC6907190 DOI: 10.1186/s13063-019-3793-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 10/10/2019] [Indexed: 11/12/2022] Open
Abstract
Background Prolonged treatment with analgesic and sedative drugs in the pediatric intensive care unit (PICU) may lead to undesirable effects such as dependence and tolerance. Moreover, during analgosedation weaning, patients may develop clinical signs of withdrawal, known as withdrawal syndrome (WS). Some studies indicate that dexmedetomidine, a selective α2-adrenoceptor agonist, may be useful to prevent WS, but no clear evidence supports these data. The aims of the present study are to evaluate the efficacy of dexmedetomidine in reducing the occurrence of WS during analgosedation weaning, and to clearly assess its safety. Methods We will perform an adaptive, multicenter, randomized, double-blind, placebo-controlled trial. Patients aged < 18 years receiving continuous intravenous analgosedation treatment for at least 5 days and presenting with clinical conditions that allow analgosedation weaning will be randomly assigned to treatment A (dexmedetomidine) or treatment B (placebo). The treatment will be started 24 h before the analgosedation weaning at 0.4 μg/kg/h, increased by 0.2 μg/kg/h per hour up to 0.8 μg/kg/h (neonate: 0.2 μg/kg/h, increased by 0.1 μg/kg/h per hour up to 0.4 μg/kg/h) and continued throughout the whole weaning time. The primary endpoint is the efficacy of the treatment, defined by the reduction in the WS rate among patients treated with dexmedetomidine compared with patients treated with placebo. Safety will be assessed by collecting any potentially related adverse event. The sample size assuring a power of 90% is 77 patients for each group (total N = 154 patients). The study was approved by the Ethics Committee of the University-Hospital S.Orsola-Malpighi of Bologna on 22 March 2017. Discussion The present trial will allow us to clearly assess the efficacy of dexmedetomidine in reducing the occurrence of WS during weaning from analgosedation drugs. In addition, the study will provide a unique insight into the safety profile of dexmedetomidine. Trial registration ClinicalTrials.gov, NCT03645603. Registered on 24 August 2018. EudraCT, 2015–002114-80. Retrospectively registered on 2 January 2019.
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Affiliation(s)
- Maria Cristina Mondardini
- Department of Woman, Child and Urological Diseases, Pediatric Intensive Care Unit, University-Hospital S.Orsola-Malpighi Policlinic, Via Albertoni 15, 40138, Bologna, Italy.
| | - Francesca Sperotto
- Department of Woman's and Child's Health, Pediatric Intensive Care Unit, University-Hospital of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Marco Daverio
- Department of Woman's and Child's Health, Pediatric Intensive Care Unit, University-Hospital of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Fabio Caramelli
- Department of Woman, Child and Urological Diseases, Pediatric Intensive Care Unit, University-Hospital S.Orsola-Malpighi Policlinic, Via Albertoni 15, 40138, Bologna, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University-Hospital of Padua, Via Loredan18, 35131, Padua, Italy
| | - Maria Francesca Caligiuri
- Department of Woman, Child and Urological Diseases, Pediatric Intensive Care Unit, University-Hospital S.Orsola-Malpighi Policlinic, Via Albertoni 15, 40138, Bologna, Italy
| | - Francesca Vitale
- Department of Anesthesia and Intensive Care, Pediatric Intensive Care Unit and Pediatric Trauma Center, Catholic University of Rome, A Gemelli Policlinic, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Maria Teresa Cecini
- Department of Woman, Child and Urological Diseases, Pediatric Intensive Care Unit, University-Hospital S.Orsola-Malpighi Policlinic, Via Albertoni 15, 40138, Bologna, Italy
| | - Marco Piastra
- Department of Anesthesia and Intensive Care, Pediatric Intensive Care Unit and Pediatric Trauma Center, Catholic University of Rome, A Gemelli Policlinic, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Aldo Mancino
- Department of Anesthesia and Intensive Care, Pediatric Intensive Care Unit and Pediatric Trauma Center, Catholic University of Rome, A Gemelli Policlinic, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Andrea Pettenazzo
- Department of Woman's and Child's Health, Pediatric Intensive Care Unit, University-Hospital of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Giorgio Conti
- Department of Anesthesia and Intensive Care, Pediatric Intensive Care Unit and Pediatric Trauma Center, Catholic University of Rome, A Gemelli Policlinic, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Angela Amigoni
- Department of Woman's and Child's Health, Pediatric Intensive Care Unit, University-Hospital of Padua, Via Giustiniani 2, 35128, Padua, Italy
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23
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Daverio M, Da Dalt L, Panozzo M, Frigo AC, Bressan S. A two-tiered high-flow nasal cannula approach to bronchiolitis was associated with low admission rate to intensive care and no adverse outcomes. Acta Paediatr 2019; 108:2056-2062. [PMID: 31102551 DOI: 10.1111/apa.14869] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 11/29/2022]
Abstract
AIM We aimed to describe the characteristics and outcomes of infants with bronchiolitis who received high-flow nasal cannula oxygen (HFNC) following a two-tiered approach. METHODS This retrospective study included 211 infants below 12 months of age needing oxygen therapy for bronchiolitis, between 2012 and 2017, on the general paediatric ward of the tertiary Paediatric Hospital of Padova, Italy. HFNC was used as first-line therapy for moderate to severe disease and as rescue therapy for deterioration on low-flow oxygen. RESULTS Median age was 61 days (IQR 31-126), and 57.3% were males. HFNC was used as first-line therapy in 35/211 (16.6%) infants and as rescue in 73/176 (41.5%) patients on low-flow oxygen. Overall 9/211 patients (4.3%) were admitted to intensive care, representing a HFNC failure of 9/108 (8.3%). Intensive care admissions did not significantly differ between initial low-flow oxygen therapy and HFNC (8/176, 4.5% versus 1/35, 2.8%, proportion difference 1.7%, 95%CI -10.2 to 6.7), or between initial and rescue HFNC (1/35, 2.8% versus 8/73, 10.9%; proportion difference 8.1%, 95%CI -4.5 to 18). Only two patients developed air leak and were treated conservatively. CONCLUSION A two-tiered approach to HFNC use in bronchiolitis was associated with low intensive care admissions and no adverse outcomes.
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Affiliation(s)
- Marco Daverio
- Paediatric Intensive Care Unit Department of Women's and Children's Health University Hospital of Padova Padova Italy
| | - Liviana Da Dalt
- Paediatric Emergency Unit Department of Women's and Children's Health University Hospital of Padova Padova Italy
| | - Matteo Panozzo
- Paediatric Emergency Unit Department of Women's and Children's Health University Hospital of Padova Padova Italy
| | - Anna Chiara Frigo
- Biostatistics, Epidemiology and Public Health Unit Department of Cardiac Thoracic and Vascular Sciences University of Padova Padova Italy
| | - Silvia Bressan
- Paediatric Emergency Unit Department of Women's and Children's Health University Hospital of Padova Padova Italy
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24
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Zanetto L, Da Dalt L, Daverio M, Dunning J, Frigo AC, Nigrovic LE, Bressan S. Systematic review and meta-analysis found significant risk of brain injury and neurosurgery in alert children after a post-traumatic seizure. Acta Paediatr 2019; 108:1841-1849. [PMID: 30951221 DOI: 10.1111/apa.14810] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/19/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022]
Abstract
AIM This study aimed to determine the frequency of traumatic brain injury (TBI) on neuroimaging and the need for emergency neurosurgery in children with normal mental status following a post-traumatic seizure (PTS). METHODS We searched six electronic databases from inception to October 15, 2018, to identify studies including children under 18 years with head injury and a Glasgow Coma Score of 15 after an immediate PTS. Relevant non-English articles were translated to determine eligibility. RESULTS We performed random effect meta-analyses and assessed heterogeneity with I2 . The pooled estimate of the frequency of TBI, from seven studies, was 13.0% (95% CI: 4.0-26.1; I2 = 81%). Data on the need of emergency neurosurgery were reported in four studies and the pooled estimate of its frequency was 2.3% (95% CI: 0.0-9.9; I2 = 86%). Two studies reported on children with isolated PTS without any other signs of head injury, representing 0.1% of patients in both studies, for a total of 76 children. Of these, only three had TBI and one underwent neurosurgery. CONCLUSION Children with immediate PTS and normal mental status frequently have TBI with a substantial need for neurosurgery. Clinicians should strongly consider neuroimaging for these children, although prolonged observation may be considered for those with isolated PTS.
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Affiliation(s)
- Lorenzo Zanetto
- Division of Emergency Medicine Department of Women's and Children's Health University of Padova Padova Italy
| | - Liviana Da Dalt
- Division of Emergency Medicine Department of Women's and Children's Health University of Padova Padova Italy
| | - Marco Daverio
- Division of Emergency Medicine Department of Women's and Children's Health University of Padova Padova Italy
| | - Joel Dunning
- Department of Cardiothoracic Surgery James Cook University Hospital Middlesbrough UK
| | - Anna Chiara Frigo
- Unit of Biostatistics, Epidemiology and Public Health Department of Cardiac, Thoracic and Vascular Sciences University of Padova Padova Italy
| | - Lise E. Nigrovic
- Division of Emergency Medicine Harvard Medical School Boston Children's Hospital Boston MA USA
| | - Silvia Bressan
- Division of Emergency Medicine Department of Women's and Children's Health University of Padova Padova Italy
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25
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Cavicchiolo ME, Amigoni A, Martinolli F, Daverio M. Letter to the Editor. J Paediatr Child Health 2019; 55:1288. [PMID: 31629383 DOI: 10.1111/jpc.14585] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 07/16/2019] [Accepted: 07/19/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Maria Elena Cavicchiolo
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| | - Angela Amigoni
- Paediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| | - Francesco Martinolli
- Paediatric Emergency Department, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| | - Marco Daverio
- Paediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
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26
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Bonardi CM, Spadini S, Fazio PC, Galiazzo M, Voltan E, Coscini N, Padalino M, Daverio M. Nontraumatic tension pneumopericardium in nonventilated pediatric patients: a review. J Card Surg 2019; 34:829-836. [PMID: 31269314 DOI: 10.1111/jocs.14159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 12/01/2022]
Abstract
BACKGROUND AND AIMS Pneumopericardium is a rare air leak syndrome caused by the abnormal presence of air in the pericardial sac, with a high risk of morbidity and mortality. It is clinically divided into nontension and tension pneumopericardium, with the latter resulting in a decreased cardiac output and circulatory failure. There are limited data regarding nontraumatic pneumopericardium in nonventilated pediatric patients. Therefore, we aimed to describe a case of tension pneumopericardium and review the available literature. METHODS Case report and literature review of nontraumatic pneumopericardium in nonventilated pediatric patients. RESULTS A 2-month-old infant developed cardiac tamponade secondary to tension pneumopericardium 11 days after cardiac surgery promptly resolved with pericardium drainage. We reviewed the literature on this topic and retrieved 50 cases, of which 72% were nontension whereas a minority were tension pneumopericardium (28%). Patients with tension pneumopericardium were mostly neonates (35.7% vs 22.2%), presented with an isolated air leak (64.3% vs 36.1%), and had a history of surgery (28.6% vs 8.3%) or hematological disease (28.6% vs 11.1%). In all nontension cases, treatment was conservative, whilst in all other cases, pericardiocentesis/pericardium drainage was carried out. There was a high survival rate (86.0%), which was lower in patients with tension pneumopericardium (71.4% vs 91.6%). CONCLUSIONS Pneumopericardium is a rare condition with a higher mortality rate in patients with tension pneumopericardium, which requires immediate diagnosis and treatment. In nonventilated patients, tension pneumopericardium occurred more frequently in neonates, as an isolated air leak, and in those with a history of surgery or hematological disease.
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Affiliation(s)
- Claudia M Bonardi
- Department of Woman's and Child's Health, Pediatric Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Silvia Spadini
- Department of Woman's and Child's Health, Pediatric Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Paola C Fazio
- Department of Woman's and Child's Health, Pediatric Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Moreno Galiazzo
- Department of Woman's and Child's Health, Pediatric Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Elena Voltan
- Department of Woman's and Child's Health, Pediatric Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Nadia Coscini
- Department for Community Child Health, Royal Children's Hospital, Melbourne, Australia
| | - Massimo Padalino
- Department of Cardiac, Thoracic and Vascular Sciences, Pediatric and Congenital Cardiac Surgery Unit, University of Padua, Padua, Italy
| | - Marco Daverio
- Department of Woman's and Child's Health, Pediatric Intensive Care Unit, University Hospital of Padua, Padua, Italy
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Sperotto F, Mondardini MC, Vitale F, Daverio M, Campagnano E, Ferrero F, Rossetti E, Vasile B, Dusio MP, Ferrario S, Savron F, Brugnaro L, Amigoni A. Prolonged sedation in critically ill children: is dexmedetomidine a safe option for younger age? An off-label experience. Minerva Anestesiol 2018; 85:164-172. [PMID: 30394067 DOI: 10.23736/s0375-9393.18.13062-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Dexmedetomidine (DEX) is an alpha-2-adrenergic agonist, recently approved by Italian-Medicines-Agency for difficult sedation in pediatrics, but few data exist regarding prolonged infusions in critically-ill children, especially in younger ages. Aim of our study was to evaluate DEX use and safety for prolonged sedation in Pediatric Intensive Care Units (PICUs). METHODS Patients receiving DEX for ≥24 hours were retrospectively evaluated to analyze DEX indications, dosages, use of analgesics or sedatives, adverse events (AEs), withdrawal syndrome or delirium. RESULTS Forty-seven patients (median 0.7years) from nine PICUs were enrolled. Main indications were adjuvant for drugs sparing (59.6%) and for analgosedation weaning (36.2%). Median infusion duration was 82.0 hours (IQR 62.2-126.0), with dosages between 0.4 (IQR 0.2-0.5) and 0.8 mcg/kg/h (IQR 0.6-1.2). Fifty-nine-percent of patients received other sedatives, 83% other analgesics. Twenty-one-percent presented withdrawal syndrome, 4.2% delirium, none of them DEX-related. Forty-six-percent experienced a potentially-DEX-related AE. AEs were all hemodynamic, 14.9% requiring intervention but none DEX interruption. The median minimum and maximum dosages were significantly higher in patients with AEs (0.5 vs. 0.3,P=0.001; 1.0 vs. 0.7,P<0.001), without correlations with the infusion duration. AEs rate was higher in patients receiving benzodiazepines (P=0.020) or more than one analgesic (P=0.003) and in those presenting withdrawal syndrome (P<0.001). CONCLUSIONS DEX was confirmed as useful and relatively safe drug for prolonged sedation in critically-ill children, particularly in younger ages. Main AEs were cardiovascular, reversible, related with higher doses, with the concomitant use of benzodiazepines or multiple sedation drugs and with the presence of withdrawal syndrome.
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Affiliation(s)
- Francesca Sperotto
- Unit of Pediatric Intensive Care, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy -
| | - Maria C Mondardini
- Unit of Pediatric Intensive Care, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Francesca Vitale
- Unit of Pediatric Intensive Care, A. Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - Marco Daverio
- Unit of Pediatric Intensive Care, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Emiliana Campagnano
- Unit of Pediatric Intensive Care, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Federica Ferrero
- Unit of Pediatric and Neonatal Intensive Care, Maggiore della Carità Hospital, Novara, Italy
| | - Emanuele Rossetti
- Unit of Pediatric Intensive Care, Bambino Gesù Children's Hospital, Rome, Italy
| | - Beatrice Vasile
- Department of Pediatric Anesthesia and Intensive Care, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Maria P Dusio
- Unit of Pediatric Intensive Care, C. Arrigo Children's Hospital, Alessandria, Italy
| | - Stefania Ferrario
- Unit of Pediatric Intensive Care, V. Buzzi Children's Hospital, Milan, Italy
| | - Fabio Savron
- Unit of Pediatric Intensive Care, Burlo Garofalo Hospital, University of Trieste, Trieste, Italy
| | - Luca Brugnaro
- Department Education and Training, University Hospital of Padua, Padua, Italy
| | - Angela Amigoni
- Unit of Pediatric Intensive Care, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
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Gaio P, Verlato G, Daverio M, Cavicchiolo ME, Nardo D, Pasinato A, de Terlizzi F, Baraldi E. Incidence of metabolic bone disease in preterm infants of birth weight <1250 g and in those suffering from bronchopulmonary dysplasia. Clin Nutr ESPEN 2018; 23:234-239. [PMID: 29460805 DOI: 10.1016/j.clnesp.2017.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 02/02/2017] [Revised: 08/15/2017] [Accepted: 09/26/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS Preterm infants are exposed to a higher risk of developing Metabolic Bone Disease (MBD) with an increased bone fragility, a higher fracture risk and a long-term reduced linear growth and childhood height. Monitoring bone growth has become mandatory in neonatology. Several risk factors have been identified among the population of extremely low birth weight infants, but we still do not know which is the real incidence of MBD since its evaluation is not routinely performed worldwide. The aim of this study was to evaluate the incidence of MBD in preterm infants and in those suffering from bronchopulmonary dysplasia (BPD). METHODS Prospective evaluation of patients who developed BPD (BPD group) versus infants who did not develop it (no-BPD group). We examined, in preterms <1.250 g, the metacarpus bone transmission time (mc-BTT) at birth, 21 days and 36 weeks of gestational age (GA) together with biochemical markers of bone status. RESULTS We included 135 patients, 55 with BPD. BPD patients received less total proteins in the first two weeks and less energy in the first month of life (p = 0.007 and p < 0.001 respectively). BPD patients had a worse growth velocity at two weeks of age (12.36 ± 7.86 vs 16.59 ± 7.05 g/kg/day, p = 0.001). At 21 days, BPD patients had lower phosphatemia (1.65 ± 0.031 mmol/L vs 1.85 ± 0.034 mmol/L, p = 0.007) and higher alkaline phosphatase levels (411.62 ± 135.31 IU/l vs 338.98 ± 102.20 IU/l, p = 0.005). BPD patients had significantly worse mc-BTT at 36 weeks GA (0.45 ± 0.06 vs 0.50 ± 0.08 μsec, p < 0.001) and a higher incidence of MBD (60% vs 34%; p = 0.012). CONCLUSIONS BPD infants are a special subset of patients among preterms who receive, in the first month of life, a lower energy intake than patients without BPD. BPD patients have a suboptimal bone growth and a higher incidence of MBD. Monitoring growth, bone status and optimizing nutritional intakes need to be further improved in preterm infants with BPD.
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Affiliation(s)
- Paola Gaio
- Neonatal Intensive Care Unit, Department of Woman and Child's Health, University of Padova, Via Giustiniani 3, 35127, Padova, Italy.
| | - Giovanna Verlato
- Neonatal Intensive Care Unit, Department of Woman and Child's Health, University of Padova, Via Giustiniani 3, 35127, Padova, Italy.
| | - Marco Daverio
- Neonatal Intensive Care Unit, Department of Woman and Child's Health, University of Padova, Via Giustiniani 3, 35127, Padova, Italy.
| | - Maria Elena Cavicchiolo
- Neonatal Intensive Care Unit, Department of Woman and Child's Health, University of Padova, Via Giustiniani 3, 35127, Padova, Italy.
| | - Daniel Nardo
- Neonatal Intensive Care Unit, Department of Woman and Child's Health, University of Padova, Via Giustiniani 3, 35127, Padova, Italy.
| | - Alessandra Pasinato
- Neonatal Intensive Care Unit, Department of Woman and Child's Health, University of Padova, Via Giustiniani 3, 35127, Padova, Italy.
| | | | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Woman and Child's Health, University of Padova, Via Giustiniani 3, 35127, Padova, Italy.
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Daverio M, Babl FE, Barker R, Gregori D, Da Dalt L, Bressan S. Helmet use in preventing acute concussive symptoms in recreational vehicle related head trauma. Brain Inj 2018; 32:335-341. [PMID: 29355399 DOI: 10.1080/02699052.2018.1426107] [Citation(s) in RCA: 13] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Helmets use has proved effective in reducing head trauma (HT) severity in children riding non-motorised recreational vehicles. Scant data are available on their role in reducing concussive symptoms in children with HT while riding non-motorised recreational vehicles such as bicycles, push scooters and skateboards (BSS). We aimed to investigate whether helmet use is associated with a reduction in acute concussive symptoms in children with BSS-related-HT. METHODS Prospective study of children <18 years who presented with a BSS related-HT between April 2011 and January 2014 at a tertiary Paediatric Emergency Department (ED). RESULTS We included 190 patients. Median age 9.4 years (IQR 4.8-13.8). 66% were riding a bicycle, 23% a push scooter, and 11% a skateboard. 62% were wearing a helmet and 62% had at least one concussive symptom. Multivariate logistic regression analysis adjusting for age, gender, and type of vehicle showed that patients without a helmet presented more likely with headache (adjusted odds-ratio (aOR) 2.54, 95% CI 1.27-5.06), vomiting (aOR 2.16, 95% CI 1.00-4.66), abnormal behaviour (aOR 2.34, 95% CI 1.08-5.06), or the presence of at least one concussive symptom (aOR 2.39, 95% CI 1.20-4.80). CONCLUSIONS In children presenting to the ED following a wheeled BSS-related HT helmet use was associated with less acute concussive symptoms. ABBREVIATIONS aOR, adjusted odds ratio; APHIRST, Australasian Paediatric Head Injury Rules Study; BSS, bicycles, push scooters and skateboards; CI, confidence interval; CT, computed tomography; ED, emergency department; HT, head trauma; IQR, interquartile range; OR, odds ratio; RCH, Royal Children's Hospital; RV, recreational vehicle.
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Affiliation(s)
- Marco Daverio
- a Murdoch Children's Research Institute , Melbourne , Victoria , Australia.,b Department of Woman's and Child's Health, Department of Paediatrics , University of Padova , Padova , Italy
| | - Franz E Babl
- a Murdoch Children's Research Institute , Melbourne , Victoria , Australia.,c Emergency Department , Royal Children's Hospital , Melbourne , Victoria , Australia.,d Department of Paediatrics, Faculty of Medicine , Dentistry and Health Sciences, University of Melbourne , Melbourne , VIC , Australia
| | - Ruth Barker
- e Queensland Injury Surveillance Unit , Mater Medical Research Institute , South Brisbane Queensland , Australia
| | - Dario Gregori
- f Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences , University of Padova , Padova , Italy
| | - Liviana Da Dalt
- b Department of Woman's and Child's Health, Department of Paediatrics , University of Padova , Padova , Italy
| | - Silvia Bressan
- a Murdoch Children's Research Institute , Melbourne , Victoria , Australia.,b Department of Woman's and Child's Health, Department of Paediatrics , University of Padova , Padova , Italy
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Cavicchiolo ME, Daverio M, Lanzoni P, Segafredo G, Pizzol D, Putoto G, Trevisanuto D. Participants' opinions of the limited impact of an adapted neonatal resuscitation course in a low-resource setting. Acta Paediatr 2017; 106:344. [PMID: 27862301 DOI: 10.1111/apa.13661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Maria Elena Cavicchiolo
- Department of Woman's and Child's Health University of Padua Padua Italy
- Doctors with Africa CUAMM Beira Mozambique
| | - Marco Daverio
- Department of Woman's and Child's Health University of Padua Padua Italy
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Cavicchiolo ME, Lanzoni P, Wingi MO, Pizzol D, Daverio M, Da Dalt L, Putoto G, Trevisanuto D. Reduced neonatal mortality in a regional hospital in Mozambique linked to a Quality Improvement intervention. BMC Pregnancy Childbirth 2016; 16:366. [PMID: 27876013 PMCID: PMC5120470 DOI: 10.1186/s12884-016-1170-y] [Citation(s) in RCA: 24] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 11/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neonatal mortality remains a serious health issue especially in low resource countries, where 99% of neonatal deaths occur. Doctors with Africa CUAMM is an Italian non-governmental organization in the field of healthcare that has been working in Africa since 1955. In Mozambique, at the Central Beira Hospital (CBH), it has a project with the aim of supporting the neonatal intensive care unit (NICU) and the Obstetrical Department of the CBH through a multi-level intervention. Our aim was to evaluate the effectiveness of CUAMM continuous Quality Improvement intervention in terms of reduction of the overall neonatal mortality rate in the NICU of CBH. METHODS A baseline analysis was performed in order to assess the actual standard of neonatal care. Subsequently, the intervention was focused on three main areas: infrastructure, equipment and clinical protocols improvement. A retrospective pre- (2013)/post- (2014) implementation analysis of clinical outcomes was performed. RESULTS Total population included 4,276 newborns, 2,118 (50%) born in 2013 and 2158 (50%) born after implementation. Baseline characteristics of the two groups were similar apart from a higher incidence of outborn neonates (33% vs 30%, p = 0.02) and a lower incidence of Apgar score < 7 at 5 min (37% vs 43%, p < 0.01). The rates of admissions for asphyxia (22% vs 30%), sepsis (4% vs 7%) and prematurity (18% vs 28%) increased between the two study period. Mortality rate for each of these causes decreased from before to after the implementation: asphyxia (34% vs 19%, p < 0.01), sepsis (39% vs 28%, p = 0.06) and prematurity (43% vs 33%, p < 0.01). CONCLUSION We found a reduction in mortality rate among newborns admitted to CBH's NICU after the first year of CUAMM intervention. Most of this reduction can be attributed to the decrease in deaths for asphyxia, sepsis and prematurity. A Quality Improvement intervention based on infrastructural, equipment and clinical objectives was associated with a reduction of neonatal mortality rate in a low-resource NICU.
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Affiliation(s)
- Maria Elena Cavicchiolo
- Doctors with Africa CUAMM, Padova, Italy. .,Department of Woman's and Child's Health, University of Padova, Via Giustiniani 3, Padova, 35128, Italy.
| | | | | | | | - Marco Daverio
- Department of Woman's and Child's Health, University of Padova, Via Giustiniani 3, Padova, 35128, Italy
| | - Liviana Da Dalt
- Department of Woman's and Child's Health, University of Padova, Via Giustiniani 3, Padova, 35128, Italy
| | | | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University of Padova, Via Giustiniani 3, Padova, 35128, Italy
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Daverio M, Vecchi M. In Reply: Supraventricular Tachycardia During Status Epilepticus in Dravet Syndrome: A Link Between Brain and Heart? Pediatr Neurol 2016; 63:e5. [PMID: 27480955 DOI: 10.1016/j.pediatrneurol.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Marco Daverio
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Marilena Vecchi
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy.
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Daverio M, Bressan S, Gregori D, Babl FE, Mackay MT. Patient and Process Factors Associated With Type of First Neuroimaging and Delayed Diagnosis in Childhood Arterial Ischemic Stroke. Acad Emerg Med 2016; 23:1040-7. [PMID: 27155309 DOI: 10.1111/acem.13001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/27/2016] [Accepted: 05/04/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVES In-hospital factors contribute more to delayed diagnosis of childhood arterial ischemic stroke (AIS) than prehospital factors. We aimed to explore process and patient factors associated with type of and timing to neuroimaging in childhood AIS in the emergency department (ED). METHODS This was a retrospective hospital registry-based study of children with AIS, presenting to an Australian tertiary pediatric ED between January 2003 and December 2012. Neuroimaging data and timelines of care were also collected from referring hospitals for transferred patients. RESULTS Seventy-one AIS episodes and 19 transient ischemic attacks were recorded. The majority (56%) were initially seen at a referring hospital. Patients underwent computed tomography (CT) as first scan more frequently than magnetic resonance imaging (MRI) as first scan (61% vs. 32%) at both the referring and the tertiary hospitals. Time to first scan as CT was significantly shorter compared with MRI (median = 1.5 hours vs. 10.9 hours, p < 0.001). MRI was performed more often at the tertiary hospital (92.5% vs. 26%, p = 0.001). Median time to performance of diagnostic MRI was 15.1 hours (interquartile range = 7.1-23.5), with no significant difference between patients first presenting to a referring hospital and those directly accessing the tertiary center. Patient characteristics including age, past medical history, conscious state, focal symptoms, and signs on arrival were not associated with the type of first neuroimaging or time to diagnostic MRI. Patients presenting during weekends were less likely to receive an MRI as first scan (odds ratio [OR] = 0.3, 95% confidence interval [CI] = 0.1-0.8), while time to MRI was significantly longer for children presenting after hours (5 pm-8 am; median = 17.6 hours vs. 8.4 hours, p = 0.026). MRI overall and as first scan was associated with a higher use of sedation than CT (OR = 6.5, 95% CI = 1.3-32.9; and OR = 3.9, 95% CI = 1.3-11.8), particularly for children younger than 5 years of age (OR = 12.5, 95% CI = 3-52.4). CONCLUSIONS Strategies to improve rapid diagnosis of pediatric stroke should include shared regional hospital networks protocols to optimize local imaging strategies and where possible rapid transfer to the tertiary center. Future priorities should include development of pediatric ED physician decision support tools to differentiate stroke from mimics and the development and implementation of rapid ED imaging stroke protocols to improve access to confirmatory MRI scanning.
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Affiliation(s)
- Marco Daverio
- Department of Woman's and Child's Health; University of Padova; Padova Italy
- Emergency Research Group and Neuroscience Research Groups Murdoch Childrens Research Institute; Melbourne Victoria Australia
| | - Silvia Bressan
- Department of Woman's and Child's Health; University of Padova; Padova Italy
- Emergency Research Group and Neuroscience Research Groups Murdoch Childrens Research Institute; Melbourne Victoria Australia
| | - Dario Gregori
- Unit of Biostatistics; Epidemiology and Public Health; Department of Cardiac; Thoracic and Vascular Sciences; University of Padova; Padova Italy
| | - Franz E. Babl
- Emergency Research Group and Neuroscience Research Groups Murdoch Childrens Research Institute; Melbourne Victoria Australia
- Emergency Department; Royal Children's Hospital Melbourne; Melbourne Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
| | - Mark T. Mackay
- Emergency Research Group and Neuroscience Research Groups Murdoch Childrens Research Institute; Melbourne Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
- Department of Neurology; Royal Children's Hospital; Melbourne Victoria Australia
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Bressan S, Daverio M, Barker R, Molesworth C, Babl FE. Paediatric recreational vehicle-related head injuries presenting to the emergency department of a major paediatric trauma centre in Australia: Is there room for improvement? Emerg Med Australas 2016; 28:425-33. [PMID: 27400755 DOI: 10.1111/1742-6723.12617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 01/05/2016] [Accepted: 05/04/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study examines clinical characteristics and helmet use of children presenting to the ED with a recreational vehicle (RV)-related head injury (HI). METHODS Observational retrospective study of children <18 years presenting with a RV-related HI to the ED of a state-wide paediatric trauma centre in Australia between April 2011 and January 2014. RESULTS In the 647 presentations identified, corresponding to 7.5% (95% CI 7.0-8.1) of all HI presentations, RVs involved were bicycles (36.3%), push scooters (18.5%), motorcycles (18.4%), horses (11.7%), skateboards (11.6%), quadbikes (2.8%) and go-karts (0.6%). Recorded helmet use was the highest in motorcycle, horse and bicycle riders (83.2%, 82.9% and 65.1%, respectively), and the lowest for push scooter (25.8%) and skateboard riders (17.3%). Overall 23% underwent a CT scan, 8.8% had intracranial injuries on CT, 30.6% were admitted, and 2.2% underwent neurosurgery. Push scooter-related HIs were the least severe. Age (in years), riding a motorised vehicle and not wearing a helmet were independently associated with intracranial injuries on CT on multiple logistic regression (OR 1.1, 95% CI 1.0-1.2; OR 2.4, 95% CI 1.3-4.6 and OR 6.0, 95% CI 3.2-11.2, respectively). CONCLUSIONS RV-related HIs accounted for a non-negligible proportion of paediatric HIs presenting to the ED and for significant morbidity and use of hospital resources. Interventions such as introduction of mandatory helmet use for off-road motorised vehicle riding and skateboard riding in children, enhanced injury prevention campaigns, and strict adult supervision during motorised vehicle riding may reduce the morbidity and health care costs associated with paediatric RV-related HIs.
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Affiliation(s)
- Silvia Bressan
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Marco Daverio
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Ruth Barker
- Queensland Injury Surveillance Unit, Mater Medical Research Institute, Brisbane, Queensland, Australia
| | | | - Franz E Babl
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Daverio M, Ciccone O, Boniver C, De Palma L, Corrado D, Vecchi M. Supraventricular Tachycardia During Status Epilepticus in Dravet Syndrome: A Link Between Brain and Heart? Pediatr Neurol 2016; 56:69-71. [PMID: 26803335 DOI: 10.1016/j.pediatrneurol.2015.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 12/05/2015] [Accepted: 12/12/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND The possibility that epileptic seizures and arrhythmias are different clinical manifestations of a common channelopathy is an interesting but unproved hypothesis. Patients with Dravet syndrome show heart rate variability and affected individuals with arrhythmias have also been documented. The possibility that a genetic mutation affecting sodium channel functions may predispose to both Dravet syndrome and arrhythmogenic disorders is an interesting hypothesis. PATIENT PRESENTATION We describe a 5-month-old girl with Dravet syndrome who presented with paroxysmal supraventricular tachycardia during status epilepticus. She presented to the hospital the first time with afebrile tonic-clonic seizures and then several subsequent times with status epilepticus confirmed with electroencephalography. During two of these episodes she also exhibited paroxysmal supraventricular tachycardia. She received propofol for status epilepticus and adenosine for the arrhythmia. A clinical and genetic (denovo mutation of a sodium channel, SCN1A) diagnosis of Dravet syndrome was made. CONCLUSIONS Our patient supports the hypothesis that SCN1A mutation might have a role as a common substrate to both epilepsy and cardiac arrhythmia. More studies are needed to better assess genetic, cardiac, respiratory, and autonomic dysfunction in patients with Dravet syndrome.
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Affiliation(s)
- Marco Daverio
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Ornella Ciccone
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Clementina Boniver
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Luca De Palma
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Domenico Corrado
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, Padua, Italy
| | - Marilena Vecchi
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy.
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Daverio M, Fino G, Luca B, Zaggia C, Pettenazzo A, Parpaiola A, Lago P, Amigoni A. Failure mode and effective analysis ameliorate awareness of medical errors: a 4-year prospective observational study in critically ill children. Paediatr Anaesth 2015; 25:1227-34. [PMID: 26432066 DOI: 10.1111/pan.12772] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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] [Accepted: 08/13/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Errors in are estimated to occur with an incidence of 3.7-16.6% in hospitalized patients. The application of systems for detection of adverse events is becoming a widespread reality in healthcare. Incident reporting (IR) and failure mode and effective analysis (FMEA) are strategies widely used to detect errors, but no studies have combined them in the setting of a pediatric intensive care unit (PICU). AIM The aim of our study was to describe the trend of IR in a PICU and evaluate the effect of FMEA application on the number and severity of the errors detected. METHODS With this prospective observational study, we evaluated the frequency IR documented in standard IR forms completed from January 2009 to December 2012 in the PICU of Woman's and Child's Health Department of Padova. On the basis of their severity, errors were classified as: without outcome (55%), with minor outcome (16%), with moderate outcome (10%), and with major outcome (3%); 16% of reported incidents were 'near misses'. We compared the data before and after the introduction of FMEA. RESULTS Sixty-nine errors were registered, 59 (86%) concerning drug therapy (83% during prescription). Compared to 2009-2010, in 2011-2012, we noted an increase of reported errors (43 vs 26) with a reduction of their severity (21% vs 8% 'near misses' and 65% vs 38% errors with no outcome). CONCLUSION With the introduction of FMEA, we obtained an increased awareness in error reporting. Application of these systems will improve the quality of healthcare services.
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Affiliation(s)
- Marco Daverio
- Department of Woman's and Child's Health, Pediatric Residency Program, University of Padova, Padova, Italy
| | - Giuliana Fino
- Department of Woman's and Child's Health, Pediatric Residency Program, University of Padova, Padova, Italy
| | - Brugnaro Luca
- Education and Training Department, University-Hospital, Padova, Italy
| | - Cristina Zaggia
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University-Hospital, Padova, Italy
| | - Andrea Pettenazzo
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University-Hospital, Padova, Italy
| | | | - Paola Lago
- Quality Assurance Service, University-Hospital, Padova, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University-Hospital, Padova, Italy
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Menniti-Ippolito F, Da Cas R, Traversa G, Santuccio C, Felicetti P, Tartaglia L, Trotta F, Di Pietro P, Barabino P, Renna S, Riceputi L, Tovo PA, Gabiano C, Urbino A, Baroero L, Le Serre D, Virano S, Perilongo G, Daverio M, Gnoato E, Maretti M, Galeazzo B, Rubin G, Scanferla S, Da Dalt L, Stefani C, Zerbinati C, Chiappini E, Sollai S, De Martino M, Mannelli F, Becciani S, Giacalone M, Montano S, Remaschi G, Stival A, Furbetta M, Abate P, Leonardi I, Pirozzi N, Raucci U, Reale A, Rossi R, Russo C, Mancinelli L, Manuela O, Carlo C, Mores N, Romagnoli C, Chiaretti A, Compagnone A, Riccardi R, Delogu G, Sali M, Prete V, Tipo V, Dinardo M, Auricchio F, Polimeno T, Sodano G, Maccariello A, Rafaniello C, Fucà F, Di Rosa E, Altavilla D, Mecchio A, Arrigo T. Vaccine effectiveness against severe laboratory-confirmed influenza in children: results of two consecutive seasons in Italy. Vaccine 2014; 32:4466-4470. [PMID: 24962760 DOI: 10.1016/j.vaccine.2014.06.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 12/04/2013] [Revised: 03/20/2014] [Accepted: 06/11/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of seasonal influenza vaccine in preventing Emergency Department (ED) visits and hospitalisations for influenza like illness (ILI) in children. METHODS We conducted a test negative case-control study during the 2011-2012 and 2012-2013 influenza seasons. Eleven paediatric hospital/wards in seven Italian regions participated in the study. Consecutive children visiting the ED with an ILI, as diagnosed by the doctor according to the European Centre for Disease Control case definition, were eligible for the study. Data were collected from trained pharmacists/physicians by interviewing parents during the ED visit (or hospital admission) of their children. An influenza microbiological test (RT-PCR) was carried out in all children. RESULTS Seven-hundred and four children, from 6 months to 16 years of age, were enrolled: 262 children tested positive for one of the influenza viruses (cases) and 442 tested negative (controls). Cases were older than controls (median age 46 vs. 29 months), though with a similar prevalence of chronic conditions. Only 25 children (4%) were vaccinated in the study period. The overall age-adjusted vaccine effectiveness (VE) was 38% (95% confidence interval -52% to 75%). A higher VE was estimated for hospitalised children (53%; 95% confidence interval -45% to 85%). DISCUSSION This study supports the effectiveness of the seasonal influenza vaccine in preventing visits to the EDs and hospitalisations for ILI in children, although the estimates were not statistically significant and with wide confidence intervals. Future systematic reviews of available data will provide more robust evidence for recommending influenza vaccination in children.
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Affiliation(s)
| | - Roberto Da Cas
- National Centre of Epidemiology, National Institute of Health, Roma, Italy
| | - Giuseppe Traversa
- National Centre of Epidemiology, National Institute of Health, Roma, Italy
| | | | | | | | | | | | | | | | | | | | - Clara Gabiano
- Regina Margherita Paediatric Hospital, Torino, Italy
| | | | - Luca Baroero
- Regina Margherita Paediatric Hospital, Torino, Italy
| | | | - Silvia Virano
- Regina Margherita Paediatric Hospital, Torino, Italy
| | | | - Marco Daverio
- Department of Paediatrics, University of Padova, Italy
| | - Elisa Gnoato
- Department of Paediatrics, University of Padova, Italy
| | | | | | - Giulia Rubin
- Department of Paediatrics, University of Padova, Italy
| | | | | | - Chiara Stefani
- Department of Paediatrics, Treviso Hospital, Treviso, Italy
| | | | | | - Sara Sollai
- Anna Meyer Children's University Hospital, Firenze, Italy
| | | | | | | | | | - Simona Montano
- Anna Meyer Children's University Hospital, Firenze, Italy
| | | | - Alessia Stival
- Anna Meyer Children's University Hospital, Firenze, Italy
| | - Mario Furbetta
- Department of Paediatrics, University Hospital, Perugia, Italy
| | - Piera Abate
- Department of Paediatrics, University Hospital, Perugia, Italy
| | - Ilaria Leonardi
- Department of Paediatrics, University Hospital, Perugia, Italy
| | - Nicola Pirozzi
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Umberto Raucci
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Antonino Reale
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Rossella Rossi
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Cristina Russo
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Livia Mancinelli
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Onori Manuela
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Concato Carlo
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Nadia Mores
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Costantino Romagnoli
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Antonio Chiaretti
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Adele Compagnone
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Riccardo Riccardi
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Giovanni Delogu
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Michela Sali
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Valentina Prete
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Vincenzo Tipo
- Santobono Paediatric Hospital and Virology Unit-Cotugno, Napoli, Italy
| | - Michele Dinardo
- Santobono Paediatric Hospital and Virology Unit-Cotugno, Napoli, Italy
| | - Fabiana Auricchio
- Santobono Paediatric Hospital and Virology Unit-Cotugno, Napoli, Italy
| | - Teodoro Polimeno
- Santobono Paediatric Hospital and Virology Unit-Cotugno, Napoli, Italy
| | - Giuseppe Sodano
- Santobono Paediatric Hospital and Virology Unit-Cotugno, Napoli, Italy
| | | | | | - Fortunata Fucà
- Giovanni Di Cristina Paediatric Hospital, Palermo, Italy
| | | | - Domenica Altavilla
- Department of Paediatric, Gynecologic, Microbiologic and Biomedical Sciences, University Hospital, Messina, Italy
| | - Anna Mecchio
- Department of Paediatric, Gynecologic, Microbiologic and Biomedical Sciences, University Hospital, Messina, Italy
| | - Teresa Arrigo
- Department of Paediatric, Gynecologic, Microbiologic and Biomedical Sciences, University Hospital, Messina, Italy
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Bressan S, Daverio M, Martinolli F, Dona' D, Mario F, Steiner IP, Dalt LD. The use of handheld near-infrared device (Infrascanner)for detecting intracranial haemorrhages in children with minor head injury. Childs Nerv Syst 2014; 30:477-84. [PMID: 24469947 DOI: 10.1007/s00381-014-2368-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE A handheld device using near-infrared technology(Infrascanner) has shown good accuracy for detection of traumatic intracranial haemorrhages in adults. This study aims to determine the feasibility of use of Infrascanner in children with minor head injury (MHI) in the Emergency Department(ED). Secondary aim was to assess its potential usefulness to reduce CT scan rate. METHODS Prospective pilot study conducted in two paediatric EDs, including children at high or intermediate risk for clinically important traumatic brain injury (ciTBI) according to the adapted PECARN rule in use. Completion of Infrascanner measurements and time to completion were recorded. Decision on CT scan and CT scan reporting were performed independently and blinded to Infrascanner results. RESULTS Completion of the Infrascanner measurement was successfully achieved in 103 (94 %) of 110 patients enrolled,after a mean of 4.4±2.9 min. A CT scan was performed in 18(17.5 %) children. Only one had an intracranial haemorrhage that was correctly identified by the Infrascanner. The exploratory analysis showed a specificity of 93 % (95 % CI, 86.5–96.6) and a negative predictive value of 100 % (95 % CI,81.6–100) for ciTBI. The use of Infrascanner would have led to avoid ten CT scan, reducing the CT scan rate by 58.8 %. CONCLUSIONS Infrascanner seems an easy-to-use tool for children presenting to the ED following a MHI, given the high completion rate and short time to completion. Our preliminary results suggest that Infrascanner is worthy of further investigation as a potential tool to decrease the CT scan rate in children with MHI.
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Bressan S, Daverio M, Martinolli F, Dona' D, Mario F, Steiner IP, Da Dalt L. The use of handheld near-infrared device (Infrascanner) for detecting intracranial haemorrhages in children with minor head injury. Childs Nerv Syst 2013; 30:477-484. [PMID: 24232074 DOI: 10.1007/s00381-013-2314-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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] [Received: 09/25/2013] [Accepted: 10/22/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A handheld device using near-infrared technology (Infrascanner) has shown good accuracy for detection of traumatic intracranial haemorrhages in adults. This study aims to determine the feasibility of use of Infrascanner in children with minor head injury (MHI) in the Emergency Department (ED). Secondary aim was to assess its potential usefulness to reduce CT scan rate. METHODS Prospective pilot study conducted in two paediatric EDs, including children at high or intermediate risk for clinically important traumatic brain injury (ciTBI) according to the adapted PECARN rule in use. Completion of Infrascanner measurements and time to completion were recorded. Decision on CT scan and CT scan reporting were performed independently and blinded to Infrascanner results. RESULTS Completion of the Infrascanner measurement was successfully achieved in 103 (94 %) of 110 patients enrolled, after a mean of 4.4 ± 2.9 min. A CT scan was performed in 18 (17.5 %) children. Only one had an intracranial haemorrhage that was correctly identified by the Infrascanner. The exploratory analysis showed a specificity of 93 % (95 % CI, 86.5-96.6) and a negative predictive value of 100 % (95 % CI, 81.6-100) for ciTBI. The use of Infrascanner would have led to avoid ten CT scan, reducing the CT scan rate by 58.8 %. CONCLUSIONS Infrascanner seems an easy-to-use tool for children presenting to the ED following a MHI, given the high completion rate and short time to completion. Our preliminary results suggest that Infrascanner is worthy of further investigation as a potential tool to decrease the CT scan rate in children with MHI.
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Affiliation(s)
- Silvia Bressan
- Department of Woman's and Child's Health, University of Padova, Padova, Italy,
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