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Robino C, Toncelli G, Sorrentino LA, Fioccola A, Tedesco B, Giugni C, L'Erario M, Ricci Z. Fluid balance in critically ill children with lower respiratory tract viral infection: a cohort study. J Anesth Analg Crit Care 2023; 3:10. [PMID: 37386553 DOI: 10.1186/s44158-023-00093-8] [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] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/18/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Increasing evidence has associated positive fluid balance of critically ill patients with poor outcomes. The aim of this study was to explore the pattern of daily fluid balances and their association with outcomes in critically ill children with lower respiratory tract viral infection. METHODS A retrospective single-center study was conducted, in children supported with high-flow nasal cannula, non-invasive ventilation, or invasive ventilation. Median (interquartile range) daily fluid balances, cumulative fluid overload (FO) and peak FO variation, indexed as the % of admission body weight, over the first week of Pediatric Intensive Care Unit admission, and their association with the duration of respiratory support were assessed. RESULTS Overall, 94 patients with a median age of 6.9 (1.9-18) months, and a respiratory support duration of 4 (2-7) days, showed a median (interquartile range) daily fluid balance of 18 (4.5-19.5) ml/kg at day 1, which decreased up to day 3 to 5.9 (- 14 to 24.9) ml/kg and increased to 13 (- 11 to 29.9) ml/kg at day 7 (p = 0.001). Median cumulative FO% was 4.6 (- 0.8 to 11) and peak FO% was 5.7 (1.9-12.4). Daily fluid balances, once patients were stratified according to the respiratory support, were significantly lower in those requiring mechanical ventilation (p = 0.003). No correlation was found between all examined fluid balances and respiratory support duration or oxygen saturation, even after subgroup analysis of patients with invasive mechanical ventilation, or respiratory comorbidities, or bacterial coinfection, or of patients under 1 year old. CONCLUSIONS In a cohort of children with bronchiolitis, fluid balance was not associated with duration of respiratory support or other parameters of pulmonary function.
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Affiliation(s)
- Chiara Robino
- Department of Anesthesia and Critical Care, Pediatric Intensive Care Unit, Meyer Children's University Hospital, IRCCS, Florence, Italy
| | - Guido Toncelli
- Department of Anesthesia and Critical Care, Pediatric Intensive Care Unit, Meyer Children's University Hospital, IRCCS, Florence, Italy
| | - Laura Arianna Sorrentino
- Department of Health Sciences, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy
| | - Antonio Fioccola
- Department of Health Sciences, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy
| | - Brigida Tedesco
- Department of Anesthesia and Critical Care, Pediatric Intensive Care Unit, Meyer Children's University Hospital, IRCCS, Florence, Italy
| | - Cristina Giugni
- Department of Anesthesia and Critical Care, Pediatric Intensive Care Unit, Meyer Children's University Hospital, IRCCS, Florence, Italy
| | - Manuela L'Erario
- Department of Anesthesia and Critical Care, Pediatric Intensive Care Unit, Meyer Children's University Hospital, IRCCS, Florence, Italy
| | - Zaccaria Ricci
- Department of Anesthesia and Critical Care, Pediatric Intensive Care Unit, Meyer Children's University Hospital, IRCCS, Florence, Italy.
- Department of Health Sciences, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy.
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Giugni C, Cecchi C, Santucci C, Giometto S, Lucenteforte E, Ricci Z. Why is corneal donation so rare in children's hospices? A survey of multidisciplinary team members attitudes, knowledge, practice, and experience. Pediatr Transplant 2022; 26:e14217. [PMID: 34994059 DOI: 10.1111/petr.14217] [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: 07/24/2021] [Revised: 12/13/2021] [Accepted: 12/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Corneal donation is a rare event among pediatric patients dying in children's hospices in Italy. Previous research suggests that lack of knowledge and negative attitude of Health Care Professionals (HCPs) are the most relevant factors for low donation rates in hospice, rather than patient ineligibility or public refusal. We conducted a national survey to explore children's hospice staff's knowledge and attitude toward corneal donation, to survey HCPs confidence in discussing the subject with patients and families, to investigate whether staff members receive specific training about corneal donation and its potential impact on the willingness to raise the topic with patients and families. METHODS An anonymous web-based survey with multiple-choice responses was delivered to the team members of seven Italian children's hospices to test their knowledge and attitude about corneal donation. RESULTS Of the seven children's hospices approached, four agreed to participate with a response rate of 48.5%. Among respondents, 70% declared that they had not received specific training about corneal donation. Results of statistical analysis showed that there were no significant differences in responses between trained and non-trained staff and among the different professionals (nurses, doctors, psychologists, AND social workers) regarding confidence in discussing the subject with patients and families. CONCLUSIONS In our sample of HCPs working in Italian children's hospices, there was no difference in self-reported trust between professionals who reported receiving specific cornea donation training and those who did not. It is remarkable that training on corneal donation was endorsed by a minority of the sample.
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Affiliation(s)
- Cristina Giugni
- Department of Anesthesiology and Critical Care Medicine, Pediatric Intensive Care Unit, Meyer Children's Hospital, Florence, Italy
| | - Costanza Cecchi
- Department of Anesthesiology and Critical Care Medicine, Pediatric Intensive Care Unit, Meyer Children's Hospital, Florence, Italy
| | - Claudia Santucci
- Department of Anesthesiology and Critical Care Medicine, Pediatric Intensive Care Unit, Meyer Children's Hospital, Florence, Italy
| | - Sabrina Giometto
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ersilia Lucenteforte
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Zaccaria Ricci
- Department of Anesthesiology and Critical Care Medicine, Pediatric Intensive Care Unit, Meyer Children's Hospital, Florence, Italy.,Anesthesiology and Critical Care medicine, Department of Health Science, University of Florence, Florence, Italy
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Giugni C, Cecchi C, Santucci C, Scuncia G. Is donation after circulatory determination of death feasible for pediatric patients in italy? Pediatr Transplant 2021; 25:e13977. [PMID: 33522647 DOI: 10.1111/petr.13977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/14/2020] [Accepted: 01/08/2021] [Indexed: 12/01/2022]
Abstract
To determine the potential effect of a donation after cardiac death active program on the number of organ donors in a Italian Pediatric Intensive Care Unit (PICU). We conducted a retrospective study of all deaths in PICU of an academic Children Hospital between 2012 and 2020, tracing the organ donation activity. Patients were categorized as brain deaths, deaths despite maximal resuscitation, and deaths after withdrawal or limitation of life support. Patient demographics, premortem physiology, end-of-life circumstances, and functional warm ischemia time were recorded. Eligible donors after cardiac death were identified by the absence of medical contraindication and functional warm ischemia time <60 minutes. Of 124 deaths that occurred during the study period, 34 met criteria for brain death, 23 were potential donors, and 13 became actual donors. Of the remaining 90 patients that met criteria for cardiac death, 66 died despite maximal resuscitation, 24 died after withdrawal or limitation of care and between them 13 were identified as theoretically eligible DCD donors. Of these, 5 patients had a functional warm ischemia time of <1 hour and were potential candidates for DCD of 10 kidneys and 2 lungs. Even if few children could have been eligible for DCD in the study period, an active program could have been able to increase the number of potential organ donors by 20% in the last eight years at our institution. DCD deserves to be explored in Italy as a new option for children.
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Affiliation(s)
- Cristina Giugni
- Department of Anaesthesiology and Critical Care Medicine, Pediatric Intensive Care Unit, Meyer Children's Hospital, Florence, Italy
| | - Costanza Cecchi
- Department of Anaesthesiology and Critical Care Medicine, Pediatric Intensive Care Unit, Meyer Children's Hospital, Florence, Italy
| | - Claudia Santucci
- Department of Anaesthesiology and Critical Care Medicine, Pediatric Intensive Care Unit, Meyer Children's Hospital, Florence, Italy
| | - Glenda Scuncia
- Department of Anaesthesiology and Critical Care Medicine, Pediatric Intensive Care Unit, Meyer Children's Hospital, Florence, Italy
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McIntosh J, Aresté ME, Brierley J, Giugni C, McGreevy KS, Cambra FJ, Tibboel D, Diaz R, Zanobini A. Safeguarding children's right to health in hospital during COVID-19. Lancet Child Adolesc Health 2020; 4:800-802. [PMID: 32941785 PMCID: PMC7490005 DOI: 10.1016/s2352-4642(20)30300-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/25/2020] [Indexed: 10/31/2022]
Affiliation(s)
- Jennifer McIntosh
- European Children's Hospitals Organisation, Barcelona, Spain; International Department, Sant Joan de Déu Barcelona Children's Hospital, Barcelona, Spain.
| | | | - Joe Brierley
- Paediatric Bioethics Centre, Great Ormond Street Hospital, London, UK
| | | | - Kathleen S McGreevy
- Office of International Relations and the Promotion of Innovation, Florence, Italy
| | - Francisco José Cambra
- Paediatric Intensive Care Unit, Sant Joan de Déu Barcelona Children's Hospital, Barcelona, Spain; Borja Bioethics Institute-URL, Barcelona, Spain
| | - Dick Tibboel
- Department of Paediatric Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ruben Diaz
- European Children's Hospitals Organisation, Barcelona, Spain; International Department, Sant Joan de Déu Barcelona Children's Hospital, Barcelona, Spain
| | - Alberto Zanobini
- European Children's Hospitals Organisation, Barcelona, Spain; Meyer Children's Hospital, Florence, Italy
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Honsel M, Giugni C, Brierley J. Limited professional guidance and literature are available to guide the safe use of neuromuscular block in infants. Acta Paediatr 2014; 103:e370-3. [PMID: 24813671 PMCID: PMC4228760 DOI: 10.1111/apa.12682] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 02/26/2014] [Accepted: 05/06/2014] [Indexed: 11/26/2022]
Abstract
AIM Neuromuscular blocking agents (NMBAs) are used in a range of critical illnesses in neonates and infants, despite a lack of guidelines and professional standards. This study reviewed the current evidence base and ascertained UK practice regarding the continuous use of these agents in this age range. METHODS We reviewed the literature and carried out a telephone questionnaire of all tertiary units in England and specialist children's hospital neonatal units in the UK. RESULTS No best practice guidelines or general consensus statements were found, and the only randomised trial to feature an NMBA protocol expressed concerns about its use in such young babies. Of the 56 units contacted, 54 (96.4%) shared information. Only three of the 56 (5.4%) used intermittent boluses of NMBAs, 91.1% used NMBA infusions, 11 (19.6%) routinely used regular neuromuscular blocker pause to assess depth, and only one (1.8%) used peripheral nerve stimulation monitoring. All the units carried out clinical assessments, but only one (1.8%) had a written protocol. CONCLUSION There is a paucity of literature and professional standards to guide the safe use of NMBAs in infants. Of the 54 units who participated in the survey, only one had a protocol for using NMBAs in babies.
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Affiliation(s)
- Maik Honsel
- Paediatric and Neonatal Intensive Care Unit; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - Cristina Giugni
- Paediatric and Neonatal Intensive Care Unit; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - Joe Brierley
- Paediatric and Neonatal Intensive Care Unit; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
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Giugni C. Palliative care: improving care at the coalface. BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000053.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Theiller E, Minella K, Solís E, Giugni C, Garnero N. [Typing of colorectal epithelium by lectin histochemistry: expression of T glycoepitope]. Acta Gastroenterol Latinoam 2001; 31:7-11. [PMID: 11370182] [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] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
The current study deals with the setting up of a new tool that enables the benign versus the malignant nature of colorectal epithelium to be determined early and accurately. The objective is to determine a different biologic characteristic between normal and malignant colorectal tissue, which is the site and the level of expression of the T glycoepitope (Thomsen-Friedenreich antigen). It was characterized in a series of 62 colorectal samples, including 31 normal (without pathologic lesion) and 31 cancerous (mostly moderately or poorly differentiated) tissue sections. The glycoconjugate expression was demonstrated by lectin-histochemistry, using PNA lectin. The binding patterns of the lectin were determined in both columnar and goblet cells, from normal and malignant colorectal tissue. The results show that specific and different glycochemical staining patterns could be identified between benign and malignant epithelium. The data of the cytostructural localization were submitted to statistical analyses, which strongly suggested the association between the patterns of expression of the T antigen and the degree of the tissue differentiation. The methodology developed can be applied directly in routine diagnosis and it has an important prognostic value.
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Affiliation(s)
- E Theiller
- Departamento de Bioquímica Clínica y Cuantitativa y Catedra de Morfología Normal, de la Facultad de Bioquímica y Ciencias Biológicas de la Universidad Nacional del Litoral
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