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PEDIATRIC INTENSIVE CARE UNIT
HUMAYUN IQBAL KHAN
The Professional Medical Journal , 2006,
Abstract: Background: Intensive care is predominantly concerned with the managementof patients with acute life threatening conditions in a specialized unit. Children having acute neurological deterioration,respiratory distress, cardiovascular compromise, severe infections and accidental poisonings constitute the majoradmission to a pediatric intensive care unit. Objective: To document the number, disease pattern and outcome ofpatients admitted to Pediatric intensive care unit. Design: Descriptive study. Place and Duration: The study wasconducted in the intensive care unit of department of Pediatrics, King Edward Medical University/Mayo hospital, Lahorefrom July 01, 2004 to June 30, 2005. Patients and Methods: The data of all the admitted patients was analyzed forage, sex, cause of admission and outcome. Results: A total of 1012 children were admitted during the study period.Among them 59.68% were male and 40.32% were female. Bronchopneumonia was the major cause of admission(29.05%) followed by septicemia (14.43%), acute bacterial meningitis (8.1%), acute watery diarrhea (6.92%), congenitalheart diseases (5.14%), tetanus (3.75%) ,acute myocarditis (2.67%) and others (29.94%) including acute bronchialasthma, hepatic encephalopathy, diabetic ketoacidosis, encephalitis, tuberculous meningitis, accidental poisoning andGuillain-Barre syndrome. Out of total admissions, 64.43% were shifted to different units of the department, 4.05%discharged in satisfactory condition, 9.49% left against medical advice (LAMA) and 22.03% died. The case fatality ofsepticemia (65.07%) was highest. Conclusion: Bronchopneumonia and septicemia were the major causes ofadmission while case fatality was highest for septicemia in intensive care unit.
Evaluation of the Medical Care of Patients with Hypertension in an Emergency Department and in Ambulatory Hypertension Unit
Nobre, Fernando;Chauchar, Fause;Viana, Jaciara Machado;Pereira, Gustavo José Veras;Lima, Nereida Kilza da Costa;
Arquivos Brasileiros de Cardiologia , 2002, DOI: 10.1590/S0066-782X2002000200003
Abstract: objective: to evaluate the characteristics of the patients receiving medical care in the ambulatory of hypertension of the emergency department, division of cardiology, and in the emergency unit of the clinical hospital of the ribeir?o preto medical school. methods: using a protocol, we compared the care of the same hypertensive patients in on different occasions in the 2 different places. the characteristics of 62 patients, 29 men with a mean age of 57 years, were analyzed between january 1996 and december 1997. results: the care of these patients resulted in different medical treatment regardless of their clinical features and blood pressure levels. thus, in the emergency unit, 97% presented with symptoms, and 64.5% received medication to rapidly reduce blood pressure. in 50% of the cases, nifedipine sl was the elected medication. patients who applied to the ambulatory of hypertension presenting with similar features, or, in some cases, presenting with similar clinically higher levels of blood pressure, were not prescribed medication for a rapid reduction of blood pressure at any of the appointments. conclusion: the therapeutic approach to patients with high blood pressure levels, symptomatic or asymptomatic, was dependent on the place of treatment. in the emergency unit, the conduct was, in the majority of cases, to decrease blood pressure immediately, whereas in the ambulatory of hypertension, the same levels of blood pressure, in the same individuals, resulted in therapeutic adjustment with nonpharmacological management. these results show the need to reconsider the concept of hypertensive crises and their therapeutical implications.
Evaluation of the Medical Care of Patients with Hypertension in an Emergency Department and in Ambulatory Hypertension Unit
Nobre Fernando,Chauchar Fause,Viana Jaciara Machado,Pereira Gustavo José Veras
Arquivos Brasileiros de Cardiologia , 2002,
Abstract: OBJECTIVE: To evaluate the characteristics of the patients receiving medical care in the Ambulatory of Hypertension of the Emergency Department, Division of Cardiology, and in the Emergency Unit of the Clinical Hospital of the Ribeir o Preto Medical School. METHODS: Using a protocol, we compared the care of the same hypertensive patients in on different occasions in the 2 different places. The characteristics of 62 patients, 29 men with a mean age of 57 years, were analyzed between January 1996 and December 1997. RESULTS: The care of these patients resulted in different medical treatment regardless of their clinical features and blood pressure levels. Thus, in the Emergency Unit, 97% presented with symptoms, and 64.5% received medication to rapidly reduce blood pressure. In 50% of the cases, nifedipine SL was the elected medication. Patients who applied to the Ambulatory of Hypertension presenting with similar features, or, in some cases, presenting with similar clinically higher levels of blood pressure, were not prescribed medication for a rapid reduction of blood pressure at any of the appointments. CONCLUSION: The therapeutic approach to patients with high blood pressure levels, symptomatic or asymptomatic, was dependent on the place of treatment. In the Emergency Unit, the conduct was, in the majority of cases, to decrease blood pressure immediately, whereas in the Ambulatory of Hypertension, the same levels of blood pressure, in the same individuals, resulted in therapeutic adjustment with nonpharmacological management. These results show the need to reconsider the concept of hypertensive crises and their therapeutical implications.
Sedation and analgesia in pediatric intensive care unit  [cached]
Khilnani P,Kaur J
Indian Journal of Critical Care Medicine , 2003,
Abstract: Common indications of sedation in the PICU (Pediatric intensive care unit) include mechanical Ventilation and various procedures performed in the PICU and in radiology or endoscopy suites. Sedation potentiates the effect of narcotics, thereby ensuring better comfort and analgesia. Sedation is a mandatory prerequisite prior to and during administration of neuromuscular blockers. This review includes practical pharmacology and uses of commonly used agents in the PICU.
Cerebrovascular complications in pediatric intensive care unit  [cached]
Sachdev Anil,Sharma Rachna,Gupta Dhiren
Indian Journal of Critical Care Medicine , 2010,
Abstract: Cerebrovascular complications are being frequently recognized in the pediatric intensive care unit in the recent few years. The epidemiology and risk factors for pediatric stroke are different from that of the adults. The incidence of ischemic stroke is almost slightly more than that of hemorrhagic stroke. The list of diagnostic causes is increasing with the availability of newer imaging modalities and laboratory tests. The diagnostic work up depends on the age of the child and the rapidity of presentation. Magnetic resonance imaging, computerized tomography and arteriography and venography are the mainstay of diagnosis and to differentiate between ischemic and hemorrhagic events. Very sophisticated molecular diagnostic tests are required in a very few patients. There are very few pediatric studies on the management of stroke. General supportive management is as important as the specific treatment. Most of the treatment guidelines and suggestions are extrapolated from the adult studies. Few guidelines are available for the use of anticoagulants and thrombolytic agents in pediatric patients. So, our objective was to review the available literature on the childhood stroke and to provide an insight into the subject for the pediatricians and critical care providers.
Platelet counts and outcome in the pediatric intensive care unit  [cached]
Agrawal Shruti,Sachdev Anil,Gupta Dhiren,Chugh Krishan
Indian Journal of Critical Care Medicine , 2008,
Abstract: Objectives: Thrombocytopenia is commonly observed in critically ill patients. This study was undertaken to evaluate the variation in platelet counts and the risk factors associated with thrombocytopenia and mortality in pediatric intensive care patients. In addition, prognostic value of platelet counts for outcome in pediatric intensive care unit was studied. Study Design: Prospective, observational cohort analysis. Setting: 8- bedded pediatric intensive care unit of a tertiary care teaching hospital. Patients: All consecutively admitted patients (n=138) staying in the pediatric intensive care unit (PICU) for at least 48h over a 7 months period were studied. Measurements and Main Results: Thrombocytopenia was defined as platelet counts < 150.0/nL. Median 1 st day Pediatric Risk of Mortality Score (PRISM) was 5 (range 0-30) and median ICU stay was 4 days (range 2-98 days). Twenty five percent patients had at least one episode of thrombocytopenia during the stay. Twenty percent of these patients had thrombocytopenia on admission and rest (80%) developed it during the PICU stay. Seventy one percent (19) of the patients developed thrombocytopenia by fourth day of admission. Patients with PICU acquired thrombocytopenia had statistically significant lower baseline, nadir and 4th day platelet counts and a significantly higher drop in platelet counts (56% vs. 6% P< 0.001) as compared to non thrombocytopenic patients. PRISM score, long PICU stay, sepsis, coagulopathy, and creatinine levels were significantly associated with occurrence of thrombocytopenia. Patients with thrombocytopenia had higher probability of bleeding (34% vs. 15%, P=0.01). Higher platelet counts on admission were associated with significantly reduced risk of thrombocytopenia (P=0.00) Baseline, nadir and day-4 platelet counts, presence of thrombocytopenia on admission, sepsis, coagulopathy and a higher mean PRISM score on univariate analysis were significantly associated with mortality. Leucopenia or leucocytosis, thrombocytopenia and coagulopathy were found to significantly affect outcome. Drop in platelet counts was found to have slightly higher discriminative value for mortality prediction than PRISM on the ROC curve. The survivors had higher platelet counts throughout the PICU stay and after an initial fall in platelet counts in the PICU showed a significantly higher rise in the platelet counts in the following days than the non-survivors. Conclusions: Thrombocytopenia is common in PICU. Patients requiring cardiopulmonary resuscitation or with circulatory shock, coagulopathy, sepsis and wi
Prediction of Mortality Circumstances in the Pediatric Intensive Care Unit
Robabeh Ghergherehchi,Mandana Rafeey
Research Journal of Biological Sciences , 2012,
Abstract: We aimed to describe mode of death and the circumstances surrounding dying a pediatric intensive care unit. A retrospective descriptive study all patients (<15 years) dying in the PICU of tertiary care hospital from April 2004 to Jun 2006 (n = 74). Information regarding sex, age, Length of Stay (LOS), primary and admission diagnosis and the way of death was determined. Deaths were classified in 5 groups: Do not resuscitate (DNR), Withdrawal or Limitation of Therapy (W/LT), failed cardiopulmonary resuscitation (Failed CPR), brain death (BD) and terminal organ failure (TOF). Among 1075 admission, 6.8% patients died. Afton admitted during evening (43%). 40.8% died in the first two days. Failed CPR was the most common mode of death (66.2%), BD was found in 14.9%, TOF in 12.2%, W/LT in 2.7% and DNR in 4.1%. We observed that failed CPR is the most common mod of death and active withdrawal is still not widely practiced in our PICU because pediatricians in developing countries have to consider socio cultural and religious factors when making such decisions.
Prediction of Mortality Circumstances in the Pediatric Intensive Care Unit
Robabeh Ghergherehchi,Mandana Rafeey
Research Journal of Biological Sciences , 2008,
Abstract: We aimed to describe mode of death and the circumstances surrounding dying a pediatric intensive care unit. A retrospective descriptive study all patients (<15 years) dying in the PICU of tertiary care hospital from April 2004 to Jun 2006 (n = 74). Information regarding sex, age, Length of Stay (LOS), primary and admission diagnosis and the way of death was determined. Deaths were classified in 5 groups: Do not resuscitate (DNR), Withdrawal or Limitation of Therapy (W/LT), failed cardiopulmonary resuscitation (Failed CPR), brain death (BD) and terminal organ failure (TOF). Among 1075 admission, 6.8% patients died. Afton admitted during evening (43%). 40.8% died in the first two days. Failed CPR was the most common mode of death (66.2%), BD was found in 14.9%, TOF in 12.2%, W/LT in 2.7% and DNR in 4.1%. We observed that failed CPR is the most common mod of death and active withdrawal is still not widely practiced in our PICU because pediatricians in developing countries have to consider socio cultural and religious factors when making such decisions.
Pediatric risk and index of mortality in an intensive care unit  [cached]
Ay?e Berna An?l,Murat An?l,Nevin ?etin,Münevver Y?ld?r?mer
Turk Pediatri Ar?ivi , 2010,
Abstract: Aim: The purpose of the study is to determine the discriminative ability and calibration of Pediatric Risk of Mortality (PRISM I) I and Pediatric Index of Mortality (PIM) II in predicting the mortality in children admitted to a medical-surgical pediatric intensive care unit (PICU) in Turkey.Material and Method: A total of 277 children were evaluated from September 1, 2007, to, August 31, 2008, prospectively. Of these 277 patients, 39 patients (14.7%) died at the end of the PICU stay. Discrimination between death and survival was assessed by calculating the area under the ROC curve for each model. The standardized mortality ratios (SMRs) were also determined. Calibration was assessed using Hosmer Lemeshow’s test. Results: In our analysis, PRISM I (area under ROC curve: 0.884; SMR: 1; Hosmer Lemeshow chi-square p value: 0.09) and PIM II (area under ROC curve: 0.912; SMR: 1; Hosmer Lemeshow chi-square p value: 0.30) showed an adequate discrimination between death and survival as well as good calibration.Conclusions: In conclusion, both PRISM I and PIM II are reliable models for evaluating the prognosis of children in PICU. However, PIM II seems to be more useful because of its higher discrimination, better calibration and easier to use. (Turk Arch Ped 2010; 45: 18-24)
Admissions to pediatric intensive care unit due to preventable injuries  [cached]
Ali Ertu? Arslank?ylü,Mustafa K?mür,Sercan Uysal,Semra Erdo?an
Turk Pediatri Ar?ivi , 2012,
Abstract: Aim: One of the major causes of the morbidity and mortality in chidhood is preventable injuries. In the present study we aimed to analyze the admissions to pediatric intensive care unit because of preventable injuries.Material and Method: Demographic characteristics, injury category, pediatric intensive care unit days, ventilation days and, mortality of the patients admitted to the pediatric intensive care unit of Mersin University Faculty of Medicine Hospital due to preventable injuries between July 2006 and December 2009 were reviewed retrospectively.Results: Out of 822 admissions 124 (15%) were preventable injuries. Of the admissions, 69 (55.6%) were male and 55 (44.3%) were female. Patients were in pediatric intensive care unit for 3.7 ± 3.1 days, ventilated in 9.7%, and had a mortality of 12.5%. The most common admission reason was intoxications (64.6%), following trauma (17.7%), and the others (burns, animal bites, near drowning and foreign body aspiration) (17.7%).Conclusions: Preventable injuries is a common reason for pediatric intensive care unit admission. Taking more preventive measures against preventable injuries may reduce the morbidity and mortality rates during childhood. (Turk Arch Ped 2012; 47: 43-6)
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