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Original Articles
Pediatrics
Outcomes of extracorporeal membrane oxygenation support in pediatric hemato-oncology patients
Hong Yul An, Hyoung Jin Kang, June Dong Park
Acute Crit Care. 2024;39(1):108-116.   Published online January 24, 2024
DOI: https://doi.org/10.4266/acc.2023.01088
  • 1,051 View
  • 87 Download
AbstractAbstract PDFSupplementary Material
Background
In this study, we reviewed the outcomes of pediatric patients with malignancies who underwent hematopoietic stem cell transplantation (HSCT) and extracorporeal membrane oxygenation (ECMO). Methods: We retrospectively analyzed the records of pediatric hemato-oncology patients treated with chemotherapy or HSCT and who received ECMO in the pediatric intensive care unit (PICU) at Seoul National University Children’s Hospital from January 2012 to December 2020. Results: Over a 9-year period, 21 patients (14 males and 7 females) received ECMO at a single pediatric institute; 10 patients (48%) received veno-arterial (VA) ECMO for septic shock (n=5), acute respiratory distress syndrome (ARDS) (n=3), stress-induced myopathy (n=1), or hepatopulmonary syndrome (n=1); and 11 patients (52%) received veno-venous (VV) ECMO for ARDS due to pneumocystis pneumonia (n=1), air leak (n=3), influenza (n=1), pulmonary hemorrhage (n=1), or unknown etiology (n=5). All patients received chemotherapy; 9 received anthracycline drugs and 14 (67%) underwent HSCT. Thirteen patients (62%) were diagnosed with malignancies and 8 (38%) were diagnosed with non-malignant disease. Among the 21 patients, 6 (29%) survived ECMO in the PICU and 5 (24%) survived to hospital discharge. Among patients treated for septic shock, 3 of 5 patients (60%) who underwent ECMO and 5 of 10 patients (50%) who underwent VA ECMO survived. However, all the patients who underwent VA ECMO or VV ECMO for ARDS died. Conclusions: ECMO is a feasible treatment option for respiratory or heart failure in pediatric patients receiving chemotherapy or undergoing HSCT.
Pediatrics
Eleven years of experience in operating a pediatric rapid response system at a children’s hospital in South Korea
Yong Hyuk Jeon, Bongjin Lee, You Sun Kim, Won Jin Jang, June Dong Park
Acute Crit Care. 2023;38(4):498-506.   Published online November 29, 2023
DOI: https://doi.org/10.4266/acc.2023.01354
  • 1,215 View
  • 54 Download
AbstractAbstract PDFSupplementary Material
Background
Various rapid response systems have been developed to detect clinical deterioration in patients. Few studies have evaluated single-parameter systems in children compared to scoring systems. Therefore, in this study we evaluated a single-parameter system called the acute response system (ARS).
Methods
This retrospective study was performed at a tertiary children’s hospital. Patients under 18 years old admitted from January 2012 to August 2023 were enrolled. ARS parameters such as systolic blood pressure, heart rate, respiratory rate, oxygen saturation, and whether the ARS was activated were collected. We divided patients into two groups according to activation status and then compared the occurrence of critical events (cardiopulmonary resuscitation or unexpected intensive care unit admission). We evaluated the ability of ARS to predict critical events and calculated compliance. We also analyzed the correlation between each parameter that activates ARS and critical events.
Results
The critical events prediction performance of ARS has a specificity of 98.5%, a sensitivity of 24.0%, a negative predictive value of 99.6%, and a positive predictive value of 8.1%. The compliance rate was 15.6%. Statistically significant increases in the risk of critical events were observed for all abnormal criteria except low heart rate. There was no significant difference in the incidence of critical events.
Conclusions
ARS, a single parameter system, had good specificity and negative predictive value for predicting critical events; however, sensitivity and positive predictive value were not good, and medical staff compliance was poor.
Pediatrics
Multicenter validation of a deep-learning-based pediatric early-warning system for prediction of deterioration events
Yunseob Shin, Kyung-Jae Cho, Yeha Lee, Yu Hyeon Choi, Jae Hwa Jung, Soo Yeon Kim, Yeo Hyang Kim, Young A Kim, Joongbum Cho, Seong Jong Park, Won Kyoung Jhang
Acute Crit Care. 2022;37(4):654-666.   Published online October 26, 2022
DOI: https://doi.org/10.4266/acc.2022.00976
  • 3,039 View
  • 184 Download
  • 3 Web of Science
  • 5 Crossref
AbstractAbstract PDFSupplementary Material
Background
Early recognition of deterioration events is crucial to improve clinical outcomes. For this purpose, we developed a deep-learning-based pediatric early-warning system (pDEWS) and aimed to validate its clinical performance. Methods: This is a retrospective multicenter cohort study including five tertiary-care academic children’s hospitals. All pediatric patients younger than 19 years admitted to the general ward from January 2019 to December 2019 were included. Using patient electronic medical records, we evaluated the clinical performance of the pDEWS for identifying deterioration events defined as in-hospital cardiac arrest (IHCA) and unexpected general ward-to-pediatric intensive care unit transfer (UIT) within 24 hours before event occurrence. We also compared pDEWS performance to those of the modified pediatric early-warning score (PEWS) and prediction models using logistic regression (LR) and random forest (RF). Results: The study population consisted of 28,758 patients with 34 cases of IHCA and 291 cases of UIT. pDEWS showed better performance for predicting deterioration events with a larger area under the receiver operating characteristic curve, fewer false alarms, a lower mean alarm count per day, and a smaller number of cases needed to examine than the modified PEWS, LR, or RF models regardless of site, event occurrence time, age group, or sex. Conclusions: The pDEWS outperformed modified PEWS, LR, and RF models for early and accurate prediction of deterioration events regardless of clinical situation. This study demonstrated the potential of pDEWS as an efficient screening tool for efferent operation of rapid response teams.

Citations

Citations to this article as recorded by  
  • Predicting cardiac arrest after neonatal cardiac surgery
    Alexis L. Benscoter, Mark A. Law, Santiago Borasino, A. K. M. Fazlur Rahman, Jeffrey A. Alten, Mihir R. Atreya
    Intensive Care Medicine – Paediatric and Neonatal.2024;[Epub]     CrossRef
  • Volumetric regional MRI and neuropsychological predictors of motor task variability in cognitively unimpaired, Mild Cognitive Impairment, and probable Alzheimer's disease older adults
    Michael Malek-Ahmadi, Kevin Duff, Kewei Chen, Yi Su, Jace B. King, Vincent Koppelmans, Sydney Y. Schaefer
    Experimental Gerontology.2023; 173: 112087.     CrossRef
  • Predicting sepsis using deep learning across international sites: a retrospective development and validation study
    Michael Moor, Nicolas Bennett, Drago Plečko, Max Horn, Bastian Rieck, Nicolai Meinshausen, Peter Bühlmann, Karsten Borgwardt
    eClinicalMedicine.2023; 62: 102124.     CrossRef
  • A model study for the classification of high-risk groups for cardiac arrest in general ward patients using simulation techniques
    Seok Young Song, Won-Kee Choi, Sanggyu Kwak
    Medicine.2023; 102(37): e35057.     CrossRef
  • An advanced pediatric early warning system: a reliable sentinel, not annoying extra work
    Young Joo Han
    Acute and Critical Care.2022; 37(4): 667.     CrossRef
Pediatrics
Hearing screening outcomes in pediatric critical care survivors: a 1-year report
Pattita Suwannatrai, Chanapai Chaiyakulsil
Acute Crit Care. 2022;37(2):209-216.   Published online March 8, 2022
DOI: https://doi.org/10.4266/acc.2021.00899
  • 3,108 View
  • 159 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDF
Background
Hearing loss is a potentially serious complication that can occur after surviving a critical illness. Study on screening for hearing problems in pediatric critical care survivors beyond the neonatal period is lacking. This study aimed to identify the prevalence of abnormal hearing screening outcomes using transitory evoked otoacoustic emission (TEOAE) screening in children who survived critical illness and to find possible associating factors for abnormal hearing screening results.
Methods
This study was a single-center, prospective, observational study. All children underwent otoscopy to exclude external and middle ear abnormalities before undergoing TEOAE screening. The screening was conducted before hospital discharge. Descriptive statistics, chi-square, and logistic regression tests were used for data analysis.
Results
A total of 92 children were enrolled. Abnormal TEOAE responses were identified in 26 participants (28.3%). Children with abnormal responses were significantly younger than those with normal responses with a median age of 10.0 months and 43.5 months, respectively (P<0.001). Positive association with abnormal responses was found in children younger than 12 months of age (adjusted odds ratio [OR], 3.07; 95% confidence interval [CI], 1.06–8.90) and children with underlying genetic conditions (adjusted OR, 6.95; 95% CI, 1.49–32.54).
Conclusions
Our study demonstrates a high prevalence of abnormal TEOAE screening responses in children surviving critical illness, especially in patients younger than 12 months of age. More extensive studies should be performed to identify the prevalence and associated risk factors of hearing problems in critically ill children.

Citations

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  • Physiological and electrophysiological evaluation of the hearing system in low birth weight neonates treated with cholestin: a cohort study
    Nastaran Khosravi, Malihah Mazaheryazdi, Majid Kalani, Nasrin Khalesi, Zinat Shakeri, Saeedeh Archang, Maryam Archang
    The Egyptian Journal of Otolaryngology.2023;[Epub]     CrossRef
Pediatrics
Determining the diagnostic value of tracheal intubation by palpation and auscultation methods compared to the chest X-ray method in children
Gholamreza Masoumi, Mojtaba Mansouri, Omid Fathali
Acute Crit Care. 2022;37(2):224-229.   Published online February 3, 2022
DOI: https://doi.org/10.4266/acc.2021.00787
  • 3,588 View
  • 178 Download
AbstractAbstract PDF
Background
It is important to determine the proper location of tracheal tube for proper ventilation. In this study, we compared the diagnostic value of tracheal intubation with two methods of palpation and auscultation with chest X-ray (CXR) method in pediatric.
Methods
In this interventional study, 80 patients under 6 years of age were included. After tracheal intubation appropriate depth of tracheal tube was determined by auscultation and recorded, then by palpation depth of tracheal tube determined and tube was fixed. The length of the tube was calculated with the standard formula based on age. After surgery, CXR was taken and, according to the landmark, the distance from the end of the tube to the anterior lower tooth was recorded.
Results
Interclass correlation coefficient (ICC) between the palpation method and the standard method in the number of fixing tracheal intubation was 0.573, which shows the average and significant correlation between these two methods in determining the fixed number of tracheal intubation. ICC between the auscultation and the standard method in fixing tracheal intubation number was 0.430, which shows the average and significant agreement between these two methods in determining the fixed number of tracheal intubation. There is no significant relationship between sex and the average number of fixing tracheal intubation in all methods.
Conclusions
This study has shown that both palpation and auscultation methods are appropriate, but with a slightly higher palpation ICC, the palpation can be considered relatively better.
Pediatric
Abstract to publication conversion in pediatric critical care medicine in Pakistan
Anwarul Haque, Mohammad Shahzad, Humaira Jurair, Naveed Ur Rehman Siddiqui, Sidra Ishaque, Qalab Abbas
Acute Crit Care. 2021;36(1):62-66.   Published online February 5, 2021
DOI: https://doi.org/10.4266/acc.2020.00780
  • 4,565 View
  • 91 Download
  • 2 Web of Science
  • 1 Crossref
AbstractAbstract PDF
Background
To determine the rate of conversion of abstracts presented at conferences into full-text articles published in peer-reviewed journals in the field of pediatric critical care medicine (PCCM) in a developing country.
Methods
We retrospectively reviewed PCCM abstracts from Pakistan presented at national and international pediatric and critical care conferences over 10 years (January 2010 to March 2020). Data included abstract characteristics, such as presentation (poster/oral), presenter (fellow/resident), time of meeting (month and year), type of meeting, study design and topic; and publication characteristics, such as journal name, time (month and year) and first author. The primary outcome was publication rate of PCCM abstracts presented in meetings and time (months) from presentation to publication.
Results
A total of 79 PCCM abstracts were presented in 20 meetings during the study period. There were 65 poster presentations (82.28%), of which 63 (79.74%) were presented at international critical care conferences and all presenters were PCCM fellows. In total, 64 (81%) abstracts were descriptive observational studies (retrospective: 50, 63.29%) and prospective (14, 17.72%). Only one was an interventional randomized controlled trial. The publication rate of PCCM abstracts was 63.3% (50/79) and the mean time to publication was 12.39±13.61 months. The publication rate was significantly correlated to the year of publication (P<0.001).
Conclusions
The PCCM abstract publication rate and mean time from presentation to publication was 63.3% and 12.39±13.61 months, respectively, in a developing country.

Citations

Citations to this article as recorded by  
  • From Concept to Publication
    Aaron W. Calhoun, Isabel T. Gross, Leah B. Mallory, Lindsay N. Shepard, Mark D. Adler, Tensing Maa, Marc A. Auerbach, Adam Cheng, David O. Kessler, Travis M. Whitfill, Jonathan P. Duff
    Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare.2022; 17(6): 385.     CrossRef
Case Report
Cardiology
Percutaneous bicaval dual lumen cannula for extracorporeal life support
Woojung Kim, Hye Won Kwon, Jooncheol Min, Sungkyu Cho, Jae Gun Kwak, June Dong Park, Woong-Han Kim
Acute Crit Care. 2020;35(3):207-212.   Published online September 23, 2019
DOI: https://doi.org/10.4266/acc.2019.00584
  • 6,956 View
  • 160 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Veno-venous extracorporeal membrane oxygenation (ECMO) is a useful mechanical device for pediatric patients with severe respiratory failure. Conventional veno-venous ECMO using double cannulation, however, is not feasible due to size limitations in pediatric patients who have small femoral vessels. Recently, percutaneous bicaval dual-lumen cannula can be inserted using single cannulation via the right internal jugular vein. Herein, we report the case of a pediatric patient with severe respiratory failure who was weaned off the ECMO successfully after treatment with bicaval dual-lumen cannulation for 5 days despite the small body size and immunocompromised condition due to chemotherapy for hemophagocytic lymphohistiocytosis.

Citations

Citations to this article as recorded by  
  • Lipid Emulsion Treatment for Drug Toxicity Caused by Nonlocal Anesthetic Drugs in Pediatric Patients
    Soo Hee Lee, Sunmin Kim, Ju-Tae Sohn
    Pediatric Emergency Care.2023; 39(1): 53.     CrossRef
  • Mechanisms underlying lipid emulsion resuscitation for drug toxicity: a narrative review
    Soo Hee Lee, Ju-Tae Sohn
    Korean Journal of Anesthesiology.2023; 76(3): 171.     CrossRef
Original Articles
Pediatric
Oxygenation Index in the First 24 Hours after the Diagnosis of Acute Respiratory Distress Syndrome as a Surrogate Metric for Risk Stratification in Children
Soo Yeon Kim, Byuhree Kim, Sun Ha Choi, Jong Deok Kim, In Suk Sol, Min Jung Kim, Yoon Hee Kim, Kyung Won Kim, Myung Hyun Sohn, Kyu-Earn Kim
Acute Crit Care. 2018;33(4):222-229.   Published online November 29, 2018
DOI: https://doi.org/10.4266/acc.2018.00136
  • 6,197 View
  • 183 Download
  • 3 Web of Science
  • 1 Crossref
AbstractAbstract PDFSupplementary Material
Background
The diagnosis of pediatric acute respiratory distress syndrome (PARDS) is a pragmatic decision based on the degree of hypoxia at the time of onset. We aimed to determine whether reclassification using oxygenation metrics 24 hours after diagnosis could provide prognostic ability for outcomes in PARDS.
Methods
Two hundred and eighty-eight pediatric patients admitted between January 1, 2010 and January 30, 2017, who met the inclusion criteria for PARDS were retrospectively analyzed. Reclassification based on data measured 24 hours after diagnosis was compared with the initial classification, and changes in pressure parameters and oxygenation were investigated for their prognostic value with respect to mortality.
Results
PARDS severity varied widely in the first 24 hours; 52.4% of patients showed an improvement, 35.4% showed no change, and 12.2% either showed progression of PARDS or died. Multivariate analysis revealed that mortality risk significantly increased for the severe group, based on classification using metrics collected 24 hours after diagnosis (adjusted odds ratio, 26.84; 95% confidence interval [CI], 3.43 to 209.89; P=0.002). Compared to changes in pressure variables (peak inspiratory pressure and driving pressure), changes in oxygenation (arterial partial pressure of oxygen to fraction of inspired oxygen) over the first 24 hours showed statistically better discriminative power for mortality (area under the receiver operating characteristic curve, 0.701; 95% CI, 0.636 to 0.766; P<0.001).
Conclusions
Implementation of reclassification based on oxygenation metrics 24 hours after diagnosis effectively stratified outcomes in PARDS. Progress within the first 24 hours was significantly associated with outcomes in PARDS, and oxygenation response was the most discernable surrogate metric for mortality.

Citations

Citations to this article as recorded by  
  • A single‐center PICU present status survey of pediatric sepsis‐related acute respiratory distress syndrome
    Liang Zhou, Shaojun Li, Tian Tang, Xiu Yuan, Liping Tan
    Pediatric Pulmonology.2022; 57(9): 2003.     CrossRef
CPR/Resuscitation
Validation of Pediatric Index of Mortality 3 for Predicting Mortality among Patients Admitted to a Pediatric Intensive Care Unit
Jae Hwa Jung, In Suk Sol, Min Jung Kim, Yoon Hee Kim, Kyung Won Kim, Myung Hyun Sohn
Acute Crit Care. 2018;33(3):170-177.   Published online August 31, 2018
DOI: https://doi.org/10.4266/acc.2018.00150
  • 13,238 View
  • 711 Download
  • 13 Web of Science
  • 11 Crossref
AbstractAbstract PDF
Background
The objective of this study was to evaluate the usefulness of the newest version of the pediatric index of mortality (PIM) 3 for predicting mortality and validating PIM 3 in Korean children admitted to a single intensive care unit (ICU).
Methods
We enrolled children at least 1 month old but less than 18 years of age who were admitted to the medical ICU between March 2009 and February 2015. Performances of the pediatric risk of mortality (PRISM) III, PIM 2, and PIM 3 were evaluated by assessing the area under the receiver operating characteristic (ROC) curve, conducting the Hosmer-Lemeshow test, and calculating the standardized mortality ratio (SMR).
Results
In total, 503 children were enrolled; the areas under the ROC curve for PRISM III, PIM 2, and PIM 3 were 0.775, 0.796, and 0.826, respectively. The area under the ROC curve was significantly greater for PIM 3 than for PIM 2 (P<0.001) and PRISM III (P=0.016). There were no significant differences in the Hosmer-Lemeshow test results for PRISM III (P=0.498), PIM 2 (P=0.249), and PIM 3 (P=0.337). The SMR calculated using PIM 3 (1.11) was closer to 1 than PIM 2 (0.84).
Conclusions
PIM 3 showed better prediction of the risk of mortality than PIM 2 for the Korean pediatric population admitted in the ICU.

Citations

Citations to this article as recorded by  
  • Clinical Features and Management of Status Epilepticus in the Pediatric Intensive Care Unit
    Ekin Soydan, Yigithan Guzin, Sevgi Topal, Gulhan Atakul, Mustafa Colak, Pinar Seven, Ozlem Sarac Sandal, Gokhan Ceylan, Aycan Unalp, Hasan Agin
    Pediatric Emergency Care.2023; 39(3): 142.     CrossRef
  • Evaluation of the Performance of PRISM III and PIM II Scores in a Tertiary Pediatric Intensive Care Unit
    Büşra Uzunay Gündoğan, Oğuz Dursun, Nazan Ülgen Tekerek, Levent Dönmez
    Turkish Journal of Pediatric Emergency and Intensive Care Medicine.2023; 10(1): 8.     CrossRef
  • Incidence and Mortality Trends in Critically Ill Children: A Korean Population-Based Study
    Jaeyoung Choi, Esther Park, Ah Young Choi, Meong Hi Son, Joongbum Cho
    Journal of Korean Medical Science.2023;[Epub]     CrossRef
  • Internal validation and evaluation of the predictive performance of models based on the PRISM-3 (Pediatric Risk of Mortality) and PIM-3 (Pediatric Index of Mortality) scoring systems for predicting mortality in Pediatric Intensive Care Units (PICUs)
    Zahra Rahmatinejad, Fatemeh Rahmatinejad, Majid Sezavar, Fariba Tohidinezhad, Ameen Abu-Hanna, Saeid Eslami
    BMC Pediatrics.2022;[Epub]     CrossRef
  • Performance of Pediatric Risk of Mortality III and Pediatric Index of Mortality III Scores in Tertiary Pediatric Intensive Unit in Saudi Arabia
    Ahmed S. Alkhalifah, Abdulaziz AlSoqati, Jihad Zahraa
    Frontiers in Pediatrics.2022;[Epub]     CrossRef
  • Clinical implications of discrepancies in predicting pediatric mortality between Pediatric Index of Mortality 3 and Pediatric Logistic Organ Dysfunction-2
    Eui Jun Lee, Bongjin Lee, You Sun Kim, Yu Hyeon Choi, Young Ho Kwak, June Dong Park
    Acute and Critical Care.2022; 37(3): 454.     CrossRef
  • Administrative data in pediatric critical care research—Potential, challenges, and future directions
    Nora Bruns, Anna-Lisa Sorg, Ursula Felderhoff-Müser, Christian Dohna-Schwake, Andreas Stang
    Frontiers in Pediatrics.2022;[Epub]     CrossRef
  • Development of a machine learning model for predicting pediatric mortality in the early stages of intensive care unit admission
    Bongjin Lee, Kyunghoon Kim, Hyejin Hwang, You Sun Kim, Eun Hee Chung, Jong-Seo Yoon, Hwa Jin Cho, June Dong Park
    Scientific Reports.2021;[Epub]     CrossRef
  • Meta-Analysis for the Prediction of Mortality Rates in a Pediatric Intensive Care Unit Using Different Scores: PRISM-III/IV, PIM-3, and PELOD-2
    Yaping Shen, Juan Jiang
    Frontiers in Pediatrics.2021;[Epub]     CrossRef
  • Simplified Pediatric Index of Mortality 3 Score by Explainable Machine Learning Algorithm
    Orkun Baloglu, Matthew Nagy, Chidiebere Ezetendu, Samir Q. Latifi, Aziz Nazha
    Critical Care Explorations.2021; 3(10): e0561.     CrossRef
  • Performance of Pediatric Index of Mortality in a Tertiary Care PICU in India
    Nisha Toteja, Bharat Choudhary, Daisy Khera, Rohit Sasidharan, Prem Prakash Sharma, Kuldeep Singh
    Journal of Pediatric Intensive Care.2021;[Epub]     CrossRef
Pediatric
Serum Albumin as a Biomarker of Poor Prognosis in the Pediatric Patients in Intensive Care Unit
Young Suh Kim, In Suk Sol, Min Jung Kim, Soo Yeon Kim, Jong Deok Kim, Yoon Hee Kim, Kyung Won Kim, Myung Hyun Sohn, Kyu-Earn Kim
Korean J Crit Care Med. 2017;32(4):347-355.   Published online November 30, 2017
DOI: https://doi.org/10.4266/kjccm.2017.00437
  • 8,567 View
  • 317 Download
  • 7 Web of Science
  • 8 Crossref
AbstractAbstract PDFSupplementary Material
Background
Serum albumin as an indicator of the disease severity and mortality is suggested in adult patients, but its role in pediatric patients has not been established. The objectives of this study are to investigate the albumin level as a biomarker of poor prognosis and to compare it with other mortality predictive indices in children in intensive care unit (ICU).
Methods
Medical records of 431 children admitted to the ICU at Severance Hospital from January 1, 2012 to December 31, 2015 were retrospectively analyzed. Children who expired within 24 hours after ICU admission, children with hepatic or renal failure, and those who received albumin replacement before ICU admission were excluded.
Results
The children with hypoalbuminemia had higher 28-day mortality rate (24.60% vs. 9.28%, P < 0.001), Pediatric Index of Mortality (PIM) 3 score (9.23 vs. 8.36, P < 0.001), Pediatric Risk of Mortality (PRISM) III score (7.0 vs. 5.0, P < 0.001), incidence of septic shock (12% vs. 3%, P < 0.001), C-reactive protein (33.0 mg/L vs. 5.8 mg/L, P < 0.001), delta neutrophil index (2.0% vs. 0.6%, P < 0.001), lactate level (1.6 mmol/L vs. 1.2 mmol/L, P < 0.001) and lower platelet level (206,000/μl vs. 341,000/μl, P < 0.001) compared to the children with normal albumin level. PIM 3 (r = 0.219, P < 0.001) and PRISM III (r = 0.375, P < 0.001) were negatively correlated with serum albumin level, respectively.
Conclusions
Our results highlight that hypoalbuminemia can be a biomarker of poor prognosis including mortality in the children in ICU.

Citations

Citations to this article as recorded by  
  • Prognostic factors and models to predict pediatric sepsis mortality: A scoping review
    Irene Yuniar, Cut Nurul Hafifah, Sharfina Fulki Adilla, Arifah Nur Shadrina, Anthony Christian Darmawan, Kholisah Nasution, Respati W. Ranakusuma, Eka Dian Safitri
    Frontiers in Pediatrics.2023;[Epub]     CrossRef
  • The association between serum albumin and long length of stay of patients with acute heart failure: A retrospective study based on the MIMIC-IV database
    Tao Liu, Haochen Xuan, Lili Wang, Xiaoqun Li, Zhihao Lu, Zhaoxuan Tian, Junhong Chen, Chaofan Wang, Dongye Li, Tongda Xu, Chiara Lazzeri
    PLOS ONE.2023; 18(2): e0282289.     CrossRef
  • Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2 (PIMS-TS) and Serous Effusions in a Child With Severe Hypoalbuminemia: A Case Report
    Zohair El Haddar, Aziza Elouali, Ilham Belga, Maria Rkain, Abdeladim Babakhouya
    Cureus.2023;[Epub]     CrossRef
  • Inappropriate empirical antibiotic therapy was an independent risk factor of pediatric persistent S. aureus bloodstream infection
    Xingmei Wang, Ziyao Guo, Xi Zhang, Guangli Zhang, Qinyuan Li, Xiaoyin Tian, Dapeng Chen, Zhengxiu Luo
    European Journal of Pediatrics.2022; 182(2): 719.     CrossRef
  • Evaluation of models for predicting pediatric fraction unbound in plasma for human health risk assessment
    Yejin Esther Yun, Andrea N. Edginton
    Journal of Toxicology and Environmental Health, Part A.2021; 84(2): 67.     CrossRef
  • Diabetes Mellitus and Hypertension Increase Risk of Death in Novel Corona Virus Patients Irrespective of Age: a Prospective Observational Study of Co-morbidities and COVID-19 from India
    Anirban Gupta, Neelabh Nayan, Ranjith Nair, Krishna Kumar, Aditya Joshi, Shivangi Sharma, Jasdeep Singh, Rajan Kapoor
    SN Comprehensive Clinical Medicine.2021; 3(4): 937.     CrossRef
  • Overview of Albumin Physiology and its Role in Pediatric Diseases
    Charles B. Chen, Bilasan Hammo, Jessica Barry, Kadakkal Radhakrishnan
    Current Gastroenterology Reports.2021;[Epub]     CrossRef
  • The effect of nutritional status on post-operative outcomes in pediatric otolaryngology-head and neck surgery
    Jordan Luttrell, Matthew Spence, Hiba Al-Zubeidi, Michael J. Herr, Madhu Mamidala, Anthony Sheyn
    International Journal of Pediatric Otorhinolaryngology.2021; 150: 110875.     CrossRef
Case Reports
Trauma
Long-term extracorporeal membrane oxygenation after severe blunt traumatic lung injury in a child
Ok Jeong Lee, Yang Hyun Cho, Jinwook Hwang, Inae Yoon, Young-Ho Kim, Joongbum Cho
Acute Crit Care. 2019;34(3):223-227.   Published online February 10, 2017
DOI: https://doi.org/10.4266/acc.2016.00472
  • 27,158 View
  • 183 Download
  • 3 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Managing acute respiratory distress syndrome (ARDS) after severe blunt traumatic lung injury can be challenging. In cases where patients are refractory to conventional therapy, extracorporeal membrane oxygenation (ECMO) should be considered. In addition, the heparin-coated circuit can reduce hemorrhagic complications in patients with multiple traumas. Although prolonged ECMO may be necessary, excellent outcomes are frequently associated. In this study, we report long-term support with venovenous-ECMO applied in a child with severe blunt trauma in Korea. This 10-year-old and 30-kg male with severe blunt thoracic trauma after a car accident developed severe ARDS a few days later, and ECMO was administered for 33 days. Because of pulmonary hemorrhage during ECMO support, heparin was stopped for 3 days and then restarted. He was weaned from ECMO successfully and has been able to run without difficulty for the 2 years since discharge.

Citations

Citations to this article as recorded by  
  • Traumatic main airway rupture successfully rescued by extracorporeal membrane oxygenation: A case report
    Lijun Cao, Jun Xu, Linfeng Tang, Yuli Zhou, Xianhua Xiang
    Experimental and Therapeutic Medicine.2023;[Epub]     CrossRef
  • Extracorporeal membrane oxygenation in trauma patients: a systematic review
    Changtian Wang, Lei Zhang, Tao Qin, Zhilong Xi, Lei Sun, Haiwei Wu, Demin Li
    World Journal of Emergency Surgery.2020;[Epub]     CrossRef
Cardiology/Pediatric
Suspected Pulmonary Embolism during Hickman Catheterization in a Child: What Else Should Be Considered besides Pulmonary Embolism?
Haemi Lee, Jonghyun Baek, Sangyoung Park, Daelim Jee
Korean J Crit Care Med. 2016;31(1):63-67.   Published online February 29, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.1.63
  • 5,859 View
  • 59 Download
AbstractAbstract PDF
A 16-month-old girl with acute lymphoblastic leukemia expired during Hickman catheter insertion. She had undergone chemoport insertion of the left subclavian vein six months earlier and received five cycles of chemotherapy. Due to malfunction of the chemoport and the consideration of hematopoietic stem cell transplantation, insertion of a Hickmann catheter on the right side and removal of the malfunctioning chemoport were planned under general anesthesia. The surgery was uneventful during catheter insertion, but the patient experienced the sudden onset of pulseless electrical activity just after saline was flushed through the newly inserted catheter. Cardiopulmonary resuscitation was commenced aggressively, but the patient was refractory. Migration of a thrombus generated by the previous central catheter to the pulmonary circulation was suspected, resulting in a pulmonary embolism.
Original Articles
Cardiology/Pediatric
Effectiveness of Bradycardia as a Single Parameter in the Pediatric Acute Response System
Yu Hyeon Choi, Hyeon Seung Lee, Bong Jin Lee, Dong In Suh, June Dong Park
Korean J Crit Care Med. 2014;29(4):297-303.   Published online November 30, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.4.297
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AbstractAbstract PDF
BACKGROUND
Various tools for the acute response system (ARS) predict and prevent acute deterioration in pediatric patients. However, detailed criteria have not been clarified. Thus we evaluated the effectiveness of bradycardia as a single parameter in pediatric ARS.
METHODS
This retrospective study included patients who had visited a tertiary care children's hospital from January 2012 to June 2013, in whom ARS was activated because of bradycardia. Patient's medical records were reviewed for clinical characteristics, cardiologic evaluations, and reversible causes that affect heart rate.
RESULTS
Of 271 cases, 261 (96%) had ARS activation by bradycardia alone with favorable outcomes. Evaluations and interventions were performed in 165 (64.5%) and 13 cases (6.6%) respectively. All patients in whom ARS was activated owing to bradycardia and another criteria underwent evaluation, unlike those with bradycardia alone (100.0% vs. 63.2%, p = 0.016). Electrocardiograms were evaluated in 233 (86%) cases: arrhythmias were due to borderline QT prolongation and atrioventricular block (1st and 2nd-degree) in 25 cases (9.2%). Bradycardia-related causes were reversible in 202 patients (74.5%). Specific causes were different in departments at admission. Patients admitted to the hemato-oncology department required ARS activation during the night (69.3%, p = 0.03), those to the endocrinology department required ARS activation because of medication (72.4%, p < 0.001), and those to the gastroenterology department had low body mass indexes (32%, p = 0.01).
CONCLUSIONS
Using bradycardia alone in pediatric ARS is not useful, because of its low specificity and poor predictive ability for deterioration. However, bradycardia can be applied to ARS concurrently with other parameters.

Citations

Citations to this article as recorded by  
  • Effect of Diurnal Variation of Heart Rate and Respiratory Rate on Activation of Rapid Response System and Clinical Outcome in Hospitalized Children
    Lia Kim, Kyoung Sung Yun, June Dong Park, Bongjin Lee
    Children.2023; 10(1): 167.     CrossRef
  • Eleven years of experience in operating a pediatric rapid response system at a children’s hospital in South Korea
    Yong Hyuk Jeon, Bongjin Lee, You Sun Kim, Won Jin Jang, June Dong Park
    Acute and Critical Care.2023; 38(4): 498.     CrossRef
  • Pediatric triage modifications based on vital signs: a nationwide study
    Bongjin Lee, June Dong Park, Young Ho Kwak, Do Kyun Kim
    Clinical and Experimental Emergency Medicine.2022; 9(3): 224.     CrossRef
Implementation of Therapeutic Hypothermia after Pediatric Out-of Hospital Cardiac Arrest in One Tertiary Emergency Center
Woo Jin Kim, Jin Joo Kim, Jae Ho Jang, Sung Youl Hyun, Hyuk Jun Yang, Gun Lee
Korean J Crit Care Med. 2013;28(1):25-32.
DOI: https://doi.org/10.4266/kjccm.2013.28.1.25
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AbstractAbstract PDF
BACKGROUND
Cardiac arrest in infants and children is rare than adults yet, it is critical. The efficacy and feasibility of therapeutic hypothermia after cardiac arrest in adults is proved through many studies however, there are few data on pediatric out-of hospital cardiac arrest. We analyzed several variables in pediatric therapeutic hypothermia after out-of hospital cardiac arrest.
METHODS
Infants and children (1 to 17 years old), who were admitted to our emergency intensive care units following the return of spontaneous circulation after out-of hospital cardiac arrest from Jan 2008 to Apr 2012, were included in this study. Basal patients' characteristics and variables about therapeutic hypothermia were analyzed.
RESULTS
A total of seventy-six patients visited our emergency center after a pediatric cardiac arrest during the study period. Among this, sixty-three patients received pediatric advanced life support, twenty one patients were admitted to intensive care units and nine patients received therapeutic hypothermia. Overall, the survival discharge was 7.9% (5 of 63). Among the admitted patients, 3 patients (14.3%) had a good Cerebral Performance Category (CPC). Two patients received endovascular cooling and seven patients received surface cooling. The mean time from the induction of therapeutic hypothermia to reaching the temperature with in the therapeutic range was 193.9 minutes. There were no critical adverse events during induction, maintenance and the rewarming period of therapeutic hypothermia.
CONCLUSIONS
Therapeutic hypothermia after pediatric out-of hospital cardiac arrest was performed safely and effectively in one emergency center. The standardized pediatric therapeutic hypothermia protocol should be established in order to be used widely in pediatric intensive care units. Further, larger studies are needed on the subject of pediatric therapeutic hypothermia.

Citations

Citations to this article as recorded by  
  • Epidemiological and Survival Trends of Pediatric Cardiac Arrests in Emergency Departments in Korea: A Cross-sectional, Nationwide Report
    Jae Yun Ahn, Mi Jin Lee, Hyun Kim, Han Deok Yoon, Hye Young Jang
    Journal of Korean Medical Science.2015; 30(9): 1354.     CrossRef
The Values of the Pediatric Logistic Organ Dysfunction (PELOD) Score and the Pediatric Index of Mortality (PIM) 2 Score in Emergency Department and Intensive Care Unit
Si Kyoung Jeong, Woon Jeong Lee, Yun Joo Moon, Seon Hee Woo, Yeon Young Kyong, Se Min Choi, Won Jung Jeong, Kyu Nam Park
Korean J Crit Care Med. 2010;25(3):144-148.
DOI: https://doi.org/10.4266/kjccm.2010.25.3.144
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AbstractAbstract PDF
BACKGROUND
This study was conducted to compare two models of the pediatric logistic organ dysfunction (PELOD) score and the pediatric index of mortality (PIM) 2 score in the emergency department (ED) and intensive care unit (ICU).
METHODS
90 pediatric patients who were admitted to the ICU in ED from January 2003 to December 2008 were enrolled in this study. PELOD score and PIM 2 score calculations were performed in the ED and ICU. We classified these patients into either the survivor or non-survivor groups and analyzed the clinical variables between two groups. We used Hosmer-Lemeshow goodness-of-fit tests to evaluate calibration, receiver operating characteristic (ROC) curves and standardized mortality ratio (SMR).
RESULTS
Among the 90 pediatric patients, 56 (62.2%) were male, and 9 (10.0%) patients died. Expected mortalities were PIM 2 = 10.35, PELOD = 8.33 in ED and PIM 2 = 8.84, PELOD = 8.26 in ICU. PIM 2 showed fit calibration (x(2) = 6.228, p = 0.622) in the ED. In the ICU, both PELOD and PIM 2 showed calibration (x(2) = 4.625, p = 0.185) and (x(2) = 7.616, p = 0.472), respectively. PIM 2 in ED showed the best discrimination, with area under the curve (AUC) = 0.949 (95% CI, 0.881-0.984).
CONCLUSIONS
PIM 2 score in ED was fit. Also, PELOD and PIM 2 score in ICU was fit. But PELOD in ED was unfit.

Citations

Citations to this article as recorded by  
  • Usefulness of Thrombocytopenia and Changes in Platelet Counts as Prognostic Markers in Pediatric Intensive Care Units
    Yoon Hee Kim, Hyun Bin Park, Min Jung Kim, Hwan Soo Kim, Hee Seon Lee, Yoon Ki Han, Kyung Won Kim, Myung Hyun Sohn, Kyu-Earn Kim
    Korean Journal of Critical Care Medicine.2013; 28(2): 93.     CrossRef

ACC : Acute and Critical Care