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15 pages, 905 KiB

Open AccessArticle

Causes of Intensive Care Unit Admissions in Children with SARS-CoV-2: A Single-Centre Observational Study

by Lukáš Homola, Jozef Klučka, Dominik Fabián, Petr Štourač, Josef Šikula, Eva Vávrová, Barbora Jeřábková, Martin Sihlovec, Václav Musil, Klára Španělová, Patricia Mužlayová and Pavlína Danhofer

Children 2023, 10(1), 75; https://doi.org/10.3390/children10010075 - 30 Dec 2022

Cited by 1 | Viewed by 1338

Abstract

Background: The proportion of intensive care unit (ICU) admissions in children that have and have not been directly caused by SARS-CoV-2 remains unclear. The aim of the study is to analyse a cohort of children admitted to the ICU with SARS-CoV-2 and determine [...] Read more.

Background: The proportion of intensive care unit (ICU) admissions in children that have and have not been directly caused by SARS-CoV-2 remains unclear. The aim of the study is to analyse a cohort of children admitted to the ICU with SARS-CoV-2 and determine whether the infection was the primary cause of their hospitalisation, a significant contributor, a suspected accomplice, or an incidental finding. Methods: This was a retrospective observational study of all the children admitted to the ICU with SARS-CoV-2 from March 2020 to February 2022 from the South Moravia region. The aim of the study was to assess whether the hospitalisation was likely to be directly caused by the virus (i.e., patients with acute COVID-19; the COVID group), whether the virus was a significant contributor to the hospitalisation (i.e., patients with multisystem inflammatory syndrome in children due to COVID-19; the MIS-C group), whether it may have contributed to the worsening of their underlying disease (the WORSENING group), or whether it was an incidental finding very likely unrelated to hospitalisation where SARS-CoV-2 positivity merely placed patients in the COVID-19 unit (the ISOLATION group). The groups were compared using a series of secondary outcomes. Results: The study population represented 150 paediatric ICU cases (age 8.6; IQR 3.5–13.3 years), with 66.7% being male. The COVID group represented 32.7% of cases (49/150); MIS-C, 30% (45/150); WORSENING, 14.7% (22/150); and ISOLATION, 22.7% (34/150). The median length of hospitalisation was found for the MIS-C group (11 days; 9 days in the ICU), the COVID group (6 days; five days in the ICU), WORSENING group (4.5 days; 4.5 days in the ICU) and the ISOLATION group (5.5 days; 3.5 days in the ICU), where the difference was significant (p < 0.001). Asymptomatic and mild cases were most common in the WORSENING (36.4% and 63.6%) and ISOLATION (52.9% and 44.1%) groups. Severe and critical cases were only present in the COVID (6.1% and 12.2%) and MIS-C (4.4% and 11.1%) groups; the severity difference was significant (p < 0.001). The groups did not differ significantly in the proportion of complete recovery and short- and long-term sequelae (p = 0.09). Conclusions: Patients with acute COVID-19 accounted for one-third of all ICU admissions, patients with MIS-C accounted for approximately another third, patients with worsening underlying disease accounted for 15%, and patients with incidental findings of SARS-CoV-2 positivity accounted for one-fifth of ICU admissions. A more significant disease was seen with acute COVID-19 and MIS-C. Full article

(This article belongs to the Special Issue Intensive Care Medicine in Children: Current Concepts and Future Perspetives)

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9 pages, 1196 KiB

Open AccessArticle

Feasibility of Mouth-to-Mouth Ventilation through FFP2 Respirator in BLS Training during COVID-19 Pandemic (MOVERESP Study): Simulation-Based Study

by Martina Kosinová, Petr Štourač, Tereza Prokopová, Tereza Vafková, Václav Vafek, Daniel Barvík, Tamara Skříšovská, Jan Dvořáček, Jana Djakow, Jozef Klučka, Jiří Jarkovský and Pavel Plevka

Children 2022, 9(11), 1751; https://doi.org/10.3390/children9111751 - 15 Nov 2022

Viewed by 1317

Abstract

Background: Due to the COVID-19 pandemic, Basic Life Support (BLS) training has been limited to compression-only or bag–mask ventilation. The most breathable nanofiber respirators carry the technical possibility for inflation of the mannequin. The aim of this study was to assess the efficacy [...] Read more.

Background: Due to the COVID-19 pandemic, Basic Life Support (BLS) training has been limited to compression-only or bag–mask ventilation. The most breathable nanofiber respirators carry the technical possibility for inflation of the mannequin. The aim of this study was to assess the efficacy of mouth-to-mouth breathing through a FFP2 respirator during BLS. Methods: In the cross-over simulation-based study, the medical students performed BLS using a breathable nanofiber respirator for 2 min on three mannequins. The quantitative and qualitative efficacy of mouth-to-mouth ventilation through the respirator in BLS training was analyzed. The primary aim was the effectivity of mouth-to-mouth ventilation through a breathable respirator. The secondary aims were mean pause, longest pause, success in achieving the optimal breath volume, technique of ventilation, and incidence of adverse events. Results: In 104 students, effective breath was reached in 951 of 981 (96.9%) attempts in Adult BLS mannequin (Prestan), 822 of 906 (90.7%) in Resusci Anne, and 1777 of 1857 (95.7%) in Resusci Baby. In Resusci Anne and Resusci Baby, 28.9%/15.9% of visible chest rises were evaluated as low-, 33.0%/44.0% as optimal-, and 28.8%/35.8% as high-volume breaths. Conclusions: Mouth-to-mouth ventilation through a breathable respirator had an effectivity greater than 90%. Full article

(This article belongs to the Special Issue Intensive Care Medicine in Children: Current Concepts and Future Perspetives)

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10 pages, 881 KiB

Open AccessArticle

Incidence of Emergence Delirium in the Pediatric PACU: Prospective Observational Trial

by Eva Klabusayová, Tereza Musilová, Dominik Fabián, Tamara Skříšovská, Václav Vafek, Martina Kosinová, Michaela Ťoukálková, Adéla Vrtková, Jozef Klučka and Petr Štourač

Children 2022, 9(10), 1591; https://doi.org/10.3390/children9101591 - 21 Oct 2022

Cited by 6 | Viewed by 2301

Abstract

Emergence delirium (ED) is a postoperative complication in pediatric anesthesia characterized by perception and psychomotor disorder and has a negative impact on morbidity in the form of maladaptive behavior, which can last weeks after anesthesia. Patients with developed ED present with psychomotor anxiety, [...] Read more.

Emergence delirium (ED) is a postoperative complication in pediatric anesthesia characterized by perception and psychomotor disorder and has a negative impact on morbidity in the form of maladaptive behavior, which can last weeks after anesthesia. Patients with developed ED present with psychomotor anxiety, agitation, and are at higher risk of unintentional extraction of an intravenous cannula, self-harm and nausea and vomiting. The described incidence of ED varies between 25–80%, with a higher prevalence among children younger than 6 years of age. We aimed to determine the incidence of ED in pediatric patients (>1 month) after general anesthesia in the post-anesthesia care unit (PACU), using Paediatric Anaesthesia Emergence Delirium (PAED) score, Watcha score and Richmond agitation and sedation scale (RASS). The incidence of ED was the highest in the PAED score with cutoff ≥10 points (89.0%, n = 1088). When using PAED score >12 points, ED incidence was 19.3% (n = 236). The lowest incidence was described by Watcha and RASS scores, 18.8% (n = 230) vs. 18.1% (n = 221), respectively. The threshold for PAED ≥10 points seems to give false-positive results, whereas the threshold >12 points is more accurate. RASS scale, although intended primarily for estimation of the depth of sedation, seems to have a good predictive value for ED. Full article

(This article belongs to the Special Issue Intensive Care Medicine in Children: Current Concepts and Future Perspetives)

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10 pages, 7632 KiB

Open AccessArticle

New Resident Training Strategy Based on Gamification Techniques: An Escape Room on Sepsis in Children

by Carme Alejandre, Patricia Corniero, Gemma Claret, Carlos Alaez, Elisabeth Esteban and Iolanda Jordan

Children 2022, 9(10), 1503; https://doi.org/10.3390/children9101503 - 30 Sep 2022

Cited by 2 | Viewed by 1488

Abstract

Aim: Adapting “escape rooms” for educational purposes is an innovative teaching method. The aim of this study was to ascertain the degree of learning of the residents. A secondary objective was to determine their degree of satisfaction. Methods: A prospective, observational study took [...] Read more.

Aim: Adapting “escape rooms” for educational purposes is an innovative teaching method. The aim of this study was to ascertain the degree of learning of the residents. A secondary objective was to determine their degree of satisfaction. Methods: A prospective, observational study took place in October 2019. A sepsis-based escape room was designed and carried out. A mix of paediatric medical residents and paediatric nursing residents were enrolled. A prior knowledge test was carried out, which was repeated right at the end of the escape room and then again three months later. Furthermore, all participants completed an anonymous post-study survey. Results: We enrolled 48 residents, 79.2% of whom were women. The mean score for the pre-escape room exam was 7.85/9 (SD 1.65), that for the post-escape room exam was 8.75/9 (SD 0.53), and for the exam three months later, it was 8.30/9 (SD 0.94). Among the participants, 18.8% did not manage to leave before the established 60 min time limit. The results of the satisfaction survey showed high participant satisfaction. Conclusions: The escape room proved to be a valuable educational game that increased students’ knowledge of sepsis management and showed a positive overall perceived value among the participants. Full article

(This article belongs to the Special Issue Intensive Care Medicine in Children: Current Concepts and Future Perspetives)

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Review

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10 pages, 1092 KiB

Open AccessReview

Current Management of Generalized Convulsive Status Epilepticus in Children

by Štefania Aulická

Children 2022, 9(10), 1586; https://doi.org/10.3390/children9101586 - 20 Oct 2022

Viewed by 2981

Abstract

Generalized convulsive status epilepticus (GCSE) in pediatric patients is an emergency condition with high morbidity and mortality and potentially irreversible brain damage, leading to cognitive deterioration, psychomotor retardation, chronic epilepsy with recurring seizures, and other complications. Treatment must be initiated in the impending [...] Read more.

Generalized convulsive status epilepticus (GCSE) in pediatric patients is an emergency condition with high morbidity and mortality and potentially irreversible brain damage, leading to cognitive deterioration, psychomotor retardation, chronic epilepsy with recurring seizures, and other complications. Treatment must be initiated in the impending GCSE phase, within five minutes of the onset of a generalized convulsive seizure. Early initiation of treatment and adequate therapy is a prerequisite for a good patient outcome. Full article

(This article belongs to the Special Issue Intensive Care Medicine in Children: Current Concepts and Future Perspetives)

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12 pages, 567 KiB

Open AccessReview

Nutrition in Pediatric Intensive Care: A Narrative Review

by Milan Kratochvíl, Jozef Klučka, Eva Klabusayová, Tereza Musilová, Václav Vafek, Tamara Skříšovská, Jana Djakow, Pavla Havránková, Denisa Osinová and Petr Štourač

Children 2022, 9(7), 1031; https://doi.org/10.3390/children9071031 - 11 Jul 2022

Cited by 4 | Viewed by 3906

Abstract

Nutrition support in pediatric intensive care is an integral part of a complex approach to treating critically ill children. Smaller energy reserves with higher metabolic demands (a higher basal metabolism rate) compared to adults makes children more vulnerable to starvation. The nutrition supportive [...] Read more.

Nutrition support in pediatric intensive care is an integral part of a complex approach to treating critically ill children. Smaller energy reserves with higher metabolic demands (a higher basal metabolism rate) compared to adults makes children more vulnerable to starvation. The nutrition supportive therapy should be initiated immediately after intensive care admission and initial vital sign stabilization. In absence of contraindications (unresolving/decompensated shock, gut ischemia, critical gut stenosis, etc.), the preferred type of enteral nutrition is oral or via a gastric tube. In the acute phase of critical illness, due to gluconeogenesis and muscle breakdown with proteolysis, the need for high protein delivery should be emphasized. After patient condition stabilization, the acute phase with predominant catabolism converts to the anabolic phase and intensive rehabilitation, where high energy demands are the keystone of a positive outcome. Full article

(This article belongs to the Special Issue Intensive Care Medicine in Children: Current Concepts and Future Perspetives)

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14 pages, 325 KiB

Open AccessReview

Paediatric Deep Neck Infection—The Risk of Needing Intensive Care

by Vojtech Perina, David Szaraz, Hana Harazim, Milan Urik and Eva Klabusayova

Children 2022, 9(7), 979; https://doi.org/10.3390/children9070979 - 29 Jun 2022

Cited by 3 | Viewed by 2237

Abstract

Deep neck infections are potentially dangerous complications of upper respiratory tract or odontogenic infections. The pathophysiology, clinical presentation, and potential spreading depend on the complex anatomy of the neck fascia. These infections can lead to severe pathological conditions, such as mediastinitis, sepsis, and [...] Read more.

Deep neck infections are potentially dangerous complications of upper respiratory tract or odontogenic infections. The pathophysiology, clinical presentation, and potential spreading depend on the complex anatomy of the neck fascia. These infections can lead to severe pathological conditions, such as mediastinitis, sepsis, and especially airway impairment with difficult management. Because of the risk of life-threatening emergency situations and the possible impacts on the overall health status of affected children, their early recognition is of utmost importance. Torticollis, drooling, and stridor are the most common signs of advancing disease. Children presenting with these symptoms should be admitted to the paediatric intensive care unit for vital function monitoring, where the airway could be readily secured if function is compromised. Full article

(This article belongs to the Special Issue Intensive Care Medicine in Children: Current Concepts and Future Perspetives)

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13 pages, 319 KiB

Open AccessReview

Critically Ill Pediatric Patient and SARS-CoV-2 Infection

by Jozef Klučka, Eva Klabusayová, Milan Kratochvíl, Tereza Musilová, Václav Vafek, Tamara Skříšovská, Martina Kosinová, Pavla Havránková and Petr Štourač

Children 2022, 9(4), 538; https://doi.org/10.3390/children9040538 - 11 Apr 2022

Cited by 3 | Viewed by 1764

Abstract

In December 2019 SARS-CoV-2 initiated a worldwide COVID-19 pandemic, which is still ongoing in 2022. Although adult elderly patients with chronic preexisting diseases had been identified as the most vulnerable group, COVID-19 has also had a significant impact on pediatric intensive care. Early [...] Read more.

In December 2019 SARS-CoV-2 initiated a worldwide COVID-19 pandemic, which is still ongoing in 2022. Although adult elderly patients with chronic preexisting diseases had been identified as the most vulnerable group, COVID-19 has also had a significant impact on pediatric intensive care. Early in 2020, a new disease presentation, multisystemic inflammatory syndrome, was described in children. Despite the vaccination that is available for all age categories, due to its selection process, new viral mutations and highly variable vaccination rate, COVID-19 remains a significant clinical challenge in adult and pediatric intensive care in 2022. Full article

(This article belongs to the Special Issue Intensive Care Medicine in Children: Current Concepts and Future Perspetives)

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