Procalcitonin to stop antibiotics after cardiovascular surgery in a pediatric intensive
care unit—the PROSACAB study
Ontology highlight
ABSTRACT:
SUBMITTER: Sara Bobillo-Perez
PROVIDER: S-BSST279 | biostudies-other |
REPOSITORIES: biostudies-other
Similar Datasets
Project description:PurposeThe final decision for discharge from the intensive care unit (ICU) is uncertain because it is made according to various patient parameters; however, it should be made on an objective evaluation. Previous reports have been inconsistent and unreliable in predicting post-ICU mortality. To identify predictive factors associated with post-ICU mortality, we analyzed physiological and laboratory data at ICU discharge.MethodsPatients admitted to our ICU between September 2012 and August 2013 and staying for critical care>2 days were included. Sequential Organ Failure Assessment (SOFA) score; systemic inflammatory response syndrome score; white blood cell count; and serum C reactive protein, procalcitonin (PCT), interleukin-6 (IL-6), lactate, albumin, and hemoglobin levels were recorded. The primary end point was 90-day mortality after ICU discharge. Two hundred eighteen patients were enrolled (195 survivors, 23 non-survivors).ResultsNon-survivors presented a higher SOFA score and serum PCT, and IL-6 levels, as well as lower serum albumin and hemoglobin levels. Serum PCT, albumin, and SOFA score were associated with 90-day mortality in multiple logistic regression analysis. Hosmer-Lemeshow test showed chi-square value of 6.96, and P value of 0.54. The area under the curve (95% confidence interval) was 0.830 (0.771-0.890) for PCT, 0.688 (0.566-0.810) for albumin, 0.861 (0.796-0.927) for SOFA score, and increased to 0.913 (0.858-0.969) when these were combined. Serum PCT level at 0.57 ng/mL, serum albumin at 2.5 g/dL and SOFA score at 5.5 predict 90-day mortality, and high PCT, low albumin and high SOFA groups had significantly higher mortality. Serum PCT and SOFA score were significantly associated with survival days after ICU discharge in Cox regression analysis.ConclusionsSerum PCT level and SOFA score at ICU discharge predict post-ICU mortality and survival days after ICU discharge. The combination of these two and albumin level might enable accurate prediction.
| S-EPMC4252062 | biostudies-literature
Project description:Unnecessary long-term use of broad-spectrum antibiotics is linked to the emergence and selection of resistant bacteria, prolonged hospitalisation and increased costs. Several clinical trials indicate that the biomarker procalcitonin (PCT) can guide antibiotic therapy. Some of these trials have shown a promising reduction in the number of antibiotic prescriptions, duration of antibiotic therapy and even length of stay in the ICU, although their size and selection criteria limit their external validity. The objectives of the Stop Antibiotics on guidance of Procalcitonin Study (SAPS) are to evaluate whether daily PCT can improve "real-life" antibiotic use in Dutch ICU's by reduction of the duration of antibiotic treatment without an increase of recurrent infections and mortality.Multicenter randomised controlled intervention trial. Powered for superiority of the primary efficacy endpoint and non-inferiority on the primary safety endpoints (non-inferiority margin is set on 8%).(1) ICU-patients aged ?18 years and (2) receiving antibiotics for a presumed or proven infection and (3) signed informed consent.(1) patients who require prolonged antibiotic therapy, (2) suffer from Mycobacterium tuberculosis, (3) cystic fibrosis, (4) viral or parasitic infections and (5) those that are severely immunocompromised or (6) moribund.The intervention consists solely of an advice to discontinue antibiotic treatment in case PCT has decreased by more than 80% of its peak level (relative stopping threshold) or decrease below a value of 0.5 ng/ml (absolute stopping threshold).The study hypothesis is that PCT-guided therapy is non-inferior to standard care based on implemented guidelines and local expertise, whilst reducing antibiotic usage. Computerised 1:1 randomisation will allocate 908 patients per arm. Arm 1: standard of care. Arm 2: procalcitonin-guided therapy. The primary efficacy endpoint is consumption of antibiotics expressed as the defined daily dosage and duration of antibiotic therapy expressed in days of therapy. This trial is designed to shorten antibiotics safely, therefore the primary safety endpoint is mortality measured at 28 day and 1 year.This will be the largest procalcitonin-guided antibiotic intervention trial in ICU setting thus far. Currently 1600 of the planned 1816 patients are randomised (November 2012). The first interim analysis has passed without any safety or futility issues.Trial registration number at www.clinicaltrials.gov: Id. Nr. NCT01139489, at www.trialregister.nl: Id.nr. NTR1861.
| S-EPMC3637799 | biostudies-literature
Project description:IntroductionConsistent medical knowledge acquisition while caring for the critically ill can be challenging for learners and educators in the pediatric intensive care unit (PICU), a unit often distinguished by fluctuating acuity and severity. We implemented a standardized didactic curriculum for PICU residents to facilitate their acquisition and retention of knowledge in core PICU topics.MethodsWe developed a comprehensive standardized curriculum for PGY 2-PGY 4 PICU pediatric and internal medicine-pediatric residents. Thirteen core topics were administered as 30-minute didactic sessions during the rotation, using either PowerPoint slides or a dry-erase board. Residents were tested to assess knowledge acquisition and retention.ResultsSeventy-eight residents participated, 86% of whom completed posttests. Seventeen percent completed follow-up tests. Of the learners who participated, 60 (77%) completed pretests and posttests, indicating their confidence level each time. The pretest mean was 55% (SD = 14.4%), and the posttest mean was 64% (SD = 15.6%). This 9% increase was statistically significant (p = .001; CI, 3.9% to 14.8%). The follow-up test at 3 months, completed by 15% of this subgroup, demonstrated a mean score of 62% (SD = 14.5%). When matched with posttest scores (mean score of 64%, SD = 13.3%), there was no significant difference (p = .7398; CI, -11.7% to 16.2%), suggesting retention of previously acquired knowledge.DiscussionOur standardized didactic curriculum effectively facilitated the acquisition and retention of the medical knowledge of core PICU topics among PICU residents, in addition to their usual experiential learning.
| S-EPMC7566227 | biostudies-literature
Project description:Renal replacement therapy (RRT) is used in a wide variety of pediatric populations. In this article, we will review the advantages and disadvantages of the different RRT modalities and the technical aspects of providing pediatric RRT. In addition, we will review the use of RRT with extracorporeal membrane oxygenation, the use of continuous RRT in the critically ill child with acute kidney injury and fluid overload, and the use of RRT for the removal of toxins and treatment of inborn errors of metabolism.
| S-EPMC5545793 | biostudies-other
Project description:Thyroid hormones are key factors necessary for normal growth and development in children. They have tight control of metabolic rate and, as a result, frequently become altered in their synthesis and/or release during times of stress or critical illness. Disturbances in thyroid hormone homeostasis have been well described in several pathologic states, including sepsis/septic shock, renal failure, trauma, severe malnutrition, and following cardiopulmonary bypass. Specifically, a decrease in serum triiodothyronine (T3) and a concomitant increase in reverse triiodothyronine (rT3) levels are the most common changes observed. It is further noteworthy that serum thyroxine (T4), rT3, and T3 levels change in relation to severity of nonthyroidal illness. Many past investigators have speculated that these alterations are a teleological adaptation to severe illness and the increased metabolic demands that critical illness bears. However, this paradigm has been challenged through multiple avenues and has lost support over the past few years. Instead the "inflammatory hypothesis" has emerged implicating a cytokine surge as the mediator of thyroid hormone disruption. Overall, the demonstrated association between low thyroid hormone levels and poor clinical outcomes, the beneficial effects of thyroid hormone supplementation in multiple critically ill subpopulations, and the well-established safety profile of T3 therapy make thyroid hormone supplementation in the pediatric ICU worth consideration.
| S-EPMC6512769 | biostudies-literature
Project description:We determined whether we could identify clusters of children with critical asthma by plasma cytokine concentration. Differences in gene expression between the two clusters were analyzed using a targeted Nanostring immunology array. We performed a single-center, prospective, observational cohort study of 64 children ages 6 – 17 years admitted to a pediatric intensive care unit for an asthma attack between July 2019 to February 2021.
2022-07-15 | GSE208220 | GEO
Project description:Introduction:Point-of-care ultrasound (POCUS) is ultrasound performed by the provider at the patient's bedside to answer a specific clinical question. No guidelines exist for teaching POCUS to pediatric residents, and there are currently no pediatric-specific POCUS resources on MedEdPORTAL. To fill this gap, we designed an educational resource to introduce pediatric residents to POCUS during their pediatric intensive care unit (PICU) rotation. Methods:Our POCUS curriculum included content on ultrasound basics, lung ultrasound, and focused cardiac ultrasound. Residents completed a precourse knowledge test at the start of the PICU rotation. Self-study modules were provided to the residents for independent review. During small group, residents performed ultrasound scanning on subjects with normal anatomy. Residents also participated in weekly POCUS rounds to perform supervised ultrasound scanning on PICU patients with known abnormal ultrasound findings. After completion of the PICU rotation, residents competed a postcourse knowledge test and survey. Knowledge test scores were compared to a historical cohort of residents who had completed the PICU rotation but not the POCUS curriculum. Results:Six residents completed the curriculum, and all completed the postcourse knowledge test with significant improvement in test scores compared to a historical cohort. Residents reported increased knowledge of POCUS indications and comfort performing POCUS. All residents rated the small-group sessions and POCUS rounds highly. Discussion:Pediatric residents have little POCUS training and perform poorly on POCUS knowledge testing. A basic POCUS curriculum can be instituted during the PICU rotation and improve resident knowledge and comfort with POCUS.
| S-EPMC6342342 | biostudies-other
Project description:Purpose of review:With increasing survival of children requiring admission to pediatric intensive care units (PICU), neurodevelopmental outcomes of these patients are an area of increased attention. Our goal was to systematically review recently published literature on neurologic outcomes of PICU patients. Recent Findings:Decline in neurofunctional status occurs in 3%-20% of children requiring PICU care. This proportion varies based on primary diagnosis and severity of illness, with children admitted for primary neurologic diagnosis, children who suffer cardiac arrest or who require invasive interventions during the PICU admission, having worse outcomes. Recent research focuses on early identification and treatment of modifiable risk factors for unfavorable outcomes, and on long-term follow-up that moves beyond global cognitive outcomes and is increasingly including tests assessing multidimensional aspects of neurodevelopment. Summary:The pediatric critical care research community has shifted focus from survival to survival with favorable neurologic outcomes of children admitted to the PICU.
| S-EPMC5714514 | biostudies-literature
Project description:Multiple organ dysfunction syndrome (MODS) can result from a variety of initiating events such as infection or trauma. The clinical condition of some MODS patients may deteriorate and require intense resource and high-risk cardiopulmonary support via extracorporeal membrane oxygenation (ECMO). Until now, no diagnostic criteria/molecular biomarker has been developed to identify MODS patients who require subsequent ECMO support. We used multi-time point (0h, 72h and 8d) whole transcriptomics from total blood of 27 patients (contro-4, MODS-17 and ECMO-6) to derived the molecular signatures to diagnose the MODS patients required ECMO support. We observed that immune response (neutrophil level) was compromised in MODS patients, who required ECMO support. Differential gene expression analysis and gene ontology enrichment has revealed that epigenetic modifications has got activated during the MODS deterioration to ECMO. In addition, signature of 6 genes were identified using logistic regression, which can be used as putative diagnostic markers for patients needed ECMO support.
2020-09-30 | GSE144406 | GEO