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Respiratory acidosis and alkalosis
Kundan Mittal, HK Aggarwal, N Rungta, Vinayak Patki
May-June 2021, 8(3):161-166
Respiratory illnesses and failure are common in pediatric population compared to adults due to anatomical and physiological differences in respiratory system. Respiratory acidosis is commonly seen in intensive care settings and needs immediate attention. Treatment depends on underlying pathology and mechanical ventilation. Respiratory alkalosis is least common only mainly iatrogenic or child is hyperventilating.
  2,934 398 -
Efficacy of nebulized magnesium sulfate in moderate bronchiolitis
N Guruprasad, C A Gopalakrishna Mithra, Vinod H Ratageri
May-June 2022, 9(3):90-94
Background: Bronchiolitis is a common cause of illness and hospitalization in infants and young children. The effectiveness of various bronchodilators remains unclear. This study was conducted to assess the efficacy of nebulized magnesium sulfate in hospitalized children with moderate bronchiolitis in the age group of 1–24 months. Subjects and Methods: This was a prospective observational study done from December 2018 to June 2020. All children with moderate bronchiolitis (clinical severity score [CSS]-4–8) meeting inclusion/exclusion criteria were enrolled. A detailed history, demographic profile, CSS and oxygen saturation in room air, and heart rate were recorded. They were given two doses of magnesium sulfate in the form of nebulization for 10 min each, at 30 min apart. The children were assessed for CSS at 0 h, 1 h, and 4 h after nebulization. The children were considered improved if CSS <4 at the end of 4 h. The children were monitored for adverse reactions of magnesium sulfate. Results: Sixty children were enrolled. The mean age was 7.5 ± 6.47 months. Most children (51.7%) were in 1–6 months. The mean CSS scores at 0 h, 1 h, and 4 h were 6 ± 1.008, 2.95 ± 1.395, and 2.40 ± 1.564, respectively (P = < 0.001). Fifty-three (88.3%) children improved and seven (11.7%) children did not improve. In nonimproved group, subanalysis was done and found hypoxia (odds ratio − 12.6) as a significant risk factor. Flushing was the most common adverse effect noticed in eight (13.3%) children. Conclusions: Children with moderate bronchiolitis were improved with nebulized magnesium sulfate.
  3,191 96 -
Quality indicators and improvement measures for pediatric intensive care units
Farhan Shaikh
September-October 2020, 7(5):260-270
Quality and patient safety is an integral part of pediatric critical care. Quality indicators (QIs) or key performance indicators (KPIs) are crucial to measure various aspects of quality and patient safety in pediatric intensive care. If we want a system which gives us reproducible results, it is crucial that various aspects of structure, process, and outcomes in that system are measurable and reproducible. It is crucial that the data used for measurements are accurate and they are analyzed using appropriate tools, and the KPIs/QIs calculated from the data are appropriately validated. These QIs/KPIs should be compared to the “accepted” international or national benchmarks on a periodic basis so that the team of doctors, nurses, and administrators are aware of the performance of their unit. In India, there are no national benchmarks available to compare the QIs/KPIs of our pediatric intensive care units (PICUs), and there is a dearth of such benchmarks for PICUs at international level too. In this review article, we aim to discuss the various aspects of data collection, data validation, and measurement of some important QIs of a PICU. We have also tried to gather some international benchmarks for some important QIs, which can be used by PICUs for their comparisons. Eventually, the best thing will be to develop a national database from various PICUs across India so that a national benchmark is created.
  2,675 243 -
Personal protective equipment during COVID-19 epidemic
Dhiren Gupta, Ashish Kumar Simalti, Neeraj Gupta, Anil Sachdev, Arun Bansal, Ashwani Kumar Sood, Tripti Sharan, Vinayak Patki
May 2020, 7(7):22-30
Personal Protective Equipments (PPEs) are used to safeguard the health of workers. Airborne aerosol with size below 5 micron can enter lower respiratory system directly whereas bigger size particles either settles on surrounding equipment and become fomites. COVID 19 can stay in air after 3 hours with airborne spread in health care with fomites especially plastic showing infection up to 72 hours. Examples of PPE include items as mask, gloves, shield, goggles, gowns and full body suits. All health care workers need to be taught the correct sequence of wearing and taking off the PPE in order to avoid contamination.
  2,531 313 -
COVID-19: Epidemiology and virology
Antariksh Deep, Aparna Yadav, Madhu Sharma, Kundan Mittal, Anupama Mittal
May 2020, 7(7):3-9
The novel coronavirus (CoV), termed Severe Acute Respiratory Syndrome related CoV-2 (SARS CoV-2), responsible for an outbreak of unusual viral pneumonia in Wuhan city, Hubei province, China is a testimony to the risk the CoVs pose to the public health. In this review, a brief introduction of the human CoVs (hCoV), along with the epidemiology and pathogenesis of the infection caused by the hCoVs, especially the SARS-CoV-2, shall help in the understanding of the COVID-19.
  2,127 327 -
Clinico-etiological profile of children who had unplanned extubation and subsequent re-intubation in level-4 pediatric intensive care unit
Vishnu Vardhan Kodicherla, Farhan Shaikh, Pawan Kumar Duvvana, Anupama Yerra, Yashwanth Reddy, Parag Dekate, Kapil Sachane, Dinesh Kumar Chirla
March-April 2021, 8(2):67-73
Background: There are few studies on unplanned extubation (UE) in pediatric intensive care units (PICU). This study is to identify factors associated with UE in PICUs. Subjects and Methods: In this observational study, the data of UE from January 1, 2013, to May 31, 2019, in a level-4 PICU were analyzed with an objective to study the etiology of UE and its impact on therapeutic outcomes. Results: Of 7079 patients hospitalized in PICU, 1721 were invasively ventilated (mean ventilator days 4.33 days). UE occurred in 39 patients (2.26% of intubated patients) at 0.52 UE events per 100 ventilation days. The median age was 14 months. The most common cause of UE was inadequate sedation (n = 24, 61.53%), endotracheal tube suctioning (n = 05, 20.8%), one during adjusting ET tube (4.1%), one during central venous line insertion (4.1%), and one during Foley's catheter insertion (4.1%) and 7 unexplained (29.1%). As long as the appropriate nurse: patient ratio was maintained, the incidence of UE was un-affected by day versus night shift or high versus low bed occupancy rates. Re-intubation rate in UE cohort was higher (74.35%) than planned-extubation cohort 0.11% (P < 0.001). All re-intubations were within 2 h of UE. Most common cause of re-intubation following UE was respiratory distress (72.41%), stridor (17.24%), and apnea (10.34%). Re-intubations following UE showed higher incidence of ventilator-associated pneumonia but statistically not significant (P = 0.54). Conclusion: UE is associated with a significantly high incidence of re-intubations and associated complications arising from re-intubations. Maintaining a pool of skilled nurses in adequate nurse-to-patient ratio may play an important role in preventing UE. UE can be minimized by optimizing sedation and monitoring during common ICU procedures. Multicentric studies are warranted to design a uniform standard of care of ventilated patients aimed at reducing the incidence of UE.
  2,179 180 -
Correlation of preoperative risk factors in children having congenital heart diseases with outcome of cardiac surgery: A 1-year hospital-based observational study
Chinmay Joshi, Manvi F Veeresh
January-February 2020, 7(1):7-10
Background and Objectives: The risk factors are associated with surgical outcomes of cardiac surgery. This study was aimed to correlate the effect of preoperative risk factors in children with congenital heart diseases (CHDs) on the outcome of cardiac surgery. Materials and Methods: This 1-year prospective observational study was conducted in a tertiary referral hospital. A total of 200 children with congenital cardiac diseases undergoing cardiac surgery were studied pre- and post-operatively for 3 months. Results: Cyanotic and acyanotic CHDs were noted in 33% and 67%, respectively. The most common acyanotic CHD was ventricular septal defect (35%) and the common cyanotic CHD was tetralogy of Fallot (17%). Majority of the children (75.5%) presented with risk factors. 63% of the children were under risk-adjusted classification for congenital heart surgery (RACHS)-II category while 19% were in RACHS-IV. 7.5% of the children expired. Conclusion and Interpretation: Significantly high mortality was recorded in children aged <1 year, those who presented with cyanotic CHDs, those having a risk factor, and children with RACHS-IV criteria.
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Comparison of effectiveness of metered dose inhaler with spacer and jet nebulizer in children aged 5–14 years with acute exacerbation of asthma: A pilot randomized controlled trial
Kundan Mittal, Rishabh Batra, Alok Khanna
July-August 2021, 8(4):177-181
Background: Asthma is a common and potentially serious chronic disease that imposes a substantial burden on patients, their families, and community. The main treatment of an acute exacerbation includes inhaled short-acting β2-agonists (SABA). The aim of this of study was to compare the effectiveness of metered dose inhaler (MDI) with spacer and jet nebulizer for delivering SABA in children aged 5-14 years presenting to the emergency department with acute asthma. Subjects and Methods: One hundred subjects were randomly assigned to receive salbutamol by an MDI with spacer or a nebulizer at fixed intervals. The parameters such as respiratory rate, heart rate, use of accessory muscles, auscultatory findings, peak expiratory flow rate (PEFR), development of tremor, pCO2 on venous blood gas, need for hospital admission, and duration of stay in the emergency department were compared between two groups. Statistical tests used were Student's t-test, Chi-square test, and Fisher's exact test. Results: Clinical improvement in the form reduction of respiratory rate, use of accessary muscles, wheeze, and PEFR was comparable between two groups. Increase in heart rate in children with MDI with spacer group was significantly lower (P < 0.001) than that of nebulizer group at all time intervals during the study period. No significant difference was observed for the need of pediatric intensive care unit admission, duration of stay in emergency department, and adverse events between two groups. Conclusions: In children aged 5-14 years presenting to the emergency department with acute exacerbation of asthma, the efficacy of MDI with spacer for delivering SABA was comparable with that of nebulizer.
  1,961 207 -
COVID-19: Evaluation and diagnosis
Govind Benkatti, Vinayak Patki
May 2020, 7(7):16-21
Rapid and accurate COVID-19 diagnostic testing is essential for controling the ongoing COVID-19 pandemic. Evaluation and diagnosis of COVID-19 infection is done on the basis of the clinical suspicion and appropriate laboratory tests. The current gold standard for COVID-19 diagnosis is real-time reverse transcription–polymerase chain reaction detection of SARS-CoV-2 from nasopharyngeal swabs. The World Health Organization, Centre for Disease control and Indian Council of Medical Research has published various guidelines about the scientific use and interpretation of results. Recently rapid antibody testing has also been recommended for clusters with influenza-like illness. These laboratory tests have their own limitations about their sensitivity and specificity; clinician has to interpret the results in the light of clinical condition of patient with suspected COVID-19 infection. Health-care provider should take due precautions while collecting, packaging, and transport of these samples. One has to adhere strictly to the guidelines published by the Government authorities in the diagnosis of these patients.
  1,830 308 -
Plasmalyte versus normal saline as resuscitation fluid in children: A randomized controlled trial
Vandana Arya, M Kavitha, Kundan Mittal, Virender Kumar Gehlawat
May-June 2021, 8(3):134-138
Background: Plasmalyte A, a balanced solution is reported to be associated with a reduced incidence of hyperchloremia and metabolic acidosis when compared with 0.9% NaCl among adults. Considering the paucity of evidence in the pediatric population, the present study was conducted with an objective to compare the efficacy and safety of plasmalyte and normal saline as intravenous fluid bolus therapy in children with shock in terms of Electrolytes and Acid-base balance at admission and at 6 h. Subjects and Methods: This double-blinded, randomized controlled trial was conducted in the pediatric emergency department (ED) of a tertiary care hospital among children aged 1 month to 14 years who presented to the ED with shock. A total of 400 children were randomized to receive either plasmalyte or 0.9% saline solution as intravenous fluid bolus therapy. Changes in laboratory parameters including pH, serum bicarbonate levels, serum lactate level, and serum electrolytes-sodium, potassium, chloride levels from baseline (hour 0) to hour 6 were compared in both groups. Secondary outcomes included the need for vasopressors, duration of hospital stay, and in-hospital mortality. Results: The two groups were similar in terms of baseline clinical characteristics. Patients receiving plasmalyte demonstrated significantly greater improvement in the pH (P = 0.001), bicarbonate (P = 0.001) and lactate levels (P = 0.03) compared with patients receiving normal saline. In addition, normal saline group patients had a higher rise in sodium (P = 0.11) and chloride levels (P = 0.02) as compared to the plasmalyte group. The children who received plasmalyte had a significantly lesser need for vasopressors (P = 0.04), shorter mean duration of hospital stay (P = 0.01), and lower mortality (P = 0.03). Conclusion: Plasmalyte was superior to Normal saline when used as a resuscitation fluid in children with shock, in terms of better improvement of acid-base balance after fluid bolus therapy, a lower rise in serum chloride level at 6 h from baseline, shorter hospital stay, lesser need for vasoactive drugs and lower mortality.
  1,884 199 1
A multicenter study of clinical and biochemical profiles, treatments, and short-term outcomes in children with multisystem inflammatory syndrome associated with SARS-CoV-2 infection from Western India
Rachit Mehta, Vinay H Joshi, Preetha Joshi, Amit Bhondve, Madhu Otiv, Soonu Udani, Mahesh Mohite, Bhakti U Sarang, Parmanand Andankar, Abhijit Bagade, Sameer Sadawarte, Sagar Sharad Lad, Pradeep Suryawanshi, Ashish Ramchadra Dhongade
November-December 2021, 8(6):270-277
Background: Severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) infection can lead to multisystem inflammatory syndrome in children (MIS-C). This study was conducted to study epidemiology, clinical profile, treatment strategies associated in children MIS-C in two cities in Western India. Subjects and Methods: This is a retrospective, observational study of children who fulfilled the criteria for MIS-C, admitted to eleven pediatric intensive care units (PICUs) in Western India during the first wave SARS-CoV-2 infection in India, between February 2020 and December 2020. Demographic and clinical data including laboratory parameters, treatment regimens, and outcomes were collected and analyzed. Results: Of the 234 children presenting with MIS-C, they were categorized into 3 clinical phenotypes: fever and hyperinflammation, Kawasaki disease (KD)-like, and shock with multisystem organ dysfunction syndrome (MODS). C-reactive protein, procalcitonin (PCT), D-dimer, and pro-B-type natriuretic peptide levels were elevated in all patients. Intravenous immunoglobulin (IVIG) was used in 128 (54.7%), corticosteroids in 214 (91.45%), tocilizumab in 1 (0.4%), and remdesivir in 4 (1.7%). 95 (40.5%) children required vasopressors and invasive mechanical ventilation was necessary in 26 (11.1%). Two hundred and twenty-nine patients were discharged home with median duration of PICU stay of 4 days and hospital stay of 7 days, and 5 (2.1%) patients died during treatment. Significant reduction in the duration of hospital stay was observed in those who received both steroid and IVIG (P < 0.05) and also in the shock ± MODS group (P < 0.05). Conclusions: Combination of steroid and IVIG for the treatment of MISC, especially with Shock and MODS reduce the duration of PICU stay than treated with steroid alone.
  1,820 211 2
Comparison between continuous positive airway pressure and T piece as spontaneous breathing trial at a tertiary care pediatric intensive care unit: A pilot randomized control trial
Ramesh Chand Bairwa, Hiremath Sagar, Anil Kumar Sapare, Rajiv Aggarwal
May-June 2021, 8(3):123-127
Background: A spontaneous breathing trial (SBT) is often used to decide about extubation readiness in mechanically ventilated patients. Studies done to identify the best method of SBT have shown variable results. As there was no published data comparing continuous positive airway pressure (CPAP) and T piece, this study was conducted to compare CPAP and T piece as method of SBT for postextubation outcomes. Subjects and Methods: This study was a pilot randomized controlled trial conducted at a tertiary care pediatric intensive care unit (PICU) from November 2018 to October 2019. Criteria for starting SBT and to identify trial as failure were predefined. Sixty patients were included in the study and randomly assigned to CPAP and T-piece group, of 30 each. Demographic data, diagnosis, duration of mechanical ventilation (MV), endotracheal tube size, need of inotropes, vasopressors, and sedation were all recorded. The primary outcome of the study was extubation failure within 48 h. The secondary outcomes studied were mortality, need of respiratory support, duration of oxygen requirement, and length of PICU (LOPICU) stay after extubation. Results: Age, gender, indication of intubation, duration of MV, and number of SBT attempts were similar in both the groups. There was no statistically significant difference in extubation failure within 48 h between the two groups. Four patients were reintubated in both the groups and two patients died in T piece group and one patient in CPAP group. Postextubation respiratory support, duration of oxygen therapy, LOPICU stay, and mortality were not significant different between the two groups. Conclusion: There was no significant difference in extubation outcomes when CPAP and T piece were used as methods of SBT.
  1,876 148 2
Study of use of intravenous immunoglobulin in pediatric intensive care unit in a tertiary care center: An audit and review of evidence
Maaz Ahmed, ML Keshavamurthy, KS Sanjay, Raghavendra Gumnur, GV Basavaraja
January-February 2020, 7(1):1-6
Introduction: The label and off-label use of intravenous immunoglobulin (IVIG) in pediatric intensive care unit (PICU) is done as a replacement therapy also for immunomodulation. As there are no standard guidelines for the use of IVIG in PICU; hence, the need to study the pattern of indications for which IVIG has been used in critically ill children and review the quality of evidence as per the available data. Materials and Methods: The retrospective chart review of indications for IVIG therapy in children over a period of 4 years in a tertiary care PICU from January 2015 to December 2018. Collection of data included demographic profile, indication of transfusion of IVIG, dose of IVIG received, and outcome of the patients. Results: The IVIG therapy was given to 301 children under the following groups, 120 children for neuroimmunologic disorders, 73 children for cardiology-related indications, 65 children for infection and infection-related causes, 31 children for autoimmune diseases, seven and five children each for primary immunodeficiency and dermatological causes, respectively. The indications, for which IVIG therapy given included, approved by the Food and Drug Administration in 56 children, under evidence category Level Ia in 50 children and with strength of recommendation Grade A in 51 children. Conclusion: There is a rise in off-label use of IVIG as the quality of evidence is variable for different indications hence there is a need for better quality of evidence and more multicentric randomized control trials to define the precise impact of IVIG on various conditions.
  1,764 255 1
Clinical manifestations, laboratory findings, and imaging in COVID-19
Goutam Goswami, Nikhil Vinayak, Maneesh Kumar, Pradeep Kumar Sharma
May 2020, 7(7):10-15
Coronavirus disease 2019 (COVID 19) caused by severe acute corona virus 2 (SARS-CoV2) strain is an ongoing pandemic affecting more than 200 countries worldwide. On April 15, 2020 total 2,000,995 persons are affected with 126,783 deaths worldwide. It is mainly an adult disease, but it can affect any age group. Children are less likely to be affected and severity and mortality is less compared to adults. Infants however are more prone to develop severe disease. The disease has human to human transmission with an incubation period of 2–14 days. It spread through respiratory droplets which enter the body through respiratory tract or conjunctiva. Children usually present with fever, cough, and breathing difficulty. Diarrhea and abdominal pain can also be seen. Pulmonary and extrapulmonary complications can occur, but these are less frequent in children except infants. Critical illness and mortality increase significantly with age and associated comorbidities. In children, no typical laboratory findings are seen. Radiological investigations are not specific and hence their routine use is not recommended especially in milder cases. Subpleural lesion with ground glass opacification is the most common radiological finding. Confirmation is done by real-time reverse transcriptase polymerase chain reaction. The management is mainly supportive. Drugs and vaccines are under trial. Prevention is done by breaking the chain of transmission.
  1,646 358 -
Predictive value of full outline of unresponsiveness (FOUR) score and GLASGOW coma scale (GCS) in outcome of children aged 1-14 years admitted with altered sensorium
Kundan Mittal, Jaya Shankar Kaushik, Krishnendra Dhar Dwivedi
January-February 2020, 7(1):14-21
Background: Evaluation of altered consciousness in children is a challenge and an important aspect of emergency care. There is no objective measure to communicate and document the severity of coma as distinct from vital signs. Various coma scales have been developed for recording depth of consciousness which are widely used in clinical practice in adults and children. Studies are conflicting on the best quick assessment tool for neurologic status. One of the newer tools is the Full Outline of Unresponsiveness (FOUR) score has been developed to assess the depth of coma in a more detailed manner than the Glasgow Coma Scale (GCS) scale. Objectives: The present study was taken to determine the predictive value of FOUR score and GCS in outcome of children aged 1–14 years presenting with altered sensorium. Materials and Methods: This prospective observational study was conducted in the teaching hospital of Haryana. A total of 150 children aged between 1 and 14 years were included. FOUR score and GCS were obtained within 1 h of admission. This assessment was repeated at 12th h and 24th h after admission. Children who left against medical advice were telephonically contacted to determine the final outcome, and they were called for 1-month follow-up. Results: The mean age was 6.64 ± 4.13 years. Seventy-nine (52.66%) patients were male and 71 (47.33%) were female. GCS at admission, 12th h, and 24th h was 7.76 ± 2.91, 7.22 ± 3.60, and 7.22 ± 4.57, respectively. The mean FOUR score was 10.12 ± 3.92 which decreased continuously at 12th h, 24th h, and finally, at discharge, i.e., 10.29 ± 8.13 (P > 0.05). A total of 53 (35.33%) patients expired and 97 (64.66%) were discharged. A total of 69 patients were admitted to the pediatric intensive care unit (PICU). The mean duration of PICU stay was 5.84 ± 5.25. Patients who expired had lesser GCS score as compared to FOUR score at the time of admission and 12th h, i.e., 5.79 ± 2.18 and 6.54 ± 3.40 and 4.20 ± 2.62 and 4.30 ± 3.70, respectively. The mean GCS at the time of admission was 5.79 ± 2.8 which decreased significantly to 0.679 ± 2.28 and FOUR score decreased from 6.54 ± 3.40 to 0.35 ± 2.21 at the time in expired (P &#A60; 0.001). Conclusions: FOUR score can be used as good as GCS for predicting the inhospital mortality. GCS and FOUR scores both have a significant correlation with death. The study shows an excellent degree of agreement between GCS and FOUR scores at admission, at 12th h, at 24th h, and at discharge. FOUR score has better odds for predicting mortality on admission and at 24th h, whereas GCS at 12th h is better than FOUR score at 12th h in predicting mortality.
  1,761 218 -
Infusion of vasoactive drug through peripheral line: A myth or fact?
Muthu Chidambaram, Ramachandran Rameshkumar
March-April 2021, 8(2):63-64
  1,759 210 -
Comparison of high-flow nasal cannula and noninvasive positive pressure ventilation in children with acute bronchiolitis
Anil Sachdev, Rohit Vohra, Neeraj Gupta, Dhiren Gupta, Suresh Gupta
July-August 2020, 7(4):168-173
Objective: In recent years, there has been an increase in the use of noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula (HFNC) in children with increased work of breathing due to acute bronchiolitis. However, there are only limited studies comparing the efficacy of these two interventions. This study was done to compare efficacy and patients' comfort while receiving HFNC and NIPPV for acute bronchiolitis. Materials and Methods: Children admitted with the first episode of acute bronchiolitis with respiratory distress (modified Wood's Clinical Asthma Score >3) were randomized to receive NIPPV and HFNC. FiO2was titrated to achieve a SpO2of ≥94%. If the child was agitated and had a COMFORT B score of ≥17, dexmedetomidine infusion was started. The protocol lasted for at least 24 h or till the respiratory support was required as decided by the treating physician. Outcome parameters measured were failure of intervention and patient comfort (using COMFORT B scores). Social science system version SPSS 17.0 was used for statistical testing.P < 0.05 was taken to indicate a significant difference for all statistical tests. Results: Twenty-five cases were enrolled in each study group. Failure of therapy was noted in 11 (44%) patients in the HFNC group and 6 (24%) in the NIPPV group (P = 0.18). COMFORT B score was significantly better in the HFNC group as compared to the NIPPV group (NIPPV12 vs. HFNC 8;P < 0.001). A number of cases requiring sedation and duration of sedation (dexmedetomidine) were more in the NIPPV group as compared to the HFNC group (22 vs. 10, P = 0.02, and 31.2 vs. 20.6 h, P = 0.04). Conclusion: This study suggests that possibly HFNC and NIPPV are equally efficient in the treatment of moderate-to-severe bronchiolitis. HFNC is more comfortable for bronchiolitis patients in comparison to NIPPV.
  1,717 209 -
Unplanned extubation in the pediatric intensive care unit: Alert, acknowledge, and avert
Suresh Kumar Angurana
March-April 2021, 8(2):59-60
  1,741 183 -
First line vasoactive therapy after fluid resuscitation in pediatric septic shock – Dopamine, Adrenaline or Noradrenaline?
Mehak Bansal, Praveen Khilnani
March-April 2019, 6(2):22-28
Severe sepsis and septic shock are the leading cause of morbidity and mortality in children all over the world, in both developed and developing nations. Surviving Sepsis Guidelines 2016 have recommended norepinephrine as the first choice of vasoactive agent in adult septic shock flowed by adrenaline or vasopressin in cases who do not respond to norepinephrine. In this article we have reviewed the literature and compared noradrenaline and adrenaline as first line vasoactive drug in children with fluid refractory septic shock. We have also discussed the change in the paradigm -use of dopamine as alternative instead of first line vasoactive agent
  1,740 182 -
Pediatric intensive care management in coronavirus infection-19
Namita Ravikumar, Manu Sundaram, Utpal Bhalala, Dhiren Gupta, Arun Bansal
May 2020, 7(7):36-41
Coronovirus-19 disease (CVOID-19) caused by severe acute respiratory syndrome-CoV2 has more than affected 3 million people worldwide, accounting for one of the largest pandemics known to humankind. Originating in China and traveling all across the globe, it spreads by droplets and fomites. Cohort intensive care units have been set up to manage critically ill CVOID-19 patients requiring organ support. Respiratory support, including low and high-flow oxygen devices, noninvasive and invasive ventilatory support have been used in the management of patients with severe acute respiratory illness. Aerosol generating procedures pose a high risk of transmission to health-care workers and need strict infection control practices and the use of personal protective equipment. Various anti-viral drugs have been tried, but there is inadequate evidence to recommend their routine use.
  1,541 370 -
Management of COVID-19-positive asymptomatic and mildly symptomatic children
GV Basavaraja, KS Sanjay, ML Keshavamurthy, GR Rajashekar Murthy, Pooja Gujjal Chebbi
May 2020, 7(7):31-35
Coronavirus disease (COVID) in children is milder in comparison to adults with a better prognosis and minimal mortality. The most common clinical presentation of COVID-19 in children includes fever and cough, but a significant number of infected children may be asymptomatic contributing to transmission of the disease. Several hypotheses have been put forth to explain the less severe disease in children including lower expression of angiotensin converting enzyme 2 (ACE2) receptors in the lungs of pediatric patients which is the main receptor through which the virus enters the cells in the lung and mediates its effects, lower exposure to virions, higher likelihood of viral co-infection in children which may be responsible for limited replication of the severe acute respiratory syndrome coronavirus 2 by direct virus-to-virus interaction and competition and the protective role of Bacillus Calmette-Guerin vaccine. Reverse transcriptase-polymerase chain reaction testing of upper or lower respiratory tract secretions is the recommended confirmatory test and management is guided by the severity of illness in the child. In this review, we will discuss the management of asymptomatic and mildly symptomatic children.
  1,563 303 -
Pediatric intensivists in India: The pursuit of happiness
Utpal S Bhalala
January-February 2021, 8(1):1-2
  1,647 218 -
COVID-19: The war against the invisible enemy
Vinayak Patki, Arun Bansal, GV Basavraja
May 2020, 7(7):1-2
  1,561 277 -
Point-of-care capillary ketone testing for diabetic ketoacidosis: A step to the future
Preetha Joshi, Vinay H Joshi
November-December 2020, 7(6):305-306
  1,629 170 -
Pharmacological management of COVID-19
Veena Raghunathan, Maninder Singh Dhaliwal
May 2020, 7(7):42-48
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) pandemic has brought the world to a standstill and is the largest public health crisis in the world in the present generation. As the cases continue to increase globally, and more patients are developing severe disease, large volumes of clinical data collection and aggressive research is being carried out to find effective medical therapies for this disease. No definitive proven treatment option exists till date. Various immunomodulatory and anti-viral drugs have shown potential, and are being studied extensively through randomized trials. The most available literature is based on the adult study population, with few/no children being included. This review attempts to summarize the pharmacotherapeutic options presently in consideration in children in the treatment of SARS-CoV2.
  1,495 294 1