Tassos Hatzis - Academia.edu (original) (raw)
Papers by Tassos Hatzis
Intensive Care Medicine, 2004
Objective: To describe the daily practice of mechanical ventilation (MV), and secondarily, its ou... more Objective: To describe the daily practice of mechanical ventilation (MV), and secondarily, its outcome in pediatric intensive care units (PICUs). Design: Prospective cohort of infants and children who received MV for at least 12 h. Setting: Thirty-six medical surgical PICUs. Patients: All consecutive patients admitted to the PICUs during 2-month period. Measurements and main results: Of the 1893 patients admitted, 659 (35%) received MV for a median time of 4 days (25th percentile, 75%: 2, 6). Median of age was 13 months (25th percentile, 75%: 5, 48). Common indications for MV were acute respiratory failure (ARF) in 72% of the patients, altered mental status in 14% of the patients, and ARF on chronic pulmonary disease in 10% of the patients. Median length of stay in the PICUs was 8 days (25th percentile, 75%: 5, 13). Overall mortality rate in the PICUs was 15% (confidence interval 95%: 13-18) for the entire population, 50% (95% CI: 25-74) in patients who received MV because of acute respiratory distress syndrome, 24% (95% CI: 16-35) in patients who received MV for altered mental status and 16% (95% CI: 9-29) in patients who received MV for ARF on chronic pulmonary disease. Conclusion: One in every 3 patients admitted to the PICUs requires ventilatory support.. The ARF was the most common reason for MV, and survival of unselected infants and children receiving MV for more than 12 h was 85%.
B106. RESPIRATORY FAILURE IN CHILDREN, 2010
Pharmaceutical Research, 2004
Purpose. Better dosing is needed for antibiotics, including teicoplanin (TEI), to prevent emergen... more Purpose. Better dosing is needed for antibiotics, including teicoplanin (TEI), to prevent emergence of resistant bacterial strains. Here, we assess the TEI pharmacokinetics (PK) related to a 10 mg/l minimum inhibitory concentration (MIC) target in ICU children (4 to 120 months; n ס 20) with gram+ infections. Methods. Standard administration of TEI was with three 10 mg/kg Q12h, loading infusions, and maintainance with 10 mg/kg or 15 mg/kg Q24h. During maintenance, 9 samples (3/day) were collected per patient and the PK analyzed with Nonlinear Mixed Effects Model (NONMEM). Results. Thirty-five percent of concentrations in older children (Ն2 months) vs. 8% in younger infants (<12 months) were below the target MIC. The global bicompartmental population PK parameters were [mean (interindividual CV%)] CL ס 0.23 l/h [72%], V ס 3.16 l [58%], k 12 ס 0.23 h −1 , and k 21 ס 0.04 h −1. Two PK subpopulations were identified. The older children had CL ס 0.29 [23%] l/h, V ס 3.9 l and the younger infants, CLס 0.09 [37%] l/h, V ס 1.05 l. Residual error was reduced from 52% to around 30% in the final models. Conclusions. Older children in the ICU may require relatively higher doses of teicoplanin. However, a study in a larger population is needed.
Intensive Care Medicine, 1999
PubMed, Jun 1, 1985
A 13 year-old boy with Wilson's disease was treated with zinc sulphate per os for 4 years. This t... more A 13 year-old boy with Wilson's disease was treated with zinc sulphate per os for 4 years. This treatment, which was effective and non toxic, could substitute for penicillamine as long term treatment of Wilson's disease.
Annals of clinical microbiology and antimicrobials, Jan 17, 2004
The aim of this study was to determine whether prior antimicrobial therapy is an important risk f... more The aim of this study was to determine whether prior antimicrobial therapy is an important risk factor for extended antimicrobial therapy among critically ill children. To evaluate other predisposing factors influencing the usage of antibiotics in a pediatric intensive care unit (PICU) setting. To examine the relationship between the extent of antimicrobial treatment and the incidence of nosocomial infections and outcome. This prospective observational cohort study was conducted at a university-affiliated teaching hospital (760 beds) in Athens. Clinical data were collected upon admission and on each consecutive PICU day. The primary reason for PICU admission was recorded using a modified classification for mutually exclusive disease categories. All administered antibiotics to the PICU patients were recorded during a six-month period. Microbiological and pharmacological data were also collected over this period. The cumulative per patient and the maximum per day numbers of administer...
Veterinary and human toxicology, 2001
A familial occurrence of acute paraquat (PQ) poisoning is reported. The mother administered a PQ ... more A familial occurrence of acute paraquat (PQ) poisoning is reported. The mother administered a PQ solution to their 3 children aged 8 y, 6 y and 15 mo and then ingested an unknown amount of the herbicide herself. In the absence of history or diagnostic signs, the poisoning was initially misdiagnosed as gastroenteritis. Thirty h after the ingestions, serum PQ concentrations of the children were 60, <6 and 25 ng/ml respectively. Hemoperfusion was performed on all patients, and 2 of the children also received plasmapheresis and erythropheresis. The 3 children recovered fully but the mother died. According to these patients' data, the extracorporeal techniques had little effect on PQ removal, and the decreases in serum PQ were related to its urinary excretion.
Archives françaises de pédiatrie
A 13 year-old boy with Wilson's disease was treated with zinc sulphate per os for 4 years. Th... more A 13 year-old boy with Wilson's disease was treated with zinc sulphate per os for 4 years. This treatment, which was effective and non toxic, could substitute for penicillamine as long term treatment of Wilson's disease.
QJM, 2004
Background: Advances in paediatric critical care have resulted in increased survival of criticall... more Background: Advances in paediatric critical care have resulted in increased survival of critically ill patients, many of whom require long-term ventilation as a means of life support. Aim: To determine current trends in resource utilization, and problems in the care of acute and chronic paediatric intensive care patients. Design: Open observational study. Methods: We evaluated consecutive admissions (n ¼ 1629) to a 10-bed paediatric intensive care unit (PICU) over a 5-year period. Three previously defined criteria for resource utilization were used: mean length of stay (LOS); length of mechanical ventilation (LOMV); and LOMV/LOS ratio. Results: A total of 10 310 patient bed days and 5223 ventilator days were used. Mean LOS increased from 5.3 AE 12 days in 1998 to 8.7 AE 27 days in 2001 (p < 0.05). Although LOMV/LOS ratio (50.7%) was significantly correlated with Paediatric Risk of Mortality score (p < 0.0001), there was no significant change in mortality rate (12.6% vs. 12%). Patients hospitalized for >2 weeks (n ¼ 320, 20%) used 55% of LOS and 57% of LOMV, in contrast to the 1298 (80%) hospitalized for <7 days, who used only 29% of LOS and 20% of LOMV. Patients hospitalized for >3 months (11, 0.7%) consumed 17% of LOS and 23% of LOMV. Five of these (45%) were eventually discharged home, two on ventilators. Conclusions: The increasing trend of occupation of PICU bed and ventilator days by critically ill children may be related to the increasing trend for hospitalization of chronic care patients. Severity scoring systems were predictive of resource consumption, but not of the overall trend in mortality rate.
Pediatric Research, 2010
Background: VLBWI mortality rates vary across NICUs, however few comparisons are available betwee... more Background: VLBWI mortality rates vary across NICUs, however few comparisons are available between different national networks. Aim: To compare and analyze differences in neonatal mortality rates of two VLBWI cohorts from Neonatal Networks in Spain and Japan. Methods: Risk/protective factors, complications, and morbi-mortality outcomes were compared among inborn VLBWI admitted to NICU´s from SEN-1500 (7,006 infants, 63 NICU's) and NRNJ (8,695 infants, 69 NICU's) from 2005 to 2007. Nonparametric independent comparison analysis and logistic regression models were performed to predict mortality adjusting for perinatal risks factors. Results: Significant differences were found in gestation [mean(SD); 29.3(2.9) vs. 28.6(3.3) wks] and birthweigh [1117(271) vs. 1031(304)g. Both, 28-days neonatal and pre-discharge mortality rates were significantly higher in SEN-1500 (12.5% and 14.7%) than in NRNJ (6.4 and 9.2%). Differences in mortality remained even when adjusting for GA, birthweight, prenatal steroid use, 1 and 5-min Apgar scores and presence of major congenital anomalies. There were many differences in clinical management among networks. In SEN-1500, use of surfactant and high frequency ventilation and DBP and PDA ligation rates were lower, but had higher rates of NEC, grades 3-4 IVH, and specially of sepsis (32.7% vs. 7.3%; p< 0.001). Conclusion: Differences in neonatal and predischarge mortality rates of VLBWI form SEN-1500 and NRNJ could not completely be explained by initial risk and protective factors. Sepsis-related mortality accounted for 61.3% of the excess mortality in SEN-1500. The implementation of systematic preventive strategies for sepsis seems mandatory.
Pediatric Pulmonology, 2006
KL-6 is a high molecular weight glycoprotein that is expressed on the apical borders of normal se... more KL-6 is a high molecular weight glycoprotein that is expressed on the apical borders of normal secretary alveolar epithelial cells. The aim of our study was to elucidate the potential role of circulating levels of KL-6, related to C-reacting protein (CRP), disease severity (PRISM, TISS), length of stay (LOS) or mechanical ventilation (LOMV), and outcome, in children with acute respiratory distress syndrome (ARDS), sepsis, or traumatic brain injury (TBI). KL-6 concentrations were monitored using solid phase sandwich enzyme-linked immunosorbent assay in plasma of nine patients with ARDS and compared to nine patients with TBI, nine with sepsis, and nine ventilated patients with cancer of matched illness severity on days 1, 3, 5, 7, and 10. Initial respiratory/ventilatory parameters (oxygenation index, plateau pressures) were recorded for ARDS patients. Patients with ARDS had higher early plasma levels of KL-6 (956 AE 400 U/ml), as compared to patients with TBI (169 AE 9 U/ml), sepsis (282 AE 81 U/ml), and ventilated controls (255 AE 40 U/ml). Significant correlations were demonstrated between plasma KL-6 concentration and oxygenation index, PaO 2 : FiO 2 ratio, LOS and LOMV, but not with CRP or PRISM. Only in patients with ARDS, plasma KL-6 levels were higher in non-survivors than survivors (P < 0.03). Plasma KL-6 levels have possible prognostic significance and may provide a useful marker for ARDS in critically ill children.
Pediatric Neurology, 1998
A 2-year-old male developed generalized tonic-clonic seizure activity, tremor of limbs, muscle we... more A 2-year-old male developed generalized tonic-clonic seizure activity, tremor of limbs, muscle weakness, ataxia, and hypertonia after he swallowed 16 50-mg tablets of lamotrigine. His vital signs were normal, as were electroencephalography and laboratory investigation tests. The urine toxicologic screen revealed no other drugs. Treatment included midazolam and gastric lavage followed by activated charcoal and fluid loads. Symptoms resolved within 24 hours, and the child was discharged without any further complications. Serial blood samples revealed plasma lamotrigine levels at the high adult therapeutic range (3.8 mg/L) but a slow elimination rate. This is the first report of seizure activity reported in a patient receiving an overdose of lamotrigine. However, no evident concentration-effect-side-effect relationship has been established in children. Interestingly in this child, lamotrigine overdose presented exclusively with treatment-emergent neurologic abnormalities, sparing all other systems.
Pediatric Hematology-Oncology, 1999
Pediatric Emergency Care, 2000
Children with acute meningococcemia may have impaired myocardial function resulting in low cardia... more Children with acute meningococcemia may have impaired myocardial function resulting in low cardiac output despite normal intravascular volume. Severe meningococcal infection has been associated with acute interstitial myocarditis, endocarditis, and pericarditis, but not with myocardial infarction. We present the case of a 10-year-old girl with positive family history for premature myocardial infarction who sustained an acute myocardial infarction temporally related to meningococcemia. This is the first pediatric case of non-Q wave acute myocardial infarction associated with purpura fulminans in meningococcemia. Similarly, the association of high troponin I levels and meningococcemia has not been described previously. Although, the patient's genetic predisposition for myocardial infarction might have been a potential contributing factor, there was no angiographic evidence of coronary artery disease in this patient. Thereby, other factors related to shock, endotoxin, microthrombi of meningococcemia, and their treatment might have been also contributing. We propose possible mechanisms for this rare but serious complication of meningococcemia and review the literature.
Pediatric Critical Care Medicine, 2001
OBJECTIVES: To investigate the feasibility, adequacy, and efficacy of early poststress intragastr... more OBJECTIVES: To investigate the feasibility, adequacy, and efficacy of early poststress intragastric feeding (EPIGF) in critically ill children. DESIGN: A prospective clinical study. SETTING: Pediatric intensive care unit in a tertiary care children's hospital. PATIENTS: Seventy-one consecutively enrolled critically ill children requiring prolonged mechanical ventilation. INTERVENTIONS: Full-strength intragastric tube feedings (Nutrison Pediatric, Standard) were initiated within 12 hrs of the study-entry event. Enteral feedings were advanced to a target volume of energy intake = 1/2, 1, 5/4, 6/4, and 6/4 of the predicted basal metabolic rate (PBMR) on days 1-5, respectively. MEASUREMENTS AND MAIN RESULTS: Nutritional status by the caloric intake, recommended dietary allowances, PBMR, predicted energy expenditure (PEE), anthropometry, and clinical indices were evaluated on days 1 and 5. Safety was assessed by the clinical course of disease, laboratory findings, and occurrence of complications. Success was determined by accomplishment of the PEE target. The early success rate was 94.4% and predicted late enteral feeding success accurately (p =.0001). Caloric intake approached PBMR the second day (43 +/- 1.7 kcal/kg/day vs. 43.2 +/- 1.1 kcal/kg/day) and PEE the fifth day (66.2 +/- 2.7 kcal/kg/day vs. 67.7 +/- 6.4 kcal/kg/day). Multivariate stepwise regression analysis showed that poor outcome and a high Therapeutic Intervention Scoring System score correlated with failure of EPIGF (p <.0001). Patients who succeeded EPIGF had significantly higher myocardial ejection (65% vs. 43%; p <.0001) or shortening fractions (34% vs. 20%; p =.0001) on day 1 than those who failed. Patients tolerated EPIGF well; 9.9% developed nosocomial pneumonia, 5.6% developed diarrhea, and 8.5% needed treatment with cisapride because of a delay of gastric emptying. The mortality rate (5.6%) was different between initial and final success and failure groups (p <.0001) and was lower than predicted by the admission severity scores (12% +/- 2%). CONCLUSIONS: This study showed that increases of caloric intake during the acute phase of a critical illness are well tolerated and may approach PBMR by the second day and PEE by the fourth day in critically ill children. Caloric intake lower than PBMR is associated with higher mortality and morbidity rates.
Pediatric Critical Care Medicine, 2006
Objectives: In the intensive care unit for ill new-borns far-reaching decisions are taken by doct... more Objectives: In the intensive care unit for ill new-borns far-reaching decisions are taken by doctors, nurses, and other practitioners. These decisions revolve around the health and death of new-borns who are highly dependent on the practitioners. Due to enormous medical-technical developments boundaries have been extended further and further over the past decade. Because of this the views on the preservation of life, the lengthening of life and the quality of life are under discussion. Nurses supposedly play an important role in the decision-making process. However, it is not clear what the implications of that role are. Methods: Research was carried out among nurses working in the intensive care unit neonatalogy of the Wilhelmina Children's Hospital in Utrecht. Ten respondents who all had ample experience in decision-making processes on life-terminating treatment in new-borns were interviewed. Nurses told about their experiences with the decisionmaking process in the neonatal unit. The findings were analysed according to the stages as described by Maso (1994). Results: The results of this qualitative study yielded two categories: 'representing' and 'supporting'. Within the category 'supporting' two subcategories arose, namely 'assisting' and 'taking care of '. Conclusions: In the decision-making process the nurses mainly act as representatives. They also play an important role in the support process. They assist and take good care of parents and other persons involved. The representative role is essential to the decisionmaking process, while the supporting role can be regarded as being part of the job's profile of nurses in general and of pediatric nurses in particular. The intensity of the representative role is to a large degree related to the nurse's experience and position within the team which takes the decision.
Intensive Care Medicine, 2004
Objective: To describe the daily practice of mechanical ventilation (MV), and secondarily, its ou... more Objective: To describe the daily practice of mechanical ventilation (MV), and secondarily, its outcome in pediatric intensive care units (PICUs). Design: Prospective cohort of infants and children who received MV for at least 12 h. Setting: Thirty-six medical surgical PICUs. Patients: All consecutive patients admitted to the PICUs during 2-month period. Measurements and main results: Of the 1893 patients admitted, 659 (35%) received MV for a median time of 4 days (25th percentile, 75%: 2, 6). Median of age was 13 months (25th percentile, 75%: 5, 48). Common indications for MV were acute respiratory failure (ARF) in 72% of the patients, altered mental status in 14% of the patients, and ARF on chronic pulmonary disease in 10% of the patients. Median length of stay in the PICUs was 8 days (25th percentile, 75%: 5, 13). Overall mortality rate in the PICUs was 15% (confidence interval 95%: 13-18) for the entire population, 50% (95% CI: 25-74) in patients who received MV because of acute respiratory distress syndrome, 24% (95% CI: 16-35) in patients who received MV for altered mental status and 16% (95% CI: 9-29) in patients who received MV for ARF on chronic pulmonary disease. Conclusion: One in every 3 patients admitted to the PICUs requires ventilatory support.. The ARF was the most common reason for MV, and survival of unselected infants and children receiving MV for more than 12 h was 85%.
B106. RESPIRATORY FAILURE IN CHILDREN, 2010
Pharmaceutical Research, 2004
Purpose. Better dosing is needed for antibiotics, including teicoplanin (TEI), to prevent emergen... more Purpose. Better dosing is needed for antibiotics, including teicoplanin (TEI), to prevent emergence of resistant bacterial strains. Here, we assess the TEI pharmacokinetics (PK) related to a 10 mg/l minimum inhibitory concentration (MIC) target in ICU children (4 to 120 months; n ס 20) with gram+ infections. Methods. Standard administration of TEI was with three 10 mg/kg Q12h, loading infusions, and maintainance with 10 mg/kg or 15 mg/kg Q24h. During maintenance, 9 samples (3/day) were collected per patient and the PK analyzed with Nonlinear Mixed Effects Model (NONMEM). Results. Thirty-five percent of concentrations in older children (Ն2 months) vs. 8% in younger infants (<12 months) were below the target MIC. The global bicompartmental population PK parameters were [mean (interindividual CV%)] CL ס 0.23 l/h [72%], V ס 3.16 l [58%], k 12 ס 0.23 h −1 , and k 21 ס 0.04 h −1. Two PK subpopulations were identified. The older children had CL ס 0.29 [23%] l/h, V ס 3.9 l and the younger infants, CLס 0.09 [37%] l/h, V ס 1.05 l. Residual error was reduced from 52% to around 30% in the final models. Conclusions. Older children in the ICU may require relatively higher doses of teicoplanin. However, a study in a larger population is needed.
Intensive Care Medicine, 1999
PubMed, Jun 1, 1985
A 13 year-old boy with Wilson's disease was treated with zinc sulphate per os for 4 years. This t... more A 13 year-old boy with Wilson's disease was treated with zinc sulphate per os for 4 years. This treatment, which was effective and non toxic, could substitute for penicillamine as long term treatment of Wilson's disease.
Annals of clinical microbiology and antimicrobials, Jan 17, 2004
The aim of this study was to determine whether prior antimicrobial therapy is an important risk f... more The aim of this study was to determine whether prior antimicrobial therapy is an important risk factor for extended antimicrobial therapy among critically ill children. To evaluate other predisposing factors influencing the usage of antibiotics in a pediatric intensive care unit (PICU) setting. To examine the relationship between the extent of antimicrobial treatment and the incidence of nosocomial infections and outcome. This prospective observational cohort study was conducted at a university-affiliated teaching hospital (760 beds) in Athens. Clinical data were collected upon admission and on each consecutive PICU day. The primary reason for PICU admission was recorded using a modified classification for mutually exclusive disease categories. All administered antibiotics to the PICU patients were recorded during a six-month period. Microbiological and pharmacological data were also collected over this period. The cumulative per patient and the maximum per day numbers of administer...
Veterinary and human toxicology, 2001
A familial occurrence of acute paraquat (PQ) poisoning is reported. The mother administered a PQ ... more A familial occurrence of acute paraquat (PQ) poisoning is reported. The mother administered a PQ solution to their 3 children aged 8 y, 6 y and 15 mo and then ingested an unknown amount of the herbicide herself. In the absence of history or diagnostic signs, the poisoning was initially misdiagnosed as gastroenteritis. Thirty h after the ingestions, serum PQ concentrations of the children were 60, <6 and 25 ng/ml respectively. Hemoperfusion was performed on all patients, and 2 of the children also received plasmapheresis and erythropheresis. The 3 children recovered fully but the mother died. According to these patients' data, the extracorporeal techniques had little effect on PQ removal, and the decreases in serum PQ were related to its urinary excretion.
Archives françaises de pédiatrie
A 13 year-old boy with Wilson's disease was treated with zinc sulphate per os for 4 years. Th... more A 13 year-old boy with Wilson's disease was treated with zinc sulphate per os for 4 years. This treatment, which was effective and non toxic, could substitute for penicillamine as long term treatment of Wilson's disease.
QJM, 2004
Background: Advances in paediatric critical care have resulted in increased survival of criticall... more Background: Advances in paediatric critical care have resulted in increased survival of critically ill patients, many of whom require long-term ventilation as a means of life support. Aim: To determine current trends in resource utilization, and problems in the care of acute and chronic paediatric intensive care patients. Design: Open observational study. Methods: We evaluated consecutive admissions (n ¼ 1629) to a 10-bed paediatric intensive care unit (PICU) over a 5-year period. Three previously defined criteria for resource utilization were used: mean length of stay (LOS); length of mechanical ventilation (LOMV); and LOMV/LOS ratio. Results: A total of 10 310 patient bed days and 5223 ventilator days were used. Mean LOS increased from 5.3 AE 12 days in 1998 to 8.7 AE 27 days in 2001 (p < 0.05). Although LOMV/LOS ratio (50.7%) was significantly correlated with Paediatric Risk of Mortality score (p < 0.0001), there was no significant change in mortality rate (12.6% vs. 12%). Patients hospitalized for >2 weeks (n ¼ 320, 20%) used 55% of LOS and 57% of LOMV, in contrast to the 1298 (80%) hospitalized for <7 days, who used only 29% of LOS and 20% of LOMV. Patients hospitalized for >3 months (11, 0.7%) consumed 17% of LOS and 23% of LOMV. Five of these (45%) were eventually discharged home, two on ventilators. Conclusions: The increasing trend of occupation of PICU bed and ventilator days by critically ill children may be related to the increasing trend for hospitalization of chronic care patients. Severity scoring systems were predictive of resource consumption, but not of the overall trend in mortality rate.
Pediatric Research, 2010
Background: VLBWI mortality rates vary across NICUs, however few comparisons are available betwee... more Background: VLBWI mortality rates vary across NICUs, however few comparisons are available between different national networks. Aim: To compare and analyze differences in neonatal mortality rates of two VLBWI cohorts from Neonatal Networks in Spain and Japan. Methods: Risk/protective factors, complications, and morbi-mortality outcomes were compared among inborn VLBWI admitted to NICU´s from SEN-1500 (7,006 infants, 63 NICU's) and NRNJ (8,695 infants, 69 NICU's) from 2005 to 2007. Nonparametric independent comparison analysis and logistic regression models were performed to predict mortality adjusting for perinatal risks factors. Results: Significant differences were found in gestation [mean(SD); 29.3(2.9) vs. 28.6(3.3) wks] and birthweigh [1117(271) vs. 1031(304)g. Both, 28-days neonatal and pre-discharge mortality rates were significantly higher in SEN-1500 (12.5% and 14.7%) than in NRNJ (6.4 and 9.2%). Differences in mortality remained even when adjusting for GA, birthweight, prenatal steroid use, 1 and 5-min Apgar scores and presence of major congenital anomalies. There were many differences in clinical management among networks. In SEN-1500, use of surfactant and high frequency ventilation and DBP and PDA ligation rates were lower, but had higher rates of NEC, grades 3-4 IVH, and specially of sepsis (32.7% vs. 7.3%; p< 0.001). Conclusion: Differences in neonatal and predischarge mortality rates of VLBWI form SEN-1500 and NRNJ could not completely be explained by initial risk and protective factors. Sepsis-related mortality accounted for 61.3% of the excess mortality in SEN-1500. The implementation of systematic preventive strategies for sepsis seems mandatory.
Pediatric Pulmonology, 2006
KL-6 is a high molecular weight glycoprotein that is expressed on the apical borders of normal se... more KL-6 is a high molecular weight glycoprotein that is expressed on the apical borders of normal secretary alveolar epithelial cells. The aim of our study was to elucidate the potential role of circulating levels of KL-6, related to C-reacting protein (CRP), disease severity (PRISM, TISS), length of stay (LOS) or mechanical ventilation (LOMV), and outcome, in children with acute respiratory distress syndrome (ARDS), sepsis, or traumatic brain injury (TBI). KL-6 concentrations were monitored using solid phase sandwich enzyme-linked immunosorbent assay in plasma of nine patients with ARDS and compared to nine patients with TBI, nine with sepsis, and nine ventilated patients with cancer of matched illness severity on days 1, 3, 5, 7, and 10. Initial respiratory/ventilatory parameters (oxygenation index, plateau pressures) were recorded for ARDS patients. Patients with ARDS had higher early plasma levels of KL-6 (956 AE 400 U/ml), as compared to patients with TBI (169 AE 9 U/ml), sepsis (282 AE 81 U/ml), and ventilated controls (255 AE 40 U/ml). Significant correlations were demonstrated between plasma KL-6 concentration and oxygenation index, PaO 2 : FiO 2 ratio, LOS and LOMV, but not with CRP or PRISM. Only in patients with ARDS, plasma KL-6 levels were higher in non-survivors than survivors (P < 0.03). Plasma KL-6 levels have possible prognostic significance and may provide a useful marker for ARDS in critically ill children.
Pediatric Neurology, 1998
A 2-year-old male developed generalized tonic-clonic seizure activity, tremor of limbs, muscle we... more A 2-year-old male developed generalized tonic-clonic seizure activity, tremor of limbs, muscle weakness, ataxia, and hypertonia after he swallowed 16 50-mg tablets of lamotrigine. His vital signs were normal, as were electroencephalography and laboratory investigation tests. The urine toxicologic screen revealed no other drugs. Treatment included midazolam and gastric lavage followed by activated charcoal and fluid loads. Symptoms resolved within 24 hours, and the child was discharged without any further complications. Serial blood samples revealed plasma lamotrigine levels at the high adult therapeutic range (3.8 mg/L) but a slow elimination rate. This is the first report of seizure activity reported in a patient receiving an overdose of lamotrigine. However, no evident concentration-effect-side-effect relationship has been established in children. Interestingly in this child, lamotrigine overdose presented exclusively with treatment-emergent neurologic abnormalities, sparing all other systems.
Pediatric Hematology-Oncology, 1999
Pediatric Emergency Care, 2000
Children with acute meningococcemia may have impaired myocardial function resulting in low cardia... more Children with acute meningococcemia may have impaired myocardial function resulting in low cardiac output despite normal intravascular volume. Severe meningococcal infection has been associated with acute interstitial myocarditis, endocarditis, and pericarditis, but not with myocardial infarction. We present the case of a 10-year-old girl with positive family history for premature myocardial infarction who sustained an acute myocardial infarction temporally related to meningococcemia. This is the first pediatric case of non-Q wave acute myocardial infarction associated with purpura fulminans in meningococcemia. Similarly, the association of high troponin I levels and meningococcemia has not been described previously. Although, the patient's genetic predisposition for myocardial infarction might have been a potential contributing factor, there was no angiographic evidence of coronary artery disease in this patient. Thereby, other factors related to shock, endotoxin, microthrombi of meningococcemia, and their treatment might have been also contributing. We propose possible mechanisms for this rare but serious complication of meningococcemia and review the literature.
Pediatric Critical Care Medicine, 2001
OBJECTIVES: To investigate the feasibility, adequacy, and efficacy of early poststress intragastr... more OBJECTIVES: To investigate the feasibility, adequacy, and efficacy of early poststress intragastric feeding (EPIGF) in critically ill children. DESIGN: A prospective clinical study. SETTING: Pediatric intensive care unit in a tertiary care children's hospital. PATIENTS: Seventy-one consecutively enrolled critically ill children requiring prolonged mechanical ventilation. INTERVENTIONS: Full-strength intragastric tube feedings (Nutrison Pediatric, Standard) were initiated within 12 hrs of the study-entry event. Enteral feedings were advanced to a target volume of energy intake = 1/2, 1, 5/4, 6/4, and 6/4 of the predicted basal metabolic rate (PBMR) on days 1-5, respectively. MEASUREMENTS AND MAIN RESULTS: Nutritional status by the caloric intake, recommended dietary allowances, PBMR, predicted energy expenditure (PEE), anthropometry, and clinical indices were evaluated on days 1 and 5. Safety was assessed by the clinical course of disease, laboratory findings, and occurrence of complications. Success was determined by accomplishment of the PEE target. The early success rate was 94.4% and predicted late enteral feeding success accurately (p =.0001). Caloric intake approached PBMR the second day (43 +/- 1.7 kcal/kg/day vs. 43.2 +/- 1.1 kcal/kg/day) and PEE the fifth day (66.2 +/- 2.7 kcal/kg/day vs. 67.7 +/- 6.4 kcal/kg/day). Multivariate stepwise regression analysis showed that poor outcome and a high Therapeutic Intervention Scoring System score correlated with failure of EPIGF (p <.0001). Patients who succeeded EPIGF had significantly higher myocardial ejection (65% vs. 43%; p <.0001) or shortening fractions (34% vs. 20%; p =.0001) on day 1 than those who failed. Patients tolerated EPIGF well; 9.9% developed nosocomial pneumonia, 5.6% developed diarrhea, and 8.5% needed treatment with cisapride because of a delay of gastric emptying. The mortality rate (5.6%) was different between initial and final success and failure groups (p <.0001) and was lower than predicted by the admission severity scores (12% +/- 2%). CONCLUSIONS: This study showed that increases of caloric intake during the acute phase of a critical illness are well tolerated and may approach PBMR by the second day and PEE by the fourth day in critically ill children. Caloric intake lower than PBMR is associated with higher mortality and morbidity rates.
Pediatric Critical Care Medicine, 2006
Objectives: In the intensive care unit for ill new-borns far-reaching decisions are taken by doct... more Objectives: In the intensive care unit for ill new-borns far-reaching decisions are taken by doctors, nurses, and other practitioners. These decisions revolve around the health and death of new-borns who are highly dependent on the practitioners. Due to enormous medical-technical developments boundaries have been extended further and further over the past decade. Because of this the views on the preservation of life, the lengthening of life and the quality of life are under discussion. Nurses supposedly play an important role in the decision-making process. However, it is not clear what the implications of that role are. Methods: Research was carried out among nurses working in the intensive care unit neonatalogy of the Wilhelmina Children's Hospital in Utrecht. Ten respondents who all had ample experience in decision-making processes on life-terminating treatment in new-borns were interviewed. Nurses told about their experiences with the decisionmaking process in the neonatal unit. The findings were analysed according to the stages as described by Maso (1994). Results: The results of this qualitative study yielded two categories: 'representing' and 'supporting'. Within the category 'supporting' two subcategories arose, namely 'assisting' and 'taking care of '. Conclusions: In the decision-making process the nurses mainly act as representatives. They also play an important role in the support process. They assist and take good care of parents and other persons involved. The representative role is essential to the decisionmaking process, while the supporting role can be regarded as being part of the job's profile of nurses in general and of pediatric nurses in particular. The intensity of the representative role is to a large degree related to the nurse's experience and position within the team which takes the decision.