Vincent Geukers - Academia.edu (original) (raw)
Papers by Vincent Geukers
Introduction: With the many alluring features of HRM including superior spatial resolution and ra... more Introduction: With the many alluring features of HRM including superior spatial resolution and rapid recording frequency, interest in manometric evaluation of the pharynx during swallowing has been renewed. However, crucial information about the physiologic variability of pharyngeal peristaltic pressure wave parameters is scarce. These data are vital for developing normative data and correct interpretation of pharyngeal manometry results. The aims of the present study were to determine: 1) the variability of pharyngeal peristaltic pressure wave amplitude and duration between swallows at various distances from the upper esophageal sphincter (UES) and 2) Pharyngeal Contractile Integral(PCI),hypo-pharyngeal intra-bolus pressure(IBP) and nadir UES pressure(N-UESP) for a range of swallowed volumes. Methods: We studied seven healthy individuals (age:51±25 years, 6F) in upright head neutral position using a high resolution manometry catheter with 36 recording sites positioned trans-nasally such that pressure was recorded from the entire pharynx, UES and proximal esophagus. In each subject, we tested three repetitions each of dry and room temperature 0.5,5 and 10ml water at 20-30second intervals. Statistical analysis included ANOVA, Kruskal-Wallis Testing, Bartlett's Test of variance, Conover's Squared Rank Test of Variance and the coefficient of variation. Results: Spatial variation of the peak peristaltic pressure wave amplitude showed significant difference in variance across locations 2, 3, 4, 5, 6, 7 and 8cm above the upper margin of the UES high pressure zone (umUESHPZ) for dry(p=0.043), 0.5 (p=0.006) and 5ml (p=0.049)swallows (table). There was significant variability in the peak amplitude between swallows at all sites as seen by the standard deviation bars in the figure (representative example for 5ml swallows). The smallest degree of variability across sites was seen at p6 (6 cm above the umUESHPZ) shown in the figure as circles representing the coefficients of variation. Variance due to volume effects also showed significant differences; however, these difference in variance were confined only to sites 3 (p=0.015), 4 (p=0.020) and 6 (p=0.022) cm above the umUESHPZ. In contrast, PCI and IBP showed similar variability for the tested swallow volumes. Conclusions: 1) Parameters of pharyngeal peristaltic pressure wave vary significantly from one swallow to the other for dry and water swallows,2) this variability is significantly different for different locations across the pharynx. 3) these findings should be taken into account for defining normative data and using pharyngeal manometry for clinical purposes. Supported in part by R01DK025731 and P01DK068051.
Background: Fluid overload is common in critically ill children and is associated with adverse ou... more Background: Fluid overload is common in critically ill children and is associated with adverse outcome. Therefore, restricting uid intake may be bene cial. This study aims to pilot the feasibility of a RCT comparing a conservative to a standard, more liberal, strategy of uid management in mechanically ventilated (MV) pediatric patients with acute respiratory tract infection (ARTI). Methods: This is a pilot RCT and feasibility study in a single, tertiary referral pediatic intensive care unit. Twenty-three children receiving MV for ARTI, without ongoing hemodynamic support, admitted to the PICU of the Emma Children's Hospital/Amsterdam UMC between 2016-2018 were included. Patients were randomized to a conservative (<70% of normal intake) or standard (>85% of normal intake) uid strategy, which was kept throughout the period of MV. Results: Primary endpoints were adherence to uid strategy and safety parameters such as calorie and protein intake. Secondary outcomes were cumulative uid intake (CFI) and cumulative uid balance (CFB) on day 3. In the conservative group, in 75% of the MV days patients reached their target uid intake. Median calorie intake over all MV days was 67.8 [53.1-75.2] kcal/kg/day and 1.6 [1.3-1.7] gr protein/kg/day (no difference between groups). No adverse effects on hemodynamics
The use of patient histories has become an essential part of medical education. Patient histories... more The use of patient histories has become an essential part of medical education. Patient histories are important for the relevance, effectiveness and appeal of medical education. The sharing of patient-related information in education and further training is expected to increase in the coming years. The sharing of patient information with colleagues, students or other interested parties can conflict with the rules protecting patient privacy. The most important rule in this context is that it is the patients who decide whether their cases can be shown to others for educational purposes. Patient consent is not required if the data or images used have been fully anonymized. If the information can be traced to the patient, consent is required, preferably documented in writing. The teaching physician is responsible for the storage, protection and destruction of patient data and for controlling access to information
PubMed, 2015
The use of patient histories has become an essential part of medical education. Patient histories... more The use of patient histories has become an essential part of medical education. Patient histories are important for the relevance, effectiveness and appeal of medical education. The sharing of patient-related information in education and further training is expected to increase in the coming years. The sharing of patient information with colleagues, students or other interested parties can conflict with the rules protecting patient privacy. The most important rule in this context is that it is the patients who decide whether their cases can be shown to others for educational purposes. Patient consent is not required if the data or images used have been fully anonymized. If the information can be traced to the patient, consent is required, preferably documented in writing. The teaching physician is responsible for the storage, protection and destruction of patient data and for controlling access to information.
Nederlands Tijdschrift voor Geneeskunde, 2010
&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;Acute respiratory distress syndrome&... more &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;Acute respiratory distress syndrome&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (ARDS) developed as a serious complication of an infection with the influenza virus A (H1N1) (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;swine flu&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;) in 3 children: a 15-year-old girl, a 6-year-old boy and a 14-year-old girl. The latter two patients also suffered from septic shock. Intensive ICU treatment, including mechanical ventilation, did not lead to recovery. The first two patients eventually recovered following treatment with extracorporeal membrane oxygenation (ECMO), but the third patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s condition was too unstable for transfer to an ECMO centre. This patient died.
Nederlands Tijdschrift voor Geneeskunde, Jul 26, 2021
Background: Infants who are born in The Netherlands receive oral vitamin K to prevent bleeding du... more Background: Infants who are born in The Netherlands receive oral vitamin K to prevent bleeding due to a vitamin K deficiency. However the incidence of such bleedings are higher compared to other European countries. Therefore, the Dutch Health Council advised in 2017 to change this guideline from oral to intramuscular administration. Case description: A 2 months old girl presented with a fatal intracranial hemorrhage. A day before she developed a hematoma on her foot and orbit. Despite daily oral vitamin K, blood results revealed a severe vitamin K deficiency-related bleeding. Postmortem liver biopsy and genetic studies showed cholestasis as the most likely cause of malabsorption of fat soluble vitamins due to a heterozygous pathogenic variant in the ABCB11 gene, which could possibly be transient. Conclusion: Our case illustrates the importance of revising the national guideline for vitamin K prophylaxis to intramuscular administration, according to the recommendation of the Dutch Health Council.
Clinical Pediatrics, Sep 13, 2010
Objective: This study describes the clinical course, treatment, and outcome of 13 critically ill ... more Objective: This study describes the clinical course, treatment, and outcome of 13 critically ill children due to infection with new influenza A H1N1, admitted to 2 pediatric intensive care units (PICUs) in the northwestern part of the Netherlands. Methods: Retrospective case series, conducted in 2 PICUs in Amsterdam, the Netherlands. Results: A total of 13 children with a new influenza A H1N1 infection were admitted at 2 Dutch PICUs. The majority of these children were 12 to 16 years old and had an underlying disease. All children required mechanical ventilatory support. Shock was present in 7 of 13 (54%) children. Two children were transferred to a supraregional PICU with facilities for extracorporeal membrane oxygenation. Conclusions: In a Dutch cohort of 13 critically ill children due to infection with new influenza (H1N1), respiratory (100%) and circulatory (54%) failure characterized the course of this infection in most of these children. All children survived.
Frontiers in Pediatrics, Dec 10, 2019
Background: Fluid overload is common in critically ill children and is associated with adverse ou... more Background: Fluid overload is common in critically ill children and is associated with adverse outcome. Therefore, restricting fluid intake may be beneficial. This study aims to study the feasibility of a randomized controlled trial (RCT) comparing a conservative to a standard, more liberal, strategy of fluid management in mechanically ventilated pediatric patients with acute respiratory tract infection (ARTI). Methods: This is a feasibility study in a single, tertiary referral pediatric intensive care unit (PICU). Twenty-three children receiving mechanical ventilation for ARTI, without ongoing hemodynamic support, admitted to the PICU of the Emma Children's Hospital/Amsterdam UMC between 2016 and 2018 were included. Patients were randomized to a conservative (<70% of normal intake) or standard (>85% of normal intake) fluid strategy, which was kept throughout the period of mechanical ventilation. Results: Primary endpoints were adherence to fluid strategy and safety parameters such as calorie and protein intake. Secondary outcomes were cumulative fluid intake (CFI) and cumulative fluid balance (CFB) on day 3. In the conservative group, in 75% of the mechanical ventilation days patients achieved their target fluid intake. Median [25th−75th percentiles] calorie intake over all mechanical ventilation days was 67.9 [51.5-74.0] kcal/kg/day in the conservative vs. 67.2 [58.0-75.2] kcal/kg/day in the standard group (p = 0.878). Protein intake was 1.6 [1.3-1.8] gr protein/kg in the conservative and 1.5 [1.2-1.7] gr protein/kg in the standard group (p = 0.598). No adverse effects on hemodynamics or electrolyte imbalances were noted. Mean (±SD) CFI on day 3 was 262.3 (±58.9) ml/kg in the conservative group vs. 360.5 (±52.6) ml/kg in the standard fluid group (p < 0.001), which did not result in a lower CFB. Conclusions: A conservative fluid strategy in mechanically ventilated children with ARTI seems feasible, without limiting metabolic needs. However, in our study a conservative
Journal of Neurochemistry, Aug 1, 1992
The effect of long-term potentiation (LTP) on endogenous amino acid release from rat hippocampus ... more The effect of long-term potentiation (LTP) on endogenous amino acid release from rat hippocampus slices was studied. LTP was induced in vivo by application of a tetanus (200 Hz, 200 ms) to the Schaffer collateral fibers in unanesthetized rats. Endogenous release of glutamate and y-aminobutyric acid (GABA) was investigated 60 min after tetanization in CA1 subslices of potentiated and control rats. No significant effects of LTP were observed in basal and K+-induced Ca2+-independent release components of these amino acids. In contrast, K+-induced Caz+-dependent release of both glutamate and GABA increased-100% in slices from potentiated rats. No differences were observed in total content of glutamate and GABA between the subslices from control and LTP animals. These results suggest a persistent increase in the recruitment of the presynaptic vesicular pool of glutamate and GABA during LTP.
e-SPEN Journal, Feb 1, 2012
Background: Critical care providers fail to meet patients' nutritional demands particularly durin... more Background: Critical care providers fail to meet patients' nutritional demands particularly during the first days of stay on a pediatric intensive care unit (PICU). Objective: We aimed to study if the introduction of a feeding algorithm combined with a nutritional support team (NST) can improve nutrition delivery in a PICU. Design: In our PICU we compared the delivered percentages of goals for energy and macronutrients during the first 10 days of admission before and after the introduction of a feeding algorithm and NST. Patients with length of stay > 3 days and mechanical ventilation were included. The algorithm was based on early and aggressively incremental, nurse-driven enteral feeding with additional parenteral nutrition, if necessary. The NST reviewed and adjusted the nutrition regimens once a week and on demand. Results: The percentages of enteral nutrition delivered on day 1 doubled from 40% to 78% (p < 0.01), and increased from 60% to 92% on day 2 (p < 0.01) without increase in adverse gastrointestinal events, compared to the control period. More than 85% of nutritional targets were reached on day 3 compared to on day 4 before the protocol. Conclusion: The introduction of an early and aggressive, nurse-driven nutrition protocol, together with an NST, is an effective and safe tool to increase nutrition delivery on a PICU.
Pediatric Anesthesia, Jun 1, 2008
A 9-year-old boy underwent a thoracotomy for excision of his right third rib under combined gener... more A 9-year-old boy underwent a thoracotomy for excision of his right third rib under combined general and epidural anesthesia for a Ewings sarcoma. Postoperatively, he was found to have a complete T2-3 paraplegia. Permanent paraplegia was described as a rare complication of thoracotomy in adults, and very rarely after epidural analgesia in adults and babies. This was the first report in a child.
Nutrition, Jun 1, 2012
Objective: In pediatric cardiac surgery, fluid-restricted low-protein (LoProt) diets account for ... more Objective: In pediatric cardiac surgery, fluid-restricted low-protein (LoProt) diets account for cumulative protein deficits with increased morbidity. In this setting, we aimed to inhibit proteolysis by a high-carbohydrate (HiCarb)-intake-induced hyperinsulinemia and improve protein balance. Methods: The effect of a HiCarb/LoProt (glucose 10 mg $ kg À1 $ min À1 /protein 0.7 g $ kg À1 $ d À1) versus a normal-carbohydrate (NormCarb)/LoProt (glucose 7.5 mg $ kg À1 $ min À1 /protein 0.3 g $ kg À1 $ d À1) enteral diet on whole-body protein breakdown and balance was compared in a prospective, randomized, single-blinded trial in 24 children after cardiac surgery. On the second postoperative day, plasma insulin and amino acid concentrations, protein breakdown (endogenous rate of appearance of valine), protein synthesis (non-oxidative disposal of valine), protein balance, and the rate of appearance of urea were measured by using an isotopic infusion of [1-13 C]valine and [ 15 N 2 ] urea. Results: The HiCarb/LoProt diet led to a serum insulin concentration that was three times higher than the NormCarb/LoProt diet (596 pmol/L, 80-1833, and 198 pmol/L, 76-1292, respectively, P ¼ 0.02), without differences in plasma glucose concentrations. There were no differences in plasma amino acid concentrations, non-oxidative disposal of valine, and endogenous rate of appearance of valine between the groups, with a negative valine balance in the two groups (À0.65 mmol $ kg À1 $ min À1 , À1.91 to 0.01, and À0.58 mmol $ kg À1 $ min À1 , À2.32 to À0.07, respectively, P ¼ 0.71). The serum cortisol concentration in the HiCarb/LoProt group was lower compared with the NormCarb/LoProt group (204 nmol/L, 50-544, and 532 nmol/L, 108-930, respectively, P ¼ 0.02). Conclusion: In children with fluid restriction after cardiac surgery, a HiCarb/LoProt diet compared with a NormCarb/LoProt diet stimulates insulin secretion but does not inhibit proteolysis further and therefore cannot be advocated for this purpose.
Background: Fluid overload is common in critically ill children and is associated with adverse ou... more Background: Fluid overload is common in critically ill children and is associated with adverse outcome. Therefore, restricting fluid intake may be beneficial. This study aims to study the feasibility of a randomized controlled trial (RCT) comparing a conservative to a standard, more liberal, strategy of fluid management in mechanically ventilated pediatric patients with acute respiratory tract infection (ARTI). Methods: This is a feasibility study in a single, tertiary referral pediatic intensive care unit (PICU). Twenty-three children receiving mechanical ventilation for ARTI, without ongoing hemodynamic support, admitted to the PICU of the Emma Children’s Hospital/Amsterdam UMC between 2016-2018 were included. Patients were randomized to a conservative (<70% of normal intake) or standard (>85% of normal intake) fluid strategy, which was kept throughout the period of mechanical ventilation. Results: Primary endpoints were adherence to fluid strategy and safety parameters such...
e-SPEN Journal, 2012
Background: Critical care providers fail to meet patients' nutritional demands particularly durin... more Background: Critical care providers fail to meet patients' nutritional demands particularly during the first days of stay on a pediatric intensive care unit (PICU). Objective: We aimed to study if the introduction of a feeding algorithm combined with a nutritional support team (NST) can improve nutrition delivery in a PICU. Design: In our PICU we compared the delivered percentages of goals for energy and macronutrients during the first 10 days of admission before and after the introduction of a feeding algorithm and NST. Patients with length of stay > 3 days and mechanical ventilation were included. The algorithm was based on early and aggressively incremental, nurse-driven enteral feeding with additional parenteral nutrition, if necessary. The NST reviewed and adjusted the nutrition regimens once a week and on demand. Results: The percentages of enteral nutrition delivered on day 1 doubled from 40% to 78% (p < 0.01), and increased from 60% to 92% on day 2 (p < 0.01) without increase in adverse gastrointestinal events, compared to the control period. More than 85% of nutritional targets were reached on day 3 compared to on day 4 before the protocol. Conclusion: The introduction of an early and aggressive, nurse-driven nutrition protocol, together with an NST, is an effective and safe tool to increase nutrition delivery on a PICU.
Journal of Neurosurgery: Pediatrics, 2012
The authors report a case of a gunshot wound to the brain in a 2.5-year-old girl. To treat the un... more The authors report a case of a gunshot wound to the brain in a 2.5-year-old girl. To treat the uncontrollably elevated intracranial pressure, the patient underwent bilateral decompressive craniectomy and experimental open-wound treatment. She recovered to a good functional level.
Human Genetics - HUM GENET, 1998
Pediatric Anesthesia, 2008
A 9-year-old boy underwent a thoracotomy for excision of his right third rib under combined gener... more A 9-year-old boy underwent a thoracotomy for excision of his right third rib under combined general and epidural anesthesia for a Ewings sarcoma. Postoperatively, he was found to have a complete T2-3 paraplegia. Permanent paraplegia was described as a rare complication of thoracotomy in adults, and very rarely after epidural analgesia in adults and babies. This was the first report in a child.
Introduction: With the many alluring features of HRM including superior spatial resolution and ra... more Introduction: With the many alluring features of HRM including superior spatial resolution and rapid recording frequency, interest in manometric evaluation of the pharynx during swallowing has been renewed. However, crucial information about the physiologic variability of pharyngeal peristaltic pressure wave parameters is scarce. These data are vital for developing normative data and correct interpretation of pharyngeal manometry results. The aims of the present study were to determine: 1) the variability of pharyngeal peristaltic pressure wave amplitude and duration between swallows at various distances from the upper esophageal sphincter (UES) and 2) Pharyngeal Contractile Integral(PCI),hypo-pharyngeal intra-bolus pressure(IBP) and nadir UES pressure(N-UESP) for a range of swallowed volumes. Methods: We studied seven healthy individuals (age:51±25 years, 6F) in upright head neutral position using a high resolution manometry catheter with 36 recording sites positioned trans-nasally such that pressure was recorded from the entire pharynx, UES and proximal esophagus. In each subject, we tested three repetitions each of dry and room temperature 0.5,5 and 10ml water at 20-30second intervals. Statistical analysis included ANOVA, Kruskal-Wallis Testing, Bartlett's Test of variance, Conover's Squared Rank Test of Variance and the coefficient of variation. Results: Spatial variation of the peak peristaltic pressure wave amplitude showed significant difference in variance across locations 2, 3, 4, 5, 6, 7 and 8cm above the upper margin of the UES high pressure zone (umUESHPZ) for dry(p=0.043), 0.5 (p=0.006) and 5ml (p=0.049)swallows (table). There was significant variability in the peak amplitude between swallows at all sites as seen by the standard deviation bars in the figure (representative example for 5ml swallows). The smallest degree of variability across sites was seen at p6 (6 cm above the umUESHPZ) shown in the figure as circles representing the coefficients of variation. Variance due to volume effects also showed significant differences; however, these difference in variance were confined only to sites 3 (p=0.015), 4 (p=0.020) and 6 (p=0.022) cm above the umUESHPZ. In contrast, PCI and IBP showed similar variability for the tested swallow volumes. Conclusions: 1) Parameters of pharyngeal peristaltic pressure wave vary significantly from one swallow to the other for dry and water swallows,2) this variability is significantly different for different locations across the pharynx. 3) these findings should be taken into account for defining normative data and using pharyngeal manometry for clinical purposes. Supported in part by R01DK025731 and P01DK068051.
Background: Fluid overload is common in critically ill children and is associated with adverse ou... more Background: Fluid overload is common in critically ill children and is associated with adverse outcome. Therefore, restricting uid intake may be bene cial. This study aims to pilot the feasibility of a RCT comparing a conservative to a standard, more liberal, strategy of uid management in mechanically ventilated (MV) pediatric patients with acute respiratory tract infection (ARTI). Methods: This is a pilot RCT and feasibility study in a single, tertiary referral pediatic intensive care unit. Twenty-three children receiving MV for ARTI, without ongoing hemodynamic support, admitted to the PICU of the Emma Children's Hospital/Amsterdam UMC between 2016-2018 were included. Patients were randomized to a conservative (<70% of normal intake) or standard (>85% of normal intake) uid strategy, which was kept throughout the period of MV. Results: Primary endpoints were adherence to uid strategy and safety parameters such as calorie and protein intake. Secondary outcomes were cumulative uid intake (CFI) and cumulative uid balance (CFB) on day 3. In the conservative group, in 75% of the MV days patients reached their target uid intake. Median calorie intake over all MV days was 67.8 [53.1-75.2] kcal/kg/day and 1.6 [1.3-1.7] gr protein/kg/day (no difference between groups). No adverse effects on hemodynamics
The use of patient histories has become an essential part of medical education. Patient histories... more The use of patient histories has become an essential part of medical education. Patient histories are important for the relevance, effectiveness and appeal of medical education. The sharing of patient-related information in education and further training is expected to increase in the coming years. The sharing of patient information with colleagues, students or other interested parties can conflict with the rules protecting patient privacy. The most important rule in this context is that it is the patients who decide whether their cases can be shown to others for educational purposes. Patient consent is not required if the data or images used have been fully anonymized. If the information can be traced to the patient, consent is required, preferably documented in writing. The teaching physician is responsible for the storage, protection and destruction of patient data and for controlling access to information
PubMed, 2015
The use of patient histories has become an essential part of medical education. Patient histories... more The use of patient histories has become an essential part of medical education. Patient histories are important for the relevance, effectiveness and appeal of medical education. The sharing of patient-related information in education and further training is expected to increase in the coming years. The sharing of patient information with colleagues, students or other interested parties can conflict with the rules protecting patient privacy. The most important rule in this context is that it is the patients who decide whether their cases can be shown to others for educational purposes. Patient consent is not required if the data or images used have been fully anonymized. If the information can be traced to the patient, consent is required, preferably documented in writing. The teaching physician is responsible for the storage, protection and destruction of patient data and for controlling access to information.
Nederlands Tijdschrift voor Geneeskunde, 2010
&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;Acute respiratory distress syndrome&... more &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;Acute respiratory distress syndrome&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (ARDS) developed as a serious complication of an infection with the influenza virus A (H1N1) (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;swine flu&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;) in 3 children: a 15-year-old girl, a 6-year-old boy and a 14-year-old girl. The latter two patients also suffered from septic shock. Intensive ICU treatment, including mechanical ventilation, did not lead to recovery. The first two patients eventually recovered following treatment with extracorporeal membrane oxygenation (ECMO), but the third patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s condition was too unstable for transfer to an ECMO centre. This patient died.
Nederlands Tijdschrift voor Geneeskunde, Jul 26, 2021
Background: Infants who are born in The Netherlands receive oral vitamin K to prevent bleeding du... more Background: Infants who are born in The Netherlands receive oral vitamin K to prevent bleeding due to a vitamin K deficiency. However the incidence of such bleedings are higher compared to other European countries. Therefore, the Dutch Health Council advised in 2017 to change this guideline from oral to intramuscular administration. Case description: A 2 months old girl presented with a fatal intracranial hemorrhage. A day before she developed a hematoma on her foot and orbit. Despite daily oral vitamin K, blood results revealed a severe vitamin K deficiency-related bleeding. Postmortem liver biopsy and genetic studies showed cholestasis as the most likely cause of malabsorption of fat soluble vitamins due to a heterozygous pathogenic variant in the ABCB11 gene, which could possibly be transient. Conclusion: Our case illustrates the importance of revising the national guideline for vitamin K prophylaxis to intramuscular administration, according to the recommendation of the Dutch Health Council.
Clinical Pediatrics, Sep 13, 2010
Objective: This study describes the clinical course, treatment, and outcome of 13 critically ill ... more Objective: This study describes the clinical course, treatment, and outcome of 13 critically ill children due to infection with new influenza A H1N1, admitted to 2 pediatric intensive care units (PICUs) in the northwestern part of the Netherlands. Methods: Retrospective case series, conducted in 2 PICUs in Amsterdam, the Netherlands. Results: A total of 13 children with a new influenza A H1N1 infection were admitted at 2 Dutch PICUs. The majority of these children were 12 to 16 years old and had an underlying disease. All children required mechanical ventilatory support. Shock was present in 7 of 13 (54%) children. Two children were transferred to a supraregional PICU with facilities for extracorporeal membrane oxygenation. Conclusions: In a Dutch cohort of 13 critically ill children due to infection with new influenza (H1N1), respiratory (100%) and circulatory (54%) failure characterized the course of this infection in most of these children. All children survived.
Frontiers in Pediatrics, Dec 10, 2019
Background: Fluid overload is common in critically ill children and is associated with adverse ou... more Background: Fluid overload is common in critically ill children and is associated with adverse outcome. Therefore, restricting fluid intake may be beneficial. This study aims to study the feasibility of a randomized controlled trial (RCT) comparing a conservative to a standard, more liberal, strategy of fluid management in mechanically ventilated pediatric patients with acute respiratory tract infection (ARTI). Methods: This is a feasibility study in a single, tertiary referral pediatric intensive care unit (PICU). Twenty-three children receiving mechanical ventilation for ARTI, without ongoing hemodynamic support, admitted to the PICU of the Emma Children's Hospital/Amsterdam UMC between 2016 and 2018 were included. Patients were randomized to a conservative (<70% of normal intake) or standard (>85% of normal intake) fluid strategy, which was kept throughout the period of mechanical ventilation. Results: Primary endpoints were adherence to fluid strategy and safety parameters such as calorie and protein intake. Secondary outcomes were cumulative fluid intake (CFI) and cumulative fluid balance (CFB) on day 3. In the conservative group, in 75% of the mechanical ventilation days patients achieved their target fluid intake. Median [25th−75th percentiles] calorie intake over all mechanical ventilation days was 67.9 [51.5-74.0] kcal/kg/day in the conservative vs. 67.2 [58.0-75.2] kcal/kg/day in the standard group (p = 0.878). Protein intake was 1.6 [1.3-1.8] gr protein/kg in the conservative and 1.5 [1.2-1.7] gr protein/kg in the standard group (p = 0.598). No adverse effects on hemodynamics or electrolyte imbalances were noted. Mean (±SD) CFI on day 3 was 262.3 (±58.9) ml/kg in the conservative group vs. 360.5 (±52.6) ml/kg in the standard fluid group (p < 0.001), which did not result in a lower CFB. Conclusions: A conservative fluid strategy in mechanically ventilated children with ARTI seems feasible, without limiting metabolic needs. However, in our study a conservative
Journal of Neurochemistry, Aug 1, 1992
The effect of long-term potentiation (LTP) on endogenous amino acid release from rat hippocampus ... more The effect of long-term potentiation (LTP) on endogenous amino acid release from rat hippocampus slices was studied. LTP was induced in vivo by application of a tetanus (200 Hz, 200 ms) to the Schaffer collateral fibers in unanesthetized rats. Endogenous release of glutamate and y-aminobutyric acid (GABA) was investigated 60 min after tetanization in CA1 subslices of potentiated and control rats. No significant effects of LTP were observed in basal and K+-induced Ca2+-independent release components of these amino acids. In contrast, K+-induced Caz+-dependent release of both glutamate and GABA increased-100% in slices from potentiated rats. No differences were observed in total content of glutamate and GABA between the subslices from control and LTP animals. These results suggest a persistent increase in the recruitment of the presynaptic vesicular pool of glutamate and GABA during LTP.
e-SPEN Journal, Feb 1, 2012
Background: Critical care providers fail to meet patients' nutritional demands particularly durin... more Background: Critical care providers fail to meet patients' nutritional demands particularly during the first days of stay on a pediatric intensive care unit (PICU). Objective: We aimed to study if the introduction of a feeding algorithm combined with a nutritional support team (NST) can improve nutrition delivery in a PICU. Design: In our PICU we compared the delivered percentages of goals for energy and macronutrients during the first 10 days of admission before and after the introduction of a feeding algorithm and NST. Patients with length of stay > 3 days and mechanical ventilation were included. The algorithm was based on early and aggressively incremental, nurse-driven enteral feeding with additional parenteral nutrition, if necessary. The NST reviewed and adjusted the nutrition regimens once a week and on demand. Results: The percentages of enteral nutrition delivered on day 1 doubled from 40% to 78% (p < 0.01), and increased from 60% to 92% on day 2 (p < 0.01) without increase in adverse gastrointestinal events, compared to the control period. More than 85% of nutritional targets were reached on day 3 compared to on day 4 before the protocol. Conclusion: The introduction of an early and aggressive, nurse-driven nutrition protocol, together with an NST, is an effective and safe tool to increase nutrition delivery on a PICU.
Pediatric Anesthesia, Jun 1, 2008
A 9-year-old boy underwent a thoracotomy for excision of his right third rib under combined gener... more A 9-year-old boy underwent a thoracotomy for excision of his right third rib under combined general and epidural anesthesia for a Ewings sarcoma. Postoperatively, he was found to have a complete T2-3 paraplegia. Permanent paraplegia was described as a rare complication of thoracotomy in adults, and very rarely after epidural analgesia in adults and babies. This was the first report in a child.
Nutrition, Jun 1, 2012
Objective: In pediatric cardiac surgery, fluid-restricted low-protein (LoProt) diets account for ... more Objective: In pediatric cardiac surgery, fluid-restricted low-protein (LoProt) diets account for cumulative protein deficits with increased morbidity. In this setting, we aimed to inhibit proteolysis by a high-carbohydrate (HiCarb)-intake-induced hyperinsulinemia and improve protein balance. Methods: The effect of a HiCarb/LoProt (glucose 10 mg $ kg À1 $ min À1 /protein 0.7 g $ kg À1 $ d À1) versus a normal-carbohydrate (NormCarb)/LoProt (glucose 7.5 mg $ kg À1 $ min À1 /protein 0.3 g $ kg À1 $ d À1) enteral diet on whole-body protein breakdown and balance was compared in a prospective, randomized, single-blinded trial in 24 children after cardiac surgery. On the second postoperative day, plasma insulin and amino acid concentrations, protein breakdown (endogenous rate of appearance of valine), protein synthesis (non-oxidative disposal of valine), protein balance, and the rate of appearance of urea were measured by using an isotopic infusion of [1-13 C]valine and [ 15 N 2 ] urea. Results: The HiCarb/LoProt diet led to a serum insulin concentration that was three times higher than the NormCarb/LoProt diet (596 pmol/L, 80-1833, and 198 pmol/L, 76-1292, respectively, P ¼ 0.02), without differences in plasma glucose concentrations. There were no differences in plasma amino acid concentrations, non-oxidative disposal of valine, and endogenous rate of appearance of valine between the groups, with a negative valine balance in the two groups (À0.65 mmol $ kg À1 $ min À1 , À1.91 to 0.01, and À0.58 mmol $ kg À1 $ min À1 , À2.32 to À0.07, respectively, P ¼ 0.71). The serum cortisol concentration in the HiCarb/LoProt group was lower compared with the NormCarb/LoProt group (204 nmol/L, 50-544, and 532 nmol/L, 108-930, respectively, P ¼ 0.02). Conclusion: In children with fluid restriction after cardiac surgery, a HiCarb/LoProt diet compared with a NormCarb/LoProt diet stimulates insulin secretion but does not inhibit proteolysis further and therefore cannot be advocated for this purpose.
Background: Fluid overload is common in critically ill children and is associated with adverse ou... more Background: Fluid overload is common in critically ill children and is associated with adverse outcome. Therefore, restricting fluid intake may be beneficial. This study aims to study the feasibility of a randomized controlled trial (RCT) comparing a conservative to a standard, more liberal, strategy of fluid management in mechanically ventilated pediatric patients with acute respiratory tract infection (ARTI). Methods: This is a feasibility study in a single, tertiary referral pediatic intensive care unit (PICU). Twenty-three children receiving mechanical ventilation for ARTI, without ongoing hemodynamic support, admitted to the PICU of the Emma Children’s Hospital/Amsterdam UMC between 2016-2018 were included. Patients were randomized to a conservative (<70% of normal intake) or standard (>85% of normal intake) fluid strategy, which was kept throughout the period of mechanical ventilation. Results: Primary endpoints were adherence to fluid strategy and safety parameters such...
e-SPEN Journal, 2012
Background: Critical care providers fail to meet patients' nutritional demands particularly durin... more Background: Critical care providers fail to meet patients' nutritional demands particularly during the first days of stay on a pediatric intensive care unit (PICU). Objective: We aimed to study if the introduction of a feeding algorithm combined with a nutritional support team (NST) can improve nutrition delivery in a PICU. Design: In our PICU we compared the delivered percentages of goals for energy and macronutrients during the first 10 days of admission before and after the introduction of a feeding algorithm and NST. Patients with length of stay > 3 days and mechanical ventilation were included. The algorithm was based on early and aggressively incremental, nurse-driven enteral feeding with additional parenteral nutrition, if necessary. The NST reviewed and adjusted the nutrition regimens once a week and on demand. Results: The percentages of enteral nutrition delivered on day 1 doubled from 40% to 78% (p < 0.01), and increased from 60% to 92% on day 2 (p < 0.01) without increase in adverse gastrointestinal events, compared to the control period. More than 85% of nutritional targets were reached on day 3 compared to on day 4 before the protocol. Conclusion: The introduction of an early and aggressive, nurse-driven nutrition protocol, together with an NST, is an effective and safe tool to increase nutrition delivery on a PICU.
Journal of Neurosurgery: Pediatrics, 2012
The authors report a case of a gunshot wound to the brain in a 2.5-year-old girl. To treat the un... more The authors report a case of a gunshot wound to the brain in a 2.5-year-old girl. To treat the uncontrollably elevated intracranial pressure, the patient underwent bilateral decompressive craniectomy and experimental open-wound treatment. She recovered to a good functional level.
Human Genetics - HUM GENET, 1998
Pediatric Anesthesia, 2008
A 9-year-old boy underwent a thoracotomy for excision of his right third rib under combined gener... more A 9-year-old boy underwent a thoracotomy for excision of his right third rib under combined general and epidural anesthesia for a Ewings sarcoma. Postoperatively, he was found to have a complete T2-3 paraplegia. Permanent paraplegia was described as a rare complication of thoracotomy in adults, and very rarely after epidural analgesia in adults and babies. This was the first report in a child.