Polyneuropathy in Critically Ill Mechanically Ventilated Children
| Autor: | Shantanu Shubham, Sanjay Kumar Patel, Ashok Kumar Jaryal, S. K. Kabra, Akanksha Singh, Nitin Dhochak, Rakesh Lodha, Jhuma Sankar, Sheffali Gulati, Biswaroop Chakrabarty |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Neuromuscular disease Critical Illness India 030204 cardiovascular system & hematology Intensive Care Units Pediatric Critical Care and Intensive Care Medicine Severity of Illness Index Tertiary Care Centers Sepsis Polyneuropathies 03 medical and health sciences 0302 clinical medicine Adrenal Cortex Hormones Risk Factors Severity of illness Prevalence medicine Humans Vasoconstrictor Agents Body Weights and Measures Hypoalbuminemia Critical illness polyneuropathy Child business.industry Organ dysfunction 030208 emergency & critical care medicine Length of Stay medicine.disease Respiration Artificial Socioeconomic Factors Child Preschool Pediatrics Perinatology and Child Health Female medicine.symptom business Polyneuropathy Cohort study |
| Zdroj: | Pediatric Critical Care Medicine. 20:826-831 |
| ISSN: | 1529-7535 |
| DOI: | 10.1097/pcc.0000000000002012 |
| Popis: | Objectives To determine the prevalence of critical illness polyneuropathy and its risk factors in critically ill children mechanically ventilated for 7 days or more. Design Observational cohort study. Setting PICU of a tertiary care hospital from North India. Patients Children 1-15 years old admitted in PICU from June 2016 to September 2017, mechanically ventilated for 7 days or more, excluding those with diagnosed neuromuscular disease, stroke, or spinal pathology. Intervention Demographic details, diagnosis, treatment details, and anthropometry at admission and enrolment were recorded. Nerve conduction studies were performed after enrolment and repeated a week later, if the child was still in PICU. Medical Research Council scoring for muscle strength was performed in survivors. Risk factors including Pediatric Index of Mortality-2 score, sepsis, multiple organ dysfunction, hypoalbuminemia, use of steroids, neuromuscular-blocking agents, and vasopressors were recorded. Samples for the level of micronutrients (copper, zinc, folate, and vitamin B12) were collected at the time of enrolling the child and at the time of discharge. Measurements and main results Thirty-two children were enrolled, of whom 29 had features of critical illness polyneuropathy on evaluation at day 8 of mechanical ventilation (prevalence, 90.6% [95% CI, 80.5-100%]). The polyneuropathy was axonal in 26 (81.2%), mixed in one patient (3.1%), and uncharacterized in two (6.2%). Sepsis and multiple organ dysfunction were present in 31 subjects (96.9%). No risk factors for critical illness polyneuropathy could be identified although the study was not sufficiently powered to do so. The difference between serum micronutrient levels (copper, zinc, folate, and vitamin B12) between patients who developed polyneuropathy, and those who did not, was statistically insignificant. Conclusions We observed a high prevalence of critical illness polyneuropathy in children in PICU, mechanically ventilated for 7 days or more; almost all of whom had underlying sepsis. |
| Databáze: | OpenAIRE |
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