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14. Clinical phenotypes and outcomes in children with multisystem inflammatory syndrome across SARS-CoV-2 variant eras: a multinational study from the 4CE consortium

Author

Aaron, James R., Adam, Atif, Agapito, Giuseppe, Albayrak, Adem, Albi, Giuseppe, Alessiani, Mario, Alloni, Anna, Amendola, Danilo F., Angoulvant, François, Anthony, Li LLJ., Aronow, Bruce J., Ashraf, Fatima, Atz, Andrew, Avillach, Paul, Panickan, Vidul Ayakulangara, Azevedo, Paula S., Badenes, Rafael, Balshi, James, Batugo, Ashley, Beaulieu-Jones, Brendin R., Beaulieu-Jones, Brett K., Bell, Douglas S., Bellasi, Antonio, Bellazzi, Riccardo, Benoit, Vincent, Beraghi, Michele, Bernal-Sobrino, José Luis, Bernaux, Mélodie, Bey, Romain, Bhatnagar, Surbhi, Blanco-Martínez, Alvar, Boeker, Martin, Bonzel, Clara-Lea, Booth, John, Bosari, Silvano, Bourgeois, Florence T., Bradford, Robert L., Brat, Gabriel A., Bréant, Stéphane, Brown, Nicholas W., Bruno, Raffaele, Bryant, William A., Bucalo, Mauro, Bucholz, Emily, Burgun, Anita, Cai, Tianxi, Cannataro, Mario, Carmona, Aldo, Cattelan, Anna Maria, Caucheteux, Charlotte, Champ, Julien, Chen, Jin, Chen, Krista Y., Chiovato, Luca, Chiudinelli, Lorenzo, Cho, Kelly, Cimino, James J., Colicchio, Tiago K., Cormont, Sylvie, Cossin, Sébastien, Craig, Jean B., Cruz-Bermúdez, Juan Luis, Cruz-Rojo, Jaime, Dagliati, Arianna, Daniar, Mohamad, Daniel, Christel, Das, Priyam, Devkota, Batsal, Dionne, Audrey, Duan, Rui, Dubiel, Julien, DuVall, Scott L., Esteve, Loic, Estiri, Hossein, Fan, Shirley, Follett, Robert W., Ganslandt, Thomas, García-Barrio, Noelia, Garmire, Lana X., Gehlenborg, Nils, Getzen, Emily J., Geva, Alon, Goh, Rachel SJ., González, Tomás González, Gradinger, Tobias, Gramfort, Alexandre, Griffier, Romain, Griffon, Nicolas, Grisel, Olivier, Gutiérrez-Sacristán, Alba, Guzzi, Pietro H., Han, Larry, Hanauer, David A., Haverkamp, Christian, Hazard, Derek Y., He, Bing, Henderson, Darren W., Hilka, Martin, Ho, Yuk-Lam, Holmes, John H., Honerlaw, Jacqueline P., Hong, Chuan, Huling, Kenneth M., Hutch, Meghan R., Issitt, Richard W., Jannot, Anne Sophie, Jouhet, Vianney, Kainth, Mundeep K., Kate, Kernan F., Kavuluru, Ramakanth, Keller, Mark S., Kennedy, Chris J., Kernan, Kate F., Key, Daniel A., Kirchoff, Katie, Klann, Jeffrey G., Kohane, Isaac S., Krantz, Ian D., Kraska, Detlef, Krishnamurthy, Ashok K., L'Yi, Sehi, Leblanc, Judith, Lemaitre, Guillaume, Lenert, Leslie, Leprovost, Damien, Liu, Molei, Will Loh, Ne Hooi, Long, Qi, Lozano-Zahonero, Sara, Luo, Yuan, Lynch, Kristine E., Mahmood, Sadiqa, Maidlow, Sarah E., Makoudjou, Adeline, Makwana, Simran, Malovini, Alberto, Mandl, Kenneth D., Mao, Chengsheng, Maram, Anupama, Maripuri, Monika, Martel, Patricia, Martins, Marcelo R., Marwaha, Jayson S., Masino, Aaron J., Mazzitelli, Maria, Mazzotti, Diego R., Mensch, Arthur, Milano, Marianna, Minicucci, Marcos F., Moal, Bertrand, Ahooyi, Taha Mohseni, Moore, Jason H., Moraleda, Cinta, Morris, Jeffrey S., Morris, Michele, Moshal, Karyn L., Mousavi, Sajad, Mowery, Danielle L., Murad, Douglas A., Murphy, Shawn N., Naughton, Thomas P., Breda Neto, Carlos Tadeu, Neuraz, Antoine, Newburger, Jane, Ngiam, Kee Yuan, Njoroge, Wanjiku FM., Norman, James B., Obeid, Jihad, Okoshi, Marina P., Olson, Karen L., Omenn, Gilbert S., Orlova, Nina, Ostasiewski, Brian D., Palmer, Nathan P., Paris, Nicolas, Patel, Lav P., Pedrera-Jiménez, Miguel, Pfaff, Ashley C., Pfaff, Emily R., Pillion, Danielle, Pizzimenti, Sara, Priya, Tanu, Prokosch, Hans U., Prudente, Robson A., Prunotto, Andrea, Quirós-González, Víctor, Ramoni, Rachel B., Raskin, Maryna, Rieg, Siegbert, Roig-Domínguez, Gustavo, Rojo, Pablo, Romero-Garcia, Nekane, Rubio-Mayo, Paula, Sacchi, Paolo, Sáez, Carlos, Salamanca, Elisa, Samayamuthu, Malarkodi Jebathilagam, Sanchez-Pinto, L. Nelson, Sandrin, Arnaud, Santhanam, Nandhini, Santos, Janaina C.C., Sanz Vidorreta, Fernando J., Savino, Maria, Schriver, Emily R., Schubert, Petra, Schuettler, Juergen, Scudeller, Luigia, Sebire, Neil J., Serrano-Balazote, Pablo, Serre, Patricia, Serret-Larmande, Arnaud, Shah, Mohsin A., Hossein Abad, Zahra Shakeri, Silvio, Domenick, Sliz, Piotr, Son, Jiyeon, Sonday, Charles, South, Andrew M., Sperotto, Francesca, Spiridou, Anastasia, Strasser, Zachary H., Tan, Amelia LM., Tan, Bryce W.Q., Tan, Byorn W.L., Tanni, Suzana E., Taylor, Deanne M., Terriza-Torres, Ana I., Tibollo, Valentina, Tippmann, Patric, Toh, Emma MS., Torti, Carlo, Trecarichi, Enrico M., Vallejos, Andrew K., Varoquaux, Gael, Vella, Margaret E., Verdy, Guillaume, Vie, Jill-Jênn, Visweswaran, Shyam, Vitacca, Michele, Wagholikar, Kavishwar B., Waitman, Lemuel R., Wang, Xuan, Wassermann, Demian, Weber, Griffin M., Wolkewitz, Martin, Wong, Scott, Xia, Zongqi, Xiong, Xin, Ye, Ye, Yehya, Nadir, Yuan, William, Zachariasse, Joany M., Zahner, Janet J., Zambelli, Alberto, Zhang, Harrison G., Zöller, Daniela, Zuccaro, Valentina, Zucco, Chiara, Li, Xiudi, Rofeberg, Valerie N., Elias, Matthew D., Laird-Gion, Jessica, and Newburger, Jane W.

Published
2023
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19. Abstract 13839: Value of 2D Speckle Tracking Echocardiography in Predicting Short-Term Cardiovascular Outcomes in Multisystem Inflammatory Syndrome in Children: Analysis of the MUSIC Data

Author

Sperotto, Francesca, Kazlova, Valiantsina, Trachtenberg, Felicia, Truong, Dongngan, AGGARWAL, Sanjeev, Bradford, Tamara T, Block, Joseph R, Buddhe, Sujatha, Dionne, Audrey, Dragulescu, Andreea, Farooqi, Kanwal M, Forsha, Daniel E, Giglia, Therese, Golding, Ian F, Hasbani, Keren, Jone, Pei-Ni, Krishnan, Anita, Lang, Sean, McFarland, Carol, Mitchell, Elizabeth, Moussi, Elias, Nowlen, Todd, Pignatelli, Ricardo H, Pletzer, Scott, Serrano, Ryan, Shakti, Divya, Srivastava, Shubhika, Thorsson, Thor, Votava-Smith, Jodie, and Friedman, Kevin G

Published
2023
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35. Efficacy and safety of dexmedetomidine for prevention of withdrawal syndrome in the pediatric intensive care unit: protocol for an adaptive, multicenter, randomized, double-blind, placebo-controlled, non-profit clinical trial

Author

Mondardini, Maria Cristina, Sperotto, Francesca, Daverio, Marco, Caramelli, Fabio, Gregori, Dario, Caligiuri, Maria Francesca, Vitale, Francesca, Cecini, Maria Teresa, Piastra, Marco, Mancino, Aldo, Pettenazzo, Andrea, Conti, Giorgio, and Amigoni, Angela

Published
2019
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45. International comparisons of laboratory values from the 4CE collaborative to predict COVID-19 mortality

Author

Weber, Griffin, Hong, Chuan, Xia, Zongqi, Palmer, Nathan, Avillach, Paul, L’yi, Sehi, Keller, Mark, Murphy, Shawn, Gutiérrez-Sacristán, Alba, Bonzel, Clara-Lea, Serret-Larmande, Arnaud, Neuraz, Antoine, Omenn, Gilbert, Visweswaran, Shyam, Klann, Jeffrey, South, Andrew, Loh, Ne Hooi Will, Cannataro, Mario, Beaulieu-Jones, Brett, Bellazzi, Riccardo, Agapito, Giuseppe, Alessiani, Mario, Aronow, Bruce, Bell, Douglas, Benoit, Vincent, Bourgeois, Florence, Chiovato, Luca, Cho, Kelly, Dagliati, Arianna, Duvall, Scott, Barrio, Noelia García, Hanauer, David, Ho, Yuk-Lam, Holmes, John, Issitt, Richard, Liu, Molei, Luo, Yuan, Lynch, Kristine, Maidlow, Sarah, Malovini, Alberto, Mandl, Kenneth, Mao, Chengsheng, Matheny, Michael, Moore, Jason, Morris, Jeffrey, Morris, Michele, Mowery, Danielle, Ngiam, Kee Yuan, Patel, Lav, Pedrera Jiménez, Miguel, Ramoni, Rachel, Schriver, Emily, Schubert, Petra, Balazote, Pablo Serrano, Spiridou, Anastasia, Tan, Amelia, Tan, Byorn, Tibollo, Valentina, Torti, Carlo, Trecarichi, Enrico, Wang, Xuan, Aaron, James, Albayrak, Adem, Albi, Giuseppe, Balshi, James, Alloni, Anna, Amendola, Danilo, Angoulvant, François, Anthony, Li, Ashraf, Fatima, Atz, Andrew, Azevedo, Paula, Bellasi, Antonio, Beraghi, Michele, Bernal-Sobrino, José Luis, Bernaux, Mélodie, Bey, Romain, Bhatnagar, Surbhi, Blanco-Martínez, Alvar, Boeker, Martin, Booth, John, Bosari, Silvano, Bradford, Robert, Brat, Gabriel, Bréant, Stéphane, Brown, Nicholas, Bruno, Raffaele, Bryant, William, Bucalo, Mauro, Bucholz, Emily, Burgun, Anita, Cai, Tianxi, Carmona, Aldo, Caucheteux, Charlotte, Champ, Julien, Chen, Krista, Chen, Jin, Chiudinelli, Lorenzo, Cimino, James, Colicchio, Tiago, Cormont, Sylvie, Cossin, Sébastien, Craig, Jean, Cruz-Bermúdez, Juan Luis, Cruz-Rojo, Jaime, Daniar, Mohamad, Daniel, Christel, Das, Priyam, Devkota, Batsal, Garmire, Lana, Dionne, Audrey, Duan, Rui, Dubiel, Julien, Esteve, Loic, Estiri, Hossein, Fan, Shirley, Follett, Robert, Ganslandt, Thomas, García-Barrio, Noelia, Gehlenborg, Nils, Getzen, Emily, Geva, Alon, Gradinger, Tobias, Gramfort, Alexandre, Griffier, Romain, Griffon, Nicolas, Grisel, Olivier, Han, Larry, Haverkamp, Christian, Key, Daniel, Hazard, Derek, He, Bing, Henderson, Darren, Hilka, Martin, Huling, Kenneth, Hutch, Meghan, Jannot, Anne Sophie, Jouhet, Vianney, Kavuluru, Ramakanth, Kennedy, Chris, Kernan, Kate, Kirchoff, Katie, Kohane, Isaac, Krantz, Ian, Kraska, Detlef, Krishnamurthy, Ashok, Le, Trang, Leblanc, Judith, Lemaitre, Guillaume, Lenert, Leslie, Leprovost, Damien, Long, Qi, Lozano-Zahonero, Sara, Mahmood, Sadiqa, Makoudjou, Adeline, Maram, Anupama, Martel, Patricia, Martins, Marcelo, Marwaha, Jayson, Masino, Aaron, Mazzitelli, Maria, Mensch, Arthur, Milano, Marianna, Minicucci, Marcos, Moal, Bertrand, Ahooyi, Taha Mohseni, Moraleda, Cinta, Moshal, Karyn, Mousavi, Sajad, Murad, Douglas, Naughton, Thomas, Neto, Carlos Tadeu Breda, Newburger, Jane, Njoroge, Wanjiku, Norman, James, Obeid, Jihad, Okoshi, Marina, Olson, Karen, Orlova, Nina, Ostasiewski, Brian, Paris, Nicolas, Pedrera-Jiménez, Miguel, Pfaff, Ashley, Pfaff, Emily, Pillion, Danielle, Pizzimenti, Sara, Prokosch, Hans, Prudente, Robson, Prunotto, Andrea, Quirós-González, Víctor, Raskin, Maryna, Rieg, Siegbert, Roig-Domínguez, Gustavo, Rojo, Pablo, Rubio-Mayo, Paula, Sacchi, Paolo, Sáez, Carlos, Salamanca, Elisa, Samayamuthu, Malarkodi Jebathilagam, Sanchez-Pinto, L. Nelson, Sandrin, Arnaud, Santhanam, Nandhini, Santos, Janaina, Sanz Vidorreta, Fernando, Savino, Maria, Schuettler, Juergen, Scudeller, Luigia, Sebire, Neil, Serrano-Balazote, Pablo, Serre, Patricia, Shah, Mohsin, Abad, Zahra Shakeri Hossein, Silvio, Domenick, Sliz, Piotr, Son, Jiyeon, Sonday, Charles, Sperotto, Francesca, Strasser, Zachary, Tan, Bryce, Tanni, Suzana, Taylor, Deanne, Terriza-Torres, Ana, Tippmann, Patric, Toh, Emma, Tseng, Yi-Ju, Vallejos, Andrew, Varoquaux, Gael, Vella, Margaret, Verdy, Guillaume, Vie, Jill-Jênn, Vitacca, Michele, Wagholikar, Kavishwar, Waitman, Lemuel, Wassermann, Demian, Wolkewitz, Martin, Wong, Scott, Xiong, Xin, Ye, Ye, Yehya, Nadir, Yuan, William, Zambelli, Alberto, Zhang, Harrison, Zöller, Daniela, Zuccaro, Valentina, Zucco, Chiara, Harvard Medical School [Boston] (HMS), University of Pittsburgh (PITT), Pennsylvania Commonwealth System of Higher Education (PCSHE), Massachusetts General Hospital [Boston], Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Service d'informatique médicale et biostatistiques [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Cité (UPCité), Health data- and model- driven Knowledge Acquisition (HeKA), Inria de Paris, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité)-École Pratique des Hautes Études (EPHE), University of Michigan [Ann Arbor], University of Michigan System, Wake Forest School of Medicine [Winston-Salem], Wake Forest Baptist Medical Center, National University Health System [Singapore] (NUHS), Università degli Studi 'Magna Graecia' di Catanzaro = University of Catanzaro (UMG), Università degli Studi di Pavia = University of Pavia (UNIPV), Istituti Clinici Scientifici Maugeri [Pavia] (IRCCS Pavia - ICS Maugeri), ASST Pavia, University of Cincinnati (UC), University of California [Los Angeles] (UCLA), University of California (UC), VA Boston Healthcare System, Hospital Universitario 12 de Octubre [Madrid], University of Pennsylvania, Great Ormond Street Hospital for Children [London] (GOSH), Harvard School of Public Health, Northwestern University [Chicago, Ill. USA], VA Salt Lake City Health Care System, Boston Children's Hospital, University of Kansas [Kansas City], and National University Hospital [Singapore] (NUH)

Subjects
Health Information Management, Medicine (miscellaneous), Health Informatics, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Computer Science Applications
Abstract

Given the growing number of prediction algorithms developed to predict COVID-19 mortality, we evaluated the transportability of a mortality prediction algorithm using a multi-national network of healthcare systems. We predicted COVID-19 mortality using baseline commonly measured laboratory values and standard demographic and clinical covariates across healthcare systems, countries, and continents. Specifically, we trained a Cox regression model with nine measured laboratory test values, standard demographics at admission, and comorbidity burden pre-admission. These models were compared at site, country, and continent level. Of the 39,969 hospitalized patients with COVID-19 (68.6% male), 5717 (14.3%) died. In the Cox model, age, albumin, AST, creatine, CRP, and white blood cell count are most predictive of mortality. The baseline covariates are more predictive of mortality during the early days of COVID-19 hospitalization. Models trained at healthcare systems with larger cohort size largely retain good transportability performance when porting to different sites. The combination of routine laboratory test values at admission along with basic demographic features can predict mortality in patients hospitalized with COVID-19. Importantly, this potentially deployable model differs from prior work by demonstrating not only consistent performance but also reliable transportability across healthcare systems in the US and Europe, highlighting the generalizability of this model and the overall approach.

Published
2022

46. Assessment and management of iatrogenic withdrawal syndrome and delirium in pediatric intensive care units across Europe: An ESPNIC survey.

Author

Sperotto, Francesca, Ramelet, Anne‐Sylvie, Daverio, Marco, Mondardini, Maria Cristina, von Borell, Florian, Brenner, Sebastian, Tibboel, Dick, Ista, Erwin, Pokorna, Paula, Amigoni, Angela, Kola, Ermira, Vittinghoff, Maria, Duval, Els, Polić, Branka, Valla, Frederic, Neunhoeffer, Felix, Konstantinos, Tziouvas, Györgyi, Zoltán, Tan, Mong Hoi, and Hasani, Antigona

Subjects
*PEDIATRIC intensive care, *INTENSIVE care units, *SYNDROMES in children, *INTERPROFESSIONAL collaboration, *IATROGENIC diseases, *ARIPIPRAZOLE, *ANTIPSYCHOTIC agents
Abstract

Introduction: Analgesia and sedation are essential for the care of children in the pediatric intensive care unit (PICU); however, when prolonged, they may be associated with iatrogenic withdrawal syndrome (IWS) and delirium. We sought to evaluate current practices on IWS and delirium assessment and management (including non‐pharmacologic strategies as early mobilization) and to investigate associations between the presence of an analgosedation protocol and IWS and delirium monitoring, analgosedation weaning, and early mobilization. Methods: We conducted a multicenter cross‐sectional survey‐based study collecting data from one experienced physician or nurse per PICU in Europe from January to April 2021. We then investigated differences among PICUs that did or did not follow an analgosedation protocol. Results: Among 357 PICUs, 215 (60%) responded across 27 countries. IWS was systematically monitored with a validated scale in 62% of PICUs, mostly using the Withdrawal Assessment Tool‐1 (53%). The main first‐line treatment for IWS was a rescue bolus with interruption of weaning (41%). Delirium was systematically monitored in 58% of PICUs, mostly with the Cornell Assessment of Pediatric Delirium scale (48%) and the Sophia Observation Scale for Pediatric Delirium (34%). The main reported first‐line treatment for delirium was dexmedetomidine (45%) or antipsychotic drugs (40%). Seventy‐one percent of PICUs reported to follow an analgosedation protocol. Multivariate analyses adjusted for PICU characteristics showed that PICUs using a protocol were significantly more likely to systematically monitor IWS (odds ratio [OR] 1.92, 95% confidence interval [CI] 1.01–3.67) and delirium (OR 2.00, 95% CI 1.07–3.72), use a protocol for analgosedation weaning (OR 6.38, 95% CI 3.20–12.71) and promote mobilization (OR 3.38, 95% CI 1.63–7.03). Conclusions: Monitoring and management of IWS and delirium are highly variable among European PICUs. The use of an analgosedation protocol was associated with an increased likelihood of monitoring IWS and delirium, performing a structured analgosedation weaning and promoting mobilization. Education on this topic and interprofessional collaborations are highly needed to help reduce the burden of analgosedation‐associated adverse outcomes. [ABSTRACT FROM AUTHOR]

Published
2023
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47. Predicting favorable response to intravenous morphine in pediatric critically ill cardiac patients.

Author

Sperotto, Francesca, Emani, Siva, Zhu, Lin, Delgado, Marlòn, Santillana, Mauricio, and Kheir, John N.

Subjects
*DEXMEDETOMIDINE, *CLINICAL decision support systems, *MACHINE learning, *CRITICALLY ill children, *CARDIAC patients, *CRITICALLY ill
Abstract

Introduction: Analgesia and sedation are integral to the care of critically ill children. However, the choice and dose of the analgesic or sedative drug is often empiric, and models predicting favorable responses are lacking. We aimed to compute models to predict a patient's response to intravenous morphine. Methods: We retrospectively analyzed data from consecutive patients admitted to the Cardiac Intensive Care Unit (January 2011–January 2020) who received at least one intravenous bolus of morphine. The primary outcome was a decrease in the State Behavioral Scale (SBS) ≥1 point; the secondary outcome was a decrease in the heart rate Z‐score (zHR) at 30 min. Effective doses were modeled using logistic regression, Lasso regression, and random forest modeling. Results: A total of 117,495 administrations of intravenous morphine among 8140 patients (median age 0.6 years [interquartile range [IQR] 0.19, 3.3]) were included. The median morphine dose was 0.051 mg/kg (IQR 0.048, 0.099) and the median 30‐day cumulative dose was 2.2 mg/kg (IQR 0.4, 15.3). SBS decreased following 30% of doses, did not change following 45%, and increased following 25%. The zHR significantly decreased after morphine administration (median delta‐zHR −0.34 [IQR−1.03, 0.00], p < 0.001). The following factors were associated with favorable response to morphine: A concomitant infusion of propofol, higher prior 30‐day cumulative dose, being invasively ventilated and/or on vasopressors. Higher morphine dose, higher zHR pre‐morphine, an additional analgosedation bolus ±30 min around the index bolus, a concomitant ketamine or dexmedetomidine infusion, and showing signs of withdrawal syndrome were associated with unfavorable response. Logistic regression (area under the receiver operating characteristic [ROC] curve [AUC] 0.900) and machine learning models (AUC 0.906) performed comparably, with a sensitivity of 95%, specificity of 71%, and negative predictive value of 97%. Conclusions: Statistical models identify 95% of effective intravenous morphine doses in pediatric critically ill cardiac patients, while incorrectly suggesting an effective dose in 29% of cases. This work represents an important step toward computer‐aided, personalized clinical decision support tool for sedation and analgesia in ICU patients. [ABSTRACT FROM AUTHOR]

Published
2023
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48. Is ketamine infusion effective and safe as an adjuvant of sedation in the PICU? Results from the Ketamine Infusion Sedation Study (KISS).

Author

Tessari, Anna, Sperotto, Francesca, Pece, Federico, Pettenuzzo, Giulia, Porcellato, Nicola, Poletto, Elisa, Mondardini, Maria Cristina, Pettenazzo, Andrea, Daverio, Marco, and Amigoni, Angela

Subjects
*KETAMINE, *PEDIATRIC intensive care, *CONCOMITANT drugs, *INTENSIVE care units, *PEOPLE with paralysis
Abstract

Study Objective: We aimed to evaluate the efficacy and safety of ketamine in ensuring comfort and sparing conventional drugs when used as an adjuvant for analgesia and sedation in the Pediatric Intensive Care Unit (PICU) as a continuous infusion (≥12 h). Design: Observational prospective study. Setting: Tertiary‐care‐center PICU. Patients: All consecutive patients <18 years who received ketamine for ≥12 h between January 2019 and July 2021. Interventions: ketamine infusion for ≥12 h. Measurements and Main Results: Seventy‐seven patients (median age 16 months, Interquartile Range (IQR) 7–43) were enrolled. Twenty‐six percent of patients (n = 20) were paralyzed, while 74% (n = 57) were not. The median infusion duration was 90 h (IQR 39–193), with doses between 15 (IQR 15–20) and 30 μg/kg/min (IQR 20–50). At 24 h of ketamine infusion, values of COMFORT‐B‐Scale (CBS) were significantly lower compared with values pre‐ketamine (p < 0.001). Simultaneously, doses/kg/h of opioids and benzodiazepines significantly decreased at 24 h (p < 0.001 and p = 0.002, respectively), while doses/kg/h of propofol (p = 0.500) and dexmedetomidine (p = 0.072) did not significantly change. Seventy‐four percent of non‐paralyzed patients (42/57) had a decrease in CBS ≥2 points with no increase of concomitant analgosedation drugs. Among paralyzed patients (n = 20), 13 (65%) had no increase of concomitant analgosedation within 24 h after ketamine initiation. Overall, 55/77 (71%) of patients responded to ketamine. The mean and maximum ketamine infusion dosages were significantly higher in the non‐responders (p = 0.021 and 0.028, respectively). Eleven patients had adverse events potentially related to ketamine (hypersalivation, systemic hypertension, dystonia/dyskinesia, tachycardia, and agitation) and six patients required intervention (dose reduction, suspension, or pharmacologic therapy). None of the patients developed delirium during ketamine infusion. Conclusions: Ketamine used as a continuous infusion in the PICU might represent a valid strategy to ensure comfort and spare opioids and benzodiazepines in difficult‐to‐sedate PICU patients. Adverse events are minor and easily reversible. Future study will be needed to investigate long‐term outcomes. [ABSTRACT FROM AUTHOR]

Published
2023
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49. World Workshop on Oral Medicine VIII: Dentists' compliance with infective endocarditis prophylaxis guidelines for patients with high-risk cardiac conditions: a systematic review.

Author

Diz Dios, Pedro, Monteiro, Luis, Pimolbutr, Kununya, Gobbo, Margherita, France, Katherine, Bindakhil, Mohammed, Holmes, Haly, Sperotto, Francesca, Graham, Laurel, Turati, Federica, Salvatori, Andrea, Hong, Catherine, Sollecito, Thomas P., Lodi, Giovanni, Thornhill, Martin H., Lockhart, Peter B., and Edefonti, Valeria

Abstract

To determine dentists' awareness and/or adherence to antibiotic prophylaxis (AP) guidelines for preventing infective endocarditis (IE) in patients with high-risk heart conditions. A systematic literature review was performed on MEDLINE/PubMed, Scopus, Web of Science, Cochrane Library, Proquest, Embase, Dentistry, and Oral Sciences Source databases, following the Preferred Reporting Items for Systematic Reviews and Meta–Analyses checklist. Nationwide studies based on questionnaires, surveys, and interviews completed by dentists and published since 2007 were included. From 2907 articles screened, 28 studies were selected (across 20 countries). The quality of included studies was poor due to a lack of standard evaluation tools, low response rates, and lack of questionnaire validity and/or reliability. Approximately 75% of surveyed dentists reported being knowledgeable about AP guidelines, but only ∼25% complied. Reported compliance with American Heart Association (AHA) guidelines was 4 times higher than with the National Institute for Health and Care Excellence (NICE) recommendations. Some of the highest adherence rates were reported for other national AP guidelines. Significant geographic differences were observed in the estimated adherence to AHA guidelines and the percentage of dentists who reported seeking advice from physicians and/or cardiologists. Rates of compliance and/or adherence were substantially different from rates of knowledge and/or awareness, including relevant geographic dissimilarities. Compliance/adherence was higher for AHA than NICE. [ABSTRACT FROM AUTHOR]

Published
2023
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