5 results on '"Nadkarni, Vinay"'
Search Results
2. Effect of Amplitude Spectral Area on Termination of Fibrillation and Outcomes in Pediatric Cardiac Arrest.
- Author
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Raymond TT, Pandit SV, Griffis H, Zhang X, Hanna R, Niles DE, Silver A, Lasa JJ, Haskell SE, Atkins DL, and Nadkarni VM
- Subjects
- Adolescent, Age Factors, Canada, Cardiopulmonary Resuscitation, Child, Child, Preschool, Defibrillators, Electric Countershock instrumentation, Europe, Female, Heart Arrest physiopathology, Heart Arrest therapy, Hospital Mortality, Humans, Infant, Male, Predictive Value of Tests, Retrospective Studies, Return of Spontaneous Circulation, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, United States, Ventricular Fibrillation physiopathology, Ventricular Fibrillation therapy, Electrocardiography, Heart Arrest diagnosis, Ventricular Fibrillation diagnosis
- Abstract
Background Amplitude spectral area (AMSA) predicts termination of fibrillation (TOF) with return of spontaneous circulation (ROSC) and survival in adults but has not been studied in pediatric cardiac arrest. We characterized AMSA during pediatric cardiac arrest from a Pediatric Resuscitation Quality Collaborative and hypothesized that AMSA would be associated with TOF and ROSC. Methods and Results Children aged <18 years with cardiac arrest and ventricular fibrillation were studied. AMSA was calculated for 2 seconds before shock and averaged for each subject (AMSA-avg). TOF was defined as termination of ventricular fibrillation 10 seconds after defibrillation to any non-ventricular fibrillation rhythm. ROSC was defined as >20 minutes without chest compressions. Univariate and multivariable logistic regression analyses controlling for weight, current, and illness category were performed. Primary end points were TOF and ROSC. Secondary end points were 24-hour survival and survival to discharge. Between 2015 and 2019, 50 children from 14 hospitals with 111 shocks were identified. In univariate analyses AMSA was not associated with TOF and AMS-Aavg was not associated with ROSC. Multivariable logistic regression showed no association between AMSA and TOF but controlling for defibrillation average current and illness category, there was a trend to significant association between AMSA-avg and ROSC (odds ratio, 1.10 [1.00‒1.22] P =0.058). There was no significant association between AMSA-avg and 24-hour survival or survival to hospital discharge. Conclusions In pediatric patients, AMSA was not associated with TOF, whereas AMSA-avg had a trend to significance for association in ROSC, but not 24-hour survival or survival to hospital discharge. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02708134.
- Published
- 2021
- Full Text
- View/download PDF
3. The Association of Nutrition Status Expressed as Body Mass Index z Score With Outcomes in Children With Severe Sepsis: A Secondary Analysis From the Sepsis Prevalence, Outcomes, and Therapies (SPROUT) Study.
- Author
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Irving SY, Daly B, Verger J, Typpo KV, Brown AM, Hanlon A, Weiss SL, Fitzgerald JC, Nadkarni VM, Thomas NJ, and Srinivasan V
- Subjects
- Adolescent, Asia, Child, Child, Preschool, Comorbidity, Europe, Female, Humans, Intensive Care Units, Pediatric, Male, Malnutrition therapy, North America, Prevalence, Risk Assessment methods, Sepsis therapy, South America, Body Mass Index, Malnutrition epidemiology, Nutritional Status, Sepsis epidemiology, Severity of Illness Index
- Abstract
Objectives: The impact of nutrition status on outcomes in pediatric severe sepsis is unclear. We studied the association of nutrition status (expressed as body mass index z score) with outcomes in pediatric severe sepsis., Design: Secondary analysis of the Sepsis Prevalence, Outcomes, and Therapies study. Patient characteristics, ICU interventions, and outcomes were compared across nutrition status categories (expressed as age- and sex-adjusted body mass index z scores using World Health Organization standards). Multivariable regression models were developed to determine adjusted differences in all-cause ICU mortality and ICU length of stay by nutrition status., Setting: One-hundred twenty-eight PICUs across 26 countries., Patients: Children less than 18 years with severe sepsis enrolled in the Sepsis Prevalence, Outcomes, and Therapies study (n = 567)., Interventions: None., Measurements and Main Results: Nutrition status data were available for 417 patients. Severe undernutrition was seen in Europe (25%), Asia (20%), South Africa (17%), and South America (10%), with severe overnutrition seen in Australia/New Zealand (17%) and North America (14%). Severe undernutrition was independently associated with all-cause ICU mortality (adjusted odds ratio, 3.0; 95% CI, 1.2-7.7; p = 0.02), whereas severe overnutrition in survivors was independently associated with longer ICU length of stay (1.6 d; p = 0.01)., Conclusions: There is considerable variation in nutrition status for children with severe sepsis treated across this selected network of PICUs from different geographic regions. Severe undernutrition was independently associated with higher all-cause ICU mortality in children with severe sepsis. Severe overnutrition was independently associated with greater ICU length of stay in childhood survivors of severe sepsis.
- Published
- 2018
- Full Text
- View/download PDF
4. Characterization of Pediatric In-Hospital Cardiopulmonary Resuscitation Quality Metrics Across an International Resuscitation Collaborative.
- Author
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Niles DE, Duval-Arnould J, Skellett S, Knight L, Su F, Raymond TT, Sweberg T, Sen AI, Atkins DL, Friess SH, de Caen AR, Kurosawa H, Sutton RM, Wolfe H, Berg RA, Silver A, Hunt EA, and Nadkarni VM
- Subjects
- Adolescent, Canada, Cardiopulmonary Resuscitation methods, Cardiopulmonary Resuscitation statistics & numerical data, Child, Child, Preschool, Europe, Female, Hospitals, Pediatric statistics & numerical data, Humans, Infant, Infant, Newborn, Male, Practice Guidelines as Topic, Quality Assurance, Health Care, Retrospective Studies, United States, Cardiopulmonary Resuscitation standards, Guideline Adherence statistics & numerical data, Hospitals, Pediatric standards, Quality Indicators, Health Care statistics & numerical data
- Abstract
Objectives: Pediatric in-hospital cardiac arrest cardiopulmonary resuscitation quality metrics have been reported in few children less than 8 years. Our objective was to characterize chest compression fraction, rate, depth, and compliance with 2015 American Heart Association guidelines across multiple pediatric hospitals., Design: Retrospective observational study of data from a multicenter resuscitation quality collaborative from October 2015 to April 2017., Setting: Twelve pediatric hospitals across United States, Canada, and Europe., Patients: In-hospital cardiac arrest patients (age < 18 yr) with quantitative cardiopulmonary resuscitation data recordings., Interventions: None., Measurements and Main Results: There were 112 events yielding 2,046 evaluable 60-second epochs of cardiopulmonary resuscitation (196,669 chest compression). Event cardiopulmonary resuscitation metric summaries (median [interquartile range]) by age: less than 1 year (38/112): chest compression fraction 0.88 (0.61-0.98), chest compression rate 119/min (110-129), and chest compression depth 2.3 cm (1.9-3.0 cm); for 1 to less than 8 years (42/112): chest compression fraction 0.94 (0.79-1.00), chest compression rate 117/min (110-124), and chest compression depth 3.8 cm (2.9-4.6 cm); for 8 to less than 18 years (32/112): chest compression fraction 0.94 (0.85-1.00), chest compression rate 117/min (110-123), chest compression depth 5.5 cm (4.0-6.5 cm). "Compliance" with guideline targets for 60-second chest compression "epochs" was predefined: chest compression fraction greater than 0.80, chest compression rate 100-120/min, and chest compression depth: greater than or equal to 3.4 cm in less than 1 year, greater than or equal to 4.4 cm in 1 to less than 8 years, and 4.5 to less than 6.6 cm in 8 to less than 18 years. Proportion of less than 1 year, 1 to less than 8 years, and 8 to less than 18 years events with greater than or equal to 60% of 60-second epochs meeting compliance (respectively): chest compression fraction was 53%, 81%, and 78%; chest compression rate was 32%, 50%, and 63%; chest compression depth was 13%, 19%, and 44%. For all events combined, total compliance (meeting all three guideline targets) was 10% (11/112)., Conclusions: Across an international pediatric resuscitation collaborative, we characterized the landscape of pediatric in-hospital cardiac arrest chest compression quality metrics and found that they often do not meet 2015 American Heart Association guidelines. Guideline compliance for rate and depth in children less than 18 years is poor, with the greatest difficulty in achieving chest compression depth targets in younger children.
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- 2018
- Full Text
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5. Sustained Aeration of Infant Lungs (SAIL) trial: study protocol for a randomized controlled trial.
- Author
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Foglia EE, Owen LS, Thio M, Ratcliffe SJ, Lista G, Te Pas A, Hummler H, Nadkarni V, Ades A, Posencheg M, Keszler M, Davis P, and Kirpalani H
- Subjects
- Australia, Bronchopulmonary Dysplasia etiology, Canada, Clinical Protocols, Europe, Gestational Age, Humans, Infant, Extremely Premature, Infant, Newborn, Prospective Studies, Research Design, Respiratory Distress Syndrome, Newborn diagnosis, Respiratory Distress Syndrome, Newborn mortality, Respiratory Distress Syndrome, Newborn physiopathology, Risk Factors, Time Factors, Treatment Outcome, United States, Intermittent Positive-Pressure Ventilation adverse effects, Intermittent Positive-Pressure Ventilation mortality, Lung physiopathology, Positive-Pressure Respiration adverse effects, Positive-Pressure Respiration mortality, Respiratory Distress Syndrome, Newborn therapy
- Abstract
Background: Extremely preterm infants require assistance recruiting the lung to establish a functional residual capacity after birth. Sustained inflation (SI) combined with positive end expiratory pressure (PEEP) may be a superior method of aerating the lung compared with intermittent positive pressure ventilation (IPPV) with PEEP in extremely preterm infants. The Sustained Aeration of Infant Lungs (SAIL) trial was designed to study this question., Methods/design: This multisite prospective randomized controlled unblinded trial will recruit 600 infants of 23 to 26 weeks gestational age who require respiratory support at birth. Infants in both arms will be treated with PEEP 5 to 7 cm H2O throughout the resuscitation. The study intervention consists of performing an initial SI (20 cm H20 for 15 seconds) followed by a second SI (25 cm H2O for 15 seconds), and then PEEP with or without IPPV, as needed. The control group will be treated with initial IPPV with PEEP. The primary outcome is the combined endpoint of bronchopulmonary dysplasia or death at 36 weeks post-menstrual age., Trial Registration: www.clinicaltrials.gov , Trial identifier NCT02139800 , Registered 13 May 2014.
- Published
- 2015
- Full Text
- View/download PDF
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