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51. New or Progressive Multiple Organ Dysfunction Syndrome in Pediatric Severe Sepsis: A Sepsis Phenotype With Higher Morbidity and Mortality

Author

Lin, John C, Spinella, Philip C., Fitzgerald, Julie C., Tucci, Marisa, Bush, Jenny L., Nadkarni, Vinay M., Thomas, Neal J., Weiss, Scott L., Fontela, P., Tucci, M., Dumistrascu, M., Skippen, P., Krahn, G., Bezares, E., Puig, G., Puig Ramos, A., Garcia, R., Villar, M., Bigham, M., Polanski, T., Latifi, S., Giebner, D., Anthony, H., Hume, J., Galster, A., Linnerud, L., Sanders, R., Hefley, G., Madden, K., Thompson, A., Shein, S., Gertz, S., Han, Y., Williams, T., Hughes Schalk, A., Chandler, H., Orioles, A., Zielinski, E., Doucette, A., Zebuhr, C., Wilson, T., Dimitriades, C., Ascani, J., Layburn, S., Valley, S., Markowitz, B., Terry, J., Morzov, R., Mcinnes, A., Mcarthur, J., Woods, K., Murkowski, K., Spaeder, M., Sharron, M., Wheeler, D., Beckman, E., Frank, E., Howard, K., Carroll, C., Nett, S., Jarvis, D., Patel, V., Higgerson, R., Christie, L., Typpo, K., Deschenes, J., Kirby, A., Uhl, T., Rehder, K., Cheifetz, I., Wrenn, S., Kypuros, K., Ackerman, K., Maffei, F., Bloomquist, G., Rizkalla, N., Kimura, D., Shah, S., Tigges, C., Su, F., Barlow, C., Michelson, K., Wolfe, K., Goodman, D., Campbell, L., Sorce, L., Bysani, K., Monjure, T., Evans, M., Totapally, B., Chegondi, M., Rodriguez, C., Frazier, J., Steele, L., Viteri, S., Costarino, A., Thomas, N., Spear, D., Hirshberg, E., Lilley, J., Rowan, C., Rider, C., Kane, J., Zimmerman, J., Greeley, C., Lin, J., Jacobs, R., Parker, M., Culver, K., Loftis, L., Jaimon, N., Goldsworthy, M., Diliberto, M., Alen, C., Gessouroun, M., Sapru, A., Lang, T., Alkhouli, M., Kamath, S., Friel, D., Daufeldt, J., Hsing, D., Carlo, C., Pon, S., Scimeme, J., Shaheen, A., Hassinger, A., Qiao, H., Giuliano, J., Tala, J., Vinciguerra, D., Fernandez, A., Carrero, R., Hoyos, P., Jaramillo, J., Posada, A., Izquiierdo, L., Pineres Olave, B. E., Donado, J., Dalmazzo, R., Rendich, S., Palma, L., Lapadula, M., Acuna, C., Cruces, P., De Clety, S. Clement, Dujardin, M., Berghe, C., Renard, S., Zurek, J., Steinherr, H., Mougkou, K., Critselis, E., Di Nardo, M., Picardo, S., Tortora, F., Rossetti, E., Fragasso, T., Cogo, Paola, Netto, R., Dagys, A., Gurskis, V., Kevalas, R., Neeleman, C., Lemson, J., Luijten, C., Wojciech, K., Pagowska Klimek, I., Szczepanska, M., Karpe, J., Nunes, P., Almeida, H., Rios, J., Vieira, M., Garcia Iniguez, J. P., Revilla, P., Urbano, J., Lopez Herce, J., Bustinza, A., Cuesta, A., Hofheinz, S., Rodriguez Nunez, A., Sanagustin, S., Gonzalez, E., Riaza, M., Piaya, R., Soler, P., Esteban, E., Laraudogoitia, J., Monge, C., Herrera, V., Granados, J., Gonzalez, C., Koroglu, T., Ozcelik, E., Baines, P., Plunkett, A., Davis, P., George, S., Tibby, S., Harris, J., Agbeko, R., Lampitt, R., Brierley, J., Peters, M., Jones, A., Dominguez, T., Thiruchelvam, T., Deep, A., Ridley, L., Bowen, W., Levin, R., Macleod, I., Gray, M., Hemat, N., Alexander, J., Ali, S., Pappachan, J., Mccorkell, J., Fortune, P., Macdonald, M., Hudnott, P., Suyun, Q., Singhi, S., Nallasamy, K., Lodha, R., Shime, N., Tabata, Y., Saito, O., Ikeyama, T., Kawasaki, T., Lum, L., Abidin, A., Kee, S., Tang, S., Jalil, R., Guan, Y., Yao, L., Lin, K., Ong, J., Salloo, A., Doedens, L., Mathivha, L., Reubenson, G., Moaisi, S., Pentz, A., Green, R., Schibler, A., Erickson, S., Mceneiry, J., Long, D., Dorofaeff, T., Coulthard, M., Millar, J., Delzoppo, C., Williams, G., Morritt, M., Watts, N., Beca, J., Sherring, C., and Bushell, T.

Subjects
Male, medicine.medical_specialty, Adolescent, Cross-sectional study, Multiple Organ Failure, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Prevalence, children, epidemiology, multiple organ dysfunction syndrome, severe sepsis, Pediatrics, Perinatology and Child Health, Critical Care and Intensive Care Medicine, 030204 cardiovascular system & hematology, Global Health, Intensive Care Units, Pediatric, Pediatrics, Article, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Epidemiology, medicine, Humans, Hospital Mortality, Prospective Studies, 030212 general & internal medicine, Child, Intensive care medicine, Prospective cohort study, Septic shock, business.industry, Infant, Newborn, Infant, Perinatology and Child Health, Prognosis, medicine.disease, Clinical trial, Cross-Sectional Studies, Phenotype, Child, Preschool, Disease Progression, Female, Multiple organ dysfunction syndrome, business
Abstract

Copyright © 2016 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.Objectives: To describe the epidemiology, morbidity, and mortality of new or progressive multiple organ dysfunction syndrome in children with severe sepsis. Design: Secondary analysis of a prospective, cross-sectional, point prevalence study. Setting: International, multicenter PICUs. Patients: Pediatric patients with severe sepsis identified on five separate days over a 1-year period. Interventions: None. Measurements and Main Results: Of 567 patients from 128 PICUs in 26 countries enrolled, 384 (68%) developed multiple organ dysfunction syndrome within 7 days of severe sepsis recognition. Three hundred twenty-seven had multiple organ dysfunction syndrome on the day of sepsis recognition. Ninety-one of these patients developed progressive multiple organ dysfunction syndrome, whereas an additional 57 patients subsequently developed new multiple organ dysfunction syndrome, yielding a total proportion with severe sepsis-associated new or progressive multiple organ dysfunction syndrome of 26%. Hospital mortality in patients with progressive multiple organ dysfunction syndrome was 51% compared with patients with new multiple organ dysfunction syndrome (28%) and those with single-organ dysfunction without multiple organ dysfunction syndrome (10%) (p < 0.001). Survivors of new or progressive multiple organ dysfunction syndrome also had a higher frequency of moderate to severe disability defined as a Pediatric Overall Performance Category score of greater than or equal to 3 and an increase of greater than or equal to 1 from baseline: 22% versus 29% versus 11% for progressive, new, and no multiple organ dysfunction syndrome, respectively (p < 0.001). Conclusions: Development of new or progressive multiple organ dysfunction syndrome is common (26%) in severe sepsis and is associated with a higher risk of morbidity and mortality than severe sepsis without new or progressive multiple organ dysfunction syndrome. Our data support the use of new or progressive multiple organ dysfunction syndrome as an important outcome in trials of pediatric severe sepsis although efforts are needed to validate whether reducing new or progressive multiple organ dysfunction syndrome leads to improvements in more definitive morbidity and mortality endpoints.

Published
2017

52. Using research to prepare for outbreaks of severe acute respiratory infection

Author

Mich, V. (Vann), Pho, Y. (Yaty), Bory, S. (Sotharith), Vann, M. (Mich), Teav, B. (Bunlor), Som, L. (Leakhann), Jarrvisalo, M. J. (Mikko J.), Pulkkinen, A. (Anni), Kuitunen, A. (Anne), Ala-kokko, T. (Tero), Melto, S. (Sari), Daix, T. (Thomas), Philippart, F. (Francois), Antoine, M. (Marchalot), Tiercelet, K. (Kelly), Bruel, C. (Cedric), Nicholas, S. (Sedillot), Siami, S. (Shidasp), Fabienne, T. (Taimon), Bruyere, R. (Raomi), Forceville, X. (Xavier), Erickson, S. (Simon), Campbell, L. (Lewis), Sonawane, R. (Ravikiran), Santamaria, J. (John), Kol, M. (Mark), Awasthi, S. (Shally), Powis, J. (Jeff), Hall, R. (Richard), McCarthy, A. E. (Anne E.), Jouvet, P. (Philippe), Opaysky, M. A. (Mary Anne), Gilfoyle, E. (Elaine), Farshait, N. (Nataly), Martin, D.-A. (Dori-Ann), Griesdale, D. (Donald), Katz, K. (Kevin), Ruberto, A. J. (Aaron J.), Carrier, F. M. (Francois Martin), Lamontagne, F. (Francois), Muscedere, J. (John), Rishu, A. (Asgar), Sin, W. C. (Wai Ching), Ngai, W. C. (Wallace Chun Wai), Young, P. (Paul), Forrest, A. (Annette), Kazemi, A. (Alex), Henderson, S. (Seton), Browne, T. (Troy), Ganeshalingham, A. (Anusha), McConnochie, R. (Rachael), Cho, J. H. (Jae Hwa), Park, T. S. (Tai Sun), Sim, Y. S. (Yun Su), Chang, Y. (Youjin), Lee, H. B. (Heung Bum), Park, S. Y. (Seung Yong), Chan, W. M. (Wai Ming), Lee, W.-Y. (Won-Yeon), Wallace, D. J. (David J.), Angus, D. C. (Derek C.), Charles, A. G. (Anthony G.), van Doom, H. R. (H. Rogier), Prin, M. (Meghan), Twagirumugabe, T. (Theogene), Umuhire, O. F. (Olivier Felix), Sylvain, H. (Habarurema), Al Qasim, E. (Eman), Heraud, J.-M. (Jean-Michel), Raberahona, M. (Mihaja), Rabarison, J. H. (Joelinotahiana Hasina), Patrigeon, S. P. (Santiago Perez), Ramirez-Venegas, A. (Alejandra), Melendez, J. A. (Javier Araujo), Guerrero, M. L. (M. Lourdes), Mambule, I. (Ivan), Ochieng, O. G. (Otieno George), Nadjm, B. (Behzad), Li, I. W. (Iris Wai Sum), Choi, W.-I. (Won-Il), Florence, K.-P. (Komurian-Pradel), Arabi, Y. M. (Yaseen M.), West, T. E. (T. Eoin), Riviello, E. D. (Elisabeth D.), Parke, R. (Rachael), Djillali, A. E. (Annane E.), Fowler, R. (Robert), Murthy, S. (Srinivas), Nichol, A. (Alistair), Cheng, A. C. (Allen C.), Semple, C. (Calum), George, M. (Maya), Valkonen, M. (Miia), McArthur, C. (Colin), Carson, G. (Gail), O'Neill, G. (Genevieve), Cobb, J. P. (J. Perren), Dunning, J. (Jake), Chiche, J.-D. (Jean-Daniel), Huh, J.-W. (Jin-Won), Marshall, J. (John), Rello, J. (Jordi), Guillebaud, J. (Julia), Razanazatovo, N. (Norosoa), Otieno, J. W. (Juilett Wambura), Green, K. (Karen), Rowan, K. (Kathy), Baillie, J. K. (John Kenneth), Merson, L. (Laura), Hsu, L. Y. (Li Yang), Christian, M. D. (Michael D.), Egi, M. (Moritoki), Shindo, N. (Nahoko), Horby, P. (Peter), Pardinaz-Solis, R. (Raul), Ubiergo, S. U. (Sebastian Ugarte), Webb, S. A. (Steve A. R.), Uyeki, T. M. (Timothy M.), Gordon, A. C. (Anthony C.), Paterson, D. L. (David L.), Everett, D. (Dean), Giamarellos-Bourboulis, E. J. (Evangelos J.), Longuere, K.-S. (Kajsa-Stina), Maslove, D. (David), Ohuma, E. (Eric), Growl, G. (Gloria), PedutemHumber, T. (Theresa), EllazarHumber, E. (Edward), Bahinskaya, I. (Ilona), Osbourne-Townsend, J. (Joan), Bentley, A. (Andrew), Goodson, J. (Jennifer), Welters, I. (Ingeborg), Malik, N. (Nadia), Browne, T. S. (T. S.), and Mahesh, V. (Vinaya)

Abstract

Severe acute respiratory infections (SARI) remain one of the leading causes of mortality around the world in all age groups. There is large global variation in epidemiology, clinical management and outcomes, including mortality. We performed a short period observational data collection in critical care units distributed globally during regional peak SARI seasons from 1 January 2016 until 31 August 2017, using standardised data collection tools. Data were collected for 1 week on all admitted patients who met the inclusion criteria for SARI, with follow-up to hospital discharge. Proportions of patients across regions were compared for microbiology, management strategies and outcomes. Regions were divided geographically and economically according to World Bank definitions. Data were collected for 682 patients from 95 hospitals and 23 countries. The overall mortality was 9.5%. Of the patients, 21.7% were children, with case fatality proportions of 1% for those less than 5 years. The highest mortality was in those above 60 years, at 18.6%. Case fatality varied by region: East Asia and Pacific 10.2% (21 of 206), Sub-Saharan Africa 4.3% (8 of 188), South Asia 0% (0 of 35), North America 13.6% (25 of 184), and Europe and Central Asia 14.3% (9 of 63). Mortality in low-income and low-middle-income countries combined was 4% as compared with 14% in high-income countries. Organ dysfunction scores calculated on presentation in 560 patients where full data were available revealed Sequential Organ Failure Assessment (SOFA) scores on presentation were significantly associated with mortality and hospital length of stay. Patients in East Asia and Pacific (48%) and North America (24%) had the highest SOFA scores of >12. Multivariable analysis demonstrated that initial SOFA score and age were independent predictors of hospital survival. There was variability across regions and income groupings for the critical care management and outcomes of SARI. Intensive care unit-specific factors, geography and management features were less reliable than baseline severity for predicting ultimate outcome. These findings may help in planning future outbreak severity assessments, but more globally representative data are required.

Published
2019

54. Transnasal Humidified Rapid Insufflation Ventilatory Exchange in children requiring emergent intubation (Kids THRIVE): a protocol for a randomised controlled trial

Author

George, S, Humphreys, S, Williams, T, Gelbart, B, Chavan, A, Rasmussen, K, Ganeshalingham, A, Erickson, S, Ganu, SS, Singhal, N, Foster, K, Gannon, B, Gibbons, K, Schlapbach, LJ, Festa, M, Dalziel, S, Schibler, A, Sargent, P, Bell, C, George, S, Humphreys, S, Williams, T, Gelbart, B, Chavan, A, Rasmussen, K, Ganeshalingham, A, Erickson, S, Ganu, SS, Singhal, N, Foster, K, Gannon, B, Gibbons, K, Schlapbach, LJ, Festa, M, Dalziel, S, Schibler, A, Sargent, P, and Bell, C

Abstract

INTRODUCTION: Emergency intubation of children with abnormal respiratory or cardiac physiology is a high-risk procedure and associated with a high incidence of adverse events including hypoxemia. Successful emergency intubation is dependent on inter-related patient and operator factors. Preoxygenation has been used to maximise oxygen reserves in the patient and to prolong the safe apnoeic time during the intubation phase. Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) prolongs the safe apnoeic window for a safe intubation during elective intubation. We designed a clinical trial to test the hypothesis that THRIVE reduces the frequency of adverse and hypoxemic events during emergency intubation in children and to test the hypothesis that this treatment is cost-effective compared with standard care. METHODS AND ANALYSIS: The Kids THRIVE trial is a multicentre randomised controlled trial performed in participating emergency departments and paediatric intensive care units. 960 infants and children aged 0-16 years requiring emergency intubation for all reasons will be enrolled and allocated to THRIVE or control in a 1:1 allocation with stratification by site, age (<1, 1-7 and >7 years) and operator (junior and senior). Children allocated to THRIVE will receive weight appropriate transnasal flow rates with 100% oxygen, whereas children in the control arm will not receive any transnasal oxygen insufflation. The primary outcomes are defined as follows: (1) hypoxemic event during the intubation phase defined as SpO2 <90% (patient-dependent variable) and (2) first intubation attempt success without hypoxemia (operator-dependent variable). Analyses will be conducted on an intention-to-treat basis. ETHICS AND DISSEMINATION: Ethics approval for the protocol and consent process has been obtained (HREC/16/QRCH/81). The trial has been actively recruiting since May 2017. The study findings will be submitted for publication in a peer-reviewed journal. TRIAL REG

Published
2019

55. Defining benefit threshold for extracorporeal membrane oxygenation in children with sepsis-a binational multicenter cohort study

Author

Schlapbach, LJ, Chilettr, R, Straney, L, Festa, M, Alexander, D, Butt, W, MacLaren, G, Ganeshalingam, A, Sherring, C, Erickson, S, Barr, S, Schibler, A, Long, D, Schlapbach, L, Alexander, J, George, S, Williams, G, Smith, V, Delzoppo, C, Millar, J, Gelbart, B, Oberender, F, Ganu, S, Letton, G, Egan, J, Harper, G, Schlapbach, LJ, Chilettr, R, Straney, L, Festa, M, Alexander, D, Butt, W, MacLaren, G, Ganeshalingam, A, Sherring, C, Erickson, S, Barr, S, Schibler, A, Long, D, Schlapbach, L, Alexander, J, George, S, Williams, G, Smith, V, Delzoppo, C, Millar, J, Gelbart, B, Oberender, F, Ganu, S, Letton, G, Egan, J, and Harper, G

Abstract

BACKGROUND: The surviving sepsis campaign recommends consideration for extracorporeal membrane oxygenation (ECMO) in refractory septic shock. We aimed to define the benefit threshold of ECMO in pediatric septic shock. METHODS: Retrospective binational multicenter cohort study of all ICUs contributing to the Australian and New Zealand Paediatric Intensive Care Registry. We included patients < 16 years admitted to ICU with sepsis and septic shock between 2002 and 2016. Sepsis-specific risk-adjusted models to establish ECMO benefit thresholds with mortality as the primary outcome were performed. Models were based on clinical variables available early after admission to ICU. Multivariate analyses were performed to identify predictors of survival in children treated with ECMO. RESULTS: Five thousand sixty-two children with sepsis and septic shock met eligibility criteria, of which 80 (1.6%) were treated with veno-arterial ECMO. A model based on 12 clinical variables predicted mortality with an AUROC of 0.879 (95% CI 0.864-0.895). The benefit threshold was calculated as 47.1% predicted risk of mortality. The observed mortality for children treated with ECMO below the threshold was 41.8% (23 deaths), compared to a predicted mortality of 30.0% as per the baseline model (16.5 deaths; standardized mortality rate 1.40, 95% CI 0.89-2.09). Among patients above the benefit threshold, the observed mortality was 52.0% (13 deaths) compared to 68.2% as per the baseline model (16.5 deaths; standardized mortality rate 0.61, 95% CI 0.39-0.92). Multivariable analyses identified lower lactate, the absence of cardiac arrest prior to ECMO, and the central cannulation (OR 0.31, 95% CI 0.10-0.98, p = 0.046) as significant predictors of survival for those treated with VA-ECMO. CONCLUSIONS: This binational study demonstrates that a rapidly available sepsis mortality prediction model can define thresholds for survival benefit in children with septic shock considered for ECMO. Survival on ECMO wa

Published
2019

56. Study protocol: NITric oxide during cardiopulmonary bypass to improve Recovery in Infants with Congenital heart defects (NITRIC trial): a randomised controlled trial

Author

Schlapbach, LJ, Horton, SB, Long, DA, Beca, J, Erickson, S, Festa, M, d'Udekem, Y, Alphonso, N, Winlaw, D, Johnson, K, Delzoppo, C, van Loon, K, Gannon, B, Fooken, J, Blumenthal, A, Young, P, Jones, M, Butt, W, Schibler, A, Millar, J, Buckley, D, Evans, T, Sherring, C, Artrip, J, O'Shaughnessy, K, Fletcher, R, Byrne, S, Barr, S, Kelly, R, Andrews, D, Johnston, K, Zuzak, C, Anderson, B, van Belle-van Haaren, NJCW, van Wijk, B, Koomen, E, Schlapbach, LJ, Horton, SB, Long, DA, Beca, J, Erickson, S, Festa, M, d'Udekem, Y, Alphonso, N, Winlaw, D, Johnson, K, Delzoppo, C, van Loon, K, Gannon, B, Fooken, J, Blumenthal, A, Young, P, Jones, M, Butt, W, Schibler, A, Millar, J, Buckley, D, Evans, T, Sherring, C, Artrip, J, O'Shaughnessy, K, Fletcher, R, Byrne, S, Barr, S, Kelly, R, Andrews, D, Johnston, K, Zuzak, C, Anderson, B, van Belle-van Haaren, NJCW, van Wijk, B, and Koomen, E

Abstract

INTRODUCTION: Congenital heart disease (CHD) is a major cause of infant mortality. Many infants with CHD require corrective surgery with most operations requiring cardiopulmonary bypass (CPB). CPB triggers a systemic inflammatory response which is associated with low cardiac output syndrome (LCOS), postoperative morbidity and mortality. Delivery of nitric oxide (NO) into CPB circuits can provide myocardial protection and reduce bypass-induced inflammation, leading to less LCOS and improved recovery. We hypothesised that using NO during CPB increases ventilator-free days (VFD) (the number of days patients spend alive and free from invasive mechanical ventilation up until day 28) compared with standard care. Here, we describe the NITRIC trial protocol. METHODS AND ANALYSIS: The NITRIC trial is a randomised, double-blind, controlled, parallel-group, two-sided superiority trial to be conducted in six paediatric cardiac surgical centres. One thousand three-hundred and twenty infants <2 years of age undergoing cardiac surgery with CPB will be randomly assigned to NO at 20 ppm administered into the CPB oxygenator for the duration of CPB or standard care (no NO) in a 1:1 ratio with stratification by age (<6 and ≥6 weeks), single ventricle physiology (Y/N) and study centre. The primary outcome will be VFD to day 28. Secondary outcomes include a composite of LCOS, need for extracorporeal membrane oxygenation or death within 28 days of surgery; length of stay in intensive care and in hospital; and, healthcare costs. Analyses will be conducted on an intention-to-treat basis. Preplanned secondary analyses will investigate the impact of NO on host inflammatory profiles postsurgery. ETHICS AND DISSEMINATION: The study has ethical approval (HREC/17/QRCH/43, dated 26 April 2017), is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12617000821392) and commenced recruitment in July 2017. The primary manuscript will be submitted for publication in a peer-reviewed

Published
2019

57. RACHS-ANZ: A Modified Risk Adjustment in Congenital Heart Surgery Model for Outcome Surveillance in Australia and New Zealand

Author

McSharry, B, Straney, L, Alexander, J, Gentles, T, Winlaw, D, Beca, J, Millar, J, Shann, F, Wilkins, B, Numa, A, Stocker, C, Erickson, S, Slater, A, McSharry, B, Straney, L, Alexander, J, Gentles, T, Winlaw, D, Beca, J, Millar, J, Shann, F, Wilkins, B, Numa, A, Stocker, C, Erickson, S, and Slater, A

Abstract

Background Outcomes for pediatric cardiac surgery are commonly reported from international databases compiled from voluntary data submissions. Surgical outcomes for all children in a country or region are less commonly reported. We aimed to describe the bi-national population-based outcome for children undergoing cardiac surgery in Australia and New Zealand and determine whether the Risk Adjustment for Congenital Heart Surgery ( RACHS ) classification could be used to create a model that accurately predicts in-hospital mortality in this population. Methods and Results The study was conducted in all children's hospitals performing cardiac surgery in Australia and New Zealand between January 2007 and December 2015. The performance of the original RACHS -1 model was assessed and compared with an alternative RACHS - ANZ (Australia and New Zealand) model, developed balancing discrimination with parsimonious variable selection. A total of 14 324 hospital admissions were analyzed. The overall hospital mortality was 2.3%, ranging from 0.5% for RACHS category 1 procedures, to 17.0% for RACHS category 5 or 6 procedures. The original RACHS -1 model was poorly calibrated with death overpredicted (1161 deaths predicted, 289 deaths observed). The RACHS - ANZ model had better performance in this population with excellent discrimination (Az- ROC of 0.830) and acceptable Hosmer and Lemeshow goodness-of-fit ( P=0.216). Conclusions The original RACHS -1 model overpredicts mortality in children undergoing heart surgery in the current era. The RACHS - ANZ model requires only 3 risk variables in addition to the RACHS procedure category, can be applied to a wider range of patients than RACHS -1, and is suitable to use to monitor regional pediatric cardiac surgery outcomes.

Published
2019

59. Subduction initiation at passive margins: the Scotian Basin, eastern Canada as a potential example

Author

Erickson, S. Gregg and Arkani-Hamed, Jafar

Subjects
Scotia Sea -- Natural history, Subduction zones (Geology) -- Research, Earth sciences
Abstract

An analysis of the shear resistance associated lithospheric faulting and thermal evolution modeling show the difficulty of subduction initiation at passive margin. Pulses of compression related to plate reorganization may facilitate subduction initiation along a part of the margin by the deformation of strike slip and weaker continental lithosphere, the heating and weakening of oceanic lithosphere. Shear resistance is reduced when initiation is in an extensional or strike slip setting, the continents proximity to a mature passive margin is less, or when a passage of a mantle plume beneath the margin heats the continental lithosphere.

Published
1993

60. Sedimentary loading, lithospheric flexure, and subduction initiation at passive margins

Author

Erickson, S. Gregg

Subjects
Sedimentary basins -- Observations, Geology, Structural -- Observations, Continental margins -- Observations, Earth sciences
Abstract

Investigation of lithospheric flexure at continental margins by sedimentary loading has been carried out using elastic-plate theory. The geometry of mature marginal basins fits the deflection produced by loading of an infinite plate in which the flexural rigidity of the continental lithosphere is larger than that of oceanic lithosphere. Decoupling of a previously locked passive margin by reactivation of margin faults may cause the lithospheric bending behavior of the margin to change from that of an infinite plate to that of a semi-infinite plate, with a resultant increase in deflection of the marginal basin and possible subduction initiation.

Published
1993

62. Structure of the Kelley Mountain culmination, central Alabama, and implications for the evolution of the southeastern southern Appalachian foreland thrust belt

Author

Erickson, S. Gregg

Subjects
Alabama -- Natural history, Thrust faults (Geology) -- Research, Geology, Structural -- Alabama, Folds (Geology) -- Research, Stratigraphic correlation -- Alabama, Earth sciences
Abstract

The Kelley Mountain structural culmination forms a half window with respect to the metamorphic Talladega-Cartersville thrust sheet. Fault rocks along one of the contacts within this half window indicate that this contact is a thrust fault. Based on regional structural relationships, this contact is interpreted as the Pell City fault, a regional thrust fault within the Alabama foreland thrust belt northwest of the Talladega-Cartersville fault. Therefore, the Kelley Mountain culmination is interpreted as an eyelid window exposing the Pell City and Talladega-Cartersville faults. The Pell City thrust sheet at Kelley Mountain is interpreted as a horse beneath the Talladega-Cartersville fault that has moved up a footwall ramp through Cambrian-Ordovician carbonates and onto a flat of Mississippian shale and sandstone. A similar thrust geometry at the Fort McClellan window, 90 km to the northeast, indicates that the Pell City thrust sheet may be a large horse associated with a regional footwall ramp. Both the Talladega-Cartersville and Pell City faults are folded by the Kelley Mountain antiform and adjacent Columbiana synform. The Kelley Mountain antiform continues northward from the Kelley Mountain area to the southern terminus of the Coosa deformed belt, where shortening associated with folding may be transferred to imbricate faulting in the footwall of the Pell City fault.

Published
1991

63. Biomass transformation: Hydration and isomerization reactions of turpentine oil using ion exchange resins as catalyst

Author

Paulo G.C. Gonçalves, Erickson S. Silva, Vitor T. Salvador, and Rodrigo Cella

Subjects
Turpentine Oil, Pharmaceutical Science, Biomass, Turpentine, Management, Monitoring, Policy and Law, Pollution, Catalysis, chemistry.chemical_compound, chemistry, Environmental Chemistry, Camphene, Selectivity, Ion-exchange resin, Isomerization, Nuclear chemistry
Abstract

The hydration and isomerization of the biomass turpentine have been studied in the presence of Purolite CT175. The ion exchange resin catalyst was active for hydration and selective for producing terpenic alcohols, with a conversion of 97% and showed 57% selectivity for α-terpineol using heating and stirring. The Purolite CT175-catalyzed isomerization of turpentine taken place in a high intensity ultrasound (HIU) condition; and showed conversion of 90% and 30% selectivity for camphene at 30 min. Recyclability of ion exchange resin was evaluated in both reaction and its activity remained good even after four runs.

Published
2020

65. Risk Factors for Mortality in Pediatric Postsurgical versus Medical Severe Sepsis

Author

Thakkar, Rajan K., primary, Weiss, Scott L., additional, Fitzgerald, Julie C., additional, Keele, Luke, additional, Thomas, Neal J., additional, Nadkarni, Vinay M., additional, Muszynski, Jennifer A., additional, Hall, Mark W., additional, Fontela, P., additional, Tucci, M., additional, Dumistrascu, M., additional, Skippen, P., additional, Krahn, G., additional, Bezares, E., additional, Puig, G., additional, Puig-Ramos, A., additional, Garcia, R., additional, Villar, M., additional, Bigham, M., additional, Polanski, T., additional, Latifi, S., additional, Giebner, D., additional, Anthony, H., additional, Hume, J., additional, Galster, A., additional, Linnerud, L., additional, Sanders, R., additional, Hefley, G., additional, Madden, K., additional, Thompson, A., additional, Shein, S., additional, Gertz, S., additional, Han, Y., additional, Williams, T., additional, Hughes-Schalk, A., additional, Chandler, H., additional, Orioles, A., additional, Zielinski, E., additional, Doucette, A., additional, Zebuhr, C., additional, Wilson, T., additional, Dimitriades, C., additional, Ascani, J., additional, Layburn, S., additional, Valley, S., additional, Markowitz, B., additional, Terry, J., additional, Morzov, R., additional, Mcinnes, A., additional, McArthur, J., additional, Woods, K., additional, Murkowski, K., additional, Spaeder, M., additional, Sharron, M., additional, Wheeler, D., additional, Beckman, E., additional, Frank, E., additional, Howard, K., additional, Carroll, C., additional, Nett, S., additional, Jarvis, D., additional, Patel, V., additional, Higgerson, R., additional, Christie, L., additional, Typpo, K., additional, Deschenes, J., additional, Kirby, A., additional, Uhl, T., additional, Rehder, K., additional, Cheifetz, I., additional, Wrenn, S., additional, Kypuros, K., additional, Ackerman, K., additional, Maffei, F., additional, Bloomquist, G., additional, Rizkalla, N., additional, Kimura, D., additional, Shah, S., additional, Tigges, C., additional, Su, F., additional, Barlow, C., additional, Michelson, K., additional, Wolfe, K., additional, Goodman, D., additional, Campbell, L., additional, Sorce, L., additional, Bysani, K., additional, Monjure, T., additional, Evans, M., additional, Totapally, B., additional, Chegondi, M., additional, Rodriguez, C., additional, Frazier, J., additional, Steele, L., additional, Viteri, S., additional, Costarino, A., additional, Thomas, N., additional, Spear, D., additional, Hirshberg, E., additional, Lilley, J., additional, Rowan, C., additional, Rider, C., additional, Kane, J., additional, Zimmerman, J., additional, Greeley, C., additional, Lin, J., additional, Jacobs, R., additional, Parker, M., additional, Culver, K., additional, Loftis, L., additional, Jaimon, N., additional, Goldsworthy, M., additional, Fitzgerald, J., additional, Weiss, S., additional, Nadkarni, V., additional, Bush, J., additional, Diliberto, M., additional, Allen, C., additional, Gessouroun, M., additional, Sapru, A., additional, Lang, T., additional, Alkhouli, M., additional, Kamath, S., additional, Friel, D., additional, Daufeldt, J., additional, Hsing, D., additional, Carlo, C., additional, Pon, S., additional, Scimeme, J., additional, Shaheen, A., additional, Hassinger, A., additional, Qiao, H., additional, Giuliano, J., additional, Tala, J., additional, Vinciguerra, D., additional, Fernandez, A., additional, Carrero, R., additional, Hoyos, P., additional, Jaramillo, J., additional, Posada, A., additional, Izquiierdo, L., additional, Olave, B.E. Piñeres, additional, Donado, J., additional, Dalmazzo, R., additional, Rendich, S., additional, Palma, L., additional, Lapadula, M., additional, Acuna, C., additional, Cruces, P., additional, De Clety, S. Clement, additional, Dujardin, M., additional, Berghe, C., additional, Renard, S., additional, Zurek, J., additional, Steinherr, H., additional, Mougkou, K., additional, Critselis, E., additional, Di Nardo, M., additional, Picardo, S., additional, Tortora, F., additional, Rossetti, E., additional, Fragasso, T., additional, Cogo, P., additional, Netto, R., additional, Dagys, A., additional, Gurskis, V., additional, Kevalas, R., additional, Neeleman, C., additional, Lemson, J., additional, Luijten, C., additional, Wojciech, K., additional, Pagowska-Klimek, I., additional, Szczepanska, M., additional, Karpe, J., additional, Nunes, P., additional, Almeida, H., additional, Rios, J., additional, Vieira, M., additional, Iniguez, J. P. Garcia, additional, Revilla, P., additional, Urbano, J., additional, Lopez-Herce, J., additional, Bustinza, A., additional, Palacios, A., additional, Hofheinz, S., additional, Rodriguez-Nunez, A., additional, Sanagustin, S., additional, Gonzalez, E., additional, Riaza, M., additional, Piaya, R., additional, Soler, P., additional, Esteban, E., additional, Laraudogoitia, J., additional, Monge, C., additional, Herrera, V., additional, Granados, J., additional, Gonzalez, C., additional, Koroglu, T., additional, Ozcelik, E., additional, Baines, P., additional, Plunkett, A., additional, Davis, P., additional, George, S., additional, Tibby, S., additional, Harris, J., additional, Agbeko, R., additional, Lampitt, R., additional, Brierley, J., additional, Peters, M., additional, Jones, A., additional, Dominguez, T., additional, Thiruchelvam, T., additional, Deep, A., additional, Ridley, L., additional, Bowen, W., additional, Levin, R., additional, Macleod, I., additional, Gray, M., additional, Hemat, N., additional, Alexander, J., additional, Ali, S., additional, Pappachan, J., additional, McCorkell, J., additional, Fortune, P., additional, MacDonald, M., additional, Hudnott, P., additional, Suyun, Q., additional, Singhi, S., additional, Nallasamy, K., additional, Lodha, R., additional, Shime, N., additional, Tabata, Y., additional, Saito, O., additional, Ikeyama, T., additional, Kawasaki, T., additional, Lum, L., additional, Abidin, A., additional, Kee, S., additional, Tang, S., additional, Jalil, R., additional, Guan, Y., additional, Yao, L., additional, Lin, K., additional, Ong, J., additional, Salloo, A., additional, Doedens, L., additional, Mathivha, L., additional, Reubenson, G., additional, Moaisi, S., additional, Pentz, A., additional, Green, R., additional, Schibler, A., additional, Erickson, S., additional, McEneiry, J., additional, Long, D., additional, Dorofaeff, T., additional, Coulthard, M., additional, Millar, J., additional, Delzoppo, C., additional, Williams, G., additional, Morritt, M., additional, Watts, N., additional, Beca, J., additional, Sherring, C., additional, and Bushell, T., additional

Published
2019
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71. Fluid bolus therapy: A survey of practice among paediatric intensive care doctors in australia and New Zealand.

Author

Ganu S., Erickson S., Oberender F., Hoq M., Williams G., George S., Gelbart B., Schlapbach L., Festa M., Ganeshalingham A., Ganu S., Erickson S., Oberender F., Hoq M., Williams G., George S., Gelbart B., Schlapbach L., Festa M., and Ganeshalingham A.

Abstract

Aims & Objectives: Objective: Fluid bolus therapy (FBT) is a widely used intervention in paediatric critical illness. The aim of this study was to describe the attitudes and practices of paediatric intensive care doctors in Australia and New Zealand (ANZ) towards FBT. Method(s): We conducted an internet-based survey of paediatric intensive care specialists and junior medical staff in paediatric intensive care units with greater than 400 admissions annually between November 7th 2016 and November 30th 2016. Preferences for composition of FBT, markers of fluid responsiveness and preferences in specific disease states were sought. Result(s): There were 106/175(61%) respondents. 0.9% saline and 4% albumin are used frequently or almost always by 86% and 57% of respondents respectively. The preferred volume and duration were 10ml/kg in less than 10 minutes. Highest rated markers of fluid responsiveness were heart rate and blood pressure; rated as good or very good by 75% and 58% respectively. Central venous saturations and serum lactate were the highest rated biochemical markers. The most frequently expected magnitude of change for heart rate and blood pressure was 6-15% by 89% and 76% of respondents respectively. 0.9% saline was the preferred fluid for sepsis, trauma, traumatic brain injury and acute lung injury but not for post-op cardiac surgery. Conclusion(s): Paediatric intensive care doctors prefer 0.9% saline and 4% albumin for FBT. Heart rate and blood pressure are the most preferred markers to assess fluid responsiveness. Disease specific preferences for FBT exist.

Published
2018

72. Fluid bolus therapy in critically ill children: a survey of practice among paediatric intensive care doctors in Australia and New Zealand.

Author

Williams G., Oberender F., Hoq M., George S., Festa M., Gelbart B., Schlapbach L., Ganeshalingham A., Ganu S., Erickson S., Williams G., Oberender F., Hoq M., George S., Festa M., Gelbart B., Schlapbach L., Ganeshalingham A., Ganu S., and Erickson S.

Abstract

OBJECTIVE: Fluid bolus therapy (FBT) is a widely used intervention in paediatric critical illness. The aim of this study was to describe the attitudes and practices towards FBT of paediatric intensive care doctors in Australia and New Zealand. DESIGN: An internet-based survey of paediatric intensive care doctors in Australia and New Zealand between 7 and 30 November 2016. SETTING: Paediatric intensive care units with greater than 400 admissions annually. PARTICIPANTS: Paediatric intensive care specialists and junior medical staff. MAIN OUTCOME MEASURES: Preferences for FBT and markers of fluid responsiveness. RESULTS: There were 106/175 respondents (61%); 0.9% saline and 4% albumin are used frequently or almost always by 86% and 57% of respondents respectively. The preferred volume and duration were 10 mL/kg in less than 10 minutes. The highest rated markers of fluid responsiveness were heart rate and blood pressure - rated as "good" or "very good" by 75% and 58% of respondents respectively. Central venous saturations and serum lactate were the highest rated biochemical markers. The most frequently expected magnitude of change for heart rate and blood pressure was 6-15% by 89% and 76% of respondents respectively. The preferred fluid composition for sepsis, trauma, traumatic brain injury and acute lung injury was 0.9% saline, and 4% albumin for post-operative cardiac surgery. CONCLUSIONS: Paediatric intensive care doctors prefer 0.9% saline and 4% albumin for FBT. Heart rate and blood pressure are the most preferred markers to assess fluid responsiveness. Preferences for FBT in specific conditions exist.

Published
2018

73. Effects of dimethyl prostaglandin A1 on herpes simplex virus and human immunodeficiency virus replication

Author

Hughes-Fulford, M, McGrath, M. S, Hanks, D, Erickson, S, and Pulliam, L

Subjects
Life Sciences (General)
Abstract

We have investigated the direct effect of dimethyl prostaglandin A1 (dmPGA1) on the replication of herpes simplex virus (HSV) and human immunodeficiency virus type 1 (HIV-1). dmPGA1 significantly inhibited viral replication in both HSV and HIV infection systems at concentrations of dmPGA1 that did not adversely alter cellular DNA synthesis. The 50% inhibitory concentration (ID50) for several HSV type 1 (HSV-1) strains ranged from 3.8 to 5.6 micrograms/ml for Vero cells and from 4.6 to 7.3 micrograms/ml for human foreskin fibroblasts. The ID50s for two HSV-2 strains varied from 3.8 to 4.5 micrograms/ml for Vero cells; the ID50 was 5.7 micrograms/ml for human foreskin fibroblasts. We found that closely related prostaglandins did not have the same effect on the replication of HSV; dmPGE2 and dmPGA2 caused up to a 60% increase in HSV replication compared with that in untreated virus-infected cells. HIV-1 replication in acutely infected T cells (VB line) and chronically infected macrophages was assessed by quantitative decreases in p24 concentration. The effective ID50s were 2.5 micrograms/ml for VB cells acutely infected with HIV-1 and 5.2 micrograms/m for chronically infected macrophages. dmPGA1 has an unusual broad-spectrum antiviral activity against both HSV and HIV-1 in vitro and offers a new class of potential therapeutic agents for in vivo use.

Published
1992

75. Abstract P-008

Author

Gelbart, B., primary, Schlapbach, L., additional, Festa, M., additional, Ganeshalingham, A., additional, Ganu, S., additional, Erickson, S., additional, Oberender, F., additional, Hoq, M., additional, Williams, G., additional, and George, S., additional

Published
2018
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81. Structural and transport properties of Ba8Ga16SixGe30-x clathrates.

Author

Martin, J., Erickson, S., Nolas, G. S., Alboni, P., Tritt, T. M., and Yang, J.

Subjects
*CLATHRATE compounds, *THERMAL conductivity, *MATERIALS testing, *THERMAL electromotive force, *THERMOELECTRIC materials, *MATERIALS science
Abstract

We report on the structural, chemical, electrical resistivity, Seebeck coefficient, thermal conductivity, and Hall measurements of polycrystalline Si–Ge type-I clathrates with nominal composition of Ba8Ga16SixGe30-x such that a constant Ga-to-group-IV element ratio is maintained while varying the Si-to-Ge ratio. Electrical transport measurements on the n-type specimens show a modest increase in the absolute Seebeck coefficient and a decrease in electrical resistivity with increasing Si content. This may imply a modification in the band structure with Si substitution and reveals a possible approach for optimizing these materials for thermoelectric applications. These data are compared with those of Ba8Ga16Ge30 and Sr8Ga16SixGe30-x. [ABSTRACT FROM AUTHOR]

Published
2006
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82. Intensive care discharge delay is associated with increased hospital length of stay: A multicentre prospective observational study.

Author

Eastwood G., Mitchell I., Pilcher D., Rickerby S., Goldsmith D., Tiruvoipati R., Botha J., Fletcher J., Gangopadhyay H., Majumdar M., Vij S., Paul E., French C., McArthur C., Peake S., Parke R., Gattas D., Saxena M., Young P., Cohen J., Deane A., Cooper D., Udy A., Litton E., Erickson S., Eastwood G., Mitchell I., Pilcher D., Rickerby S., Goldsmith D., Tiruvoipati R., Botha J., Fletcher J., Gangopadhyay H., Majumdar M., Vij S., Paul E., French C., McArthur C., Peake S., Parke R., Gattas D., Saxena M., Young P., Cohen J., Deane A., Cooper D., Udy A., Litton E., and Erickson S.

Abstract

Background: Some patients experience a delayed discharge from the intensive care unit (ICU) where the intended and actual discharge times do not coincide. The clinical implications of this remain unclear. Objective(s): To determine the incidence and duration of delayed ICU discharge, identify the reasons for delay and evaluate the clinical consequences. Method(s): Prospective multi-centre observational study involving five ICUs over a 3-month period. Delay in discharge was defined as >6 hours from the planned discharge time. The primary outcome measure was hospital length stay after ICU discharge decision. Secondary outcome measures included ICU discharge after-hours, incidence of delirium, survival to hospital discharge, discharge destination, the incidence of ICU acquired infections, revocation of ICU discharge decision, unplanned readmissions to ICU within 72 hours, review of patients admitting team after ICU discharge decision. Result(s): A total of 955 out of 1118 patients discharged were included in analysis. 49.9% of the patients discharge was delayed. The most common reason (74%) for delay in discharge was non-availability of ward bed. The median duration of the delay was 24 hours. On univariable analysis, the duration of hospital stay from the time of ICU discharge decision was significantly higher in patients who had ICU discharge delay (Median days-5 vs 6; p = 0.003). After-hours discharge was higher in patients whose discharge was delayed (34% Vs 10%; p<0.001). There was no statistically significant difference in the other secondary outcomes analysed. Multivariable analysis adjusting for known confounders revealed delayed ICU discharge was independently associated with increased hospital length of stay. Conclusion(s): Half of all ICU patients experienced a delay in ICU discharge. Delayed discharge was associated with increased hospital length of stay.Copyright © 2017 Tiruvoipati et al. This is an open access article distributed under the terms of the Cre

Published
2017

89. Comparison of Pediatric Severe Sepsis Managed in U.S. and European ICUs

Author

Giuliano, John S, Markovitz, Barry P., Brierley, Joe, Levin, Richard, Williams, Gary, Lum, Lucy Chai See, Dorofaeff, Tavey, Cruces, Pablo, Bush, Jenny L., Keele, Luke, Nadkarni, Vinay M., Thomas, Neal J., Fitzgerald, Julie C., Weiss, Scott L., Fontela, P., Tucci, M., Dumistrascu, M., Skippen, P., Krahn, G., Bezares, E., Puig, G., Puig Ramos, A., Garcia, R., Villar, M., Bigham, M., Polanski, T., Latifi, S., Giebner, D., Anthony, H., Hume, J., Galster, A., Linnerud, L., Sanders, R., Hefley, G., Madden, K., Thompson, A., Shein, S., Gertz, S., Han, Y., Williams, T., Hughes Schalk, A., Chandler, H., Orioles, A., Zielinski, E., Doucette, A., Zebuhr, C., Wilson, T., Dimitriades, C., Ascani, J., Layburn, S., Valley, S., Markowitz, B., Terry, J., Morzov, R., Mcinnes, A., Mcarthur, J., Woods, K., Murkowski, K., Spaeder, M., Sharron, M., Wheeler, D., Beckman, E., Frank, E., Howard, K., Carroll, C., Nett, S., Jarvis, D., Patel, V., Higgerson, R., Christie, L., Typpo, K., Deschenes, J., Kirby, A., Uhl, T., Rehder, K., Cheifetz, I., Wrenn, S., Kypuros, K., Ackerman, K., Maffei, F., Bloomquist, G., Rizkalla, N., Kimura, D., Shah, S., Tigges, C., Su, F., Barlow, C., Michelson, K., Wolfe, K., Goodman, D., Campbell, L., Sorce, L., Bysani, K., Monjure, T., Evans, M., Totapally, B., Chegondi, M., Rodriguez, C., Frazier, J., Steele, L., Viteri, S., Costarino, A., Thomas, N., Spear, D., Hirshberg, E., Lilley, J., Rowan, C., Rider, C., Kane, J., Zimmerman, J., Greeley, C., Lin, J., Jacobs, R., Parker, M., Culver, K., Loftis, L., Jaimon, N., Goldsworthy, M., Fitzgerald, J., Weiss, S., Nadkarni, V., Bush, J., Diliberto, M., Alen, C., Gessouroun, M., Sapru, A., Lang, T., Alkhouli, M., Kamath, S., Friel, D., Daufeldt, J., Hsing, D., Carlo, C., Pon, S., Scimeme, J., Shaheen, A., Hassinger, A., Qiao, H., Giuliano, J., Tala, J., Vinciguerra, D., Fernandez, A., Carrero, R., Hoyos, P., Jaramillo, J., Posada, A., Izquiierdo, L., Piñeres Olave, B. E., Donado, J., Dalmazzo, R., Rendich, S., Palma, L., Lapadula, M., Acuna, C., Cruces, P., Clement De Clety, S., Dujardin, M., Berghe, C., Renard, S., Zurek, J., Steinherr, H., Mougkou, K., Critselis, E., Di Nardo, M., Picardo, S., Tortora, F., Rossetti, E., Fragasso, T., Cogo, Paola, Netto, R., Dagys, A., Gurskis, V., Kevalas, R., Neeleman, C., Lemson, J., Luijten, C., Wojciech, K., Pagowska Klimek, I., Szczepanska, M., Karpe, J., Nunes, P., Almeida, H., Rios, J., Vieira, M., Revilla, P., Urbano, J., Lopez Herce, J., Bustinza, A., Cuesta, A., Hofheinz, S., Rodriguez Nunez, A., Sanagustin, S., Gonzalez, E., Riaza, M., Piaya, R., Soler, P., Esteban, E., Laraudogoitia, J., Monge, C., Herrera, V., Granados, J., Gonzalez, C., Koroglu, T., Ozcelik, E., Baines, P., Plunkett, A., Davis, P., George, S., Tibby, S., Harris, J., Agbeko, R., Lampitt, R., Brierley, J., Peters, M., Jones, A., Dominguez, T., Thiruchelvam, T., Deep, A., Ridley, L., Bowen, W., Levin, R., Macleod, I., Gray, M., Hemat, N., Alexander, J., Ali, S., Pappachan, J., Mccorkell, J., Fortune, P., Macdonald, M., Hudnott, P., Suyun, Q., Singhi, S., Nallasamy, K., Lodha, R., Shime, N., Tabata, Y., Saito, O., Ikeyama, T., Kawasaki, T., Lum, L., Abidin, A., Kee, S., Tang, S., Jalil, R., Guan, Y., Yao, L., Lin, K., Ong, J., Salloo, A., Doedens, L., Mathivha, L., Reubenson, G., Moaisi, S., Pentz, A., Green, R., Schibler, A., Erickson, S., Mceneiry, J., Long, D., Dorofaeff, T., Coulthard, M., Millar, J., Delzoppo, C., Williams, G., Morritt, M., Watts, N., Beca, J., Sherring, C., and Bushell, T.

Subjects
Male, Pediatrics, Cross-sectional study, shock, Critical Care and Intensive Care Medicine, Severity of Illness Index, 0302 clinical medicine, Prevalence, Hospital Mortality, Prospective Studies, 030212 general & internal medicine, Practice Patterns, Physicians', Child, Prospective cohort study, Pediatric intensive care unit, Perinatology and Child Health, Europe, Treatment Outcome, Child, Preschool, outcome, children, management, pediatric intensive care unit, Pediatrics, Perinatology and Child Health, Female, medicine.symptom, medicine.medical_specialty, Adolescent, Critical Care, Intensive Care Units, Pediatric, Sepsis, 03 medical and health sciences, Intensive care, Severity of illness, medicine, Humans, Healthcare Disparities, business.industry, Organ dysfunction, Infant, Newborn, Infant, 030208 emergency & critical care medicine, Health Status Disparities, medicine.disease, United States, Clinical trial, Cross-Sectional Studies, Multivariate Analysis, Emergency medicine, business
Abstract

Copyright © 2016 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.Objectives: Pediatric severe sepsis remains a significant global health problem without new therapies despite many multicenter clinical trials. We compared children managed with severe sepsis in European and U.S. PICUs to identify geographic variation, which may improve the design of future international studies. Design: We conducted a secondary analysis of the Sepsis PRevalence, OUtcomes, and Therapies study. Data about PICU characteristics, patient demographics, therapies, and outcomes were compared. Multivariable regression models were used to determine adjusted differences in morbidity and mortality. Setting: European and U.S. PICUs. Patients: Children with severe sepsis managed in European and U.S. PICUs enrolled in the Sepsis PRevalence, OUtcomes, and Therapies study. Interventions: None. Measurements and Main Results: European PICUs had fewer beds (median, 11 vs 24; p < 0.001). European patients were younger (median, 1 vs 6 yr; p < 0.001), had higher severity of illness (median Pediatric Index of Mortality-3, 5.0 vs 3.8; p = 0.02), and were more often admitted from the ward (37% vs 24%). Invasive mechanical ventilation, central venous access, and vasoactive infusions were used more frequently in European patients (85% vs 68%, p = 0.002; 91% vs 82%, p = 0.05; and 71% vs 50%; p < 0.001, respectively). Raw morbidity and mortality outcomes were worse for European compared with U.S. patients, but after adjusting for patient characteristics, there were no significant differences in mortality, multiple organ dysfunction, disability at discharge, length of stay, or ventilator/vasoactive-free days. Conclusions: Children with severe sepsis admitted to European PICUs have higher severity of illness, are more likely to be admitted from hospital wards, and receive more intensive care therapies than in the United States. The lack of significant differences in morbidity and mortality after adjusting for patient characteristics suggests that the approach to care between regions, perhaps related to PICU bed availability, needs to be considered in the design of future international clinical trials in pediatric severe sepsis.

Published
2016

90. Comparison of Pediatric Severe Sepsis Managed in US and European ICUs

Author

Giuliano, J.S., Markovitz, B.P., Brierley, J., Levin, R., Williams, G., Lum, L.C.S., Dorofaeff, T., Cruces, P., Bush, J.L., Keele, L., Nadkarni, V.M., Thomas, N.J., Fitzgerald, J.C., Weiss, S.L., Fontela, P., Tucci, M., Dumistrascu, M., Skippen, P., Krahn, G., Bezares, E., Puig, G., Puig-Ramos, A., Garcia, R., Villar, M., Bigham, M., Polanski, T., Latifi, S., Giebner, D., Anthony, H., Hume, J., Galster, A., Linnerud, L., Sanders, R., Hefley, G., Madden, K., Thompson, A., Shein, S., Gertz, S., Han, Y., Williams, T., Hughes-Schalk, A., Chandler, H., Orioles, A., Zielinski, E., Doucette, A., Zebuhr, C., Wilson, T., Dimitriades, C., Ascani, J., Layburn, S., Valley, S., Markowitz, B., Terry, J., Morzov, R., McInnes, A., McArthur, J., Woods, K., Murkowski, K., Spaeder, M., Sharron, M., Wheeler, D., Beckman, E., Frank, E., Howard, K., Carroll, C., Nett, S., Jarvis, D., Patel, V., Higgerson, R., Christie, L., Typpo, K., Deschenes, J., Kirby, A., Uhl, T., Rehder, K., Cheifetz, I., Wrenn, S., Kypuros, K., Ackerman, K., Maffei, F., Bloomquist, G., Rizkalla, N., Kimura, D., Shah, S., Tigges, C., Su, F., Barlow, C., Michelson, K., Wolfe, K., Goodman, D., Campbell, L., Sorce, L., Bysani, K., Monjure, T., Evans, M., Totapally, B., Chegondi, M., Rodriguez, C., Frazier, J., Steele, L., Viteri, S., Costarino, A., Spear, D., Hirshberg, E., Lilley, J., Rowan, C., Rider, C., Kane, J., Zimmerman, J., Greeley, C., Lin, J., Jacobs, R., Parker, M., Culver, K., Loftis, L., Jaimon, N., Goldsworthy, M., Fitzgerald, J., Nadkarni, V., Bush, J., Diliberto, M., Alen, C., Gessouroun, M., Sapru, A., Lang, T., Alkhouli, M., Kamath, S., Friel, D., Daufeldt, J., Hsing, D., Carlo, C., Pon, S., Scimeme, J., Shaheen, A., Hassinger, A., Qiao, H., Giuliano, J., Tala, J., Vinciguerra, D., Fernandez, A., Carrero, R., Hoyos, P., Jaramillo, J., Posada, A., Izquiierdo, L., Piñeres Olave, B.E., Donado, J., Dalmazzo, R., Rendich, S., Palma, L., Lapadula, M., Acuna, C., Clement De Clety, S., Dujardin, M., Berghe, C., Renard, S., Zurek, J., Steinherr, H., Mougkou, K., Critselis, E., Di Nardo, M., Picardo, S., Tortora, F., Rossetti, E., Fragasso, T., Cogo, P., Netto, R., Dagys, A., Gurskis, V., Kevalas, R., Neeleman, C., Lemson, J., Luijten, C., Wojciech, K., Pagowska-Klimek, I., Szczepanska, M., Karpe, J., Nunes, P., Almeida, H., Rios, J., Vieira, M., Revilla, P., Urbano, J., Lopez-Herce, J., Bustinza, A., Cuesta, A., Hofheinz, S., Rodriguez-Nunez, A., Sanagustin, S., Gonzalez, E., Riaza, M., Piaya, R., Soler, P., Esteban-Torne E, Laraudogoitia, J., Monge, C., Herrera, V., Granados, J., Gonzalez, C., Koroglu, T., Ozcelik, E., Baines, P., Plunkett, A., Davis, P., George, S., Tibby, S., Harris, J., Agbeko, R., Lampitt, R., Peters, M., Jones, A., Dominguez, T., Thiruchelvam, T., Deep, A., Ridley, L., Bowen, W., Macleod, I., Gray, M., Hemat, N., Alexander, J., Ali, S., Pappachan, J., McCorkell, J., Fortune, P., MacDonald, M., Hudnott, P., Suyun, Q., Singhi, S., Nallasamy, K., Lodha, R., Shime, N., Tabata, Y., Saito, O., Ikeyama, T., Kawasaki, T., Lum, L., Abidin, A., Kee, S., Tang, S., Jalil, R., Guan, Y., Yao, L., Lin, K., Ong, J., Salloo, A., Doedens, L., Mathivha, L., Reubenson, G., Moaisi, S., Pentz, A., Green, R., Schibler, A., Erickson, S., McEneiry, J., Long, D., Coulthard, M., Millar, J., Delzoppo, C., Morritt, M., Watts, N., Beca, J., Sherring, C., and Bushell, T.

Published
2016

95. Standalone Internet speech restructuring treatment for adults who stutter: A phase I study

Author

Erickson, S, Block, S, Menzies, R, O’Brian, S, Packman, A, Onslow, M, Erickson, S, Block, S, Menzies, R, O’Brian, S, Packman, A, and Onslow, M

Abstract

© 2015 The Speech Pathology Association of Australia Limited Published by Taylor & Francis. Purpose: This Phase I trial reports the results of a clinician-free Internet speech restructuring treatment for adults who stutter. The program consists of nine phases with concepts loosely based on the Camperdown Program. Method: Twenty adults who stutter were recruited. They were given unlimited access to the program for 6 months. Primary outcome measures were the percentage of syllables stuttered and self-reported severity ratings. Result: Five participants accessed all phases of the program, while another five accessed more than half the phases. The remaining 10 accessed between one and four phases. Four of five participants who accessed all phases reduced their stuttering frequency by more than 50% and an additional two participants who accessed more than half the phases also achieved similar reductions. These results were confirmed by self-reports of stuttering severity. Stuttering reductions were largely commensurate with the amount of the program accessed. Conclusion: As with other clinician-free programs in related health areas, maintaining adherence to the program’s procedures was a significant issue. Nonetheless, this novel approach to treating stuttering has the potential to be a viable alternative for some clients and may help to address the significant access and relapse issues that affect treatment provision for adults who stutter.

Published
2016

96. Dissolution of Uric Acid Stones

Author

Erickson, S. B., Wilson, D. M., Smith, L. H., Walker, Valerie R., editor, Sutton, Roger A. L., editor, Cameron, E. C. Bert, editor, Pak, Charles Y. C., editor, and Robertson, William G., editor

Published
1989
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