41 results on '"Chiusolo F"'
Search Results
2. PP373 [Quality and Safety » Antimicrobial Stewardship]: THE INTRODUCING OF FILMARRAY RESPIRATORY PANEL FOR ANTIBIOTIC STEWARDSHIP
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Chiusolo, F., primary, Dei Giudici, L., additional, Tortora, F., additional, Bianchi, R., additional, De Luca, M., additional, and Bernaschi, P., additional
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- 2022
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3. Nosocomial infection rates in an Italian intensive care unit using the national nosocomial infection surveillance system
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Pallavicini, F., Pennisi, M. A., Izzi, I., Ammassari, A., Mazzini, P., Caricato, A., Chiusolo, F., Ardito, F., Leone, F., and Proietti, R.
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- 2001
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4. How 217 Pediatric Intensivists Manage Anemia at PICU Discharge: Online Responses to an International Survey*
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Demaret, P., Karam, O., Labreuche, J., Chiusolo, F., Colunga, J.M., Erickson, S., Nellis, M., Perez, M.H., Ray, S., Tucci, M., Willems, A., Duhamel, A., Lebrun, F., Loeckx, I., Mulder, A., Leteurtre, S., Grp Francophone Reanimation Urgenc, Pediat Critical Care Blood Res Net, and Pediat Acute Lung Injury Sepsis In
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medicine.medical_specialty ,Heart disease ,Anemia ,Psychological intervention ,Critical Care and Intensive Care Medicine ,Intensive Care Units, Pediatric ,03 medical and health sciences ,Hemoglobins ,0302 clinical medicine ,iron ,030225 pediatrics ,Surveys and Questionnaires ,medicine ,Humans ,Medical prescription ,Child ,Craniofacial surgery ,business.industry ,030208 emergency & critical care medicine ,medicine.disease ,Polytrauma ,anemia ,Patient Discharge ,Cardiac surgery ,Europe ,Erythropoietin ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,North America ,erythrocyte ,erythropoietin ,business ,Erythrocyte Transfusion ,critically ill child ,medicine.drug - Abstract
Objective:To describe the management of anemia at PICU discharge by pediatric intensivists.Design:Self-administered, online, scenario-based survey.Setting:PICUs in Australia/New Zealand, Europe, and North America.Subjects:Pediatric intensivists.Interventions:None.Measurements and Main Results:Respondents were asked to report their decisions regarding RBC transfusions, iron, and erythropoietin prescription to children ready to be discharged from PICU, who had been admitted for hemorrhagic shock, cardiac surgery, craniofacial surgery, and polytrauma. Clinical and biological variables were altered separately in order to assess their effect on the management of anemia. Two-hundred seventeen responses were analyzed. They reported that the mean (+/- sem) transfusion threshold was a hemoglobin level of 6.9 +/- 0.09 g/dL after hemorrhagic shock, 7.6 +/- 0.10 g/dL after cardiac surgery, 7.0 +/- 0.10 g/dL after craniofacial surgery, and 7.0 +/- 0.10 g/dL after polytrauma (p < 0.001). The most important increase in transfusion threshold was observed in the presence of a cyanotic heart disease (mean increase ranging from 1.80 to 2.30 g/dL when compared with baseline scenario) or left ventricular dysfunction (mean increase, 1.41-2.15 g/dL). One third of respondents stated that they would not prescribe iron at PICU discharge, regardless of the hemoglobin level or the baseline scenario. Most respondents (69.4-75.0%, depending on the scenario) did not prescribe erythropoietin.Conclusions:Pediatric intensivists state that they use restrictive transfusion strategies at PICU discharge similar to those they use during the acute phase of critical illness. Supplemental iron is less frequently prescribed than RBCs, and prescription of erythropoietin is uncommon. Optimal management of post-PICU anemia is currently unknown. Further studies are required to highlight the consequences of this anemia and to determine appropriate management.
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- 2020
5. P165 Early enteral nutrition versus early parenteral nutrition in critically ill children: safety and efficacy
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Chiusolo, F., primary, Ciofi Degli Atti, M.L., additional, Capriati, T., additional, Rossetti, E., additional, Iacoella, C., additional, Bianchi, R., additional, Raucci, U., additional, Reale, A., additional, Cecchetti, C., additional, Picardo, S., additional, and Diamanti, A., additional
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- 2018
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6. CPAP by helmet for treatment of acute respiratory failure after pediatric liver transplantation
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Chiusolo, F., primary, Fanelli, V., additional, Ciofi degli Atti, M. L., additional, Conti, G., additional, Tortora, F., additional, Pariante, R., additional, Ravà, L., additional, Grimaldi, C., additional, de Ville de Goyet, J., additional, and Picardo, S., additional
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- 2017
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7. From intravenous to enteral ketogenic diet in PICU: A potential treatment strategy for refractory status epilepticus
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Chiusolo, F., primary, Diamanti, A., additional, Bianchi, R., additional, Fusco, L., additional, Elia, M., additional, Capriati, T., additional, Vigevano, F., additional, and Picardo, S., additional
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- 2016
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8. Pediatric intensive care unit admission criteria for haematooncological patients: A basis for clinical guidelines implementation
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Piastra, M, Fognani, G, Franceschi, A, Pietrini, D, Tornesello, A, Ingelmo, P, Locatelli, F, Pession, A, Cogo, P, Cesaro, S, Conio, A, Grossetti, R, Ottonello, G, Gallini, C, Racca, F, Ferrero, F, Calderini, E, Chidini, G, Wolfler, A, Salvo, I, Lamperti, M, Codazzi, D, Fumagalli, R, Molinaro, Mg, Carnevale, L, Pettenazzo, A, Biban, P, Furlan, S, Savron, F, Pagni, R, Baroncini, S, Calamandrei, M, Marano, M, Stoppa, F, Pirozzi, N, Chiusolo, F, De Luca, D, Stival, E, Marzano, L, Caliandro, F, Conti, G, Testa, R, Savoia, G, Guddo, A, Gitto, Eloisa, Melchionda, G, Del Gaudio, A, Caione, R., Piastra, M, Fognani, G, Franceschi, A, Pietrini, D, Tornesello, A, Ingelmo, P, Locatelli, F, Pession, A, Cogo, P, Cesaro, S, Conio, A, Grossetti, R, Ottonello, G, Gallini, C, Racca, F, Ferrero, F, Calderini, E, Chidini, G, Wolfler, A, Salvo, I, Lamperti, M, Codazzi, D, Fumagalli, R, Molinaro, M, Carnevale, L, Pettenazzo, A, Biban, P, Furlan, S, Savron, F, Pagni, R, Baroncini, S, Calamandrei, M, Marano, M, Stoppa, F, Pirozzi, N, Chiusolo, F, De Luca, D, Stival, E, Marzano, L, Caliandro, F, Conti, G, Testa, R, Savoia, G, Guddo, A, Gitto, E, Melchionda, G, Del Gaudio, A, and Caione, R
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medicine.medical_specialty ,lcsh:Medicine ,Case Report ,critically ill ,Children ,Critically ill ,Intensive Care ,Malignancy ,Pediatric intensive care unit admission criteria ,Pediatrics ,law.invention ,law ,Critical care nursing ,Intensive care ,medicine ,Intensive care medicine ,Pediatric intensive care unit ,business.industry ,Septic shock ,lcsh:R ,lcsh:RJ1-570 ,Cancer ,lcsh:Pediatrics ,MED/38 - PEDIATRIA GENERALE E SPECIALISTICA ,medicine.disease ,Intensive care unit ,Respiratory failure ,business - Abstract
Cancer remains a major death cause in children, though outcomes have considerably improved over the past decades (1-3). Outcomes for children diagnosed with cancer have changed since ’70 from 80% mortality to 80% survival (2), while children with solid tumors 5-year survival has been reported as 67%, cure rates for childhood leukemia now approach 90% [4-5). Moreover, hematopoietic stem cell transplantation (HSCT) indications are still expanding for both malignant and non-malignant diseases.
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- 2011
9. THE INTRODUCING OF FILMARRAY RESPIRATORY PANEL FOR ANTIBIOTIC STEWARDSHIP.
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Chiusolo, F., Dei Giudici, L., Tortora, F., Bianchi, R., De Luca, M., and Bernaschi, P.
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- 2022
10. Neonatal massive small bowel resection: How much the multidisciplinary approach does impact on the outcome?
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Capriati, T., primary, Torre, G., additional, Fusaro, F., additional, Grimaldi, C., additional, Candusso, M., additional, Elia, D., additional, Goyet, J. De Ville De, additional, Rollo, M., additional, Chiusolo, F., additional, Schingo, P.M.S., additional, and Diamanti, A., additional
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- 2015
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11. CPAP by helmet for treatment of acute respiratory failure after pediatric liver transplantation.
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Chiusolo, F., Tortora, F., Pariante, R., Picardo, S., Fanelli, V., Ciofi degli Atti, M. L., Ravà, L., Conti, G., Grimaldi, C., and de Ville de Goyet, J.
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LIVER transplantation , *CONTINUOUS positive airway pressure , *ADULT respiratory distress syndrome treatment , *TRANSPLANTATION of organs, tissues, etc. in children , *MULTIVARIATE analysis , *MORTALITY - Abstract
Abstract: ARF after pediatric liver transplantation accounts for high rate of morbidity and mortality associated with this procedure. The role of CPAP in postoperative period is still unknown. The aim of the study was to describe current practice and risk factors associated with the application of helmet CPAP. In this retrospective observational cohort study, 119 recipients were divided into two groups based on indication to CPAP after extubation. Perioperative variables were studied, and determinants of CPAP application were analyzed in a multivariate logistic model. Sixty patients (60/114) developed ARF and were included in the CPAP group. No differences were found between the two groups for primary disease, graft type, and blood product transfused. At multivariate analysis, weight <11 kg (OR = 2.9; 95% CI = 1.1‐7.3;
P = .026), PaO2/FiO2 <380 before extubation (OR = 5.4; 95% CI = 2.1‐13.6;P < .001), need of vasopressors (OR = 2.6; 95% CI = 1.1‐6.4;P = .038), and positive fluid balance >148 mL/kg (OR = 4.0; 95% CI = 1.6‐10.1;P = .004) were the main determinants of CPAP application. In the CPAP group, five patients (8.4%) needed reintubation. Pediatric liver recipients with lower weight, higher need of inotropes/vasopressors, higher positive fluid balance after surgery, and lower PaO2/FiO2 before extubation were at higher odds of developing ARF needing CPAP application. [ABSTRACT FROM AUTHOR]- Published
- 2018
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12. Sarcopenia as a paradigm of frailty in pediatric end-stage liver disease before and after liver transplantation: a single-center, retrospective study.
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Veraldi, S., Pietrobattista, A., Basso, M. S., Liccardo, D., Corte, C. Della, Mosca, A., Alterio, T., Soglia, G., Chiusolo, F., Monti, L., Spada, M., and Maggiore, G.
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- 2022
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13. Availability and Quality of Grief and Bereavement Care in Pediatric Intensive Care Units Around the World, Opportunities for Improvement
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Michelle Grunauer, Caley Mikesell, Gabriela Bustamante, Danielle Aronowitz, Kevin Zambrano, Andrea P. Icaza-Freire, Antonio W. D. Gavilanes, Rafael Barrera, the PICU-MIC Research Group, Jorge López González, Jesús López-Herce, Emanuele Rossetti, Chiusolo Fabrizio, Oliver Karam, Marie Saint-Faust, Paolo Biban, Silvia Carlassara, Bettina von Dessauer, Nadia Ordenes, Fabiola Figueroa Urízar, Adriana Wegner A, Michael Canarie, Kathryn Miller, José Irazuzta, Daniel Tawfik, Elizabeth W. Tucker, Nicole Shilkofski, Wang Wenchao, Zhang Yuxia, Lucy Lum Chai See, Sister Priscilla, Recep Tekin, Fesih Aktar, Duygu Sönmez Düzkaya, Oguz Dursun, Ebru Atike Ongun, Resul Yilmaz, Dincer Yildizdas, Hakan Tekgüç, Vitaliy Sazonov, Timur Tsoy, Askhat Saparov, Elizaveta Kalmbakh, Ernesto Quiñones, Luis Eguiguren, Killen Briones, Yaneth Tovilla, Sandra Tania Ventura Gómez, Silvio Fabio Torres, Paul Cobarrubias, Dmytro Dmytriiev, Alejandro Martínez, Gustavo Guzaman, Rudy Sanabria, Ravikumar Krupanandan, Bala Ramachandran, Nirmal Choraria, Jignesh Patel, Puneet A Pooni, Karambir Singh Gill, John Adabie Appiah, Tigist Bacha Heye, Rahel Argaw, Asrat Demtse, and Israel Abebe Admasu
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grief ,bereavement ,pediatric palliative care ,pediatric critical care ,end of life ,Pediatrics ,RJ1-570 - Abstract
Pediatric Intensive Care Units (PICUs) provide multidisciplinary care to critically ill children and their families. Grief is present throughout the trajectory of illness and can peak around the time of death or non-death losses. The objective of this study was to assess how PICUs around the world implement grief and bereavement care (GBC) as part of an integrated model of care. This is a multicenter cross-sectional, prospective survey study. Questionnaires with multiple-choice and open-ended questions focusing on unit infrastructure, personnel, policies, limited patient data, and practices related to GBC for families and health care professionals (HCPs) were completed by on-site researchers, who were HCPs on the direct care of patients. PICU fulfillment of GBC goals was evaluated using a custom scoring based on indicators developed by the Initiative for Pediatric Palliative Care (IPPC). We compared average total and individual items fulfillment scores according to the respective country's World Bank income. Patient characteristics and details of unit infrastructure were also evaluated as potential predictors of total GBC fulfillment scores. Statistical analysis included multilevel generalized linear models (GLM) with a Gaussian distribution adjusted by child age/gender and clustering by center, using high income countries (HICs) as the comparative reference. Additionally, we applied principals of content analysis to analyze and summarize open-ended answers to contextualize qualitative data. The study included 34 PICUs from 18 countries: high-income countries (HICs): 32.4%, upper middle-income countries (UMICs): 44.1%, low middle-income and low-income countries (LMI/LICs): 23.5%. All groups reported some compliance with GBC goals; no group reported perfect fulfillment. We found statistically significant differences in GBC fulfillment scores between HICs and UMICs (specifically, HCP grief support), and between HICs and LMICs (specifically, family grief support and HCP grief support). PICUs world-wide provide some GBC, independent of income, but barriers include lack of financial support, time, and training, overall unit culture, presence of a palliative care consultation service, and varying cultural perceptions of child death. Disparities in GBC for families and HCPs exist and were related to the native countries' income level. Identifying barriers to support families and HCPs, can lead to opportunities of improving GBC in PICUs world-wide.
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- 2021
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14. Pain Assessment and Management in Pediatric Intensive Care Units Around the World, an International, Multicenter Study
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Michelle Grunauer, Caley Mikesell, Gabriela Bustamante, Gissela Cobo, Sebastián Sánchez, Ana María Román, Andrea P. Icaza-Freire, Antonio W. D. Gavilanes, Nancy Ewen Wang, The PICU-MIC Research Group, Jorge López González, Jesús López-Herce, Emanuele Rossetti, Chiusolo Fabrizio, Oliver Karam, Marie Saint-Faust, Paolo Biban, Silvia Carlassara, Bettina von Dessauer, Nadia Ordenes, Fabiola Figueroa Urízar, Adriana Wegner A, Michael Canarie, Kathryn Miller, José Irazuzta, Nicolas Chiriboga, Daniel Tawfik, Barbara Sourkes, Hursuong Vongsachang, Elizabeth W. Tucker, Nicole Shilkofski, 王文超 Wang, Wenchao RN, Zhang Yuxia RN, Lucy Lum Chai See, Sister Priscilla, Recep Tekin, Fesih Aktar, Duygu Sönmez Düzkaya, Oguz Dursun, Ebru Atike Ongun, Resul Yilmaz, Dincer Yildizdas, Hakan Tekgüç, Vitaliy Sazonov, Timur Tsoy, Askhat Saparov, Elizaveta Kalmbakh, Luis Eguiguren, Killen Harold Briones Claudette, Yaneth Tovilla, Sandra Tania Ventura Gómez, Silvio Fabio Torres, Paul Cobarrubias, Dmytro Dmytriiev, Alejandro Martínez, Gustavo Guzaman, Rudy Sanabria, Ravikumar Krupanandan, Bala Ramachandran, Nirmal Choraria, Jignesh Patel, Puneet A Pooni, Karambir Singh Gill, John Adabie Appiah, Komfo Anokye, Tigist Bacha Heye, Rahel Argaw, Asrat Demtse, and Israel Abebe Admasu
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pain ,pediatric critical care units ,pediatric palliative care ,under resourced settings ,pediatric ,Pediatrics ,RJ1-570 - Abstract
The adequate assessment and management of pain remains a challenging task in the Pediatric Intensive Care Unit (PICU). Our goal is to describe how pain is assessed and managed in PICUs around the world and to examine how human and material resources impact achievement of this goal. An international multicenter cross-sectional observational study was designed with the participation of 34 PICUs located in urban, suburban, and rural areas of 18 countries. We evaluated how PICUs around the world assessed and managed pain according to the Initiative for Pediatric Palliative Care recommendations, and how human and material resources impacted achievement of this goal. Data was collected for this study from 2016 to 2018 using questionnaires completed by medical doctors and nurses. In this paper, we focus on the indicators related to how pain is managed and assessed. The average achievement of the goal of pain relief across all centers was 72.2% (SD: 21.1). We found a statistically significant trend of more effective pain management scores, routine assessment, proper documentation, and involvement of pain management experts by increasing country income. While there are efforts being made worldwide to improve the knowledge in pain assessment and management, there is a lack of resources to do so appropriately in low-middle-income countries. There is a mismatch between the existing guidelines and policies, which are mainly designed in high income countries, and the resources available in lower resourced environments.
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- 2021
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15. FILMARRAY PNEUMONIAE AND ANTIBIOTIC STEWARDSHIP.
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Bianchi, R., Tortora, F., Chiusolo, F., Dei Giudici, L., Mascilini, I., Picardo, S. G., Polisca, F., Bernaschi, P., Agosta, M., and Sisto, A.
- Published
- 2022
16. CO6 LIVER TRANSPLANTATION IN CHILDREN: PRELIMINARY DATA IN ROME, OSPEDALE BAMBINO GESÙ
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Candusso, M., primary, Grimaldi, C., additional, Monti, L., additional, Francalanci, P., additional, Onofri, A., additional, Chiusolo, F., additional, Lo Zupone, C., additional, Russo, C., additional, Pariante, R., additional, Panetta, F., additional, Callea, F., additional, de Ville de Goyet, J., additional, and Torre, G., additional
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- 2011
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17. Mobilization practices in critically ill children: a European point prevalence study (EU PARK-PICU)
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Ista, Erwin, Scholefield, Barnaby R., Manning, Joseph C., Harth, Irene, Gawronski, Orsola, Bartkowska-Śniatkowska, Alicja, Ramelet, Anne-Sylvie, Kudchadkar, Sapna R., Ritson, Paul C., Nikolaou, Filippia, de Neef, Marjorie, Kneyber, Martin, Penny-Thomas, Kate, Linton, Christina, Balmaks, Reinis, Richter, Matthias, Chiusolo, Fabrizio, Cecchetti, Corrado, Roberti, Marco, di Furia, Michela, Grandjean, Chantal, Nygaard, Bettina, Lopez, Yolanda, Koroglu, Tolga, Besci, Tolga, Mora, Roberta Da Rin Della, Agbeko, Rachel S., Borrows, Emma, Bochaton, Nathalie, Mattsson, Janet, Ksellmann, Anne, Hero, Barbara, Rosada-Kurasinska, Jowita, Świder, Magdalena, Bonaldi, Amabile, Giugni, Cristina, Oruganti, Siva, Gates, Simon, Smith, Hazel, van Zwol, Annelies, Hills, Jenna, Conroy, Johanna, Bebbington, Mark, Neunhoeffer, Felix, Duval, Els, EU PARK-PICU Collaborators, Internal Medicine, Pediatric Surgery, Ritson, P.C., Nikolaou, F., de Neef, M., Kneyber, M., Penny-Thomas, K., Linton, C., Balmaks, R., Richter, M., Chiusolo, F., Cecchetti, C., Roberti, M., Di Furia, M., Grandjean, C., Nygaard, B., Lopez, Y., Koroglu, T., Besci, T., Mora, RDRD, Agbeko, R.S., Borrows, E., Bochaton, N., Mattsson, J., Ksellmann, A., Hero, B., Rosada-Kurasinska, J., Świder, M., Bonaldi, A., Giugni, C., Oruganti, S., Gates, S., Smith, H., van Zwol, A., Hills, J., Conroy, J., Bebbington, M., Neunhoeffer, F., Duval, E., Nursing, and Paediatric Intensive Care
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Male ,Occupational therapy ,medicine.medical_specialty ,Time Factors ,Critical Illness ,medicine.medical_treatment ,Developmental paediatrics ,Prevalence ,Intensive Care Units, Pediatric ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Intensive care ,Odds Ratio ,medicine ,Humans ,Child ,Contraindication ,Early Ambulation ,Mechanical ventilation ,Intensive care units ,Rehabilitation ,Mobilization ,Critically ill ,business.industry ,Research ,Infant, Newborn ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Infant ,030208 emergency & critical care medicine ,Paediatrics ,lcsh:RC86-88.9 ,Europe ,Critical care ,Cross-Sectional Studies ,030228 respiratory system ,Child, Preschool ,Emergency medicine ,Female ,Human medicine ,business ,Physical therapy - Abstract
Background Early mobilization of adults receiving intensive care improves health outcomes, yet little is known about mobilization practices in paediatric intensive care units (PICUs). We aimed to determine the prevalence of and factors associated with physical rehabilitation in PICUs across Europe. Methods A 2-day, cross-sectional, multicentre point prevalence study was conducted in May and November 2018. The primary outcome was the prevalence of physical therapy (PT)- or occupational therapy (OT)-provided mobility. Clinical data and data on patient mobility, potential mobility safety events, and mobilization barriers were prospectively collected in patients admitted for ≥72 h. Results Data of 456 children admitted to one of 38 participating PICUs from 15 European countries were collected (456 patient days); 70% were under 3 years of age. The point prevalence of PT- and/or OT-provided mobility activities was 39% (179/456) (95% CI 34.7–43.9%) during the patient days, with significant differences between European regions. Nurses were involved in 72% (924/1283) of the mobility events; in the remaining 28%, PT/OT, physicians, family members, or other professionals were involved. Of the factors studied, family presence was most strongly positively associated with out-of-bed mobilization (aOR 7.83, 95% CI 3.09–19.79). Invasive mechanical ventilation with an endotracheal tube was negatively associated with out-of-bed mobility (aOR 0.28, 95% CI 0.12–0.68). Patients were completely immobile on 25% (115/456) of patient days. Barriers to mobilization were reported on 38% of patient days. The most common reported patient-related barriers were cardiovascular instability (n = 47, 10%), oversedation (n = 39, 9%), and medical contraindication (n = 37, 8%). Potential safety events occurred in 6% of all documented mobilization events. Conclusion Therapists are infrequently consulted for mobilization of critically ill children in European PICUs. This study highlights the need for a systematic and interdisciplinary mobilization approach for critically ill children. Graphical abstract
- Published
- 2020
18. What Italian PICU Healthcare Providers Think About Donation After Cardiocirculatory Determination of Death: A National Survey.
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Giugni C, Cecchi C, Giometto S, Lucenteforte E, Mondardini C, Chiusolo F, Giannini A, Astuto M, Figini M, Piazza M, Tosoni A, and Ricci Z
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- Humans, Italy, Female, Male, Surveys and Questionnaires, Adult, Child, Health Personnel psychology, Health Knowledge, Attitudes, Practice, Middle Aged, Intensive Care Units, Pediatric organization & administration, Tissue and Organ Procurement, Attitude of Health Personnel, Death
- Abstract
Background: Italy presently does not have a pediatric organ donation program after cardiocirculatory determination of death (pDCDD). Before implementing a pDCDD program, many centers globally have conducted studies on the attitudes of pediatric intensive care unit (PICU) staff. This research aims to minimize potential adverse reactions and evaluate the acceptance of the novel donation practice., Methods: We conducted an electronic and anonymous survey on attitudes toward pDCDD among healthcare professionals (HCPs) working at eight Italian PICUs. The survey had three parts: (I) questions about general demographic data; (II) 18 statements about personal wishes to donate, experience of discussing donation, and knowledge about donation; (III) attitudinal statements regarding two pediatric Maastricht III scenarios of organ donation., Results: The response rate was 54.4%, and the majority of respondents were nurses. Of those who responded, 45.3% worked in the Center, 40.8% in the North, and 12.8% in the South of Italy. In total, 93.9% supported pediatric organ and tissue donation, 90.3% supported donation after neurological determination of death (DNDD), 78.2% supported pDCDD, and 69.7% felt comfortable about the idea of participating in pDCDD on Type III patients, with a higher percentage of supportive responses in the Center (77.2%) than in the North (65.1%) and South (54.5%) of Italy (p-value < 0.004). Concerning scenarios, 79.3% of participants believed that organ retrieval took place in a patient who was already deceased. Overall, 27.3% considered their knowledge about DCDD to be adequate., Conclusions: Our study provides insight into the attitudes and knowledge of PICU staff members regarding pDCDD in Italy. Despite a general lack of knowledge on the subject, respondents showed positive attitudes toward pDCDD and a strong consensus that the Italian legislation protocol for determining death based on cardiocirculatory criteria respects the "dead donor rule." There were several distinctions among the northern, central, and southern regions of Italy, and in our view, these disparities can be attributed to the varying practices of commemorating the deceased. In order to assess how practice and training influence the attitude of PICU staff members, it would be interesting to repeat the survey after the implementation of a program., (© 2024 Wiley Periodicals LLC.)
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- 2024
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19. European survey on Paediatric Early Warning Systems, and other processes used to aid the recognition and response to children's deterioration on hospital wards.
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Gawronski O, Briassoulis G, El Ghannudi Z, Ilia S, Sánchez-Martín M, Chiusolo F, Jensen CS, Manning JC, Valla FV, Pavelescu C, Dall'Oglio I, Coad J, and Sefton G
- Abstract
Background: Internationally, there is an increasing trend in using Rapid Response Systems (RRS) to stabilize in-patient deterioration. Despite a growing evidence base, there remains limited understanding of the processes in place to aid the early recognition and response to deteriorating children in hospitals across Europe., Aim/s: To describe the processes in place for early recognition and response to in-patient deterioration in children in European hospitals., Study Design: A cross-sectional opportunistic multi-centre European study, of hospitals with paediatric in-patients, using a descriptive self-reported, web-based survey, was conducted between September 2021 and March 2022. The sampling method used chain referral through members of European and national societies, led by country leads. The survey instrument was an adaptation to the survey of Recognition and Response Systems in Australia. The study received ethics approval. Descriptive analysis and Chi-squared tests were performed to compare results in European regions., Results: A total of 185 questionnaires from 21 European countries were received. The majority of respondents (n = 153, 83%) reported having written policies, protocols, or guidelines, regarding the measurement of physiological observations. Over half (n = 120, 65%) reported that their hospital uses a Paediatric Early Warning System (PEWS) and 75 (41%) reported having a Rapid Response Team (RRT). Approximately one-third (38%) reported that their hospital collects specific data about the effectiveness of their RRS, while 100 (54%) reported providing regular training and education to support it. European regional differences existed in PEWS utilization (North = 98%, Centre = 25%, South = 44%, p < .001) and process evaluation (North = 49%, Centre = 6%, South = 36%, p < .001)., Conclusions: RRS practices in European hospitals are heterogeneous. Differences in the uptake of PEWS and RRS process evaluation emerged across Europe., Relevance to Clinical Practice: It is important to scope practices for the safe monitoring and management of deteriorating children in hospital across Europe. To reduce variance in practice, a consensus statement endorsed by paediatric and intensive care societies could provide guidance and resources to support PEWS implementation and for the operational governance required for continuous quality improvement., (© 2024 The Author(s). Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)
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- 2024
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20. Adverse Tracheal Intubation Events in Critically Ill Underweight and Obese Children: Retrospective Study of the National Emergency Airway for Children Registry (2013-2020).
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Gladen KM, Tellez D, Napolitano N, Edwards LR, Sanders RC Jr, Kojima T, Malone MP, Shults J, Krawiec C, Ambati S, McCarthy R, Branca A, Polikoff LA, Jung P, Parsons SJ, Mallory PP, Komeswaran K, Page-Goertz C, Toal MC, Bysani GK, Meyer K, Chiusolo F, Glater-Welt LB, Al-Subu A, Biagas K, Hau Lee J, Miksa M, Giuliano JS Jr, Kierys KL, Talukdar AM, DeRusso M, Cucharme-Crevier L, Adu-Arko M, Shenoi AN, Kimura D, Flottman M, Gangu S, Freeman AD, Piehl MD, Nuthall GA, Tarquinio KM, Harwayne-Gidansky I, Hasegawa T, Rescoe ES, Breuer RK, Kasagi M, Nadkarni VM, and Nishisaki A
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- Infant, Child, Humans, Infant, Newborn, Child, Preschool, Adolescent, Retrospective Studies, Overweight etiology, Thinness complications, Thinness epidemiology, Intubation, Intratracheal adverse effects, Intubation, Intratracheal methods, Hypoxia epidemiology, Hypoxia etiology, Registries, Critical Illness, Pediatric Obesity complications, Pediatric Obesity epidemiology
- Abstract
Objectives: Extremes of patient body mass index are associated with difficult intubation and increased morbidity in adults. We aimed to determine the association between being underweight or obese with adverse airway outcomes, including adverse tracheal intubation (TI)-associated events (TIAEs) and/or severe peri-intubation hypoxemia (pulse oximetry oxygen saturation < 80%) in critically ill children., Design/setting: Retrospective cohort using the National Emergency Airway for Children registry dataset of 2013-2020., Patients: Critically ill children, 0 to 17 years old, undergoing TI in PICUs., Interventions: None., Measurements and Main Results: Registry data from 24,342 patients who underwent TI between 2013 and 2020 were analyzed. Patients were categorized using the Centers for Disease Control and Prevention weight-for-age chart: normal weight (5th-84th percentile) 57.1%, underweight (< 5th percentile) 27.5%, overweight (85th to < 95th percentile) 7.2%, and obese (≥ 95th percentile) 8.2%. Underweight was most common in infants (34%); obesity was most common in children older than 8 years old (15.1%). Underweight patients more often had oxygenation and ventilation failure (34.0%, 36.2%, respectively) as the indication for TI and a history of difficult airway (16.7%). Apneic oxygenation was used more often in overweight and obese patients (19.1%, 19.6%) than in underweight or normal weight patients (14.1%, 17.1%; p < 0.001). TIAEs and/or hypoxemia occurred more often in underweight (27.1%) and obese (24.3%) patients ( p < 0.001). TI in underweight children was associated with greater odds of adverse airway outcome compared with normal weight children after adjusting for potential confounders (underweight: adjusted odds ratio [aOR], 1.09; 95% CI, 1.01-1.18; p = 0.016). Both underweight and obesity were associated with hypoxemia after adjusting for covariates and site clustering (underweight: aOR, 1.11; 95% CI, 1.02-1.21; p = 0.01 and obesity: aOR, 1.22; 95% CI, 1.07-1.39; p = 0.002)., Conclusions: In underweight and obese children compared with normal weight children, procedures around the timing of TI are associated with greater odds of adverse airway events., Competing Interests: Ms. Napolitano’s, Dr. Shults’s, Dr. Nadkarni’s, and Dr. Nishisaki’s institution received funding from the Agency for Healthcare Research and Quality (R18HS024511). Ms. Napolitano’s institution received funding from Dräger, Actuated Medical, and Philips Respironics; they received support for article research from Timpel and VERO-Biotech. Dr. Krawiec received funding from New England Journal of Medicine Healer Cases and Carle Illinois School of Medicine Admissions Committee. Dr. Polikoff received funding from Novavax. Dr. Lee’s institution received funding from National Research Medical Council, Singapore. Dr. Shenoi is an elected member of the Society of Critical Care Medicine (SCCM) Council of the SCCM. Dr. Peihl disclosed that he is founder and Chief Medical Officer of 410 Medical; his institution received funding the Department of Defense (grants: USSOCOM W81XWH-22-C-0002, USAF SBIR AF212-CSO1 Phase II, F2-15653 USAF, SBIR AF211-CSO1 Phase II, F2-15254). Dr. Hasegawa disclosed work for hire. Dr. Nishisaki’s institution received funding from Chiesi USA, AHRA, and the National Institute of Child Health and Human Development. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)
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- 2024
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21. Safety of primary nasotracheal intubation in the pediatric intensive care unit (PICU).
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Ducharme-Crevier L, Furlong-Dillard J, Jung P, Chiusolo F, Malone MP, Ambati S, Parsons SJ, Krawiec C, Al-Subu A, Polikoff LA, Napolitano N, Tarquinio KM, Shenoi A, Talukdar A, Mallory PP, Giuliano JS Jr, Breuer RK, Kierys K, Kelly SP, Motomura M, Sanders RC Jr, Freeman A, Nagai Y, Glater-Welt LB, Wilson J, Loi M, Adu-Darko M, Shults J, Nadkarni V, Emeriaud G, and Nishisaki A
- Abstract
Background: Nasal tracheal intubation (TI) represents a minority of all TI in the pediatric intensive care unit (PICU). The risks and benefits of nasal TI are not well quantified. As such, safety and descriptive data regarding this practice are warranted., Methods: We evaluated the association between TI route and safety outcomes in a prospectively collected quality improvement database (National Emergency Airway Registry for Children: NEAR4KIDS) from 2013 to 2020. The primary outcome was severe desaturation (SpO
2 > 20% from baseline) and/or severe adverse TI-associated events (TIAEs), using NEAR4KIDS definitions. To balance patient, provider, and practice covariates, we utilized propensity score (PS) matching to compare the outcomes of nasal vs. oral TI., Results: A total of 22,741 TIs [nasal 870 (3.8%), oral 21,871 (96.2%)] were reported from 60 PICUs. Infants were represented in higher proportion in the nasal TI than the oral TI (75.9%, vs 46.2%), as well as children with cardiac conditions (46.9% vs. 14.4%), both p < 0.001. Severe desaturation or severe TIAE occurred in 23.7% of nasal and 22.5% of oral TI (non-adjusted p = 0.408). With PS matching, the prevalence of severe desaturation and or severe adverse TIAEs was 23.6% of nasal vs. 19.8% of oral TI (absolute difference 3.8%, 95% confidence interval (CI): - 0.07, 7.7%), p = 0.055. First attempt success rate was 72.1% of nasal TI versus 69.2% of oral TI, p = 0.072. With PS matching, the success rate was not different between two groups (nasal 72.2% vs. oral 71.5%, p = 0.759)., Conclusion: In this large international prospective cohort study, the risk of severe peri-intubation complications was not significantly higher. Nasal TI is used in a minority of TI in PICUs, with substantial differences in patient, provider, and practice compared to oral TI.A prospective multicenter trial may be warranted to address the potential selection bias and to confirm the safety of nasal TI., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2024.)- Published
- 2024
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22. Unplanned admissions after day-case surgery in an Italian third-level pediatric hospital: a retrospective study.
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Vittori A, Tritapepe L, Chiusolo F, Rossetti E, Cascella M, Petrucci E, Pedone R, Marinangeli F, Francia E, Mascilini I, Marchetti G, and Picardo SG
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Background: Increasing procedures in day-case surgery can mitigate the costs of health service, without reducing safety and quality standards. The Ospedale Pediatrico Bambino Gesù has adopted an educational program for healthcare personnel and patients' families to increase the number of day-case surgery procedures performed without reducing the level of safety. The unplanned admission rate after day-case surgery can be a quality benchmark for pediatric day-case surgery, and in literature, there are no Italian data., Methods: We made a retrospective analysis of the hospital database and focused on children requiring unplanned admission to the central venue of the hospital for the night. The audit covered the period from September 2012 to April 2018., Results: We performed general anesthesia for 8826 procedures (urology 33.60%, plastic surgery 30.87%, general surgery 17.44%, dermatology 11.66%, dentistry 3.16%, orthopedics 1.64%, digestive endoscopy 1.63%). Unplanned admission for anesthetic reasons resulted in two cases: one case of syncope and one case of vomit (0.023% rate). No one major complication., Conclusions: Good quality of patient selection, the safety of the structure, family education, and an efficient organizational model combined with an educational program for anesthesiologists can improve the safety of anesthesia for day-case surgery., (© 2023. BioMed Central Ltd., part of Springer Nature.)
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- 2023
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23. Correction: ESPNIC clinical practice guidelines: intravenous maintenance fluid therapy in acute and critically ill children- a systematic review and meta-analysis.
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Brossier DW, Tume LN, Briant AR, Jotterand Chaparro C, Moullet C, Rooze S, Verbruggen SCAT, Marino LV, Alsohime F, Beldjilali S, Chiusolo F, Costa L, Didier C, Ilia S, Joram NL, Kneyber MCJ, Kühlwein E, Lopez J, López-Herce J, Mayberry HF, Mehmeti F, Mierzewska-Schmidt M, Miñambres Rodríguez M, Morice C, Pappachan JV, Porcheret F, Reis Boto L, Schlapbach LJ, Tekguc H, Tziouvas K, Parienti JJ, Goyer I, and Valla FV
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- 2023
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24. ESPNIC clinical practice guidelines: intravenous maintenance fluid therapy in acute and critically ill children- a systematic review and meta-analysis.
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Brossier DW, Tume LN, Briant AR, Jotterand Chaparro C, Moullet C, Rooze S, Verbruggen SCAT, Marino LV, Alsohime F, Beldjilali S, Chiusolo F, Costa L, Didier C, Ilia S, Joram NL, Kneyber MCJ, Kühlwein E, Lopez J, López-Herce J, Mayberry HF, Mehmeti F, Mierzewska-Schmidt M, Miñambres Rodríguez M, Morice C, Pappachan JV, Porcheret F, Reis Boto L, Schlapbach LJ, Tekguc H, Tziouvas K, Parienti JJ, Goyer I, and Valla FV
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- Infant, Newborn, Child, Humans, Isotonic Solutions, Infusions, Intravenous, Glucose, Critical Illness therapy, Fluid Therapy methods
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Purpose: Intravenous maintenance fluid therapy (IV-MFT) prescribing in acute and critically ill children is very variable among pediatric health care professionals. In order to provide up to date IV-MFT guidelines, the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) undertook a systematic review to answer the following five main questions about IV-MFT: (i) the indications for use (ii) the role of isotonic fluid (iii) the role of balanced solutions (iv) IV fluid composition (calcium, magnesium, potassium, glucose and micronutrients) and v) and the optimal amount of fluid., Methods: A multidisciplinary expert group within ESPNIC conducted this systematic review using the Scottish Intercollegiate Guidelines Network (SIGN) grading method. Five databases were searched for studies that answered these questions, in acute and critically children (from 37 weeks gestational age to 18 years), published until November 2020. The quality of evidence and risk of bias were assessed, and meta-analyses were undertaken when appropriate. A series of recommendations was derived and voted on by the expert group to achieve consensus through two voting rounds., Results: 56 papers met the inclusion criteria, and 16 recommendations were produced. Outcome reporting was inconsistent among studies. Recommendations generated were based on a heterogeneous level of evidence, but consensus within the expert group was high. "Strong consensus" was reached for 11/16 (69%) and "consensus" for 5/16 (31%) of the recommendations., Conclusions: Key recommendations are to use isotonic balanced solutions providing glucose to restrict IV-MFT infusion volumes in most hospitalized children and to regularly monitor plasma electrolyte levels, serum glucose and fluid balance., (© 2022. The Author(s).)
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- 2022
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25. Instruments to evaluate non-technical skills during high fidelity simulation: A systematic review.
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Gawronski O, Thekkan KR, Genna C, Egman S, Sansone V, Erba I, Vittori A, Varano C, Dall'Oglio I, Tiozzo E, and Chiusolo F
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Introduction: High Fidelity Simulations (HFS) are increasingly used to develop Non-Technical Skills (NTS) in healthcare providers, medical and nursing students. Instruments to measure NTS are needed to evaluate the healthcare providers' (HCPs) performance during HFS. The aim of this systematic review is to describe the domains, items, characteristics and psychometric properties of instruments devised to evaluate the NTS of HCPs during HFS., Methods: A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Studies were retrieved from PubMed, Cinahl, Web of Science, Cochrane Library, ProQuest and PubPsych. Studies evaluating the measurement properties of instruments used to assess NTS during HFS training were included. Pairs of independent reviewers determined the eligibility, extracted and evaluated the data. Risk of bias and appraisal of the methodological quality of the studies was assessed using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist, and the quality of the evidence with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE)., Results: A total of 3,953 articles were screened. A total of 110 reports were assessed for eligibility and 26 studies were included. Studies were conducted in Europe/United Kingdom ( n = 13; 50%), North America/Australia ( n = 12; 46%) and Thailand ( n = 1; 4%). The NTS instruments reported in this review included from 1 to 14 domains (median of 4, Q
1 = 3.75, Q3 = 5) and from 3 to 63 items (median of 15, Q1 = 10, Q3 = 19.75). Out of 19 NTS assessment instruments for HFS, the Team Emergency Assessment Measure (TEAM) can be recommended for use to assess NTS. All the other instruments require further research to assess their quality in order to be recommended for use during HFS training. Eight NTS instruments had a positive overall rating of their content validity with at least a moderate quality of evidence., Conclusion: Among a large variety of published instruments, TEAM can be recommended for use to assess NTS during HFS. Evidence is still limited on essential aspects of validity and reliability of all the other NTS instruments included in this review. Further research is warranted to establish their performance in order to be reliably used for HFS., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Gawronski, Thekkan, Genna, Egman, Sansone, Erba, Vittori, Varano, Dall’Oglio, Tiozzo and Chiusolo.)- Published
- 2022
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26. Sarcopenia in children with chronic liver disease: Prevalence and impact on liver transplant outcomes.
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Veraldi S, Pietrobattista A, Soglia G, Monti L, Alterio T, Mosca A, Liccardo D, Basso MS, Della Corte C, Russo L, Candusso M, Chiusolo F, Tortora F, Spada M, and Maggiore G
- Abstract
Sarcopenia is a clinical condition characterized by a reduction in muscle mass, which typically affects adult patients; however, it has recently been recognized in pediatric literature. Few studies in children with chronic liver disease (CLD) undergoing liver transplantation (LT) have investigated the role of sarcopenia, with controversial results. The aim of our study was to assess the prevalence and impact of sarcopenia among children with CLD who are candidates for LT. We conducted a retrospective, single-center study at Bambino Gesù Children's Hospital (Rome, Italy) from July 2016 to July 2021, evaluating all children (0-16 years old) with CLD listed for LT with an abdomen computed tomography imaging available before LT. The total psoas muscle surface area (t-PMSA) was defined as the sum of left and right psoas muscle surface area measured at L4-L5 on axial images. The t-PMSA z -score was calculated according to reference data, and sarcopenia was defined as a t-PMSA z -score of ≤-2 (1-16 years) or a psoas muscle index [PMI; PMI = t-PMSA/(100 × BSA)] of <50th percentile of the population examined (<1 year). Clinical, laboratory, and LT outcome data were collected from all the patients with CLD. 27 out 48 (56%) of the patients aged 1-16 years were sarcopenic. No differences were noted in anthropometrics, nutritional support, liver function tests, model for ESLD (MELD), or pediatric ESLD (PELD) scores between patients with and without sarcopenia. The former showed a higher prevalence of respiratory complications (66.7% vs. 42.1%) and need for inotropes (40.7% vs. 10.8%) after LT. Among patients aged 0-1 years ( n : 36), those with reduced muscle mass (50%) had a longer hospitalization time (44 vs. 24 days) and higher incidences of multi-organ failure syndrome (38.9% vs. 0%) and intensive care unit-related infections (61.1% vs. 27.8%) compared to those with greater muscle mass. t-PMSA and PMI were statistically significant predictors of LT outcomes. Sarcopenia is a reliable index of frailty in children with CLD, as its presence is associated with the risk of a more challenging LT. Future studies will have to investigate the functional aspects of sarcopenia and conceive preventive measures of muscle wasting in CLD patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Veraldi, Pietrobattista, Soglia, Monti, Alterio, Mosca, Liccardo, Basso, Della Corte, Russo, Candusso, Chiusolo, Tortora, Spada and Maggiore.)
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- 2022
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27. Therapeutic Drug Monitoring of Amphotericin-B in Plasma and Peritoneal Fluid of Pediatric Patients after Liver Transplantation: A Case Series.
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Tortora F, Dei Giudici L, Simeoli R, Chiusolo F, Cairoli S, Bernaschi P, Bianchi R, Picardo SG, Dionisi Vici C, and Goffredo BM
- Abstract
Fungal infections represent a serious complication during the post-liver transplantation period. Abdominal infections can occur following pre-existing colonization, surgical procedures, and permanence of abdominal tubes. In our center, liposomal amphotericin-B is used as antifungal prophylaxis in pediatric patients undergoing liver transplantation. The aim of this study is to evaluate peritoneal levels of amphotericin-B following intravenous administration. Six liver recipients received liposomal amphotericin-B. Three of them were treated as prophylaxis; meanwhile, three patients received liposomal amphotericin-B to treat Candida albicans infection. Plasma and peritoneal amphotericin-B levels were measured by LC-MS/MS in two consecutive samplings. Cmin (pre-dose) and Cmax (2 h after the end of infusion) were evaluated as drug exposure parameters for both plasma and peritoneum. Our results showed that peritoneal amphotericin-B levels were significantly lower than plasma and that the correlation coefficient was 0.72 (p = 0.03) between plasma and peritoneal Cmin. Moreover, although peritoneal levels were within the therapeutic range, they never reached the PK/PD target (Cmax/MIC > 4.5). In conclusion, PK exposure parameters could be differently used to analyze amphotericin-B concentrations in plasma and peritoneum. However, liposomal amphotericin-B should be preferred in these patients as prophylactic rather than therapeutic treatment for fungal infections.
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- 2022
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28. Life-Threatening Bleeding in Children: A Prospective Observational Study.
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Leonard JC, Josephson CD, Luther JF, Wisniewski SR, Allen C, Chiusolo F, Davis AL, Finkelstein RA, Fitzgerald JC, Gaines BA, Goobie SM, Hanson SJ, Hewes HA, Johnson LH, McCollum MO, Muszynski JA, Nair AB, Rosenberg RB, Rouse TM, Sikavitsas A, Singleton MN, Steiner ME, Upperman JS, Vogel AM, Wills H, Winkler MK, and Spinella PC
- Subjects
- Adolescent, Antifibrinolytic Agents therapeutic use, Blood Component Transfusion statistics & numerical data, Canada, Child, Child, Preschool, Female, Hemorrhage mortality, Humans, Infant, Infant, Newborn, Italy, Male, Prospective Studies, United States, Blood Transfusion statistics & numerical data, Emergency Medical Services, Hemorrhage therapy
- Abstract
Objectives: The purpose of our study was to describe children with life-threatening bleeding., Design: We conducted a prospective observational study of children with life-threatening bleeding events., Setting: Twenty-four childrens hospitals in the United States, Canada, and Italy participated., Subjects: Children 0-17 years old who received greater than 40 mL/kg total blood products over 6 hours or were transfused under massive transfusion protocol were included., Interventions: Children were compared according bleeding etiology: trauma, operative, or medical., Measurements and Main Results: Patient characteristics, therapies administered, and clinical outcomes were analyzed. Among 449 enrolled children, 55.0% were male, and the median age was 7.3 years. Bleeding etiology was 46.1% trauma, 34.1% operative, and 19.8% medical. Prior to the life-threatening bleeding event, most had age-adjusted hypotension (61.2%), and 25% were hypothermic. Children with medical bleeding had higher median Pediatric Risk of Mortality scores (18) compared with children with trauma (11) and operative bleeding (12). Median Glasgow Coma Scale scores were lower for children with trauma (3) compared with operative (14) or medical bleeding (10.5). Median time from bleeding onset to first transfusion was 8 minutes for RBCs, 34 minutes for plasma, and 42 minutes for platelets. Postevent acute respiratory distress syndrome (20.3%) and acute kidney injury (18.5%) were common. Twenty-eight-day mortality was 37.5% and higher among children with medical bleeding (65.2%) compared with trauma (36.1%) and operative (23.8%). There were 82 hemorrhage deaths; 65.8% occurred by 6 hours and 86.5% by 24 hours., Conclusions: Patient characteristics and outcomes among children with life-threatening bleeding varied by cause of bleeding. Mortality was high, and death from hemorrhage in this population occurred rapidly., Competing Interests: Drs. Leonard’s, Nair’s, and Spinella’s institutions received funding from the National Heart, Lung, and Blood Institute (NHLBI). Drs. Leonard, Josephson, Davis, Fitzgerald, Muszynski, Steiner, Wills, and Spinella received support for article research from the National Institutes of Health (NIH). Dr. Josephson received funding from Immucor, LLC, and Octapharma. Drs. Allen’s, Hewes’s, Rouse’s, and Steiner’s institutions received funding from the NIH grant administered by Washington University in St. Louis. Drs. Davis’, Nair’s, and Steiner’s institutions received funding from an NIH Exploratory/Developmental Research Grant Award (R21). Dr. Finkelstein received funding from Trauma In Kids Course via the Royal College of Physicians and Surgeons of Canada and the Pediatric Trauma Society from New York Presbyterian Weill Cornell, Carilion Clinic, and Texas Children’s Hospital, Society of Critical Care Medicine as a Faculty Instructor, Giblin, Combs, Schwartz, Cunningham, & Scarpa, LLC, Aaronson Rappaport Feinstein & Deutsch, LLP, and Ruprecht Hart Weeks & Ricciardulli, LLP; he disclosed that his wife has stock in Pfizer and Proctor & Gamble. Drs. Fitzgerald’s, Muszynski’s, and Spinella’s institutions received funding from the NIH. Drs. Johnson’s and Wills’ institutions institution received funding from Massive Transfusion Epidemiology and Outcomes in Children Study, 5R21HL128863-02 NHLBI. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
- Published
- 2021
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29. Pediatric Mechanical Circulatory Support: Pathophysiology of Pediatric Hemostasis and Available Options.
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Giorni C, Rizza A, Favia I, Amodeo A, Chiusolo F, Picardo SG, Luciani M, Di Felice G, and Di Chiara L
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Pediatric mechanical circulatory support (MCS) is considered a strategy for heart failure management as a bridge to recovery and transplantation or as a destination therapy. The final outcome is significantly impacted by the number of complications that may occur during MCS. Children on ventricular assist devices (VADs) and extracorporeal membrane oxygenation (ECMO) are at high risk for bleeding and thrombotic complications that are managed through anticoagulation. The first detailed guideline in pediatric VADs (Edmonton Anticoagulation and Platelet Inhibition Protocol) was based on conventional antithrombotic drugs, such as unfractionated heparin (UFH) and warfarin. UFH is the first-line anticoagulant in pediatric MCS, although its profile is not considered optimal in pediatric setting. The broad variation in heparin doses among children is associated with frequent occurrence of cerebrovascular accidents, bleeding, and thrombocytopenia. Direct thrombin inhibitors (DTIs) have been utilized as alternative strategies to heparin. Since 2018, bivalirudin has become the chosen anticoagulant in the long-term therapy of patients undergoing MCS implantation, according to the most recent protocols shared in North America. This article provides a review of the non-traditional anticoagulation strategies utilized in pediatric MCS, focusing on pharmacodynamics, indications, doses, and monitoring aspects of bivalirudin. Moreover, it exposes the efforts and the collaborations among different specialized centers, which are committed to an ongoing learning in order to minimize major complications in this special pediatric population. Further prospective trials regarding DTIs in a pediatric MCS setting are necessary and in specific well-designed randomized control trials between UFH and bivalirudin. To conclude, based on the reported literature, the clinical use of the bivalirudin in pediatric MCS seems to be a value added in controlling and maybe reducing thromboembolic complications. Further research is necessary to confirm all the results provided by this literature review., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Giorni, Rizza, Favia, Amodeo, Chiusolo, Picardo, Luciani, Di Felice and Di Chiara.)
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- 2021
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30. Retrospective study found that helmet continuous positive airway pressure provided effective support for severe bronchiolitis.
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Rossetti E, De Galasso L, Appierto L, Bianchi R, Chiusolo F, Germani A, Tortora F, Wolfler A, and Picardo S
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- Continuous Positive Airway Pressure, Head Protective Devices, Humans, Infant, Retrospective Studies, Bronchiolitis therapy, Bronchiolitis, Viral
- Published
- 2020
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31. Management of Enteral Nutrition in the Pediatric Intensive Care Unit: Prokinetic Effects of Amoxicillin/Clavulanate in Real Life Conditions.
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Chiusolo F, Capriati T, Erba I, Bianchi R, Ciofi Degli Atti ML, Picardo S, and Diamanti A
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Purpose: Malnutrition is a common feature in critically ill children. Enteral nutrition (EN) is the main strategy to nutritionally support critical ill children, but its use can be hindered by the development of intolerance. The study aimed to assess the effectiveness and safety of amoxicillin/clavulanate (A/C) to treat EN intolerance., Methods: We retrospectively evaluated patients admitted to the pediatric intensive care unit from October 2018 to October 2019. We conducted a case-control study: in the first 6 months (October 2018-April 2019) we implemented the nutritional protocol of our Institution with no drug, whereas in the second half (May 2019-October 2019) we employed A/C for 1 week at a dose of 10 mg/kg twice daily., Results: Twelve cases were compared with 12 controls. At the final evaluation, enteral intake was significantly higher than that at baseline in the cases (from 2.1±3.7 to 66.1±27.4% of requirement, p =0.0001 by Wilcoxon matched-pairs signed rank test) but not in the controls (from 0.2±0.8 to 6.0±14.1% of the requirement, p =NS). Final gastric residual volume at the end of the observation was significantly lower in the cases than in the controls ( p =0.0398). The drug was well tolerated as shown by the similar safety outcomes in both cases and controls., Conclusion: Malnutrition exposes critically ill children to several complications that affect the severity of disease course, length of stay, and mortality; all may be prevented by early EN. The development of intolerance to EN could be addressed with the use of A/C. Future prospective clinical trials are needed to confirm these conclusions., Competing Interests: Conflict of Interest: The authors have no financial conflicts of interest., (Copyright © 2020 by The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition.)
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- 2020
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32. International Survey on Determinants of Antibiotic Duration and Discontinuation in Pediatric Critically Ill Patients.
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Noël KC, Papenburg J, Lacroix J, Quach C, O'Donnell S, Gonzales M, Willson DF, Gilfoyle E, McNally JD, Reynolds S, Kazzaz Y, Kawaguchi A, Sato M, Kongkiattikul L, Leteurtre S, Dubos F, Karaca Y, Chiusolo F, Piva J, Dendukuri N, and Fontela PS
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- Brazil, Canada, Child, Cross-Sectional Studies, France, Humans, Italy, Japan, Surveys and Questionnaires, United States, Anti-Bacterial Agents therapeutic use, Critical Illness therapy
- Abstract
Objectives: We hypothesized that antibiotic use in PICUs is based on criteria not always supported by evidence. We aimed to describe determinants of empiric antibiotic use in PICUs in eight different countries., Design: Cross-sectional survey., Setting: PICUs in Canada, the United States, France, Italy, Saudi Arabia, Japan, Thailand, and Brazil., Subjects: Pediatric intensivists., Interventions: None., Measurements and Main Results: We used literature review and focus groups to develop the survey and its clinical scenarios (pneumonia, septic shock, meningitis, and intra-abdominal infections) in which cultures were unreliable due to antibiotic pretreatment. Data analyses included descriptive statistics and linear regression with bootstrapped SEs. Overall response rate was 39% (482/1,251), with individual country response rates ranging from 25% to 76%. Respondents in all countries prolonged antibiotic duration based on patient characteristics, disease severity, pathogens, and radiologic findings (from a median increase of 1.8 d [95% CI, 0.5-4.0 d] to 9.5 d [95% CI, 8.5-10.5 d]). Younger age, severe disease, and ventilator-associated pneumonia prolonged antibiotic treatment duration despite a lack of evidence for such practices. No variables were reported to shorten treatment duration for all countries. Importantly, more than 39% of respondents would use greater than or equal to 7 days of antibiotics for patients with a positive viral polymerase chain reaction test in all scenarios, except in France for pneumonia (29%), septic shock (13%), and meningitis (6%). The use of elevated levels of inflammatory markers to prolong antibiotic treatment duration varied among different countries., Conclusions: Antibiotic-related decisions are complex and may be influenced by cultural and contextual factors. Evidence-based criteria are necessary to guide antibiotic duration and ensure the rational use of antibiotics in PICUs.
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- 2020
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33. How 217 Pediatric Intensivists Manage Anemia at PICU Discharge: Online Responses to an International Survey.
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Demaret P, Karam O, Labreuche Bst J, Chiusolo F, Mayordomo Colunga J, Erickson S, Nellis ME, Perez MH, Ray S, Tucci M, Willems A, Duhamel A, Lebrun F, Loeckx I, Mulder A, and Leteurtre S
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- Child, Erythrocyte Transfusion, Europe, Hemoglobins, Humans, Intensive Care Units, Pediatric, North America, Surveys and Questionnaires, Anemia, Patient Discharge
- Abstract
Objective: To describe the management of anemia at PICU discharge by pediatric intensivists., Design: Self-administered, online, scenario-based survey., Setting: PICUs in Australia/New Zealand, Europe, and North America., Subjects: Pediatric intensivists., Interventions: None., Measurements and Main Results: Respondents were asked to report their decisions regarding RBC transfusions, iron, and erythropoietin prescription to children ready to be discharged from PICU, who had been admitted for hemorrhagic shock, cardiac surgery, craniofacial surgery, and polytrauma. Clinical and biological variables were altered separately in order to assess their effect on the management of anemia. Two-hundred seventeen responses were analyzed. They reported that the mean (± SEM) transfusion threshold was a hemoglobin level of 6.9 ± 0.09 g/dL after hemorrhagic shock, 7.6 ± 0.10 g/dL after cardiac surgery, 7.0 ± 0.10 g/dL after craniofacial surgery, and 7.0 ± 0.10 g/dL after polytrauma (p < 0.001). The most important increase in transfusion threshold was observed in the presence of a cyanotic heart disease (mean increase ranging from 1.80 to 2.30 g/dL when compared with baseline scenario) or left ventricular dysfunction (mean increase, 1.41-2.15 g/dL). One third of respondents stated that they would not prescribe iron at PICU discharge, regardless of the hemoglobin level or the baseline scenario. Most respondents (69.4-75.0%, depending on the scenario) did not prescribe erythropoietin., Conclusions: Pediatric intensivists state that they use restrictive transfusion strategies at PICU discharge similar to those they use during the acute phase of critical illness. Supplemental iron is less frequently prescribed than RBCs, and prescription of erythropoietin is uncommon. Optimal management of post-PICU anemia is currently unknown. Further studies are required to highlight the consequences of this anemia and to determine appropriate management.
- Published
- 2020
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34. Effective neurally-adjusted ventilatory assist weaning off mechanical ventilation in separated conjoined thoraco-omphalopagus twins with sternal MEDPOR implant patch.
- Author
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Rossetti E, Dei Giudici L, Bianchi R, Chiusolo F, Grimaldi C, Cetrano E, Inserra A, and Picardo S
- Subjects
- Critical Care, Female, Humans, Infant, Intubation, Gastrointestinal, Pericardium abnormalities, Pericardium diagnostic imaging, Polyethylenes, Prostheses and Implants, Thoracic Wall abnormalities, Thoracic Wall diagnostic imaging, Tomography, X-Ray Computed, Interactive Ventilatory Support methods, Pericardium surgery, Thoracic Wall surgery, Twins, Conjoined surgery, Ventilator Weaning methods
- Published
- 2020
- Full Text
- View/download PDF
35. Effect of Fresh vs Standard-issue Red Blood Cell Transfusions on Multiple Organ Dysfunction Syndrome in Critically Ill Pediatric Patients: A Randomized Clinical Trial.
- Author
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Spinella PC, Tucci M, Fergusson DA, Lacroix J, Hébert PC, Leteurtre S, Schechtman KB, Doctor A, Berg RA, Bockelmann T, Caro JJ, Chiusolo F, Clayton L, Cholette JM, Guerra GG, Josephson CD, Menon K, Muszynski JA, Nellis ME, Sarpal A, Schafer S, Steiner ME, and Turgeon AF
- Subjects
- Adolescent, Child, Child, Preschool, Critical Illness mortality, Disease Progression, Female, Hospital Mortality, Humans, Infant, Infant, Newborn, Intensive Care Units, Pediatric, Kaplan-Meier Estimate, Male, Multiple Organ Failure mortality, Patient Acuity, Respiratory Distress Syndrome, Newborn therapy, Sepsis etiology, Blood Preservation, Critical Illness therapy, Erythrocyte Transfusion adverse effects, Multiple Organ Failure prevention & control
- Abstract
Importance: The clinical consequences of red blood cell storage age for critically ill pediatric patients have not been examined in a large, randomized clinical trial., Objective: To determine if the transfusion of fresh red blood cells (stored ≤7 days) reduced new or progressive multiple organ dysfunction syndrome compared with the use of standard-issue red blood cells in critically ill children., Design, Setting, and Participants: The Age of Transfused Blood in Critically-Ill Children trial was an international, multicenter, blinded, randomized clinical trial, performed between February 2014 and November 2018 in 50 tertiary care centers. Pediatric patients between the ages of 3 days and 16 years were eligible if the first red blood cell transfusion was administered within 7 days of intensive care unit admission. A total of 15 568 patients were screened, and 13 308 were excluded., Interventions: Patients were randomized to receive either fresh or standard-issue red blood cells. A total of 1538 patients were randomized with 768 patients in the fresh red blood cell group and 770 in the standard-issue group., Main Outcomes and Measures: The primary outcome measure was new or progressive multiple organ dysfunction syndrome, measured for 28 days or to discharge or death., Results: Among 1538 patients who were randomized, 1461 patients (95%) were included in the primary analysis (median age, 1.8 years; 47.3% girls), in which there were 728 patients randomized to the fresh red blood cell group and 733 to the standard-issue group. The median storage duration was 5 days (interquartile range [IQR], 4-6 days) in the fresh group vs 18 days (IQR, 12-25 days) in the standard-issue group (P < .001). There were no significant differences in new or progressive multiple organ dysfunction syndrome between fresh (147 of 728 [20.2%]) and standard-issue red blood cell groups (133 of 732 [18.2%]), with an unadjusted absolute risk difference of 2.0% (95% CI, -2.0% to 6.1%; P = .33). The prevalence of sepsis was 25.8% (160 of 619) in the fresh group and 25.3% (154 of 608) in the standard-issue group. The prevalence of acute respiratory distress syndrome was 6.6% (41 of 619) in the fresh group and 4.8% (29 of 608) in the standard-issue group. Intensive care unit mortality was 4.5% (33 of 728) in the fresh group vs 3.5 % (26 of 732) in the standard-issue group (P = .34)., Conclusions and Relevance: Among critically ill pediatric patients, the use of fresh red blood cells did not reduce the incidence of new or progressive multiple organ dysfunction syndrome (including mortality) compared with standard-issue red blood cells., Trial Registration: ClinicalTrials.gov Identifier: NCT01977547.
- Published
- 2019
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36. Life-saving vascular access after combined liver and kidney transplantation: A challenging access to the right atrium.
- Author
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Grimaldi C, Crocoli A, Angelico R, Saffioti MC, Nappo SG, Chiusolo F, Tortora F, Picardo SG, Dello Strologo L, Basso MS, Monti L, Guccione P, Rollo M, and Spada M
- Subjects
- Child, Delayed Graft Function diagnosis, Delayed Graft Function etiology, Delayed Graft Function physiopathology, Humans, Kidney Diseases diagnosis, Kidney Diseases etiology, Kidney Diseases physiopathology, Kidney Diseases, Cystic complications, Kidney Diseases, Cystic diagnosis, Liver Cirrhosis complications, Liver Cirrhosis diagnosis, Male, Phlebography, Treatment Outcome, Vascular Calcification diagnostic imaging, Vascular Calcification physiopathology, Vascular Patency, Angioplasty, Balloon, Catheterization, Central Venous methods, Delayed Graft Function therapy, Kidney Diseases therapy, Kidney Diseases, Cystic surgery, Kidney Transplantation adverse effects, Liver Cirrhosis surgery, Liver Transplantation adverse effects, Renal Dialysis, Vascular Calcification therapy, Vena Cava, Superior diagnostic imaging, Vena Cava, Superior physiopathology
- Abstract
Exhaustion of vascular accesses is a major complication in patients undergoing hemodialysis, especially in pediatric setting. We report the case of a boy treated for loss of hemodialysis access after a combined liver-kidney transplantation and transient renal dysfunction. An interventional dilatation of calcific superior vena cava allowed to insert a stable central venous line for dialysis until full graft recovery. Careful management of central lines allows to spare the main vessels and reduces the need for unusual accesses.
- Published
- 2019
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37. Aggressive prevention and preemptive management of vascular complications after pediatric liver transplantation: A major impact on graft survival and long-term outcome.
- Author
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Grimaldi C, di Francesco F, Chiusolo F, Angelico R, Monti L, Muiesan P, and de Ville de Goyet J
- Subjects
- Adolescent, Blood Coagulation, Child, Child, Preschool, Female, Follow-Up Studies, Hepatic Artery pathology, Humans, Immunosuppression Therapy, Incidence, Infant, Infant, Newborn, Male, Portal Vein pathology, Postoperative Complications prevention & control, Retrospective Studies, Treatment Outcome, Ultrasonography, Doppler, Vascular Diseases complications, Vena Cava, Inferior, Graft Survival, Liver Transplantation, Vascular Diseases prevention & control
- Abstract
Vascular complications are a major cause of patient and graft loss after LTs. The aim of this study was to evaluate the effect of a multimodal perioperative strategy aimed at reducing the incidence of vascular complications. A total of 126 first isolated LTs-performed between November 2008 and December 2015-were retrospectively analyzed. A minimum follow-up period of 24 months was analyzable for 124/126 patients (98.4%). The aggressive preemptive strategy consisted of identifying and immediately managing any problem and any abnormality in the vascular flow, in any of the hepatic vessels, and at any time after the liver graft revascularization. As a result, with a median follow-up of 57 months (3-112 months), not a single graft has been lost from vascular or biliary problems. The actuarial 8-year graft survival is 96.5%. These results have shown that a combination of technical attention, medical prevention, an early diagnosis, and rapid interventions reduced the negative impact of vascular problems on the outcome of both grafts and patients., (© 2018 Wiley Periodicals, Inc.)
- Published
- 2018
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38. Percutaneous dilation tracheostomy by Melker cricothyrotomy set in PICU: retrospective evaluation of a new combined approach.
- Author
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Rossetti E, Bianchi R, Germani A, Chiusolo F, Appierto L, and Picardo S
- Subjects
- Child, Child, Preschool, Dilatation, Humans, Infant, Intensive Care Units, Pediatric, Intubation, Intratracheal, Length of Stay, Neck diagnostic imaging, Retrospective Studies, Cricoid Cartilage surgery, Thyroid Cartilage surgery, Tracheostomy methods
- Published
- 2016
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- View/download PDF
39. Clinical management of post-pyloric enteral feeding in children.
- Author
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Capriati T, Cardile S, Chiusolo F, Torroni F, Schingo P, Elia D, and Diamanti A
- Subjects
- Child, Contraindications, Deglutition Disorders etiology, Deglutition Disorders therapy, Duodenum, Gastric Mucosa metabolism, Humans, Infant, Newborn, Infant, Premature, Intestinal Diseases therapy, Jejunum, Nervous System Diseases complications, Pancreas metabolism, Pancreatitis therapy, Stomach Diseases therapy, Enteral Nutrition adverse effects, Enteral Nutrition methods, Intubation, Gastrointestinal adverse effects, Intubation, Gastrointestinal methods
- Abstract
Post-pyloric feeding (PF) allows the administration of enteral nutrition beyond the pylorus, either into the duodenum or, ideally, into the jejunum. The main indications of PF are: upper gastrointestinal tract obstructions, pancreatic rest (e.g., acute pancreatitis), gastric dysmotility (e.g., critically ill patients and chronic intestinal pseudo-obstruction) or severe gastroesophageal reflux with risk of aspiration (e.g., neurological disability). Physiological and clinical evidence derives from adults, but can also be pertinent to children. This review will discuss the practical management and potential clinical applications of PF in pediatric patients. Some key studies pertaining to the physiological changes during PF will also be considered because they support the strategy of PF management.
- Published
- 2015
- Full Text
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40. Extracorporeal membrane oxygenation in a 10-year-old girl with macrophage activation syndrome.
- Author
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Rossetti E, Bianchi R, Chiusolo F, Onofri A, and Picardo S
- Subjects
- Anticoagulants therapeutic use, Biopsy, Bone Marrow pathology, Child, Creatinine blood, Critical Care, Female, Heparin therapeutic use, Humans, Macrophage Activation Syndrome diagnosis, Pulmonary Edema etiology, Renal Replacement Therapy, Respiration, Artificial, Extracorporeal Membrane Oxygenation methods, Macrophage Activation Syndrome therapy
- Published
- 2012
- Full Text
- View/download PDF
41. Pre-anesthesiological assessment in paediatric cataract surgery.
- Author
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Sammartino M, Morelli Sbarra G, Ferro G, Chiusolo F, Garra R, Marzola M, and Pascale F
- Subjects
- Child, Humans, Preoperative Care, Abnormalities, Multiple, Anesthesia, Cataract congenital, Cataract Extraction
- Abstract
The authors underline the importance of accurate pre-anesthesiological assessment in children undergoing cataract. The alteration is frequently related to many genetic, metabolic and infectious pathologies that could interfere in anesthesia management whatever surgery is requested. Some possibly responsible congenital syndromes and related alterations are mentioned, particularly focusing on Down's syndrome.
- Published
- 2003
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