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An evidence-based threshold for thrombocytopenia associated with clinically significant bleeding in pediatric intensive care unit patients.

https://arctichealth.org/en/permalink/ahliterature122894
Source
Pediatr Crit Care Med. 2012 Sep;13(5):e316-22
Publication Type
Article
Date
Sep-2012
Author
Paul C Moorehead
Janelle Cyr
Robert Klaassen
Nicholas J Barrowman
Kusum Menon
Author Affiliation
From the Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada. pmoorehead@yahoo.com
Source
Pediatr Crit Care Med. 2012 Sep;13(5):e316-22
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Antacids
Anti-Bacterial Agents
Child
Child, Preschool
Evidence-Based Medicine
Female
Hemorrhage - complications - epidemiology
Humans
Infant
Intensive Care Units, Pediatric
Logistic Models
Male
Multivariate Analysis
Ontario - epidemiology
Platelet Count
Prevalence
Respiration, Artificial
Retrospective Studies
Risk factors
Thrombocytopenia - complications
Abstract
To determine the epidemiology and identify the risk factors for clinically significant bleeding in the pediatric intensive care unit.
A retrospective cohort study over 6 months with up to 7 days of observation for each patient.
The pediatric intensive care unit in a tertiary care children's hospital.
Three hundred twenty-six consecutive patients admitted to the pediatric intensive care unit during the study period, with 214 eligible for inclusion.
Clinically significant bleeding, defined using a composite of outcomes. Clinically significant bleeding occurred in 19 patients (8.9%). Recursive partitioning identified a platelet count
Notes
Comment In: Pediatr Crit Care Med. 2012 Sep;13(5):613-522955470
PubMed ID
22760429 View in PubMed
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Consenting to pediatric critical care research: understanding the perspective of parents.

https://arctichealth.org/en/permalink/ahliterature105907
Source
Dynamics. 2013;24(3):18-24
Publication Type
Article
Date
2013
Author
Margot Thomas
Kusum Menon
Author Affiliation
Children's Hospital of Eastern Ontario, Ottawa, ON. thomas@cheo.on.ca
Source
Dynamics. 2013;24(3):18-24
Date
2013
Language
English
Publication Type
Article
Keywords
Attitude to Health
Canada
Child
Critical Care
Decision Making
Female
Humans
Intensive Care Units, Pediatric
Male
Narration
Parental Consent - ethics
Parents
Patient Selection - ethics
Pediatrics
Qualitative Research
Abstract
Pediatric clinical research is dependent on obtaining consentfrom the parents or legal guardian of eligible patients. Little is known about parents' perspectives and the process by which they make the decision to enroll their child in a pediatric critical care trial.
To describe the experience of parents/legal guardians who consented or declined consent for their child to be enrolled in a pediatric critical care research study. Factors that influenced parents' decisions and suggestions for improving and modifying the consent process were explored.
This study used a qualitative descriptive research design. Seven semi-structured qualitative interviews were conducted with parents who had given or declined consent for their child to participate in a clinical research study while their child was in a pediatric critical care unit in one of two Canadian pediatric teaching hospitals. Parents were interviewed within 48 hours of their child's transfer from the PICU to a hospital ward unit. The interviews were audio recorded, transcribed, and analyzed using a content analysis method.
Parental decision-making related to research consent in the context of pediatric critical care is influenced by specific characteristics of the consent encounter (timing, location, and information), parent (emotional state, decision-making style, familiarity with environment, past experience, and personal motivation), child (condition and response to pain/needles) and study (risk, method, burden, and benefit). Parents identified that the timing and ways in which they received information during the consent encounter could be improved.
Pediatric critical care researchers can improve the parental consent encounter experience by considering how parents perceive the approach to consent for a research trial for their child to balance the need to support parents with the need for participants in pediatric critical care research trials.
PubMed ID
24288878 View in PubMed
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Critical illness in children with influenza A/pH1N1 2009 infection in Canada.

https://arctichealth.org/en/permalink/ahliterature144724
Source
Pediatr Crit Care Med. 2010 Sep;11(5):603-9
Publication Type
Article
Date
Sep-2010
Author
Philippe Jouvet
Jamie Hutchison
Ruxandra Pinto
Kusum Menon
Rachel Rodin
Karen Choong
Murray Kesselman
Stasa Veroukis
Marc André Dugas
Miriam Santschi
Anne-Marie Guerguerian
Davinia Withington
Basem Alsaati
Ari R Joffe
Tanya Drews
Peter Skippen
Elizabeth Rolland
Anand Kumar
Robert Fowler
Author Affiliation
Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada. philippe.jouvet@umontreal.ca
Source
Pediatr Crit Care Med. 2010 Sep;11(5):603-9
Date
Sep-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Canada - epidemiology
Child
Child, Preschool
Critical Illness
Female
Hospital Mortality
Humans
Infant
Influenza A Virus, H1N1 Subtype
Influenza, Human - epidemiology - therapy
Intensive Care Units, Pediatric - statistics & numerical data
Length of Stay - statistics & numerical data
Male
Pandemics
Respiration, Artificial - statistics & numerical data
Risk factors
Socioeconomic Factors
Abstract
To describe characteristics, treatment, and outcomes of critically ill children with influenza A/pandemic influenza A virus (pH1N1) infection in Canada.
An observational study of critically ill children with influenza A/pH1N1 infection in pediatric intensive care units (PICUs).
Nine Canadian PICUs.
A total of 57 patients admitted to PICUs between April 16, 2009 and August 15, 2009.
None.
Characteristics of critically ill children with influenza A/pH1N1 infection were recorded. Confirmed intensive care unit cases were compared with a national surveillance database containing all hospitalized pediatric patients with influenza A/pH1N1 infection. Risk factors were assessed with a Cox proportional hazard model. The PICU cohort and national surveillance data were compared, using chi-square tests. Fifty-seven children were admitted to the PICU for community-acquired influenza A/pH1N1 infection. One or more chronic comorbid illnesses were observed in 70.2% of patients, and 24.6% of patients were aboriginal. Mechanical ventilation was used in 68% of children, 20 children (35.1%) had acute lung injury on the first day of admission, and the median duration of ventilation was 6 days (range, 0-67 days). The PICU mortality rate was 7% (4 of 57 patients). When compared with nonintensive care unit hospitalized children, PICU children were more likely to have a chronic medical condition (relative risk, 1.73); aboriginal ethnicity was not a risk factor of intensive care unit admission.
During the first outbreak of influenza A/pH1N1 infection, when the population was naïve to this novel virus, severe illness was common among children with underlying chronic conditions and aboriginal children. Influenza A/pH1N1-related critical illness in children was associated with severe hypoxemic respiratory failure and prolonged mechanical ventilation. However, this higher rate and severity of respiratory illness did not result in an increased mortality when compared with seasonal influenza.
Notes
Comment In: Pediatr Crit Care Med. 2010 Sep;11(5):637-820823741
PubMed ID
20308929 View in PubMed
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Critically ill patients with 2009 influenza A(H1N1) infection in Canada.

https://arctichealth.org/en/permalink/ahliterature148024
Source
JAMA. 2009 Nov 4;302(17):1872-9
Publication Type
Article
Date
Nov-4-2009
Author
Anand Kumar
Ryan Zarychanski
Ruxandra Pinto
Deborah J Cook
John Marshall
Jacques Lacroix
Tom Stelfox
Sean Bagshaw
Karen Choong
Francois Lamontagne
Alexis F Turgeon
Stephen Lapinsky
Stéphane P Ahern
Orla Smith
Faisal Siddiqui
Philippe Jouvet
Kosar Khwaja
Lauralyn McIntyre
Kusum Menon
Jamie Hutchison
David Hornstein
Ari Joffe
Francois Lauzier
Jeffrey Singh
Tim Karachi
Kim Wiebe
Kendiss Olafson
Clare Ramsey
Sat Sharma
Peter Dodek
Maureen Meade
Richard Hall
Robert A Fowler
Author Affiliation
Section of Critical Care Medicine, Health Sciences Centre, JJ 399, 700 William Ave, Winnipeg, MB R3E-0Z3 Canada. akumar61@yahoo.com
Source
JAMA. 2009 Nov 4;302(17):1872-9
Date
Nov-4-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Aged, 80 and over
Anoxia - etiology
Canada - epidemiology
Child
Child, Preschool
Comorbidity
Critical Illness
Disease Outbreaks
Female
Humans
Infant
Influenza A Virus, H1N1 Subtype
Influenza, Human - complications - diagnosis - mortality - therapy
Intensive Care Units
Kaplan-Meier Estimate
Length of Stay
Male
Middle Aged
Multiple Organ Failure - etiology - mortality
Prospective Studies
Respiration, Artificial
Respiratory Distress Syndrome, Adult - etiology - mortality
Young Adult
Abstract
Between March and July 2009, the largest number of confirmed cases of 2009 influenza A(H1N1) infection occurred in North America.
To describe characteristics, treatment, and outcomes of critically ill patients in Canada with 2009 influenza A(H1N1) infection.
A prospective observational study of 168 critically ill patients with 2009 influenza A(H1N1) infection in 38 adult and pediatric intensive care units (ICUs) in Canada between April 16 and August 12, 2009.
The primary outcome measures were 28-day and 90-day mortality. Secondary outcomes included frequency and duration of mechanical ventilation and duration of ICU stay.
Critical illness occurred in 215 patients with confirmed (n = 162), probable (n = 6), or suspected (n = 47) community-acquired 2009 influenza A(H1N1) infection. Among the 168 patients with confirmed or probable 2009 influenza A(H1N1), the mean (SD) age was 32.3 (21.4) years; 113 were female (67.3%) and 50 were children (29.8%). Overall mortality among critically ill patients at 28 days was 14.3% (95% confidence interval, 9.5%-20.7%). There were 43 patients who were aboriginal Canadians (25.6%). The median time from symptom onset to hospital admission was 4 days (interquartile range [IQR], 2-7 days) and from hospitalization to ICU admission was 1 day (IQR, 0-2 days). Shock and nonpulmonary acute organ dysfunction was common (Sequential Organ Failure Assessment mean [SD] score of 6.8 [3.6] on day 1). Neuraminidase inhibitors were administered to 152 patients (90.5%). All patients were severely hypoxemic (mean [SD] ratio of Pao(2) to fraction of inspired oxygen [Fio(2)] of 147 [128] mm Hg) at ICU admission. Mechanical ventilation was received by 136 patients (81.0%). The median duration of ventilation was 12 days (IQR, 6-20 days) and ICU stay was 12 days (IQR, 5-20 days). Lung rescue therapies included neuromuscular blockade (28% of patients), inhaled nitric oxide (13.7%), high-frequency oscillatory ventilation (11.9%), extracorporeal membrane oxygenation (4.2%), and prone positioning ventilation (3.0%). Overall mortality among critically ill patients at 90 days was 17.3% (95% confidence interval, 12.0%-24.0%; n = 29).
Critical illness due to 2009 influenza A(H1N1) in Canada occurred rapidly after hospital admission, often in young adults, and was associated with severe hypoxemia, multisystem organ failure, a requirement for prolonged mechanical ventilation, and the frequent use of rescue therapies.
Notes
Comment In: JAMA. 2010 Mar 10;303(10):939-40; author reply 940-120215605
PubMed ID
19822627 View in PubMed
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Factors affecting consent in pediatric critical care research.

https://arctichealth.org/en/permalink/ahliterature129306
Source
Intensive Care Med. 2012 Jan;38(1):153-9
Publication Type
Article
Date
Jan-2012
Author
Kusum Menon
Roxanne E Ward
Isabelle Gaboury
Margot Thomas
Ari Joffe
Karen Burns
Deborah Cook
Author Affiliation
Department of Pediatrics, University of Ottawa, Ottawa, Canada. menon@cheo.on.ca
Source
Intensive Care Med. 2012 Jan;38(1):153-9
Date
Jan-2012
Language
English
Publication Type
Article
Keywords
Biomedical research
Canada
Child, Preschool
Cohort Studies
Humans
Infant
Informed Consent - statistics & numerical data
Intensive Care Units, Pediatric
Prospective Studies
Proxy
Abstract
Consent for research is a difficult and unpredictable process in pediatric critical care populations. The objectives of this study were to describe consent rates in pediatric critical care research and their association with patient, legal guardian, consent process, and study design-related factors.
A prospective, cohort study was conducted from 2009 to 2010 in six tertiary care pediatric intensive care units (PICU) in Canada with legal guardians of patients who were approached for consent for any ongoing PICU research study. Data were recorded on details of the consent process for all consent encounters.
We recorded 271 consent encounters. The overall consent rate was 80.1% (217/271). We observed higher consent rates when the research assistant was introduced by a member of the clinical team prior to approaching the family (89.7 vs. 77.7%; P = 0.04). Legal guardians of cardiac surgery patients were less likely to provide consent than those of all other patients (75.3 vs. 86.0%; P = 0.03). There was no difference in consent rates between therapeutic (117/145, 80.7%) versus non-therapeutic studies (100/126, 79.4%; P = 0.88).
This study provides future researchers with consent data for determination of recruitment rates, sample sizes, budget estimations, and study timelines. Future pediatric critical care studies should consider incorporating the lower consent rates in cardiac surgery patients and routine introduction of the research assistant to the family by a member of the patient's care team into their study designs. The potential influence of parental factors on consent rates in pediatric critical care studies requires further research.
Notes
Comment In: Intensive Care Med. 2012 Jan;38(1):4-622120772
PubMed ID
22120768 View in PubMed
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Identification of adrenal insufficiency in pediatric critical illness.

https://arctichealth.org/en/permalink/ahliterature164241
Source
Pediatr Crit Care Med. 2007 May;8(3):276-8
Publication Type
Article
Date
May-2007
Author
Kusum Menon
Margaret Lawson
Author Affiliation
Department of Pediatrics, Children's Hospital of Eastern Ontario and University of Ottawa, Ontario, Canada. menon@cheo.on.ca
Source
Pediatr Crit Care Med. 2007 May;8(3):276-8
Date
May-2007
Language
English
Publication Type
Article
Keywords
Adrenal Insufficiency - diagnosis - drug therapy
Canada
Child
Critical Illness
Cross-Sectional Studies
Endocrinology
Humans
Intensive Care
Abstract
To determine physicians' beliefs and practices regarding adrenal dysfunction in pediatric critical illness.
Cross-sectional mail survey.
Canada.
All members of the Canadian Pediatric Endocrine Group and all physicians identified as practicing pediatric intensive care medicine in any of 16 tertiary care teaching centers in Canada.
Three pediatric intensive care physicians and three pediatric endocrinologists reviewed the questionnaire before administration to ensure clarity. We asked participants to report their views on the following: a) the frequency of adrenal insufficiency in pediatric critical illness; b) diagnosis/definition of adrenal insufficiency in pediatric critical illness; and c) the use of empirical glucocorticoids in fluid/vasopressor-resistant hypotension in pediatric critical illness.
Forty-six of 57 (80.7%) endocrinologists responded, with 43 participating (75.4%). Among intensivists, 59 of 70 (84.3%) responded with no refusals. Of intensivists, 81.4% believe that adrenal insufficiency occurs sometimes or often in critically ill pediatric intensive care unit patients, whereas 41.8% of endocrinologists believe adrenal insufficiency occurs never or rarely in these patients. Six definitions of adrenal insufficiency were proposed (varying cortisol level vs. peak/increment of cortisol in response to corticotropin), with no consensus on the definition of adrenal insufficiency from the endocrinologists or intensivists. Half (50.9%) of intensivists said they would sometimes or often empirically treat hypotensive pediatric patients with glucocorticoids, whereas 81.0% of endocrinologists would occasionally or never recommend glucocorticoids on this basis.
There is no consensus among pediatric intensivists or endocrinologists as to how often adrenal insufficiency occurs in pediatric critical illness or how to diagnose this condition. Despite this lack of consensus, however, many pediatric intensivists would empirically treat hypotensive patients who they suspect may have adrenal insufficiency. Prospective studies are required to determine the definition, frequency, and appropriate treatment of adrenal insufficiency in critically ill pediatric patients.
Notes
Comment In: Pediatr Crit Care Med. 2007 May;8(3):305-717496522
PubMed ID
17417118 View in PubMed
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A multidisciplinary survey on capillary refill time: Inconsistent performance and interpretation of a common clinical test.

https://arctichealth.org/en/permalink/ahliterature157063
Source
Pediatr Crit Care Med. 2008 Jul;9(4):386-91
Publication Type
Article
Date
Jul-2008
Author
Anna-Theresa Lobos
Kusum Menon
Author Affiliation
Department of Pediatrics, University of Ottawa, Department of Critical Care, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada. alobos@cheo.on.ca
Source
Pediatr Crit Care Med. 2008 Jul;9(4):386-91
Date
Jul-2008
Language
English
Publication Type
Article
Keywords
Canada
Capillaries - physiopathology
Child, Preschool
Diagnostic Techniques and Procedures
Humans
Intensive Care Units, Pediatric - organization & administration
Microcirculation
Nurses
Pediatrics
Quality of Health Care
Abstract
Capillary refill time is a common clinical test used in pediatric critical care and emergency medicine. Despite this, we hypothesize that capillary refill time is performed inconsistently and its interpretation by healthcare providers in the acute care setting is variable.
Multidisciplinary survey.
Canadian tertiary care pediatric hospital.
Subjects were 198 pediatric healthcare providers.
A self-administered questionnaire survey was sent to healthcare providers in pediatric and neonatal critical care, emergency medicine, and cardiology.
Seventy-eight surveys were returned: 23 of 33 pediatric trainees (70%), 22 of 38 staff physicians (58%), and 33 of 125 nurses (26%). Ninety-five percent of pediatric healthcare providers reported performing capillary refill time on most patients. However, while 90% of nurses and 70% of trainees described performing capillary refill time on every patient, only 18% of staff physicians reported performing capillary refill time routinely on every patient. Although all participants responded that a capillary refill time of >3 secs was abnormal, responders were divided on the definition of normal capillary refill time. While other sites were described, responders most commonly reported performing capillary refill time on a patient's chest. Ninety-six percent of responders agreed that prolonged capillary refill time indicates abnormal perfusion.
The results of this single-institution survey show that while most nurses and pediatric trainees reported using capillary refill time on every patient as a test for perfusion, only a few staff physicians reported using capillary refill time on every patient. In addition, although this study shows that the majority of survey responders stated that they used capillary refill time frequently, we observed no consistent response in how they performed and interpreted capillary refill time. Given that the use of this simple, noninvasive clinical test is supported by many pediatric organizations and pediatricians, the results of this study emphasize the need to examine why this test is inconsistently performed by healthcare providers so as to ensure its reliable performance in the future.
PubMed ID
18496415 View in PubMed
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A prospective multicenter study of adrenal function in critically ill children.

https://arctichealth.org/en/permalink/ahliterature144791
Source
Am J Respir Crit Care Med. 2010 Jul 15;182(2):246-51
Publication Type
Article
Date
Jul-15-2010
Author
Kusum Menon
Roxanne E Ward
Margaret L Lawson
Isabelle Gaboury
James S Hutchison
Paul C Hébert
Author Affiliation
Pediatric Intensive Care Unit, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1S 3H2 Canada. menon@cheo.on.ca
Source
Am J Respir Crit Care Med. 2010 Jul 15;182(2):246-51
Date
Jul-15-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adrenal Insufficiency - diagnosis - epidemiology - therapy
Adrenocorticotropic Hormone - blood
Age Factors
Canada
Cardiac Surgical Procedures - statistics & numerical data
Catecholamines - therapeutic use
Child
Child, Preschool
Critical Illness
Female
Fluid Therapy
Humans
Hydrocortisone - blood
Infant
Intensive Care Units, Pediatric
Male
Prevalence
Prospective Studies
Risk factors
Sensitivity and specificity
Wounds and Injuries - epidemiology
Abstract
Adrenal insufficiency is a clinical condition associated with fluid- and catecholamine-resistant hypotension.
The objectives of this study were to determine the prevalence of adrenal insufficiency, risk factors and potential mechanisms for its development, and its association with clinically important outcomes in critically ill children.
A prospective, cohort study was conducted from 2005 to 2008 in seven tertiary-care, pediatric intensive care units in Canada on patients up to 17 years of age with existing vascular access. Adrenocorticotropic hormone stimulation tests (1 microg) were performed and adrenocorticotropic hormone levels measured in all participants.
A total of 381 patients had adrenal testing on admission. The prevalence of adrenal insufficiency was 30.2% (95% confidence interval, 25.9-35.1). Patients with adrenal insufficiency had higher baseline cortisol levels (28.6 microg/dl vs. 16.7 microg/dl, P
PubMed ID
20299532 View in PubMed
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The relationship between vitamin D status and adrenal insufficiency in critically ill children.

https://arctichealth.org/en/permalink/ahliterature115082
Source
J Clin Endocrinol Metab. 2013 May;98(5):E877-81
Publication Type
Article
Date
May-2013
Author
J Dayre McNally
Dermot R Doherty
Margaret L Lawson
Osama Y Al-Dirbashi
Pranesh Chakraborty
Tim Ramsay
Kusum Menon
Author Affiliation
Department of Pediatrics, Faculty of Medicine, University of Ottawa and Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, Canada. dmcnally@cheo.on.ca
Source
J Clin Endocrinol Metab. 2013 May;98(5):E877-81
Date
May-2013
Language
English
Publication Type
Article
Keywords
25-Hydroxyvitamin D 2 - blood
Adolescent
Adrenal Cortex - drug effects - physiopathology - secretion
Adrenal Insufficiency - complications - diagnosis - physiopathology
Calcifediol - blood
Canada
Cardiovascular Diseases - blood - etiology - physiopathology - therapy
Cardiovascular System - drug effects - physiopathology
Catecholamines - administration & dosage - therapeutic use
Child
Child, Preschool
Cohort Studies
Cosyntropin - diagnostic use
Hormones - diagnostic use
Humans
Hydrocortisone - blood - secretion
Infant
Intensive Care Units, Pediatric
Nutritional Status
Prospective Studies
Tertiary Care Centers
Vitamin D Deficiency - complications - epidemiology - physiopathology
Abstract
Recent studies in critically ill populations have suggested both adrenal insufficiency (AI) and vitamin D deficiency to be associated with worse clinical outcome. There are multiple mechanisms through which these pleiotropic hormones might synergistically influence critical illness.
The aim of the study was to investigate potential relationships between vitamin D status, adrenal status, and cardiovascular dysfunction in critically ill children.
We conducted a secondary analysis of data from a prospective cohort study.
The study was conducted on 319 children admitted to 6 Canadian tertiary-care pediatric intensive care units.
Vitamin D status was determined through total 25-hydroxyvitamin D (25OHD) levels. AI was defined as a cortisol increment under 9 µg/dL after low-dose cosyntropin. Clinically significant cardiovascular dysfunction was defined as catecholamine requirement during pediatric intensive care unit admission.
Using 3 different thresholds to define vitamin D deficiency, no association was found between vitamin D status and AI. Furthermore, linear regression failed to identify a relationship between 25OHD and baseline or post-cosyntropin cortisol. However, the association between AI and cardiovascular dysfunction was influenced by vitamin D status; compared to children with 25OHD above 30 nmol/L, AI in the vitamin D-deficient group was associated with significantly higher odds of catecholamine use (odds ratio, 5.29 vs 1.63; P = .046).
We did not find evidence of a direct association between vitamin D status and critical illness-related AI. However, our results do suggest that vitamin D deficiency exacerbates the effect of AI on cardiovascular stability in critically ill children.
PubMed ID
23547046 View in PubMed
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A survey of stated physician practices and beliefs on the use of steroids in pediatric fluid and/or vasoactive infusion-dependent shock.

https://arctichealth.org/en/permalink/ahliterature114298
Source
Pediatr Crit Care Med. 2013 Jun;14(5):462-6
Publication Type
Article
Date
Jun-2013
Author
Kusum Menon
James D McNally
Karen Choong
Roxanne E Ward
Margaret L Lawson
Tim Ramsay
Hector R Wong
Author Affiliation
Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada. menon@cheo.on.ca
Source
Pediatr Crit Care Med. 2013 Jun;14(5):462-6
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Adrenal Cortex Function Tests - utilization
Adrenal Cortex Hormones - therapeutic use
Attitude of Health Personnel
Canada
Cardiovascular Agents - adverse effects
Child
Cross-Sectional Studies
Fluid Therapy - adverse effects
Humans
Intensive Care Units, Pediatric
Physician's Practice Patterns - statistics & numerical data
Questionnaires
Randomized Controlled Trials as Topic
Shock, Septic - drug therapy - etiology
Abstract
Limited evidence exists on the use of corticosteroids in pediatric shock. We sought to determine physicians' practices and beliefs with regard to the management of pediatric shock.
Cross-sectional, Internet-based survey.
Canada.
Physicians identified as practicing pediatric intensive care in any of 15 academic centers.
Seventy of 97 physicians (72.2%) responded. Physicians stated that they were more likely to prescribe steroids for septic shock than for shock following cardiac surgery (odds ratio, 1.9 [95% CI, 0.9-4.3]) or trauma (odds ratio, 11.46 [95% CI, 2.5-51.2]), and 91.4% (64/70) would administer steroids to patients who had received 60 cc/kg of fluid and two or more vasoactive medications. Thirty-five percent of respondents (25/70) reported that they rarely or never conducted adrenal axis testing before giving steroids to patients in shock. Eighty-seven percent of respondents (61/70) stated that the role of steroids in the treatment of fluid and/or vasoactive drug-dependent shock needed to be clarified and that 84.3% would be willing to randomize patients into a trial of steroid efficacy who were fluid resuscitated and on one high-dose vasoactive medication. However, 74.3% stated that they would start open-label steroids in patients who required two high-dose vasoactive medications.
This survey provides information on the stated beliefs and practices of pediatric critical care physicians with regard to the use of steroids in fluid and/or vasoactive drug-dependent shock. Clinicians feel that the role of steroids in shock still requires clarification and that they would be willing to randomize patients into a trial. This survey may be useful as an initial framework for the development of a future trial on the use of steroids in pediatric shock.
Notes
Comment In: Pediatr Crit Care Med. 2013 Jun;14(5):541-323867432
PubMed ID
23628832 View in PubMed
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