SAFETY, EFFICACY, AND TOLERABILITY OF EARLY INITIATION OF NONINVASIVE POSITIVE PRESSURE VENTILATION IN PEDIATRIC PATIENTS ADMITTED WITH STATUS ASTHMATICUS: A PILOT STUDY
Basnet S, Gurrett M, Andoh J, Klaska H, Verhulst S, Koirala J. Pediatr Crit Care Med. 2012;13(4):393-398.
The researchers of this study sought to study the safety, tolerability, and the efficacy of early initiation of noninvasive positive-pressure ventilation (NPPV) in addition to standard of care with children affected with status asthmaticus. Although the use of NPPV has increased, there are few data to support its use in children with status asthmaticus.
This study was a prospective, randomized, controlled clinical trial that took place in a pediatric intensive care unit. Patients (n = 20) were randomly placed into study groups: NPPV plus standard-of-care therapy and standard-of-care therapy alone.
Patients in the standard of care and NPPV had an improvement in their clinical asthma score at 2, 4 to 8, and 24 hours, with a decrease in respiratory rate at more than 24 hours' oxygen requirement as compared with the standard-of-care group (P = .01 and P = .03, respectively). There were no major adverse events in the NPPV group.
The authors concluded that NPPV with standard-of-care treatment is safe, well tolerated, and effective in the treatment of children with status asthmaticus.
THROMBOSIS RISK FACTOR ASSESSMENT AND IMPLICATION FOR PREVENTION IN CRITICALLY ILL CHILDREN
Reiter P, Wathen B, Valuck RJ, Dobyns EL. Pediatr Crit Care Med. 2012;13(4):381-386.
This prospective observational cohort study sought to describe nursing compliance with a computer-based pediatric thrombosis risk assessment tool, estimate risk factors present in their population, and explore the relationships between risk factors and confirmed thrombotic events.
Subjects included all infants and children (n = 800) admitted into a pediatric intensive care unit in a tertiary care children's hospital during a 6-month period. A 12-point assessment tool was developed and unloaded with the shift assessment. Education was done prior to the implementation of the tool. Thrombosis risk scores were recorded for 707 admissions (88%), with 32 thrombi present in the study group.
The researchers used logistic regression and found that for every 1-point increase in the total thrombus score, the risk for developing a symptomatic thrombus increased by 1.57-fold to 2.12-fold. Risk factors included for thrombus development included either acquired or inherited thrombophilia (P < .001), presence of a central catheter (P = .01), and age younger than 1 or older than 14 years (P = .052).
The authors concluded that the incorporation of scoring system with the bedside nursing assessment was effective and identified children at risk for developing an in-hospital thrombus and that the overall score appears indicative of thrombus risk.