Dataset Information

Pediatric Profound Dengue Shock Syndrome and Use of Point-of-Care Ultrasound During Mechanical Ventilation to Guide Treatment: Single-Center Retrospective Study, 2013-2021.

ABSTRACT:

Objectives

Profound dengue shock syndrome (DSS) complicated by severe respiratory failure necessitating mechanical ventilation (MV) accounts for high case fatality rates among PICU-admitted patients. A major challenge to management is the assessment of intravascular volume, which can be hampered by severe plasma leakage and the use of MV.

Design

Retrospective cohort, from 2013 to 2021.

Patients

Sixty-seven children with profound DSS supported by MV, some of whom underwent bedside point-of-care ultrasound (POCUS) for assessment and monitoring of hemodynamics and fluid administration.

Setting

PICU of the tertiary Children's Hospital No. 2 in Vietnam.

Interventions

None.

Measurements and main results

We analyzed data clinical and laboratory data during PICU stay. In particular, during use of MV (i.e., at times 0-, 6-, and 24-hr after commencement) and fluid resuscitation. The primary study outcome was 28-day in-hospital mortality, and the secondary outcomes were associations with changes in hemodynamics, blood lactate, and vasoactive-inotrope score (VIS). Patients had a median age of 7 years (interquartile range, 4-9). Use of POCUS during fluid management (39/67), as opposed to not using (28/67), was associated with lower mortality (6/39 [15%] vs. 18/28 [64%]; difference 49 % [95% CI, 28-70%], p < 0.001). Use of POCUS was associated with lower odds of death (adjusted odds ratio 0.17 [95% CI, 0.04-0.76], p = 0.02). The utilization of POCUS, versus not, was associated with greater use of resuscitation fluid, and reductions in VIS and pediatric logistic organ dysfunction (PELOD-2) score at 24 hours after MV and PICU discharge.

Conclusions

In our experience of pediatric patients with profound DSS and undergoing MV (2013-2021), POCUS use was associated with lower odds of death, a higher volume of resuscitation fluid, and improvements in the blood lactate levels, VIS, and PELOD-2 score.

SUBMITTER: Vo LT

PROVIDER: S-EPMC10986784 | biostudies-literature | 2024 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Pediatric Profound Dengue Shock Syndrome and Use of Point-of-Care Ultrasound During Mechanical Ventilation to Guide Treatment: Single-Center Retrospective Study, 2013-2021.

Vo Luan Thanh LT Nguyen Dat Tat DT Tran Thinh Ngoc TN Tran Hang Hoang-Thanh HH Đoan Trang Thi-Hoai TT Pham Tram Ngoc TN Mai Thanh Thi-Hoai TT Nguyen Quynh Xuan-Thuy QX Nguyen Thuan Khac TK Nguyen Thuong Thi-Kim TT Burza Sakib S Nguyen Thanh Tat TT

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 20231115 4

<h4>Objectives</h4>Profound dengue shock syndrome (DSS) complicated by severe respiratory failure necessitating mechanical ventilation (MV) accounts for high case fatality rates among PICU-admitted patients. A major challenge to management is the assessment of intravascular volume, which can be hampered by severe plasma leakage and the use of MV.<h4>Design</h4>Retrospective cohort, from 2013 to 2021.<h4>Patients</h4>Sixty-seven children with profound DSS supported by MV, some of whom underwent b ...[more]

PMID: 37966344

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Project description:BackgroundPatients with severe dengue who develop severe respiratory failure requiring mechanical ventilation (MV) support have significantly increased mortality rates. This study aimed to develop a robust machine learning-based risk score to predict the need for MV in children with dengue shock syndrome (DSS) who developed acute respiratory failure.MethodsThis single-institution retrospective study was conducted at a tertiary pediatric hospital in Vietnam between 2013 and 2022. The primary outcome was severe respiratory failure requiring MV in the children with DSS. Key covariables were predetermined by the LASSO method, literature review, and clinical expertise, including age (< 5 years), female patients, early onset day of DSS (≤ day 4), large cumulative fluid infusion, higher colloid-to-crystalloid fluid infusion ratio, severe bleeding, severe transaminitis, low platelet counts (< 20 x 109/L), elevated hematocrit, and high vasoactive-inotropic score. These covariables were analyzed using supervised models, including Logistic Regression (LR), Random Forest (RF), Support Vector Machine (SVM), k-Nearest Neighbor (KNN), and eXtreme Gradient Boosting (XGBoost). Shapley Additive Explanations (SHAP) analysis was used to assess feature contribution.ResultsA total of 1,278 patients were included, with a median patient age of 8.1 years (IQR: 5.4-10.7). Among them, 170 patients (13.3%) with DSS required mechanical ventilation. A significantly higher fatality rate was observed in the MV group than that in the non-MV group (22.4% vs. 0.1%). The RF and SVM models showed the highest model discrimination. The SHAP model explained the significant predictors. Internal validation of the predictive model showed high consistency between the predicted and observed data, with a good slope calibration in training (test) sets 1.0 (0.934), and a low Brier score of 0.04. Complete-case analysis was used to construct the risk score.ConclusionsWe developed a robust machine learning-based risk score to estimate the need for MV in hospitalized children with DSS.

Project description:BackgroundLung and diaphragm ultrasound methods have recently been introduced to predict the outcome of weaning from mechanical ventilation (MV). The aim of this study is to assess the reliability and accuracy of these techniques for predicting successful weaning in critically ill adults.MethodsWe conducted two studies: a cross-sectional interobserver agreement study between two sonographers and a prospective cohort study to assess the accuracy of lung and diaphragm ultrasound for predicting weaning and extubation outcome. For the interobserver agreement study, we included 50 general critical care patients who were consecutively admitted to the ICU. For the predictive accuracy study, we included consecutively 69 patients on MV who were ready for weaning. We assessed interobserver agreement of ultrasound measurements, using the weighted kappa coefficient for LUSm score (modified lung ultrasound score) and the intraclass correlation coefficient (ICC) and Bland-Altman method for TI (diaphragm thickening index). We assessed the predictive value of LUSm and TI in weaning outcome by plotting the corresponding ROC curves.ResultsWe found adequate interobserver agreement for both LUSm (weighted kappa 0.95) and TI (ICC 0.78, difference according to Bland-Altman analysis ± 12.5%). LUSm showed good-moderate discriminative power for successful weaning and extubation (area under the ROC curve (AUC) for successful weaning 0.80, and sensitivity and specificity at optimal cut-off point 0.76 and 0.73, respectively; AUC for successful extubation 0.78, and optimal sensitivity and specificity 0.76 and 0.47, respectively. TI was more sensitive but less specific for predicting successful weaning (AUC 0.71, optimal sensitivity and specificity 0.93 and 0.48) and successful extubation (AUC 0.76, optimal sensitivity and specificity 0.93 and 0.58). The area under the ROC curve for predicting weaning success was 0.83 for both ultrasound measurements together.ConclusionsInterobserver agreement was excellent for LUSm and moderate-good for TI. A low TI value or high LUSm value indicates high risk of weaning failure.

Dataset Information

Pediatric Profound Dengue Shock Syndrome and Use of Point-of-Care Ultrasound During Mechanical Ventilation to Guide Treatment: Single-Center Retrospective Study, 2013-2021.

Objectives

Design

Patients

Setting

Interventions

Measurements and main results

Conclusions

Publications

Pediatric Profound Dengue Shock Syndrome and Use of Point-of-Care Ultrasound During Mechanical Ventilation to Guide Treatment: Single-Center Retrospective Study, 2013-2021.

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