Subclinical Acute Kidney Injury (AKI) describes patients who did not fulfill the classical criteria for AKI diagnosis but showed elevated levels of new biomarkers reflecting tubular injury. One of these biomarkers is Neutrophil Gelatinase-Associated Lipocalin (NGAL). The aim of this study is to investigate the role of urinary NGAL and microalbuminuria as non-invasive biomarkers in the detection of subclinical AKI. Analysis of urinary NGAL and microalbuminuria in 91 subjects [30 pediatric intensive care unit (PICU) patients, 31 diabetic patients and 30 healthy controls] recruited from Cairo University Pediatric Hospital was done. Our study revealed that urinary NGAL was significantly higher in the PICU group followed by the diabetic group and lowest in the controls group (p=0.022). A positive correlation was found between urinary NGAL and microalbuminuria in the PICU group (Rvalue= 0.585, p-value=0.001). In diabetic group, a positive correlation was found between urinary NGAL and fasting blood glucose, 2 hours post prandial and HbA1C (R-value=0.421; pvalue= 0.021; R-value=0.426; p-value=0.019; R-value=0.438; pvalue= 0.018 respectively). Urinary NGAL may be a potential biomarker to detect subclinical AKI before actual functional renal damage leading to early intervention and reduction of mortality.
Background: Extubation failure is failure to maintain normal spontaneous breathing after a period of mechanical ventilation with the need for reintubation within 24-72 hours. It has multiple risk factors such as deconditioned muscles, upper airway edema and others. Aim of the Work:To study the frequency and causes of extubation failure in mechanically ventilated children. Patients and Methods: This is an observational prospective study that included all admitted children in Pediatric Intensive Care Unit (PICU), Cairo University Children Hospital who underwent mechanical ventilation (MV) through endotracheal tube for more than 48 hours (145 child) with Glasgow coma scale above 8. They were subdivided into successfully extubated (78 children) and failed extubation (67 children). Results:The mean ± SD age of the cohort was 13.5 ± 15.15 months (range1.3-48, median= 8 months). Of them 80 (55.17%) were males, and 65 (44.8%) were females. The commonest underlying diagnosis was pneumonia in 38 (26.2%), bronchial asthma in 32 (22%), encephalopathy in 32 (22%), and aspiration in 11 (7.58%). Failed extubation was encountered in 67 (46.2%) children. The encountered risk factors of extubation failure were: sedation in 12 (16.7%) (p=0.001), excessive tracheal secretion of more than 200 ml /24 h in 14 (18.7%) (p=0.03), accidental extubation in 27 (40.3%) (p=0.01) and the need for higher setting on MV in all 67 children with failed extubation. Among failed extubated patients, the mean± SD for peak inspiratory pressure (PIP), positive end-expiratory pressure (PEEP), and fraction of inspired oxygen (FiO2) were 14.5± 1.8 /cm H2O, 5.5± 0.5/cm H2O, and 27.5± 6.1% respectively. While, PIP, PEEP, and FiO2 in the successfully extubated group were 12.8± 1.6 /cm H2O, 4.1± 0.4/cm H2O, and 24.8± 5.3%, (p= 0.01, p=0.001 and p= 0.001) respectively. Patients who underwent gradual withdrawal of ventilatory support had a higher frequency of successful extubation than those extubated accidentally (p= 0.01). Sensitivity, and specificity of above mentioned indices for successful extubation were 53.79%, and 28.72% respectively. Conclusion: Causes of extubation failure are the need for long duration of sedation, excessive tracheal secretion, and need for high setting on MV. Furthermore, gradual weaning decreases the frequency of extubation failure. There is a need for a more sensitive and specific comprehensive objective indicator(s) for successful timely extubation.
Background: Fluids are an integral line of management of septic shock as circulatory instability and myocardial dysfunction are the major causes of death in septic shock. Several indicators of fluid responsiveness (FR) have been proposed. Aim of the Work: to assess predictive value of assessment of fluid responsiveness on outcome of children with sepsis. Methods: This study was a prospective observational cohort study which was conducted on 25 children who were admitted to Pediatric Intensive Care Unit with septic shock at Children Hospital, Cairo University from February 2020 to May 2020. All underwent bedside echocardiography assessment of fluid responsiveness (FR) using inferior vena cava's (IVC) diameter: distensibility, collapsibility, variability indices and time velocity integral across aortic valve before and after fluid resuscitation. Results:The mean age ± SD of the studied cohort was 33.72 ± 39.65 months, 17 (68%) were males and 8 (32%) were females. All patients presented by septic shock, of them 13 (52%) were fluid responsive and 12(48%) were fluid nonresponsive (p=0.118). FR was different between ventilated patients and non-ventilated patients as regards IVC variability % before and after IV fluids (p= 0.001) and (p=0.001) respectively, stroke volume and cardiac output after IV fluids (p =0.033) and (p=0.001) respectively. FR correlated with central venous pressure measurements (p=0.000017) and inotropic support (p=0.0074) but not with main diagnosis of septic shock, mechanical ventilation of patients or not and not with number of system failure. Ten (40%) of them were on mechanical ventilation and inotropes. Nineteen (76%) improved and 6 (24%) died. There was no correlation between FR and outcome (p= 0.316). Conclusion: Bedside echocardiography may be a useful non-invasive method for follow up, evaluation of fluid responsiveness in children septic shock and to assess CI which helps in assessment of fluid response, make decision on medication, and help evaluate the different forms of shock, but it has no significant relation to the outcome of these children. Outcome of septic shock is multifactorial, depends on timing of diagnosis, fluid administration, inotropic support, and cardiac condition not fluid responsiveness only.
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