Infections in severely traumatized children

Bell, Louis M.; Baker, M. Douglas; Beatty, D. C.; Taylor, Lesli

doi:10.1016/0022-3468(92)90184-9

Cited by 21 publications

(10 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our observed nosocomial infection rate of 21% is comparable to previously published studies of critically injured children (1). It should be noted that these infections included all nosocomial infections by CDC criteria, not just ventilator-associated pneumonia or catheter-associated bloodstream infections.…”

Section: Discussionsupporting

confidence: 90%

See 1 more Smart Citation

Innate Immune Function Predicts the Development of Nosocomial Infection in Critically Injured Children

Muszynski¹,

Nofziger

Greathouse

et al. 2014

Shock

View full text Add to dashboard Cite

Background Critical injury has been associated with reduction in innate immune function in adults, with infection risk being related to degree of immune suppression. This relationship has not been reported in critically injured children. Hypothesis Innate immune function will be reduced in critically injured children, and the degree of reduction will predict the subsequent development of nosocomial infection. Materials and Methods Children (≤ 18 years of age) were enrolled in this longitudinal, prospective, observational, single-center study after admission to the pediatric intensive care unit (PICU) following critical injury, along with a cohort of outpatient controls. Serial blood sampling was performed to evaluate plasma cytokine levels and innate immune function as measured by ex vivo LPS-induced TNFα production capacity. Results Seventy-six critically injured children (and 21 outpatient controls) were enrolled. Sixteen critically injured subjects developed nosocomial infection. Those subjects had higher plasma IL-6 and IL-10 levels on post-trauma day (PTD) 1–2 compared to those who recovered without infection and outpatient controls. Ex vivo LPS-induced TNFα production capacity was lower in children on PTD 1–2 (p=0.006) and over the first week following injury (p=0.04) in those who went on to develop infection. A TNFα response of < 520 pg/ml at any time in the first week after injury was highly associated with infection risk by univariate and multivariate analysis. Among transfused children, longer red blood cell storage age, not transfusion volume, was associated with lower innate immune function (p < 0.0001). Trauma-induced innate immune suppression was reversible ex vivo via co-culture of whole blood with GM-CSF. Conclusions Trauma-induced innate immune suppression is common in critically injured children and is associated with increased risks for the development of nosocomial infection. Potential exacerbating factors, including red blood cell transfusion, and potential therapies for pediatric trauma-induced innate immune suppression are deserving of further study.

show abstract

Section: Discussionsupporting

confidence: 90%

“…In addition to the risks critically injured children face from their primary injuries, they also face substantial morbidity due to nosocomial infection (1). These hospital-acquired infections contribute to longer intensive care unit (ICU) stays and increase health care costs by tens of thousands of dollars per infection (2).…”

Section: Introductionmentioning

confidence: 99%

Innate Immune Function Predicts the Development of Nosocomial Infection in Critically Injured Children

Muszynski¹,

Nofziger

Greathouse

et al. 2014

Shock

View full text Add to dashboard Cite

show abstract

“…Underlying disease exerting immunosuppression, surgery, state of nutrition, immunomodulation therapy, and site of infection increase the risk for development of invasive disease and determine the extent of SIR. [6][7][8] However, sepsis in the paediatric population occurs very frequently in previously healthy children and, in comparison to adults, is more overwhelming. Mortality is mainly confined to the first 48 hours after onset of disease.…”

mentioning

confidence: 99%

Management of Sepsis and Septic Shock in Infants and Children

Rosenstiel¹,

Rosenstiel

Adam³

2001

Paediatric Drugs

View full text Add to dashboard Cite

Sepsis and septic shock constitute an important cause of morbidity and mortality in critically ill children. Thus, the systemic response to infection and its management remains a major challenge in clinical medicine. Apart from antibiotic administration, the majority of available therapies are limited to supportive strategies, although considerable efforts are being undertaken to devise innovative approaches that modulate host inflammatory responses. In suspected sepsis, 2 or 3 days' empiric antibiotic therapy should begin immediately after cultures have been obtained without awaiting results. Antibiotics should be re-evaluated when the results of the cultures and susceptibility tests are available. The initial antibiotic (combination) is determined by the likely causative agent, susceptibility patterns within a specific institution, CNS penetration, toxicity, and the patient's hepatic and renal function. The likely offending micro-organism in turn depends primarily on the patient's age, coexistence of any premorbid condition leading to impaired immune response, and the presenting signs and symptoms. Close attention to cardiovascular, respiratory, fluid and electrolyte, haematological, renal and metabolic/nutritional support is essential to optimise outcome. Fluid resuscitation is of utmost importance to overcome hypovolaemia on the basis of a diffuse capillary leak. Monitoring and normalisation of the heart rate is essential. In case of nonresponse to fluid resuscitation, inotropic and vasoactive agents are commonly used to increase cardiac output, maintain adequate blood pressure and enhance oxygen delivery to the tissue. Because respiratory distress syndrome is seen in about 40% of critically ill children with septic shock, increased inspired oxygen is essential. To provide optimal relief from respiratory muscle fatigue and facilitate the provision of positive airway pressure, early intubation and mechanical ventilation should be considered. Renal support is essential to avoid prolonged renal shutdown in hypoperfusion states. Haematological support comprises replacement therapy of clotting factors to overcome disseminated intravascular coagulation. Metabolic support may include glucose support, extraction of ammonia from the body and recognition of liver dysfunction. Nutritional support may modify the inflammatory host response, and early enteral feeding can improve outcome in critical illness. To date, glucocorticoid and non-glucocorticoid anti-inflammatory agents have not shown significant benefit in septic patients.

show abstract

“…Complications arising from the head injury further influence LOS. Complications include the type of lesion (Alberico et al, 1987;Genarelli et al, 1982), infections (Bell, Baker, Beatty, & Taylor, 1992;Schimpft, Miller, Polakavetz, & Hornick, 1974), and increased intracranial pressure (Berger, Pitts, Lovely, Edwards, & Bartkowski, 1985;Hans, Albert, & Born, 1987). Individually, these factors have been shown to adversely affect the outcome for children.…”

mentioning

confidence: 99%

Impact of early discharge planning and case management on length of hospital stay for children with acquired brain injury

Sakzewski

Ziviani

Swanson

1996

Aus Occup Therapy J

View full text Add to dashboard Cite

The aim of this study was to determine the impact of co‐ordinated management and early discharge planning as an intervention strategy to reduce hospital length of stay for children with acquired brain injury. Data for children admitted to the Royal Children's Hospital, Brisbane, between 1987 and 1993 were compared with data collected for children receiving the intervention programme from August 1993 to August 1994. In total, 99 children were included in the study, of whom 84 were retrospective and 15 were prospective patients. Age, sex, Glasgow Coma Score, mechanism of injury (traumatic vs non‐traumatic), and treatment intervention were predictor variables, and total length of hospital stay and associated hospital costs were the outcome variables. Univariate analyses were performed to determine differences between the retrospective and intervention groups and showed a highly significant difference between the two groups in relation to length of stay and total hospital costs (P<0.001). Multiple regression analyses were carried out to determine what factors could predict length of stay. Along with the Glasgow Coma Score (P<0.01), the intervention programme was found to be a statistically significant predictor of total hospital days (P<0.01). A couple of issues, nevertheless, remain unanswered. These pertain to the functional status of the patient at discharge and the nature of community supports required. This study opens up an area of investigation not before undertaken in occupational therapy and points towards future studies.

show abstract

Infections in severely traumatized children

Cited by 21 publications

References 10 publications

Innate Immune Function Predicts the Development of Nosocomial Infection in Critically Injured Children

Innate Immune Function Predicts the Development of Nosocomial Infection in Critically Injured Children

Management of Sepsis and Septic Shock in Infants and Children

Impact of early discharge planning and case management on length of hospital stay for children with acquired brain injury

Contact Info

Product

Resources

About