Search of Unknown Fever Focus Using PET in Critically Ill Children With Complicated Underlying Diseases

Chang, Li-Ren; Cheng, Mei‐Fang; Jou, Shiann-Tarng; Ko, C. M.; Huang, Jian-Jia; Tzen, Kai-Yuan; Yen, Ruoh‐Fang

doi:10.1097/pcc.0000000000000601

Cited by 16 publications

(8 citation statements)

References 29 publications

(36 reference statements)

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“…At the same time, the critically ill patients are often accompanied by increasing age, complicated with many basic diseases, and the damage of important organs etc. (21). The excessive volume load will also aggravate the injury of tissues and organs.…”

Section: Discussionmentioning

confidence: 99%

A novel supplemental maneuver to predict fluid responsiveness in critically ill patients: blood pump-out test performed before renal replacement therapy

Huang¹,

Ma²,

Ma³

et al. 2020

Ann Transl Med

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Background: Passive leg raising (PLR) test, known as reversible increasing venous return, could predict hemodynamic intolerance induced by renal replacement therapy (RRT). Oppositely, blood drainage procedure at the start of RRT cuts down intravascular capacity which is likely to have changes in fluid responsiveness has been little studied. Our study aimed to determine whether blood drainage procedure, defined as blood pump-out test, which is essential and inevitable at the beginning of RRT could predict fluid responsiveness in critically ill patients.Methods: Critically ill patients underwent RRT with pulse contour analysis were included. During PLR, an increase of cardiac output (CO, derived from pulse contour analysis) ≥10% compared to baseline was considered responders as the gold standard. BPT was performed at a constant speed after the increase of CO induced by PLR returned to baseline and the maximal of CO within 2 minutes was recorded. Then area under ROC curve of CO changes to identify responders from non-responders in BPT was calculated based on the results from PLR test.Results: Sixty-five patients were enrolled. Thirty-one/sixty-five patients (47.7%) were considered responders during PLR. And after analysis by ROC curve, a decrease in CO greater than 11.0% during BPT predicted fluid responsiveness with 70.9% sensitivity and 76.5% specificity. The highest area under the curve (AUC) was found for an increase in CO (0.74±0.06; 95% CI: 0.62 to 0.84).Conclusions: BPT could be a supplement to PLR, providing a novel maneuver to predict fluid responsiveness in critically ill patients underwent RRT. (Trial registration: ChiCTR-DDD-17010534).Registered 30 January 2017 (retrospective registration).

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Section: Discussionmentioning

confidence: 99%

A novel supplemental maneuver to predict fluid responsiveness in critically ill patients: blood pump-out test performed before renal replacement therapy

Huang¹,

Ma²,

Ma³

et al. 2020

Ann Transl Med

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“…The fact that pathological 18 FDG-uptake in the bone marrow may in some cases be impossible to distinguish from physiological 18 FDG-uptake, or increased nonspecific 18 FDG-uptake seen in infectious or inflammatory diseases, has also been illustrated in other studies with cases of leukaemia, where patchy or diffusely increased splenic and bone marrow activity was regarded as reactive haematopoietic tissues. [15][16][17] Concerning other false negative scans, our study did not include cases of infectious diseases, but such have been reported in meningitis, endocarditis, arthritis and urinary tract infection. 9,15,18,19 This may be due to the fact that high physiological 18 FDG-uptake in the brain, heart and joints, and the 18 FDG excretion through the kidneys, which in some cases may hinder the detection of pathological 18 FDG-uptake.…”

Section: Discussionmentioning

confidence: 99%

“…Six of these seven patients had normal Creactive protein at repeated investigations, in contrast to only one of 11 of the remaining cases where a final diagnosis was subsequently established (Table 1). During the follow-up period of a median of 4 years (3-5 years), six of the seven cases with spontaneous fever resolution had affiliation to outpatient clinics for psychology and/or psychiatry due to persistent non-specific complaints, primarily fatigue, pain and/or school absence (cases [13][14][15][16][17][18]. Finally, among cases with no focal suspicion of fever, 18 FDG-PET/CT was misleading in two cases; one false positive case where 18 FDG-PET/CT-uptake proposed appendicitis, which was subsequently disproven by appendectomy (case 4) and one false negative case with recurrent fever and normal haematology finally diagnosed with leukaemia (case 5).…”

Section: Re Sultsmentioning

confidence: 99%

Unexplained fever in children—Benefits and challenges of FDG‐PET/CT

et al. 2022

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Aim To explore [fluorine‐18]‐fluoro‐2‐deoxy‐d‐glucose positron‐emission‐tomography/computed tomography (18FDG‐PET/CT) in patients where standard investigations were non‐diagnostic. Methods We reviewed medical records of previously healthy children who had 18FDG‐PET/CT performed at Copenhagen University Hospital in 2015–2020 due to unexplained fever. Results Thirty‐five of 819 paediatric 18FDG‐PET/CT were performed due to unexplained fever. The final diagnoses were malignancy (11%), infections (23%), inflammatory diseases (43%) and miscellaneous (26%). 18FDG‐PET/CT was diagnostic in six cases with Takayasu's arteritis, tuberculosis, Langerhans cell histiocytosis and Ewing sarcoma. Sixteen cases had focal 18FDG‐uptake, but 18FDG‐PET/CT could only differentiate malignancy, infection and inflammation in three cases. In six cases with inflammatory diseases and no focal signs, PET/CT was normal except increased non‐specific 18FDG‐uptake in bone marrow and spleen in five cases. One case was false positive (suspicion of appendicitis) and two false negative (leukaemia and inflammatory disease). Conclusion 18FDG‐PET/CT was diagnostic, or contributed to the diagnosis, in several children with unexplained fever referred to a tertiary centre. Challenges comprised (i) only increased non‐specific 18FDG‐uptake in bone marrow and spleen in half of cases with inflammatory diseases, (ii) no differentiation between complicated infections, malignancy and inflammation in most cases with focal processes and (iii) a small risk of false positive and false negative results.

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“…B. bei kritisch kranken Kindern in 84 % der Fälle. Dies zeigt den hohen Stellenwert von nuklearmedizinischen Verfahren für dieses Patientenkollektiv [8]. Zudem ist eine opportunistische Erkrankung je nach Herkunft und Aufenthaltsort des Patienten unterschiedlich.…”

Section: Pet-ctunclassified

Infektionen als Ursache für Fieber unklarer Genese

Salzberger¹,

Birkenfeld²,

Iberer³

et al. 2017

Dtsch med Wochenschr

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Fever of unexplained (or unknown) origin (FUO) remains a relevant clinical problem even with modern diagnostic methods. In addition to the classical definition, new categories of FUO describe different clinical situations: nosocomial FUO, FUO in neutropenic/immundeficient patients and FUO in patients with HIV-infection. The new categories are defined by much shorter duration of fever, i. e. mostly three days. Each category of FUO shows a different spectrum of infectious diseases. Often, subacute bacterial endocarditis is very difficult to verify. In many cases, patients in intensive care suffer from FUO caused by reactivation of CMV. In patients with HIV the most important diagnostic indicator concerning the origin of infection is the degree of immundeficiency. Biological and nuclear medical (PET-CT) verification procedures have been established in diagnostics. A national or international register should be created with the purpose of data transfer and validation of strategies concerning the treatment of FUO.

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Search of Unknown Fever Focus Using PET in Critically Ill Children With Complicated Underlying Diseases

Cited by 16 publications

References 29 publications

A novel supplemental maneuver to predict fluid responsiveness in critically ill patients: blood pump-out test performed before renal replacement therapy

A novel supplemental maneuver to predict fluid responsiveness in critically ill patients: blood pump-out test performed before renal replacement therapy

Unexplained fever in children—Benefits and challenges of FDG‐PET/CT

Infektionen als Ursache für Fieber unklarer Genese

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