The impact of cervical cannulation on neurologic outcome has not been yet studied among children ... more The impact of cervical cannulation on neurologic outcome has not been yet studied among children receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the context of severe sepsis or septic shock. A retrospective cohort study was performed using the extracorporeal life support organization (ELSO) registry. A total of 559 children weighing less than 20 kg with a primary or secondary diagnosis of severe sepsis, septic shock or toxic shock syndrome were included between January 1, 2010, and December 31, 2019. Cervical cannulation was performed in 485 children (87%) and central cannulation in 74 children (13%). The prevalence of acute neurologic event (ANE) was 32%, including clinical and/or electroencephalographic seizures, cerebral infarction, cerebral hemorrhage, and/or brain death. In multivariable analysis, we did not find an association between cervical cannulation and greater/lesser odds of ANE during ECMO (adjusted odds ratio [aOR] = 1.39, 95% confidence interval [CI] 0.72–2.65; P = 0.326). Only pre-ECMO acidosis was independently associated with the development of ANE (pH < 6.99; aOR = 2.71, 95% CI 1.34–5.49; P = 0.006; pH 6.99 to <7.12; aOR = 2.57, 95% CI 1.37–4.82; P = 0.003). Thus, the site of cannulation appears not as a modifiable neurologic risk factor in this young septic population.
Airway surgery involving trachea or main stem bronchi in neonates and children is challenging. Th... more Airway surgery involving trachea or main stem bronchi in neonates and children is challenging. The use of extracorporeal support for such unusual indications is poorly described. Here, we report on three patients receiving peripheral extracorporeal membrane oxygenation (ECMO) to maintain adequate ventilation while improving surgical site exposure. Case 1 is a 9-year-old boy diagnosed with proximal left stem bronchus endoluminal tumor; cases 2 and 3 are a neonate and a young infant diagnosed with a subcarinal bronchogenic cyst. Planned ECMO use consisted in peripheral venoarterial cannulation through jugular and carotid access. There was no bleeding complication during and after surgical care. Hemodynamic and respiratory supports were optimized in all cases. Children were successfully weaned off ECMO immediately after surgery. Planned peripheral ECMO cannulation offers optimal conditions for high-risk airway surgery in neonates and children.
OBJECTIVES To describe the frequency and outcomes on the use of extracorporeal membrane oxygenati... more OBJECTIVES To describe the frequency and outcomes on the use of extracorporeal membrane oxygenation among critically ill neonates and children within a structured pediatric critical care network in the West of France. To assess the optimality of decision-making process for patients primarily admitted in nonextracorporeal membrane oxygenation centers. DESIGN Observational prospective population-based study from January 2015 to December 2019. PATIENTS Neonates over 34 weeks of gestational age, weighing more than 2,000 g and children under 15 years and 3 months old admitted in one of the 10 units belonging to a Regional Pediatric Critical Care Network. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Eight-thousand one-hundred eighty-nine children and 3,947 newborns were admitted within one of the 10 units of the network over the study period. Sixty-five children (8.1‰ [95% CI, 6.2-10‰]) and 35 newborns (9.4‰ [95% CI, 6.4-12‰]) required extracorporeal membrane oxygenation support. Of these patients, 31 were first admitted to a nonextracorporeal membrane oxygenation center, where 20 were cannulated in situ (outside the regional extracorporeal membrane oxygenation center) and 11 after transfer to the extracorporeal membrane oxygenation regional center. Cardiogenic shock, highest serum lactate level, and cardiac arrest prior to first phone call with the regional extracorporeal membrane oxygenation center were associated with higher rate of in situ cannulation. During the study period, most of the patients were cannulated for underlying cardiac issue (42/100), postoperative cardiac surgery instability (38/100), and pediatric (10/100) and neonatal (10/100) respiratory distress syndrome. Patients primarily admitted in nonextracorporeal membrane oxygenation centers or not had similar 28-day post-ICU survival rates compared with those admitted in the referral extracorporeal membrane oxygenation center (58% vs 51%; p = 0.332). Preextracorporeal membrane oxygenation cardiac arrest, extracorporeal cardiopulmonary resuscitation, and lower pH at extracorporeal membrane oxygenation onset were associated with lower 28-day post-ICU survival. CONCLUSIONS Our local results suggest that a structured referral network for neonatal and pediatric extracorporeal membrane oxygenation in the region of Western France facilitated escalation of care with noninferior (or similar) early mortality outcome. Our data support establishing referral networks in other equivalent regions.
Cerebral autoregulation (CA) impairment is associated with neurological complications among child... more Cerebral autoregulation (CA) impairment is associated with neurological complications among children supported by extracorporeal membrane oxygenation (ECMO). Severe variations of arterial CO2 (PaCO2) and O2 (PaO2) tension after ECMO onset are common and associate with mortality and poor neurological outcome. The impact of gas exchange on CA among critically ill patients is poorly studied. Retrospective analysis of data collected prospectively from 30 children treated with veno-arterial or veno-venous ECMO in the PICU of Nantes University Hospital, France. A correlation coefficient between the variations of regional cerebral oxygen saturation (rSO2) and the variations of mean arterial blood pressure (MAP) was calculated as an index of CA (cerebral oxygenation reactivity index, COx). Cox–MAP plots were investigated allowing determining lower limit of autoregulation (LLA) and upper limit of autoregulation (ULA) limits of autoregulation. Age-based normal blood pressure was used to adjust the MAP, LLA, and ULA data from each patient and then reported as percentage (nMAP, nLLA, and nULA, respectively). RSO2, COx, nMAP, nLLA, and nULA values were averaged over one hour before each arterial blood gas (ABG) sample during ECMO run. Thirty children (median age 4.8 months [Interquartile range (IQR) 0.7–39.1], median weight 5 kg [IQR 4–15]) experiencing 31 ECMO runs were included in the study. Three hundred and ninety ABGs were analyzed. The highest values of COx were observed on day 1 (D1) of ECMO. The relationship between COx and PaCO2 was nonlinear, but COx values tended to be lower in case of hypercapnia compared to normocapnia. During the whole ECMO run, a weak but significant correlation between PaCO2 and nULA was observed (R = 0.432, p = 0.02). On D1 of ECMO, this correlation was stronger (R = 0.85, p = 0.03) and a positive correlation between nLLA and PaCO2 was also found (R = 0.726, p < 0.001). A very weak negative correlation between PaO2 and nULA was observed within the whole ECMO run and on D1 of ECMO (R = −0.07 p = 0.04 and R = −0.135 p = <0.001, respectively). The difference between nULA and nLLA representing the span of the autoregulation plateau was positively correlated with PaCO2 and negatively correlated with PaO2 (R = 0.224, p = 0.01 and R = −0.051, p = 0.004, respectively). We observed a complex relationship between PaCO2 and CA, influenced by the level of blood pressure. Hypercapnia seems to be globally protective in normotensive or hypertensive condition, while, in case of very low MAP, hypercapnia may disturb CA as it increases LLA. These data add additional arguments for very cautiously lower PaCO2, especially after ECMO start.
Children supported by extracorporeal membrane oxygenation present a high risk of neurological com... more Children supported by extracorporeal membrane oxygenation present a high risk of neurological complications. Although carotid cannulation is known to be associated with neurologic injury, conflicting data exist with regard to the predominance of right- or left-sided lesions. We describe here two infants requiring veno-arterial extracorporeal membrane oxygenation for septic shock who encountered right watershed infarction ipsilateral to carotid artery cannulation. Hemodynamic failure seems to be the most probable underlying mechanism. The asymmetry of transcranial Doppler metrics in one case and the low right regional cerebral oxygen saturation value observed soon after right cannulation in both cases suggest an insufficient cerebral collateral flow compensation. The risk of ipsilateral watershed injury should be considered before cervical cannulation, notably in the context of sepsis and an evaluation of the cerebral collateral blood flow before and just after cannulation may be int...
I thank Chenouard et al (1) for their insightful comments in relation to the role of primary meta... more I thank Chenouard et al (1) for their insightful comments in relation to the role of primary metabolic conditions as a possible precipitant to sepsis induced or associated rhabdomyolysis. It is an important consideration when assessing for a potential underlying diagnosis and one that has acute and long-term implications. There were only six of 182 children (3%) with a primary metabolic condition including one case of newly diagnosed lipin-1 deficiency, one with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency, and one with holocarboxylase synthetase deficiency within our cohort (2), published recently in Pediatric Critical Care Medicine. In these children, the highest Virus or Bacteria: Is It the Only Cause of Sepsis-Induced Rhabdomyolysis? Rhabdomyolysis results from the breakdown of skeletal muscle fibers, which leads to release of toxic products into the bloodstream. There are few epidemiologic data concerning rhabdomyolysis in children admitted to PICUs. Hence, the study by Gelbart et al (1) published in a recent issue of Pediatric Critical Care Medicine is very welcome. Even so, we would like to add points that seem important to consider. In this cohort of 182 children, the most common etiology for rhabdomyolysis was sepsis/septic shock (82 children; 45%) with 48 organisms identified. It is well known that some microorganisms produce direct muscle injury, whereas others produce substances that have the ability to cause destruction of muscle cell membrane leading to rhabdomyolysis (2). However, some inherited diseases (e.g., fatty acid oxidation disorders, mutations in LPIN1, RYR1, or TANGO2) should be mentioned in case of severe rhabdomyolysis even if a microorganism has been identified, as these disorders are clearly triggered by several conditions almost always present in sepsis (e.g., fever, fasting, dehydration). Inherited diseases represent about 10% of all of causes of rhabdomyolysis in children, but this is probably an underestimate because of the lack of research on this topic (3). In the cohort described by Gelbart et al (1), we were surprised to not see any metabolic or genetic studies performed to exclude some inherited causes of rhabdomyolysis. The plasma acylcarnitine profile and urine organic acids should be assessed in the acute phase in all patients with an episode of severe sepsis-induced rhabdomyolysis to exclude fatty acid oxidation diseases (3). In a second step, monitoring levels of creatine kinase are essential until normalization. If the creatine kinase levels remain high, further studies should be completed. Finally, recent advances in genetics have led to the discovery of new mutations leading to rhabdomyolysis episodes in childhood (3, 4), but the threshold level of creatine kinase elevation that should trigger these genetic analyses remains to be established. Why is it important that inherited causes of rhabdomyolysis are recognized by intensivist, even if a microorganism has been identified? First, they can lead to specific therapeutic interventions, notably in case of suspicion of fatty acid oxidation. Supplementation with carnitine, riboflavin, and coenzyme Q10 may be instituted in this situation, along with taking care to both avoid fasting and to maintain a regular carbohydrate intake (5). Second, when the diagnosis is known, an “emergency” plan should be established to avoid triggering events and to optimize management, thus reducing the risk of lifethreatening rhabdomyolysis (4, 6). Finally, prognosis is clearly different depending on the presence or absence of an inherited
Objectives: To assess the ability of amplitude-integrated electroencephalography monitoring withi... more Objectives: To assess the ability of amplitude-integrated electroencephalography monitoring within 24 hours of the return of spontaneous circulation to prognosticate neurologic outcomes in children following cardiac arrest Design: Retrospective review of prospectively recorded data. An amplitude-integrated electroencephalography background score was calculated according to background activity during the first 24 hours after return of spontaneous circulation, a higher score correlating with more impaired background activity. The primary endpoint was the neurologic outcome as defined by the Pediatric Cerebral Performance Category at PICU discharge (Pediatric Cerebral Performance Category 1–3: a good neurologic outcome; Pediatric Cerebral Performance Category 4–6: a poor neurologic outcome). Setting: A referral PICU. Patients: Thirty children with a median age of 10 months (2–38 mo) and a male/female sex ratio of 1.3 were included. Interventions: None. Measurements and Main Results: Ei...
Purposes: Amplitude-integrated EEG (aEEG) has been widely developed in neonatal intensive care un... more Purposes: Amplitude-integrated EEG (aEEG) has been widely developed in neonatal intensive care unit, but few studies focused on pediatric intensive care unit. Furthermore, reliability of aEEG under real-life conditions is unknown. Methods: Participants were nurses from a 12-bed pediatric intensive care unit in a referral university hospital in France. Amplitude EEG was implemented after standardized training, including e-learning course, individual feedback and bedside teaching concerning monitoring installation, background classification patterns recognition, artefact analysis, and seizure detection. The primary judgment criterion was the agreement (Cohen Kappa) between nurses and aEEG experts for the detection of abnormal aEEG traces (moderately or severely altered background pattern according to Hellström–Westas classification and/or seizure activity). Results: During the study period, 196 consecutives traces from 79 patients were analyzed by 51 nurses. According to expert's ...
Duchenne muscular dystrophy (DMD) has as standard pharmacological therapy with corticoisteroids (... more Duchenne muscular dystrophy (DMD) has as standard pharmacological therapy with corticoisteroids (CS) that decrease inflammation and immune responses present in patients and animal models. CS have however limited efficacy and important and numerous side effects. Therefore, there is a need for new anti-inflammatory and pro-tolerogenic treatments that could replace or decrease doses of CS. We first assessed the status of immune system of dystrophin-deficient rats (Dmdmdx) that closely reproduce the phenotype of DMD patients.Dmdmdxrats showed increased leukocyte infiltration in skeletal and cardiac muscles, containing mostly macrophages but also T cells, and increased expression of several cytokines. Anti-CD45RC Monoclonal antibody (Mab) treatment induced immune tolerance in models of organ transplantation and GVHD (Graft Versus Host Disease). We observed that muscles and blood of DMD patients contained T CD4+and CD8+expressing high levels of CD45RChighcells. Treatment of youngDmdmdxrat...
The impact of cervical cannulation on neurologic outcome has not been yet studied among children ... more The impact of cervical cannulation on neurologic outcome has not been yet studied among children receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the context of severe sepsis or septic shock. A retrospective cohort study was performed using the extracorporeal life support organization (ELSO) registry. A total of 559 children weighing less than 20 kg with a primary or secondary diagnosis of severe sepsis, septic shock or toxic shock syndrome were included between January 1, 2010, and December 31, 2019. Cervical cannulation was performed in 485 children (87%) and central cannulation in 74 children (13%). The prevalence of acute neurologic event (ANE) was 32%, including clinical and/or electroencephalographic seizures, cerebral infarction, cerebral hemorrhage, and/or brain death. In multivariable analysis, we did not find an association between cervical cannulation and greater/lesser odds of ANE during ECMO (adjusted odds ratio [aOR] = 1.39, 95% confidence interval [CI] 0.72–2.65; P = 0.326). Only pre-ECMO acidosis was independently associated with the development of ANE (pH < 6.99; aOR = 2.71, 95% CI 1.34–5.49; P = 0.006; pH 6.99 to <7.12; aOR = 2.57, 95% CI 1.37–4.82; P = 0.003). Thus, the site of cannulation appears not as a modifiable neurologic risk factor in this young septic population.
Airway surgery involving trachea or main stem bronchi in neonates and children is challenging. Th... more Airway surgery involving trachea or main stem bronchi in neonates and children is challenging. The use of extracorporeal support for such unusual indications is poorly described. Here, we report on three patients receiving peripheral extracorporeal membrane oxygenation (ECMO) to maintain adequate ventilation while improving surgical site exposure. Case 1 is a 9-year-old boy diagnosed with proximal left stem bronchus endoluminal tumor; cases 2 and 3 are a neonate and a young infant diagnosed with a subcarinal bronchogenic cyst. Planned ECMO use consisted in peripheral venoarterial cannulation through jugular and carotid access. There was no bleeding complication during and after surgical care. Hemodynamic and respiratory supports were optimized in all cases. Children were successfully weaned off ECMO immediately after surgery. Planned peripheral ECMO cannulation offers optimal conditions for high-risk airway surgery in neonates and children.
OBJECTIVES To describe the frequency and outcomes on the use of extracorporeal membrane oxygenati... more OBJECTIVES To describe the frequency and outcomes on the use of extracorporeal membrane oxygenation among critically ill neonates and children within a structured pediatric critical care network in the West of France. To assess the optimality of decision-making process for patients primarily admitted in nonextracorporeal membrane oxygenation centers. DESIGN Observational prospective population-based study from January 2015 to December 2019. PATIENTS Neonates over 34 weeks of gestational age, weighing more than 2,000 g and children under 15 years and 3 months old admitted in one of the 10 units belonging to a Regional Pediatric Critical Care Network. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Eight-thousand one-hundred eighty-nine children and 3,947 newborns were admitted within one of the 10 units of the network over the study period. Sixty-five children (8.1‰ [95% CI, 6.2-10‰]) and 35 newborns (9.4‰ [95% CI, 6.4-12‰]) required extracorporeal membrane oxygenation support. Of these patients, 31 were first admitted to a nonextracorporeal membrane oxygenation center, where 20 were cannulated in situ (outside the regional extracorporeal membrane oxygenation center) and 11 after transfer to the extracorporeal membrane oxygenation regional center. Cardiogenic shock, highest serum lactate level, and cardiac arrest prior to first phone call with the regional extracorporeal membrane oxygenation center were associated with higher rate of in situ cannulation. During the study period, most of the patients were cannulated for underlying cardiac issue (42/100), postoperative cardiac surgery instability (38/100), and pediatric (10/100) and neonatal (10/100) respiratory distress syndrome. Patients primarily admitted in nonextracorporeal membrane oxygenation centers or not had similar 28-day post-ICU survival rates compared with those admitted in the referral extracorporeal membrane oxygenation center (58% vs 51%; p = 0.332). Preextracorporeal membrane oxygenation cardiac arrest, extracorporeal cardiopulmonary resuscitation, and lower pH at extracorporeal membrane oxygenation onset were associated with lower 28-day post-ICU survival. CONCLUSIONS Our local results suggest that a structured referral network for neonatal and pediatric extracorporeal membrane oxygenation in the region of Western France facilitated escalation of care with noninferior (or similar) early mortality outcome. Our data support establishing referral networks in other equivalent regions.
Cerebral autoregulation (CA) impairment is associated with neurological complications among child... more Cerebral autoregulation (CA) impairment is associated with neurological complications among children supported by extracorporeal membrane oxygenation (ECMO). Severe variations of arterial CO2 (PaCO2) and O2 (PaO2) tension after ECMO onset are common and associate with mortality and poor neurological outcome. The impact of gas exchange on CA among critically ill patients is poorly studied. Retrospective analysis of data collected prospectively from 30 children treated with veno-arterial or veno-venous ECMO in the PICU of Nantes University Hospital, France. A correlation coefficient between the variations of regional cerebral oxygen saturation (rSO2) and the variations of mean arterial blood pressure (MAP) was calculated as an index of CA (cerebral oxygenation reactivity index, COx). Cox–MAP plots were investigated allowing determining lower limit of autoregulation (LLA) and upper limit of autoregulation (ULA) limits of autoregulation. Age-based normal blood pressure was used to adjust the MAP, LLA, and ULA data from each patient and then reported as percentage (nMAP, nLLA, and nULA, respectively). RSO2, COx, nMAP, nLLA, and nULA values were averaged over one hour before each arterial blood gas (ABG) sample during ECMO run. Thirty children (median age 4.8 months [Interquartile range (IQR) 0.7–39.1], median weight 5 kg [IQR 4–15]) experiencing 31 ECMO runs were included in the study. Three hundred and ninety ABGs were analyzed. The highest values of COx were observed on day 1 (D1) of ECMO. The relationship between COx and PaCO2 was nonlinear, but COx values tended to be lower in case of hypercapnia compared to normocapnia. During the whole ECMO run, a weak but significant correlation between PaCO2 and nULA was observed (R = 0.432, p = 0.02). On D1 of ECMO, this correlation was stronger (R = 0.85, p = 0.03) and a positive correlation between nLLA and PaCO2 was also found (R = 0.726, p < 0.001). A very weak negative correlation between PaO2 and nULA was observed within the whole ECMO run and on D1 of ECMO (R = −0.07 p = 0.04 and R = −0.135 p = <0.001, respectively). The difference between nULA and nLLA representing the span of the autoregulation plateau was positively correlated with PaCO2 and negatively correlated with PaO2 (R = 0.224, p = 0.01 and R = −0.051, p = 0.004, respectively). We observed a complex relationship between PaCO2 and CA, influenced by the level of blood pressure. Hypercapnia seems to be globally protective in normotensive or hypertensive condition, while, in case of very low MAP, hypercapnia may disturb CA as it increases LLA. These data add additional arguments for very cautiously lower PaCO2, especially after ECMO start.
Children supported by extracorporeal membrane oxygenation present a high risk of neurological com... more Children supported by extracorporeal membrane oxygenation present a high risk of neurological complications. Although carotid cannulation is known to be associated with neurologic injury, conflicting data exist with regard to the predominance of right- or left-sided lesions. We describe here two infants requiring veno-arterial extracorporeal membrane oxygenation for septic shock who encountered right watershed infarction ipsilateral to carotid artery cannulation. Hemodynamic failure seems to be the most probable underlying mechanism. The asymmetry of transcranial Doppler metrics in one case and the low right regional cerebral oxygen saturation value observed soon after right cannulation in both cases suggest an insufficient cerebral collateral flow compensation. The risk of ipsilateral watershed injury should be considered before cervical cannulation, notably in the context of sepsis and an evaluation of the cerebral collateral blood flow before and just after cannulation may be int...
I thank Chenouard et al (1) for their insightful comments in relation to the role of primary meta... more I thank Chenouard et al (1) for their insightful comments in relation to the role of primary metabolic conditions as a possible precipitant to sepsis induced or associated rhabdomyolysis. It is an important consideration when assessing for a potential underlying diagnosis and one that has acute and long-term implications. There were only six of 182 children (3%) with a primary metabolic condition including one case of newly diagnosed lipin-1 deficiency, one with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency, and one with holocarboxylase synthetase deficiency within our cohort (2), published recently in Pediatric Critical Care Medicine. In these children, the highest Virus or Bacteria: Is It the Only Cause of Sepsis-Induced Rhabdomyolysis? Rhabdomyolysis results from the breakdown of skeletal muscle fibers, which leads to release of toxic products into the bloodstream. There are few epidemiologic data concerning rhabdomyolysis in children admitted to PICUs. Hence, the study by Gelbart et al (1) published in a recent issue of Pediatric Critical Care Medicine is very welcome. Even so, we would like to add points that seem important to consider. In this cohort of 182 children, the most common etiology for rhabdomyolysis was sepsis/septic shock (82 children; 45%) with 48 organisms identified. It is well known that some microorganisms produce direct muscle injury, whereas others produce substances that have the ability to cause destruction of muscle cell membrane leading to rhabdomyolysis (2). However, some inherited diseases (e.g., fatty acid oxidation disorders, mutations in LPIN1, RYR1, or TANGO2) should be mentioned in case of severe rhabdomyolysis even if a microorganism has been identified, as these disorders are clearly triggered by several conditions almost always present in sepsis (e.g., fever, fasting, dehydration). Inherited diseases represent about 10% of all of causes of rhabdomyolysis in children, but this is probably an underestimate because of the lack of research on this topic (3). In the cohort described by Gelbart et al (1), we were surprised to not see any metabolic or genetic studies performed to exclude some inherited causes of rhabdomyolysis. The plasma acylcarnitine profile and urine organic acids should be assessed in the acute phase in all patients with an episode of severe sepsis-induced rhabdomyolysis to exclude fatty acid oxidation diseases (3). In a second step, monitoring levels of creatine kinase are essential until normalization. If the creatine kinase levels remain high, further studies should be completed. Finally, recent advances in genetics have led to the discovery of new mutations leading to rhabdomyolysis episodes in childhood (3, 4), but the threshold level of creatine kinase elevation that should trigger these genetic analyses remains to be established. Why is it important that inherited causes of rhabdomyolysis are recognized by intensivist, even if a microorganism has been identified? First, they can lead to specific therapeutic interventions, notably in case of suspicion of fatty acid oxidation. Supplementation with carnitine, riboflavin, and coenzyme Q10 may be instituted in this situation, along with taking care to both avoid fasting and to maintain a regular carbohydrate intake (5). Second, when the diagnosis is known, an “emergency” plan should be established to avoid triggering events and to optimize management, thus reducing the risk of lifethreatening rhabdomyolysis (4, 6). Finally, prognosis is clearly different depending on the presence or absence of an inherited
Objectives: To assess the ability of amplitude-integrated electroencephalography monitoring withi... more Objectives: To assess the ability of amplitude-integrated electroencephalography monitoring within 24 hours of the return of spontaneous circulation to prognosticate neurologic outcomes in children following cardiac arrest Design: Retrospective review of prospectively recorded data. An amplitude-integrated electroencephalography background score was calculated according to background activity during the first 24 hours after return of spontaneous circulation, a higher score correlating with more impaired background activity. The primary endpoint was the neurologic outcome as defined by the Pediatric Cerebral Performance Category at PICU discharge (Pediatric Cerebral Performance Category 1–3: a good neurologic outcome; Pediatric Cerebral Performance Category 4–6: a poor neurologic outcome). Setting: A referral PICU. Patients: Thirty children with a median age of 10 months (2–38 mo) and a male/female sex ratio of 1.3 were included. Interventions: None. Measurements and Main Results: Ei...
Purposes: Amplitude-integrated EEG (aEEG) has been widely developed in neonatal intensive care un... more Purposes: Amplitude-integrated EEG (aEEG) has been widely developed in neonatal intensive care unit, but few studies focused on pediatric intensive care unit. Furthermore, reliability of aEEG under real-life conditions is unknown. Methods: Participants were nurses from a 12-bed pediatric intensive care unit in a referral university hospital in France. Amplitude EEG was implemented after standardized training, including e-learning course, individual feedback and bedside teaching concerning monitoring installation, background classification patterns recognition, artefact analysis, and seizure detection. The primary judgment criterion was the agreement (Cohen Kappa) between nurses and aEEG experts for the detection of abnormal aEEG traces (moderately or severely altered background pattern according to Hellström–Westas classification and/or seizure activity). Results: During the study period, 196 consecutives traces from 79 patients were analyzed by 51 nurses. According to expert's ...
Duchenne muscular dystrophy (DMD) has as standard pharmacological therapy with corticoisteroids (... more Duchenne muscular dystrophy (DMD) has as standard pharmacological therapy with corticoisteroids (CS) that decrease inflammation and immune responses present in patients and animal models. CS have however limited efficacy and important and numerous side effects. Therefore, there is a need for new anti-inflammatory and pro-tolerogenic treatments that could replace or decrease doses of CS. We first assessed the status of immune system of dystrophin-deficient rats (Dmdmdx) that closely reproduce the phenotype of DMD patients.Dmdmdxrats showed increased leukocyte infiltration in skeletal and cardiac muscles, containing mostly macrophages but also T cells, and increased expression of several cytokines. Anti-CD45RC Monoclonal antibody (Mab) treatment induced immune tolerance in models of organ transplantation and GVHD (Graft Versus Host Disease). We observed that muscles and blood of DMD patients contained T CD4+and CD8+expressing high levels of CD45RChighcells. Treatment of youngDmdmdxrat...
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