Critical Care Commons^™

Successful Hepatectomy, Anhepatic State, And Liver Transplant On Ecmo, Jenna Miller, Kari L. Davidson, Bhargava Mullapudi, Richard J. Hendrickson, Ryan T. Fischer, Lisa Conley, Wes Ware, Michelle Mckain, Tara Benton

Presentations

We discuss the case of a 13-month-old previously healthy male who presented with acute liver failure (ALF) of unknown etiology. He progressed to fulminant cardiopulmonary failure requiring mechanical ventilation and high dose inotropes with persistent lactate >20. He was cannulated to VA ECMO and tandem continuous renal replacement therapy (CRRT) with single pass albumin dialysis (SPAD) and plasma exchange (PLEX) therapies. He required high dose inotropes on ECMO and had persistently elevated lactate despite maximal medical therapy. Limited imaging studies suggested cirrhotic liver and possible intestinal pneumatosis. Due to evidence of fulminant ALF and potential for a reversible process, he …

Improving Nutritional Delivery To Pediatric Patients On Continuous Renal Replacement Therapy, Jennifer Ruiz-Boada, Sarah Brunner, Tara Benton, Vimal Chadha

Presentations

INTRODUCTION: Continuous renal replacement therapy (CRRT) is used in critically ill children with acute renal failure. CRRT can lead to malnutrition by removing essential proteins and micronutrients. Malnutrition is associated with worse outcomes, including increased length of stay and mortality. CRRT guidelines suggest the importance of early nutrition and ensuring high protein intake. After evaluating our CRRT patients, we found sub-optimal adherence to the guidelines. This Quality Improvement project aimed to increase the percentage of patients achieving 75% of their goal protein and caloric intake by day 5 of CRRT initiation by 15% by August 2023. METHODS: A multidisciplinary group …

Pediatric In-Hospital Cardiac Arrests: We Have More To Learn About Patient Demographics And Outcomes, Nathan Lavoy, John Cowden, Jenna Miller, Asdis Finnsdottir Wagner, Shekinah Hensley, Stephen Pfeiffer

Presentations

Introduction: Prior pediatric studies show an association between patient demographics and mortality after in-hospital cardiac arrests (IHCA). To our knowledge, this has not been assessed in pediatric intensive care units (PICU). This study aims to evaluate the impact of demographics and code characteristics on outcomes after IHCA in a quaternary referral PICU. Methods: A single center retrospective review of PICU IHCA events from 2010-2021 was performed. Patient demographics included age, gender, race/ethnicity, and language. Primary diagnosis was defined as cardiac or non-cardiac. The use of ECMO, CRRT, or defibrillation were included as code characteristics. The primary outcome was survival to …

Clinical Features And Outcomes In Pediatric Severe Scald Burn Patients, Ashley Daniel

Presentations

Introduction/Hypothesis Young children with scald burns experience severe complications compared to older children. A paucity of data exists to support these observations. This study compares clinical features and complications of younger versus older pediatric patients with scald burns at four children’s hospitals participating in the Pediatric Injury Quality Improvement Collaborative (PIQIC). This collaborative includes five pediatric burn centers that utilize research to improve quality of burn care. 485 Methods This is a retrospective cohort study of scald burn patients admitted from 2010 to 2020 to four pediatric hospitals participating in PIQIC. Patients with total body surface area (TBSA) < 15% were excluded. Patients were categorized by age into three groups: toddlers (0–3 years), children (3-10 years), and adolescents (>10 years). …

Utilization Of Enteral Tranexamic Acid To Stabilize Gastrointestinal Hemorrhage In Pediatric Patients On Ecmo, Gina Patel, Jenna Miller, Thomas M. Attard, Asdis Finnsdottir Wagner

Presentations

Background:

Incidence and management of Gastrointestinal (GI) bleeding on ECMO isn’t well reported Patients on ECMO require systemic anticoagulation making GI bleeding difficult to manage We describe the use of enteral tranexamic acid (TXA) in two pediatric patients with GI hemorrhage on ECMO

Improved Coordination Of Care For Picu Patients With Newly Diagnosed Anterior Mediastinal Masses, Laura Mccarthy

Presentations

This presentation describes a quality improvement project to develop a multi-disciplinary standardized approach for prompt surgical intervention to establish a diagnosis of anterior mediastinal mass. The aim was to decrease the time from presentation to surgical diagnostic procedure totreatment.