المؤلفون: Arthur, Lindsay, Prodhan, Parthak, Blaszak, Richard, Crawford, Brendan, Brown, Clare C., Arthur, Jason

المصدر: Pediatric Nephrology; Jul2023, Vol. 38 Issue 7, p2165-2170, 6p, 1 Diagram, 1 Chart, 3 Graphs

مصطلحات موضوعية: LUNG volume measurements, HEMATOCRIT, CONFIDENCE intervals, LUNGS, LUNG diseases, WATER-electrolyte imbalances, DESCRIPTIVE statistics, RESEARCH funding, HEMODIALYSIS, CHILDREN

مستخلص: Background: Lung ultrasound is a well-established technique to assess extravascular lung water, a proxy for volume status, in the adult population. Despite its utility, the data are limited supporting the use of ultrasound to evaluate fluid volume status among pediatric patients. Our study uses a simplified ultrasound protocol to evaluate changes in extravascular lung water, represented by b-lines, among pediatric patients undergoing hemodialysis. Methods: This prospective single-center study included children from birth to 18 years of age. The number of b-lines per ml/kg of fluid removed was compared prior to, at the midpoint, and following termination of dialysis. An 8-zone protocol was utilized, and b-lines were correlated to hemoconcentration measured by the CRIT-LINE® hematocrit. Results: Six patients with a total of 26 hemodialysis sessions were included in this study. The b-line measurements post-dialysis were 2.27 (p < 0.001; 94%CI -3.31, -1.22) lower relative to pre-dialysis. The number of b-lines was reduced by 1.69 (p < 0.001; -2.58, -0.80) between pre-dialysis and at the midpoint of dialysis and by 0.58 (p = 0.001; -0.90, -0.24) between the midpoint of dialysis and post-dialysis. A 1 mL/kg fluid loss correlated to a decrease in the original b-lines by 0.079. An inverse relationship (r = -0.54; 95% CI: -0.72, -0.34; p < 0.001) was noted between the b-lines and the patients' hematocrit levels. Conclusions: A simplified 8-zone ultrasound protocol can assess fluid volume change in real time and correlates with hematocrit levels obtained throughout dialysis. This provides a valuable method for monitoring fluid status in volume overloaded patient populations. [ABSTRACT FROM AUTHOR]

: Copyright of Pediatric Nephrology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Wasik, Heather L., Neu, Alicia, Warady, Bradley, Crawford, Brendan, Richardson, Troy, De Souza, Heidi G., Cardwell, Diana, Ruebner, Rebecca

المصدر: Pediatric Nephrology; Jun2023, Vol. 38 Issue 6, p1915-1923, 9p, 1 Diagram, 4 Charts, 1 Graph

مصطلحات موضوعية: LENGTH of stay in hospitals, INTENSIVE care units, CATHETER-related infections, CONFIDENCE intervals, MEDICAL care costs, RETROSPECTIVE studies, ACQUISITION of data, REGRESSION analysis, HOSPITAL care, MEDICAL records, DESCRIPTIVE statistics, HEMODIALYSIS, CENTRAL venous catheters, BLOODBORNE infections, LONGITUDINAL method, CHILDREN, ADOLESCENCE

مستخلص: Background: Hospitalization costs for treatment of hemodialysis (HD) catheter-associated blood stream infections (CA-BSI) in adults are high. No studies have evaluated hospitalization costs for HD CA-BSI in children or identified factors associated with high-cost hospitalizations. Methods: We analyzed 160 HD CA-BSIs from the Standardizing Care to Improve Outcomes in Pediatric End-stage Kidney Disease (SCOPE) collaborative database linked to hospitalization encounters in the Pediatric Health Information System (PHIS) database. Charge-to-cost ratios were used to convert hospitalization charges reported in PHIS database to estimated hospital costs. Generalized linear mixed modeling was used to assess the relationship between higher-cost hospitalization (cost above 50^th percentile) and patient and clinical characteristics. Generalized linear regression models were used to assess differences in mean service line costs between higher- and lower-cost hospitalizations. Results: The median (IQR) length of stay for HD CA-BSI hospitalization was 5 (3–10) days. The median (IQR) cost for HD CA-BSI hospitalization was $18,375 ($11,584–$36,266). ICU stay (aOR 5.44, 95% CI 1.62–18.26, p = 0.01) and need for a catheter procedure (aOR = 6.08, 95% CI 2.45–15.07, p < 0.001) were associated with higher-cost hospitalization. Conclusions: Hospitalizations for HD CA-BSIs in children are often multiple days and are associated with substantial costs. Interventions to reduce CA-BSI may reduce hospitalization costs for children who receive chronic HD. [ABSTRACT FROM AUTHOR]

: Copyright of Pediatric Nephrology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)