Muralidharan Jayashree

Post Graduate Institute of Medical Education and Research

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Arun Bansal

Post Graduate Institute of Medical Education and Research

107

Karthi Nallasamy

Post Graduate Institute of Medical Education and Research

100

Sunit Singhi

Biogen (United States)

Suresh Kumar Angurana

Post Graduate Institute of Medical Education and Research

Arun Baranwal

Post Graduate Institute of Medical Education and Research

Pratibha Singhi

Post Graduate Institute of Medical Education and Research

Vijai Williams

Shaikh Khalifa Medical City

Lalit Takia

Post Graduate Institute of Medical Education and Research

Naveen Sankhyan

Post Graduate Institute of Medical Education and Research

Manjinder Singh Randhawa

Post Graduate Institute of Medical Education and Research

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Post Graduate Institute of Medical Education and Research

499

University of Zurich

129

All India Institute of Medical Sciences

124

Institute of Post Graduate Medical Education and Research

121

Creative Commons

101

Institute of Medical Sciences

All India Institute of Medical Sciences Raipur

Chandigarh University

Deakin University

All India Institute of Medical Sciences Bhopal

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Multiple Electrolytes Solution Versus Saline as Bolus Fluid for Resuscitation in Pediatric Septic Shock: A Multicenter Randomized Clinical Trial*

Critical Care Medicine (2023)

Jhuma Sankar Muralidharan Jayashree A. V. Lalitha Ramachandran Rameshkumar Mona Pathak

OBJECTIVE: To determine if initial fluid resuscitation with balanced crystalloid (e.g., multiple electrolytes solution [MES]) or 0.9% saline adversely affects kidney function in children with septic shock. DESIGN: Parallel-group, blinded multicenter trial. SETTING: PICUs of four tertiary care centers in India from 2017 to 2020. PATIENTS: Children up to 15 years of age with septic shock. METHODS: Children were randomized to receive fluid boluses of either MES (PlasmaLyte A) or 0.9% saline at the time of identification of shock. All children were managed as per standard protocols and monitored until discharge/death. The primary outcome was new and/or progressive acute kidney injury (AKI), at any time within the first 7 days of fluid resuscitation. Key secondary outcomes included hyperchloremia, any adverse event (AE), at 24, 48, and 72 hours, and all-cause ICU mortality. INTERVENTIONS: MES solution ( n = 351) versus 0.9% saline ( n = 357) for bolus fluid resuscitation during the first 7 days. MEASUREMENTS AND MAIN RESULTS: The median age was 5 years (interquartile range, 1.3–9); 302 (43%) were girls. The relative risk (RR) for meeting the criteria for new and/or progressive AKI was 0.62 (95% CI, 0.49–0.80; p < 0.001), favoring the MES (21%) versus the saline (33%) group. The proportions of children with hyperchloremia were lower in the MES versus the saline group at 24, 48, and 72 hours. There was no difference in the ICU mortality (33% in the MES vs 34% in the saline group). There was no difference with regard to infusion-related AEs such as fever, thrombophlebitis, or fluid overload between the groups. CONCLUSIONS: Among children presenting with septic shock, fluid resuscitation with MES (balanced crystalloid) as compared with 0.9% saline resulted in a significantly lower incidence of new and/or progressive AKI during the first 7 days of hospitalization.

Hyperchloremia

Interquartile range

Bolus (digestion)

Multicenter trial

10.1097/ccm.0000000000005952

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Citations (18)

Table of Contents

Pediatric Neurology (2023)

Lokesh Saini Kumar Gunasekaran Sarbesh Tiwari Deepthi Krishna Veena Laxmi

Table (database)

10.1016/s0887-8994(23)00046-2

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Citations (0)

Weighing a Critically Ill Child: The ‘Weight’ of Evidence

The Indian Journal of Pediatrics (2023)

Muthuvel Rajangam Muralidharan Jayashree

10.1007/s12098-023-05008-7

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Citations (0)

Referrals to a Pediatric Emergency Department of a Tertiary Care Teaching Hospital Before and After Introduction of a Referral Education Module - A Quality Improvement Study

Research Square (Research Square) (2020)

Gopalakrishnan Ezhumalai Muralidharan Jayashree Karthi Nallasamy Arun Bansal Bhavneet Bharti

Abstract Background: Provision of timely care to critically ill children is essential for good outcome. Referral from smaller peripheral hospitals to higher centers for intensive care is common. However, lack of an organized referral and feedback system compromises optimal care. We studied the quality of referral letters coming to our Emergency Department (ED) with respect to their demography, association with severity of illness and mortality before and after referral education. Methods : Our study was completed in three phases in the Pediatric ED; Pre-intervention, Intervention and Post intervention phases. Quality of referral letter was matched with a quality checklist proforma and graded as ‘good’, ‘fair’ and ‘poor’ if it scored >7, 5 –7 and < 5 points respectively. A peer reviewed referral education module was prepared using case studies, expert opinions, and lacunae observed in the first phase and administered to health care providers (HCP’s) of referring hospitals. Quality of referral letter was compared between pre and post intervention phases. Results: Most referrals belonged to the neighboring states of Punjab (48.2%) and Haryana (22.4%). Major referring hospitals were from public sector (80.9%), of which the teaching hospitals topped the list (53.6%). Government run ambulance services (85.5%) was commonest mode of transport used and need for a PICU bed and/or mechanical ventilation (50.4%) was the commonest reason for referral. The post intervention phase saw a significant decline in the proportion of poor (93.2 vs.78.2%; p=0.001) and a significant increase in the proportion of fair (6.1 vs 18%; p=0.001) and good referral letters (0.7 vs 18%; p=0.001). The proportion of children with physiological decompensation at triage had reduced significantly in the post intervention phase [513 out of 1403 (36.5%) vs. 310 out of 957 (32.3%); p= 0.001]. Conclusion: Referral education had significantly improved the quality of referral letters. Proportion of children with physiological decompensation at triage had decreased significantly after referral module. This change suggests sensitization of the peripheral hospitals towards a better referral process. Continued multifaceted approach will be required for sustained and increased benefits.

Triage

10.21203/rs.3.rs-53721/v1

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Citations (2)

Tension pneumoperitoneum in a child as complication of high frequency oscillatory ventilation: A case report

JOURNAL OF PEDIATRIC CRITICAL CARE (2019)

Arun Baranwal M.J. Reddy Muralidharan Jayashree

Pneumoperitoneum is most often secondary to a perforated hollow viscous mandating urgent surgical intervention. Pneumoperitoneum as a life-threatening complication of mechanical ventilation is rarely reported and presents a diagnostic and therapeutic challenge. Here, we report an 18-month old boy who developed tension pneumoperitoneum and abdominal compartment syndrome as complication of high frequency oscillatory ventilation, and was managed with percutaneous needle paracentesis. Awareness and thus early recognition of this rare complication of mechanical ventilation may help avoid needless laparotomy, and its associated morbidity.

Paracentesis

10.21304/2019.0606.00543

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Development and validation of the “Pediatric Risk of Nosocomial Sepsis (PRiNS)” score for health care–associated infections in a medical pediatric intensive care unit of a developing economy—a prospective observational cohort study

Journal of Critical Care (2015)

Saptharishi Lalgudi Ganesan Muralidharan Jayashree Sunit Singhi

10.1016/j.jcrc.2015.11.016

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Citations (9)

Penicillin and gentamicin therapyvs amoxicillin/clavulanate in severe hypoxemic pneumonia

The Indian Journal of Pediatrics (2006)

Arun Bansal Sunit Singhi Muralidharan Jayashree

Tachypnea

Group B

10.1007/bf02825824

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Citations (17)

Biomarkers in COVID-19: An Up-To-Date Review

Frontiers in Pediatrics (2021)

Madhusudan Samprathi Muralidharan Jayashree

The ongoing pandemic of coronavirus disease 2019 (COVID-19) poses several challenges to clinicians. Timely diagnosis and hospitalization, risk stratification, effective utilization of intensive care services, selection of appropriate therapies, monitoring and timely discharge are essential to save the maximum number of lives. Clinical assessment is indispensable, but laboratory markers, or biomarkers, can provide additional, objective information which can significantly impact these components of patient care. COVID-19 is not a localized respiratory infection but a multisystem disease caused by a diffuse systemic process involving a complex interplay of the immunological, inflammatory and coagulative cascades. The understanding of what the virus does to the body and how the body reacts to it has uncovered a gamut of potential biomarkers. This review discusses the different classes of biomarkers – immunological, inflammatory, coagulation, hematological, cardiac, biochemical and miscellaneous – in terms of their pathophysiological basis followed by the current evidence. Differences between children and adults are highlighted. The role of biomarkers in the diagnosis and management of Multisystem Inflammatory Syndrome in Children (MIS-C) is reviewed. The correlation of biomarkers with clinical and radiological features and the viral load, temporal evolution and the effect of treatment remain to be studied in detail. Which biomarker needs to be evaluated when and in whom, and how best this information can contribute to patient care are questions which currently lack convincing answers. With the evidence currently available broad guidelines on the rational use of available biomarkers are presented. Integrating clinical and laboratory data, monitoring trends rather than a single value, correlating with the natural course of the disease and tailoring guidelines to the individual patient and healthcare setting are essential.

Biomarker Discovery

Pandemic

10.3389/fped.2020.607647

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Citations (267)

Practical guideline for setting up a comprehensive pediatric care unit for critical care delivery at district hospitals and medical colleges under ECRP-II

JOURNAL OF PEDIATRIC CRITICAL CARE (2023)

Lokesh Tiwari Muralidharan Jayashree Atul Jindal Daisy Khera Amrita Banerjee

Pediatric critical care is highly sophisticated and precise and is possible only in specialized areas such as pediatric intensive care units (PICUs) or high dependency units equipped with round-the-clock monitoring facilities, skilled and trained staff, and treatment equipment. The need for critical care beds was sharply felt during the COVID-19 pandemic and the Government of India launched the COVID-19 emergency response and health system preparedness package: phase II (ECRP-II) with a hub and spoke model to strengthen pediatric critical care delivery at district level under the skilled supervision of state-level PICUs of the identified center of excellence (CoE). The CoEs will have well-equipped PICUs providing tele-ICU service, mentoring, and technical hand-holding to the district pediatric unit. This model was envisioned to be extended to critically ill children with nonCOVID illnesses after the pandemic abates. For achieving the proposed objectives under the ECRP-II scheme, this guideline aims to provide a practical framework for setting up comprehensive pediatric care units at district hospitals and medical colleges (spoke) well connected with a CoE (hub) for teleconsultation, knowledge exchange, referral, and back referral between hub and spokes.

Guideline

Preparedness

Excellence

10.4103/jpcc.jpcc_12_23

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Citations (2)

Acute iron poisoning: clinical picture, intensive care needs and outcome.

PubMed (2003)

Sunit Singhi Arun Baranwal Muralidharan Jayashree

Gastric lavage

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Citations (34)