Hari Krishnan Kanthimathinathan

Birmingham Children's Hospital

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Barnaby R. Scholefield

Hospital for Sick Children

Deepthi Jyothish

Birmingham Women’s and Children’s NHS Foundation Trust

Steven B. Welch

University Hospitals Birmingham NHS Foundation Trust

Scott Hackett

University Hospitals Birmingham NHS Foundation Trust

Ashish Chikermane

Birmingham Children's Hospital

Eslam Al‐Abadi

Birmingham Children's Hospital

Kevin Morris

Birmingham Women’s and Children’s NHS Foundation Trust

Alex Richter

University of Birmingham

Sian Faustini

University of Birmingham

Eleni Syrimi

University of Birmingham

Cooperative Institutions

Birmingham Children's Hospital

Birmingham Women’s and Children’s NHS Foundation Trust

University of Birmingham

University College London

Great Ormond Street Hospital

National Health Service

Boston Children's Hospital

Intensive Care Society

University of Oxford

University Hospitals Birmingham NHS Foundation Trust

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Abstract O-45: PATTERNS OF INTRACRANIAL PRESSURE AND PRESSUREREACTIVITY INDEX IN CHILDREN WITH SEVERE TRAUMATIC BRAIN INJURY

Pediatric Critical Care Medicine (2018)

Hari Krishnan Kanthimathinathan Sarah Dance L.R. Dowd B. Scholefield Kevin Morris

Aims & Objectives: Pressure-reactivity index (PRx) has been widely studied as a surrogate marker of cerebral autoregulation in adults with traumatic brain injury (TBI). Raised intracranial pressure (ICP) and PRx >0.3 are associated with adverse neurological outcomes in TBI. Prospective studies in adults are evaluating an individualised optimum cerebral perfusion pressure (CPPopt) strategy based on PRx monitoring. Much less is known about patterns of autoregulation impairment in paediatric TBI. To describe the patterns of ICP and PRx measurements in paediatric TBI patients. Methods Retrospective analysis of prospectively collected neuromonitoring data using ICM+ software (Cambridge enterprises, UK). Using minute by minute paired ICP and PRx values from first 48 hour period, the neuromonitoring observations were categorised into one of four ICP-PRx groups (combinations of high/low ICP and high/low PRx based on threshold values of 20mmHg for ICP and 0.3 for PRx). Results 30962 paired ICP and PRx observations from 15 patients were analysed. Median (IQR) ICP was 16 (12–21) and median PRx was -0.14 (-0.40, +0.16). Overall 28.7% of ICP readings were above 20mmHg and 16.5% of PRx readings were above 0.3. ICP-PRx distribution showed significant variation between patients (Table). Low ICP & low PRx was the most frequent pattern with high ICP& high PRx being the least common pattern.Conclusions A CPPopt approach has the greatest potential to improve outcome in the context of a high ICP & high PRx combination, which is found in the majority of monitored patients but occupies a small proportion of monitoring time.

Cerebral autoregulation

10.1097/01.pcc.0000537387.38074.83

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PP387 [Comfort Management » Other]: HEALTH-RELATED QUALITY OF LIFE AND IT’S DETERMINANTS IN CHILDREN WITH SICKLE CELL ANAEMIA IN LAGOS, NIGERIA

Pediatric Critical Care Medicine (2022)

Uche Maureen Nzelu Christopher Imokhuede Esezobor Andrew T Olagunju Hari Krishnan Kanthimathinathan AO Akinsulie

Anene Nzelu, U. U.; Esezobor, C. I.; Olagunju, A. T.; Kanthimathinathan, H. K.; Akinsulie, A. O. Author Information

10.1097/01.pcc.0000901288.52114.07

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Short Term Respiratory Outcomes in Children with Antibody Positive PIMS -TS

Authorea (Authorea) (2021)

Deevena Chinthala Chris Hine Pamela Dawson Steven B. Welch Scott Hackett

Paediatric multisystem inflammatory syndrome: temporally associated with SARS-COV-2 (PIMS-TS) is a well described rare but severe COVID-19 related syndrome. PIMS-TS have been reported in children from geographical areas of high COVID-19 infection. Most children with PIMS-TS require management in an intensive care unit with variable respiratory involvement. Adults recovering from COVID-19 infection have been reported to suffer from respiratory morbidity but such outcomes are unknown in children. We present the first report of normal short term respiratory outcomes as measured by spirometry in children with SARS-COV-2 antibody positive, PIMS-TS syndrome managed at a specialist children’s hospital in the UK.

10.22541/au.161005487.70908822/v1

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Transition from neonatal to paediatric intensive care of very preterm-born children: a cohort study of children born between 2013 and 2018 in England and Wales

Archives of Disease in Childhood Fetal & Neonatal (2024)

Tim J van Hasselt Stephen C. Newman Hari Krishnan Kanthimathinathan Peter J. Davis Elizabeth S. Draper

Following very preterm birth, some children require ongoing intensive care after the neonatal period and transition directly from neonatal units (NNUs) to paediatric intensive care units (PICUs) around term-corrected age.We aimed to understand, at a national level, characteristics and outcomes of children born very preterm who transitioned directly from NNUs to PICUs.

10.1136/archdischild-2024-327457

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Focus on paediatrics 2018

Intensive Care Medicine (2018)

Hari Krishnan Kanthimathinathan Mark Peters

Pain medicine

10.1007/s00134-018-5421-4

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Association between Treatments and Short-Term Biochemical and Clinical Outcomes in Paediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS)

SSRN Electronic Journal (2020)

Patrick Davies Jon Lillie Andrew Prayle Claire Evans Benedict Griffiths

Background: Clinicians observed a cluster of children with unexplained inflammation requiring admission to United Kingdom (UK) paediatric intensive care units (PICUs) in April 2020. Despite multiple guidelines, which treatments are effective in Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS) is unknown.Methods: Multicentre observational study of children (<18 years) admitted to UK PICUs between 1 April and 10 May 2020, fulfilling the case definition of PIMS-TS. Routinely collected, de-identified data was analysed. Linear mixed effects models were used to analyse the effect of steroids, intravenous immunoglobulin (IVIG), and biologic agents on C-reactive protein (CRP), platelet counts,and lymphocyte counts. The content of UK clinical guidelines was collated. Findings: Over the six week study period: 59/78 (76%) children received IVIG, 57/78 (73%) steroids, and 17/78 (22%) a biologic agent. We found no evidence of a difference in response in clinical markers of inflammation between patients with PIMS-TS who were treated with IVIG, steroids or biologics, compared to those who were not. Despite a progression to near universal treatment with immunomodulators, the proportion of patients with coronary artery abnormalities increased. Guidelines universally advised or considered the use of IVIG, steroids, and biologics. Interpretation: We were unable to identify any short term benefit from any of the treatments, or treatment combinations administered. Despite a lack of evidence, worldwide treatment guidelines for PIMS-TS have become very similar. Clinicians treating PIMS-TS should continue to have equipoise and participate in robust clinical trials of all treatments currently being utilised for this important condition. Funding: NoneDeclaration of Interests: All authors have completed the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest, and have no conflicts of interest to disclose.Ethics Approval Statement: The project was classified as a service evaluation by the Nottingham Research and Innovation team (Nottingham Clinical Effectiveness Team ref: 20- 235C), and ethics approval was not required. The study team analysed routinely collected de-identified data submitted by clinicians from the individual PICUs as a local service evaluation. Clinicians obtained informed parental consent if required locally.

2019-20 coronavirus outbreak

Association (psychology)

10.2139/ssrn.3692427

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Is There an Optimum Duration of Fluid Bolus in Pediatric Septic Shock? A Critical Appraisal of “Fluid Bolus Over 15–20 Versus 5–10 Minutes Each in the First Hour of Resuscitation in Children With Septic Shock: A Randomized Controlled Trial” by Sankar et al (Pediatr Crit Care Med 2017; 18:e435–e445)

Pediatric Critical Care Medicine (2018)

Mark J Russell Hari Krishnan Kanthimathinathan

Objectives: To review the findings and discuss the implications of a longer duration for fluid boluses in the resuscitation of children with septic shock. Data Sources: We performed a PubMed.gov search using the criteria “Fluid Bolus” and “Children” and “Septic Shock,” which yielded 29 references. Study Selection: One trial compared different durations of fluid boluses in pediatric septic shock and was therefore selected for critical appraisal. (Sankar J, Ismail J, Sankar MJ, et al: Fluid Bolus Over 15–20 Versus 5–10 Minutes Each in the First Hour of Resuscitation in Children with Septic Shock: A Randomized Controlled Trial. Pediatr Crit Care Med 2017; 18:e435–e445.) Data Extraction: This trial compared the effectiveness of 20 mL/kg fluid boluses, in children with septic shock, given over 15–20 versus 5–10 minutes in terms of need for invasive ventilation and/or increase in oxygenation index by 5 from baseline at 6 and 24 hours post initial fluid resuscitation. The relative risk of the primary outcome was 0.62 ( p = 0.04; 95% CI, 0.39–0.99) at 6 hours and 0.63 ( p = 0.02; 95% CI, 0.42–0.93) at 24 hours. Data Synthesis: Fragility Index calculations for the primary outcomes of this trial were 1 and 2. Therefore, only one and two children would have needed different outcomes to have given nonsignificant p values greater than 0.05. Analysis of the results did not support the early stopping of this trial at the interim period. Conclusions: The article reviewed does not support a change in practice to a longer duration of fluid bolus. The “push” technique for titration of fluid boluses in pediatric septic shock should continue to be the method of choice. Critical Care trials using binary outcomes as endpoints should publish Fragility Index results to aid interpretation and generate stronger conclusions.

Bolus (digestion)

Interim analysis

10.1097/pcc.0000000000001459

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Traumatic head injuries in children: demographics, injury patterns, and outcomes in Saudi Arabia

International Journal of Emergency Medicine (2025)

Hussin Albargi Rayan Jafnan Alharbi Ateeq Almuwallad Naif Harthi Yahya H. Khormi

Abstract Background Traumatic head injuries (THIs) are among the leading cause of mortality and intensive care unit (ICU) admission in children worldwide. Most of the published literature concerning THIs arises predominantly from North America and Europe. However, only limited data about the incidence, characteristics and impact on children in Saudi Arabia exists. Methods We conducted a retrospective analysis of THIs in children (≤ 18 years of age) using data from the Saudi TraumA Registry (STAR) from August 2017 to December 2022. Data included patient demographic characteristics, the mechanism, type and severity of injury. We used multivariable logistic regression to assess the association between outcomes and clinical factors. Results We identified 466 children with THI. Most children were over six years of age (69.5%) and male (76.6%). Motor vehicle crashes (MVCs) were the most common cause of THIs (51.9%), with falls being more common in infants (69.8%). Over half of the children required ICU admission. Children with higher injury severity score, heart rate at presentation to the ED, hospital stay duration, respiratory assistance and need for surgery were more likely to require ICU admission. The overall mortality rate was 7.7%, with schoolchildren (age: 6–12 years) having the highest mortality rate (10.8%). Higher rates of ICU admission were associated with increases in the injury severity score (ISS), hospital stay duration, respiratory assistance and the need for surgery. Conclusions Children in the 6–12 year age-group had the highest mortality rate, reflecting high injury severities associated with increased ICU admissions. These findings highlight the importance of targeting preventive measures for MVCs in older children and improving trauma care for severe cases. Clinical trial number Not applicable.

Angiology

10.1186/s12245-024-00808-w

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Visualization of the Intracranial Pressure and Time Burden in Childhood Brain Trauma: What We Have Learned One Decade on With KidsBrainIT

Journal of Neurotrauma (2024)

Bavo Kempen Bart Depreitere Ian Piper Juan Sahuquillo Şt. M. Iencean

To validate the intracranial pressure (ICP) dose-response visualization plot for the first time in a novel prospectively collected pediatric traumatic brain injury (pTBI) data set from the multi-center, multi-national KidsBrainIT consortium. Prospectively collected minute-by-minute ICP and mean arterial blood pressure time series of 104 pTBI patients were categorized in ICP intensity-duration episodes. These episodes were correlated with the 6-month Glasgow Outcome Score (GOS) and displayed in a color-coded ICP dose-response plot. The influence of cerebrovascular reactivity and cerebral perfusion pressure (CPP) were investigated. The generated ICP dose-response plot on the novel data set was similar to the previously published pediatric plot. This study confirmed that higher ICP episodes were tolerated for a shorter duration of time, with an approximately exponential decay curve delineating the positive and negative association zones. ICP above 20 mm Hg for any duration in time was associated with poor outcome in our patients. Cerebrovascular reactivity state did not influence their respective transition curves above 10 mm Hg ICP. CPP below 50 mm Hg was not tolerated, regardless of ICP and duration, and was associated with worse outcome. The ICP dose-response plot was reproduced in a novel and independent pTBI data set. ICP above 20 mm Hg and CPP below 50 mm Hg for any duration in time were associated with worse outcome. This highlighted a pressing need to reduce pediatric ICP therapeutic thresholds used at the bedside.

10.1089/neu.2023.0254

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Examining safety and efficacy of a fixed concentration heparin dosing strategy for anticoagulation in neonatal extracorporeal membrane oxygenation

Perfusion (2023)

Shambhavi Tewary Sanket Sontakke Kiri Dean David W. Ellis Arun Ghose

Objectives The paediatric intensive care unit changed heparin infusion dosing from a variable weight-based concentration to a fixed concentration strategy, when smart pump-based drug library was introduced. This change meant significantly lower rates of infusion were needed for the same dose of heparin in the neonatal population. We performed a safety and efficacy assessment of this change. Methods We performed a retrospective single-centre evaluation based on data from respiratory VA-extracorporeal membrane oxygenation (ECMO) patients weighing ≤5 kg, pre and post the change to fixed strength heparin infusion. Efficacy was analysed by distribution of activated clotting times (ACT) and heparin dose requirements between the groups. Safety was analysed using thrombotic and haemorrhagic event rates. Continuous variables were reported as median, interquartile ranges, and non-parametric tests were used. Generalised estimating equations (GEE) were used to analyse associations of heparin dosing strategy with ACT and heparin dose requirements in the first 24 h of ECMO. Incidence rate ratios of circuit related thrombotic and haemorrhagic events between groups were analysed using Poisson regression with offset for run hours. Results 33 infants (20 variable weight-based, 13 fixed concentration) were analysed. Distribution of ACT ranges and heparin dose requirements were similar between the two groups during the ECMO run and this was confirmed by GEE. Incidence rate ratios of thrombotic (fixed v weight-based) (1.9 [0.5–8], p = .37), and haemorrhagic events (0.9 [0.1–4.9], p = .95) did not show statistically significant differences. Conclusions Fixed concentration dosing of heparin was at least equally effective and safe compared to a weight-based dosing.

Interquartile range

Activated clotting time

Loading dose

10.1177/02676591231167709

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