INTRODUCTION: There are limited reports on the epidemiology of paediatric intensive care unit (PICU) admissions, deaths and organ donation candidacy. We aimed to describe PICU admission characteristics and outcomes, determine risk factors for mortality, and perform an independent assessment of missed organ donation opportunities. METHOD: We adopted a clinical audit design recruiting consecutive patients admitted to a single-centre multidisciplinary PICU from June 2020 to December 2023. Clinical characteristics and outcomes of survivors and non-survivors were described. Multivariable regression was performed to identify independent risk factors for mortality. Organ donation candidacy was evaluated by an independent team based on the criteria by Singapore's National Organ Transplant Unit. RESULTS: There were 1766 PICU admissions with mean age ± standard deviation of 5.9 ± 6.0 years. Surgical admissions accounted for 707/1766 (40%), while the most common medical admission category was respiratory (416/1766; 23.6%). The majority of 983/1766 (55.7%) had a chronic comorbidity and 312/1766 (17.6%) were dependent on at least 1 medical technology device. Mortality occurred in 99/1766 (5.6%). After adjusting for elective admissions and admission category; comorbidity with adjusted odds ratio (aOR) 95% confidence interval (CI) 3.03 (1.54-5.96); higher Pediatric Index of Mortality 3 (PIM 3) score with aOR 1.06 (95% CI 1.04-1.08); and functional status scale with aOR 1.07 (95% CI 1.00-1.13) were associated with mortality. Among non-survivors, organ donor candidacy was 21/99 (21.2%) but successful organ donation occurred in only 2/99 (2.0%). CONCLUSION In this single-centre audit, comorbidities, PIM 3 score and functional impairment were associated with mortality. Efforts are needed to improve paediatric organ donation rates.
Humans ; Male ; Female ; Tissue and Organ Procurement/statistics & numerical data* ; Intensive Care Units, Pediatric/statistics & numerical data* ; Child, Preschool ; Child ; Infant ; Singapore/epidemiology* ; Risk Factors ; Patient Admission/statistics & numerical data* ; Hospital Mortality ; Adolescent ; Medical Audit ; Comorbidity ; Clinical Audit

Carotid blowout syndrome (CBS) is a fatal complication of head and neck cancer. Endovascular treatment, particularly deconstructive embolization, is effective for CBS, but it might result in thromboembolic events. We report the case of a 57-year-old man with underlying recurrent head and neck cancer who had CBS. The patient received endovascular embolization of the right internal, external, and common carotid arteries. Right internal carotid artery to middle cerebral artery embolic occlusion was noted immediately after the procedure, and left-sided weakness and facial palsy were found. Ipsilateral suprabulbar cervical internal carotid artery puncture was performed under fluoroscopic guidance, and rescue suction thrombectomy was successful. The patient had no significant neurological sequela. Transcarotid intraarterial thrombectomy is a reasonable method for managing postembolization large vessel occlusion, even in the neck, after irradiation.

BACKGROUND: Recentry, the prevalence of HBsAg in children has been gradually decreased in Korea may be due to extensive vaccination. The object of this study is to identify the HbsAg positive rate in 6 to 7 year-old school children in Seoul and to outline the surveilance status of the HBsAg positive subjects. METHODS: We analyzed HBV mass screening results of 120,106 6 to 7-year-old school children in Seoul. For 188 HBsAg positive children who complied with the follow up visit, we tested HBeAg, LFT and interviewed their parents. We also compared the questionnaire results of HbsAg positive group with those of 694 random-sampled HBsAg negative controls. RESULTS: The overall HBsAg positive rate was 0.79%(0.81% in boys and 0.76% in girls). Children in poverty area showed significantly higher rate(1.04%) of HBsAg positivity than those in non-poverty area(0.77%). Among HbsAg positive children, 86.7% was also HBeAg positive and had higher ALT levels than those with negative HBeAg. More than 70% of parents of HBsAg positive children was not aware of their children's HBsAg status before the screening and 28.7% of mothers did not know their own HbsAg status. The complete vaccination rate of the HBsAg positive and HBsAg negative group were 75.5% and 77.4% respectively, which shows no significant difference. Having family history of HBV infection was significantly associated with HBsAg positive status(OR=32. 8). CONCLUSIONS: The HBsAg positive rate in 6- to 7-year-old school children has decreased in Korea compared to the data from previous studies. However in the aspects of public awareness and health care compliance, there are much room for quality improvement. Above all, more rigorous and continuous surveilance system is required for antenatal and postpartum care.
Child* ; Compliance ; Delivery of Health Care ; Follow-Up Studies ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens ; Hepatitis B* ; Hepatitis* ; Humans ; Korea ; Mass Screening ; Mothers ; Parents ; Pilot Projects* ; Postnatal Care ; Poverty Areas ; Prevalence ; Quality Improvement ; Seoul* ; Vaccination ; Surveys and Questionnaires

SIMV (synchronized intermittent mandatory ventilation) is a volume assisted mode which a patient inspiratory demand results in a clinician-controlled tidal volume and flow rate. However, PSV (pressure support ventilation) has the ability to augment spontaneous breaths with a variable amount of inspiratory positive pressure with a clinician-selected level of inspiratory airway pressure. To compare the effects of SIMV and PSV on respiratory function, experiments were performed on 12 stable patients during the weaning process and tidal volume, airway pressure, arterial blood gas tensions, blood pressure, and heart rates were measured during SIMV, and after 2 mins after removal of mechanical ventilation support. The same measurement as SIMV (except mandatory respiratory rates) were performed during PSV. The PSV level was reduced in the 5 cm2O step every 10-15 mins. The results of respiratory parameters and hemodynamic data showed that tidal volume, blood pressure, heart rates, and arterial blood gas tensions were similar, but there were significantly lower ventilatory rates, lower peak airway pressure and lower mean airway pressure during PSVmax than SlMV, and PSV resulted in improved patient comfort. It was concluded that PSV could be used to unload the patients ventilatory muscles and provide an appropriate level of mechanical ventilation support similar to SIMV weaning approaches.
Arterial Pressure ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Respiration, Artificial ; Respiratory Muscles ; Tidal Volume ; Ventilation* ; Weaning*