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Can we predict severe reactions during peanut challenges in children?

Pediatr Allergy Immunol. 2013 Jul 31;

Authors: van Erp FC, Knulst AC, Kentie PA, Pasmans SG, van der Ent CK, Meijer Y

Abstract
BACKGROUND: Limited and contrasting data are available about risk factors for severe reactions during double-blind, placebo-controlled food challenge (DBPCFC). Knowing these risk factors would help to improve safety precautions and choosing the best setting for challenge. We assessed whether we could determine predictors for positive and severe food challenge outcome (FCO) with regular available patient data in children suspected for peanut allergy.
METHODS: A retrospective study in children referred for DBPCFC with peanut was performed during a 3-year period. Reactions during challenge were classified as mild/moderate (Sampson's grade 1-3) and severe (Sampson's grade 4-5). We performed uni- and multivariable logistic regression to determine predictors for positive and severe FCO.
RESULTS: A group of 225 children with a median age of 6.7 (IQR 5.0-9.5) years were studied. In 109 (48%) children, food challenge outcome was positive and 24 (11%) children developed a severe reaction. The level of sIgE for peanut OR 1.14 (1.08-1.20), male gender OR 0.40 (0.20-0.81), having another food allergy OR 0.43 (0.20-0.88), were independently related to positive FCO. No significant differences were found between children with severe and non-severe FCO with respect to age, gender, asthma, sIgE, or previous reaction to peanut.
CONCLUSIONS: Although predictors of positive FCO could be identified, none of the studied risk factors could predict a severe reaction during peanut challenge. When challenging a child sensitized to peanut, clinicians should be prepared and equipped to handle any reaction in all cases.

PMID: 23902435 [PubMed - as supplied by publisher]

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Extracorporeal life support for acute respiratory distress syndromes.

Ann Thorac Med. 2013 Jul;8(3):133-41

Authors: Hayes D, Tobias JD, Kukreja J, Preston TJ, Yates AR, Kirkby S, Whitson BA

Abstract
The morbidity and mortality of acute respiratory distress syndrome remain to be high. Over the last 50 years, the clinical management of these patients has undergone vast changes. Significant improvement in the care of these patients involves the development of mechanical ventilation strategies, but the benefits of these strategies remain controversial. With a growing trend of extracorporeal support for critically ill patients, we provide a historical review of extracorporeal membrane oxygenation (ECMO) including its failures and successes as well as discussing extracorporeal devices now available or nearly accessible while examining current clinical indications and trends of ECMO in respiratory failure.

PMID: 23922607 [PubMed]

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Impact of bacterial and viral coinfection on mycoplasmal pneumonia in childhood community-acquired pneumonia.

J Microbiol Immunol Infect. 2013 Aug 5;

Authors: Chiu CY, Chen CJ, Wong KS, Tsai MH, Chiu CH, Huang YC

Abstract
BACKGROUND/PURPOSE: Coinfection of Mycoplasma pneumoniae is not uncommon in children with respiratory syndromes. The purpose of this study was to investigate the impact of bacterial and viral coinfection on mycoplasmal pneumonia in hospitalized children with community-acquired pneumonia (CAP).
METHODS: Children coinfected with M. pneumoniae in a prospective study of the etiology of CAP at a tertiary pediatric facility Children's Hospital were enrolled and retrospectively reviewed. The data of clinical characteristics, complications, and outcomes of these children were collected and analyzed.
RESULTS: A total of 59 children were enrolled and stratified into three groups: M. pneumoniae infection alone (n = 31), M. pneumoniae with Streptococcus pneumoniae coinfection (n = 9), and M. pneumoniae with virus coinfection (n = 19). As compared with children infected with M. pneumoniae alone, coinfection of children with S. pneumoniae was more likely to occur under the age of 5 years with a longer duration of fever and hospital stay. Furthermore, total leukocyte count and serum C-reactive protein level were also significantly higher in these children (p < 0.01). However, no significant difference in clinical characteristics, complications, and outcomes was observed between the patients infected with either M. pneumoniae alone or with virus coinfection.
CONCLUSION: In children with CAP, the influence on the clinical outcomes of M. pneumoniae infection may be heavily dependent on the coinfected pathogen. A potential coexistence of M. pneumoniae infection should be considered in children with features suggesting typical bacterial pneumonia.

PMID: 23927825 [PubMed - as supplied by publisher]

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Choosing and Using Screening Criteria for Palliative Care Consultation in the ICU: A Report From the Improving Palliative Care in the ICU (IPAL-ICU) Advisory Board.

Crit Care Med. 2013 Aug 9;

Authors: Nelson JE, Curtis JR, Mulkerin C, Campbell M, Lustbader DR, Mosenthal AC, Puntillo K, Ray DE, Bassett R, Boss RD, Brasel KJ, Frontera JA, Hays RM, Weissman DE

Abstract
OBJECTIVE:: To review the use of screening criteria (also known as "triggers") as a mechanism for engaging palliative care consultants to assist with care of critically ill patients and their families in the ICU.
DATA SOURCES:: We searched the MEDLINE database from inception to December 2012 for all English-language articles using the terms "trigger," "screen," "referral," "tool," "triage," "case-finding," "assessment," "checklist," "proactive," or "consultation," together with "intensive care" or "critical care" and "palliative care," "supportive care," "end-of-life care," or "ethics." We also hand-searched reference lists and author files and relevant tools on the Center to Advance Palliative Care website.
STUDY SELECTION: Two members (a physician and a nurse with expertise in clinical research, intensive care, and palliative care) of the interdisciplinary Improving Palliative Care in the ICU Project Advisory Board presented studies and tools to the full Board, which made final selections by consensus.
DATA EXTRACTION: We critically reviewed the existing data and tools to identify screening criteria for palliative care consultation, to describe methods for selecting, implementing, and evaluating such criteria, and to consider alternative strategies for increasing access of ICU patients and families to high-quality palliative care.
DATA SYNTHESIS: The Improving Palliative Care in the ICU Advisory Board used data and experience to address key questions relating to: existing screening criteria; optimal methods for selection, implementation, and evaluation of such criteria; and appropriateness of the screening approach for a particular ICU.
CONCLUSIONS:: Use of specific criteria to prompt proactive referral for palliative care consultation seems to help reduce utilization of ICU resources without changing mortality, while increasing involvement of palliative care specialists for critically ill patients and families in need. Existing data and resources can be used in developing such criteria, which should be tailored for a specific ICU, implemented through an organized process involving key stakeholders, and evaluated by appropriate measures. In some settings, other strategies for increasing access to palliative care may be more appropriate.

PMID: 23939349 [PubMed - as supplied by publisher]