22 results found
Meyer R, Kulinskaya E, Briassoulis G, et al., 2012, The Challenge of Developing a New Predictive Formula to Estimate Energy Requirements in Ventilated Critically Ill Children, NUTRITION IN CLINICAL PRACTICE, Vol: 27, Pages: 669-676, ISSN: 0884-5336
Ng KW, Allen ML, Desai A, et al., 2012, Cardioprotective effects of insulin: how intensive insulin therapy may benefit cardiac surgery patients, Circulation, Vol: 125, Pages: 721-728, ISSN: 0009-7322
Pathan N, Burmester M, Adamovic T, et al., 2011, Intestinal injury and endotoxemia in children undergoing surgery for congenital heart disease, American Journal of Respiratory & Critical Care Medicine, Vol: 184, Pages: 1261-1269, ISSN: 1073-449X
RATIONALE: Children with congenital heart disease are at risk of gut barrier dysfunction and translocation of gut bacterial antigens into the bloodstream. This may contribute to inflammatory activation and organ dysfunction postoperatively.OBJECTIVES: To investigate the role of intestinal injury and endotoxemia in the pathogenesis of organ dysfunction after surgery for congenital heart disease.METHODS: We analyzed blood levels of intestinal fatty acid binding protein and endotoxin (endotoxin activity assay) alongside global transcriptomic profiling and assays of monocyte endotoxin receptor expression in children undergoing surgery for congenital heart disease.MEASUREMENTS AND MAIN RESULTS: Levels of intestinal fatty acid binding protein and endotoxin were greater in children with duct-dependent cardiac lesions. Endotoxemia was associated with severity of vital organ dysfunction and intensive care stay. We identified activation of pathogen-sensing, antigen-processing, and immune-suppressing pathways at the genomic level postoperatively and down-regulation of pathogen-sensing receptors on circulating immune cells.CONCLUSIONS: Children undergoing surgery for congenital heart disease are at increased risk of intestinal mucosal injury and endotoxemia. Endotoxin activity correlates with a number of outcome variables in this population, and may be used to guide the use of gut-protective strategies.
Pathan N, Franklin JL, Eleftherohorinou H, et al., 2011, Myocardial depressant effects of interleukin 6 in meningococcal sepsis are regulated by p38 mitogen-activated protein kinase, CRITICAL CARE MEDICINE, Vol: 39, Pages: 1692-1711, ISSN: 0090-3493
Pathan N, Burmester M, Adamovic T, et al., 2010, GUT BARRIER DYSFUNCTION AND ACTIVATION OF ENDOTOXIN SIGNALING PATHWAYS IN CHILDREN UNDERGOING SURGERY FOR CONGENITAL HEART DISEASE, 40th Critical Care Congress, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: U34-U34, ISSN: 0090-3493
Leadbeater P, Pathan N, Paul-Clark M, et al., 2010, Serum lipoteichoic acid in paediatric patients undergoing surgery with cardiopulmonary bypass, Meeting of the Clinical Pharmacology Section of the British-Pharmacological-Society, Publisher: WILEY-BLACKWELL, Pages: 293-293, ISSN: 0306-5251
De Wit B, Meyer R, Desai A, et al., 2010, Challenge of predicting resting energy expenditure in children undergoing surgery for congenital heart disease, Pediatr Crit Care Med, Vol: 11, Pages: 496-501, ISSN: 1529-7535
OBJECTIVES: To determine pre- and postoperative predictors of energy expenditure in children with congenital heart disease requiring open heart surgery; and to compare measured resting energy expenditure with current predictive equations. DESIGN: Prospective resting energy expenditure data were collected, using indirect calorimetry, for ventilated children admitted consecutively to the pediatric intensive care unit after surgery for congenital heart disease. A 30-min steady-state measurement was performed in suitable patients. Resting energy expenditure was compared to pre- and postoperative clinical variables, and to predicted energy expenditure, using currently used predictive equations. SETTING: Pediatric intensive care unit at the Royal Brompton Hospital, London. PATIENTS: Children ventilated in the pediatric intensive care unit post surgery for congenital heart disease. INTERVENTIONS: Measurement of energy expenditure by indirect calorimetry. MEASUREMENTS AND MAIN RESULTS: Twenty-one mechanically ventilated children (n = 17 boys, 4 girls) were enrolled in the study. Mean +/- sd measured resting energy expenditure was 67.8 +/- 15.4 kcal/kg/day. Most children had inadequate delivery of nutrients compared with actual requirements. Cardiopulmonary bypass had a significant influence on energy expenditure after surgery; in patients who underwent cardiopulmonary bypass during surgery, mean resting energy expenditure was 73.6 +/- 14.45 kcal/kg/day vs. 58.3 +/- 10.29 kcal/kg/day in patients undergoing nonbypass surgery. Children who were malnourished preoperatively had greater resting energy expenditure postoperatively. There was also a significant difference between measured energy expenditure and the Schofield (p = .006), World Health Organization (p = .002), and pediatric intensive care unit-specific formula (p < .0001). However, energy expenditure or a relative energy deficit in the early postoperative period was not associated with severity or duration of organ
Allen ML, Pathan N, 2009, Steroids in cardiac surgery: Right time, right dose, right patient group, CRITICAL CARE MEDICINE, Vol: 37, Pages: 1815-1815, ISSN: 0090-3493
Allen M, Sundararajan S, Pathan N, et al., 2009, Anti-inflammatory modalities: their current use in pediatric cardiac surgery in the United Kingdom and Ireland, Pediatr Crit Care Med, Vol: 10, Pages: 341-345, ISSN: 1529-7535
OBJECTIVE: To determine the use of anti-inflammatory therapies in infants and children undergoing cardiac surgery in the United Kingdom and Ireland. DESIGN: Questionnaire survey. SUBJECTS: All centers that undertake pediatric cardiac surgery in the United Kingdom and Ireland. RESULTS: All centers use at least one anti-inflammatory therapy, with 46% of centers using more than one. Both modified ultrafiltration (80%) and steroids (80%) are widely used as anti-inflammatory strategies. Among centers that use steroids, dose, preparation, and timing of steroid administered was highly variable. Heparin-bonded circuits and aprotinin are infrequently used as anti-inflammatory techniques. CONCLUSION: Although anti-inflammatory interventions are believed to contribute to improved patient outcome following cardiopulmonary bypass, this survey has shown that there are still widespread variations in practice. Rather than reflecting poor clinical practice, we believe this reflects a lack of good evidence supporting clinical benefit.
Pathan N, Ridout D, Smith E, et al., 2008, Predictors of outcome for children requiring respiratory extra-corporeal life support: implications for inclusion and exclusion criteria, Intensive Care Med., Vol: 12, Pages: 2256-2263
AbstractOBJECTIVES:A range of children receive extra-corporeal life support (ECLS) for respiratory failure, but there is little published data on this group. Our aims were: (1) to analyse predictors of outcome and (2) comment on inclusion and exclusion criteria.DESIGN:Retrospective review.SETTING:Tertiary ECLS centre.PATIENTS:A total of 124 children categorised as 'paediatric respiratory ECLS' from July 1992 to December 2005.RESULTS:Fifty-three percent of children had one or more co-morbid conditions; the median age was 10.1 (IQR 3-34) months; the median ECLS duration was 9 (IQR 5-17) days; survival to discharge was 62% and at 1 year was 59%. Although survival varied according to primary reason for ECLS (range 36-100%), after adjustment for this, the presence of a co-morbid condition was unrelated to mortality (OR = 1.49, 95% CI 0.65, 3.42, P = 0.34) Predictors of mortality were increased pre-ECLS oxygenation index (OR = 1.09, 95% CI 1.00, 1.18, P = 0.05) and shock (OR 2.53, 95% CI 1.21, 5.28, P = 0.01). The relationship between mortality and end organ dysfunction (OR 2.12, 95% CI 0.89, 5.02, P = 0.09) and greater number of pre-ECLS ventilator days (OR 1.10, 95% CI 0.99, 1.22, P = 0.08) was less conclusive.CONCLUSIONS:Pre-existing co-morbid conditions may predispose children to develop severe respiratory failure but with careful case selection, do not appear to reduce the chance of survival. Severity of pulmonary dysfunction determined by OI and shock were key predictors of outcome and should remain important determinants of referral for ECLS.
Meyer R, Kulinskaya E, Briassoulis G, et al., 2008, A NEW PREDICTIVE FORMULA TO CALCULATE ENERGY REQUIREMENTS IN CRITICALLY ILL CHILDREN
Objectives: The estimation of energy requirements in critically ill children (CIC) currently relies on predictive formulae, which have been shown to be inaccurate in this population. Routine indirect calorimetry is a suitable alternative, but is technically challenging and costly. The aim of this study was to develop a new PICU-specific predictive equation.Methods: This study included all CIC with an endotracheal tube leak of <10% and fractional inspired oxygen of <60%. A 30 minute steady-state energy expenditure (EE) measurement was performed with the Deltatrac II. Polynomial regression analysis was used to establish the impact of diagnosis, day of admission, temperature, severity of disease and medication on EE and for the development of the new equation. This was followed by a validation study.Results: One hundred patients were enrolled. Day of admission (p = 0.976), temperature (p = 0.212) and severity of disease (p = 0.794) did not impact significantly on EE, however diagnosis did (p = 0.055). The new equation included weight, age and diagnosis and accounted for 83.3% of variation in energy expenditure (R2 = 0.833). The validation study (n = 25) indicated a mean difference of 16.7% between measured and predicted EE with no statistical difference (p = 0.433). Accuracy increased in patients <3 years (<10%).Conclusion: This new predictive equation estimates EE more accurately than previously published equations. However further research is required in older patients and those with cardiac and liver disease due to limited numbers recruited in this study.
Pathan N, Williams J, Oragui EE, et al., 2005, Changes in the interleukin-6/soluble interleukin-6 receptor axis in meningococcal septic shock, CRITICAL CARE MEDICINE, Vol: 33, Pages: 1839-1844, ISSN: 0090-3493
Franklin JL, Pathan N, Levin M, et al., 2005, Myocardial depression by IL-6 is reversed by P38 MAP kinase inhibition, 25th Annual Scientific Session of the European Section of the International-Society-for-Heart-Research, Publisher: ACADEMIC PRESS LTD- ELSEVIER SCIENCE LTD, Pages: 1021-1021, ISSN: 0022-2828
Pathan N, Hemingway CA, Alizadeh AA, et al., 2004, Role of interleukin 6 in myocardial dysfunction of meningococcal septic shock, LANCET, Vol: 363, Pages: 203-209, ISSN: 0140-6736
Pathan N, Faust SN, Levin M, 2003, Pathophysiology of meningococcal meningitis and septicaemia, ARCHIVES OF DISEASE IN CHILDHOOD, Vol: 88, Pages: 601-607, ISSN: 0003-9888
Pathan N, Stephens A, Oragui E, et al., 2003, IL6 and TNF alpha: A double-edged sword in the myocardial dysfunction of meningococcal septicaemia, 32nd Critical Care Congress of the Society-of-Critical-Care-Medicine, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: A49-A49, ISSN: 0090-3493
Pathan N, Hemingway C, Levin M, et al., 2003, The complexity of the inflammatory response to meningococcal sepsis revealed by gene expression profiling using cDNA microarrays, 32nd Critical Care Congress of the Society-of-Critical-Care-Medicine, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: A47-A47, ISSN: 0090-3493
Pathan N, Stephens A, Oragui E, et al., 2002, IL6 and TNF alpha: A double-edged sword in the myocardial dysfunction of meningococcal septicaemia?, 32nd Critical Care Congress, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: A49-A49, ISSN: 0090-3493
Pathan N, Hemingway C, Levin M, 2002, The complexity of the inflammatory response to meningococcal sepsis revealed by gene expression profiling using CDNA microarrays, 32nd Critical Care Congress, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: A47-A47, ISSN: 0090-3493
Pathan N, Sandiford C, Harding SE, et al., 2002, Characterization of a myocardial depressant factor in meningococcal septicemia, CRITICAL CARE MEDICINE, Vol: 30, Pages: 2191-2198, ISSN: 0090-3493
Pathan N, Nadel S, Levin M, 2000, Pathophysiology and management of meningococcal septicaemia, JOURNAL OF THE ROYAL COLLEGE OF PHYSICIANS OF LONDON, Vol: 34, Pages: 436-444, ISSN: 0035-8819
Thiru Y, Pathan N, Bignall S, et al., 2000, A myocardial cytotoxic process is involved in the cardiac dysfunction of meningococcal septic shock, CRITICAL CARE MEDICINE, Vol: 28, Pages: 2979-2983, ISSN: 0090-3493
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