Author
Huei Hsin Shieh
Bio: Huei Hsin Shieh is an academic researcher from University of São Paulo. The author has contributed to research in topics: Septic shock & Sepsis. The author has an hindex of 8, co-authored 21 publications receiving 274 citations.
Topics: Septic shock, Sepsis, Penicillin, Clindamycin, Pneumonia
Papers
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TL;DR: Dopamine was associated with an increased risk of death and healthcare–associated infection and early administration of peripheral or intraosseous epinephrine wasassociated with increased survival in this population of children.
Abstract: Objectives:The primary outcome was to compare the effects of dopamine or epinephrine in severe sepsis on 28-day mortality; secondary outcomes were the rate of healthcare–associated infection, the need for other vasoactive drugs, and the multiple organ dysfunction score.Design:Double-blind, prospecti
133 citations
TL;DR: Initial empiric antimicrobial treatment of UTI should consider the significant prevalence of other agents different from E. coli in infants < 3 months, the high prevalence of Staphylococcus saprophyticus in patients > 10 years and Proteus mirabilis in males.
Abstract: INTRODUCAO: A escolha do antimicrobiano para tratamento inicial de infeccao de trato urinario (ITU) costuma ser empirica e deve considerar a prevalencia dos uropatogenos nas diversas faixas etarias e sexo. OBJETIVO: Avaliar a prevalencia de uropatogenos em ITU comunitaria e sua relacao com idade e sexo. METODOS: Estudo transversal conduzido em pronto socorro (PS) de hospital geral, de janeiro a dezembro, 2010, em pacientes menores de 15 anos com suspeita clinica de ITU, que colheram urocultura quantitativa. Definida ITU como [...]
49 citations
TL;DR: Multivariate analysis showed that higher Pediatric Risk of Mortality and Pediatric Logistic Organ Dysfunction scores, the presence of two or more chronic conditions, and admission from pediatric wards were independently associated with death.
Abstract: Objectives:To report the prevalence of sepsis within the first 24 hours at admission and the PICU sepsis-related mortality among critically ill children admitted to PICU in South America.Design:A prospective multicenter cohort study.Setting:Twenty-one PICU, located in five South America countries.Pa
39 citations
TL;DR: The Berlin definition can identify a subgroup of patients with distinctly worse outcomes, as shown by the increased mortality and reduced number of ventilator-free days in pediatric patients with severe acute respiratory distress syndrome.
Abstract: Objectives:In 2012, a new acute respiratory distress syndrome definition was proposed for adult patients. It was later validated for infants and toddlers. Our objective was to evaluate the prevalence, outcomes, and risk factors associated with acute respiratory distress syndrome in children up to 15
34 citations
TL;DR: A significant potential impact of conjugate vaccines, mainly 10-valent and 13-valents, on invasive pneumonia is confirmed and susceptibility testing results show that penicillin is still the treatment of choice for invasive pneumonia in the authors' setting.
Abstract: Objectives: To identify the most common pneumococcal serotypes in children hospitalized with invasive pneumonia, correlate isolated serotypes with those included in conjugate vaccines, and ascertain the sensitivity of the isolated pneumococcal strains to penicillin and other antibiotics Methods: From January 2003 to October 2008, a retrospective study of hospitalized children with a diagnosis of Streptococcus pneumoniae pneumonia was conducted at the university hospital of Universidade de Sao Paulo Criteria for inclusion were: age greater than 29 days and less than 15 years, radiological and clinical diagnosis of pneumonia, and isolation of Streptococcus pneumoniae in blood cultures and/or pleural effusion Results: The study included 107 children The most common serotypes were 14 (365%), 1 (16%), 5 (146%), 6B (63%) and 3 (42%) The proportion of identified serotypes contained in the heptavalent, 10-valent and 13-valent conjugate vaccines was 531, 865, and 969%, respectively Pneumococcal strains were sensitive to penicillin (minimum inhibitory concentration, MIC ≤ 2 μg/mL) in 100 cases (935%) and displayed intermediate resistance (MIC = 4 μg/mL) in 7 cases (65%) No strains were penicillin-resistant (MIC ≥ 8 µg/mL) according to the Clinical and Laboratory Standards Institute 2008 standards Tested isolates were highly sensitive to vancomycin, rifampicin, ceftriaxone, clindamycin, erythromycin, and chloramphenicol Conclusions: Our results confirm a significant potential impact of conjugate vaccines, mainly 10-valent and 13-valent, on invasive pneumonia Furthermore, susceptibility testing results show that penicillin is still the treatment of choice for invasive pneumonia in our setting
21 citations
Cited by
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University of Pittsburgh1, Riley Hospital for Children2, Washington University in St. Louis3, Baylor College of Medicine4, Texas Tech University5, Northwestern University6, University of British Columbia7, Medical College of Wisconsin8, Saint Barnabas Medical Center9, University of Pennsylvania10, University College London11, University of Alberta12, Duke University13, McMaster University14, Yeshiva University15, University of Michigan16, Laval University17, Kaiser Permanente18, Emory University19, University of Maryland, Baltimore20, Cornell University21, Nationwide Children's Hospital22, Children's Mercy Hospital23, Texas Tech University Health Sciences Center at El Paso24, University of Florida25, St Mary's Hospital26, University of Rochester27, University of Washington28, Stanford University29, University of California, San Diego30, Valley Hospital31, Royal Children's Hospital32, University of Melbourne33, Loma Linda University34, Great Ormond Street Hospital35, Boston Children's Hospital36, Austral University37, University of Colorado Denver38, Nemours Foundation39
TL;DR: A major new recommendation in the 2014 update of the 2007 American College of Critical Care Medicine “Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock” is consideration of institution—specific use of a recognition bundle containing a trigger tool for rapid identification of patients with septic shock.
Abstract: Objectives:The American College of Critical Care Medicine provided 2002 and 2007 guidelines for hemodynamic support of newborn and pediatric septic shock Provide the 2014 update of the 2007 American College of Critical Care Medicine “Clinical Guidelines for Hemodynamic Support of Neonates and Child
605 citations
TL;DR: The Pediatric Basic and Advanced Life Support Collaborators aim to provide real-time information and guidance to parents and clinicians on how to care for their children during the neonatal intensive care unit and beyond.
Abstract: Alexis A. Topjian, MD, MSCE, Chair; Tia T. Raymond, MD, Vice-Chair; Dianne Atkins, MD; Melissa Chan, MD; Jonathan P. Duff, MD, Med; Benny L. Joyner Jr, MD, MPH; Javier J. Lasa, MD; Eric J. Lavonas, MD, MS; Arielle Levy, MD, Med; Melissa Mahgoub, PhD; Garth D. Meckler, MD, MSHS; Kathryn E. Roberts, MSN, RN; Robert M. Sutton, MD, MSCE; Stephen M. Schexnayder, MD; On behalf of the Pediatric Basic and Advanced Life Support Collaborators
567 citations
Children's Hospital of Philadelphia1, Great Ormond Street Hospital2, McMaster University3, Boston Children's Hospital4, St Mary's Hospital5, University of Queensland6, University of Cape Town7, University of Liverpool8, Durham University9, French Institute of Health and Medical Research10, South University11, University of Cambridge12, University Hospital Southampton NHS Foundation Trust13, Nationwide Children's Hospital14, Erasmus University Medical Center15, All India Institute of Medical Sciences16, Radboud University Nijmegen17, Royal Children's Hospital18, Children's Hospital Los Angeles19, New York University20, Stony Brook University21, Apollo Hospitals22, Johns Hopkins University23, University of the West of England24, University of Iowa25, St. Jude Children's Research Hospital26, Cincinnati Children's Hospital Medical Center27, Seattle Children's28, University of British Columbia29, Centre national de la recherche scientifique30
TL;DR: A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations.
Abstract: OBJECTIVES: To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction. DESIGN: A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. METHODS: The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. RESULTS: The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 52 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 49 research priorities were identified. CONCLUSIONS: A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research.
541 citations
Children's Hospital of Philadelphia1, Great Ormond Street Hospital2, McMaster University3, Boston Children's Hospital4, St Mary's Hospital5, University of Queensland6, University of Cape Town7, University of Liverpool8, Durham University9, French Institute of Health and Medical Research10, South University11, University of Cambridge12, University Hospital Southampton NHS Foundation Trust13, Nationwide Children's Hospital14, Erasmus University Medical Center15, All India Institute of Medical Sciences16, Radboud University Nijmegen17, University Health System18, Royal Children's Hospital19, Children's Hospital Los Angeles20, New York University21, Stony Brook University22, Apollo Hospitals23, Johns Hopkins University24, University of the West of England25, University of Iowa26, St. Jude Children's Research Hospital27, Cincinnati Children's Hospital Medical Center28, Seattle Children's29, University of British Columbia30, Centre national de la recherche scientifique31
TL;DR: A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations.
Abstract: OBJECTIVES: To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction. DESIGN: A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. METHODS: The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. RESULTS: The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 49 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 52 research priorities were identified. CONCLUSIONS: A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research.
361 citations
TL;DR: In this article, the authors proposed a new method to solve the problem of "missing data".S.October 20, 2020 S337.0.00.00% 0.00
Abstract: October 20, 2020 S337
332 citations