Papers by George Briassoulis
Children
Suicidality is a growing public health problem in children and adolescents. The aim of this retro... more Suicidality is a growing public health problem in children and adolescents. The aim of this retrospective data analysis study was to estimate the prevalence of suicidality in pediatric patients admitted to an academic Pediatric Psychiatric Clinic (PPC) and to analyze social and environmental risk factors associated with suicide. Suicidal ideation was assessed by the Self-Injurious Thoughts and Behaviors Interview. Using established psychometric scales, social and stressful events were analyzed. During the four-year study, 249 episodes of care were experienced by 152 individuals (mean age 15.2 ± 2 years, girls/boys 107/45). Twenty-eight patients (11.2%) were admitted from the Pediatric Intensive Care Unit and the Department of Pediatrics, 162 (65.1%) from the Pediatric Emergency Department, and 59 (23.7%) from other Hospitals (p = 0.003). A significant longitudinal increase in admissions to PPC, with increasing trends of suicidal ideation, suicide attempts, and suicidality, was recor...
Neurological Sciences
Originally, the article was published with inverted author names. The author names are now correc... more Originally, the article was published with inverted author names. The author names are now correctly cited. The original article has been corrected.
Critical Care, Oct 3, 2022
Respiratory Care
BACKGROUND: It is unknown whether lung mechanics differ between patients with pediatric ARDS and ... more BACKGROUND: It is unknown whether lung mechanics differ between patients with pediatric ARDS and at risk for ARDS. We aimed to examine the hypothesis that, compared to ARDS, subjects at risk of ARDS are characterized by higher end-expiratory lung volume (EELV) or respiratory system compliance (C RS) and lower distending pressure (stress) applied on the lung or parenchymal deformation (strain) during mechanical ventilation. METHODS: Consecutively admitted subjects fulfilling the PALICC ARDS criteria were considered eligible for inclusion in this study. A ventilator with an integrated gas exchange module was used to calculate EELV, C RS , strain, and stress after a steady state had been achieved based on nitrogen washout/washin technique. All subjects were subjected to incremental PEEP trials at 0, 6, 12, 24, 48, and 72 h. RESULTS: A total of 896 measurements were longitudinally calculated in 32 mechanically ventilated subjects (n 5 15 subjects with ARDS; n 5 17 subjects at risk for ARDS). EELV correlated positively with strain or stress in the ARDS group (r 5 0.30, P < .001) and the at risk group (r 5 0.60, P < .001). C RS correlated with strain (r 5 0.40, P < .001) only in subjects at risk for ARDS. EELV increased over time as PEEP rose from 4 to 10 cm H 2 O in subjects with ARDS (P 5 .001). In the at risk group, EELV only increased at 48 h (P 5 .001). Longitudinally, C RS (P 5 .001) and EELV (P 5 .002) were lower and strain and stress were higher in subjects with ARDS compared to those at risk for ARDS (P 5 .002), remaining within safe limits. Strain and stress increased by 24 h but declined by 72 h in subjects with ARDS at a PEEP of 4 cm H 2 O (P 5 .02). In the at risk group, strain and stress declined from 6 h to 72 h at a PEEP of 10 cm H 2 O (P 5 .001). CONCLUSIONS: Longitudinally, C RS and EELV were lower and strain and stress were higher in subjects with ARDS compared to subjects at risk for ARDS. These parameters behaved differently over time at PEEP values of 4 or 10 cm H 2 O. At these PEEP levels, strain and stress remained within safe limits in both groups.
Pediatric Reports
Background: Intracranial hypertension (IC-HTN) is significantly associated with higher risk for a... more Background: Intracranial hypertension (IC-HTN) is significantly associated with higher risk for an unfavorable outcome in pediatric trauma. Intracranial pressure (ICP) monitoring is widely becoming a standard of neurocritical care for children. Methods: The present study was designed to evaluate influences of IC-HTN on clinical outcomes of pediatric TBI patients. Demographic, injury severity, radiologic characteristics were used as possible predictors of IC-HTN or of functional outcome. Results: A total of 118 pediatric intensive care unit (PICU) patients with severe TBI (sTBI) were included. Among sTBI cases, patients with GCS < 5 had significantly higher risk for IC-HTN and for mortality. Moreover, there was a statistically significant positive correlation between IC-HTN and severity scoring systems. Kaplan–Meier analysis determined a significant difference for good recovery among patients who had no ICP elevations, compared to those who had at least one episode of IC-HTN (log-...
Annals of the Rheumatic Diseases
BackgroundThe treatment of rheumatoid arthritis (RA) includes conventional synthetic disease-modi... more BackgroundThe treatment of rheumatoid arthritis (RA) includes conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and biologic DMARDs (bDMARDs). RA is associated with an increased risk of serious infections (SI) and the use of bDMARDs almost doubles this risk. SI can lead to sepsis, a life-threatening condition manifested by organ failure caused by a dysregulated host response to a pathogen. bDMARDs target pro-inflammatory cytokines which mediate the inflammation cascade activated both in RA and sepsis. However, very few data exist regarding the incidence of sepsis in patients with a SI while on treatment with bDMARDs.ObjectivesTo assess the outcomes of sepsis and death in RA patients with a SI and compare them between patients on bDMARD and csDMARDs. Secondary aims were the comparison of subgroups of patients treated with different bDMARD classes [Tumor necrosis factor inhibitor (TNFi) vs. non-TNFi] and subgroups based on age (geriatric vs. younger patients).Me...
Critical Care
Background Mechanical power is a composite variable for energy transmitted to the respiratory sys... more Background Mechanical power is a composite variable for energy transmitted to the respiratory system over time that may better capture risk for ventilator-induced lung injury than individual ventilator management components. We sought to evaluate if mechanical ventilation management with a high mechanical power is associated with fewer ventilator-free days (VFD) in children with pediatric acute respiratory distress syndrome (PARDS). Methods Retrospective analysis of a prospective observational international cohort study. Results There were 306 children from 55 pediatric intensive care units included. High mechanical power was associated with younger age, higher oxygenation index, a comorbid condition of bronchopulmonary dysplasia, higher tidal volume, higher delta pressure (peak inspiratory pressure—positive end-expiratory pressure), and higher respiratory rate. Higher mechanical power was associated with fewer 28-day VFD after controlling for confounding variables (per 0.1 J·min−1·...
Open Forum Infectious Diseases, 2017
Conclusion. This study demonstrates that CAZ-AVB displays linear dose proportional exposures simu... more Conclusion. This study demonstrates that CAZ-AVB displays linear dose proportional exposures simulating those of human plasma pharmacokinetics profiles and further establishes the preclinical foundation for treatment of immunocompromised patients.
Critical Care Medicine, 2021
OBJECTIVES: Interventional trials aimed at pediatric acute respiratory distress syndrome preventi... more OBJECTIVES: Interventional trials aimed at pediatric acute respiratory distress syndrome prevention require accurate identification of high-risk patients. In this study, we aimed to characterize the frequency and outcomes of children meeting “at risk for pediatric acute respiratory distress syndrome” criteria as defined by the Pediatric Acute Lung Injury Consensus Conference. DESIGN: Planned substudy of the prospective multicenter, international Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology study conducted during 10 nonconsecutive weeks (May 2016–June 2017). SETTING: Thirty-seven international PICUs. PATIENTS: Three-hundred ten critically ill children meeting Pediatric Acute Lung Injury Consensus Conference “at-risk for pediatric acute respiratory distress syndrome” criteria. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We evaluated the frequency of children at risk for pediatric acute respiratory distress syndrome and rate of subsequent pediatric a...
Critical Care Medicine, 2021
OBJECTIVES: To describe mechanical ventilation management and factors associated with nonadherenc... more OBJECTIVES: To describe mechanical ventilation management and factors associated with nonadherence to lung-protective ventilation principles in pediatric acute respiratory distress syndrome. DESIGN: A planned ancillary study to a prospective international observational study. Mechanical ventilation management (every 6 hr measurements) during pediatric acute respiratory distress syndrome days 0–3 was described and compared with Pediatric Acute Lung Injury Consensus Conference tidal volume recommendations (< 7 mL/kg in children with impaired respiratory system compliance, < 9 mL/kg in all other children) and the Acute Respiratory Distress Syndrome Network lower positive end-expiratory pressure/higher Fio 2 grid recommendations. SETTING: Seventy-one international PICUs. PATIENTS: Children with pediatric acute respiratory distress syndrome. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Analyses included 422 children. On pediatric acute respiratory distress syndrome day 0, me...
Journal of Thoracic Disease, 2017
Intensive Care Medicine, 2019
The ratio of tidal volume to functional residual capacity (FRC), defined as "volumetric" strain, ... more The ratio of tidal volume to functional residual capacity (FRC), defined as "volumetric" strain, causes physical lung deformation. The corresponding change in transpulmonary pressure at end inspiration, defined as stress, is directly applied to the alveolus [1]. Both stress and strain may cause global or local lung deformation and microscopic or macroscopic tissue damage, representing significant determinants of ventilator-induced lung injury [1]. A modified nitrogen washout/washin technique, measuring end-expiratory lung volume (EELV), correlated well with computed tomography and was proposed as a valuable tool to optimize ventilator settings, improving lung protective ventilation [2]. The aim of this study was to evaluate the effect of positive end-expiratory pressure (PEEP) on EELV, compliance of the respiratory system (Crs), and stress/strain in children with acute respiratory distress syndrome (ARDS), and compare it with children "at risk of ARDS" and those with no lung injury using the modified nitrogen washout/washin technique (see electronic supplementary material). To monitor the effects of the disease evolution on the PEEP-induced increases in lung stress/strain, measurements were repeated at predetermined time points. We hypothesized that PEEP escalation increases EELV, Crs, strain, and stress in mechanically ventilated children, potentially influenced by disease severity and timing. A total of 700 measurements were recorded in 25 mechanically ventilated critically ill children (ARDS, n = 8; at risk of ARDS, n = 5; without lung injury, n = 12). ARDS patients had higher oxygenation index (OI > 4) and PaCO 2 , lower PaO 2 /FiO 2 , PaO 2 , and prolonged length of
Journal of Pediatric Gastroenterology and Nutrition, 2018
Postgraduate Medical Journal, 2017
A 7.5-year-old previously healthy boy presented with progressively persisting headaches and acute... more A 7.5-year-old previously healthy boy presented with progressively persisting headaches and acute blindness. Ophthalmologic examination disclosed visual acuity of 1/10, diminished colour vision and bilateral florid papilloedema. MR venography showed acute cerebral venous sinus thrombosis (CVST), (figure 1) and MRI showed signs of intracranial and optic nerve sheath hypertension without brain parenchymal anomalies (figure 2). Intracranial pressure (ICP) was measured at 23 mm Hg (normal value <15 mm Hg). Thrombophilic workup revealed homozygosity for the mutation C677T for methylenetetrahydrofolate reductase, a controversially discussed candidate genetic risk factor for hypercoagulability.1 The patient was put on low-molecular-weight heparin (enoxaparin 100 units/kg/dose two times per day). Additional therapeutic measures were conditioned by intracranial hypertension and vision-threatening papilloedema.2 Repeated therapeutic lumbar punctures followed by cerebrospinal fluid (CSF) re...
Intensive Care Medicine Experimental, 2015
Intensive Care Medicine Experimental, 2015
Archives of Disease in Childhood, 2012
and outcome of H1N1 in children with respiratory tract infection required hospitalization in PICU... more and outcome of H1N1 in children with respiratory tract infection required hospitalization in PICU. Material and Methods Influenza A in children hospitalized in our unit with respiratory infection during the period April 2009-March 2012 was confirmed by special pharyngeal sample. Results During this period, 58 out of 322 children were admitted in our Unit with respiratory infection. Seven patients (12%) (4 girls and 3 boys, age 2 1/2 , 4 1/2 , 5, 6 1/2 , 8, 9 and 10 years), all unvaccinated for H1N1, were influenza A infected. Their initial symptoms were: 844 845 on May 25, 2020 by guest.
Archives of Disease in Childhood, 2012
Acinetobacter and Klebsiella pneumoniae were the most common identified pathogens. Conclusion Hos... more Acinetobacter and Klebsiella pneumoniae were the most common identified pathogens. Conclusion Hospital-acquired pneumonia adversely affects patients outcome in our setting. Moreover, m-PCR permits simultaneous detection of several bacterial pathogens in a single reaction which can optimize the emergency diagnosis of HAP and can improve etiology-directed clinical management of bacterial pneumonia.
Archives of Disease in Childhood, 2012
Archives of Disease in Childhood, 2012
Objectives To examine whether plasma concentrations of high (HDL)-or low (LDL)-density lipoprotei... more Objectives To examine whether plasma concentrations of high (HDL)-or low (LDL)-density lipoproteins are related to nCD64, triglycerides, glucose, severity of illness (PRISM, PELOD), length of stay (LOS) or mechanical ventilation (LOMV), and mortality in children with sepsis (S) and severe sepsis/septic shock (SS) compared to those with trauma (T) or healthy controls (C). Methods 48 children were classified into 4 groups of SS, S, T, and C (12 each). Blood samples were collected on 3 consecutive days following admission. Results On day 1 HDL, LDL, and cholesterol were found to be significantly lower in SS and S compared to C (29.5±2.7 and 27.3±4.2, vs. 58.8±5.8 mg/dl, p<0.001, 33.4±5.8 and 66.2±9, vs. 98.1±6.5 mg/dl, p<0.001, 100.6±9 and 125.2±16, vs. 171.3±7 mg/dl, p<0.001 respectively). Opposite trends followed triglycerides (209±61 and 151.7±25, vs. 71.8±10 mg/dl, p=0.007) and glucose (117±8 and 115±12, vs. 83±3 mg/dl, p=0.002). HDL and triglycerides differed between S or SS and T (p<0.04). Cholesterol, HDL, and LDL were negatively related with nCD64, procalcitonin, CRP, glucose, LOS, and LOMV (p<0.05), but not with severity of illness. Glucose was positively related to the LOS and PELOD (p<0.05) and triglycerides with CRP (p<0.05). Conclusions Lipoproteins and cholesterol are markedly reduced in severe sepsis, but not in trauma, and are inversely related to nCD64expression, acute phase proteins, glucose, LOS, and LOMV.
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Papers by George Briassoulis