Piet L J M Leroy

• PhD, MD
• Maastricht University

Objectives: 1) To investigate the current practice in point-of-care ultrasound use in PICUs across Europe; 2) to understand the barriers for point-of-care ultrasound implementation in the clinical practice; 3) to identify existing point-of-care ultrasound training programs; and 4) to assess training needs. Design: Cross-sectional electronic surv...

The multidisciplinary International Committee for the Advancement of Procedural Sedation presents the first fasting and aspiration prevention recommendations specific to procedural sedation, based on an extensive review of the literature. These were developed using Delphi methodology and assessment of the robustness of the available evidence. The l...

Many hospitals, and medical and dental clinics and offices, routinely monitor their procedural-sedation practices-tracking adverse events, outcomes, and efficacy in order to optimize the sedation delivery and practice. Currently, there exist substantial differences between settings in the content, collection, definition, and interpretation of such...

Providing effective sedation and analgesia in infants and children admitted on a Pediatric Intensive Care Unit (PICU) is a cornerstone of daily patient care and probably one of the most challenging tasks facing PICU professionals. The wide range in age, weight and body composition, underlying medical and neurological diseases, the usually high sens...

Purpose of review: Painful and/or stressful medical procedures mean a substantial burden for sick children. There is good evidence that procedural comfort can be optimized by a comprehensive comfort-directed policy containing the triad of nonpharmacological strategies (NPS) in all cases, timely or preventive procedural analgesia if pain is an issue...

Examination and comparison of the current DSM-IV-TR and the proposed revisions for the forthcoming DSM-5, with regard to neuropsychiatric aspects of critical illness, identified five important issues. These remain to be addressed in order to improve the care of critically ill patients. These are 1) sickness behavior, as part of the organic reaction...

The aim of the study was to assess, by a review of published evidence, the safest and most effective way to provide procedural sedation (PS) in children undergoing gastrointestinal endoscopy (GIE). The databases MEDLINE, Cochrane Library, and Embase were used. Search terms "endoscopy, gastrointestinal" or "endoscopy, digestive system" were combined...

Every system of health care is imperfect because it has limited resources and must cope with increasing demand. Europe has many independent countries and each health service has been influenced by historical, cultural, social, and economic factors. For the management of children having minor diagnostic and therapeutic procedures, there remains cons...

The worldwide prevalence of HIV is 0.8%, the annual incidence and death rate is respectively 2.7 million and 2.0 million people. HIV infection is associated with stigmatization and discrimination, independent of race en socio-economic status. This case describes a girl whose parents did not inform the doctors on admission that their daughter was HI...

There was a dearth in awareness and knowledge regarding pediatric delirium (PD) at the pediatric intensive care unit (PICU). The aim of this study is to highlight the most recent and up-to-date findings of current literature -by means of a systematic review (SR) method-, and to present the key issues and research questions. A SR of the literature p...

Delirium is a poor-prognosis neuropsychiatric disorder. Pediatric delirium (PD) remains understudied, particularly at pediatric intensive care units (PICU). Although the Pediatric Anesthesia Emergence Delirium (PAED) scale, the Delirium Rating Scale (DRS-88), and the Delirium Rating Scale-Revised (DRS-R-98) are available, none have been validated f...

Young children and children with mental impairment that have to undergo magnetic resonance imaging (MRI) will require procedural sedation (PS) to maintain the necessary immobility. In the last decade severe accidents have occurred in the Netherlands in children during PS for MRI. It has been shown that well-established guidelines on PS-related safe...

Two young girls without a notable medical history except for asthma presented with an acute toxic encephalopathy with very low serine concentrations both in plasma and cerebrospinal fluid (CSF) comparable to patients with 3-phosphoglycerate dehydrogenase (3-PGDH) deficiency. Clinical symptoms and enzyme measurement (in one patient) excluded 3-PGDH...

Samenvatting Tijdens magnetisch resonantie-onderzoek (MRI) hebben jonge kinderen en kinderen met een vertraagde ontwikkeling een vorm van procedurele sedatie (PS) nodig om voldoende (lang) bewegingloos te kunnen blijven liggen. In Nederland hebben zich in het afgelopen decennium ernstige ongevallen voorgedaan tijdens PS voor MRI. Het is aangetoond...

Objectives. To investigate which skills and competence are imperative to assure optimal effectiveness and safety of procedural sedation (PS) in children and to analyze the underlying levels of evidence. Study Design and methods. Systematic review of literature published between 1993 and March 2009. Selected papers were classified according to their...

Surgical treatment of children with meningococcal sepsis has mainly involved debridement of necrotic skin and amputation of limbs. This resulted in major functional impairment. On the contrary, when early microsurgical arteriolysis was performed, freeing up the blood vessels, the impaired blood flow could be restored, thereby significantly reducing...

Sir, With great interest, we read the excellent paper of De Vries et al. on their experience with Jeune syndrome (JS) [1]. Based on their observations, the authors conclude that respiratory condition in JS improves with age: in the 10 children surviving the first years of life, only two needed supplementary oxygen therapy beyond the age of two and...

If delirium is not diagnosed, it is unlikely that any effort will be made to reverse it. Given evidence for under-diagnosis, tools that aid recognition are required. Relating three presentations of pediatric delirium (PD) to standard criteria and developing a diagnostic algorithm. Delirium-inducing factors, disturbance of consciousness and inattent...

The objective of this study was to investigate, under circumstances of routine care, the impact of paediatric delirium (PD) on length of stay in the paediatric intensive care unit (PICU) as well as on direct financial costs. A five-year prospective observational study (2002-2007) was carried out in a tertiary eight-bed PICU in the Netherlands. Crit...

Following two fatal accidents during paediatric procedural sedation (PS), the authors investigated the level of adherence to established safety standards on PS in a nationwide cohort of fully trained general paediatricians, entrusted with PS. Sample survey Safety guidelines on PS were split into four domains ("Presedation Assessment", "Monitoring d...

Kinderen met chronische respiratoire insufficiëntie kunnen in aanmerking komen voor thuisbeademing. Bij voorkeur wordt een dergelijke behandeling in electieve, niet-acute omstandigheden opgestart, nadat zorgvuldig afgewogen is of de patiënt ervoor in aanmerking komt. Als eenmaal besloten is dat de patiënt in aanmerking komt voor thuisbeademing, moe...

Home mechanical ventilation may be a therapeutic option in children with chronic respiratory failure. Ideally, this therapy should not be initiated at the time of an acute respiratory failure but electively and after careful considerations have been made whether it is an appropriate therapeutic strategy for a particular patient. Once patient, paren...

Procedural sedation and analgesia (PSA) is a standard of care for the management of acute procedural pain and anxiety in the emergency department (ED). However, there is evidence that PSA practice is still ineffective and potentially unsafe in many pediatric settings. PSA has to be regarded as a separate medical act that should be provided only by...

Introduction Reduced concentrations of glucose-6-phospate dehydrogenase (G6PD) render erythrocytes susceptible to hemolysis under conditions of oxidative stress. In favism, the ingestion of fava beans induces an oxidative stress to erythrocytes, leading to acute hemolysis. Discussion The simultaneous occurrence of methemoglobinemia has been repo...

Nissen fundoplication is a generally accepted treatment for severe gastro-oesophageal reflux after conservative management has failed. The surgical techniques and the complications that may develop following the operation have been well described. However, necrosis of the spleen is a rare complication. We report here a patient with Down syndrome wi...

Delirium in children is a serious but understudied neuropsychiatric disorder. So there is little to guide the clinician in terms of identifying those at risk. To study, in a pediatric intensive care unit (PICU), the predictive power of widely used generic pediatric mortality scoring systems in relation to the occurrence of pediatric delirium (PD)....

We describe four children with Dravet syndrome treated with the combination of valproic acid (VPA) and topiramate (TPM) who developed transient liver toxicity. The time-interval between fever, administration of acetaminophen, epileptic status and liver enzyme disturbances in our four cases suggests that accumulation of toxic acetaminophen-metabolit...

To study the phenomenology, clinical correlates, and response to treatment of delirium in critically ill children in the pediatric intensive care unit (PICU). Descriptive study of a cohort of child psychiatric consultations from a tertiary PICU between January 2002 and December 2005. Demographic data, clinical presentation, and response to treatmen...

Invasive aspergillosis is extremely rare in immunocompetent children. Here we describe the clinical, radiologic, and laboratory course of fatal invasive pulmonary and central nervous system aspergillosis in a previously healthy child after a near-drowning incident with submersion in a pond. Findings were compared with data from the literature, whic...

Two critically ill girls, aged 2.3 years and 3.5 years respectively, developed delirium in the Paediatric Intensive Care Unit (PICU). The first child, admitted with meningococcal meningitis and septic shock with respiratory failure, suffered from hyperactive delirium which started 2 hours post-extubation. The second child, admitted due to an exacer...

Two infants presented with a recurrent methicillin-susceptible Staphylococcus aureus bacteremia occurring >2 months after the initial bacteremia. In both patients, clonal identity of the successive Staphylococcus aureus isolates, confirmed by pulsed field gel electrophoresis, pointed to relapsing bacteremia. Ultrasonographically proved persistence...

Respiratory syncytial virus (RSV) is nowadays the leading cause of bronchiolitis and viral pneumonia in children. Although the course is often benign, some children need prolonged hospitalisation and mechanical ventilation or even ECMO if conventional mechanical ventilation (CMV) fails. HFOV is currently considered to be contraindicated in obstruc...