Pediatric Critical Care Medicine最新文献

{"title":"PRoMPTing Practice Change in Pediatric Sepsis: Is There a Role for Acute Kidney Injury Biomarkers in Early Fluid Resuscitation?","authors":"Imogen Clover-Brown, Natalja L Stanski","doi":"10.1097/PCC.0000000000003745","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003745","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External Validation of the Phoenix Sepsis Score in a Single Pediatric Cardiac ICU.","authors":"Marie C Baker, Michael C Spaeder","doi":"10.1097/PCC.0000000000003748","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003748","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organ Procurement Organization Donation Requestors Describe Barriers to Pediatric Organ Donation.","authors":"Gretchen B Chapman, Mandy Lanyon, Justin Godown, Daniel J Lebovitz","doi":"10.1097/PCC.0000000000003742","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003742","url":null,"abstract":"<p><strong>Objectives: </strong>Organ procurement organization (OPO) donation requestor staff approach grieving families to discuss donating organs from their loved ones. We have carried out a qualitative study to explore the barriers that OPO donation requestor staff face in accessing pediatric families and requesting consent.</p><p><strong>Design and participants: </strong>Qualitative methods using structured interviews (n = 31) and focus groups (n = 33 participants) with donation requestor OPO personnel.</p><p><strong>Setting: </strong>Phone interviews were conducted from November 2022 to January 2023, and focus groups were held at an August 2023 conference for donation and transplant professionals.</p><p><strong>Subjects: </strong>64 donation requestor OPO personnel.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Content analysis was used to code transcribed responses. Participants described a lack of access to pediatric families and portrayed clinical care teams as sometimes protective of the family or even preventing OPO staff from talking with the family. Participants shared potential solutions to overcome barriers, including fostering teamwork between clinical care teams and OPO staff and developing bridging language for clinicians to use when introducing donation requestors.</p><p><strong>Conclusions: </strong>Donation requestors face unique challenges when approaching grieving pediatric families, and more multidisciplinary work is needed to improve communication.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time Course of Kidney Injury Biomarkers in Children With Septic Shock: Nested Cohort Study Within the Pragmatic Pediatric Trial of Balanced Versus Normal Saline Fluid in Sepsis Trial.","authors":"Scott L Weiss, Julie C Fitzgerald, Benjamin L Laskin, Ruchi Singh, Amanda S Artis, Ananya Vohra, Elena Tsemberis, Emem Kierian, Kristen C Lau, Atzael B Campos, Christopher Hickey, Katie L Hayes, Daniel Singleton, Elliot Long, Franz E Babl, Stuart R Dalziel, Graham C Thompson, Stephen B Freedman, Michelle Eckerle, Robert W Hickey, Jing Huang, Nathan Kuppermann, Fran Balamuth","doi":"10.1097/PCC.0000000000003737","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003737","url":null,"abstract":"<p><strong>Objective: </strong>Severe acute kidney injury (AKI) portends poor outcomes in pediatric sepsis. We evaluated the trajectory and prognostic utility of AKI biomarkers in pediatric septic shock using a subset of participants in the ongoing Pragmatic Pediatric Trial of Balanced vs. Normal Saline Fluid in Sepsis (PRoMPT BOLUS) trial, NCT04102371. We tested whether fluid volume is associated with persistent elevation of urine neutrophil gelatinase-associated lipocalin (Ur-NGAL).</p><p><strong>Design: </strong>Prospective, non-prespecified cohort study within the PRoMPT BOLUS trial.</p><p><strong>Setting: </strong>Three children's hospitals in the United States.</p><p><strong>Patients: </strong>Four hundred seventy-eight patients aged 2 months to younger than 18 years old with septic shock.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Ur-NGAL, kidney injury molecule-1, liver fatty acid binding protein, and interleukin-18 and plasma cystatin C were collected at presentation (T1), days 2-3 (T2), and before discharge/death (T3). At presentation, 418 (88%) had no or only stage 1 AKI and 60 (12%) had stage 2/3 AKI defined using Kidney Disease Improving Global Outcomes creatinine thresholds. All biomarkers were higher with stage 2/3 compared with no/stage 1 AKI at T1 and T2, but only cystatin C remained higher at T3. Among patients with no/stage 1 AKI at presentation, those with Ur-NGAL greater than or equal to 150 vs. less than 150 ng/mL had fewer hospital-free days (21 [interquartile range (IQR) 15-24] vs. 23 d [IQR 19-25], p = 0.05). After applying inverse probability treatment weighting to balance covariates, 14% of patients who received greater than 100 mL/kg within 48 hours had persistently elevated Ur-NGAL over time compared with 6% who received 40-100 mL/kg (odds ratio 2.7 [95% CI, 1.1-6.2]). Hospital-free days were no different across fluid volume groups.</p><p><strong>Conclusions: </strong>Although kidney injury biomarkers mirrored serum creatinine in children with septic shock, elevated Ur-NGAL identified a subset with subclinical AKI with fewer hospital-free days despite no/stage 1 AKI by creatinine. Children receiving greater than 100 mL/kg fluid had greater odds of early and persistently elevated Ur-NGAL, suggesting high fluid volumes may perpetuate initial kidney damage.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short Femoral Central Lines in Critically Ill Children: How Often and Do They Result in More Complications?","authors":"H Michael Ushay","doi":"10.1097/PCC.0000000000003739","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003739","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Children Requiring 3 or More Days of Invasive Ventilation: Secondary Analysis of Post-Discharge Change in Caregiver Employment.","authors":"Kathryn E Kalata, Kristen R Miller, Yamila L Sierra, Tellen D Bennett, R Scott Watson, Peter M Mourani, Aline B Maddux","doi":"10.1097/PCC.0000000000003676","DOIUrl":"10.1097/PCC.0000000000003676","url":null,"abstract":"<p><strong>Objectives: </strong>To describe frequency of, and risk factors, for change in caregiver employment among critically ill children with acute respiratory failure.</p><p><strong>Design: </strong>Preplanned secondary analysis of prospective cohort dataset, 2018-2021.</p><p><strong>Setting: </strong>Quaternary Children's Hospital PICU.</p><p><strong>Patients: </strong>Children who required greater than or equal to 3 days of invasive ventilation, survived hospitalization, and completed greater than or equal to 1 post-discharge survey.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We measured change in caregiver employment 1 and 12 months post-discharge relative to pre-admission and, when present, change in caregiver identity defined by relationship to the patient. Data were collected by survey. We used logistic regression to identify factors associated with these changes. We evaluated 130 children, median age 6.4 years (interquartile range, 1.10-13.3 yr), 40 (30.8%) with a complex chronic condition (CCC), and 99 (76.2%) with normal pre-illness Functional Status Scale scores. Of 123 with 1-month post-discharge data, 25 of 123 (20.3%) experienced a change in caregiver employment and an additional 14 of 123 (11.4%) had a change in caregiver(s). Of 115 with 12-month post-discharge data, 33 of 115 (28.7%) experienced a change in caregiver employment and an additional 16 of 115 (13.9%) had a change in caregiver(s). After controlling for age, CCC, baseline caregiver employment, new morbidity at discharge, and social and economic index; higher maximum Pediatric Logistic Organ Dysfunction-2 score (odds ratio [OR], 1.19 [95% CI, 1.01-1.41]) and government insurance (OR, 3.85 [95% CI, 1.33-11.11]) were associated with the composite outcome of change in caregiver employment or caregiver(s) at 1-month post-discharge.</p><p><strong>Conclusions: </strong>At 1 and 12 months post-discharge, more than one-in-five children who survived greater than or equal to 3 days of invasive ventilation had a change in caregiver employment and one-in-ten had a change in caregiver(s). Identification of risk factors, such as illness severity and social determinants of health, associated with a significant family change may improve our support of these families.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 4","pages":"e473-e481"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11976063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Central or Peripheral Venoarterial Extracorporeal Membrane Oxygenation for Pediatric Sepsis: Outcomes Comparison in the Extracorporeal Life Support Organization Dataset, 2000-2021.","authors":"Abhinav Totapally, Ryan Stark, Melissa Danko, Heidi Chen, Alyssa Altheimer, Daphne Hardison, Matthew P Malone, Elizabeth Zivick, Brian Bridges","doi":"10.1097/PCC.0000000000003692","DOIUrl":"10.1097/PCC.0000000000003692","url":null,"abstract":"<p><strong>Objectives: </strong>Small studies of extracorporeal membrane oxygenation (ECMO) support for children with refractory septic shock (RSS) suggest that high-flow (≥ 150 mL/kg/min) venoarterial ECMO and a central cannulation strategy may be associated with lower odds of mortality. We therefore aimed to examine a large, international dataset of venoarterial ECMO patients for pediatric sepsis to identify outcomes associated with flow and cannulation site.</p><p><strong>Design: </strong>Retrospective analysis of the Extracorporeal Life Support Organization (ELSO) database from January 1, 2000, to December 31, 2021.</p><p><strong>Setting: </strong>International pediatric ECMO centers.</p><p><strong>Patients: </strong>Patients 18 years old young or younger without congenital heart disease (CHD) cannulated to venoarterial ECMO primarily for a diagnosis of sepsis, septicemia, or septic shock.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Of 1242 pediatric patients undergoing venoarterial ECMO runs in the ELSO dataset, overall mortality was 55.6%. We used multivariable logistic regression analyses to evaluate explanatory factors associated with adjusted odds ratios (aORs) and 95% CI of mortality. In the regression analysis of data 4 hours after ECMO initiation, logarithm of the aOR, plotted against ECMO flow as a continuous variable, showed that higher flow was associated with lower aOR of mortality ( p = 0.03). However, at 24 hours, we failed to find such a relationship. Finally, peripheral cannulation, as opposed to central cannulation, was independently associated with greater odds of mortality (odds ratio, 1.7 [95% CI, 1.1-2.6]).</p><p><strong>Conclusions: </strong>In this 2000-2021 international cohort of venoarterial ECMO for non-CHD children with sepsis, we have found that higher ECMO flow at 4 hours after support initiation, and central- rather than peripheral-cannulation, were both independently associated with lower odds of mortality. Therefore, flow early in the ECMO run and cannula location are two important factors to consider in future research in pediatric patients requiring cannulation to venoarterial ECMO for RSS.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e463-e472"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting Blood Glucose: Searching for a Sweet Spot in Pediatric Neurocritical Care.","authors":"Ricardo G Branco","doi":"10.1097/PCC.0000000000003725","DOIUrl":"10.1097/PCC.0000000000003725","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e552-e555"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adding Insult to Injury: Posttraumatic Stress Disorder After Critical Illness.","authors":"Anjali Garg, Deanna M Behrens","doi":"10.1097/PCC.0000000000003726","DOIUrl":"10.1097/PCC.0000000000003726","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e566-e568"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Stewardship of Endotracheal Aspirate Cultures in Hospitalized Children With Artificial Airways: Expert Consensus Statements From the BrighT STAR (Testing STewardship for Antibiotic Reduction) Respiratory Collaborative.","authors":"Anna C Sick-Samuels, Daniel P Kelly, Charlotte Z Woods-Hill, Abigail Arthur, Urmi Kumar, Danielle W Koontz, Jill A Marsteller, Aaron M Milstone","doi":"10.1097/PCC.0000000000003695","DOIUrl":"10.1097/PCC.0000000000003695","url":null,"abstract":"<p><strong>Objective: </strong>To develop consensus statements that clinicians can apply to standardize and optimize endotracheal aspirate culture (EAC) practices in hospitalized children with artificial airways who are being evaluated for a bacterial lower respiratory tract infection (LRTI).</p><p><strong>Design: </strong>A modified Delphi consensus process with expert panelists. Panelists conducted a \"pre-survey\" to itemize respiratory signs of bacterial LRTI. Round 1 included a literature summary and electronic survey of 50 potential statements sent to all panelists. We surveyed panelist opinions using a 5-point Likert scale. We grouped the responses \"agree\" and \"strongly agree\" as agreement. Consensus was defined as statements reaching greater than 75% agreement. Round 2 was moderated by an independent expert in consensus methodology. Panelists convened in person in November 2023, discussed any statements not reaching consensus or statements with disagreement, were resurveyed, and finalized statements in real time.</p><p><strong>Setting: </strong>Electronic surveys and in-person meetings in Baltimore, MD.</p><p><strong>Subjects: </strong>The BrighT STAR (Testing STewardship for Antibiotic Reduction) collaborative along with U.S.-based pediatric experts in critical care, cardiac critical care, infectious diseases, hospital medicine, otolaryngology, pulmonology, and clinical microbiology.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Thirty-eight of 40 invited panelists completed round 1. Of 50 initial statements, 28 reached greater than 90% agreement, 16 had 75-89% agreement, and 6 had less than 75% agreement. Twenty-eight statements were finalized. Round 2 involved 37 panelists: 23 statements were discussed, of which 17 reached an agreement and 6 did not reach consensus. We concluded with 30 statements and 15 sub-statements, 37 of which had greater than 90% agreement. Final statements informed a clinical decision support algorithm.</p><p><strong>Conclusions: </strong>The BrighT STAR collaborative group achieved consensus for 45 clinical practice statements that can standardize EAC practices, including indications to consider for testing, reasons to defer, optimal specimen collection, and result interpretation. These statements offer a starting point for clinical decision support tools and diagnostic stewardship programs for EAC practices in patients with artificial airways.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e569-e582"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143409683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}