Pediatric Critical Care Medicine最新文献

{"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":"Focal Cerebral Injury in Pediatric Extracorporeal Life Support: Timing in Relation to Cannulation or Other Circuit Events in a Single-Center Retrospective Series, 2015-2023.","authors":"Mauro Caffarelli, Yi Li, Edilberto Amorim, Kathryn Finlay, Elan L Guterman, Giulia Benedetti, Craig A Press, Dana Harrar, Ajay X Thomas, Martina Steurer, Loren D Sacks, Christine K Fox","doi":"10.1097/PCC.0000000000003736","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003736","url":null,"abstract":"<p><strong>Objectives: </strong>To review the timing of extracorporeal life support (ECLS)-related focal cerebral injury (FCI) in relation to circuit interruptions in children and young adults.</p><p><strong>Design: </strong>Retrospective study from January 1, 2015, to December 31, 2023.</p><p><strong>Setting: </strong>Single-center academic children's hospital.</p><p><strong>Patients: </strong>Children and young adults younger than 21 years old who had neuroimaging during or after ECLS. Multiple ECLS runs in individual patients were analyzed as distinct runs.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>FCI was radiographically defined as lateralized ischemia or hemorrhagic parenchymal brain injury greater than 1 cm3 or as subdural hemorrhage causing midline shift. Timing of clinical FCI documentation was abstracted from chart review and based on times of new-onset focal neurologic examination findings, focal electroencephalography findings, or incidental discovery on imaging. In instances of FCI, electroencephalography reports and inpatient progress notes were reviewed to identify electroencephalography-related timing of FCI. Institutional ECLS registry data were used to identify times of circuit events (i.e., cannulation, decannulation, and circuit interruptions). The probable time course of FCI after circuit events was evaluated in the ECLS runs with an imaging diagnosis of FCI, and summarized using cumulative distribution with 95% CI. In 101 ECLS runs in 94 patients with brain imaging, 20 had FCI: ischemic stroke in 12, intraparenchymal hemorrhage in six, and subdural hemorrhage with midline shift in two. Eighteen FCIs were documented within 48 hours of a circuit event. Among 13 FCIs with electroencephalography recording at the time of FCIs, eight had new-onset subclinical electroencephalography abnormality as the initial documented sign of FCI. The presence of FCI vs. not was associated with lower survival to decannulation (p = 0.007).</p><p><strong>Conclusions: </strong>In this single-center retrospective series, 2015-2023, the majority of ECLS-related FCIs were evident within 48 hours of ECLS cannulation, decannulation, or circuit interruption. These events warrant increased surveillance for neurologic complications.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753776","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":"Just Because I Can't Talk Doesn't Mean I Have Nothing to Say.","authors":"Ann Schrooten, Barry Markovitz","doi":"10.1097/PCC.0000000000003741","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003741","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753780","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":"Syndecan-1 As a Clinical Marker of Fluid Overload and Acute Kidney Injury.","authors":"Venu Amula","doi":"10.1097/PCC.0000000000003740","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003740","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753820","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":"Pediatric Rapid Ultrasound for Shock and Hypotension Phenotype Differentiation in the Emergency Department: Evaluation of Feasibility and Reliability in a Malawi Cohort.","authors":"Roxanne Assies, Yamikani Chimalizeni, Mercy Kumwenda, Harriet Khofi, Josephine Langton, Job B M van Woensel, Job C J Calis","doi":"10.1097/PCC.0000000000003735","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003735","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the feasibility, reliability, and diagnostic implications of performing the pediatric Rapid Ultrasound for Shock and Hypotension (p-RUSH) in children with undifferentiated shock upon hospital presentation in a low-resource setting (LRS).</p><p><strong>Design: </strong>Prospective observational study from February 2019 to December 2019.</p><p><strong>Setting: </strong>Pediatric emergency department (ED) of a large academic referral hospital in Blantyre, Malawi.</p><p><strong>Patients: </strong>Children (2 mo to 16 yr old) with shock upon presentation to the pediatric ED.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Thirty children with shock were enrolled, of whom 14 died. The p-RUSH was performed upon admission to the ED, before administration of an IV fluid bolus. The p-RUSH was performed within a median time of 11.5 minutes, and 92.3% of the image frames in 4-second video clips were interpretable. Images were scored by two independent reviewers and the qualitative and quantitative assessments were compared and showed positive correlations as follows: 1) qualitative assessments of cardiac performance vs. left ventricle ejection fraction and fractional shortening measurements (r = 0.684 and r = 0.616, respectively, both p < 0.05) and 2) qualitative assessment of inferior vena cava (IVC) collapsibility vs. IVC collapsibility index (r = 0.470; p < 0.05). The interobserver agreement between cardiac and IVC qualitative assessments yielded a kappa statistic of up to 0.850 (cardiac views) and 0.275 (IVC collapsibility). Both reviewers applied a novel algorithmic flow diagram to diagnose the shock phenotype. In 23 of 30 children, the flowchart could be completed, which suggested either hypovolemic or distributive shock as the most common phenotype.</p><p><strong>Conclusions: </strong>In a Malawian pediatric ED, the p-RUSH was feasible and qualitative assessments were reliable. This 2019 proof-of-concept test provides a basis for further external validation of the p-RUSH and our algorithm for identifying shock phenotypes, which may lead to individualizing care of children presenting with shock in LRSs.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753807","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":"Azithromycin for Critically Ill Children With Bronchiolitis: A U.S. Pediatric Health Information Systems Registry Study, 2013-2022.","authors":"Alexa R Roberts, Nikhil Vallabhaneni, Brett W Russi, Kayla M Delaney, Jennifer W Leiding, Anthony A Sochet","doi":"10.1097/PCC.0000000000003724","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003724","url":null,"abstract":"<p><strong>Objectives: </strong>To estimate prescribing rates for azithromycin as immunomodulation among critically ill children hospitalized for acute bronchiolitis and identify institutional and chronological prescribing variation.</p><p><strong>Design: </strong>Multicenter, observational, retrospective cohort study using the Pediatric Health Information Systems registry from 2013 to 2022.</p><p><strong>Setting: </strong>Forty-seven PICUs in the United States.</p><p><strong>Patients: </strong>Critically ill children 0-3 years old hospitalized for acute viral bronchiolitis excluding those prescribed azithromycin with alternative indication (i.e., concurrent Bordetella pertussis infection, urethritis, atypical pneumonia, acute upper respiratory infections, and asthma-related diagnoses).</p><p><strong>Interventions: </strong>Azithromycin prescription during hospitalization.</p><p><strong>Measurements and main results: </strong>A total of 82,677 children met study criteria of which 3,161 (3.8%) were prescribed azithromycin. Mean (± sd) center-specific azithromycin prescribing rates exhibited a multilinear decreasing trend (joinpoint breakpoint noted in 2017) going from 4.0% ± 4.6% in 2013 to 2.2% ± 0.8% in 2022 (-0.7%/yr). The median institutional azithromycin prescribing rate was 2.8% (interquartile range [IQR], 1.8-3.9%; total range, 1.2-24.3%). Compared with those not prescribed azithromycin, receipt of azithromycin was associated with the following: older age (median, 10 mo [IQR, 3.2-20.3 mo] vs. 7.8 mo [IQR, 2.9-15.2 mo]; p < 0.001); receiving corticosteroids (57.1% vs. 38.1%; p < 0.001) or continuous albuterol (35.9% vs. 22.4%; p < 0.001); use of noninvasive respiratory support (13.4% vs. 9.7%; p < 0.001) or invasive ventilation (35.9% vs. 22.4%; p < 0.001); and extracorporeal life support (0.5% vs. 0.1%; p < 0.001).</p><p><strong>Conclusions: </strong>In this 2013-2022, U.S. multicenter registry-based cohort study, the azithromycin prescribing rate for critically ill children with bronchiolitis was 3.8%. Exposure varied by institution, patient age, and revealed a decreasing trend over the last decade.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731052","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":"Enteral Nutrition During Noninvasive Ventilation in the PICU: Single-Center Retrospective Study, 2019-2023.","authors":"Jeremy M Neese, Ran Zhang, Kimberly E McMahon","doi":"10.1097/PCC.0000000000003734","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003734","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate our practice and complications of enteral nutrition (EN) in pediatric patients supported with noninvasive positive pressure ventilation (NIPPV), excluding high-flow nasal cannula.</p><p><strong>Design: </strong>Retrospective study.</p><p><strong>Setting: </strong>Single PICU in a tertiary children's hospital.</p><p><strong>Patients: </strong>We included children (birth to 18 yr old) who were admitted between January 2019 and June 2023 and who received at least 24 hours of NIPPV. We excluded patients on home NIPPV, those dependent on parenteral nutrition, and those undergoing abdominal pathology, which precluded using EN.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We characterized and evaluated our PICU patients on NIPPV and analyzed the associated odds of initiating EN. Characteristics analyzed included age, duration and type of NIPPV, route of EN delivery, time to initiate and reach goal EN, use of sedation, and preceding intubation during admission. Complications reviewed included emesis, aspiration, radiograph exposure for feeding tube placement, intubation, and death. Overall, there were 512 separate episodes of NIPPV of which 204 required EN with about two-thirds via a post-pyloric feeding tube. Initiation of EN occurred by a median of 24 hours of NIPPV and goal calories were reached by a median of 39 hours. After multivariable analysis, episodes of NIPPV associated with greater odds of EN had medical complexity and longer NIPPV duration. Age 1 year young or younger was associated with greater odds of using EN. Emesis occurred in 36 NIPPV episodes, and there were only three aspiration events. In all episodes of NIPPV, use of EN was associated with longer PICU and hospital lengths of stay.</p><p><strong>Conclusions: </strong>EN is often limited in children receiving NIPPV. In our single-center review, few complications were noted when providing EN to children during NIPPV. As use continues to increase, further research is warranted to clarify the role of EN and its relationship to length of stay while on NIPPV.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143720632","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":"Opportunity Knocks? Toward Improving Outcome in Children With Acquired Brain Injury.","authors":"Amanda M Dave, Gabriella Giugliano, Robert S B Clark","doi":"10.1097/PCC.0000000000003729","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003729","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701129","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":"Parsimonious Electronic Health Record-Based Models to Assign Subphenotypes in Children With Acute Respiratory Distress Syndrome.","authors":"Benjamin Yoon, Tellen D Bennett","doi":"10.1097/PCC.0000000000003733","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003733","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693080","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}