Pediatric Critical Care Medicine最新文献

{"title":"Old Wine in New Bottles-The Inferior Vena Cava May Be Useful As Part of a Multimodal Monitoring System.","authors":"Suchitra Ranjit, Rajeswari Natraj, M Ignacio Monge García","doi":"10.1097/PCC.0000000000003845","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003845","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252186","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":"Three-Year Follow-Up of PICU Survivors: Time Course of Neurodevelopmental Sequelae in a Single-Center Cohort, Recruited 2017-2018.","authors":"Sarah A Sobotka, Emma J Lynch, Neethi P Pinto","doi":"10.1097/PCC.0000000000003832","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003832","url":null,"abstract":"<p><strong>Objectives: </strong>To use a multidimensional outcomes portfolio to assess neurodevelopmental sequelae among PICU survivors during the first 3 years after hospital discharge.</p><p><strong>Design: </strong>Prospective study of a cohort recruited 2017-2018, with interval follow-up for 3 years.</p><p><strong>Setting: </strong>PICU at an urban academic tertiary care center.</p><p><strong>Patients: </strong>Children 0-17 years admitted to the PICU with anticipated discharge home.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We evaluated outcomes using a PICU Outcomes Portfolio (POP) survey, which combined a study-specific Healthcare and Neurodevelopmental Profile and the Family Impact Survey and standardized measurement tools, including the Pediatric Quality of Life Inventory, the Strengths and Difficulties Questionnaire, and the National Institute for Children's Health Quality Vanderbilt Assessment Scales, to identify various components of post-PICU challenges. Our POP survey identified a sustained impact of child health on family finances and parental employment. Our multidimensional outcomes assessment flagged more at-risk children than individual measures of neurodevelopmental functioning.</p><p><strong>Conclusions: </strong>Children and families face diverse challenges during recovery from critical illness. Parent-reported outcomes and a multidimensional outcomes portfolio identify the broad impact of critical illness on family well-being as well as the long-term outcomes among PICU survivors. Future mixed-methods studies incorporating parental input regarding post-discharge needs are needed to enrich the evaluation of post-PICU outcomes using standardized measures and guide the development of post-PICU follow-up programs.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252131","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":"Platelet Count Trajectory and Survival in Children With Sepsis: Single-Center Retrospective Study in China, 2015-2023.","authors":"Xin Luo, Huan Li, Xiaofeng Feng, Liwei Zeng, Lingling Tang, Biting Li, Chunming Gu, Jinfeng Ye, Feng Zhong, Mingyong Luo","doi":"10.1097/PCC.0000000000003836","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003836","url":null,"abstract":"<p><strong>Objectives: </strong>In children with sepsis, thrombocytopenia is linked to poor outcomes, including longer hospital length of stay, increased bleeding risk, and higher mortality. However, the clinical significance of changes in platelet counts over time remain poorly characterized. We have examined dynamic platelet patterns and their association with mortality and patient-illness factors.</p><p><strong>Design: </strong>Single-center retrospective cohort study.</p><p><strong>Setting: </strong>Hospital pediatrics and PICU at Guangdong Women and Children Hospital, China.</p><p><strong>Patients: </strong>Children with sepsis between January 2015 and December 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Group-based trajectory analysis was used to examine the trend in platelet count during the first 7 days of hospital admission. A regression model was developed to investigate possible associations between patient characteristics with platelet count trajectory. Additionally, a multivariable Cox proportional hazards model, adjusted for age, sex, comorbidities, and site/source of infection, was constructed to evaluate the association between platelet count trajectories and 28-day mortality. Among 1010 children with sepsis, we identified three platelet count trajectories with distinct characteristics. Age, fibrinogen level, activated partial thromboplastin time, and lactic acid were each associated with platelet count trajectories. The overall 28-day mortality for the cohort was 5.4%, varying across groups: 1.2% in group 3 with persistently high platelet count; 2.2% in group 2 with high-normal platelet count; and 12.6% in group 1 with low platelet count. In the multivariable Cox proportional hazards model, compared with group 1, both groups 2 and 3 were independently associated with reduced hazard of death at 28 days (hazard ratio, 0.26; p < 0.001 for group 2 and hazard ratio, 0.18; p = 0.021 for group 3).</p><p><strong>Conclusions: </strong>We have identified three distinct and clinically relevant platelet count trajectories in children with sepsis, which serve as robust associations with survival in this patient population.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239328","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":"Social Determinants of Health and Delirium in the PICU: Secondary Analysis of a 2014-2015 Observational Dataset.","authors":"Kate Madden, Caroline Andy, Evan T Sholle, Linda M Gerber, Chani Traube","doi":"10.1097/PCC.0000000000003838","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003838","url":null,"abstract":"<p><strong>Objectives: </strong>To explore the association between geospatial determinants of health and prevalence of delirium in the PICU.</p><p><strong>Design: </strong>Nonprespecified secondary analysis of an observational study dataset.</p><p><strong>Setting: </strong>Urban academic tertiary care PICU.</p><p><strong>Patients: </strong>All children admitted over a 12-month period in 2014-2015.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Of 1547 admissions, there were individual 1264 patients, with race and ethnicity subgroup recorded for 961 (76%), insurance status for 1240 (98%), and language for 1227 (97%). Child Opportunity Index (COI) was determined by a patient's 2010 Census Tract and was available for 1246 (98%). Data were grouped from 1 to 5 (very low to very high). PICU delirium (PD) was present in 193 patients during PICU admission, with PD rates highest in Asian/Pacific Islander, Black non-Hispanic, and Hispanic (respectively, 26, 29, and 39 patients) as compared with White non-Hispanic children (n = 45; p < 0.001). PD was higher for patients with public insurance (113/573 [20%]) compared with those with private insurance (67/583 [12%]) and those with \"other\" (8/84 [10%]) forms of support (p < 0.001). We failed to identify a difference in delirium rates by language preference. A higher prevalence of delirium was present among patients in the lowest COI groups (1-3) as compared with highest (4-5; 135/748 [18%] vs. 55/494 [11%]; p = 0.003). In multivariable analysis, COI was associated with greater adjusted odds of delirium (after adjusting for other demographic and clinical predictors of delirium, including age, developmental disability, severity of illness at admission, need for invasive mechanical ventilation, depth of sedation, and medication exposures), with adjusted odds ratio of 1.55 (95% CI, 1.05-2.3; p = 0.028).</p><p><strong>Conclusions: </strong>In a 2014-2015 PICU dataset, we have identified an association between lower COI and greater adjusted odds of delirium. This finding calls for further study to investigate potential mediators of this relationship.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239336","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":"The Costs of Prevention Implementation: Did We Wait Long Enough to Assess the Value of the Cure?","authors":"Vanessa Toomey, Julia A Heneghan","doi":"10.1097/PCC.0000000000003819","DOIUrl":"10.1097/PCC.0000000000003819","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1291-e1293"},"PeriodicalIF":4.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001224","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":"Red Cell Transfusion During Pediatric Intensive Care: A 28-Day Point Prevalence Study in Three European Countries in 2023.","authors":"Laura Butragueño-Laiseca, Samiran Ray, Avishay Sarfatti, Simon J Stanworth, Roi Campos Rodríguez, Ana Gómez-Zamora, Alexandra Hernández Yuste, Isabel Benítez Gómez, Gema de Lama Caro-Patón, Chiara Giorni, Elisabetta Lampugnani, Marco Daverio, Fabrizio Chiusolo","doi":"10.1097/PCC.0000000000003805","DOIUrl":"10.1097/PCC.0000000000003805","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the prevalence of RBC transfusion in children admitted to PICUs in three European countries and to determine hemoglobin threshold, triggers, and outcomes for transfusions.</p><p><strong>Design: </strong>International 4-week point prevalence study in 2023.</p><p><strong>Setting: </strong>Forty-four PICUs across Spain, the United Kingdom, and Italy.</p><p><strong>Patients: </strong>PICU patients 1 month to 17 years old receiving RBC transfusion.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>During four prespecified 7-day blocks (from March 2023 to July 2023), 348 of 2713 patients (12.8%) received at least one RBC transfusion, accounting for 527 transfusions. The proportion of patients receiving RBC transfusion in Italy, the United Kingdom, and Spain was 17.3% (66/382), 13.9% (166/1195), and 10.2% (116/1136), respectively. The primary indication for transfusion in the 527 transfusion events was hemoglobin level (54.6%), followed by bleeding (10.6%), cardiovascular instability (10.5%), and extracorporeal support (10.1%). In 45.1% of RBC transfusions, there was no other physiologic trigger apart from hemoglobin. The median (interquartile range [IQR]) hemoglobin level before transfusion was 8.3 g/dL (IQR, 7.2-9.9 g/dL), with median values varying significantly among Spain, the United Kingdom, and Italy, respectively, 7.8 vs. 8.6 vs. 8.9 g/dL ( p < 0.001). When excluding cardiac patients, overall median hemoglobin threshold was 7.4 g/dL (IQR, 6.8-8.6 g/dL) and was comparable across the three countries ( p > 0.05). The overall 28-day PICU mortality in 348 patients receiving transfusions was 10.7%. The number of transfusions was associated with mortality, even after adjusting for reason for admission and admission Pediatric Index of Mortality score.</p><p><strong>Conclusions: </strong>In 44 European PICUs in 28 days during 2023, 12.8% of critically ill children received one or more RBC transfusions during their PICU stay. Hemoglobin level was the primary determinant for transfusion, often exceeding the recommended 7.0 g/dL threshold. Other clinical triggers are rarely considered. Defining hemoglobin thresholds and adopting a goal-directed transfusion strategies may optimize clinical transfusion practices.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1231-e1241"},"PeriodicalIF":4.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795022","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":"Stop the Clot: A Quality Improvement Initiative to Reduce the Rate of Venous Thromboembolism in the PICU.","authors":"Robert Murray, Jordan Brauner, Mike Welty, Jennifer Gauntt, Charles Treinen, Jennifer A Muszynski, Colleen Cloyd, Vilmarie Rodriguez","doi":"10.1097/PCC.0000000000003809","DOIUrl":"10.1097/PCC.0000000000003809","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to reduce the rate of hospital-acquired venous thromboembolism (HA-VTE) in the PICU by 50% from 2.07 to 1.04 venous thromboembolism (VTE) per 1000 patient days by June 2023 and sustain this change for 6 months.</p><p><strong>Design: </strong>Prospective quality improvement project.</p><p><strong>Setting: </strong>The PICU of an urban academic free-standing children's hospital in the United States.</p><p><strong>Patients: </strong>All patients admitted to the PICU between December 2020 and December 2023.</p><p><strong>Interventions: </strong>We identified key drivers including: provider knowledge gaps surrounding VTE risk in our patient population, identification of patients at risk of VTE, the absence of appropriate screening and prevention tools, and central venous line duration and location. These key drivers were each addressed with the most significant intervention being the creation of a simple screening tool to identify and provide thromboprophylaxis recommendations for patients most at risk for developing VTE.</p><p><strong>Measurements and main results: </strong>We identified the monthly occurrence rate of VTE as our outcome measure, the provision of VTE thromboprophylaxis as our process measure and the presence of bleeding events as our balancing measure. The rate of VTE in PICU patients decreased from 2.07 to 1.14 per 1000 patient days. There was an increase in the provision of pharmacologic thromboprophylaxis during our intervention period from 36% to 42% with no change in the rate of mechanical thromboprophylaxis. There were only two instances of clinically relevant non-major bleeding as defined by the International Society of Thrombosis and Haemostasis definition in nonsurgical patients on anti-hemostatic agents during our intervention period. There was a decrease in central venous catheter days from 43% to 31% of PICU patient days during the intervention period.</p><p><strong>Conclusions: </strong>Upon implementing a protocolized screening and prevention tool for VTE, we observed a decreased occurrence of HA-VTE.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1208-e1217"},"PeriodicalIF":4.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795023","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":"Old Tool-New Use.","authors":"Robert I Parker","doi":"10.1097/PCC.0000000000003820","DOIUrl":"10.1097/PCC.0000000000003820","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1294-e1295"},"PeriodicalIF":4.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001261","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":"What is the New Research in Pediatric Critical Illness-Related Delirium Since the 2022 Clinical Practice Guidelines.","authors":"Robert C Tasker","doi":"10.1097/PCC.0000000000003831","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003831","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 10","pages":"e1286-e1290"},"PeriodicalIF":4.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252189","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":"Early Rehabilitation Bundle in a Canadian PICU: Cost Analysis of Implementation in 2018-2020.","authors":"Shira Gertsman, Sureka Pavalagantharajah, Lindsey Falk, Sayem Borhan, Kevin Kennedy, Lehana Thabane, Feng Xie, Cynthia Cupido, Karen Choong","doi":"10.1097/PCC.0000000000003806","DOIUrl":"10.1097/PCC.0000000000003806","url":null,"abstract":"<p><strong>Objectives: </strong>First, to determine the resources and costs required to implement an early rehabilitation (ABCDEF) bundle. Second, to compare the impact of the bundle on costs pre- and post-implementation.</p><p><strong>Design and setting: </strong>Cost analysis was conducted as part of an implementation study at McMaster Children's Hospital PICU in 2018-2020.</p><p><strong>Measurements and main results: </strong>Resource estimates for all implementation activities from 2018 to 2020 were calculated from material costs and hours spent by personnel multiplied by wages. PICU and patient-level costs before (from January 2019 to March 2019) and after bundle implementation (from January 2020 to March 2020) were compared using case-costing data. Linear regression was used to analyze log-transformed costs adjusted for age, sex, and severity of illness score. Costs are reported in Canadian dollars (CAD). A total of 907 hours were spent over a 2-year implementation period, at an estimated cost of CAD 50,813. Physicians contributed the most hours, followed by the nurse educator and pharmacist. Material costs were CAD 860. There were 141 patients pre-implementation and 84 patients post-implementation in the analyses. Adjusted mean PICU cost per patient was CAD 17,342 and CAD 20,310, pre- to post-implementation, respectively; mean difference (95% CI) between post- and pre-implementation was 17% higher (95% CI, from 6.3% lower to 46% higher). Adjusted mean pharmacy cost per patient was CAD 834 pre-implementation and CAD 827 post-implementation; mean difference of 0.8% lower post-implementation (95% CI, from 27% lower to 35% higher).</p><p><strong>Conclusions: </strong>Implementation of the ABCDEF bundle requires significant time and collaboration of key stakeholders. There was no impact on PICU or patient costs following bundle implementation, but the period of observation was limited by COVID-19. Future studies should include cost analyses that incorporate longer-term, patient-centered health outcomes to determine whether this intervention is cost-effective.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1198-e1207"},"PeriodicalIF":4.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795020","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}