Pediatric Critical Care Medicine最新文献

{"title":"The Phoenix Criteria for Pediatric Sepsis.","authors":"Christopher M Horvat, Johanna R Rosen, Joseph Carcillo","doi":"10.1097/PCC.0000000000003762","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003762","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079212","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":"Group Peer Mentoring: A Strategy to Promote Career Development and Improve Well-Being Among Early-Career Faculty in Pediatric Critical Care Medicine.","authors":"L Nelson Sanchez-Pinto, Colleen M Badke, Linda Pololi","doi":"10.1097/PCC.0000000000003763","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003763","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079210","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 Take the Two Minutes\".","authors":"May Shum","doi":"10.1097/PCC.0000000000003768","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003768","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019556","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":"Point-of-Care Ultrasound in Pediatric Resuscitation? What's All the Rapid Ultrasound for Shock and Hypotension About?","authors":"Sebastian C Tume, Erik Su","doi":"10.1097/PCC.0000000000003761","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003761","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047540","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":"Extubation Practices and Outcomes During Pediatric Respiratory Extracorporeal Membrane Oxygenation: Analysis of the Extracorporeal Life Support Organization Registry, 2018-2022.","authors":"Christina R Rufener, Zaineb Boulil, Denise M Suttner, David K Werho, Helen A Harvey, Erica I Bak, Nicole O'Brien, Sapna R Kudchadkar, Nicole G Coufal","doi":"10.1097/PCC.0000000000003711","DOIUrl":"10.1097/PCC.0000000000003711","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the outcomes associated with extubation during extracorporeal membrane oxygenation (ECMO) in pediatric patients.</p><p><strong>Design: </strong>Retrospective cohort study using the Extracorporeal Life Support Organization (ELSO) registry, 2018-2022.</p><p><strong>Setting: </strong>Multicenter and international database of all ECMO centers in the ELSO registry.</p><p><strong>Patients: </strong>Patients between 30 days and 18 years old receiving pulmonary ECMO support.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Overall, 2178 patients were included, of which 105 were extubated during ECMO support (4.8%). Analysis of pre-ECMO data failed to identify an association between extubation strategy and severity using the Pediatric Pulmonary Rescue with ECMO Prediction (P-PREP) score. Use of extubation, vs. not, was associated with older age (median, 6.1 vs. 2.5 yr; p = 0.006), and longer ECMO duration (median 12.9 vs. 7.1 d; p < 0.0001). We failed to identify an association between the use of extubation, vs. not, and ECMO complications. In a propensity matching analysis with 3:1 matching of nonextubated to extubated cases, mortality was 34.3% and 43.8%, respectively ( p = 0.08). In the matched subset, extubation, vs. not, was associated with shorter median PICU length of stay (LOS) after decannulation (6.6 vs. 12.2 d; p = 0.001) and higher use of mobilization (28.6% vs. 9.8%; p < 0.0001). In a multivariable analysis, we failed to identify an association between using the extubation strategy, vs. not, and greater odds of mortality (odds ratio, 1.74; 95% CI, 0.94-3.27; p = 0.08). However, we cannot exclude the possibility that the use of an extubation strategy is associated with greater odds of mortality.</p><p><strong>Conclusions: </strong>In the 2018-2022 ELSO registry data, extubating pediatric patients on ECMO for pulmonary cause was an uncommon practice, associated with improved mobility and decreased ICU LOS after ECMO decannulation. However, given the concerns about mortality, careful consideration of patient candidacy and further studies are needed.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e680-e688"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458811","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":"Acute Respiratory Distress Syndrome in Children With Lower Respiratory Tract Infection Requiring Invasive Mechanical Ventilation: Post Hoc Analysis of the 2019-2020 Bronchiolitis and Codetection Cohort.","authors":"Benjamin R White, Lee Polikoff, Robin Alexander, Benjamin R Baer, Alexandre T Rotta, Sebastián González-Dambrauskas, Ledys M Izquierdo, Pablo Castellani, Christopher M Watson, Ryan A Nofziger, Steven Pon, Todd Karsies, Steven L Shein","doi":"10.1097/PCC.0000000000003712","DOIUrl":"10.1097/PCC.0000000000003712","url":null,"abstract":"<p><strong>Objectives: </strong>Bronchiolitis and other lower respiratory tract infections (LRTIs) are the most common causes of pediatric respiratory failure. There is insufficient evidence characterizing pediatric acute respiratory distress syndrome (PARDS) in young children with LRTI to inform clinical management. We aimed to describe the prevalence and clinical characteristics of children intubated for LRTI and meeting PARDS criteria.</p><p><strong>Design: </strong>We performed a post hoc analysis of data from the Bronchiolitis And COdetectioN (BACON) study, an international prospective observational study of critical bronchiolitis. We compared PARDS subjects (meeting criteria the first full calendar day following intubation) to non-PARDS subjects.</p><p><strong>Setting: </strong>Forty-eight international PICUs recruiting to the BACON study, from December 2019 to November 2020.</p><p><strong>Patients: </strong>Children younger than 2 years old, requiring mechanical ventilation for acute LRTI.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Complete data were available for 571 children. Day 1 PARDS was diagnosed in 240 subjects(42%) and associated with increased mortality (7.9% vs. 2.7%; p = 0.023), greater duration of invasive ventilation (165 hr [interquartile range, 112-251 hr] vs. 135 hr [76-204 hr]; p < 0.001), and PICU length of stay (11 d [7-16 d] vs. 8 d [5-13 d]; p < 0.001). In our multivariable competing risk model, the presence of PARDS on day 1 was causally related to a prolonged duration of mechanical ventilation with the probability of extubation at 7 days for those with PARDS equal to 49% (44-54%) compared with 64% (59-69%) for those without PARDS.</p><p><strong>Conclusions: </strong>PARDS development was common in this critical bronchiolitis cohort, resulted in a longer duration of mechanical ventilation, and was associated with increased mortality and PICU length of stay. Prospective studies are needed to elucidate the optimal management of critical bronchiolitis.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e600-e610"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567782","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":"10.1097/PCC.0000000000003733","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e735-e737"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","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}

{"title":"Sepsis in Critically Ill Children in Bolivia: Multicenter Retrospective Evaluation of the Phoenix Criteria for Sepsis in a 2023 Cohort.","authors":"Raul Copana-Olmos, Nils Casson-Rodriguez, Willmer Diaz-Villalobos, Victor Urquieta-Clavel, Mary Tejerina-Ortiz, Carol Mendoza-Montoya, Maricruz Fernandez-Vidal, Mariel Forest-Yepez, Danny Blanco-Espejo, Ibeth Rivera-Murguia, Claudia Castro-Auza, Milenka Gamboa-Lanza, Jhovana E Paco-Barral, Gustavo Choque-Osco, Betzhi Vera-Dorado, Magbely Cuellar-Gutierrez, Alan J Sarmiento-Zurita, Michelle G Carrillo-Vargas, Brisa W Ledezma-Hurtado, L Nelson Sanchez-Pinto","doi":"10.1097/PCC.0000000000003714","DOIUrl":"10.1097/PCC.0000000000003714","url":null,"abstract":"<p><strong>Objectives: </strong>We evaluated the Phoenix criteria and the Phoenix Sepsis Score in a multicenter retrospective cohort of critically ill children with a clinical diagnosis of sepsis or septic shock in Bolivia. In addition, we aimed to assess whether management in a PICU at high altitude in the Bolivian Andes was associated with the performance of the respiratory dysfunction component in the Phoenix Sepsis Score.</p><p><strong>Design: </strong>Multicenter retrospective cohort study.</p><p><strong>Setting: </strong>Fourteen PICUs in Bolivia.</p><p><strong>Patients: </strong>Children admitted to the PICU with a clinical diagnosis of sepsis or septic shock from January 2023 to December 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>There were 273 patients with a diagnosis of sepsis in 2023, of which 257 (94.1%) met the 2024 Phoenix criteria for sepsis, and 166 (60.8%) met the systemic inflammatory response syndrome (SIRS)-based criteria for sepsis. Among the 257 patients meeting Phoenix sepsis criteria, 86 died (33.5%). Of the patients with Phoenix-based sepsis, there were 100 of 257 (38.9%) who were SIRS-negative, and 27 of 100 died (27.0%). After correcting the oxygenation indices for altitude, 149 of 273 patients (54.6%) had a lower Phoenix respiratory score and an associated mortality more consistent with the expected mortality of the newly derived subscore. Patients at higher altitudes had higher hemoglobin levels and higher estimated oxygen carrying capacity, and these data were independently associated with lower odds of mortality after controlling for altitude-corrected Phoenix score.</p><p><strong>Conclusions: </strong>In this 2023, retrospective cohort of PICU patients with sepsis in Bolivia, we have found that the majority met the 2024 Phoenix sepsis criteria, but less than two-thirds met the SIRS-based criteria for diagnosis. However, the respiratory score in the Phoenix criteria overestimated the severity of respiratory dysfunction in more than half of the cohort, likely because the score does not take account of the Andean adaptation to high altitude, with higher oxygen carrying capacity.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e699-e707"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458841","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":"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":"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":"e708-e717"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","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":"Extubation Failure in Neonates Following Congenital Cardiac Surgery: Multicenter Retrospective Cohort, 2017-2020.","authors":"Daniel L Hames, Qalab Abbas, Ahmed Asfari, Santiago Borasino, J Wesley Diddle, Avihu Z Gazit, Stuart Lipsitz, Amanda Marshall, Katherine Reise, Luciana Rodriguez Guerineau, Joshua S Wolovits, Joshua W Salvin","doi":"10.1097/PCC.0000000000003703","DOIUrl":"10.1097/PCC.0000000000003703","url":null,"abstract":"<p><strong>Objectives: </strong>Extubation failure (EF) in neonates recovering from congenital cardiac surgery is associated with morbidity and mortality. Adding continuous physiologic monitoring data and risk analytics algorithms to clinical factors has the potential to assist clinicians in identifying those neonates at high risk for EF. We aimed to evaluate the association of two physiologic risk analytics algorithms evaluating the probability of inadequate delivery of oxygen index (ID o2 ) and inadequate ventilation of carbon dioxide index (IV co2 ) with EF in neonates receiving mechanical ventilation (MV) after cardiac surgery. A secondary aim was to evaluate the clinical factors associated with EF.</p><p><strong>Design: </strong>Multicenter retrospective cohort study.</p><p><strong>Setting: </strong>Eight international pediatric cardiac ICUs.</p><p><strong>Patients: </strong>Neonates (age < 1 mo at the time of surgery) receiving MV for longer than 48 hours following cardiac surgery between January 1, 2017, and December 31, 2020.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Data from 736 neonates were analyzed with 102 (13.9%) having EF (defined as reintubation within 48 hr of extubation). In multivariable analysis (odds ratio [OR] and 95% CI), preoperative respiratory support (OR, 1.72 [95% CI, 1.11-2.67]) was associated with greater odds of EF. In all, 611 neonates had pre-extubation ID o2 data and 478 neonates had both pre-extubation ID o2 and IV co2 data. In multivariable analysis of patients with both pre-extubation ID o2 and IV co2 data, single ventricle anatomy (OR, 2.50 [95% CI, 1.27-4.92]) and high ID o2 (≥ 25) or high IV co2 (≥ 50) in the 2 hours preceding extubation (OR, 1.77 [95% CI, 1.01-3.12]) were associated with greater odds of EF.</p><p><strong>Conclusions: </strong>In this 2017-2020 cohort, EF is high in post-cardiac surgery neonates receiving at least 48 hours of MV. The ID o2 and IV co2 algorithms may be useful in assessing risk of EF in such neonates.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e590-e599"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382898","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}