Pediatric Critical Care Medicine最新文献

{"title":"Critical Care Diaries: A Promising Intervention to Mitigate the Consequences of Secondary Trauma From a PICU Stay?","authors":"Michelle R Mayeda, Donald L Boyer","doi":"10.1097/PCC.0000000000004070","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004070","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220602","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":"Interpreting Volumetric Estimates of Transpulmonary Pressure in Mechanically Ventilated Children: Physiologic Cautions.","authors":"Rajkumar Kundavaram, Amber Kumar","doi":"10.1097/PCC.0000000000004051","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004051","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137556","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 authors reply.","authors":"Farhan A Rashid Shaikh, Monesh Kethineni Bhaskaran, Martin C J Kneyber","doi":"10.1097/PCC.0000000000004066","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004066","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137642","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":"Do Acute Kidney Injury Phenotypes MAKE a Difference in Extracorporeal Membrane Oxygenation?","authors":"James D Fortenberry","doi":"10.1097/PCC.0000000000004061","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004061","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113115","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":"Persistent Inflammation, Immunosuppression, and Catabolism Syndrome in Children: Associations With Outcomes in a Secondary Analysis of a 2019-2024 Cohort.","authors":"Soichiro Tanimura, Norihiko Tsuboi, Eisaku Nashiki, Saki Endo, Shin Tsubokura, Shuichi Ito, Shiro Hinotsu, Shotaro Matsumoto","doi":"10.1097/PCC.0000000000004063","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004063","url":null,"abstract":"<p><strong>Objectives: </strong>To identify the clinical and physiologic factors associated with mortality in pediatric patients with persistent inflammation, immunosuppression, and catabolism syndrome (PIICS).</p><p><strong>Design: </strong>Secondary analysis of a single-center cohort, 2019-2024.</p><p><strong>Setting: </strong>PICU at a tertiary children's hospital in Japan.</p><p><strong>Patients: </strong>We reviewed data on all patients younger than 21 years who had been admitted to the PICU for greater than or equal to 15 consecutive days between 2019 and 2024. Pediatric PIICS was defined as: C-reactive protein greater than 2 mg/dL, albumin less than 3 g/dL, and lymphocyte count less than 800/µL.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Among 536 patients, we identified 64 who met criteria for pediatric PIICS. Cox proportional hazards models were used to examine factors associated with greater hazard of mortality, and proportional hazards assumptions were assessed using hazard smoothing. In the primary time-to-event analysis, severity of diarrhea, maximum heart rate ratio (mHR-r), and cumulative hypotension exposure were associated with greater hazard of mortality. The Youden-derived cutoffs were 6.5 for diarrheal severity, 1.67 for mHR-r, and 63 hours for cumulative hypotension exposure. Analysis of Kaplan-Meier curves showed that lower survival was associated with data above these thresholds. However, in the sensitivity analyses evaluating confounding by case-mix and baseline severity, we failed to identify that diarrhea was associated with greater odds of mortality. Cumulative hypotension exposure and mHR-r remained consistent physiologic markers associated with greater hazard of mortality.</p><p><strong>Conclusions: </strong>In this secondary analysis of pediatric patients with PIICS, the mHR-r and cumulative hypotension exposure were associated with greater hazard of mortality. Severe diarrhea showed an association with mortality in the primary time-to-event analysis, but we failed to identify such an association after adjustment for case-mix and baseline severity. These findings suggest that diarrhea may be a clinically relevant marker of gastrointestinal dysfunction, but its prognostic role remains uncertain. Larger multicenter studies are needed.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113160","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 Impact of PICU Diaries on Posttraumatic Stress Disorder and Psychological Distress in Parents of Critically Ill Children Admitted to PICUs: A Randomized Cluster Crossover Trial.","authors":"Fernanda de Carvalho Lima, Michael Eduardo Reichenheim, Maria Clara de Magalhães-Barbosa, Evandro da Silva Freire Coutinho, Antonio Ponce de Leon, Pedro Henrique Nunes Costa Silami, Luciane Stochero, Jaqueline Rodrigues Robaina, Mariana Barros de Genuíno-Oliveira, Deylaine Lourenço Pacheco, Fabíola Pereira Borba, Maria Carvalho Laborne Valle, Melissa de Lorena Jacques, Ana Carolina Cabral Pinheiro Scarlato, Karla Gonçalves Camacho, Margarida Dos Santos Salú, Antonio José Ledo Alves da Cunha, Arnaldo Prata-Barbosa, Claudia Leite de Moraes","doi":"10.1097/PCC.0000000000004059","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004059","url":null,"abstract":"<p><strong>Objectives: </strong>The study aimed to assess the effect of using diaries during hospitalization in a PICU on the occurrence of posttraumatic stress disorder (PTSD) and psychologic distress among family members of critically ill children.</p><p><strong>Design: </strong>A two-arm, two-period, cluster-randomized, crossover trial.</p><p><strong>Settings: </strong>Four PICUs in Rio de Janeiro, Brazil.</p><p><strong>Patients: </strong>From December 2019 to December 2021, the primary caregiver of each child (age 29 d to 12 yr) admitted to the participant PICUs for more than 36 hours was enrolled in the trial.</p><p><strong>Interventions: </strong>The intervention consisted of providing diaries for the healthcare team, parents, and visitors to complete, including photographs of events during hospitalization. The standard practice served as the control group.</p><p><strong>Measurements and main results: </strong>The primary outcomes were the incidence of PTSD and psychologic distress in the primary caregiver 60 days after PICU discharge. PTSD was screened using the Posttraumatic Stress Disorder Checklist (PCL-5) instrument, and psychologic distress was assessed using the Hospital Anxiety and Depression Score. Of the 431 primary caregivers included, 339 were analyzed for PTSD, and 335 for psychologic distress. The use of diaries resulted in an average decrease of 2.97 points in the total PCL-5 score (p = 0.012) and a 42% reduction in the incidence of PTSD symptoms (incidence rate ratio [IRR], 0.58; p < 0.001). Diaries also reduced the incidence of psychologic distress (anxiety and/or depression symptoms) by 25% among the intervention group (IRR, 0.75; p = 0.009).</p><p><strong>Conclusions: </strong>This trial reinforces the potential of PICU diaries as a family-centered intervention to reduce the incidence of PTSD symptoms and psychologic distress among caregivers of critically ill children. Given their low-cost, pragmatic nature, PICU diaries may represent a promising strategy for supporting family mental health in the PICU setting.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113193","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":"Development of a Simple MRI Scoring Tool in Severe Pediatric Traumatic Brain Injury: Secondary Analysis of the 2014-2017 \"Approaches and Decisions in Acute Pediatric TBI Trial (ADAPT)\" Multicenter Study.","authors":"Anna M Janas, Furkan Camci, Aimee T Broman, Susan Rebsamen, Aaron S Field, Kerri L LaRovere, Bedda L Rosario, Michael J Bell, Andrew L Alexander, Peter A Ferrazzano","doi":"10.1097/PCC.0000000000004033","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004033","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to describe the frequency, depth, and co-occurrence of different intracerebral injury types detected on the first clinical brain MRI in children with severe traumatic brain injury (TBI) and to derive a simple MRI scoring system associated with 12-month functional outcome.</p><p><strong>Design: </strong>Secondary analysis of the Approaches and Decision in Acute Pediatric TBI (ADAPT) multicenter 2014 to 2017 study.</p><p><strong>Setting: </strong>A total of 24 ADAPT sites in the United States, United Kingdom, and Australia.</p><p><strong>Patients: </strong>Children (< 18 yr) with severe TBI who received intracranial pressure monitoring and clinical brain MRI within 30 days of injury.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>MRI was evaluated for lesion type and location, and maximal depth of any lesion was determined for each subject (grade 1, lobar gray and white matter; grade 2, deep gray matter and corpus callosum; grade 3, brainstem). The primary outcome was Glasgow Outcome Scale Extended Pediatric version (GOSE-P) at 12 months, dichotomized to favorable (GOSE-P 1-3) vs. unfavorable (GOSE-P 4-8). In the cohort of 279 patients, we found that the three most frequent lesion types were contusion (78.5%), diffuse axonal injury (70.3%), and ischemia (38.0%). When evaluating maximal injury grade, grade 1 was present in 48 children (17.2%), grade 2 in 103 children (36.9%), and grade 3 in 113 children (40.5%). Injury grade and presence of ischemia were associated with increased odds of unfavorable outcome. Injury depth and ischemia on MRI (IDIOM) were incorporated into a novel six-category MRI Injury Scale, with scores ranging from 1 to 3+ (injury grades 1-3, + indicates presence of any ischemia). We found that score 3+, that is, brainstem injury with ischemia in any location, increased the risk of unfavorable outcome 22.3-fold (95% CI, 6.81-87.37; p < 0.0001) compared with score 1 (injury isolated to lobar gray and white matter, without ischemia).</p><p><strong>Conclusions: </strong>Increased depth of injury and presence of ischemia on MRI are important risk factors for unfavorable outcome in children with severe TBI. We propose a simple MRI scoring system (IDIOM) that incorporates depth of injury and presence of ischemia that may be useful for neuroprognostication, but further validation is required.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113014","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":"Device-Patient Interface Air Leaks During Noninvasive Ventilation: Single-Center Pediatric Experience and Outcomes, 2018-2023.","authors":"Nathalie El-Hawli, Francis-Olivier Beauchamp, Sandrine Essouri, Michaël Sauthier","doi":"10.1097/PCC.0000000000004062","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004062","url":null,"abstract":"<p><strong>Objectives: </strong>Air leaks are common during noninvasive ventilation (NIV) of children in the PICU. We aimed to describe our experience with NIV and study the association between the occurrence of air leaks and clinical parameters, and the median (95% CI) of ventilator-free days (VFDs).</p><p><strong>Design: </strong>Single-center retrospective cohort, 2018-2023, identified in local health databases.</p><p><strong>Setting: </strong>A quaternary children's center PICU in Montréal, Quebec, Canada.</p><p><strong>Patients: </strong>All pediatric patients admitted to the PICU and ventilated with a dual-limb NIV circuit (2018-2023). Only the first 6 hours of NIV per admission were analyzed; repeated admissions were included as separate encounters.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Among 1460 encounters (1292 distinct patients), the median (interquartile range [IQR]) of air leak occurrence was 74% (IQR, 62-83%). Younger age was associated with a higher occurrence of air leaks (p < 0.001): 79% (IQR, 71-86%) in 681 infants 0-6 months old vs. 70% (IQR, 56-82%) in 328 older infants and toddlers 7-24 months old (n = 328, 22%) vs. 66% (IQR, 49-78%) in 451 preschool and school-aged children older than 24 months. A 10% increase in median air leak occurrence during the first 6 hours of NIV was associated with 0.6 fewer VFDs (slope estimate, -0.06 [95% CI, -0.10 to -0.01]). Lower air leaks were associated with higher peak airway pressures (slope estimate, -0.79 [95% CI, -1.44 to -0.15]), higher respiratory rate (slope estimate, -0.19 [95% CI, -0.35 to -0.03]), and greater weight (slope estimate, -0.40 [95% CI, -0.54 to -0.26]).</p><p><strong>Conclusions: </strong>In our center, 2018-2023, high air leaks were frequent during NIV and associated with fewer VFDs. As a potentially modifiable factor, further prospective research is needed to assess the impact of air leaks on outcomes.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113068","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 Noninvasive Ventilation Mask Fit: This Should Not Be a Cinderella Story.","authors":"Rosemijne R W P Pigmans, Reinout A Bem","doi":"10.1097/PCC.0000000000004065","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004065","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113158","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 Kidney Injury After Extracorporeal Membrane Oxygen in Children: Phenotypes and Prognosis in a Single-Center Cohort, 2020-2023.","authors":"Katie Brandewie, Diana Cabrera-Fernandez, Elizabeth Bixler, Pilar Anton-Martin, Andrea Ontaneda, Sameer Thadani","doi":"10.1097/PCC.0000000000004042","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004042","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the association between acute kidney injury (AKI) phenotypes and major adverse kidney events at 30 days (MAKE30) after initiating extracorporeal membranous oxygenation (ECMO).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Neonatal, pediatric and cardiac critical care units at a quaternary children's hospital in the United States.</p><p><strong>Patients: </strong>Children younger than 18 years requiring ECMO between January 2020 and September 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Overall, 284 neonatal and pediatric ECMO patients were included (80% venoarterial, 20% venovenous). MAKE30 occurred in 97 of 284 (34%) patients with persistent renal dysfunction (i.e., estimated glomerular filtration rate < 75% of baseline) in 27 of 284 (9.5%) patients, dialysis requirement in 14 of 284 (4.9%) patients, and death in 56 of 284 (20%) patients. There were 176 of 284 (62%) patients who developed AKI, with a median (interquartile range, IQR) time from cannulation to AKI diagnosis of 2 days (IQR 0-7). AKI was classified as early if diagnosed (≤ 48 hr after cannulation) vs. late (> 48 hr after cannulation) and transient (lasting < 48 hr) vs. persistent (lasting > 48 hr). In patients with AKI, early transient AKI was present in 39 of 176 (22%) patients, early-persistent in 111 of 176 (61%) patients, late transient in 14 of 176 (8%) patients, and late persistent in 17 of 176 (9%) patients. Persistent AKI was independently associated with MAKE30 (adjusted odds ratio 2.36; 95% CI, 1.21-4.75; p = 0.013).</p><p><strong>Conclusions: </strong>In our 2020-2023 experience of pediatric ECMO, persistent AKI occurred frequently and was associated with subsequent MAKE30, whereas we failed to identify such an association in those patients with transient AKI. Further studies are needed to examine the time- and duration-based AKI phenotypes in relation to renal morbidity and patient outcomes.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112960","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}