Pediatric Critical Care Medicine最新文献

{"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}

{"title":"Pediatric Acute Respiratory Distress Syndrome in Bronchiolitis and Lower Airway Infection: What's New?","authors":"Giuseppe A Marraro","doi":"10.1097/PCC.0000000000003732","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003732","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":"143693082","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":"Prevalence and Associated Explanatory Factors for Augmented Renal Clearance in Early Sepsis: Single-Center, Retrospective PICU Cohort in China, 2022-2023.","authors":"Lili Xu, Jiayue Xu, Haoyun Mao, Wen Qian, Zhushengying Ma, Yuru Zhang, Yueniu Zhu, Xiaodong Zhu, Yaya Xu","doi":"10.1097/PCC.0000000000003727","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003727","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to 1) evaluate the prevalence of augmented renal clearance (ARC) in pediatric sepsis patients; 2) analyze potential explanatory factors associated with ARC out of hemodynamic, oxygenation, and inflammatory parameters; and 3) assess ARC outcomes.</p><p><strong>Design: </strong>Retrospective, single-center, cohort from January 2022 to June 2023.</p><p><strong>Setting: </strong>PICU at a tertiary care hospital in China.</p><p><strong>Patients: </strong>Children 28 days to 16 years of age admitted with sepsis defined using Phoenix Sepsis Criteria.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Among 69 patients, 34 (49.3%) were categorized as having ARC. Designation as having ARC, vs. not, was associated with being younger (median 2.4 vs. 7.2 years, p < 0.001), hemodynamic and intrarenal flow changes, and higher C-reactive protein levels (31.0 vs. 12.0 mg/L, p < 0.05). None of the 34 patients with ARC developed acute kidney injury, but 22 of 35 non-ARC patients did. ARC was associated with shorter PICU stays (median 7 vs. 11 days, p < 0.05). Univariate regression analyses identified fluid balance, cardiac function parameters, renal resistive index, and inflammatory markers as explanatory factors associated with ARC.</p><p><strong>Conclusions: </strong>In this retrospective cohort of pediatric sepsis patients admitted to the PICU, the prevalence of early-onset ARC is around 50%, and younger patients may be at risk. The presence of ARC is associated with hemodynamic and inflammatory responses. Taken together, more prospective work is needed, with an emphasis on drug-level targeting and a better understanding of interactions with intrarenal pathophysiology.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664014","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":"In-Hospital Mortality in Mechanically Ventilated Children With Severe Dengue Fever: Explanatory Factors in a Single-Center Retrospective Cohort From Vietnam, 2013-2022.","authors":"Luan Thanh Vo, Viet Chau Do, Tung Huu Trinh, Thanh Tat Nguyen","doi":"10.1097/PCC.0000000000003728","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003728","url":null,"abstract":"<p><strong>Objectives: </strong>Severe dengue fever complicated by critical respiratory failure requiring mechanical ventilation (MV) contributes to high mortality rates among PICU-admitted patients. This study aimed to identify key explanatory variables of fatality in mechanically ventilated children with severe dengue.</p><p><strong>Design: </strong>Retrospective cohort, from 2013 to 2022.</p><p><strong>Setting: </strong>PICU of the tertiary Children's Hospital No. 2, in Vietnam.</p><p><strong>Patients: </strong>Two hundred children with severe dengue fever who received MV.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We analyzed clinical and laboratory data during the PICU stay. The primary outcome was 28-day in-hospital mortality. Backward stepwise multivariable logistic regression was performed to identify the explanatory variables associated with dengue-associated mortality at the initiation of MV. The model performance was assessed using C-statistics, calibration plot, and Brier score. The patients had a median age of 7 years (interquartile range, 4-9). Overall, 47 (24%) of 200 patients died in the hospital. Five factors were associated with greater odds of mortality: severe transaminitis (aspartate aminotransferase or alanine aminotransferase ≥ 1000 IU/L), high blood lactate levels, vasoactive-inotropic score (> 30), dengue encephalitis, and peak inspiratory pressure on MV. The model performance in training (test) sets was a C-statistic of 0.86 (0.84), a good calibration slope 1.0 (0.89), and a Brier score of 0.08.</p><p><strong>Conclusions: </strong>In our center, from 2013 to 2022, MV-experienced patients with severe dengue had a high mortality rate. The main explanatory factors associated with greater odds of death (related to critical liver injury, shock, and MV) may inform future practice in such critically ill patients.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657957","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":"Current Consent Models Perpetuate Ignorance in Pediatric Critical Care.","authors":"Nadir Yehya, Mark J Peters","doi":"10.1097/PCC.0000000000003730","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003730","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625832","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":"Parent Attitudes to Research Without Prior Consent in Two Pediatric Emergency Clinical Trials in Australia: A Qualitative Study of Transcripts From 2017.","authors":"Jeremy S Furyk, Kristin McBain-Rigg, Shane George, Natalie Phillips, Simon Craig, Donna Franklin, Kerrianne Watt, Catherine Wilson, Meredith L Borland, Richard Franklin, Stuart R Dalziel, Andreas Schibler, Franz Babl","doi":"10.1097/PCC.0000000000003719","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003719","url":null,"abstract":"<p><strong>Objectives: </strong>Research in critically ill children poses challenges in acquiring prospective informed consent. International ethical guidelines generally have provisions to perform research without prior consent (RWPC) in circumstances where consent is not feasible, but there is a paucity of data regarding the community acceptance of this process. The objectives of the current study were to explore the attitudes and experiences of parents of children enrolled into trials to determine understanding and acceptability of RWPC to parents of children involved.</p><p><strong>Design: </strong>Qualitative study of semi structured telephone interviews in 2017 exploring themes of medical research, trial participation in RWPC. Interview transcripts underwent inductive thematic analysis with intercoder agreement, using Nvivo 14 software.</p><p><strong>Setting: </strong>Two clinical interventional trials in Australia conducted in critically ill children without prospective consent.</p><p><strong>Subjects: </strong>Parents of children enrolled in critical care research.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>A total of 49 interviews were conducted and analyzed. Parents of participants were supportive of processes used in the trials and RWPC. Paperwork was often not thought to contribute to improved understanding, with verbal information more valued. There was no consensus on the optimal approach of RWPC in situations when clinical outcome was poor.</p><p><strong>Conclusions: </strong>Our study in 2017 shows that parent/carer supported RWPC in two pediatric trials involving critically ill children. Parents were satisfied with existing approval methods and safeguards. Parents valued brief verbal information at the time of randomization. These historical findings support the feasibility of conducting research on time-sensitive interventions in emergency settings with RWPC, aligning with community expectations.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586508","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":"Risk Analytics and the Art of Ventilator Liberation op After Neonatal Cardiac Surgery.","authors":"Alexandre T Rotta, Andrew G Miller","doi":"10.1097/PCC.0000000000003721","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003721","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586435","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}