Pediatric Critical Care Medicine最新文献

{"title":"Blood Glucose Range for Hyperglycemic PICU Children With Primary Neurologic Diagnoses: Analysis of the Heart and Lung Failure-Pediatric Insulin Titration Trial.","authors":"Kerri L LaRovere, Lisa A Asaro, Kerry Coughlin-Wells, Vinay M Nadkarni, Michael S D Agus","doi":"10.1097/PCC.0000000000003689","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003689","url":null,"abstract":"<p><strong>Objectives: </strong>To compare two blood glucose (BG) ranges in critically ill children with and without primary neurologic diagnoses in the Heart and Lung Failure-Pediatric Insulin Titration trial (HALF-PINT; ClinicalTrials.gov Identifier NCT01565941).</p><p><strong>Design: </strong>Non-prespecified post hoc analysis.</p><p><strong>Setting: </strong>Thirty-one PICUs in the United States, and one in Canada.</p><p><strong>Patients: </strong>Non-diabetic children enrolled from April 2012 to September 2016 with cardiovascular or respiratory failure and hyperglycemia. Patients in the neurologic subgroup had primary neurologic diagnoses on ICU admission.</p><p><strong>Interventions: </strong>Patients were randomized to insulin infusion to target lower-BG (80-110 mg/dL; 4.4-6.1 mmol/L) or higher-BG (150-180 mg/dL; 8.3-10 mmol/L).</p><p><strong>Measurements and main results: </strong>Primary diagnosis (neurologic vs. non-neurologic), daily BG and insulin values, outcomes (number of PICU-free days through day 28 and 1-y post-PICU discharge adaptive behavior composite score of Vineland Adaptive Behavior Scales, Second Edition). Of 698 patients analyzed, 64 (30 lower-BG target, 34 higher-BG target) had primary neurologic diagnoses and 634 (319 lower-BG target, 315 higher-BG target) had non-neurologic diagnoses. Within the neurologic subgroup, patients in the lower-BG targeting group had fewer ICU-free days compared with those in the higher-BG targeting group (median 8.5 vs. 21.1 d), whereas there was no difference between BG groups in the non-neurologic subgroup (20.5 vs. 19.3 d; interaction p = 0.02). One-year adaptive behavior composite score was less favorable for the lower-BG targeting group in those with neurologic diagnoses (mean 63.3 vs. 87.6), but no different in those with non-neurologic diagnoses (81.9 vs. 78.4; interaction p = 0.02). Lower-BG targeting was associated with more hypoglycemia (< 60 mg/dL) in both diagnostic subgroups, with no differential effect across subgroups (p = 0.47).</p><p><strong>Conclusions: </strong>In this non-prespecified analysis of the HALF-PINT trial data, lower-BG targeting in hyperglycemic critically ill children with primary neurologic diagnoses was associated with unfavorable outcomes, while such BG targeting in those with non-neurologic diagnoses was not associated with adverse outcomes.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190031","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":"Combining Bubble Continuous Positive Airway Pressure and Dexmedetomidine Infusion for Moderate-to-Severe Bronchiolitis Outside the PICU.","authors":"Giacomo Brisca, Marina F Strati, Marcello Mariani, Silvia Buratti, Emanuele Giacheri, Marta Romanengo, Giacomo Tardini, Marisa Mallamaci, Valentina Carrato, Isabella Buffoni, Simona Matarese, Daniela Pirlo, Andrea Moscatelli","doi":"10.1097/PCC.0000000000003694","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003694","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080659","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":"Central or Peripheral Venoarterial Extracorporeal Membrane Oxygenation for Pediatric Sepsis: Outcomes Comparison in the Extracorporeal Life Support Organization Dataset, 2000-2021.","authors":"Abhinav Totapally, Ryan Stark, Melissa Danko, Heidi Chen, Alyssa Altheimer, Daphne Hardison, Matthew P Malone, Elizabeth Zivick, Brian Bridges","doi":"10.1097/PCC.0000000000003692","DOIUrl":"10.1097/PCC.0000000000003692","url":null,"abstract":"<p><strong>Objectives: </strong>Small studies of extracorporeal membrane oxygenation (ECMO) support for children with refractory septic shock (RSS) suggest that high-flow (≥ 150 mL/kg/min) venoarterial ECMO and a central cannulation strategy may be associated with lower odds of mortality. We therefore aimed to examine a large, international dataset of venoarterial ECMO patients for pediatric sepsis to identify outcomes associated with flow and cannulation site.</p><p><strong>Design: </strong>Retrospective analysis of the Extracorporeal Life Support Organization (ELSO) database from January 1, 2000, to December 31, 2021.</p><p><strong>Setting: </strong>International pediatric ECMO centers.</p><p><strong>Patients: </strong>Patients 18 years old young or younger without congenital heart disease (CHD) cannulated to venoarterial ECMO primarily for a diagnosis of sepsis, septicemia, or septic shock.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Of 1242 pediatric patients undergoing venoarterial ECMO runs in the ELSO dataset, overall mortality was 55.6%. We used multivariable logistic regression analyses to evaluate explanatory factors associated with adjusted odds ratios (aORs) and 95% CI of mortality. In the regression analysis of data 4 hours after ECMO initiation, logarithm of the aOR, plotted against ECMO flow as a continuous variable, showed that higher flow was associated with lower aOR of mortality (p = 0.03). However, at 24 hours, we failed to find such a relationship. Finally, peripheral cannulation, as opposed to central cannulation, was independently associated with greater odds of mortality (odds ratio, 1.7 [95% CI, 1.1-2.6]).</p><p><strong>Conclusions: </strong>In this 2000-2021 international cohort of venoarterial ECMO for non-CHD children with sepsis, we have found that higher ECMO flow at 4 hours after support initiation, and central- rather than peripheral-cannulation, were both independently associated with lower odds of mortality. Therefore, flow early in the ECMO run and cannula location are two important factors to consider in future research in pediatric patients requiring cannulation to venoarterial ECMO for RSS.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024262","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":"Fluid Management Bundle in Critically Ill Children With Respiratory Failure Is Associated With a Reduced Prevalence of Excess Fluid Accumulation.","authors":"Matthew J Foglia, Sarah M Bedoyan, Christopher M Horvat, Anthony Fabio, Dana Y Fuhrman","doi":"10.1097/PCC.0000000000003693","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003693","url":null,"abstract":"<p><strong>Objectives: </strong>To report the feasibility of a fluid management practice bundle and describe the pre- vs. post-implementation prevalence and odds of cumulative fluid balance greater than 10% in critically ill pediatric patients with respiratory failure.</p><p><strong>Design: </strong>Retrospective cohort from May 2022 to December 2022.</p><p><strong>Setting: </strong>Quaternary care PICU in Pittsburgh, PA.</p><p><strong>Patients: </strong>Children older than 28 days receiving invasive mechanical ventilation for greater than 48 hours.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We reviewed data from 205 patients; 104 before bundle implementation and 101 after bundle implementation. At the time of implementation in 2022, our PICU clinicians were educated on the use of the fluid management practice bundle, which included the following during daily rounds: goal-setting for daily fluid balance; assessing transition to enteral nutrition; and fluid conservation measures such as concentrating infusions or using enteral formulations of medications. A cumulative fluid balance greater than 10% occurred in 46 of 104 patients (44%) pre-implementation and 26 of 101 patients (26%) post-implementation. We failed to identify an association between implementation epoch grouping (pre- and post-) and adverse outcomes, including mortality, duration of mechanical ventilation, acute kidney injury, and ICU length of stay. In a multivariable logistic regression model, management during the fluid management bundle was associated with lower odds of a cumulative fluid balance greater than 10% (adjusted odds ratio, 0.35 [95% CI, 0.18-0.68]).</p><p><strong>Conclusions: </strong>In our PICUs 2022 peri-implementation testing of a fluid management bundle in critically ill children with respiratory failure, we have first found that such a practice change is feasible. Second, we identified an associated decrease in the prevalence and lower odds of fluid accumulation. We continue to use this fluid management bundle in our center but more widespread prospective studies are needed to test the benefit in clinical practice.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007834","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":"Clearing the Air: Data-Driven Insights Into Critical Bronchiolitis Pharmacotherapy.","authors":"Alexandre T Rotta, Andrew G Miller","doi":"10.1097/PCC.0000000000003691","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003691","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979455","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":"My Perfect Son.","authors":"Melanie Jansen","doi":"10.1097/PCC.0000000000003687","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003687","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971812","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":"Severity of Impaired Oxygenation and Conservative Oxygenation Targets in Mechanically Ventilated Children: A Post Hoc Subgroup Analysis of the Oxy-PICU Trial of Conservative Oxygenation.","authors":"Samiran Ray, Martin Wiegand, Doug W Gould, David A Harrison, Paul R Mouncey, Mark J Peters","doi":"10.1097/PCC.0000000000003686","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003686","url":null,"abstract":"<p><strong>Objectives: </strong>A conservative oxygenation strategy is recommended in adult and pediatric guidelines for the management of acute respiratory distress syndrome to reduce iatrogenic lung damage. In the recently reported Oxy-PICU trial, targeting peripheral oxygen saturations (Spo2) between 88% and 92% was associated with a shorter duration of organ support and greater survival, compared with Spo2 greater than 94%, in mechanically ventilated children following unplanned admission to PICU. We investigated whether this benefit was greater in those who had severely impaired oxygenation at randomization.</p><p><strong>Design: </strong>Post hoc analysis of a pragmatic, open-label, multicenter randomized controlled trial.</p><p><strong>Setting: </strong>Fifteen PICUs across England and Scotland.</p><p><strong>Patients: </strong>Children between 38 weeks old corrected gestational age and 15 years accepted to a participating PICU as an unplanned admission and receiving invasive mechanical ventilation with supplemental oxygen for abnormal gas exchange.</p><p><strong>Interventions: </strong>A mixed-effects ordinal regression model was used to explore the effect of severity of lung injury, dichotomized to an oxygen saturation index (OSI) less than 12 or greater than or equal to 12 at randomization, the trial group allocation, age, and Pediatric Index of Mortality-3 on the composite ordinal outcome measure of duration of organ support at day 30 and mortality, with death being the worst outcome. An interaction term was included to specifically understand the effect of trial arm allocation on those with and OSI less than 12 and OSI greater than or equal to 12.</p><p><strong>Measurements and main results: </strong>Data were available for 1775 of 1986 eligible children. Two hundred twelve of 1775 children had an OSI greater than or equal to 12 at randomization. The trial primary outcome did not vary significantly according to OSI category. Both children with OSI less than 12 (odds ratio [OR], 0.85; 95% CI, 0.71-1.01) and OSI greater than or equal to 12 (OR, 0.95; 95% CI, 0.49-1.84) benefited from conservative arm allocation, with relative benefit greater for those with an OSI less than 12.</p><p><strong>Conclusions: </strong>These data do not provide evidence that a conservative oxygenation strategy should be limited to mechanically ventilated children with severely impaired oxygenation.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971815","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, Extracorporeal Membrane Oxygenation, and the Need for Renal Follow-Up.","authors":"Zaccaria Ricci, David Selewski","doi":"10.1097/PCC.0000000000003684","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003684","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952800","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":"Phoenix Rising: External Validation of the Phoenix Sepsis Criteria.","authors":"Lee A Polikoff","doi":"10.1097/PCC.0000000000003688","DOIUrl":"10.1097/PCC.0000000000003688","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927590","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":"Evaluation of Phoenix Sepsis Score Criteria: Exploratory Analysis of Characteristics and Outcomes in an Emergency Transport PICU Cohort From the United Kingdom, 2014-2016.","authors":"Michael J Carter, Joshua Hageman, Yael Feinstein, Jethro Herberg, Myrsini Kaforou, Mark J Peters, Simon Nadel, Naomi Edmonds, Nazima Pathan, Michael Levin, Padmanabhan Ramnarayan","doi":"10.1097/PCC.0000000000003682","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003682","url":null,"abstract":"<p><strong>Objectives: </strong>To assess characteristics and outcomes of children with suspected or confirmed infection requiring emergency transport and PICU admission and to explore the association between the 2024 Phoenix Sepsis Score (PSS) criteria and mortality.</p><p><strong>Design: </strong>Retrospective analysis of curated data from a 2014-2016 multicenter cohort study.</p><p><strong>Setting: </strong>PICU admission following emergency transport in South East England, United Kingdom, from April 2014 to December 2016.</p><p><strong>Patients: </strong>Children 0-16 years old (n = 663) of whom 444 (67%) had suspected or confirmed infection.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The PSS was calculated as a sum of four individual organ subscores (respiratory, cardiovascular, neurological, and coagulation) using the worst values during transport (i.e., from referral until the time of PICU admission). A score cutoff of greater than or equal to 2 points was used to define sepsis; and septic shock was defined as sepsis plus 1 or more cardiovascular subscore points. Sepsis occurred in 260 of 444 children (58.6%) with suspected or confirmed infection, with septic shock occurring in 177 of 260 (68.1%) of those with sepsis. A PSS score greater than or equal to 2 points occurred in 37 of 67 bronchiolitis cases, 19 of 35 meningoencephalitis cases, 30 of 47 pneumonia/empyema cases, 38 of 46 septic/toxic shock cases, nine of 15 severe sepsis cases, and 58 of 118 definite viral infections. Overall, 14 of 444 children died (3.2%). There were 12 deaths in the 260 children with PSS greater than or equal to 2, and two deaths in the 184 children with PSS less than 2 (4.6% vs. 1.1%; absolute difference, 3.5%; 95% CI, 0.1-6.9%; p = 0.04).</p><p><strong>Conclusions: </strong>In 2014-2016, over half of the critically ill children undergoing emergency transport to PICU with presumed or confirmed infection, and meeting retrospectively applied PSS criteria for sepsis, had a range of clinical diagnoses including bronchiolitis, meningoencephalitis, and pneumonia/empyema. Furthermore, the PSS criteria for categorization of sepsis and septic shock were associated with outcome and may be of value in future risk-stratification in clinical trials.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922431","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}