Pediatric Critical Care Medicine最新文献

{"title":"Family Presence at the PICU Bedside and Pediatric Patient Delirium: Retrospective Analysis of a Single-Center Cohort, 2014-2017.","authors":"Mallory B Smith, Elizabeth Y Killien, R Scott Watson, Leslie A Dervan","doi":"10.1097/PCC.0000000000003678","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003678","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the association between family presence at the PICU bedside and daily positive delirium screening scores.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary children's hospital PICU.</p><p><strong>Subjects: </strong>Children younger than 18 years old with PICU length of stay greater than 36 hours enrolled in the Seattle Children's Hospital Outcomes Assessment Program from 2014 to 2017.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>In the dataset, delirium screening had been performed bid using the Cornell Assessment of Pediatric Delirium, with scores greater than or equal to 9 classified as positive. Family presence was documented every 2 hours. Among 224 patients, 55% (n = 124/224) had positive delirium screening on 44% (n = 408/930) of PICU days. Family presence at the bedside during PICU stay (< 90% compared with ≥ 90%) was associated with higher proportion of ever (as opposed to never) being screened positive for delirium (26/37 vs. 98/187; difference, 17.9% [95% CI, 0.4-32.1%]; p = 0.046). On univariate analysis, each additional decile of increasing family presence was associated with lower odds of positive delirium screening on the same day (odds ratio [OR], 0.87 [95% CI, 0.77-0.97]) and subsequent day (OR, 0.84 [95% CI, 0.75-0.94]). On multivariable analysis after adjustments, including baseline Pediatric Cerebral Performance Category (PCPC), higher family presence was associated with lower odds of subsequent-day positive delirium screening (OR, 0.89 [95% CI, 0.81-0.98]). Among patients with PCPC less than or equal to 2, each additional decile of increasing family presence was independently associated with lower odds of both same-day (OR, 0.90 [95% CI, 0.81-0.99]) and subsequent-day (OR, 0.85 [95% CI, 0.76-0.95]) positive delirium screening.</p><p><strong>Conclusions: </strong>In our 2014-2017 retrospective cohort, greater family presence was associated with lower odds of delirium in PICU patients. Family presence is a modifiable factor that may mitigate the burden of pediatric delirium, and future studies should explore barriers and facilitators of family presence in the PICU.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865074","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":"Citrate Anticoagulation in Continuous Renal Replacement Therapy: Multicenter PICU Study of Filter-Related Outcomes.","authors":"Hasan S Kihtir, Muhterem Duyu, Mehmet E Mementoglu, Ilknur Tolunay, Tanil Kendirli, Faruk Ekinci, Edin Botan, Ebru A Ongun, Ayse Asik, Emrah Gun, Hacer Ucmak, Esra Sevketoglu, Dincer Yildizdas","doi":"10.1097/PCC.0000000000003661","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003661","url":null,"abstract":"<p><strong>Objectives: </strong>To examine citrate anticoagulation in continuous renal replacement therapy (CRRT) in the PICU.</p><p><strong>Design: </strong>Post hoc analysis of a curated, multicenter dataset collected from January 1, 2022, to June 1, 2023.</p><p><strong>Setting: </strong>Seven PICUs in Turkey.</p><p><strong>Patients: </strong>PICU admissions in need of CRRT, 28 days to 18 years old.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>In 128 filters used in 73 patients, the effective filter life (EFL) restricted to 72 hours was a median (interquartile range [IQR]) of 40.5 hours (IQR, 21-58 hr); total EFL was a median of 59 hours (IQR, 28-89 hr). Analysis of the receiver operating characteristic curve for initial citrate infusion dose (CID) and whether EFL reached 72 hours identified a cutoff level for initial CID of greater than 2.64 mmol citrate per liter of patient blood flow (mmol/L-bf). As expected, the two filter groups categorized by initial CID (≥ 2.7 vs. < 2.7 mmol/L-bf) showed filters in children receiving higher initial dosing had longer total EFL (72 hr [IQR, 48-104 hr] vs. 38.5 hr [IQR, 18-84 hr]; p = 0.03). We failed to identify an association between CRRT for over 24 or 48 hours and greater odds (odds ratio [OR], 95% CI) of citrate accumulation (OR, 2.23; 95% CI, 0.82-6.13; p = 0.118 or OR, 1.78; 95% CI, 0.84-3.8; p = 0.134, respectively). However, we cannot exclude up to 6.1- or 3.8-fold odds of citrate accumulation; of note, CRRT over 72 hours was associated with greater odds of citrate accumulation (OR, 2.17; 95% CI, 1.01-4.68; p = 0.04). Citrate lock syndrome occurred in eight of 128 (6.3%; 95% CI, 3-11.4%) filters, and resolved without termination of CRRT. On multivariable analysis, a higher patient initial lactate concentration was associated with an 18% (95% CI, 7-30%) greater hazard of developing citrate accumulation.</p><p><strong>Conclusions: </strong>Citrate anticoagulation for CRRT is an option for children. Choosing an initial CID greater than or equal to 2.7 mmol/L-bf provides longer EFL but with the associated potential of citrate accumulation. Further studies are needed on initial CID and duration of EFL.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855013","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":"Planning a Phased Guideline Implementation Strategy Across the Multicenter Ventilation Liberation for Kids (VentLib4Kids) Collaborative.","authors":"Jeremy M Loberger, Kristine R Hearld, Akira Nishisaki, Robinder G Khemani, Katherine M Steffen, Samer Abu-Sultaneh","doi":"10.1097/PCC.0000000000003673","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003673","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate contextual factors relevant to implementing pediatric ventilator liberation guidelines and to develop an implementation strategy for a multicenter collaborative.</p><p><strong>Design: </strong>Cross-sectional qualitative analysis of a 2023/2024 survey.</p><p><strong>Setting: </strong>International, multicenter Ventilation Liberation for Kids (VentLib4Kids) collaborative.</p><p><strong>Subjects: </strong>Physicians, advanced practice providers, respiratory therapists, and nurses.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The survey was distributed to 26 PICUs representing 18 unique centers (17 in North American)-14 general medical/surgical, eight cardiac, and four mixed (1935 solicitations). All 409 responses were analyzed (prescribers 39.8%, nursing 32.8%, and respiratory therapists 27.4%). Three implementation tiers were identified based on perceptions of evidence, feasibility, positive impact, and favorability constructs. Tier A (≥ 80% agreement for all constructs) included extubation readiness testing (ERT) screening, ERT bundle, spontaneous breathing trials (SBTs), upper airway obstruction (UAO) risk mitigation, and risk stratified noninvasive respiratory support (NRS). Tier B (50-79% agreement) included standard risk SBT method, risk stratified SBT duration, and UAO risk assessment. Tier C (< 50% agreement) included high-risk SBT method, respiratory muscle strength testing, and infant NRS. The smallest perceived practice gaps were noted in tier A and the largest in tier C. The smallest practice gap was risk stratified NRS (88% agreement). The largest practice gap was respiratory muscle strength (18% agreement). In regression analysis, independently significant differences in perceptions based on role and unit type for multiple constructs were identified for UAO risk assessment, UAO risk mitigation, risk stratified NRS, and infant NRS.</p><p><strong>Conclusions: </strong>This survey study of the VentLib4Kids collaborative lays the foundation for phased implementation of the 2023 pediatric ventilator liberation guidelines. Early phases should focus on the best implementation profiles and smallest practice gaps. Later phases should address those that are more challenging. Unit- and role-based tailoring of differences should be considered for some recommendations more than others.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854083","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 Pediatric Influence of Cooling Duration on Efficacy in Cardiac Arrest Patients (P-ICECAP): Statistical Methods Planned in the Bayesian, Adaptive, Duration Finding Trial.","authors":"John M VanBuren, Sharon D Yeatts, Richard Holubkov, Frank W Moler, Alexis Topjian, Kent Page, Robert G Clevenger, William J Meurer","doi":"10.1097/PCC.0000000000003667","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003667","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the optimal cooling duration for children after out-of-hospital cardiac arrest (OHCA) using an adaptive Bayesian trial design.</p><p><strong>Design: </strong>The Pediatric Influence of Cooling duration on Efficacy in Cardiac Arrest Patients (P-ICECAP) trial is a randomized, response-adaptive duration/dose-finding clinical trial with blinded outcome assessment. Participants are randomized to one of several cooling durations (0, 12, 18, 24, 36, 48, 60, 72, 84, or 96 hr). The first 150 participants are randomized 1:1:1 to 24-, 48-, and 72-hour durations. Response-adaptive randomization is used thereafter to allocate participants based on emerging duration-response data.</p><p><strong>Setting: </strong>PICUs.</p><p><strong>Patients: </strong>Up to 900 pediatric patients 2 days to younger than 18 years old who have survived OHCA and been admitted to an ICU.</p><p><strong>Interventions: </strong>Duration of targeted temperature management using a surface temperature control device.</p><p><strong>Measurements and main results: </strong>The primary outcome is the Vineland Adaptive Behavior Scales-Third Edition mortality composite score, assessed at 12 months. Secondary outcomes include changes in the Pediatric Cerebral Performance Category and Pediatric Resuscitation after Cardiac Arrest scores, as well as survival at 12 months. Bayesian modeling is employed to evaluate the duration-response curve and determine the optimal cooling duration. The trial is designed to adaptively update randomization probabilities every 10 weeks, maximizing the allocation of participants to potentially optimal cooling durations. Over 90% power is achieved for the hypothesized scenarios.</p><p><strong>Conclusions: </strong>The P-ICECAP trial aims to identify the shortest cooling duration that provides the maximum treatment effect for pediatric OHCA patients. The adaptive design allows for flexibility and efficiency in handling various clinical scenarios, potentially transforming pediatric cardiac arrest care by optimizing hypothermia treatment protocols.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854369","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 Mechanical Circulatory Support: Insight From a Cardiovascular Simulator.","authors":"Ronald A Bronicki, Sebastian C Tume, Saul Flores, Rohit S Loomba, Nirica M Borges, Daniel J Penny, Daniel Burkhoff","doi":"10.1097/PCC.0000000000003671","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003671","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854997","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":"Children Requiring 3 or More Days of Invasive Ventilation: Secondary Analysis of Post-Discharge Change in Caregiver Employment.","authors":"Kathryn E Kalata, Kristen R Miller, Yamila L Sierra, Tellen D Bennett, R Scott Watson, Peter M Mourani, Aline B Maddux","doi":"10.1097/PCC.0000000000003676","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003676","url":null,"abstract":"<p><strong>Objectives: </strong>To describe frequency of, and risk factors, for change in caregiver employment among critically ill children with acute respiratory failure.</p><p><strong>Design: </strong>Preplanned secondary analysis of prospective cohort dataset, 2018-2021.</p><p><strong>Setting: </strong>Quaternary Children's Hospital PICU.</p><p><strong>Patients: </strong>Children who required greater than or equal to 3 days of invasive ventilation, survived hospitalization, and completed greater than or equal to 1 post-discharge survey.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We measured change in caregiver employment 1 and 12 months post-discharge relative to pre-admission and, when present, change in caregiver identity defined by relationship to the patient. Data were collected by survey. We used logistic regression to identify factors associated with these changes. We evaluated 130 children, median age 6.4 years (interquartile range, 1.10-13.3 yr), 40 (30.8%) with a complex chronic condition (CCC), and 99 (76.2%) with normal pre-illness Functional Status Scale scores. Of 123 with 1-month post-discharge data, 25 of 123 (20.3%) experienced a change in caregiver employment and an additional 14 of 123 (11.4%) had a change in caregiver(s). Of 115 with 12-month post-discharge data, 33 of 115 (28.7%) experienced a change in caregiver employment and an additional 16 of 115 (13.9%) had a change in caregiver(s). After controlling for age, CCC, baseline caregiver employment, new morbidity at discharge, and social and economic index; higher maximum Pediatric Logistic Organ Dysfunction-2 score (odds ratio [OR], 1.19 [95% CI, 1.01-1.41]) and government insurance (OR, 3.85 [95% CI, 1.33-11.11]) were associated with the composite outcome of change in caregiver employment or caregiver(s) at 1-month post-discharge.</p><p><strong>Conclusions: </strong>At 1 and 12 months post-discharge, more than one-in-five children who survived greater than or equal to 3 days of invasive ventilation had a change in caregiver employment and one-in-ten had a change in caregiver(s). Identification of risk factors, such as illness severity and social determinants of health, associated with a significant family change may improve our support of these families.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865073","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 Continuous Electroencephalography, Clinical Parameters, and Short-Term Functional Outcomes in Pediatric Traumatic Brain Injury: Single-Center, Retrospective Cohort, 2010-2020.","authors":"Akilah Pascall, Anqing Zhang, Omar Dughly, Michael J Bell, Dana Harrar, Terry Dean","doi":"10.1097/PCC.0000000000003669","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003669","url":null,"abstract":"<p><strong>Objectives: </strong>Traumatic brain injury (TBI) is a leading cause of pediatric morbidity and mortality. This study first investigates clinical characteristics and continuous electroencephalography (cEEG) parameters associated with short-term functional outcomes in pediatric patients following TBI. Second, we use these data for a hypothesis-generating model about outcomes.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>PICU within a quaternary care hospital.</p><p><strong>Patients: </strong>Pediatric patients (< 18 yr) admitted from January 2010 to December 2020 with TBI who underwent cEEG within 72 hours of admission.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Patient demographics, clinical parameters, hospital course, and cEEG features were reviewed for associations with mortality and new disability (as defined by change in Functional Status Score between admission and discharge of ≥ 3 points). A statistical prediction model for patient outcome was created combining cEEG parameters with admission Glasgow Coma Scale (GCS) score and radiographic findings. We included 142 patients: 100 (70%) of whom had no new disability at hospital discharge; 42 (30%) had a new disability, including eight deaths. Univariate analysis showed favorable outcomes were associated with normal electroencephalogram background, reactivity, and sleep features (p < 0.001 for each). A model inclusive of these electroencephalogram parameters and GCS had high predictive ability for outcome with 0.94 with 95% CI (0.90-0.98).</p><p><strong>Conclusions: </strong>Specific cEEG findings observed acutely after injury, in combination with other clinical characteristics, may serve as biomarkers for short-term functional outcomes after pediatric TBI. Further validation of the model in another population is now required.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847307","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":"Hospital-Acquired Complications in Critically Ill Children and PICU Length of Stay, Duration of Respiratory Support, and Economics: Propensity Score Matching in a Single-Center Cohort, 2015-2020.","authors":"Jessica A Schults, Lisa Hall, Karina R Charles, Claire M Rickard, Renate Le Marsney, Endrias Ergetu, Alex Gregg, Joshua Byrnes, Sarfaraz Rahiman, Debbie Long, Anna Lake, Kristen Gibbons","doi":"10.1097/PCC.0000000000003668","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003668","url":null,"abstract":"<p><strong>Objectives: </strong>To identify the health and economic costs of hospital-acquired complications (HACs) in children who require PICU admission.</p><p><strong>Design: </strong>Propensity score matched cohort study analyzing routinely collected medical and costing data collected by the health service over 6 years (2015-2020).</p><p><strong>Setting: </strong>Tertiary referral PICU in Queensland, Australia.</p><p><strong>Patients: </strong>All children admitted to the PICU were included.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We assessed ventilator- and respiratory support-free days at 30 days post-PICU admission, length of PICU stay, prevalence of individual HACs, and attributable healthcare costs. A total of 8437 admissions, representing 6054 unique patients were included in the analysis. Median (interquartile range) for cohort age was 2.1 years (0.4-7.7 yr), 56% were male. Healthcare-associated infections contributed the largest proportion of HACs (incidence rate per 100 bed days, 46.5; 95% CI, 29.5-47.9). In the propensity score matched analyses (total 3852; 1306 HAC and 1371 no HAC), HAC events were associated with reduced ventilator- (adjusted subhazard ratio [aSHR], 0.88 [95% CI, 0.82-0.94]) and respiratory support-free days (aSHR, 0.74 [95% CI, 0.69-0.79]) and increased PICU length of stay (aSHR, 0.63 [95% CI, 0.58-0.68]). Healthcare costs for children who developed a HAC were higher compared with children with no HAC, with mean additional cost ranging from Australian dollar (A$) 77,825 (one HAC [95% CI, $57,501-98,150]) to $310,877 (≥ 4 HACs [95% CI, $214,572-407,181]; in 2022, the average conversion of A$ to U.S. dollar was 0.74).</p><p><strong>Conclusions: </strong>In our PICU (2015-2020), the burden of HAC for critically ill children was highest for healthcare-associated infections. Further high-quality evidence regarding HAC prevention and prospective risk assessment could lead to improved patient outcomes and reduced costs.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855018","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 Australian and New Zealand Intensive Care Society Paediatric Study Group (ANZICS PSG): 20 Years of Collaborative Research.","authors":"Kristen S Gibbons, John Beca, Carmel Delzoppo, Simon Erickson, Marino Festa, Ben Gelbart, Debbie Long, Kate Masterson, Johnny Millar, Sainath Raman, Luregn J Schlapbach, Warwick Butt","doi":"10.1097/PCC.0000000000003653","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003653","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142838637","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":"Patterns of Use of β-2 Agonists, Steroids, and Mucoactive Medications to Treat Bronchiolitis in the PICU: U.S. Pediatric Health Information System 2009-2022 Database Study.","authors":"Brian F Flaherty, Cody S Olsen, Eric R Coon, Rajendu Srivastava, Lawrence J Cook, Heather T Keenan","doi":"10.1097/PCC.0000000000003670","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003670","url":null,"abstract":"<p><strong>Objectives: </strong>Describe β2-agonists, steroids, hypertonic saline (HTS), n-acetylcysteine (NAC), and dornase alfa (DA) use to treat bronchiolitis, factors associated with use, and associations between use and PICU length of stay (LOS).</p><p><strong>Design: </strong>Retrospective, multicenter cohort study.</p><p><strong>Setting: </strong>PICUs in the Pediatric Health Information System database.</p><p><strong>Patients: </strong>PICU admitted children 24 months young or younger with bronchiolitis.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We analyzed 47,520 hospitalizations between July 1, 2018, and June 30, 2022. We calculated the rate of medication use overall and the median (range) rate for each hospital: β2-agonist (24,984/47,520 [52.6%]; median hospital, 51.7% [21.4-81.7%]), steroid (15,878/47,520 [33.4%]; median hospital, 33.4% [6.0-54.8%]), HTS (7,041/47,520 [14.8%]; median hospital, 10.5% [0-66.1%]), NAC (1,571/47,520 [3.3%]; median hospital, 0.8% [0-22.0%], and DA (840/47,520 [1.8%]; median hospital, 1.4% [0-13.6%]). Logistic regression using generalized estimating equations (GEEs) identified associations between concurrent asthma and β2-agonist (adjusted odds ratio [aOR], 8.68; 95% CI, 7.08-10.65; p < 0.001) and steroid (aOR, 10.10; 95% CI, 8.84-11.53; p < 0.001) use. Mechanical ventilation was associated with all medications: β2-agonists (aOR, 1.79; 95% CI, 1.57-2.04; p < 0.001), steroids (aOR, 2.33; 95% CI, 1.69-3.21; p < 0.001), HTS (aOR, 1.82; 95% CI, 1.47-2.25; p < 0.001), NAC (aOR, 3.29; 95% CI, 2.15-5.03; p < 0.001), and DA (aOR, 7.65; 95% CI, 4.30-13.61; p < 0.001). No medication was associated with decreased PICU LOS. To assess changes in medication use over time and associations with the 2014 American Academy of Pediatrics bronchiolitis guidelines, we expanded our analysis to 83,820 hospitalizations between July 1, 2009, and June 30, 2022. Logistic regression with GEEs found no change in β2-agonist use; steroid use increased after guideline publication (aOR, 1.05; 95% CI, 1.01-1.10; p = 0.02), HTS use changed from increasing prior to the guidelines (aOR, 1.32; 95% CI, 1.11-1.56; p = 0.001) to stable since guideline publication (aOR, 0.93; 95% CI, 0.81-1.07; p = 0.33).</p><p><strong>Conclusions: </strong>β2-agonists, steroids, and HTS are commonly, but variably used for PICU bronchiolitis treatment. Medication use appears relatively stable over the last decade.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847319","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}