Pediatric Critical Care Medicine最新文献

{"title":"Children With Severe Neurologic Impairment and Their Families in the PICU: A Secondary Qualitative Analysis to Assess Clinician-Family Collaboration and Mutuality.","authors":"Ryan F Sutyla, Jori F Bogetz, Saisha Dhar, Ellie Oslin, Victoria Parente, Sharron L Docherty, Monica Lemmon","doi":"10.1097/PCC.0000000000003796","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003796","url":null,"abstract":"<p><strong>Objectives: </strong>In children with severe neurologic impairment (SNI) admitted to the PICU, a trauma-informed approach to care may mitigate the effect of traumatic events on both parents and the child. We aimed to characterize the themes that impacted the trauma-informed care principle of collaboration and mutuality in the PICU.</p><p><strong>Design: </strong>This study is a post hoc secondary analysis of transcripts of interviews conducted for a prospective mixed methods cohort study examining the experiences of parents of children with SNI in the PICU and their clinicians in 2021-2023. Parents and clinicians had completed the semi-structured interviews peri-PICU discharge. Data were analyzed using a conventional content analysis approach. Two analysts coded all data independently, with differences resolved by consensus. Dedoose qualitative software was used to facilitate analysis, which followed Consolidated Criteria for Reporting Qualitative Research guidelines.</p><p><strong>Setting: </strong>Quaternary academic center children's hospital.</p><p><strong>Patients: </strong>The original study (2021-2023) recruited parents of children and young people (3 mo to 25 yr old) with SNI who were admitted to the PICU and their PICU clinicians.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>There were 34 transcribed interviews: 15 from parents and 19 from PICU clinicians of multiple disciplines. We identified facilitators of and barriers to collaboration and mutuality. Facilitators included: 1) knowing a patient beyond the medical chart; 2) understanding values; and 3) clinician(s)-family collaboration. Barriers included: 1) constraints of the PICU environment; 2) challenges when engaging fully with patients with SNI; 3) intrinsic variability among clinicians and parents; 4) families being overwhelmed amid critical illness; and 5) emotional toll on clinicians.</p><p><strong>Conclusions: </strong>Participants described the importance of and barriers to collaboration and mutuality in the PICU, which underscores the impact of valuing partnerships between clinicians and families.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675457","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 Inconceivable Complexity of Lung Mechanics in Critical Bronchiolitis.","authors":"Alexandre T Rotta, Tobias L Straube","doi":"10.1097/PCC.0000000000003797","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003797","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643064","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":"Derivation and Validation of Pediatric Sepsis-Associated Acute Kidney Injury Subphenotypes With Prognostic Relevance.","authors":"Natalja L Stanski, Bin Zhang, Jiarong Ouyang, L Nelson Sanchez-Pinto, E Vincent S Faustino, Colin M Rogerson, Mark W Hall, Scott L Weiss, Tellen D Bennett, Stephen W Standage, Stuart L Goldstein, Kathleen D Liu","doi":"10.1097/PCC.0000000000003789","DOIUrl":"10.1097/PCC.0000000000003789","url":null,"abstract":"<p><strong>Objectives: </strong>Sepsis-associated acute kidney injury (SAKI) is a heterogeneous syndrome associated with poor outcomes. Subphenotypes of SAKI with prognostic and therapeutic relevance have been identified in adults, but not in children. We sought to identify reproducible and clinically relevant pediatric SAKI (pSAKI) subphenotypes using readily available clinical and laboratory data.</p><p><strong>Design: </strong>Secondary analysis of a retrospective observational study of pediatric sepsis.</p><p><strong>Setting: </strong>Thirteen PICUs in the United States from January 2012 to January 2018.</p><p><strong>Patients: </strong>Patients aged 0-18 years with septic shock (sepsis and requiring vasoactive medications) and day 1-2 SAKI (≥ Kidney Disease Improving Global Outcomes stage 1 by serum creatinine).</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Fourteen hundred fifty-five patients were included after inclusion and exclusion criteria were applied: 873 (60%) in the derivation cohort and 582 (40%) in the external validation cohort. A two-subphenotype latent class analysis model had the best fit in both cohorts: pSAKI subphenotype 1 (pSAKI-1) and pSAKI subphenotype 2 (pSAKI-2). pSAKI-2 was characterized by younger age, more organ support, greater fluid accumulation, and laboratory evidence of inflammation, acid-base derangement, thrombocytopenia, and coagulopathy. pSAKI-2 had uniformly worse outcomes, including higher rates of severe and persistent AKI at days 3-4 (54% vs. 23%, p < 0.001) and day 7 (31% vs. 12%, p < 0.001), increased use of continuous renal replacement therapy (21% vs. 6%, p < 0.001), and independently increased odds of mortality after adjustment for potential confounders (adjusted odds ratio 1.59; 95% CI, 1.04-2.41; p = 0.03). A parsimonious classification model accurately identified pSAKI-2 membership (C-statistic 0.94 [95% CI, 0.92-0.95] and 0.85 [95% CI, 0.82-0.88], respectively, in the derivation and internal validation cohorts).</p><p><strong>Conclusions: </strong>We identified two distinct early pSAKI subphenotypes using readily available data that exhibit differential risk for poor outcomes and can be identified from a parsimonious set of variables. Pending external validation, operationalization of pSAKI subphenotypes may allow for prognostic enrichment to guide clinical care and inform clinical trial enrollment.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12252218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601123","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":"Pneumonia Requiring Respiratory Support in the PICU: Single-Center Study of Admission Plasma Nucleosome, Histone, and Citrullinated Histone H3 Levels in Relation to Complications.","authors":"Bin Li, Cuifen Li, Yunxiang Mao, Fangling Dong, Xishu Deng, Ling Hang, Tinghao Wu, Weihua Shou, Bo Zhang, Li Li, Tiesong Zhang, Lei Guo, Shufang Xiao","doi":"10.1097/PCC.0000000000003785","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003785","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate plasma nucleosome, histone H3 (H3), and citrullinated histone H3 (CitH3) levels in PICU patients with viral or bacterial pneumonia, and the associations with pediatric acute respiratory distress syndrome (PARDS) and sepsis.</p><p><strong>Design: </strong>Single-center observational study of plasma nucleosome, H3, and CitH3 levels collected within 24 hours of PICU admission in patients with pneumonia requiring respiratory support.</p><p><strong>Setting: </strong>A children's hospital PICU in Yunnan, China.</p><p><strong>Patients: </strong>Pneumonia patients and healthy controls seen during 2022-2024.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>A total of 152 children (0.3-12 years old) with severe pneumonia were enrolled and, post hoc, 47 met the 2024 Phoenix criteria for sepsis, and 45 met the 2023 criteria for PARDS. Pneumonia in comparison with 22 controls was associated with higher levels of all three markers (nucleosome, p = 0.0006; H3, p = 0.003; and CitH3, p = 0.029). In comparison with non-sepsis and non-PARDS cases, the sepsis and PARDS categories were associated with higher levels of all three markers (sepsis, p < 0.0001, p = 0.015, p < 0.0001; PARDS, p = 0.003, p < 0.0001, p = 0.0002). The area under the receiver operating characteristic curve (AUROC) analysis with nucleosome level using the sepsis endpoint was 0.79 (95% CI, 0.71-0.87), p < 0.0001. The relationship between H3 and PARDS vs. non-ARDS patients was AUROC 0.83 (95% CI, 0.75-0.91), p < 0.0001; and there was a negative correlation with Pao2 to Fio2 of r -0.63 (p < 0.0001). Regarding, the association between bacterial vs. viral etiology of pneumonia, the combination of plasma CitH3 and C-reactive protein showed AUROC of 0.84 (95% CI, 0.76-0.92), p < 0.0001.</p><p><strong>Conclusions: </strong>In PICU patients with pneumonia requiring respiratory support, we detected significant plasma of nucleosome, H3, and CitH3 within the first 24 hours of admission. Furthermore, categorization as PARDS or sepsis was associated with higher levels of these biomarkers.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601124","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":"Luregn J Schlapbach, Halden F Scott, Nelson Sanchez-Pinto, Tellen Bennett, R Scott Watson","doi":"10.1097/PCC.0000000000003786","DOIUrl":"10.1097/PCC.0000000000003786","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144541818","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":"Thromboprophylaxis for Critically Ill Adolescents: A Multicenter Case-Control Study From the Children's Healthcare Advancements in Thrombosis Consortium.","authors":"Nikhil Vallabhaneni, Julie Jaffray, Brian R Branchford, Marisol Betensky, Amy Stillings, Emily Krava, Maua M Alleyne, Dina Ashour, Neil A Goldenberg, Anthony A Sochet","doi":"10.1097/PCC.0000000000003788","DOIUrl":"10.1097/PCC.0000000000003788","url":null,"abstract":"<p><strong>Objectives: </strong>To determine if thromboprophylaxis, including pharmacologic, mechanical, or in combination, is associated with a hospital-acquired venous thromboembolism (HA-VTE) risk reduction among critically ill adolescents.</p><p><strong>Design: </strong>Multicenter case-control study from the Children's Healthcare Advancements in Thrombosis Consortium Registry and VTE risk-model validation study from January 2012 to July 2022.</p><p><strong>Setting: </strong>Thirty-two North American PICUs.</p><p><strong>Patients: </strong>Critically ill adolescents 12-19 years old including cases with radiographically confirmed HA-VTE (i.e., pulmonary embolism and deep venous thrombosis) and controls without HA-VTE.</p><p><strong>Interventions: </strong>Pharmacologic (i.e., prophylactic anticoagulation) and mechanical (i.e., intermittent pneumatic compression) thromboprophylaxis.</p><p><strong>Measurements and main results: </strong>Of 163 cases and 975 controls, 7.6% received pharmacologic, 23.5% mechanical, and 9.2% pharmacologic and mechanical thromboprophylaxis. Compared with controls, cases more frequently had central venous catheterization (89% vs. 21.1%), invasive ventilation (52.2% vs. 11.8%), longer median length of stay (29 d [interquartile range, 15-46 d] vs. 6 d [interquartile range, 3-10 d]), impaired mobility (72.6% vs. 22.1%), and infection (48.5% vs. 16%; all p < 0.001). Venous thromboembolism risk tiers (low, moderate, and high) were calculated using validated scoring criteria. Using multivariable logistic regression for HA-VTE risk accounting for additional prothrombotic covariates and among each VTE risk tier, pharmacologic and combined thromboprophylaxis, but not mechanical thromboprophylaxis alone, were independently associated with reduced HA-VTE risk.</p><p><strong>Conclusions: </strong>Among critically ill adolescents, pharmacologic thromboprophylaxis alone or in combination with mechanical thromboprophylaxis, but not mechanical thromboprophylaxis alone, was associated with an HA-VTE risk reduction.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144541820","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 Blood Biomarkers and MRI Injury After Cardiac Arrest: Secondary Analysis of the 2017-2020 Personalized Outcomes After Child Cardiac Arrest Study.","authors":"Anna M Janas, Kristen R Miller, Rafael Ceschin, Peter M Mourani, Christopher M Ruzas, Tellen D Bennett, Ericka L Fink, Aline B Maddux","doi":"10.1097/PCC.0000000000003756","DOIUrl":"10.1097/PCC.0000000000003756","url":null,"abstract":"<p><strong>Objectives: </strong>Brain MRI is used to inform prognosis of pediatric cardiac arrest (CA). We analyzed the association between early levels of four brain injury biomarkers and pattern of brain injury on MRI.</p><p><strong>Design, setting, and patients: </strong>This secondary analysis of a multicenter prospective cohort study in 14 U.S. hospitals (from May 16, 2017, to August 19, 2020) recruited children 48 hours to 17 years old who were resuscitated after CA and had a brain MRI within 14 days postarrest.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Brain MRI injury score was calculated as a sum of T2- and diffusion-weighted imaging lesions. We used the Kruskal-Wallis test to compare maximum biomarker values on days 1-3 between three categories of MRI injury severity (i.e., no injury, mild-moderate injury, and severe injury). Maximum neurofilament light chain (NfL), tubulin-associated unit, glial fibrillary acidic protein, and ubiquitin C-terminal hydrolase L1 levels were associated with severity of total injury, gray matter injury, and white matter injury. Using logistic regression, individual biomarker levels were associated with presence of injury on MRI after adjusting for age, presence of congenital heart disease, and severity of illness using Pediatric Index of Mortality 3 score. Of 40 patients with injury on MRI and 1-year outcome data, median (interquartile range [IQR]) NfL levels were higher in the 15 patients who died compared with the 21 patients with favorable outcome (7.10 pg/mL [IQR, 5.94-7.51 pg/mL] vs. 5.10 pg/mL [IQR, 4.10-5.94 pg/mL]; log transformed; p < 0.001), but we failed to identify a difference in levels between those with unfavorable outcome (Vineland Adaptive Behavior Score < 70, n = 4) vs. favorable outcome.</p><p><strong>Conclusions: </strong>Blood biomarkers measured early after injury are associated with MRI injury and may provide additional information for prognostication when incorporated in a multimodal evaluation.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e915-e923"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12221777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976221","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":"Diabetic Ketoacidosis and Venous Thromboembolism: A North American Virtual Pediatric Systems Registry Study, 2014-2023.","authors":"Kristin M DeMayo, Elizabeth E Havlicek, Jamie Palumbo, Gerardo Soto-Campos, Marisol Betensky, Neil A Goldenberg, Anthony A Sochet","doi":"10.1097/PCC.0000000000003769","DOIUrl":"10.1097/PCC.0000000000003769","url":null,"abstract":"<p><strong>Objectives: </strong>To estimate the occurrence rate of venous thromboembolism (VTE) among critically ill children and young adults with diabetic ketoacidosis (DKA) and evaluate putative prothrombotic risk factors using a multicenter data registry.</p><p><strong>Design: </strong>Multicenter, observational, retrospective study utilizing a cohort derived from the Virtual Pediatric Systems database from October 1, 2014, to December 31, 2023.</p><p><strong>Setting: </strong>One hundred thirty-nine North American PICUs.</p><p><strong>Patients: </strong>Critically ill children and young adults older than 30 days to younger than 21 years old with principal admission diagnosis of DKA, excluding neonates, postcardiac surgical patients, and children with length of stay (LOS) less than 1 day.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Of 21,549 encounters, 62 (0.29%) developed VTE (mean annual rate, 0.29% ± 0.06%) and 32 of 62 (55%) were hospital-acquired VTE. Patients with, as compared to without, VTE experienced greater rates of sepsis (43.6% vs. 0.7%), cerebral edema (17.7% vs. 3.1%), central venous catheterization (CVC: 66.1% vs. 3.8%), invasive mechanical ventilation (46.8% vs. 2.3%), and a greater LOS (median, 4.9 d [interquartile range (IQR), 2.6-12.2 d] vs. 1.4 d [IQR, 1.1-1.9 d]; all p < 0.001). Regarding DKA-specific prothrombotic risk factors, those with (as compared to without) VTE had more severe acidosis (median admission pH, 6.96 [IQR, 6.82-7.13] vs. 7.07 [IQR, 6.96-7.18]), hyperglycemia (median, 590 mg/dL [IQR, 453-834 mg/dL] vs. 406 mg/dL [IQR, 310-548 mg/dL]), and reduced Glasgow Coma Scale scores (median, 12 [IQR, 6-14] vs. 15 [IQR, 14-15]; all p < 0.001). In an adjusted model, the presence of a CVC (adjusted odds ratio, 23.27; 95% CI, 6.63-81.6; p < 0.001) and concurrent sepsis/infection (odds ratio, 6.69; 95% CI, 2.37-18.87; p < 0.001) were associated with VTE.</p><p><strong>Conclusions: </strong>In this multicenter observational study of critically ill children and young adults hospitalized with DKA, the estimated occurrence rate of VTE was 0.29% and, in an adjusted model, associated with CVC and concurrent infection/sepsis.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e924-e934"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174421","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 Sepsis Phenotype in a Single-Center Cohort Covering 2010-2020: Evolution in Day 1-Day 3 Trajectory and Potential Prognostic Value.","authors":"Zachary Aldewereld, Christopher Horvat, Gilles Clermont","doi":"10.1097/PCC.0000000000003708","DOIUrl":"10.1097/PCC.0000000000003708","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the utility of day 3 sepsis phenotype classifications compared with day 1 and whether these could be reliably identified using routine clinical data on day 1.</p><p><strong>Design: </strong>Retrospective cohort study of pediatric patients managed 2010-2014 and 2018-2020.</p><p><strong>Setting: </strong>Academic children's hospital.</p><p><strong>Patients: </strong>One thousand eight hundred twenty-eight children (1 mo to 18 yr old) admitted to the PICU with suspected infection who received a minimum of 7 days of systemic antibiotics.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Subjects showed significant evolution of phenotype from day 1 to day 3, with 31.7-60.9% remaining the same type. Outcomes were worst in those classifying as type D on day 3, with mortality as high as 16.6% in those that were classified as type D on both days 1 and 3, as well as 11.3% in those initially classified as type C (a lower mortality type) on day 1 but type D on day 3. Accurate statistical prediction of day 3 types using multinomial logistic regression and random forest and day 1 data was poor, despite attempts to improve performance.</p><p><strong>Conclusions: </strong>In our retrospective cohort of patients with sepsis, we identified significant evolution in phenotype over the first 3 days of illness. Day 3 phenotypes may provide more accurate statistical prediction of outcomes, but identification of day 3 phenotypes using data available early in the course of illness is challenging. New methods will likely be required to improve performance in this area.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e909-e914"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524091","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 Bronchiolitis in Infants on Invasive Mechanical Ventilation: Physiology Study of Airway Closure.","authors":"Javier Varela, Nadine Aranis, Francisca Varas, Martina Vallejos, Alejandro Bruhn","doi":"10.1097/PCC.0000000000003790","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003790","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to explore whether airway closure can be detected in patients with severe acute bronchiolitis on invasive mechanical ventilation.</p><p><strong>Design: </strong>Single-center prospective physiologic study carried out in 2023-2024.</p><p><strong>Setting: </strong>PICU in a tertiary-care general hospital.</p><p><strong>Patients: </strong>Infants with acute bronchiolitis undergoing invasive mechanical ventilation.</p><p><strong>Interventions: </strong>Under deep sedation and neuromuscular blockade, the mechanical ventilator, in a volume-controlled mode, was transiently set with a respiratory rate of five breaths/min, a tidal volume of 6 mL/kg of ideal body weight, positive end-expiratory pressure 0 cm H2O, a flow rate of 2 L/min, an inspiratory-expiratory ratio of 1:1, and a Fio2 of 1.0. After recording three breath cycles, the patient was returned to baseline ventilatory settings.</p><p><strong>Measurements and main results: </strong>We identified the presence of airway closure through the low-flow pressure-volume curve obtained from a pneumotachometer with a flow sensor placed at the Y-piece and simultaneously from the pressure-impedance curve and ventilation maps acquired using electrical impedance tomography. We included 12 patients, and airway closure was detected in seven of them. The median (interquartile range [IQR]) airway opening pressure was 14 cm H2O (IQR, 11-17 cm H2O). Patients with airway closure exhibited high levels of driving pressure, with a median of 16 cm H2O (IQR, 11-17 cm H2O), and low levels of respiratory system compliance, with a median of 0.41 mL/cm H2O/kg (IQR, 0.38-0.59 mL/cm H2O/kg). When these parameters were corrected for airway opening pressure, there was a significant decrease in driving pressure to 9 cm H2O (IQR, 8-12 cm H2O; p = 0.018) and a significant increase in respiratory system compliance to 0.70 mL/cm H2O/kg (IQR, 0.53-0.81 mL/cm H2O/kg; p = 0.018).</p><p><strong>Conclusions: </strong>Airway closure requiring high opening pressures can be detected in ventilated infants with acute bronchiolitis, and this phenomenon may impact respiratory mechanics.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144541817","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}