Pediatric Critical Care Medicine最新文献

{"title":"Quantity of Caloric Support After Pediatric Severe Traumatic Brain Injury: Description of Associated Outcomes in a Single Retrospective Center Cohort, 2010-2022.","authors":"Elizabeth C Elliott, Eduardo A Trujillo-Rivera, Omar Dughly, Terry Dean, Dana Harrar, Michael J Bell, Kitman Wai","doi":"10.1097/PCC.0000000000003641","DOIUrl":"10.1097/PCC.0000000000003641","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the relationship between adequacy of caloric nutritional support during the first week after severe traumatic brain injury (TBI) and outcome.</p><p><strong>Design: </strong>Single-center retrospective cohort, 2010-2022.</p><p><strong>Setting: </strong>Tertiary care children's hospital with a level 1 trauma center.</p><p><strong>Patients: </strong>Children younger than 18 years with PICU stay greater than 7 days for management of TBI, who had severe TBI, defined as Glasgow Coma Scale (GCS) score less than or equal to 8 at initial presentation and/or placement of an intracranial pressure monitor or external ventricular drain, and/or decompressive hemicraniectomy.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>A total of 93 patients were identified (median age 46 mo; 53% male; median GCS 5; hospital mortality 4%). Caloric goal was assigned by a dietician and the proportion of prescribed calories delivered to each patient over the first 7 days of PICU admission were analyzed. At the end of the first 7 days post-injury, overall median (interquartile range [IQR]) caloric and protein adequacies were 42% (IQR, 28-62%) and 48% (IQR, 29-61%), respectively. We failed to identify an association between adequacy of caloric support and greater odds of higher Functional Status Scale (FSS) score or higher Glasgow Outcome Scale Extended for Pediatrics score at discharge. However, at outpatient follow-up, prior adequacy of PICU caloric support was associated with greater odds of worse FSS (multiplicative increase per 10% increase in calories [MI], 1.10; 95% CI, 1.03-1.18; p = 0.002) and worse GOS E-Peds (MI, 1.16; 95% CI, 1.08-1.27; p < 0.001) at outpatient follow-up.</p><p><strong>Conclusions: </strong>In pediatric patients with severe TBI, there is an association between delivery of a greater proportion of their goal calories during the first 7 days after injury and greater odds of worse outcome at outpatient follow-up.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 1","pages":"e12-e22"},"PeriodicalIF":4.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952813","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":"Mechanical Thromboprophylaxis and Hospital-Acquired Venous Thromboembolism Among Critically Ill Adolescents: A U.S. Pediatric Health Information Systems Registry Study, 2016-2023.","authors":"Marisol Betensky, Nikhil Vallabhaneni, Neil A Goldenberg, Anthony A Sochet","doi":"10.1097/PCC.0000000000003601","DOIUrl":"10.1097/PCC.0000000000003601","url":null,"abstract":"<p><strong>Objectives: </strong>To estimate the rate of mechanical thromboprophylaxis (mTP) prescription among critically ill adolescents using a multicenter administrative database and determine whether mTP prescription is inversely associated with hospital-acquired venous thromboembolism.</p><p><strong>Design: </strong>Multicenter, observational, retrospective study of the Pediatric Health Information Systems (PHIS) Registry cohort, January 2016 to December 2023.</p><p><strong>Setting: </strong>Thirty PICUs located within quaternary pediatric referral centers in the United States.</p><p><strong>Patients: </strong>Critically ill children 12-17 years old, excluding encounters with a principal diagnosis at admission of venous thromboembolism.</p><p><strong>Interventions: </strong>mTP prescription within the first 24 hours of hospitalization.</p><p><strong>Measurements and main results: </strong>A total of 107,804 children met the study criteria, of which 21,124 (19.6%) were prescribed mTP. Hospital center prescribing rates ranged from 1.4% to 65.4% and decreased by 1.6% per year from 28.2% in 2016 to 17.1% in 2023. As compared with those without mTP, those with mTP more frequently had a concurrent central venous catheter (17.2% vs. 9.4%, p < 0.001), underwent invasive mechanical ventilation (37.4% vs. 24.8%, p < 0.001), were admitted for a primary surgical indication (30.9% vs. 12.7%, p < 0.001), and experienced a longer median duration of hospitalization (7 [interquartile range (IQR): 4-15] vs. 4 [IQR: 2-9] d, p < 0.001). Hospital-acquired venous thromboembolism occurred in 2.7% of the study sample and was more common among those with, as compared with without, prescription of mTP (4% vs. 2.4%, p < 0.001). In multivariable logistic regression models for hospital-acquired venous thromboembolism adjusting for salient prothrombotic risk factors, we failed to identify an association between mTP and greater odds of hospital-acquired venous thromboembolism (HA-VTE) among low-, moderate-, and high-risk tiers. However, we cannot exclude the possibility of 17-50% greater odds of HA-VTE in this population.</p><p><strong>Conclusions: </strong>In the multicenter PHIS cohort, 2016-2023, the prescribing patterns for mTP among critically ill adolescents showed a low rate of mTP prescription (19.6%) that varied widely across institutions, decreased annually over the study period by 1.6%/year, and was not independently associated with HA-VTE risk reduction.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e33-e41"},"PeriodicalIF":4.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004963","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":"Protocol for the Catheter-Related Early Thromboprophylaxis With Enoxaparin (CRETE) Studies.","authors":"E Vincent S Faustino, Sarah B Kandil, Matthew K Leroue, Anthony A Sochet, Michele Kong, Jill M Cholette, Marianne E Nellis, Matthew G Pinto, Madhuradhar Chegondi, Michelle Ramirez, Hilary Schreiber, Elizabeth W J Kerris, Christie L Glau, Amanda Kolmar, Teddy M Muisyo, Anjali Sharathkumar, Lee Polikoff, Cicero T Silva, Lauren Ehrlich, Oscar M Navarro, Philip C Spinella, Leslie Raffini, Sarah N Taylor, Tara McPartland, Veronika Shabanova","doi":"10.1097/PCC.0000000000003648","DOIUrl":"10.1097/PCC.0000000000003648","url":null,"abstract":"<p><strong>Objectives: </strong>In post hoc analyses of our previous phase 2b Bayesian randomized clinical trial (RCT), prophylaxis with enoxaparin reduced central venous catheter (CVC)-associated deep venous thrombosis (CADVT) in critically ill older children but not in infants. The goal of the Catheter-Related Early Thromboprophylaxis with Enoxaparin (CRETE) Studies is to investigate this newly identified age-dependent heterogeneity in the efficacy of prophylaxis with enoxaparin against CADVT in critically ill children.</p><p><strong>Design: </strong>Two parallel, multicenter Bayesian superiority explanatory RCTs, that is, phase 3 for older children and phase 2b for infants, and an exploratory mechanistic nested case-control study (Trial Registration ClinicalTrials.gov NCT04924322, June 7, 2021).</p><p><strong>Setting: </strong>At least 15 PICUs across the United States.</p><p><strong>Patients: </strong>Older children 1-17 years old ( n = 90) and infants older than 36 weeks corrected gestational age younger than 1 year old ( n = 168) admitted to the PICU with an untunneled CVC inserted in the prior 24 hours. Subjects with or at high risk of clinically relevant bleeding will be excluded.</p><p><strong>Interventions: </strong>Prophylactic dose of enoxaparin starting at 0.5 mg/kg then adjusted to anti-Xa range of 0.2-0.5 international units (IU)/mL for older children and therapeutic dose of enoxaparin starting at 1.5 mg/kg then adjusted to anti-Xa range of greater than 0.5-1.0 IU/mL or 0.2-0.5 IU/mL for infants while CVC is in situ.</p><p><strong>Measurements and main results: </strong>Randomization is 2:1 to enoxaparin or usual care (no enoxaparin) for older children and 1:1:1 to either of 2 anti-Xa ranges of enoxaparin or usual care for infants. Ultrasonography will be performed after removal of CVC to assess for CADVT. Subjects will be monitored for bleeding. Platelet poor plasma will be analyzed for markers of thrombin generation. Samples from subjects with CADVT will be counter-matched 1:1 to subjects without CADVT from the opposite trial arm. Institutional Review Board approved the \"CRETE Studies\" on July 1, 2021. Enrollment is ongoing with planned completion in July 2025 for older children and July 2026 for infants.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e95-e105"},"PeriodicalIF":4.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668585","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":"Too Much or Too Little? Nutrition After Severe Traumatic Brain Injury Matters!","authors":"Daniel Garros, Allison Ashkin, Megan R Beggs","doi":"10.1097/PCC.0000000000003651","DOIUrl":"10.1097/PCC.0000000000003651","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e109-e111"},"PeriodicalIF":4.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780498","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":"Using Implementation Science to Assess Barriers to Agreement on Sedation Goal Setting and Assessment.","authors":"Youyang Yang, Kate Becla, Heather Kennedy, Katrina Eder, Alireza Akhondi-Asl, Nilesh M Mehta, Alon Geva","doi":"10.1097/PCC.0000000000003643","DOIUrl":"10.1097/PCC.0000000000003643","url":null,"abstract":"<p><strong>Objectives: </strong>Sedation assessment and goal setting using a validated assessment tool are key components of the ICU Liberation bundle. Appropriate integration of these bundle elements into daily practice remains challenging. Understanding barriers is an important step toward implementation of these best practice bundle elements.</p><p><strong>Design: </strong>Two-phased explanatory mixed methods assessment carried out 2022-2023.</p><p><strong>Setting: </strong>Forty-bed quaternary PICU.</p><p><strong>Subjects: </strong>Bedside nurses and prescribers caring for mechanically ventilated patients on sedative infusions.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Forty-one nurses and 32 prescribers participated in the phase 1 pre-education assessments (2022). We identified lack of correlation between the providers' stated State Behavioral Scale (SBS) numerical goal and descriptive goal and hypothesized that this discrepancy was either due to a knowledge gap or disagreement on sedation goals. To investigate this hypothesis, we performed a phase 2 assessment (2022-2023), starting with a multipronged educational activity, followed by a repeat survey that included a qualitative interview. One hundred ninety nurses and 45 prescribers received the educational activity. Twenty-eight nurses and 22 prescribers participated in the phase 2 assessments with the qualitative interview. Although correlation of the sedation goal between providers improved, it remained poor. Subsequent qualitative interview data indicated that the reasons for persistent disagreement in the sedation goal for a given patient were related to individual providers' beliefs and attitudes toward sedation, rather than lack of understanding about using the SBS to set a target sedation goal.</p><p><strong>Conclusions: </strong>Barriers to setting and managing daily patient sedation goal in the PICU extend beyond providers' knowledge gaps. An improved understanding of underlying barriers is essential for successful implementation of evidence-based sedation guidelines.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 1","pages":"e51-e61"},"PeriodicalIF":4.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952820","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":"Iron Deficiency in the PICU: An Invisible Illness?","authors":"Robert I Parker","doi":"10.1097/PCC.0000000000003659","DOIUrl":"10.1097/PCC.0000000000003659","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e115-e117"},"PeriodicalIF":4.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801880","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":"Targeted Temperature Management After Pediatric Cardiac Arrest: A Quality Improvement Program With Multidisciplinary Implementation in the PICU.","authors":"Mason P McMullin, Noelle B Cadotte, Erin M Fuchs, Cory A Kartchner, Brian Vincent, Gretchen Parker, Jill S Sweney, Brian F Flaherty","doi":"10.1097/PCC.0000000000003640","DOIUrl":"10.1097/PCC.0000000000003640","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to implement a post-cardiac arrest targeted temperature management (TTM) bundle to reduce the percent of time with a fever from 7% to 3.5%.</p><p><strong>Design: </strong>A prospective, quality improvement (QI) initiative utilizing the Method for Improvement. The pre-intervention historical control period was February 2019 to March 2021, and the intervention test period was April 2021 to June 2022.</p><p><strong>Setting: </strong>The PICU of a freestanding, tertiary children's hospital, in the United States.</p><p><strong>Patients: </strong>Pediatric patients 2 days old or older to 18 young or younger than years old who experienced cardiac arrest, received greater than or equal to 2 minutes of chest compressions, required invasive mechanical ventilation post-resuscitation, and had no documented limitations of care.</p><p><strong>Interventions: </strong>We developed and implemented a TTM bundle that included standard temperature goals, instructions and training on cooling blanket use, scheduled prescription of antipyretics, an algorithm for managing shivering, and standardized orders in our electronic health record.</p><p><strong>Measurements and results: </strong>We reviewed data from 29 patients in the pre-intervention period and studied 46 in the intervention period. In comparison with historical controls, the reduction in median (interquartile range [IQR]) percentage of febrile (> 38°C) time per patient associated with the TTM bundle was 0% (IQR, 0-3%) vs. 7% (IQR, 0-13%; p < 0.001). The intervention period, vs. pre-intervention, was associated with fewer patients with fever at any time (16/46 vs. 21/29; mean reduction, 37%; 95% CI, 13.8-54.8%; p = 0.002). We failed to identify an association between the intervention period, vs. pre-intervention, and the development of hypothermia (< 35°C; 8/46 vs. 3/29; mean change, 7%; 95% CI, -10.9% to 21.8%; p = 0.40).</p><p><strong>Conclusions: </strong>In this QI project, we have demonstrated that implementation of a TTM bundle is associated with reduced duration and frequency of fever in patients who survive cardiac arrest.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e42-e50"},"PeriodicalIF":4.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710630","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":"The BASIC Bleeding Score: Does It Teach Us More Than Just How to Rate Bleeding?","authors":"Robert I Parker","doi":"10.1097/PCC.0000000000003639","DOIUrl":"10.1097/PCC.0000000000003639","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e106-e108"},"PeriodicalIF":4.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801881","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":"Timing of Palliative Care Consultation and End-of-Life Care Intensity in Pediatric Patients With Advanced Heart Disease: Single-Center, Retrospective Cohort Study, 2014-2022.","authors":"Kathryn L Songer, Sarah E Wawrzynski, Lenora M Olson, Mark E Harousseau, Huong D Meeks, Benjamin L Moresco, Claudia Delgado-Corcoran","doi":"10.1097/PCC.0000000000003647","DOIUrl":"10.1097/PCC.0000000000003647","url":null,"abstract":"<p><strong>Objectives: </strong>Pediatric patients with advanced heart disease (AHD) often receive high intensity medical care at the end of life (EOL). In this study, we aimed to determine whether receipt and timing of pediatric palliative care (PPC) consultation was associated with EOL care intensity of pediatric patients with AHD.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single-center, 16-bed cardiac ICU (CICU) in a children's hospital in the Mountain West.</p><p><strong>Patients: </strong>Pediatric patients (0-21 yr) with AHD treated in the CICU and subsequently died from January 2014 to December 2022.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We compared demographics, EOL characteristics, and care, including medical interventions and mortality characteristics for patients by receipt and timing of PPC (i.e., ≥ 30 d from [early] or < 30 d of death [late]) using chi-square and Wilcoxon rank-sum tests. Of 218 patients, 78 (36%) did not receive PPC, 76 received early PPC (35%), and 64 received late PPC (29%). Compared with patients who did not receive PPC, patients receiving PPC had lower EOL care intensity (77% vs. 96%; p = 0.004) and fewer invasive interventions within 14 days of death (74% vs. 92%; p = 0.004). Receipt of PPC, vs. not, was associated with lower rate of death during cardiopulmonary resuscitation (12% vs. 32%; p = 0.004) and more use of comfort care (23% vs. 3%; p = 0.004). Among patients receiving PPC, early PPC was associated with fewer invasive interventions within 14 days of death (65% vs. 85%; p = 0.033). Care intensity was high for patients with early and late PPC.</p><p><strong>Conclusions: </strong>Early PPC was associated with fewer invasive interventions within 14 days of death, yet the care intensity at EOL remained high. With early PPC, families likely receive timely psychosocial and advance care planning support without significantly altering goals of care.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e23-e32"},"PeriodicalIF":4.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668587","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 Critical Care Medicine 2025, Volume 26: A New Era As We Become Fully Digital.","authors":"Robert C Tasker","doi":"10.1097/PCC.0000000000003680","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003680","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 1","pages":"e1-e2"},"PeriodicalIF":4.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071145","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}