Pediatric Critical Care Medicine最新文献

{"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":"https://doi.org/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":""},"PeriodicalIF":4.0,"publicationDate":"2025-02-28","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":"Parent-Reported Secondary Stressor Inventory Scores and Bedside Presence During PICU Admission.","authors":"Robert T Ohman, Iris Chan, Lisa DelSignore","doi":"10.1097/PCC.0000000000003652","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003652","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 2","pages":"e278-e280"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468704","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 Sepsis Criteria in Critically Ill Children: Retrospective Validation Using a United States Nine-Center Dataset, 2012-2018.","authors":"L Nelson Sanchez-Pinto, Latasha A Daniels, Mihir Atreya, E Vincent S Faustino, Reid W D Farris, Alon Geva, Robinder G Khemani, Colin Rogerson, Sareen S Shah, Scott L Weiss, Tellen D Bennett","doi":"10.1097/PCC.0000000000003675","DOIUrl":"10.1097/PCC.0000000000003675","url":null,"abstract":"<p><strong>Objectives: </strong>To perform: 1) external validation of the Phoenix Sepsis Score and Phoenix sepsis criteria in a multicenter cohort of critically ill children with infection and a comparison with the 2005 International Pediatric Sepsis Consensus Conference (IPSCC) criteria; 2) a study of Phoenix sepsis criteria performance in patient subgroups based on age and comorbidities; 3) an assessment of microbiological profile of children with Phoenix sepsis; and 4) a study of the performance of the Phoenix-8 score.</p><p><strong>Design: </strong>Secondary, retrospective analysis of a multicenter cohort study from 2012 to 2018.</p><p><strong>Setting: </strong>Nine PICUs in the United States.</p><p><strong>Patients: </strong>PICU admissions with suspected infection.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Among 25,680 encounters of children with suspected or confirmed infection on PICU admission (4.6% in-hospital mortality), 11,168 (43%) met Phoenix criteria for sepsis or septic shock (9% in-hospital mortality). The Phoenix criteria generally outperformed the IPSCC criteria at discriminating mortality in all critically ill children with infections and across all subgroup analyses, including age group, malignancy, or technology dependence. Of 11,168 patients who met Phoenix criteria, 28% were negative for IPSCC criteria for sepsis and these had higher in-hospital mortality than those who met IPSCC sepsis criteria but not Phoenix criteria (4.7% vs.1.7%; p < 0.001), which was similar to the mortality of patients without sepsis (1.3%). Sepsis was associated with respiratory or bloodstream infection, most commonly Pseudomonas aeruginosa or Staphylococcus aureus. The Phoenix-8 score had good discrimination of mortality in children with infections, comparable to or better than validated and widely used severity of illness and organ dysfunction scores.</p><p><strong>Conclusions: </strong>In 2012-2018, among U.S. patients with suspected or confirmed infection admitted to nine PICUs, those with the highest risk of mortality can be identified using the Phoenix sepsis criteria, including in children of different age groups and those with major comorbidities.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 2","pages":"e155-e165"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468709","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":"Machine Learning-Based Pediatric Early Warning Score: Patient Outcomes in a Pre- Versus Post-Implementation Study, 2019-2023.","authors":"Anoop Mayampurath, Kyle Carey, Brett Palama, Monica Gonzalez, Joe Reid, Allison H Bartlett, Matthew Churpek, Dana Edelson, Priti Jani","doi":"10.1097/PCC.0000000000003656","DOIUrl":"10.1097/PCC.0000000000003656","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the deployment of pediatric Calculated Assessment of Risk and Triage (pCART), a machine learning (ML) model to predict the risk of the direct ward to the ICU transfer within 12 hours, and the associated improved outcomes among hospitalized children.</p><p><strong>Design: </strong>Pre- vs. post-implementation study.</p><p><strong>Setting: </strong>An urban, tertiary-care, academic hospital.</p><p><strong>Patients: </strong>Pediatric (age < 18 yr) admissions from May 1, 2019, to April 30, 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Patients were divided into baseline, pre-pCART implementation (May 1, 2019, to April 30 2021), and post-pCART implementation (May 1, 2021, to April 30, 2023) cohorts. First-ward admissions with a high-risk score (pCART score ≥ 92) were considered as the main cohort. The primary outcome was the occurrence of critical events, defined as invasive mechanical ventilation, vasoactive drug administration, or death within 12 hours of the first high-risk pCART score. There were 2763 and 3943 patients in the baseline and implementation cohorts, respectively. pCART implementation was associated with a decrease in the percentage of the primary outcome from baseline 1.4% to 0.4% (p < 0.001), which converted to more than two-thirds lower adjusted odds of the primary outcome (odds ratio, 0.22 [95% CI, 0.11-0.40]; p < 0.001). pCART implementation was also associated with a decreased prevalence of critical events at 24 and 48 hours after a first high-risk score. We failed to identify any association between cohort period and overall hospital and ICU length-of-stay, number of ICU transfers, and time to ICU transfer. However, there was a difference in hospital length-of-stay among a subpopulation of patients transferred to the ICU (median 6 vs. 7 d; p < 0.001). Analysis of compliance metrics indicates sustained compliance achievements over time.</p><p><strong>Conclusions: </strong>The deployment of pCART, a ML-based pediatric risk stratification tool, for clinical decision support for pediatric ward patients, was associated with lower odds of critical events among high-risk patients.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 2","pages":"e146-e154"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468702","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 2024 Phoenix Sepsis Score Criteria: Part 4, What About Using World-Oriented Criteria?","authors":"Matthew O Wiens, Enitan D Carrol, Mohammod Jobayer Chisti, Daniela Carla de Souza, Rakesh Lodha, Suchitra Ranjit, Niranjan Kissoon","doi":"10.1097/PCC.0000000000003663","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003663","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 2","pages":"e262-e265"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468735","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 2024 Phoenix Sepsis Score Criteria: Part 5, What About \"Parsimony\" in the Criteria-Is Less Really More?","authors":"Adrienne G Randolph, Mark W Hall, Niranjan Kissoon, Daniela Carla de Sousa, Mohammod Jobayer Chisti, Enitan D Carrol","doi":"10.1097/PCC.0000000000003665","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003665","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 2","pages":"e266-e271"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468738","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":"Experience for the \"Experts\": Maintenance of Airway Skills As a PICU Attending.","authors":"Teresa Lee, Sapna R Kudchadkar, Donald H Shaffner","doi":"10.1097/PCC.0000000000003666","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003666","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 2","pages":"e244-e245"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468700","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 Phoenix Sepsis Score in Pediatric Oncology Patients With Sepsis at PICU Admission: Test of Performance in a European Multicenter Cohort, 2018-2020.","authors":"Roelie M Wösten-van Asperen, Hannah M la Roi-Teeuw, Wim J E Tissing, Iolanda Jordan, Christian Dohna-Schwake, Gabriella Bottari, John Pappachan, Roman Crazzolara, Angela Amigoni, Agnieszka Mizia-Malarz, Andrea Moscatelli, María Sánchez-Martín, Jef Willems, Luregn J Schlapbach","doi":"10.1097/PCC.0000000000003683","DOIUrl":"10.1097/PCC.0000000000003683","url":null,"abstract":"<p><strong>Objectives: </strong>The Pediatric Sepsis Definition Task Force developed and validated a new organ dysfunction score, the Phoenix Sepsis Score (PSS), as a predictor of mortality in children with suspected or confirmed infection. The PSS showed improved performance compared with prior scores. However, the criteria were derived in a general pediatric population, in which only 10% had cancer. Given that pediatric cancer patients with sepsis have higher mortality compared with noncancer patients with sepsis, we aimed to assess the PSS in PICU patients with cancer and sepsis.</p><p><strong>Design: </strong>Retrospective multicenter cohort study.</p><p><strong>Setting: </strong>Twelve PICUs across Europe.</p><p><strong>Patients: </strong>Each PICU identified patients 18 years young or younger, with underlying malignancy and suspected or proven sepsis, and admission between January 1, 2018, and January 1, 2020.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The PSS and three other scores, including Phoenix-8, Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score, and pediatric Sequential Organ Failure Assessment (pSOFA) score, were calculated for comparison. The primary outcome was 90-day all-cause mortality. We compared score performance using area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC) analyses. Among 383 patients with proven or suspected sepsis, 90-day mortality was 19.3% (74/383). We failed to identify an association between a particular score and performance for 90-day mortality. The mean (95% CI) values for the AUROC of each score was: PSS 0.66 (0.59-0.72), Phoenix-8 0.65 (0.58-0.72), PELOD-2 0.64 (0.57-0.71), and pSOFA 0.67 (0.60-0.74) and for the AUPRC of each score: PSS 0.32 (0.23-0.42), Phoenix-8 0.32 (0.23-0.42), PELOD-2 0.32 (0.22-0.43), and pSOFA 0.36 (0.26-0.46). Similar results were obtained for PICU mortality or sepsis-related PICU mortality.</p><p><strong>Conclusions: </strong>Contrary to the general PICU population, our retrospective test of the PSS in a PICU oncology dataset with suspected or proved sepsis from European PICUs, 2018-2020, failed to identify improved performance in association with mortality. This unique patient population deserves development of organ dysfunction scores that reflect organ dysfunction and mortality data specifically from these patients and will require prospective validation in future studies.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 2","pages":"e177-e185"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468742","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":"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":"e241-e243"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","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":"What Do We Know About Pediatric Sepsis Scoring Post-Phoenix?","authors":"Robert C Tasker","doi":"10.1097/PCC.0000000000003690","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003690","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 2","pages":"e237-e240"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468748","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}