Pediatric Critical Care Medicine最新文献

{"title":"Syndecan-1 as a Biomarker for Fluid Overload After High-Risk Pediatric Cardiac Surgery: A Pilot Study.","authors":"Matthew A Solomon, David S Hains, Andrew L Schwaderer, Katie Gallaway, Colin J Sallee, Francis Pike, Sam Arregui, Daniel T Cater, Christopher W Mastropietro, Courtney M Rowan","doi":"10.1097/PCC.0000000000003717","DOIUrl":"10.1097/PCC.0000000000003717","url":null,"abstract":"<p><strong>Objective: </strong>Fluid overload (FO) after pediatric cardiac surgery with cardiopulmonary bypass (CPB) is common and has been associated with poor outcomes. We aimed to describe the relationship between plasma concentrations of syndecan-1 (SD1), a biomarker of endothelial glycocalyx injury, and FO in a cohort of children undergoing cardiac surgery.</p><p><strong>Design: </strong>Single-center prospective observational pilot study, 2022-2023.</p><p><strong>Setting: </strong>Twenty-six-bed pediatric cardiac ICU (CICU) at a quaternary pediatric referral center.</p><p><strong>Patients: </strong>Children younger than 18 years old undergoing Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery congenital heart surgery mortality category 3, 4, and 5 cardiac surgeries with CPB.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We enrolled 15 patients. Blood samples were collected preoperatively and 4 hours postoperatively, then processed for plasma. SD1 concentrations were measured using enzyme-linked immunosorbent assays and compared with fluid balance on postoperative days (PODs) 1, 2, 3, and peak. SD1 discriminated fluid balance of greater than or equal to 10% on POD-1, POD-2, and POD-3 with an area under the receiver operating characteristic curve (AUROC) of 0.74, 0.84, and 0.88, respectively. SD1 also discriminated peak fluid balance of greater than or equal to 10% occurring on any day over the first seven PODs with an AUROC of 0.94. Patients with greater than or equal to 10% fluid balance on POD-2 (p = 0.037), POD-3 (p = 0.020), or peak (p = 0.021) had significantly elevated delta SD1 when compared with those reaching less than 10%. Fluid balance of greater than or equal to 10% on POD-2 was associated with adverse events including longer duration of mechanical ventilation and CICU stay.</p><p><strong>Conclusions: </strong>Plasma SD1 was associated with FO in pediatric patients undergoing high-risk cardiac surgery with CPB. Further studies exploring the clinical utility of SD1 as a biomarker for FO in the postoperative management of children who undergo cardiac surgery with CPB should be pursued.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586443","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":"Targeting Blood Glucose: Searching for a Sweet Spot in Pediatric Neurocritical Care.","authors":"Ricardo G Branco","doi":"10.1097/PCC.0000000000003725","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003725","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573396","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":"Adding Insult to Injury: Posttraumatic Stress Disorder After Critical Illness.","authors":"Anjali Garg, Deanna M Behrens","doi":"10.1097/PCC.0000000000003726","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003726","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluid Management Bundles: Beginning to Build a Bridge Over Troubled Water?","authors":"Chloe G Braun, David T Selewski, Adam C Dziorny, Denise C Hasson","doi":"10.1097/PCC.0000000000003722","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003722","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573386","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":"Diagnosing Nosocomial Infections During Pediatric Extracorporeal Membrane Oxygenation.","authors":"Erika R O'Neil, Joseph E Marcus, Graeme MacLaren","doi":"10.1097/PCC.0000000000003723","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003723","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573385","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 Respiratory Distress Syndrome in Children With Lower Respiratory Tract Infection Requiring Invasive Mechanical Ventilation: Post Hoc Analysis of the 2019-2020 Bronchiolitis and Codetection Cohort.","authors":"Benjamin R White, Lee Polikoff, Robin Alexander, Benjamin R Baer, Alexandre T Rotta, Sebastián González-Dambrauskas, Ledys M Izquierdo, Pablo Castellani, Christopher M Watson, Ryan A Nofziger, Steven Pon, Todd Karsies, Steven L Shein","doi":"10.1097/PCC.0000000000003712","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003712","url":null,"abstract":"<p><strong>Objectives: </strong>Bronchiolitis and other lower respiratory tract infections (LRTIs) are the most common causes of pediatric respiratory failure. There is insufficient evidence characterizing pediatric acute respiratory distress syndrome (PARDS) in young children with LRTI to inform clinical management. We aimed to describe the prevalence and clinical characteristics of children intubated for LRTI and meeting PARDS criteria.</p><p><strong>Design: </strong>We performed a post hoc analysis of data from the Bronchiolitis And COdetectioN (BACON) study, an international prospective observational study of critical bronchiolitis. We compared PARDS subjects (meeting criteria the first full calendar day following intubation) to non-PARDS subjects.</p><p><strong>Setting: </strong>Forty-eight international PICUs recruiting to the BACON study, from December 2019 to November 2020.</p><p><strong>Patients: </strong>Children younger than 2 years old, requiring mechanical ventilation for acute LRTI.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Complete data were available for 571 children. Day 1 PARDS was diagnosed in 240 subjects(42%) and associated with increased mortality (7.9% vs. 2.7%; p = 0.023), greater duration of invasive ventilation (165 hr [interquartile range, 112-251 hr] vs. 135 hr [76-204 hr]; p < 0.001), and PICU length of stay (11 d [7-16 d] vs. 8 d [5-13 d]; p < 0.001). In our multivariable competing risk model, the presence of PARDS on day 1 was causally related to a prolonged duration of mechanical ventilation with the probability of extubation at 7 days for those with PARDS equal to 49% (44-54%) compared with 64% (59-69%) for those without PARDS.</p><p><strong>Conclusions: </strong>PARDS development was common in this critical bronchiolitis cohort, resulted in a longer duration of mechanical ventilation, and was associated with increased mortality and PICU length of stay. Prospective studies are needed to elucidate the optimal management of critical bronchiolitis.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567782","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":"Development and Validation of an Electronic Health Record-Based, Pediatric Acute Respiratory Distress Syndrome Subphenotype Classifier Model.","authors":"Daniel R Balcarcel, Mark V Mai, Sanjiv D Mehta, Kathleen Chiotos, L Nelson Sanchez-Pinto, Blanca E Himes, Nadir Yehya","doi":"10.1097/PCC.0000000000003709","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003709","url":null,"abstract":"<p><strong>Objective: </strong>To determine if hyperinflammatory and hypoinflammatory pediatric acute respiratory distress syndrome (PARDS) subphenotypes defined using serum biomarkers can be determined solely from electronic health record (EHR) data using machine learning.</p><p><strong>Design: </strong>Retrospective, exploratory analysis using data from 2014 to 2022.</p><p><strong>Setting: </strong>Single-center quaternary care PICU.</p><p><strong>Patients: </strong>Two temporally distinct cohorts of PARDS patients, 2014-2019 and 2019-2022.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Patients in the derivation cohort (n = 333) were assigned to hyperinflammatory or hypoinflammatory subphenotypes using biomarkers and latent class analysis. A machine learning model was trained on 165 EHR-derived variables to identify subphenotypes. The most important variables were selected for inclusion in a parsimonious model. The model was validated in a separate cohort (n = 114). The EHR-based classifier achieved an area under the receiver operating characteristic curve (AUC) of 0.93 (95% CI, 0.87-0.98), with a sensitivity of 88% and specificity of 83% for determining hyperinflammatory PARDS. The parsimonious model, using only five laboratory values, achieved an AUC of 0.92 (95% CI, 0.86-0.98) with a sensitivity of 76% and specificity of 87% in the validation cohort.</p><p><strong>Conclusions: </strong>This proof-of-concept study demonstrates that biomarker-based PARDS subphenotypes can be identified using EHR data at 24 hours of PARDS diagnosis. Further validation in larger, multicenter cohorts is needed to confirm the clinical utility of this approach.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567788","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":"Area-Level Socioeconomic Disadvantage and Post-PICU Outcomes in Children With an Acquired Brain Injury: Single-Center Retrospective Cohort, 2016-2023.","authors":"Jamie M Klapp, Mallory B Smith, Ashley D Turner, Cydni N Williams","doi":"10.1097/PCC.0000000000003720","DOIUrl":"10.1097/PCC.0000000000003720","url":null,"abstract":"<p><strong>Objectives: </strong>To examine associations between measures of area-level socioeconomic disadvantage and disability outcomes in children with acquired brain injuries (ABIs) after PICU hospitalization.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary academic children's hospital.</p><p><strong>Patients: </strong>Children 3-19 years old admitted to the PICU for ABI (2016-2023) who completed a post-PICU follow-up clinic visit 1-3 months after discharge.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>In 455 children with ABI, median age of 10.8 years (interquartile range, 6.6-14.2 yr), we measured area-level socioeconomic disadvantage with the Child Opportunity Index (COI; higher scores equal less disadvantage) and Area Deprivation Index (ADI; higher scores equal more disadvantage) referenced to state. COI was categorized by quintile (very low to very high) and ADI was grouped into the lowest three, middle four, and highest three deciles. New disability was defined as greater than or equal to 1 point increase from baseline in Functional Status Scale total score at follow-up. New disability was present in 97 of 455 children (21.3%). New disability, low COI, and high ADI were independently associated with severity of illness. Multivariable logistic regression controlling for demographic and clinical covariates showed very high vs. very low COI was associated with 60% lesser odds of new disability at follow-up (adjusted odds ratio [aOR], 0.41; 95% CI, 0.17-0.99). We failed to identify such an association comparing the low to high ADI group (aOR, 0.59; 95% CI, 0.30-1.16), but we are unable to exclude the possibility that living in advantaged areas was associated with up to 70% lesser odds of new disability at follow-up.</p><p><strong>Conclusions: </strong>In children with ABI, we have found that area-level socioeconomic disadvantage is associated with greater odds of post-PICU disability, when controlling for other demographic and severity of illness characteristics. Future research is needed to identify modifiable targets to reduce disparities in PICU outcomes after ABI.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567785","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":"Reduced Severity of Arterial Catheter-Associated Proximal Ischemic Injuries Through a Quality Improvement Initiative.","authors":"Mark D Weber, Eileen Nelson, Lauren Brennan, Hongyan Liu, Angela Grachen, Monica Ryan, Alexandra Billings, Samantha Steich, Danielle Traynor, Stephanie L Watts, Vitoria Moreno-Costa, Hannah R Stinson, Daniela Davis, Charlotte Woods-Hill, Amanda Ullman, Thomas W Conlon","doi":"10.1097/PCC.0000000000003715","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003715","url":null,"abstract":"<p><strong>Objectives: </strong>To define and reduce the incidence of severe arterial catheter-associated proximal ischemic injuries (ACAPII).</p><p><strong>Design: </strong>Quality improvement (QI) initiative.</p><p><strong>Setting: </strong>University affiliated PICU in a quaternary children's hospital.</p><p><strong>Patients: </strong>All patients with indwelling arterial catheters (ACs) in the PICU at the Children's Hospital of Philadelphia from January 2020 to December 2022.</p><p><strong>Interventions: </strong>Phase I (January 2021 to December 2021) included defining ACAPII and daily rounding on all ACs by a dedicated PICU-specific vascular access team. Phase II (January 2022 to December 2022) introduced standardized recommendations and interventions including the use of topical nitroglycerin ointment (TNG) as a therapeutic option for mild injuries.</p><p><strong>Measurements and main results: </strong>From January 2021 to December 2022, the rounding team evaluated 1916 ACs for a total of 5793 rounding episodes (line-days). During phase I, the overall number of ACAPII increased compared with prior year pre-QI (35 vs. 11, 318%). During phase II, the administration of TNG was associated with an increase in arterial line-days per AC in patients with mild injury (6.58 line-days per line, 158 d/24 lines) compared with pre-QI, phase I, and phase II mild injuries without use of TNG (3.27, 198/61; incident rate difference [95% CI], 3.31 [2.11-4.51]; p < 0.001). Special cause indicators shifted centerline from a weighted average 33.0-342.3 line-days between severe injuries. The cumulative severe ACAPII incidence rate decreased from its peak early in phase I (April 2021: 5.65 per 1000 line-days) to the end of phase II (December 2022: 2.11 per 1000 line-days). The overall rate of arterial line-days per AC during phase II increased compared with pre-QI (p < 0.01) and phase I (p < 0.01).</p><p><strong>Conclusions: </strong>The development of a newly defined measurable harm index, ACAPII, and implementation of increased surveillance resulted in increased awareness and reduction of severe injury as measured by rates and line-days between severe injuries in our critically ill patients. Protocolized management during phase II, including introducing TNG as a therapeutic option, resulted in increased AC line-days per catheter with sustained reduction in severe ACAPII rates.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542886","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":"26 3","pages":"e304-e314"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573399","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}