Pediatric Critical Care Medicine最新文献

{"title":"Airway Occlusion Pressure and P0.1 to Estimate Inspiratory Effort and Respiratory Drive in Ventilated Children.","authors":"Michelle W Rudolph, Maaike Sietses, Alette A Koopman, Robert G T Blokpoel, Martin C J Kneyber","doi":"10.1097/PCC.0000000000003697","DOIUrl":"10.1097/PCC.0000000000003697","url":null,"abstract":"<p><strong>Objective: </strong>To compare the level of agreement between proximal (near the subject) and distal (inside the ventilator) measured airway occlusion pressure at 100 ms (P0.1) and occlusion pressure (Δ Pocc ), and to study the correlation between Δ Pocc and peak-to-trough esophageal pressure (Δ Pes ).</p><p><strong>Design: </strong>Secondary analysis of prospectively collected physiology dataset (2021-2022).</p><p><strong>Setting: </strong>Medical-surgical 20-bed PICU.</p><p><strong>Patients: </strong>Children younger than 18 years with and without acute lung injury ventilated greater than 24 hours and spontaneously breathing with appropriate triggering of the ventilator.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Data from three expiratory hold maneuvers (with a maximum of three breaths during each maneuver) in 74 subjects (118 measurements) with median age 3 months (interquartile range 1-17), and primary respiratory failure due to a pulmonary infection in 41/74 (55.4%) were studied. The median proximal ∆ Pocc was 6.7 cm H 2 O (3.1-10.7) and median P0.1 4.9 cm H 2 O (4.1-6.0) for the first breath from the maneuver; both increased significantly ( p < 0.001) with the subsequent two breaths during the same maneuver. Median distal ∆ Pocc was 6.8 (2.9-10.8) and P0.1 4.6 (3.9-5.6) cm H 2 O; both increased significantly ( p < 0.001) with the two subsequent breaths. Proximal and distal Δ Pocc ( r > 0.99, p < 0.001) and P0.1 ( r > 0.80, p < 0.001) were correlated. Correlation between ventilator displayed and Y-piece measured Δ Pocc ( r > 0.99) and P0.1 ( r = 0.85) was good. Mean ( sd ) difference for Δ Pocc was 0.13 (0.21); levels of agreement were -0.28 and 0.54. For P0.1, mean ( sd ) difference was -0.36 (1.14) and levels of agreement -2.61 and 1.88. There was a high correlation between Δ Pes and ∆ Pocc ( r = 0.92) for the same breath and a good correlation with Δ Pes from the preceding breath ( r = 0.76). There was a poor correlation with the transpulmonary pressure ( r = 0.37).</p><p><strong>Conclusions: </strong>Δ Pocc is not affected by measurement site, whereas P0.1 may be overestimated or underestimated. Δ Pocc was highly correlated with the peak-to-trough esophageal pressure, supporting the concept that inspiratory effort can also be quantified noninvasively by measuring Δ Pocc .</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e498-e506"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143409768","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":"My Perfect Son.","authors":"Melanie Jansen","doi":"10.1097/PCC.0000000000003687","DOIUrl":"10.1097/PCC.0000000000003687","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e583-e584"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971812","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":"Blood Glucose Range for Hyperglycemic PICU Children With Primary Neurologic Diagnoses: Analysis of the Heart and Lung Failure-Pediatric Insulin Titration (HALF-PINT) Trial.","authors":"Kerri L LaRovere, Lisa A Asaro, Kerry Coughlin-Wells, Vinay M Nadkarni, Michael S D Agus","doi":"10.1097/PCC.0000000000003689","DOIUrl":"10.1097/PCC.0000000000003689","url":null,"abstract":"<p><strong>Objectives: </strong>To compare two blood glucose (BG) ranges in critically ill children with and without primary neurologic diagnoses in the Heart and Lung Failure-Pediatric Insulin Titration trial (HALF-PINT; ClinicalTrials.gov Identifier NCT01565941).</p><p><strong>Design: </strong>Non-prespecified post hoc analysis.</p><p><strong>Setting: </strong>Thirty-one PICUs in the United States, and one in Canada.</p><p><strong>Patients: </strong>Non-diabetic children enrolled from April 2012 to September 2016 with cardiovascular or respiratory failure and hyperglycemia. Patients in the neurologic subgroup had primary neurologic diagnoses on ICU admission.</p><p><strong>Interventions: </strong>Patients were randomized to insulin infusion to target lower-BG (80-110 mg/dL; 4.4-6.1 mmol/L) or higher-BG (150-180 mg/dL; 8.3-10 mmol/L).</p><p><strong>Measurements and main results: </strong>Primary diagnosis (neurologic vs. non-neurologic), daily BG and insulin values, outcomes (number of PICU-free days through day 28 and 1-y post-PICU discharge adaptive behavior composite score of Vineland Adaptive Behavior Scales, Second Edition). Of 698 patients analyzed, 64 (30 lower-BG target, 34 higher-BG target) had primary neurologic diagnoses and 634 (319 lower-BG target, 315 higher-BG target) had non-neurologic diagnoses. Within the neurologic subgroup, patients in the lower-BG targeting group had fewer ICU-free days compared with those in the higher-BG targeting group (median 8.5 vs. 21.1 d), whereas there was no difference between BG groups in the non-neurologic subgroup (20.5 vs. 19.3 d; interaction p = 0.02). One-year adaptive behavior composite score was less favorable for the lower-BG targeting group in those with neurologic diagnoses (mean 63.3 vs. 87.6), but no different in those with non-neurologic diagnoses (81.9 vs. 78.4; interaction p = 0.02). Lower-BG targeting was associated with more hypoglycemia (< 60 mg/dL) in both diagnostic subgroups, with no differential effect across subgroups ( p = 0.47).</p><p><strong>Conclusions: </strong>In this non-prespecified analysis of the HALF-PINT trial data, lower-BG targeting in hyperglycemic critically ill children with primary neurologic diagnoses was associated with unfavorable outcomes, while such BG targeting in those with non-neurologic diagnoses was not associated with adverse outcomes.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e432-e446"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190031","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":"Severity of Impaired Oxygenation and Conservative Oxygenation Targets in Mechanically Ventilated Children: A Post Hoc Subgroup Analysis of the Oxy-PICU Trial of Conservative Oxygenation.","authors":"Samiran Ray, Martin Wiegand, Doug W Gould, David A Harrison, Paul R Mouncey, Mark J Peters","doi":"10.1097/PCC.0000000000003686","DOIUrl":"10.1097/PCC.0000000000003686","url":null,"abstract":"<p><strong>Objectives: </strong>A conservative oxygenation strategy is recommended in adult and pediatric guidelines for the management of acute respiratory distress syndrome to reduce iatrogenic lung damage. In the recently reported Oxy-PICU trial, targeting peripheral oxygen saturations (Sp o2 ) between 88% and 92% was associated with a shorter duration of organ support and greater survival, compared with Sp o2 greater than 94%, in mechanically ventilated children following unplanned admission to PICU. We investigated whether this benefit was greater in those who had severely impaired oxygenation at randomization.</p><p><strong>Design: </strong>Post hoc analysis of a pragmatic, open-label, multicenter randomized controlled trial.</p><p><strong>Setting: </strong>Fifteen PICUs across England and Scotland.</p><p><strong>Patients: </strong>Children between 38 weeks old corrected gestational age and 15 years accepted to a participating PICU as an unplanned admission and receiving invasive mechanical ventilation with supplemental oxygen for abnormal gas exchange.</p><p><strong>Interventions: </strong>A mixed-effects ordinal regression model was used to explore the effect of severity of lung injury, dichotomized to an oxygen saturation index (OSI) less than 12 or greater than or equal to 12 at randomization, the trial group allocation, age, and Pediatric Index of Mortality-3 on the composite ordinal outcome measure of duration of organ support at day 30 and mortality, with death being the worst outcome. An interaction term was included to specifically understand the effect of trial arm allocation on those with and OSI less than 12 and OSI greater than or equal to 12.</p><p><strong>Measurements and main results: </strong>Data were available for 1775 of 1986 eligible children. Two hundred twelve of 1775 children had an OSI greater than or equal to 12 at randomization. The trial primary outcome did not vary significantly according to OSI category. Both children with OSI less than 12 (odds ratio [OR], 0.85; 95% CI, 0.71-1.01) and OSI greater than or equal to 12 (OR, 0.95; 95% CI, 0.49-1.84) benefited from conservative arm allocation, with relative benefit greater for those with an OSI less than 12.</p><p><strong>Conclusions: </strong>These data do not provide evidence that a conservative oxygenation strategy should be limited to mechanically ventilated children with severely impaired oxygenation.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e492-e497"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971815","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":"Subtherapeutic Meropenem Antibiotic Exposure in Children With Septic Shock Assessed by Noncompartmental Pharmacokinetic Analysis in a Prospective Dataset.","authors":"John S Bradley, Helen Harvey, Dayna Stout, Jeremiah Momper, Edmund Capparelli, Sean N Avedissian, Courtney Barbato, Robert H Mak, Tom P Jones, Douglas Jones, Jennifer Le","doi":"10.1097/PCC.0000000000003698","DOIUrl":"10.1097/PCC.0000000000003698","url":null,"abstract":"<p><strong>Objectives: </strong>To define meropenem plasma concentrations and pharmacodynamic exposure metrics in children with septic shock during the first 3 days of PICU hospitalization.</p><p><strong>Design: </strong>Pharmacokinetic sampling was undertaken in 19 subjects receiving standard meropenem dosing (20 mg/kg/dose, 8 hr) recruited from March 2019 to March 2022. Sampling occurred once each day following meropenem given 24 hours apart, during the first 3 PICU days. Data analysis was completed in 2023 and noncompartmental analysis was performed to assess pharmacodynamic exposure targets for sepsis. Clearance and volume of distribution at 20 mg/kg/dose were used to simulate mean exposures at 40 and 60 mg/kg/dose.</p><p><strong>Setting: </strong>PICU in a tertiary care center.</p><p><strong>Subjects: </strong>Patients 4 weeks old or older with hypotension requiring fluid resuscitation and vasopressor therapy, receiving meropenem as empiric therapy for sepsis.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Augmented renal clearance (ARC) was documented in eight of 19 subjects, previously associated with subtherapeutic plasma concentrations, while three of 19 had acute kidney injury and decreased renal clearance. When assessed by pharmacodynamic exposure targets for sepsis (plasma meropenem concentrations above the minimum inhibitory concentration [MIC] of Pseudomonas aeruginosa for 70% or 100% of the dosing interval), ten of 19 and nine of 19 children, respectively, had subtherapeutic plasma meropenem exposures during PICU day 1, even for pathogens with an MIC considered \"susceptible\" by U.S. Food and Drug Administration criteria. Therapeutic meropenem pharmacodynamic exposures were associated with a positive 24-hour fluid balance on PICU day 1 and a negative 24-hour fluid balance by day 3, although profound variability was noted in fluid administered and renal output.</p><p><strong>Conclusions: </strong>Given the variability in meropenem systemic exposure in pediatric septic shock, therapeutic drug monitoring, or monitoring for ARC, is suggested during the first days of hospitalization to allow daily assessments of dosing needs to achieve pharmacodynamic exposure targets for sepsis.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e507-e515"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441783","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":"Daily Surveillance Blood Cultures in Children Supported With Extracorporeal Membrane Oxygenation: Single-Center, Retrospective Cohort Study, 2021-2023.","authors":"Nicholas Schmoke, Eunice Clark, Christopher Nemeh, Diana Vargas Chaves, Lisa Saiman, Eva W Cheung, William Middlesworth, Anita I Sen","doi":"10.1097/PCC.0000000000003699","DOIUrl":"10.1097/PCC.0000000000003699","url":null,"abstract":"<p><strong>Objective: </strong>Diagnosing bloodstream infections (BSIs) in patients on extracorporeal membrane oxygenation (ECMO) can be challenging due to circuit-controlled temperature, altered hemodynamics, and questionable reliability of inflammatory markers in critically ill patients. As a result, practice variability exists among ECMO centers regarding routine blood cultures for surveillance of BSI. Our study aimed to evaluate daily surveillance blood cultures in pediatric and neonatal ECMO patients.</p><p><strong>Design: </strong>Retrospective review of daily surveillance blood cultures from January 2021 to July 2023. We evaluated signs, symptoms, and laboratory results in patients with positive blood cultures.</p><p><strong>Setting: </strong>Academic children's hospital, New York, NY.</p><p><strong>Patients: </strong>All pediatric and neonatal patients supported on ECMO.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We identified a cohort of 111 patients (39 neonates and 72 children) who were supported with ECMO. Daily blood cultures were obtained on 1059 (99%) of 1065 completed ECMO days. Overall, 3% (35/1059) of blood cultures were positive, affecting 6% (7/111) of patients. All seven patients had new evidence of infection on the day of their first positive blood culture; six had clinical signs of infection, including new-onset hypotension, hypothermia, or respiratory decline, and the remaining patients had newly elevated inflammatory markers.</p><p><strong>Conclusions: </strong>Daily surveillance blood cultures are low-yield in our practice with pediatric and neonatal ECMO patients. Our experience shows that changes in clinical status, including abnormal physical or laboratory findings consistent with infection, are associated with BSI, allowing for timely diagnosis. These criteria should prompt as-needed blood cultures, reducing blood draws and preventing costly and unnecessary daily surveillance cultures.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e447-e453"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365509","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":"10.1097/PCC.0000000000003722","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e559-e562"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","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":"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":"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":"e482-e491"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968252/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review and Meta-Analysis of Prevalence and Population-Level Factors Contributing to Posttraumatic Stress Disorder in Pediatric Intensive Care Survivors.","authors":"Rebecca E Hay, Katie O'Hearn, David J Zorko, Laurie A Lee, Sarah Mooney, Cara McQuaid, Lisa Albrecht, David E Henshall, Vanessa Campes Dannenberg, Veronica Flamenghi, Celine Thibault, Wai Kit Lee, Michelle Shi Min Ko, Michele Cree, Julia St Louis, Julia A Heneghan, Karen Ka Yan Leung, Andrea Wood, Eliana López-Barón, Mohamad-Hani Temsah, Mohammed Almazyad, Jennifer Retallack, Mounika Reddy, Nedaa Aldairi, Rubén Eduardo Lasso Palomino, Karen Choong, Geneviève Du Pont-Thibodeau, Laurence Ducharme-Crevier, Anne Tsampalieros, Lamia Hayawi, James Dayre M McNally, Gonzalo Garcia Guerra","doi":"10.1097/PCC.0000000000003696","DOIUrl":"10.1097/PCC.0000000000003696","url":null,"abstract":"<p><strong>Objectives: </strong>In survivors of illnesses or surgeries requiring PICU admission, there is a risk of posttraumatic stress disorder (PTSD). We aimed to estimate PTSD prevalence and potential contributing factors in survivors of PICU admission.</p><p><strong>Data sources: </strong>We performed a PROSPERO registered systematic review (CRD42022348997; Registered August 2022) using MEDLINE, Embase, CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) databases, 2000 to 2022, with no language restrictions.</p><p><strong>Study selection: </strong>Observational or interventional studies evaluating the incidence or prevalence of PTSD in patients' after PICU admission and/or contributing factors to PTSD. We used studies describing patients younger than 18 years old. Since there were a large number of citations, we used an integrated crowdsourcing and machine-learning model for citation screening. Each citation was reviewed independently and in duplicate by two reviewers at each stage of screening and abstraction.</p><p><strong>Data extraction: </strong>Data items included study and participant demographics, details of case definition (PTSD screening), and risk factors.</p><p><strong>Data synthesis: </strong>We followed the Preferred Reporting items for Systematic Reviews and Meta-analysis guidelines. Random-effects models were used to analyze PTSD prevalence and subgroup differences. In 24 citations meeting final review criteria, 19 had data for meta-analysis. There were 1898 PICU survivors with a median (interquartile range) cohort size of 59 (49-76). PTSD prevalence in the studies ranged from 3% to 37%; PTSD occurred in 529 of 1898 survivors ( I2 = 72%). Factors influencing PTSD variability included timing of assessment ( p < 0.01) with the highest prevalence (29%) at 6 months and the type of assessment instrument ( n = 10; range, 4-27%; p = 0.04). There was lower prevalence of PTSD (8%) in postoperative cardiac patients ( p < 0.01). Last, we failed to find an association between PICU length of stay and PTSD prevalence ( p = 0.62; I2 = 80%).</p><p><strong>Conclusions: </strong>PICU follow-up studies from 2000 to 2022 indicate that one-in-three of admissions surviving to 6 months have PTSD. However, there are population, study design factors and heterogeneity in PTSD assessment that indicate more standardization in this research is needed.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e531-e543"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391326","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":"Combining Bubble-Continuous Positive Airway Pressure and Dexmedetomidine Infusion for Moderate-to-Severe Bronchiolitis Outside the PICU.","authors":"Giacomo Brisca, Marina F Strati, Marcello Mariani, Silvia Buratti, Emanuele Giacheri, Marta Romanengo, Giacomo Tardini, Marisa Mallamaci, Valentina Carrato, Isabella Buffoni, Simona Matarese, Daniela Pirlo, Andrea Moscatelli","doi":"10.1097/PCC.0000000000003694","DOIUrl":"10.1097/PCC.0000000000003694","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e585-e587"},"PeriodicalIF":4.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080659","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}