Pediatric Critical Care Medicine最新文献

{"title":"Prospective Randomized Pilot Study Comparing Bivalirudin Versus Heparin in Neonatal and Pediatric Extracorporeal Membrane Oxygenation.","authors":"Ali McMichael, Jamie Weller, Xilong Li, Laura Hatton, Ayesha Zia, Lakshmi Raman","doi":"10.1097/PCC.0000000000003642","DOIUrl":"10.1097/PCC.0000000000003642","url":null,"abstract":"<p><strong>Objectives: </strong>To test feasibility of a randomized controlled trial (RCT) with an endpoint of time at goal anticoagulation in children on extracorporeal membrane oxygenation (ECMO) randomized to receive bivalirudin vs. unfractionated heparin.</p><p><strong>Design: </strong>Open-label pilot RCT (NCT03318393) carried out 2018-2021.</p><p><strong>Setting: </strong>Single-center quaternary U.S. pediatric hospital.</p><p><strong>Patients: </strong>Children 0 days to younger than 18 years old supported with ECMO in the PICU or cardiovascular ICU.</p><p><strong>Interventions: </strong>Randomization to bivalirudin vs. unfractionated heparin while on ECMO.</p><p><strong>Measurements and main results: </strong>Sixteen patients were randomized to bivalirudin, and 14 patients were randomized to heparin. There was no difference in the primary outcome, time spent at goal anticoagulation, for patients randomized to bivalirudin compared with those randomized to heparin. While hemorrhagic complications were similar between study groups, thrombotic complications were higher with six of 16 patients in the bivalirudin group having one or more circuit changes compared with 0 of 14 patients in heparin group (mean difference, 37.5% [95% CI, 8.7-61.4%]; p = 0.02). Patients in the bivalirudin group received less packed RBC transfusions vs. those receiving heparin (median [interquartile range], 6.3 mL/kg/d [2.5-8.4 mL/kg/d] vs. 12.2 mL/kg/d [5.5-14.5 mL/kg/d]; p = 0.02).</p><p><strong>Conclusions: </strong>In this single-center pilot RCT carried out 2018-2021, we found that the test of anticoagulation therapy of bivalirudin vs. heparin during ECMO was feasible. Larger multicenter studies are required to further assess the safety and efficacy of bivalirudin for pediatric ECMO.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e86-e94"},"PeriodicalIF":4.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710626","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":"142952809","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":"Serum Phosphorus and Hypophosphatemia During Therapy of Diabetic Ketoacidosis in Children: Single-Center, Retrospective Cohort 2016-2022.","authors":"Rashed A Hasan, Jacob Z Hesen, Nicklaus Millican, John M Pederson, Michael S D Agus","doi":"10.1097/PCC.0000000000003649","DOIUrl":"10.1097/PCC.0000000000003649","url":null,"abstract":"<p><strong>Objectives: </strong>To assess factors associated with serum phosphorus (P) and hypophosphatemia in children with type 1 diabetes mellitus (T1DM) treated for diabetic ketoacidosis (DKA).</p><p><strong>Design: </strong>Retrospective cohort.</p><p><strong>Setting: </strong>Community-based PICU in a university-affiliated hospital.</p><p><strong>Patients: </strong>Patients 1-20 years old with T1DM hospitalized for DKA from July 1, 2016, to July 31, 2022.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We collected age, sex, duration of T1DM, conscious state at presentation, and most recent glycohemoglobin level. P was tested initially and then every 4 hours. Probability of hypophosphatemia and time to hypophosphatemia and hospital length of stay (LOS) were analyzed via binomial and linear mixed-effects regression analyses, respectively. A total of 852 DKA episodes occurred in 365 patients (46.3% female, median age 14.7 yr), of which 158 (18.5%) episodes were new-onset T1DM. Hypophosphatemia developed during 656 of 852 (77%) episodes, including 49 of 852 (5.8%) episodes of severe hypophosphatemia with median (interquartile range) onset 8.0 hours (4.7-11.9 hr) and 12.0 hours (8.1-17.6 hr), respectively, following initiation of therapy. Higher glycohemoglobin was associated with greater odds of hypophosphatemia (odds ratio [OR], 1.22; p < 0.001). However, lower odds of hypophosphatemia were associated with older age (OR, 0.89; p < 0.01), male (OR, 0.11; p = 0.01), longer T1DM duration (OR, 0.87; p < 0.001), and having initial normal conscious state (OR, 0.18; p < 0.01). Older age (3.0%/yr; p = 0.02), T1DM duration (4.1%/yr; p = 0.01), and initial serum P (23.4%/mg/dL; p < 0.001) were associated with later hypophosphatemia. LOS was shorter with increased T1DM duration (3.6%/yr; p < 0.001) and normal conscious state (33.1% shorter; p < 0.001), but longer with increasing glycohemoglobin (4.0%; p < 0.001). All patients survived with normal neurologic function.</p><p><strong>Conclusions: </strong>Higher glycohemoglobin was associated with greater odds of hypophosphatemia and longer LOS. Older male, longer duration of T1DM, and conscious at admission were factors associated with lower odds of developing hypophosphatemia and with later onset when it occurred. Hypophosphatemia was associated with longer LOS.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 1","pages":"e77-e85"},"PeriodicalIF":4.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952817","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":"Timing Is Everything.","authors":"Suzanne R Gouda, K Sarah Hoehn","doi":"10.1097/PCC.0000000000003658","DOIUrl":"10.1097/PCC.0000000000003658","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e112-e114"},"PeriodicalIF":4.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780495","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 Preliminary Testing of the Withdrawal Assessment Tool-Alpha 2 Agonist: An Assessment Instrument for Monitoring Iatrogenic Withdrawal Symptoms in Children Receiving an Alpha-2 Agonist.","authors":"Jean C Solodiuk, Carolina Donado, Lia Wickerham, Lindsay Goodyear, John Hayes, Rachel E Mortell, Christine D Greco, Martha A Q Curley","doi":"10.1097/PCC.0000000000003645","DOIUrl":"10.1097/PCC.0000000000003645","url":null,"abstract":"<p><strong>Objectives: </strong>To develop and conduct preliminary testing of the Withdrawal Assessment Tool-Alpha 2 Agonist (WAT-A2A) to monitor dexmedetomidine and clonidine withdrawal symptoms in acutely ill children.</p><p><strong>Design: </strong>Three-phase instrument development study. Phase 1: retrospective chart review of symptoms exhibited by children with documented dexmedetomidine withdrawal; phase 2: WAT-A2A instrument construction based on phase 1 data; and phase 3: prospective testing of the WAT-A2A in children weaning from alpha 2 agonists (A2As).</p><p><strong>Setting: </strong>Academic free-standing children's hospital.</p><p><strong>Patients: </strong>Acutely ill children weaning from at least 5 days of dexmedetomidine. Excluded were children concurrently weaning other sedatives.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Phase 1: In 83 of 303 children weaning from at least 5 days of dexmedetomidine who had clinician documentation and were managed for A2A withdrawal, 88% ( n = 72) exhibited at least a 20% increase in heart rate (HR), 83% ( n = 69) exhibited agitation or change in usual state behavior, 46% ( n = 38) exhibited at least a 20% increase in diastolic blood pressure (DBP), and when documented, 56% (27/48) exhibited tremors during their A2A withdrawal episode. Phase 2: The WAT-A2A was constructed, based on phase 1 data, and includes four items: HR, state behavior, DBP, and tremors. Phase 3: The WAT-A2A was tested and performed well in 82 children weaning from A2A. The total WAT-A2A score correlated with clinician subjective assessment of A2A withdrawal (Spearman correlation = 0.5; p < 0.001). Inter-rater agreement, comparing paired ratings of prospectively collected WAT-A2A data, indicated moderate inter-rater reliability.</p><p><strong>Conclusions: </strong>Acutely ill children receiving sedation with an A2A for more than 5 days may develop physiologic dependence, requiring gradual dosing reductions. While further psychometric testing is advised, the WAT-A2A provides an objective instrument to help clinicians quantify dexmedetomidine withdrawal symptoms in acutely ill children may facilitate A2A weaning and limit unnecessary variation in practice.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e67-e76"},"PeriodicalIF":4.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770840","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":"Clinical Trials for Pediatric Extracorporeal Membrane Oxygenation: The Time Is Now!","authors":"Peta M A Alexander, Jennifer A Muszynski","doi":"10.1097/PCC.0000000000003660","DOIUrl":"10.1097/PCC.0000000000003660","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e118-e121"},"PeriodicalIF":4.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786400","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 Anemia in Children During and After PICU Stay: Single-Center Retrospective Cohort, 2021-2022.","authors":"Akhila Vadivelan, Elizabeta Nemeth, Tomas Ganz, Yonca Bulut","doi":"10.1097/PCC.0000000000003644","DOIUrl":"10.1097/PCC.0000000000003644","url":null,"abstract":"<p><strong>Objectives: </strong>The primary objective was to determine iron deficiency (ID) anemia (IDA) monitoring practices in children during PICU stay. A secondary objective was to determine the current follow-up practices for IDA after PICU discharge.</p><p><strong>Design: </strong>Retrospective observational study of 2 years (2021-2022).</p><p><strong>Setting: </strong>Single-center academic PICU in the United States.</p><p><strong>Subjects: </strong>All patients younger than 18 years and excluded patients who died in the PICU or within 6 months of PICU discharge.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Anemia was defined by a hemoglobin concentration of less than 11 g/dL. ID was defined by either a ferritin of less than 30 ng/mL or a transferrin saturation (TSAT) of less than or equal to 20%. Suspicion for functional iron deficiency (SID) was defined by ferritin greater than or equal to 30 ng/mL and TSAT less than or equal to 20%, given the hyperferritinemic effect of inflammation. We documented serum iron, total iron binding capacity, TSAT, ferritin, and hemoglobin at PICU admission and discharge and 3 and 6 months after discharge. Overall, 913 of 1275 met the inclusion criteria, and 492 patients had a hemoglobin of less than 11 g/dL. Only 93 of 492 (18.9%) had iron studies at any time during the PICU stay. Among the 93 patients with iron studies, 20 patients (22%) were lost to follow-up. Of the remaining 73 patients, 67 of 73 had a hemoglobin checked at 3 months, of which 37 of 67 (55%) were still anemic. At 6 months, there were 64 of 73 patients who had a hemoglobin checked, of which 32 of 64 (50%) were still anemic. At 3 months, 39 of 73 (53%) had iron studies performed; of these, 13 of 39 had ID, 12 of 39 had SID, and 14 of 39 had neither ID nor SID. At 6 months, 35 of 73 (48%) had iron studies; of these, ten of 35 had ID, 11 of 35 had SID, and 14 of 35 had neither ID nor SID.</p><p><strong>Conclusions: </strong>Detection of ID and follow-up after PICU stay remain inadequate. We recommend that future studies assess the value of screening all critically ill patients for ID at the time of discharge and followed up, as necessary.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 1","pages":"e62-e66"},"PeriodicalIF":4.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952804","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 Australian and New Zealand Intensive Care Society Paediatric Study Group (ANZICS PSG): 20 Years of Collaborative Research.","authors":"Kristen S Gibbons, John Beca, Carmel Delzoppo, Simon Erickson, Marino Festa, Ben Gelbart, Debbie Long, Kate Masterson, Johnny Millar, Sainath Raman, Luregn J Schlapbach, Warwick Butt","doi":"10.1097/PCC.0000000000003653","DOIUrl":"10.1097/PCC.0000000000003653","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e122-e130"},"PeriodicalIF":4.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142838637","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":"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}