Pediatric Critical Care Medicine最新文献

{"title":"Adjunctive Corticosteroids for Hypotension in the Pediatric Cardiac ICU: Single-Center Retrospective Study, 2020-2021.","authors":"Shreerupa Basu, Victoria Habet, Marlon Delgado, Peter Chiu, Dylan Knox, Emma Thibault, Akalpit Shukla, Emily Harrington, Valerie Bailey, Stuart Lipsitz, Yuanyuan Fu, Michael Agus, John Kheir, Jun Sasaki, Katie Moynihan","doi":"10.1097/PCC.0000000000003757","DOIUrl":"10.1097/PCC.0000000000003757","url":null,"abstract":"<p><strong>Objectives: </strong>To characterize adjunctive corticosteroid use and associations between any exposure or cumulative dose and outcomes in pediatric cardiac surgical cases.</p><p><strong>Design: </strong>A retrospective cohort was admitted over 24 months (from January 2020 to December 2021).</p><p><strong>Setting: </strong>Single-center cardiac ICU (CICU) in a quaternary hospital.</p><p><strong>Patients: </strong>Descriptive analyses of all patients receiving hydrocortisone for hypotension. Further comparative analyses were restricted to postoperative infants (< 12 mo) exposed to corticosteroids vs. not, including propensity-score inverse weighted and matched analyses.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We examined associations between cumulative hydrocortisone dose and outcomes, including severe infection. Overall, 154 patients of all ages received steroids (91 post-surgical). Median (interquartile range [IQR]) cumulative hydrocortisone dose was 10.0 mg/kg (IQR, 6.0-21.2 mg/kg). Greater cumulative dose was associated with higher adjusted odds (95% CI) of severe infection (1.08 [95% CI, 1.03-1.12]). For comparative analyses, we identified 403 infants, including 68 with postoperative corticosteroid exposure. Propensity scores based on multiple factors, including peak modified Vasoactive-Inotropic Score (mVIS, excluding milrinone), compared outcomes and hemodynamic response with quantification of rate of mVIS fall from peak among 55 matched pairs. We failed to identify a difference in rate of mVIS fall between nonsteroid and steroid recipients (-0.162 [IQR, -0.228 to -0.053] vs. -0.160 [IQR, -0.300 to -0.046]; p = 0.674).</p><p><strong>Conclusions: </strong>In our CICU cohort receiving adjunctive hydrocortisone for hypotension, we failed to identify a consistent signal regarding outcomes and rate of mVIS fall. Considering potential side effects, these data suggest prospective study is needed to better define the use of such treatment.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e877-e888"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005019","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":"Group Peer Mentoring: A Strategy to Promote Career Development and Improve Well-Being Among Early-Career Faculty in Pediatric Critical Care Medicine.","authors":"L Nelson Sanchez-Pinto, Colleen M Badke, Linda Pololi","doi":"10.1097/PCC.0000000000003763","DOIUrl":"10.1097/PCC.0000000000003763","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e952-e954"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079210","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 Admission.","authors":"Laura Butragueño-Laiseca, Lucía Alonso Rodriguez, María José Santiago Lozano","doi":"10.1097/PCC.0000000000003738","DOIUrl":"10.1097/PCC.0000000000003738","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e967-e968"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031529","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":"To Give or Not to Give? Corticosteroid Therapy in the Pediatric Cardiac ICU Is the Question.","authors":"Madeline J Wozniak, Sarah L Mayer, Jerry J Zimmerman","doi":"10.1097/PCC.0000000000003767","DOIUrl":"10.1097/PCC.0000000000003767","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e938-e940"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209108","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 PICU Data Collaborative: A Novel, Multi-Institutional, Pediatric Critical Care Dataset.","authors":"Reid W D Farris, Sareen S Shah, Tellen D Bennett, Stephanie R Brown, Timothy T Cornell, Adam C Dziorny, Alysia Flynn, Jocelyn Grunwell, Julia A Heneghan, Curt E Kennedy, Aleksandra Kretsu, Eneida Mendonca, Akira Nishisaki, Colin Rogerson, Daniel S Tawfik, Randall C Wetzel, L Nelson Sanchez-Pinto","doi":"10.1097/PCC.0000000000003758","DOIUrl":"10.1097/PCC.0000000000003758","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e941-e951"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12221772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022920","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 authors reply.","authors":"Ashley M Bach, Nicole K McKinnon, Hongming Zhuang, Elizabeth Kaufman, Matthew P Kirschen","doi":"10.1097/PCC.0000000000003766","DOIUrl":"10.1097/PCC.0000000000003766","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e965-e966"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128306","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":"Writing for Pediatric Critical Care Medicine: Reporting Clinical Trials Primary Results, Information, and Secondary Content.","authors":"Robert C Tasker","doi":"10.1097/PCC.0000000000003784","DOIUrl":"10.1097/PCC.0000000000003784","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 7","pages":"e955-e960"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144541821","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":"Focal Cerebral Injury in Pediatric Extracorporeal Life Support: Timing in Relation to Cannulation or Other Circuit Events in a Single-Center Retrospective Series, 2015-2023.","authors":"Mauro Caffarelli, Yi Li, Edilberto Amorim, Kathryn Finlay, Elan L Guterman, Giulia Benedetti, Craig A Press, Dana Harrar, Ajay X Thomas, Martina Steurer, Loren D Sacks, Christine K Fox","doi":"10.1097/PCC.0000000000003736","DOIUrl":"10.1097/PCC.0000000000003736","url":null,"abstract":"<p><strong>Objectives: </strong>To review the timing of extracorporeal life support (ECLS)-related focal cerebral injury (FCI) in relation to circuit interruptions in children and young adults.</p><p><strong>Design: </strong>Retrospective study from January 1, 2015, to December 31, 2023.</p><p><strong>Setting: </strong>Single-center academic children's hospital.</p><p><strong>Patients: </strong>Children and young adults younger than 21 years old who had neuroimaging during or after ECLS. Multiple ECLS runs in individual patients were analyzed as distinct runs.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>FCI was radiographically defined as lateralized ischemia or hemorrhagic parenchymal brain injury greater than 1 cm 3 or as subdural hemorrhage causing midline shift. Timing of clinical FCI documentation was abstracted from chart review and based on times of new-onset focal neurologic examination findings, focal electroencephalography findings, or incidental discovery on imaging. In instances of FCI, electroencephalography reports and inpatient progress notes were reviewed to identify electroencephalography-related timing of FCI. Institutional ECLS registry data were used to identify times of circuit events (i.e., cannulation, decannulation, and circuit interruptions). The probable time course of FCI after circuit events was evaluated in the ECLS runs with an imaging diagnosis of FCI, and summarized using cumulative distribution with 95% CI. In 101 ECLS runs in 94 patients with brain imaging, 20 had FCI: ischemic stroke in 12, intraparenchymal hemorrhage in six, and subdural hemorrhage with midline shift in two. Eighteen FCIs were documented within 48 hours of a circuit event. Among 13 FCIs with electroencephalography recording at the time of FCIs, eight had new-onset subclinical electroencephalography abnormality as the initial documented sign of FCI. The presence of FCI vs. not was associated with lower survival to decannulation ( p = 0.007).</p><p><strong>Conclusions: </strong>In this single-center retrospective series, 2015-2023, the majority of ECLS-related FCIs were evident within 48 hours of ECLS cannulation, decannulation, or circuit interruption. These events warrant increased surveillance for neurologic complications.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e900-e908"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753776","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 Rapid Ultrasound for Shock and Hypotension Phenotype Differentiation in the Emergency Department: Evaluation of Feasibility and Reliability in a Malawi Cohort.","authors":"Roxanne Assies, Yamikani Chimalizeni, Mercy Kumwenda, Harriet Khofi, Josephine Langton, Job B M van Woensel, Job C J Calis","doi":"10.1097/PCC.0000000000003735","DOIUrl":"10.1097/PCC.0000000000003735","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the feasibility, reliability, and diagnostic implications of performing the pediatric Rapid Ultrasound for Shock and Hypotension (p-RUSH) in children with undifferentiated shock upon hospital presentation in a low-resource setting (LRS).</p><p><strong>Design: </strong>Prospective observational study from February 2019 to December 2019.</p><p><strong>Setting: </strong>Pediatric emergency department (ED) of a large academic referral hospital in Blantyre, Malawi.</p><p><strong>Patients: </strong>Children (2 mo to 16 yr old) with shock upon presentation to the pediatric ED.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Thirty children with shock were enrolled, of whom 14 died. The p-RUSH was performed upon admission to the ED, before administration of an IV fluid bolus. The p-RUSH was performed within a median time of 11.5 minutes, and 92.3% of the image frames in 4-second video clips were interpretable. Images were scored by two independent reviewers and the qualitative and quantitative assessments were compared and showed positive correlations as follows: 1) qualitative assessments of cardiac performance vs. left ventricle ejection fraction and fractional shortening measurements ( r = 0.684 and r = 0.616, respectively, both p < 0.05) and 2) qualitative assessment of inferior vena cava (IVC) collapsibility vs. IVC collapsibility index ( r = 0.470; p < 0.05). The interobserver agreement between cardiac and IVC qualitative assessments yielded a kappa statistic of up to 0.850 (cardiac views) and 0.275 (IVC collapsibility). Both reviewers applied a novel algorithmic flow diagram to diagnose the shock phenotype. In 23 of 30 children, the flowchart could be completed, which suggested either hypovolemic or distributive shock as the most common phenotype.</p><p><strong>Conclusions: </strong>In a Malawian pediatric ED, the p-RUSH was feasible and qualitative assessments were reliable. This 2019 proof-of-concept test provides a basis for further external validation of the p-RUSH and our algorithm for identifying shock phenotypes, which may lead to individualizing care of children presenting with shock in LRSs.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e867-e876"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12212470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753807","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":"Nuclear Medicine Cerebral Perfusion Studies as an Ancillary Test to Support Evaluation of Brain Death/Death by Neurologic Criteria.","authors":"Lionel S Zuckier","doi":"10.1097/PCC.0000000000003747","DOIUrl":"10.1097/PCC.0000000000003747","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e963-e964"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041828","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}