Pediatric Critical Care Medicine最新文献

{"title":"Azithromycin for Critically Ill Children With Bronchiolitis: A U.S. Pediatric Health Information Systems Registry Study, 2013-2022.","authors":"Alexa R Roberts, Nikhil Vallabhaneni, Brett W Russi, Kayla M Delaney, Jennifer W Leiding, Anthony A Sochet","doi":"10.1097/PCC.0000000000003724","DOIUrl":"10.1097/PCC.0000000000003724","url":null,"abstract":"<p><strong>Objectives: </strong>To estimate prescribing rates for azithromycin as immunomodulation among critically ill children hospitalized for acute bronchiolitis and identify institutional and chronological prescribing variation.</p><p><strong>Design: </strong>Multicenter, observational, retrospective cohort study using the Pediatric Health Information Systems registry from 2013 to 2022.</p><p><strong>Setting: </strong>Forty-seven PICUs in the United States.</p><p><strong>Patients: </strong>Critically ill children 0-3 years old hospitalized for acute viral bronchiolitis excluding those prescribed azithromycin with alternative indication (i.e., concurrent Bordetella pertussis infection, urethritis, atypical pneumonia, acute upper respiratory infections, and asthma-related diagnoses).</p><p><strong>Interventions: </strong>Azithromycin prescription during hospitalization.</p><p><strong>Measurements and main results: </strong>A total of 82,677 children met study criteria of which 3,161 (3.8%) were prescribed azithromycin. Mean (± sd ) center-specific azithromycin prescribing rates exhibited a multilinear decreasing trend (joinpoint breakpoint noted in 2017) going from 4.0% ± 4.6% in 2013 to 2.2% ± 0.8% in 2022 (-0.7%/yr). The median institutional azithromycin prescribing rate was 2.8% (interquartile range [IQR], 1.8-3.9%; total range, 1.2-24.3%). Compared with those not prescribed azithromycin, receipt of azithromycin was associated with the following: older age (median, 10 mo [IQR, 3.2-20.3 mo] vs. 7.8 mo [IQR, 2.9-15.2 mo]; p < 0.001); receiving corticosteroids (57.1% vs. 38.1%; p < 0.001) or continuous albuterol (35.9% vs. 22.4%; p < 0.001); use of noninvasive respiratory support (13.4% vs. 9.7%; p < 0.001) or invasive ventilation (35.9% vs. 22.4%; p < 0.001); and extracorporeal life support (0.5% vs. 0.1%; p < 0.001).</p><p><strong>Conclusions: </strong>In this 2013-2022, U.S. multicenter registry-based cohort study, the azithromycin prescribing rate for critically ill children with bronchiolitis was 3.8%. Exposure varied by institution, patient age, and revealed a decreasing trend over the last decade.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e708-e717"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731052","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":"Extubation Failure in Neonates Following Congenital Cardiac Surgery: Multicenter Retrospective Cohort, 2017-2020.","authors":"Daniel L Hames, Qalab Abbas, Ahmed Asfari, Santiago Borasino, J Wesley Diddle, Avihu Z Gazit, Stuart Lipsitz, Amanda Marshall, Katherine Reise, Luciana Rodriguez Guerineau, Joshua S Wolovits, Joshua W Salvin","doi":"10.1097/PCC.0000000000003703","DOIUrl":"10.1097/PCC.0000000000003703","url":null,"abstract":"<p><strong>Objectives: </strong>Extubation failure (EF) in neonates recovering from congenital cardiac surgery is associated with morbidity and mortality. Adding continuous physiologic monitoring data and risk analytics algorithms to clinical factors has the potential to assist clinicians in identifying those neonates at high risk for EF. We aimed to evaluate the association of two physiologic risk analytics algorithms evaluating the probability of inadequate delivery of oxygen index (ID o2 ) and inadequate ventilation of carbon dioxide index (IV co2 ) with EF in neonates receiving mechanical ventilation (MV) after cardiac surgery. A secondary aim was to evaluate the clinical factors associated with EF.</p><p><strong>Design: </strong>Multicenter retrospective cohort study.</p><p><strong>Setting: </strong>Eight international pediatric cardiac ICUs.</p><p><strong>Patients: </strong>Neonates (age < 1 mo at the time of surgery) receiving MV for longer than 48 hours following cardiac surgery between January 1, 2017, and December 31, 2020.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Data from 736 neonates were analyzed with 102 (13.9%) having EF (defined as reintubation within 48 hr of extubation). In multivariable analysis (odds ratio [OR] and 95% CI), preoperative respiratory support (OR, 1.72 [95% CI, 1.11-2.67]) was associated with greater odds of EF. In all, 611 neonates had pre-extubation ID o2 data and 478 neonates had both pre-extubation ID o2 and IV co2 data. In multivariable analysis of patients with both pre-extubation ID o2 and IV co2 data, single ventricle anatomy (OR, 2.50 [95% CI, 1.27-4.92]) and high ID o2 (≥ 25) or high IV co2 (≥ 50) in the 2 hours preceding extubation (OR, 1.77 [95% CI, 1.01-3.12]) were associated with greater odds of EF.</p><p><strong>Conclusions: </strong>In this 2017-2020 cohort, EF is high in post-cardiac surgery neonates receiving at least 48 hours of MV. The ID o2 and IV co2 algorithms may be useful in assessing risk of EF in such neonates.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e590-e599"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382898","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":"Temporary Femoral Central Venous Catheters in the PICU: Two-Center, Retrospective Cohort Study of Catheter Tip Position and Symptomatic Venous Thromboembolism, 2016-2021.","authors":"Ryan J Good, Emily Ahern, Mark D Weber, Kristen R Miller, Mackenzie DeVine, Sanjiv D Mehta, Thomas W Conlon, Adam S Himebauch","doi":"10.1097/PCC.0000000000003700","DOIUrl":"10.1097/PCC.0000000000003700","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to determine the frequency and variables associated with low femoral central venous catheter (fCVC) tip position. We also examined the association between tip position and symptomatic venous thromboembolism (VTE).</p><p><strong>Design: </strong>Retrospective cohort from two PICUs.</p><p><strong>Setting: </strong>Quaternary academic children's hospitals, 2016-2021.</p><p><strong>Patients: </strong>Children (age <18 yr) in the PICU who underwent temporary fCVC placement.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Low fCVC tip position occurs when the tip is inferior to the fifth lumbar vertebra (L5) on a postprocedural abdominal radiograph. Of 936 patients: 56.3% were 1-12 years old, and 80.0% had normal weight-for-age z score. fCVC tip position was low in 67.3% of patients. In the multivariable model, older age, earlier years of placement, and higher weight-for-age were associated with low fCVC tip position. Symptomatic fCVC-associated VTE occurred in 8.8% of patients, with a rate of 16.5 per 1000 CVC days (interquartile range, 13.1-20.5 per 1000 CVC days). The percentage of VTE in low vs. recommended fCVC tip position and VTE (8.6% vs. 9.2%) were equivalent (two one-sided z-tests; p < 0.001). Furthermore, in the multivariable model, we failed to identify an association between low fCVC tip position, relative to the recommended tip position, and greater odds of VTE (OR, 1.58 [95% CI, 0.92-2.69). However, we cannot exclude the possibility of low fCVC tip position being associated with up to 2.6-fold greater odds of symptomatic VTE.</p><p><strong>Conclusions: </strong>In our two PICUs, 2016-2021, low fCVC tip position occurred in two-thirds of placements and was associated with older age and higher weight-for-age patients. fCVC-associated VTE occurred in one-in-11-catheter placements, with the raw percentage of fCVCs and subsequent VTE in low and recommended tip position being equivalent. However, the multivariable modeling indicates that future research into the relationship between tip position and VTE requires ongoing surveillance and work.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e657-e668"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391329","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":"Pediatric Acute Respiratory Distress Syndrome in Bronchiolitis and Lower Airway Infection: What's New?","authors":"Giuseppe A Marraro","doi":"10.1097/PCC.0000000000003732","DOIUrl":"10.1097/PCC.0000000000003732","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e732-e734"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693082","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 Attitudes to Research Without Prior Consent in Two Pediatric Emergency Clinical Trials in Australia: A Qualitative Study of Transcripts From 2017.","authors":"Jeremy S Furyk, Kristin McBain-Rigg, Shane George, Natalie Phillips, Simon Craig, Donna Franklin, Kerrianne Watt, Catherine Wilson, Meredith L Borland, Richard Franklin, Stuart R Dalziel, Andreas Schibler, Franz Babl","doi":"10.1097/PCC.0000000000003719","DOIUrl":"10.1097/PCC.0000000000003719","url":null,"abstract":"<p><strong>Objectives: </strong>Research in critically ill children poses challenges in acquiring prospective informed consent. International ethical guidelines generally have provisions to perform research without prior consent (RWPC) in circumstances where consent is not feasible, but there is a paucity of data regarding the community acceptance of this process. The objectives of the current study were to explore the attitudes and experiences of parents of children enrolled into trials to determine understanding and acceptability of RWPC to parents of children involved.</p><p><strong>Design: </strong>Qualitative study of semi-structured telephone interviews in 2017 exploring themes of medical research, trial participation in RWPC. Interview transcripts underwent inductive thematic analysis with intercoder agreement, using Nvivo 14 software.</p><p><strong>Setting: </strong>Two clinical interventional trials in Australia conducted in critically ill children without prospective consent.</p><p><strong>Subjects: </strong>Parents of children enrolled in critical care research.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>A total of 49 interviews were conducted and analyzed. Parents of participants were supportive of processes used in the trials and RWPC. Paperwork was often not thought to contribute to improved understanding, with verbal information more valued. There was no consensus on the optimal approach of RWPC in situations when clinical outcome was poor.</p><p><strong>Conclusions: </strong>Our study in 2017 shows that parent/carer supported RWPC in two pediatric trials involving critically ill children. Parents were satisfied with existing approval methods and safeguards. Parents valued brief verbal information at the time of randomization. These historical findings support the feasibility of conducting research on time-sensitive interventions in emergency settings with RWPC, aligning with community expectations.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e718-e727"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586508","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":"Short Femoral Central Lines in Critically Ill Children: How Often and Do They Result in More Complications?","authors":"H Michael Ushay","doi":"10.1097/PCC.0000000000003739","DOIUrl":"10.1097/PCC.0000000000003739","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e744-e747"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763552","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":"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":"e611-e621"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061561/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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":"https://doi.org/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":""},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","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":"Syndecan-1 As a Clinical Marker of Fluid Overload and Acute Kidney Injury.","authors":"Venu Amula","doi":"10.1097/PCC.0000000000003740","DOIUrl":"10.1097/PCC.0000000000003740","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e738-e740"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753820","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":"A Music Producer's Perspective on the ICU: It Is All About Dynamic Range Compression.","authors":"Otto F Bem, Reinout A Bem","doi":"10.1097/PCC.0000000000003710","DOIUrl":"10.1097/PCC.0000000000003710","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e751-e753"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458810","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}