Pediatric Critical Care Medicine最新文献

{"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}

{"title":"Risk Analytics and the Art of Ventilator Liberation Following Neonatal Cardiac Surgery.","authors":"Alexandre T Rotta, Andrew G Miller","doi":"10.1097/PCC.0000000000003721","DOIUrl":"10.1097/PCC.0000000000003721","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e728-e731"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586435","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":"e633-e646"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","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":"Outcomes of Pediatric Venovenous Extracorporeal Membrane Oxygenation Using Dual-Lumen or Multisite Cannulation: Extracorporeal Life Support Database Study, 2000-2019.","authors":"Jessica A Barreto, Pingping Qu, Ravi R Thiagarajan, John K McGuire, Thomas V Brogan","doi":"10.1097/PCC.0000000000003713","DOIUrl":"10.1097/PCC.0000000000003713","url":null,"abstract":"<p><strong>Objectives: </strong>In children reported to the Extracorporeal Life Support Organization (ELSO) registry, to compare mortality, the need for additional cannulas, and complications associated with dual-lumen (DL) or multisite cannulation for venovenous extracorporeal membrane oxygenation (ECMO).</p><p><strong>Design: </strong>Multicenter retrospective study using the ELSO registry.</p><p><strong>Setting: </strong>Centers reporting to ELSO between January 1, 2000, and December 31, 2019.</p><p><strong>Patients: </strong>Children 28 days to 18 years old supported with venovenous ECMO.</p><p><strong>Interventions: </strong>We performed univariate and multivariable regression analyses to determine the association between venovenous ECMO cannulation strategy and in-hospital mortality, ECMO duration, and need for additional cannulas. We also compared the frequency of venovenous ECMO complications using univariate analysis.</p><p><strong>Measurements and main results: </strong>We identified a cohort of 2034 patients, of whom 1441 (71%) were supported with DL. Support with DL, as opposed to multisite cannulation, was associated with median (interquartile range) of younger age (23 mo [6-89 mo] vs. 147 mo [64-189 mo]; p < 0.001). We failed to identify an association between in-hospital mortality and whether DL or multisite cannulation had been used (393/1441 [27%] vs. 184/593 [31%]); unadjusted and adjusted risk ratio (aRR) of death using DL as the reference group of 1.1 (95% CI, 0.7-1.9; p = 0.70). The other analyses failed to identify an association between cannulation type, ECMO duration, and the use of additional cannulas. ECMO complications were similar except for more frequent neurologic determination of death in the multisite group.</p><p><strong>Conclusions: </strong>In the 2000-2019 ELSO pediatric dataset, we failed to identify an association between venovenous ECMO cannulation type-DL or multisite-and greater aRR of ECMO outcomes.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e689-e698"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524089","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":"Interfacility Transfer and Admission to PICUs in the United States: Survey of Referral Communications in 2023.","authors":"Christina L Cifra, Olivia Lin, Celestine L Gonzales, Irene Pantekidis, Madhuradhar Chegondi, Ana Lia Graciano, Eleanor Gradidge, Matthew P Malone, Matthew H M Marx, Nehal R Parikh, Charlotte Z Woods-Hill, Christopher P Landrigan","doi":"10.1097/PCC.0000000000003702","DOIUrl":"10.1097/PCC.0000000000003702","url":null,"abstract":"<p><strong>Objectives: </strong>Poor communication during interfacility transfer to the PICU can harm critically ill children. Structured handoff communication can prevent harm; however, the landscape of interfacility referral communication practices across PICUs is unknown. Our objective was to describe interfacility referral communication practices among U.S. PICUs to begin identifying potential improvement opportunities.</p><p><strong>Design: </strong>Mixed methods study including a cross-sectional survey and semi-structured interviews.</p><p><strong>Setting: </strong>U.S. PICUs with greater than or equal to 10 beds in 2023.</p><p><strong>Participants: </strong>Clinical/administrative PICU leaders.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Sixty surveys with greater than 70% completed questions were returned from 170 invited participants (35% response rate). Respondents were mainly pediatric critical care medicine division chiefs (48%) or PICU medical directors (32%). PICUs in all U.S. continental regions were represented, which had a median of 1200 (interquartile range [IQR], 1000-1500) admissions per year, of which 29.5% (IQR, 15-39%) were patients directly transferred from other institutions. In 93% of PICUs, a verbal interfacility handoff occurs between the referring clinician and a PICU physician; however, only 24% were always guided by a standard communication tool. In 72% of PICUs, medical records were only sometimes available before patient arrival. Semi-structured interviews with seven volunteer respondents revealed the following themes: 1) standardizing communication can result in organized and efficient handoffs but may also result in inefficiencies, 2) trained staff dedicated to interfacility referrals will improve communication quality, 3) integration of handoff information into the electronic health record will improve dissemination and decrease PICU physicians' workload, and 4) implementing a structured process will require staff support to change current workflows.</p><p><strong>Conclusions: </strong>Referral communication for interfacility patient transfers to the PICU occurred mainly through unstructured verbal handoffs between referring clinicians and PICU physicians. PICU leaders identified several potential benefits and challenges of standardizing interfacility referral communication.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e669-e679"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365516","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":"Current Consent Models Perpetuate Ignorance in Pediatric Critical Care.","authors":"Nadir Yehya, Mark J Peters","doi":"10.1097/PCC.0000000000003730","DOIUrl":"10.1097/PCC.0000000000003730","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e748-e750"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625832","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":"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":"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":"e647-e656"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","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":"Opportunity Knocks? Toward Improving Outcome in Children With Acquired Brain Injury.","authors":"Amanda M Dave, Gabriella Giugliano, Robert S B Clark","doi":"10.1097/PCC.0000000000003729","DOIUrl":"10.1097/PCC.0000000000003729","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e741-e743"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701129","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 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":"e622-e632"},"PeriodicalIF":4.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061566/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}