Pediatric Critical Care Medicine最新文献

{"title":"Association Between Intracranial Pressure Monitoring and Discharge Outcome in Pediatric Severe Traumatic Brain Injury.","authors":"Caitlin R McNamara, Kelsey A Johnson-Nibling, Michael T Bigham, Dennis W Simon, Alicia K Au, Michael Forbes, Christopher M Horvat, Patrick M Kochanek, Christopher K Page-Goertz, Jonathan H Pelletier","doi":"10.1097/PCC.0000000000004030","DOIUrl":"10.1097/PCC.0000000000004030","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether intracranial pressure (ICP) monitoring is associated with decreased mortality among pediatric severe traumatic brain injury (TBI) patients.</p><p><strong>Design: </strong>Retrospective cohort study of the Virtual Pediatric Systems database.</p><p><strong>Patients: </strong>Patients younger than 18 years with diagnosis codes for TBI and Glasgow Coma Scale (GCS) of less than or equal to 8 between 2010 and 2024 from centers submitting ICP monitor data.</p><p><strong>Measurements: </strong>ICP monitoring practices were described using summary statistics. To estimate time-dependent association between ICP monitor placement and 30-day mortality, time-varying Cox proportional hazards modeling was performed. In a second complementary analysis to minimize immortal time bias, landmarked unadjusted Kaplan-Meier analyses and adjusted Cox proportional hazards models of ICP monitor placement by 1, 12, and 24 hours were performed.</p><p><strong>Main results: </strong>There were 6636 admissions included across 94 PICUs between January 1, 2010, and December 31, 2024; 2016 of 6636 (30.7%) had ICP monitors. Patients with ICP monitors were older (8 yr [3-14] vs. 6 yr [2-13], p < 0.001), had lower GCS (3 [3-6] vs. 6 [3-7], p < 0.001), and a higher Pediatric Risk of Mortality 3 score (12.0 [8.0-21.0] vs. 9.0 [5.0-21.0], p < 0.001). ICP monitor placement was associated with lower time-specific mortality hazard until 4.4 d (95% CI, 3.7-5.2) in unadjusted and 10.5 d (95% CI, 7.2-30.0) in adjusted time-varying Cox modeling, resulting in lower 30-day cumulative mortality in the adjusted model only (29.2% [95% CI, 28.0-30.6%]) in the unmonitored group vs. (25.1% [95% CI, 23.4-26.5%]) in the monitored group. In landmark analysis and adjustment for severity, ICP monitor placement was associated with a significantly lower 30-day-mortality hazard ratio (HR) at the 1-hour (adjusted HR 0.81 [0.69, 0.94]), 12-hr (0.83 [0.73, 0.95]), and 24-hr landmarks (0.80 [0.69, 0.92]).</p><p><strong>Conclusions: </strong>ICP monitoring was associated with reduced mortality for 10 days after admission, followed by increased mortality between days 11 and 30. The stronger effect of reduced early mortality resulted in lower 30-day cumulative mortality.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1224-1234"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796402","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: Qualitative Research Using Interviews and Mixed Methods Approaches.","authors":"Robert C Tasker","doi":"10.1097/PCC.0000000000004060","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004060","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"27 10","pages":"1335-1337"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137581","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":"Safety of Bivalirudin Use in Critically Ill Children: A Single-Center Experience.","authors":"Dalia A Bashir, Javier Leija, Rayhan N Jhanji, Jacquelyn M Powers, Katherine I Lemming, Sarah E Sartain, Duy M Dinh, Clay T Cohen","doi":"10.1097/PCC.0000000000004029","DOIUrl":"10.1097/PCC.0000000000004029","url":null,"abstract":"<p><strong>Objectives: </strong>Bivalirudin, an IV direct thrombin inhibitor, is increasingly used as an alternative anticoagulant in pediatric patients on mechanical circulatory support, with heparin failure, or for heparin-induced thrombocytopenia. Data on its use for treatment or prevention of venous or arterial thromboses in children are limited. To describe the safety of bivalirudin in critically ill children for the treatment or prevention of venous and/or arterial thromboses.</p><p><strong>Design: </strong>Retrospective review of patients under 18 years treated with bivalirudin between January 2019 and August 2024.</p><p><strong>Setting: </strong>Quaternary care Children's Hospital.</p><p><strong>Patients: </strong>Descriptive analyses were conducted for all patients receiving bivalirudin. Primary outcomes include bleeding and thrombotic events. Secondary outcomes included time to therapeutic levels, dosing, and the association of therapeutic laboratory goals (via Partial Thromboplastin Time Hepzyme [PTTHz] and dilute thrombin time-derived bivalirudin levels) with adverse events.</p><p><strong>Intervention: </strong>None.</p><p><strong>Measurements and main results: </strong>A total of 261 bivalirudin encounters in 229 patients were included in the analysis (median age, 0.51 yr; interquartile range, 0.13-3.92 yr). The most common indication was treatment of venous thrombosis ( n = 133, 51%). Eighty-six bleeding events occurred in 261 encounters (33%) involving 61 of 229 patients (27%); 20 of 86 bleeding events were considered major (23.2%). Thrombotic progression or development of new thrombi occurred in 46 of 261 (17.6%) encounters (37/229; 16% patients) with 18 of 261 experiencing both bleeding and thrombotic events. Therapeutic PTTHz/bivalirudin levels were observed in 56.5% (26/46) of new thromboses/thrombotic progression and 57% (49/86) of bleeding events. Median starting dose and dose at first therapeutic level were 0.15 and 0.2 mg/kg/hr, respectively. Median time to achieve therapeutic anticoagulation was 0.56 days.</p><p><strong>Conclusions: </strong>Bivalirudin, used in the setting of venous and/or arterial thromboses, rapidly achieves therapeutic levels. While use of bivalirudin is safe, clinically relevant bleeding and thrombotic rates on bivalirudin were frequent despite therapeutic ranges. These data highlight that bivalirudin use warrants close monitoring in critically ill children.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1207-1214"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808831","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":"Historians, Not Prophets: Sepsis Temperature Trajectories in the Machine Learning Age.","authors":"Michael L Forbes","doi":"10.1097/PCC.0000000000004045","DOIUrl":"10.1097/PCC.0000000000004045","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1328-1330"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808823","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":"Postanoxic Myoclonic Seizures After Pediatric Cardiac Arrest: Characteristics and Outcomes in a Single-Center Cohort, 2018-2024.","authors":"Ashley M Bach, Kathleen Walsh, Dominique D Cooper, France W Fung, Craig A Press, Alka Gupta, Arastoo Vossough, Matthew P Kirschen, Alexis A Topjian, Nicholas S Abend","doi":"10.1097/PCC.0000000000004005","DOIUrl":"10.1097/PCC.0000000000004005","url":null,"abstract":"<p><strong>Objectives: </strong>To describe clinical features and outcomes among children with postanoxic myoclonic seizures (PAMS) after cardiac arrest (CA).</p><p><strong>Design: </strong>Retrospective cohort.</p><p><strong>Setting: </strong>Single-center, children's hospital in the United States.</p><p><strong>Patients: </strong>Patients younger than 18 years old with in- or out-of-hospital CA with PAMS identified on video continuous electroencephalography (CEEG) within 24 hours of CA (2018-2024).</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Twenty-six children with in-hospital or out-of-hospital CA and PAMS, defined as clinical myoclonus with electrographic correlates, were identified from a CA database. PAMS was verified on video CEEG. Median (interquartile range [IQR]) age was 6.3 years (IQR, 1.1-11.9 yr). Baseline Pediatric Cerebral Performance Category (PCPC) was 1 (normal) for 17 children. PAMS were observed within 1 hour of CEEG initiation for 19 children and within 12 hours for all children. PAMS manifested as limb jerking (18/25) and rhythmic eye opening (13/25). The range in electroencephalography (EEG) background was continuous (1/26), discontinuous (2/26), burst-suppressed/burst-attenuated (20/26), and entirely suppressed (3/26). Bursts were often highly epileptiform (15/20) and identical (10/20). All patients received at least 1 anti-seizure medication, and 16 of 26 received at least 1 anesthetic infusion. Death before hospital discharge occurred in 17 of 26, and causes of death were withdrawal of life-sustaining therapy (10/17), brain death (6/17), and rearrest (1/17). Among nine survivors, PCPC scores ranged from 3 to 5, eight had gastrostomies, and one a tracheostomy. A brain MRI was available for 15 of 26 at a median 4 days (IQR, 3-5 d) after CA. All had restricted diffusion involving the precentral and postcentral gyri and cortex supplied by the posterior cerebral artery. The one child with moderate disability (PCPC = 3) at hospital discharge had continuous EEG background and limited MRI diffusion restriction.</p><p><strong>Conclusions: </strong>Children with PAMS have a range of EEG characteristics. Severe disability and death were common following PAMS. The child with moderate disability had a continuous EEG background and limited MRI diffusion restriction.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1266-1277"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423090","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":"Bivalirudin: A Viable Alternative to Heparin for Treatment of Venous Thrombosis in Children?","authors":"Robert I Parker","doi":"10.1097/PCC.0000000000004038","DOIUrl":"10.1097/PCC.0000000000004038","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1325-1327"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808839","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":"Comparison of a Computable Pediatric Sepsis Phenotype Tool in Argentinian and U.S. Cohorts.","authors":"Rebecca I Caldino Bohn, Maria Eugenia Galvan, Vanessa S Lanziotti, Kate F Kernan, Carolina Viqueira Guzmán, Juan Carlos Vassallo, Joseph A Carcillo, Luis Landry, Hyun-Jung Park, Silvina Ruvinsky, Silvia Santos, Roberto Jabornisky","doi":"10.1097/PCC.0000000000004023","DOIUrl":"10.1097/PCC.0000000000004023","url":null,"abstract":"<p><strong>Objective: </strong>Sepsis is a leading cause of mortality in low- and middle-income countries. This study identifies computable pediatric sepsis phenotypes (PedSep A, B, C, and D) previously derived in a U.S. cohort in a new independent Argentine cohort to assess plausibility for its use in personalized clinical trials in Pan-American children.</p><p><strong>Design: </strong>This retrospective cohort study uses data from the Argentinian ESSPED2 (Estudio Sepsis y Shock Séptico Pediátrico 2) Registry and the Phenotyping Pediatric Sepsis-Induced Multiple Organ Failure U.S. study.</p><p><strong>Setting: </strong>The Argentine cohort was recruited from 51 PICUs between September 15 and December 15, 2021. The U.S. cohort involved nine PICUs between 2015 and 2017.</p><p><strong>Patients: </strong>The Argentine cohort included 99 sepsis patients aged 1 month to 18 years, and the U.S. cohort included 404 sepsis patients, aged 44 weeks of gestation to 18 years.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Membership in the PedSep A, B, C, or D phenotype was identified using a computable tool ( https://pedsepsis.pitt.edu ) requiring 25 bedside variables at 24 hours. Phenotype prevalence and mortality were compared between Argentine and U.S. cohorts. Heterogeneity of treatment responses and power analyses were performed in the combined cohort. Mortality rates were 20 of 99 (20.2%) in Argentina and 45 of 404 (11.14%) in the United States ( p = 0.025). Mortality was highest in PedSep D computable phenotype, with 9 of 28 (32.14%) in Argentina and 19 of 56 (33.93%) in the United States ( p = 1.0). Heterogeneity of treatment response to anti-inflammatory therapies was observed in PedSep D compared with PedSep A, B, and C children ( p < 0.05). Sample size calculations support the requirement for 55 PedSep D patients per arm to demonstrate reduction in mortality with dexamethasone or methylprednisolone with gammaglobulin compared with placebo.</p><p><strong>Conclusions: </strong>The PedSep computable tool can identify PedSep D children for enrollment in combined Argentina-U.S. randomized controlled trials evaluating effectiveness of anti-inflammatory treatment in hyperinflammatory sepsis.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1183-1194"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760412","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":"Multisite Cannulation for Venovenous Extracorporeal Membrane Oxygenation Support in Neonates and Infants: Extracorporeal Life Support Database Study, 2013-2023.","authors":"Jon Lillie, Shane M Tibby, Peter Rycus, Marc Anders, Gail Annich, Matteo Di Nardo, Geoff Burnhill","doi":"10.1097/PCC.0000000000004009","DOIUrl":"10.1097/PCC.0000000000004009","url":null,"abstract":"<p><strong>Objectives: </strong>We have evaluated the complications and outcomes of venovenous multisite (VVMS) cannulation for support with extracorporeal membrane oxygenation (ECMO) using the Extracorporeal Life Support Organization (ELSO) registry of neonates (≤ 28 d old) and infants (29-364 d old).</p><p><strong>Design: </strong>Retrospective ELSO database cohort, comparing outcomes and complications associated with VVMS and venovenous dual lumen (VVDL) cannulation.</p><p><strong>Patients: </strong>Patients younger than 1 year supported with VV ECMO.</p><p><strong>Setting: </strong>ELSO data January 1, 2013 to December 31, 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We identified 1403 neonates and 603 infants supported with VVDL, and 42 and 77, respectively, with VVMS. At 24 hours of ECMO we found median (interquartile range [IQR]) oxygen saturations (Sa o2 ) were higher in the VVMS compared with the VVDL group: for neonates, 98% (IQR, 93-99%) vs. 94% (IQR, 89-97%); a p value of less than 0.01; and for infants, 94% (IQR, 91-97%) vs. 90% (IQR, 85-95%); a p value of less than 0.01. After adjustment for ventilatory parameters, VVMS was associated with higher mean (95% CI) Sa o2 than VVDL: for neonates by 3.3% (95% CI, 1.0-5.6%); p = 0.005; and for infants by 3.3% (95% CI, 1.3-5.3%); p = 0.002. Higher Sa o2 was also associated with higher flows rather than ventilator parameters. Median flows were higher in the VVMS group compared with VVDL for neonates (111 vs. 101 mL/kg/min) and infants (114 vs. 100 mL/kg/min); a p value of less than 0.01. In general, we failed to identify associations between support technique and mortality or complications. However, in infants, VVMS in comparison with VVDL was associated with fewer mechanical complications (23% vs. 37%; p = 0.02).</p><p><strong>Conclusions: </strong>Between 2013 and 2023, in neonatal and infant ECMO, VVMS as opposed to VVDL cannulation was associated with higher ECMO flows and Sa o2 at 24-hour support. We failed to identify associations between support technique and complications or mortality, apart from lower mechanical complications in infants supported using VVMS.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1287-1298"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148362035","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":"To ICP or Not to ICP?: Rethinking What We Measure, How We Act on It, and Which Children the Debate Leaves Behind.","authors":"Saptharishi Lalgudi Ganesan","doi":"10.1097/PCC.0000000000004036","DOIUrl":"10.1097/PCC.0000000000004036","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1331-1334"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796367","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":"Temporal Trends in Geographic Distribution of PICUs in the United States 2001-2023.","authors":"Eleanor Gradidge, Abigail Shih, Kaeli Samson, Christina Cifra, Robin Klein, Adrienne G Randolph","doi":"10.1097/PCC.0000000000004022","DOIUrl":"10.1097/PCC.0000000000004022","url":null,"abstract":"<p><strong>Objectives: </strong>To identify and describe changes in the geographic distribution of PICUs across the United States from 2001 to 2023.</p><p><strong>Design: </strong>Cross-sectional study over three time points using geographic methods to calculate distances to the nearest PICU, change in distances to the nearest PICU over time, and changes in rates of access by census tract.</p><p><strong>Setting: </strong>U.S. PICUs.</p><p><strong>Participants: </strong>None.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The primary outcome was the distance from a given U.S. census tract center to the nearest PICU. Distances were grouped by U.S. census regions and divisions. Most PICUs were located in urban areas. The median distance from census tract centers to the nearest PICU was 12.5 miles (interquartile range [IQR], 4.5-37.1 miles), 12.8 miles (IQR, 4.9-36.2 miles), and 13.3 miles (IQR, 5.2-36.0 miles) for 2001, 2016, and 2023, respectively. In all years, PICUs were localized to a single city in Arkansas, Nebraska, and Oregon, and there were no PICUs in Wyoming. In 2023, the median distance to a PICU from the nearest census tract was 7.4 miles in the Middle Atlantic division (NJ, NY, and PA) and 30.1 miles in the East South Central division (AL, KY, MS, and TN). The distance to a PICU was shorter for coastal regions compared with large areas of the Mountain and Pacific divisions.</p><p><strong>Conclusions: </strong>The geographic distribution of PICUs across the U.S. varied over time, with PICU beds remaining concentrated in urban areas, whereas rural areas were farther from the nearest PICU. This results in inequitable access for critically ill children, particularly in the western U.S. Understanding the variation in geographic access to PICUs is an essential step toward ensuring equitable access to life-saving care for all children.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1235-1243"},"PeriodicalIF":4.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819301","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}