Pediatric Critical Care Medicine最新文献

{"title":"Children With Severe Neurologic Impairment and Their Families in the PICU: A Secondary Qualitative Analysis to Assess Clinician-Family Collaboration and Mutuality.","authors":"Ryan F Sutyla, Jori F Bogetz, Saisha Dhar, Ellie Oslin, Victoria Parente, Sharron L Docherty, Monica Lemmon","doi":"10.1097/PCC.0000000000003796","DOIUrl":"10.1097/PCC.0000000000003796","url":null,"abstract":"<p><strong>Objectives: </strong>In children with severe neurologic impairment (SNI) admitted to the PICU, a trauma-informed approach to care may mitigate the effect of traumatic events on both parents and the child. We aimed to characterize the themes that impacted the trauma-informed care principle of collaboration and mutuality in the PICU.</p><p><strong>Design: </strong>This study is a post hoc secondary analysis of transcripts of interviews conducted for a prospective mixed methods cohort study examining the experiences of parents of children with SNI in the PICU and their clinicians in 2021-2023. Parents and clinicians had completed the semi-structured interviews peri-PICU discharge. Data were analyzed using a conventional content analysis approach. Two analysts coded all data independently, with differences resolved by consensus. Dedoose qualitative software was used to facilitate analysis, which followed Consolidated Criteria for Reporting Qualitative Research guidelines.</p><p><strong>Setting: </strong>Quaternary academic center children's hospital.</p><p><strong>Patients: </strong>The original study (2021-2023) recruited parents of children and young people (3 mo to 25 yr old) with SNI who were admitted to the PICU and their PICU clinicians.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>There were 34 transcribed interviews: 15 from parents and 19 from PICU clinicians of multiple disciplines. We identified facilitators of and barriers to collaboration and mutuality. Facilitators included: 1) knowing a patient beyond the medical chart; 2) understanding values; and 3) clinician(s)-family collaboration. Barriers included: 1) constraints of the PICU environment; 2) challenges when engaging fully with patients with SNI; 3) intrinsic variability among clinicians and parents; 4) families being overwhelmed amid critical illness; and 5) emotional toll on clinicians.</p><p><strong>Conclusions: </strong>Participants described the importance of and barriers to collaboration and mutuality in the PICU, which underscores the impact of valuing partnerships between clinicians and families.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1138-e1148"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675457","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 Quiet Revolution Under My Vest.","authors":"Jenna L Essakow","doi":"10.1097/PCC.0000000000003816","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003816","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963988","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 of a Novel Cardiac Arrest Ventilation Rate Metronome: A Human Factors and Implementation Science Mixed-Methods Approach.","authors":"Amanda O'Halloran, James Sannino, Cheryl Dominick, Christine Bailey, Lori Boyle, Lindsay N Shepard, Vinay Nadkarni, Heather Wolfe, Ryan W Morgan, Akira Nishisaki, Meghan Lane-Fall, Robert Sutton","doi":"10.1097/PCC.0000000000003811","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003811","url":null,"abstract":"<p><strong>Objectives: </strong>Excessive ventilation adversely affects cardiopulmonary resuscitation (CPR) hemodynamics and outcomes. Pediatric providers rarely achieve guideline-recommended CPR ventilation rates. We aimed to use human factors engineering to design a metronome to improve compliance with recommended CPR ventilation rates. We hypothesized that in usability testing, our novel metronome would achieve: 1) a System Usability Scale (SUS) score greater than 68 and 2) greater than 70% of CPR epochs with ventilation rates within target range, which would be sufficient to support a pilot trial in our PICU.</p><p><strong>Design: </strong>Prospective single-center mixed-methods study.</p><p><strong>Setting: </strong>Seventy-five-bed academic PICU.</p><p><strong>Participants: </strong>Multidisciplinary clinicians.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We elicited clinician feedback on the proposed ventilation rate metronome with a survey. Participatory design sessions determined optimal metronome components. During high-fidelity simulation usability testing, we collected qualitative and quantitative measures reflecting participant feedback and performance. Average ventilation rates were calculated during 30-second epochs of CPR, with average rates ± 2 breaths/min (bpm) from the target considered to be within goal range. Among 107 survey respondents, perceptions of appropriateness, acceptability, and feasibility of the ventilation rate metronome were favorable. The final prototype used a bell sound for high saliency in noisy environments and a scrolling timed vertical bar, with pre-set options for three guideline-recommended CPR ventilation rates (infants: 30 bpm, children 1-17 yr old: 20 bpm, adults: 10 bpm). In usability testing (three groups, 34 clinicians), median SUS was 92.5 of 100 (interquartile range, 89.4-93.1), with 0 attributable errors. Overall, 34 of 36 (94% [95% CI, 81-99%]) epochs of simulated CPR with metronome use had ventilation rates ± 2 bpm from the target rate.</p><p><strong>Conclusions: </strong>Utilizing human factors engineering and implementation science, we successfully designed a novel ventilation rate metronome. When deployed during high-fidelity cardiac arrest simulations, metronome use had high usability scores and resulted in excellent compliance with recommended ventilation rates.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855962","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":"Protocol for a Group-Sequential Two-Stratum Multicenter Open-Label Randomized Clinical Trial of Respiratory Support in Infants With Acute Bronchiolitis: Breathing Assistance in Children With Bronchiolitis (BACHb).","authors":"Isabel Johnson, Katy Bridges, Richard Cleaver, Rayka Malek, Mary Cross, Steve Cunningham, Katrina Cathie, Mark D Lyttle, Rebecca Mitting, Paul Mouncey, Damian Roland, Stephen Turner, Olu Onyimadu, Stavros Petrou, Debra Quantrill, Kate Chadwick, Leila Janani, Padmanabhan Ramnarayan","doi":"10.1097/PCC.0000000000003813","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003813","url":null,"abstract":"<p><strong>Objectives: </strong>The Breathing Assistance in Children with bronchiolitis (BACHb) trial aims to evaluate the clinical and cost-effectiveness of high-flow nasal cannula (HFNC) therapy compared with humidified standard oxygen (HSO) in infants with moderate bronchiolitis, and HFNC with continuous positive airway pressure (CPAP) in severe bronchiolitis.</p><p><strong>Design: </strong>Pragmatic, group-sequential, two-stratum, multicenter, open-label randomized clinical trial.</p><p><strong>Setting: </strong>Fifty hospitals across England, Scotland, and Wales.</p><p><strong>Patients: </strong>Hospitalized infants younger than 12 months old with a clinical diagnosis of bronchiolitis, assessed at least twice 15 minutes apart to fulfill criteria for either severe bronchiolitis (one or more of: respiratory rate > 70 breaths/min, grunting, marked chest recession, recurrent short apneas) or moderate bronchiolitis (lack of response to low-flow oxygen, indicated by persistent hypoxemia and/or moderate respiratory distress).</p><p><strong>Interventions: </strong>\"Moderate bronchiolitis stratum\": HFNC at a flow rate of 2 L/kg/min vs. HSO through a facemask or headbox at a flow rate up to 15 L/min. \"Severe bronchiolitis stratum\": HFNC at a flow rate of 2 L/kg/min vs. CPAP pressure set at 6-8 cm H2O.</p><p><strong>Measurements and main results: </strong>In each stratum, eligible infants will be randomly allocated on a 1:1 basis to the trial treatments using a web-based system by permuted block randomization, stratified by site of recruitment and age (< 6 wk and ≥ 6 wk). Due to the emergency nature of the treatments, written informed consent will be deferred. The primary outcome is time from randomization to hospital discharge within 30 days. Baseline clinical characteristics and hospital course, including details of respiratory support, and discharge and cost-effectiveness outcomes will be collected. The trial received Health Research Authority and Research Ethics Committee approval from the Yorkshire and The Humber-South Yorkshire Research Ethics Committee on August 3, 2023 (reference: 23/YH/0166). The trial registration is ISRCTN52937119.</p><p><strong>Conclusions: </strong>Trial findings will be disseminated in national and international conferences, in peer-reviewed journals and through social media.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855963","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":"Antiseizure Medication Use and Continuous Electroencephalography in Pediatric Traumatic Brain Injury.","authors":"Mohamad-Hani Temsah, Eman Amin Ahmed, Fahad Bashiri","doi":"10.1097/PCC.0000000000003795","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003795","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855961","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":"B-Type Natriuretic Peptide in Critically Ill Children: Single-Center Retrospective Study of Levels in the First 72 Hours of PICU Admission and Outcome.","authors":"Yulia Shtanko, Abhinav Totapally, Prithvi Sendi, Balagangadhar R Totapally","doi":"10.1097/PCC.0000000000003812","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003812","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822194","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":"Eight PICU Follow-Up Programs in the United States Established From 2013 to 2022: Report From the Pediatric Outcomes Studies After PICU (POST-PICU) Investigators.","authors":"Leslie A Dervan, Mary Hartman, Ericka L Fink, Julie C Fitzgerald, Trevor A Hall, Krista Laux, Lindsey A Morgan, Sarah Murphy, Neethi P Pinto, Elisabeth Schrock, Jane E Whitney, Cydni N Williams, Elizabeth Y Killien","doi":"10.1097/PCC.0000000000003804","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003804","url":null,"abstract":"<p><strong>Objectives: </strong>Children surviving critical illness are at risk for new morbidities collectively termed \"post-intensive care syndrome-pediatrics\" (PICS-p). Because PICU teams are familiar with PICS-p and motivated to improve patient outcomes, intensivists are ideally positioned to improve access to PICU follow-up care. We aimed to describe various models of care developed by existing U.S. PICU follow-up programs.</p><p><strong>Design: </strong>The Pediatric Outcomes Studies after PICU (POST-PICU) subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators network convened a virtual meeting with presentations and discussion by 11 leaders of eight follow-up programs, structured using input from the 125 POST-PICU members including advance questions.</p><p><strong>Setting: </strong>Ninety-minute virtual meeting, September 2024. We recorded and transcribed the presentations and discussion to draft this report.</p><p><strong>Panel proceedings: </strong>Each leader presented their program and participated in discussion, organized into three domains based on the provided questions: 1) the program's target population and interventions; 2) program administration and funding; and 3) program outcomes. Each program aimed to identify patients considered at-risk for physiologic, neurologic, and/or psychologic PICU sequelae and to provide screening, referral to supportive or specialist services as indicated, and collaboration with their existing healthcare teams. Funding influenced program structure and processes. Many programs provided clinical services alongside services tied to research efforts. Tracking program outcomes helped programs advocate for long-term funding and institutional support. Panelists described their programs as providing \"wraparound care,\" \"transition care,\" and \"connection\"-supporting patients and families through different stages of the PICU and hospital stay, rehabilitation, and transition to home care.</p><p><strong>Conclusions: </strong>This information can support PICU teams in developing infrastructure to provide clinically indicated education, screening, and support for their patients, as the PICU community engages in further research and advocacy to improve access to PICU follow-up care.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799853","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":"Red Cell Transfusion During Pediatric Intensive Care: A 28-Day Point Prevalence Study in Three European Countries in 2023.","authors":"Laura Butragueño-Laiseca, Samiran Ray, Avishay Sarfatti, Simon J Stanworth, Roi Campos Rodríguez, Ana Gómez-Zamora, Alexandra Hernández Yuste, Isabel Benítez Gómez, Gema de Lama Caro-Patón, Chiara Giorni, Elisabetta Lampugnani, Marco Daverio, Fabrizio Chiusolo","doi":"10.1097/PCC.0000000000003805","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003805","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the prevalence of RBC transfusion in children admitted to PICUs in three European countries and to determine hemoglobin threshold, triggers, and outcomes for transfusions.</p><p><strong>Design: </strong>International 4-week point prevalence study in 2023.</p><p><strong>Setting: </strong>Forty-four PICUs across Spain, the United Kingdom, and Italy.</p><p><strong>Patients: </strong>PICU patients 1 month to 17 years old receiving RBC transfusion.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>During four prespecified 7-day blocks (from March 2023 to July 2023), 348 of 2713 patients (12.8%) received at least one RBC transfusion, accounting for 527 transfusions. The proportion of patients receiving RBC transfusion in Italy, the United Kingdom, and Spain was 17.3% (66/382), 13.9% (166/1195), and 10.2% (116/1136), respectively. The primary indication for transfusion in the 527 transfusion events was hemoglobin level (54.6%), followed by bleeding (10.6%), cardiovascular instability (10.5%), and extracorporeal support (10.1%). In 45.1% of RBC transfusions, there was no other physiologic trigger apart from hemoglobin. The median (interquartile range [IQR]) hemoglobin level before transfusion was 8.3 g/dL (IQR, 7.2-9.9 g/dL), with median values varying significantly among Spain, the United Kingdom, and Italy, respectively, 7.8 vs. 8.6 vs. 8.9 g/dL (p < 0.001). When excluding cardiac patients, overall median hemoglobin threshold was 7.4 g/dL (IQR, 6.8-8.6 g/dL) and was comparable across the three countries (p > 0.05). The overall 28-day PICU mortality in 348 patients receiving transfusions was 10.7%. The number of transfusions was associated with mortality, even after adjusting for reason for admission and admission Pediatric Index of Mortality score.</p><p><strong>Conclusions: </strong>In 44 European PICUs in 28 days during 2023, 12.8% of critically ill children received one or more RBC transfusions during their PICU stay. Hemoglobin level was the primary determinant for transfusion, often exceeding the recommended 7.0 g/dL threshold. Other clinical triggers are rarely considered. Defining hemoglobin thresholds and adopting a goal-directed transfusion strategies may optimize clinical transfusion practices.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795022","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":"Stop the Clot: A Quality Improvement Initiative to Reduce the Rate of Venous Thromboembolism in the PICU.","authors":"Robert Murray, Jordan Brauner, Mike Welty, Jennifer Gauntt, Charles Treinen, Jennifer A Muszynski, Colleen Cloyd, Vilmarie Rodriguez","doi":"10.1097/PCC.0000000000003809","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003809","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to reduce the rate of hospital-acquired venous thromboembolism (HA-VTE) in the PICU by 50% from 2.07 to 1.04 venous thromboembolism (VTE) per 1000 patient days by June 2023 and sustain this change for 6 months.</p><p><strong>Design: </strong>Prospective quality improvement project.</p><p><strong>Setting: </strong>The PICU of an urban academic free-standing children's hospital in the United States.</p><p><strong>Patients: </strong>All patients admitted to the PICU between December 2020 and December 2023.</p><p><strong>Interventions: </strong>We identified key drivers including: provider knowledge gaps surrounding VTE risk in our patient population, identification of patients at risk of VTE, the absence of appropriate screening and prevention tools, and central venous line duration and location. These key drivers were each addressed with the most significant intervention being the creation of a simple screening tool to identify and provide thromboprophylaxis recommendations for patients most at risk for developing VTE.</p><p><strong>Measurements and main results: </strong>We identified the monthly occurrence rate of VTE as our outcome measure, the provision of VTE thromboprophylaxis as our process measure and the presence of bleeding events as our balancing measure. The rate of VTE in PICU patients decreased from 2.07 to 1.14 per 1000 patient days. There was an increase in the provision of pharmacologic thromboprophylaxis during our intervention period from 36% to 42% with no change in the rate of mechanical thromboprophylaxis. There were only two instances of clinically relevant non-major bleeding as defined by the International Society of Thrombosis and Haemostasis definition in nonsurgical patients on anti-hemostatic agents during our intervention period. There was a decrease in central venous catheter days from 43% to 31% of PICU patient days during the intervention period.</p><p><strong>Conclusions: </strong>Upon implementing a protocolized screening and prevention tool for VTE, we observed a decreased occurrence of HA-VTE.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795023","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":"Early Rehabilitation Bundle in a Canadian PICU: Cost Analysis of Implementation in 2018-2020.","authors":"Shira Gertsman, Sureka Pavalagantharajah, Lindsey Falk, Sayem Borhan, Kevin Kennedy, Lehana Thabane, Feng Xie, Cynthia Cupido, Karen Choong","doi":"10.1097/PCC.0000000000003806","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003806","url":null,"abstract":"<p><strong>Objectives: </strong>First, to determine the resources and costs required to implement an early rehabilitation (ABCDEF) bundle. Second, to compare the impact of the bundle on costs pre- and post-implementation.</p><p><strong>Design and setting: </strong>Cost analysis was conducted as part of an implementation study at McMaster Children's Hospital PICU in 2018-2020.</p><p><strong>Measurements and main results: </strong>Resource estimates for all implementation activities from 2018 to 2020 were calculated from material costs and hours spent by personnel multiplied by wages. PICU and patient-level costs before (from January 2019 to March 2019) and after bundle implementation (from January 2020 to March 2020) were compared using case-costing data. Linear regression was used to analyze log-transformed costs adjusted for age, sex, and severity of illness score. Costs are reported in Canadian dollars (CAD). A total of 907 hours were spent over a 2-year implementation period, at an estimated cost of CAD 50,813. Physicians contributed the most hours, followed by the nurse educator and pharmacist. Material costs were CAD 860. There were 141 patients pre-implementation and 84 patients post-implementation in the analyses. Adjusted mean PICU cost per patient was CAD 17,342 and CAD 20,310, pre- to post-implementation, respectively; mean difference (95% CI) between post- and pre-implementation was 17% higher (95% CI, from 6.3% lower to 46% higher). Adjusted mean pharmacy cost per patient was CAD 834 pre-implementation and CAD 827 post-implementation; mean difference of 0.8% lower post-implementation (95% CI, from 27% lower to 35% higher).</p><p><strong>Conclusions: </strong>Implementation of the ABCDEF bundle requires significant time and collaboration of key stakeholders. There was no impact on PICU or patient costs following bundle implementation, but the period of observation was limited by COVID-19. Future studies should include cost analyses that incorporate longer-term, patient-centered health outcomes to determine whether this intervention is cost-effective.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795020","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}