Pediatric Critical Care Medicine最新文献

{"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}

{"title":"Enteral Feeding Becomes the Key Barrier to Hospital Discharge After Early Extubation: Mediation Analysis of the Pediatric Heart Network Collaborative Learning Study Dataset, 2010-2011.","authors":"Aniruth Ananthanarayanan","doi":"10.1097/PCC.0000000000004067","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004067","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081631","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":"Determination of Death by Neurological Criteria in Children and Its Concordance With Ancillary Testing, Primarily With CT Angiography: Single-Center Experience in Türkiye, 2012-2025.","authors":"Feyza İnceköy Girgin, Deniz Birtan, Cansu Aydin, Ruslan Abdullayev, Eda Almus, Makbule Nilüfer Yalindağ","doi":"10.1097/PCC.0000000000004020","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004020","url":null,"abstract":"<p><strong>Objectives: </strong>Our practice in Türkiye when determining death using neurologic criteria (DNC) is to combine clinical examination and ancillary radiological investigation. We have: 1) examined the diagnostic concordance between clinical examination for DNC and the initial ancillary investigation; 2) evaluated an age cutoff of 24 months in the diagnostic clinical-radiological concordance; and 3) explored age and radiological diagnostic relationships in children with incomplete clinical assessment for DNC.</p><p><strong>Design: </strong>Single-center retrospective study, 2012-2025.</p><p><strong>Setting: </strong>Academic hospital PICU in İstanbul, Türkiye.</p><p><strong>Patients: </strong>We included patients younger than 19 years old in whom DNC was suspected.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>DNC was suspected in 86 patients. Clinical examination consistent with DNC was completed in 61 patients (mean age, 82.1 mo; 16 < 24 and 45 ≥ 24 mo) with ancillary investigation, which were concordant with DNC either on the first test (77%) or after two or more tests (23%). CT angiography (CTA) was the most used test (80%). The initial CTAs were not consistent with DNC in 23% (95% CI, 13-36%). Based on age grouping (< 24 or ≥ 24 mo), being younger was associated with greater odds of a discordant result (8/16 vs. 6/45; odds ratio, 6.5; 95% CI, 1.77-29.93; p = 0.005). Last, in 15 patients (mean age, 43.6 mo) with suspected DNC, but either incomplete clinical examination (n = 9) or apnea test (n = 6), DNC was finally confirmed using CTA, with five of 15 patients having more than one test.</p><p><strong>Conclusions: </strong>In Türkiye, where ancillary investigation is mandatory following a clinical examination consistent with DNC, and where more advanced imaging modalities are unavailable, our practice has been to use CTA. Our 2012-2025 experience of determining DNC shows that CTA is used in the pediatric population, even in children under 2 years old.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040196","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":"Meropenem Dosing for Pediatric Critical Care Patients: Multisite Pharmacokinetic Study, 2012-2020.","authors":"Anh Thi Van Nguyen, Evelyn Dhont, Zhiyuan Tan, Tatjana Van Der Heggen, Emma Beel, Nick Verougstraete, Veronique Stove, Pieter-Jan De Sutter, Sophie Vanhaesebrouck, Daphné Vania Vens, An Vermeulen, Peter De Paepe, Pieter A De Cock","doi":"10.1097/PCC.0000000000004046","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004046","url":null,"abstract":"<p><strong>Objectives: </strong>Critically ill children may present with altered pharmacokinetics (PK) and/or pharmacodynamics (PD), leading to suboptimal dosing of meropenem. We aimed to: 1) investigate meropenem PK in critically ill children, 2) identify factors associated with interindividual PK variability, and 3) evaluate the PK/PD target attainment rates of current and alternative dosing strategies against the most used PK/PD targets.</p><p><strong>Design: </strong>Observational PK study with plasma samples taken after the first and steady state doses after receiving IV meropenem. Data were analyzed using nonlinear mixed-effects modeling. Monte Carlo simulations were performed to evaluate the probability of PK/PD target attainment for different dosing strategies within the first 48 hours of treatment.</p><p><strong>Setting: </strong>Neonatal and PICU of two Belgian tertiary care hospitals, 2012-2020.</p><p><strong>Patients: </strong>Fifty-four critically ill children (7 d to 14.5 yr old) receiving meropenem infusion at 20-40 mg/kg every 6, 8, or 12 hours.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Four hundred twenty-three plasma samples were used for population PK analysis. A two-compartment model with allometric scaling and a sigmoidal maturation function accounting for the effects of growth and development best described the data. The typical values for clearance, central volume of distribution, intercompartmental clearance, and peripheral volume of distribution were 13.1, 12.5, 23.9 L/hr/70 kg, and 16.3 L/70 kg, respectively. A loading dose of 40 mg/kg, followed by a continuous infusion of 60 mg/kg/d, was required to achieve 100% of the time the unbound concentration above the minimum inhibitory concentration (MIC) against Enterobacterales species and Pseudomonas aeruginosa (MIC ≤ 2 mg/L) without compromising safety.</p><p><strong>Conclusions: </strong>Standard intermittent dosing regimens (20-40 mg/kg every 8 hr over 0.5 hr) are likely to result in subtherapeutic concentrations, thereby risking therapy failure in critically ill children. A loading dose followed by continuous infusion is suggested for optimal target attainment.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025790","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":"Preoperative Pulmonary Blood Flow, Cardiopulmonary Bypass, and Lung Inflammation in Children With Congenital Heart Disease: Post Hoc Analysis of a Single-Center Prospective Cohort.","authors":"Anna Sartori, Manuela Simonato, Virgilio Carnielli, Cristiana Carollo, Giovanni Di Salvo, Vladimiro Vida, Massimo Padalino, Paola Cogo","doi":"10.1097/PCC.0000000000004058","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004058","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate inflammatory biomarkers and lipidomic profiles in tracheal aspirates (TA) of infants with congenital heart disease (CHD), by pulmonary blood flow (Qp) high/low grouping at the time of cardiac surgery on cardiopulmonary bypass (CPB), and to examine associations across CHD phenotypes.</p><p><strong>Design: </strong>Post hoc analysis of patient samples obtained from a single-center prospective study.</p><p><strong>Setting: </strong>Pediatric Cardiovascular Surgery Unit, Padova, Italy.</p><p><strong>Patients: </strong>Samples from 79 infants with CHD who were enrolled in a prospective study were analyzed and classified by Qp (33/79 low and 46/79 high) according to pulmonary valve size at surgery. We also studied 23 infants without cardiorespiratory disease who served as controls.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Clinical data and lung mechanics at the time of anesthesia induction, at surgery end, and every 6 hours for 24 hours were collected. TA samples collected before and after surgery were used to quantify epithelial lining fluid (ELF) total proteins (TP), surfactant protein B (SP-B), and cytokines. The lipidomic profile was generated by mass spectrometry. Before surgery, ELF TP and SP-B were increased in CHD infants compared with controls. Sphingomyelin and phosphatidylglycerol percentages were significantly increased, whereas lysophosphatidylcholines and plasmalogens were significantly decreased. In the post-surgery samples, proinflammatory cytokines increased, especially in the low Qp group. This inflammatory response was associated with reduced dynamic compliance in the first 12 hours, and with longer respiratory support and ICU stay compared with the high Qp group. In the low Qp group, cytokine increase was associated with reduced oxygen diffusion capacity, and with the degree and length of minimum temperature during CPB.</p><p><strong>Conclusions: </strong>In this post hoc analysis of TA samples from CHD infants undergoing surgery with CPB, we have shown that preoperative Qp phenotype was associated with an enhanced inflammatory response, highlighting potential opportunities for phenotype-specific strategies to improve postoperative outcome.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990928","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":"Secondary analysis of the 2021-2023 Sepsis Epidemiology in Australian and New Zealand Children Observational Dataset: Association Between Presenting Venous Lactate Concentration and 72-Hour Outcomes.","authors":"Elliot Long, Stephen Hearps, Warwick Butt, Tom Rozen, James Williams, Amanda Williams, Ben Gelbart, Sarah McNab, Meredith L Borland, Jarrod Cross, Shefali Jani, Marino Festa, Eunicia Tan, Natalie Phillips, Sainath Raman, Amit Kochar, Subodh Ganu, Simon Craig, Anna Lithgow, Emma Whyte, Arjun Rao, Stuart R Dalziel, Shane George, Franz E Babl","doi":"10.1097/PCC.0000000000004055","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004055","url":null,"abstract":"<p><strong>Objectives: </strong>In pediatric patients with sepsis, we hypothesized that the initial venous lactate concentration would be associated with subsequent need for extracorporeal life support (ECLS) or death within 72 hours.</p><p><strong>Design: </strong>A planned secondary analysis of data from the multicenter, two-country Sepsis Epidemiology Emergency Departments (SENTINEL) study, collected 2021-2023.</p><p><strong>Setting: </strong>Acute care hospitals in Australia and New Zealand.</p><p><strong>Patients: </strong>SENTINEL participants were children of 0 to less than 18 years with suspected sepsis admitted to the hospital through 11 emergency departments.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We used the initial venous lactate concentration (sampling within 4 hr of hospital arrival) as an explanatory variable for subsequent need for ECLS or death within 72 hours. In 4806 children, with a median (interquartile range [IQR]) age of 1.9 years (IQR, 0.2-6.7 yr), 2651 children (55.2%) were males, and 33 children (0.7%) received ECLS or died within 72 hours. The best-performing initial lactate concentration associated with ECLS or death within 72 hours was 3.5 mmol/L and was observed in 745 of 4806 children (15.5%), including 24 of 33 children requiring ECLS or who died within 72 hours. As a \"diagnostic\" test, lactate greater than or equal to 3.5 mmol/L had sensitivity (95% CI) of 72.7% (95% CI, 54.5-86.7%), specificity of 84.9% (95% CI, 83.9-85.9%), and area under the receiver-operating characteristics curve of 0.79 (95% CI, 0.71-0.87) for ECLS or death within 72 hours, which are in the acceptable-to-fair category. That is, a 4-hour lactate concentration greater than or equal to 3.5 mmol/L takes the pre- to posttest probability of ECLS/death from 0.7% to 3.2%.</p><p><strong>Conclusions: </strong>In this secondary analysis of the 2021-2023 SENTINEL dataset, we have found that at the time children are hospitalized with suspected community-acquired sepsis, an initial venous lactate greater than or equal to 3.5 mmol/L has an acceptable-to-fair association with subsequent need for ECLS, or death, within 72 hours. Clinicians will need to decide whether such testing on its own is useful in decision-making.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963687","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":"Inspiratory Flow Amplitude in Pediatric Acute Respiratory Distress Syndrome: Outcomes in a Single-Center Cohort, 2023-2024.","authors":"Paola Caviedes, Franco Díaz, Pablo Cruces","doi":"10.1097/PCC.0000000000004054","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004054","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate whether inspiratory flow amplitude is independently associated with time to successful extubation in children with pediatric acute respiratory distress syndrome (PARDS) ventilated within lung-protective targets.</p><p><strong>Design: </strong>Post hoc analysis of a pulmonary physiologic and clinical dataset collected in 2023-2024.</p><p><strong>Setting: </strong>Single tertiary PICU.</p><p><strong>Patients: </strong>Forty-eight mechanically ventilated children with early PARDS.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Standardized measurements of ventilatory parameters and respiratory mechanics collected within 2 hours of intubation during volume-controlled ventilation (VCV) with constant inspiratory flow and neuromuscular blockade. Inspiratory flow amplitude was the ventilator-reported mean inspiratory flow in VCV, a derived, setting-dependent metric. Median (interquartile range [IQR]) age was 11 months (IQR, 3-22 mo), and most patients had mild-to-moderate PARDS of viral etiology. Ventilation was delivered within protective limits for tidal volume, plateau pressure, positive end-expiratory pressure, driving pressure, and inspiratory time. The median inspiratory flow amplitude was 0.9 L/min/kg (IQR, 0.6-1.1 L/min/kg). The primary outcome was time to successful extubation. In multivariable Cox proportional hazards regression adjusted for age, oxygenation index, tidal volume, respiratory rate, and resistive airway pressure (peak inspiratory pressure minus plateau pressure), higher inspiratory flow amplitude was independently associated with a lower hazard of successful extubation over time (hazard ratio, 0.20; 95% CI, 0.06-0.75; p = 0.017). Multicollinearity assessment showed no clinically relevant collinearity among covariates. Sensitivity analyses confirmed the robustness and directional consistency of this association. In complementary linear regression, each 0.1 L/min/kg increase in inspiratory flow amplitude was associated with 3.5 hours (95% CI, 0.7-6.3 hr) of prolonged mechanical ventilation.</p><p><strong>Conclusions: </strong>Among children with early PARDS ventilated within lung-protective limits, higher inspiratory flow amplitude was independently associated with delayed extubation. Inspiratory flow amplitude may represent an integrative marker of dynamic ventilatory load not fully captured by conventional static parameters. These findings are observational and hypothesis-generating and support further investigation of inspiratory flow in PARDS.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963692","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}