Pediatric Critical Care Medicine最新文献

{"title":"Early Blood Biomarkers and MRI Injury After Cardiac Arrest: Secondary Analysis of the 2017-2020 \"Personalized Outcomes After Child Cardiac Arrest\" Study.","authors":"Anna M Janas, Kristen R Miller, Rafael Ceschin, Peter M Mourani, Christopher M Ruzas, Tellen D Bennett, Ericka L Fink, Aline B Maddux","doi":"10.1097/PCC.0000000000003756","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003756","url":null,"abstract":"<p><strong>Objectives: </strong>Brain MRI is used to inform prognosis of pediatric cardiac arrest (CA). We analyzed the association between early levels of four brain injury biomarkers and pattern of brain injury on MRI.</p><p><strong>Design, setting, and patients: </strong>This secondary analysis of a multicenter prospective cohort study in 14 U.S. hospitals (from May 16, 2017, to August 19, 2020) recruited children 48 hours to 17 years old who were resuscitated after CA and had a brain MRI within 14 days postarrest.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Brain MRI injury score was calculated as a sum of T2- and diffusion-weighted imaging lesions. We used the Kruskal-Wallis test to compare maximum biomarker values on days 1-3 between three categories of MRI injury severity (i.e., no injury, mild-moderate injury, and severe injury). Maximum neurofilament light chain (NfL), tubulin-associated unit, glial fibrillary acidic protein, and ubiquitin C-terminal hydrolase L1 levels were associated with severity of total injury, gray matter injury, and white matter injury. Using logistic regression, individual biomarker levels were associated with presence of injury on MRI after adjusting for age, presence of congenital heart disease, and severity of illness using Pediatric Index of Mortality 3 score. Of 40 patients with injury on MRI and 1-year outcome data, median (interquartile range [IQR]) NfL levels were higher in the 15 patients who died compared with the 21 patients with favorable outcome (7.10 pg/mL [IQR, 5.94-7.51 pg/mL] vs. 5.10 pg/mL [IQR, 4.10-5.94 pg/mL]; log transformed; p < 0.001), but we failed to identify a difference in levels between those with unfavorable outcome (Vineland Adaptive Behavior Score < 70, n = 4) vs. favorable outcome.</p><p><strong>Conclusions: </strong>Blood biomarkers measured early after injury are associated with MRI injury and may provide additional information for prognostication when incorporated in a multimodal evaluation.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976221","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":"Massive Bleeding in Children With Cancer or Hematopoietic Cell Transplant: International, Multicenter Retrospective Study, 2017-2021.","authors":"Marianne E Nellis, Marie E Steiner, Saleh Bhar, Jennifer McArthur, Ali McMichael, April L Rahrig, Christine Leeper, Salvatore Perdichizzi, Fabrizio Chiusolo, Jacob Shamash, Nora Bruns, Hilary Schreiber, Matthew P Sharron, Laura Butragueño-Laiseca, James S Killinger, Charlene P Pringle, Samantha M Koenig, Cassandra Josephson, David Crawford, Briana L Scott, Kenneth E Remy, Christine Puthawala, Philip C Spinella","doi":"10.1097/PCC.0000000000003751","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003751","url":null,"abstract":"<p><strong>Objectives: </strong>To characterize the epidemiology and management of massive bleeding events in children with cancer and/or hematopoietic cell transplant (HCT).</p><p><strong>Design: </strong>Multicenter, retrospective cohort study.</p><p><strong>Setting: </strong>Nineteen pediatric hospitals in Europe and United States.</p><p><strong>Subjects: </strong>Children ages 0-21 years old with malignancy and/or HCT and massive bleeding admitted from January 1, 2017, to December 31, 2021.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Demographics, oncologic history, laboratory values, interventions, and PICU outcomes were collected. One hundred fifty-two bleeding episodes from 135 patients were analyzed. The median (interquartile range [IQR]) age was 7 years (2-14 yr). Forty-three percent (58/135) were female sex. Nineteen percent of children (26/135) had death attributable to hemorrhage. Forty percent had solid tumors and one-third had undergone at least one HCT. The majority of bleeding events occurred in the PICU (81/152, 53%). The median (IQR) platelet count at time of bleeding was 52 × 109/L (24-115 × 109/L), prothrombin time 18.5 seconds (15.2-24.8 s), activated partial thromboplastin time 42.2 seconds (33.2-56.0 s), and international normalized ratio 1.51 (1.21-2.11). To treat these bleeding events, 99% (148/152) of the time children received RBC transfusions, 84% (126/152) of the time plasma transfusions, 88% (132/152) of the time platelet transfusions, and less than one-fifth hemostatic medications. Half (77/152, 52%) of the time the children received high plasma ratios and half (73/152, 49%) received high platelet ratios. Pulmonary bleeding, oral/nasal bleeding, and receipt of prothrombin complex concentrate were each associated with greater odds of death attributed to hemorrhage: odds ratio (95% CI), respectively: 5.44 (2.250-13.171; p < 0.001); 3.30 (1.20-9.09; p = 0.021); and 3.24 (1.18-8.93; p = 0.023).</p><p><strong>Conclusions: </strong>Children with malignancy and/or HCT have a high mortality rate from hemorrhage despite being hospitalized at the time of their bleeding event. The majority of children received balanced resuscitation. Definitive trials are needed to determine optimal hemostatic resuscitation practice in this population.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013760","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":"The Prevalence and Outcome of Acute Hypoxemic Respiratory Failure (PANDORA) Study in Mechanically Ventilated Children: Prospective Multicenter Epidemiology in Spain, 2019-2021.","authors":"Yolanda M López-Fernández, Amelia Martínez-de-Azagra, Susana B Reyes-Domínguez, Ana Gómez-Zamora, Laura Herrera-Castillo, Ana Coca-Pérez, Julio Parrilla-Parrilla, Alberto Medina, Juan P García-Iñiguez, Marta Brezmes-Raposo, Alexandra Hernández-Yuste, Ana M Llorente de la Fuente, Ignacio Ibarra de la Rosa, José S León-González, Javier Trastoy-Quintela, David Arjona-Villanueva, Jesús M González-Martín, Tamas Szakmany, Jesús Villar","doi":"10.1097/PCC.0000000000003743","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003743","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the epidemiology and outcome of children with acute hypoxemic respiratory failure (AHRF) and/or pediatric acute respiratory distress syndrome (PARDS).</p><p><strong>Design: </strong>Prospective, observational study in six nonconsecutive 2-month blocks form October 2019 to September 2021.</p><p><strong>Setting: </strong>A network of 22 PICUs in Spain.</p><p><strong>Patients: </strong>Consecutive children (7 d to 15 yr old) with a diagnosis of AHRF, defined by Pao2/Fio2 ratio less than or equal to 300 mm Hg, who needed invasive mechanical ventilation (IMV) using positive end-expiratory pressure (PEEP) greater than or equal to 5 cm H2O and Fio2 greater than or equal to 0.3.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The primary outcomes were AHRF prevalence and PICU mortality. The secondary outcomes were the prevalence of IMV with PARDS (IMV-PARDS) and the use of adjunctive therapies. There were 6545 PICU admissions: 1374 (21%) underwent IMV and 181 (2.8%) had AHRF. Ninety-one patients (1.4% of PICU admissions, 6.6% of IMV cases, and 50.3% of AHRF cases) met the Second Pediatric Acute Lung Injury Consensus Conference IMV-PARDS criteria. At baseline, mean (± sd) tidal volume was 7.4 ± 1.8 mL/kg ideal body weight, PEEP 8.4 ± 3.1 cm H2O, Fio2 0.68 ± 0.23, and plateau pressure 25.7 ± 6.3 cm H2O. Unlike patients with PARDS, adjunctive therapies were used infrequently in non-PARDS AHRF patients. AHRF patients without PARDS had more ventilator-free days than PARDS patients (16.4 ± 9.4 vs. 11.2 ± 10.5; p = 0.002). All-cause PICU mortality in AHRF cases was higher in PARDS vs. non-PARDS patients (30.8% [95% CI, 21.5-41.3] vs. (14.4% [95% CI, 7.9-23.4]; p = 0.01).</p><p><strong>Conclusions: </strong>In our 2019-2021 PICU population, the prevalence of AHRF is 2.8% of IMV cases. Of such patients, the prevalence of PARDS was 50.3%, and there was a 30.8% mortality, which was higher than in cases of AHRF without PARDS.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018642","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":"Nuclear Medicine Cerebral Perfusion Studies As an Ancillary Test to Support Evaluation of Brain Death/Death by Neurologic Criteria.","authors":"Lionel S Zuckier","doi":"10.1097/PCC.0000000000003747","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003747","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041828","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":"Iron Deficiency Anemia in Children During and After PICU Admission.","authors":"Laura Butragueño-Laiseca, Lucía Alonso Rodriguez, María José Santiago Lozano","doi":"10.1097/PCC.0000000000003738","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003738","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031529","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":"Communication, Consistency, Collaboration, Compassion, and Caring When a Child Dies.","authors":"Thomas A Nakagawa, Aarti Sarwal","doi":"10.1097/PCC.0000000000003753","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003753","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041856","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":"Themes in the Management of Pediatric Brain Death Contestation: Exploratory Qualitative Work From Multidisciplinary Health Professionals in the United States.","authors":"Erica Andrist, Janice I Firn, Matthew P Kirschen, Nneka O Sederstrom, Alexander A Kon, Jessica C Fowler, Amy H J Wolfe, Mary E McIlroy, Andrew Kiragu, Wynne E Morrison, Ken Tegtmeyer, Kenya Agarwal, Thaddeus M Pope, Christian J Vercler, Denise Winiarski, Nancy McGowan, Steven M Leber, Christopher L Carroll, Heidi R Flori","doi":"10.1097/PCC.0000000000003744","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003744","url":null,"abstract":"<p><strong>Objectives: </strong>To explore health professionals' experiences of contested pediatric brain death/death by neurologic criteria (BD/DNC) cases, including factors contributing to conflict, resource needs and utilization, perceived utility of supports available, and case resolution and aftermath.</p><p><strong>Design and methods: </strong>Inductive thematic analysis of semistructured interviews with members of the Society of Critical Care Medicine (SCCM) Contestation of Pediatric Brain Death Task Force.</p><p><strong>Setting: </strong>Ten institutions across seven U.S. states and the District of Columbia.</p><p><strong>Participants: </strong>Nineteen Task Force members were interviewed in 2023, including pediatric intensivists, neurologists, nurses, respiratory therapists, attorneys, palliative care clinicians, social workers, ethicists, and hospital leadership. Task Force members were recruited primarily because of their experience with contested BD/DNC, although some were recruited because of expertise in other relevant topics, such as communication, information acquisition in BD/DNC, and health equity.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We identified five themes relevant to managing pediatric BD/DNC contestation: 1) personnel to consider involving, including subspecialty consultation, social work, hospital leadership and administration, ethics teams, legal counsel, and security; 2) timelines to maintain, including factors to consider when deciding the most appropriate family accommodations; 3) support for families and patients, including strategies to enhance communication, identifying and mitigating mistrust, and connecting families with support both within and outside the hospital; 4) support for staff, including disseminating information throughout the care team, staff support for one another, and establishing written documentation and policies; and 5) complementary strategies that may augment approaches to BD/DNC contestation, such as policies addressing requests for potentially inappropriate treatment.</p><p><strong>Conclusions: </strong>Family contestation of pediatric BD/DNC challenges all parties involved. The five themes identified from our qualitative analysis of interviews with experienced professionals do not constitute SCCM clinical practice guidance, but they will be used to inform the development of approaches to BD/DNC contestation through further scholarship and community consultation.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011626","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":"Sodium Bicarbonate in Cardiac Arrest: A True Harm or a Bystander of Prolonged Resuscitation?","authors":"Lindsay N Shepard, Justine Shults, Akira Nishisaki","doi":"10.1097/PCC.0000000000003755","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003755","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011623","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 Sodium Bicarbonate Use in Pediatric In-Hospital Cardiac Arrest: A Single-Center, Retrospective Cohort Study, 2013-2023.","authors":"Nicole A Duster, Anne V Grossestreuer, Jill L Sorcher, Michael W Donnino, Monica E Kleinman, Catherine E Ross","doi":"10.1097/PCC.0000000000003746","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003746","url":null,"abstract":"<p><strong>Objectives: </strong>To explore the association of intra-arrest sodium bicarbonate (SB) use with outcomes in pediatric in-hospital cardiac arrest (p-IHCA) when accounting for the timing of initial SB administration. We hypothesized that administration of SB within the first 5 minutes of p-IHCA would be associated with greater odds of hospital survival and return of spontaneous circulation (ROSC).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Quaternary care academic children's hospital.</p><p><strong>Patients: </strong>Children 18 years old or younger with pulseless IHCA of at least 5 minutes duration at our institution between January 2013 and January 2023 with complete data were included.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Of 243 index events of p-IHCA, 99 (41%) received SB in the first 5 minutes of cardiopulmonary resuscitation (CPR). Overall, 107 patients (44%) survived to hospital discharge and ROSC was achieved in 91 of 243 patients (37%). A logistic treatment-effects estimation utilizing inverse-probability weighting via a propensity score was performed to compare the effects of SB use within the first 5 minutes of CPR with those who did not receive early SB. In this analysis, we failed to detect an association between early SB, compared with not, and differing adjusted odds of survival to discharge (adjusted odds ratio [aOR], 0.87; 95% CI, 0.45-1.69; p = 0.687) and ROSC (aOR, 0.82; 95% CI, 0.43-1.56; p = 0.537).</p><p><strong>Conclusions: </strong>In this retrospective cohort study of p-IHCA, we failed to detect an association between timing of SB and odds of survival to hospital discharge and ROSC. These findings warrant reevaluation of the evidence and support a less restrictive recommendation for SB use during p-IHCA in U.S. national guidelines.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039361","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":"Optimizing Communication Between Organ Procurement Organization Requestors and PICU Providers; Can We Do Better?","authors":"Jill Sweney, Barry P Markovitz","doi":"10.1097/PCC.0000000000003754","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003754","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023026","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}