Pediatric Critical Care Medicine最新文献

{"title":"Burden of Intracranial Hypertension and Patterns of Brain Injury on MRI: Secondary Analysis of the 2014-2017 \"Approaches and Decisions for Acute Pediatric TBI\" Study.","authors":"Anna M Janas, Aimee T Broman, Tellen D Bennett, Susan Rebsamen, Aaron S Field, Bedda L Rosario, Michael J Bell, Andrew L Alexander, Peter A Ferrazzano","doi":"10.1097/PCC.0000000000003823","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003823","url":null,"abstract":"<p><strong>Objectives: </strong>Elevated intracranial pressure (ICP) is a complication of severe traumatic brain injury (TBI) that carries a risk of secondary brain injury. This study investigated the association between ICP burden and brain injury patterns on MRI in children with severe TBI.</p><p><strong>Design, setting, and patients: </strong>Secondary analysis of the Approaches and Decisions in Acute Pediatric TBI (ADAPT) study, which included children with severe TBI (Glasgow Coma Scale score < 9) who received a clinical MRI within 30 days of injury. We excluded patients who had ICP monitoring less than 24 hours, were missing ICP data for greater than 40% of monitoring time, or who underwent craniectomy.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>ICP burden was defined as the trapezoidal area under the curve of hourly ICP greater than 20 mm Hg. ICP was standardized to total monitoring time, and patients were categorized to four levels of ICP burden. MRI was evaluated for number of diffuse axonal injury (DAI) microhemorrhages, intracerebral hemorrhage (ICH) volume, contusion volume, and number of regions with ischemia. Fisher exact or chi-square tests were used to test the independence between ICP burden and MRI injury amount. Of the 220 patients, 156 (71%) had DAI, 31 (14%) had ICH, 161 (73%) had contusions, and 70 (32%) had ischemia on MRI. Most patients (180, 82%) experienced episodes of ICP greater than 20 mm Hg. Contusion volume (p = 0.02) and number of regions with ischemia (p = 0.007) were associated with ICP burden, but we failed to identify such an association for DAI or ICH. Severe (but not mild or moderate) ICP burden was associated with presence of ischemia (odds ratio, 4.64 [95% CI, 1.30-19.5]; p = 0.02).</p><p><strong>Conclusions: </strong>Elevated ICP was prevalent in the ADAPT cohort. Ischemia and contusion were associated with the burden of ICP. Further research is needed to determine temporal relationships between elevated ICP and ischemia.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030269","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":"Neurocritical Care Entrustable Professional Activities for Pediatric Critical Care Medicine Education and Professional Development: Standardizing Curriculum, Training, and Assessment.","authors":"Andrew E Becker, Nicholas S Abend, Giulia M Benedetti, Sandra D W Buttram, Melissa G Chung, Jennifer C Erklauer, Stuart H Friess, Sue J Hong, Jimmy Huh, Matthew P Kirschen, Kerri L LaRovere, Marlina E Lovett, Michelle E Schober, Kristen A Smith, Katie Wolfe, Adrian D Zurca, Alexis A Topjian, Donald L Boyer","doi":"10.1097/PCC.0000000000003818","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003818","url":null,"abstract":"<p><strong>Objective: </strong>To develop a set of pediatric neurocritical care (PNCC) entrustable professional activities (EPAs) for pediatric critical care medicine (PCCM).</p><p><strong>Design: </strong>Survey and Delphi methodology in a panel of experts from the Pediatric Neurocritical Care Research Group (PNCRG) and the Education in Pediatric Intensive Care (EPIC) Research Collaborative.</p><p><strong>Setting: </strong>Interprofessional local focus group, national focus group, and subsequent national multi-institutional, multidisciplinary expert panel in the United States.</p><p><strong>Subjects: </strong>The interprofessional local group of 23 members carried out work March 2022 to June 2022 and the national group of 19 members October 2022 to November 2022. Subsequently, 38 physicians from the PNCRG and EPIC networks carried out work December 2022 to August 2024.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>First, a preliminary set of 15 PNCC EPAs was developed by two local and national interprofessional groups. The EPAs were based on the American Board of Pediatrics (ABP) practice analysis for PCCM, the ABP PCCM content outline, and stakeholder opinion. Next, a panel of critical care, neurology, and education experts used Delphi methodology to generate consensus, edit, and finalize the EPAs, with content validity. All EPAs were edited; two were deemed non-essential and not included in the final set of 13 EPAs. The EPAs fit three categories: general management and principles; disease-specific management; and neuroprognostication and end-of-life care. Consensus was reached after three Delphi rounds, with response rates of 31 of 38, 29 of 31, and 29 of 31, respectively. The final set of EPAs was approved by 30 respondents (response rate 30/31), with content validity indices 0.81-1.00.</p><p><strong>Conclusions: </strong>The 2024 set of 13 EPAs are intended to be a valuable framework for competency-based curriculum and assessment to ensure consistent PCCM proficiency in the provision of neurocritical care while also promoting standardization in curriculum development for PCCM fellowship trainees.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023872","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":"Urine Output Trajectories and Dialysis Independence in Critically Ill Children With Acute Kidney Injury: A Single-Center Retrospective Cohort Study, 2014-2023.","authors":"Yusuke Tokuda, Kentaro Ide, Junichiro Morota, Eisaku Nashiki, Kentaro Nishi, Mai Miyaji, Masanori Tani, Shotaro Matsumoto, Satoshi Nakagawa","doi":"10.1097/PCC.0000000000003826","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003826","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate whether the urine output trajectory is associated with dialysis independence in critically ill children with acute kidney injury (AKI).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>A PICU in Japan.</p><p><strong>Patients: </strong>Children younger than 16 years old who received continuous kidney replacement therapy (CKRT) for AKI between July 1, 2014, and June 30, 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We identified 61 eligible patients, including 16 patients who remained dialysis-dependent 30 days after CKRT initiation. Compared with dialysis-independent patients, dialysis dependence was associated with lower urine output on days 3, 7, 14, and 21 after CKRT initiation. Dialysis independence, when compared with dialysis dependence, was associated with higher median (interquartile range) urine output (mL/kg/hr) at each timepoint (day 3: 0.3 [0.1-1.6] vs. 0.0 [0-0.2]; p = 0.001; day 7: 1.3 [0.4-2.0] vs. 0.0 [0-0.1]; p < 0.001; day 14: 1.8 [1.0-3.5] vs. 0.0 [0-0; p < 0.001]; and day 21: 2.1 [1.1-3.0] vs. 0.0 [0-0]; p < 0.001). The area under the receiver operating characteristic curve (AUROC with 95% CI) for identifying dialysis independence at day 30 after CKRT initiation, based on urine output on day 14, was 0.96 (95% CI, 0.88-1.00). Using the DeLong test, this AUROC was higher than that on day 7 (0.88 [95% CI, 0.77-0.99]; p = 0.009). Also, on day 14, with a pre-test probability of dialysis independence of 71%, the post-test probability increases to 97% when using a test urine output greater than or equal to 0.41 mL/kg/hr. The sensitivity analysis with the exclusion of neonates yielded similar results.</p><p><strong>Conclusions: </strong>In this 2014-2023 cohort of critically ill children with AKI supported with CKRT, using a urine output greater than or equal to 0.41 mL/kg/hr on day 14, CKRT may be an effective diagnostic test of dialysis independence on day 30. Further validation studies are needed.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016086","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":"Severe Neonatal Respiratory Failure and Transfer for Higher Level Intensive Care: Early Factors Associated With Mortality and Other Outcomes in a Retrospective Cohort, 2018-2020.","authors":"Livia Procopiuc, Geoffrey E Burnhill, Nandiran Ratnavel, Thomas J Brick, Rebecca Smith, Aida Lopez de Pedro, Nadia Baasher, Jon Lillie","doi":"10.1097/PCC.0000000000003821","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003821","url":null,"abstract":"<p><strong>Objectives: </strong>To identify factors associated with death, requirement for extracorporeal membrane oxygenation (ECMO), or cardiac intervention in neonates referred for higher level neonatal ICU (NICU) due to respiratory failure.</p><p><strong>Design: </strong>Retrospective cohort study, 2018-2020.</p><p><strong>Setting: </strong>Referrals for transport to tertiary-level NICUs using the London Neonatal Transfer Service in the United Kingdom.</p><p><strong>Patients: </strong>Neonates with a diagnosis of severe respiratory failure who were intubated and receiving Fio2 greater than 60% at referral. We excluded neonates younger than 34 weeks corrected gestational age, less than 2 kg, or with a known cardiac diagnosis.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We identified 170 neonates with a median (interquartile range [IQR]) age of 4 hours (2-11 hr) at referral and 9 hours (IQR, 7-16 hr) at time of departure from the referring NICU. Overall, 21 of 170 babies required immediate transfer to a center providing ECMO, of whom two of 21 died and two of 21 received ECMO support. Of the 149 transferred to NICUs that do not provide ECMO, 11 of 149 died (7%) and a further 16 of 149 (11%) required secondary transfers to an ECMO center where one of 16 died and three of 16 required ECMO. In total, there were 23 of 170 neonates with outcome of death, need for ECMO, or cardiac intervention. A composite score of Vasoactive-Inotropic Score (VIS) greater than or equal to 18 and oxygenation index (OI) greater than 24 after patient stabilization was associated with death, a need for ECMO or a previously undiagnosed cardiac lesion, with a sensitivity of 83% and a specificity of 73%.</p><p><strong>Conclusions: </strong>This 2018-2020 cohort of neonates with severe respiratory failure managed in London, United Kingdom, shows that VIS greater than or equal to 18 and OI greater than 24 after stabilization were associated with death, need for ECMO, or cardiac intervention. These parameters may have the potential to trigger discussion with ECMO centers for early consideration of transfer but needs validation in a wider neonatal population.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Tale of Two Subphenotypes in Pediatric Sepsis-Associated Acute Kidney Injury.","authors":"James D Fortenberry","doi":"10.1097/PCC.0000000000003800","DOIUrl":"10.1097/PCC.0000000000003800","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1165-e1167"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789636","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":"Derivation and Validation of Pediatric Sepsis-Associated Acute Kidney Injury Subphenotypes With Prognostic Relevance.","authors":"Natalja L Stanski, Bin Zhang, Jiarong Ouyang, L Nelson Sanchez-Pinto, E Vincent S Faustino, Colin M Rogerson, Mark W Hall, Scott L Weiss, Tellen D Bennett, Stephen W Standage, Stuart L Goldstein, Kathleen D Liu","doi":"10.1097/PCC.0000000000003789","DOIUrl":"10.1097/PCC.0000000000003789","url":null,"abstract":"<p><strong>Objectives: </strong>Sepsis-associated acute kidney injury (SAKI) is a heterogeneous syndrome associated with poor outcomes. Subphenotypes of SAKI with prognostic and therapeutic relevance have been identified in adults, but not in children. We sought to identify reproducible and clinically relevant pediatric SAKI (pSAKI) subphenotypes using readily available clinical and laboratory data.</p><p><strong>Design: </strong>Secondary analysis of a retrospective observational study of pediatric sepsis.</p><p><strong>Setting: </strong>Thirteen PICUs in the United States from January 2012 to January 2018.</p><p><strong>Patients: </strong>Patients aged 0-18 years with septic shock (sepsis and requiring vasoactive medications) and day 1-2 SAKI (≥ Kidney Disease Improving Global Outcomes stage 1 by serum creatinine).</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Fourteen hundred fifty-five patients were included after inclusion and exclusion criteria were applied: 873 (60%) in the derivation cohort and 582 (40%) in the external validation cohort. A two-subphenotype latent class analysis model had the best fit in both cohorts: pSAKI subphenotype 1 (pSAKI-1) and pSAKI subphenotype 2 (pSAKI-2). pSAKI-2 was characterized by younger age, more organ support, greater fluid accumulation, and laboratory evidence of inflammation, acid-base derangement, thrombocytopenia, and coagulopathy. pSAKI-2 had uniformly worse outcomes, including higher rates of severe and persistent AKI at days 3-4 (54% vs. 23%, p < 0.001) and day 7 (31% vs. 12%, p < 0.001), increased use of continuous renal replacement therapy (21% vs. 6%, p < 0.001), and independently increased odds of mortality after adjustment for potential confounders (adjusted odds ratio 1.59; 95% CI, 1.04-2.41; p = 0.03). A parsimonious classification model accurately identified pSAKI-2 membership (C-statistic 0.94 [95% CI, 0.92-0.95] and 0.85 [95% CI, 0.82-0.88], respectively, in the derivation and internal validation cohorts).</p><p><strong>Conclusions: </strong>We identified two distinct early pSAKI subphenotypes using readily available data that exhibit differential risk for poor outcomes and can be identified from a parsimonious set of variables. Pending external validation, operationalization of pSAKI subphenotypes may allow for prognostic enrichment to guide clinical care and inform clinical trial enrollment.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1084-e1095"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12252218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601123","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":"Acute Bronchiolitis in Infants on Invasive Mechanical Ventilation: Physiology Study of Airway Closure.","authors":"Javier Varela, Nadine Aranis, Francisca Varas, Martina Vallejos, Alejandro Bruhn","doi":"10.1097/PCC.0000000000003790","DOIUrl":"10.1097/PCC.0000000000003790","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to explore whether airway closure can be detected in patients with severe acute bronchiolitis on invasive mechanical ventilation.</p><p><strong>Design: </strong>Single-center prospective physiologic study carried out in 2023-2024.</p><p><strong>Setting: </strong>PICU in a tertiary-care general hospital.</p><p><strong>Patients: </strong>Infants with acute bronchiolitis undergoing invasive mechanical ventilation.</p><p><strong>Interventions: </strong>Under deep sedation and neuromuscular blockade, the mechanical ventilator, in a volume-controlled mode, was transiently set with a respiratory rate of five breaths/min, a tidal volume of 6 mL/kg of ideal body weight, positive end-expiratory pressure 0 cm H 2 O, a flow rate of 2 L/min, an inspiratory-expiratory ratio of 1:1, and a F io2 of 1.0. After recording three breath cycles, the patient was returned to baseline ventilatory settings.</p><p><strong>Measurements and main results: </strong>We identified the presence of airway closure through the low-flow pressure-volume curve obtained from a pneumotachometer with a flow sensor placed at the Y-piece and simultaneously from the pressure-impedance curve and ventilation maps acquired using electrical impedance tomography. We included 12 patients, and airway closure was detected in seven of them. The median (interquartile range [IQR]) airway opening pressure was 14 cm H 2 O (IQR, 11-17 cm H 2 O). Patients with airway closure exhibited high levels of driving pressure, with a median of 16 cm H 2 O (IQR, 11-17 cm H 2 O), and low levels of respiratory system compliance, with a median of 0.41 mL/cm H 2 O/kg (IQR, 0.38-0.59 mL/cm H 2 O/kg). When these parameters were corrected for airway opening pressure, there was a significant decrease in driving pressure to 9 cm H 2 O (IQR, 8-12 cm H 2 O; p = 0.018) and a significant increase in respiratory system compliance to 0.70 mL/cm H 2 O/kg (IQR, 0.53-0.81 mL/cm H 2 O/kg; p = 0.018).</p><p><strong>Conclusions: </strong>Airway closure requiring high opening pressures can be detected in ventilated infants with acute bronchiolitis, and this phenomenon may impact respiratory mechanics.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1096-e1104"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144541817","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":"Gone Today.","authors":"Zhaohui Su","doi":"10.1097/PCC.0000000000003783","DOIUrl":"10.1097/PCC.0000000000003783","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1187-e1188"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144485476","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 Inconceivable Complexity of Lung Mechanics in Critical Bronchiolitis.","authors":"Alexandre T Rotta, Tobias L Straube","doi":"10.1097/PCC.0000000000003797","DOIUrl":"10.1097/PCC.0000000000003797","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1168-e1171"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643064","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":"Clinical and Risk Analytics Associations With Extubation Failure in Children Following Congenital Cardiac Surgery: A Multicenter Retrospective Cohort Study, 2017-2020.","authors":"Daniel L Hames, Qalab Abbas, Ahmed Asfari, Santiago Borasino, J Wesley Diddle, Yuanyuan Fu, Avihu Z Gazit, Stuart Lipsitz, Amanda M Marshall, Katherine Reise, Luciana Rodriguez Guerineau, Joshua S Wolovits, Joshua W Salvin","doi":"10.1097/PCC.0000000000003793","DOIUrl":"10.1097/PCC.0000000000003793","url":null,"abstract":"<p><strong>Objectives: </strong>The use of risk analytics indices alongside clinical factors has potential to assist clinicians in identifying children at high risk for extubation failure (EF). We investigated the association of two physiologic risk analytics indices with EF in children receiving mechanical ventilation (MV) after cardiac surgery: the probability of inadequate oxygen delivery (ID o2 ) and inadequate ventilation of carbon dioxide index (IV co2 ). A secondary aim was to evaluate clinical factors associated with EF.</p><p><strong>Design: </strong>Multicenter retrospective cohort study.</p><p><strong>Setting: </strong>Eight international pediatric cardiac ICUs.</p><p><strong>Patients: </strong>Children between 1 month and 12 years old receiving MV for greater than 48 hours following cardiac surgery between January 1, 2017, and December 31, 2020.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Nine hundred twenty-two children were analyzed with 79 (8.6%) having EF (defined as reintubation within 48 hr). In multivariable analysis of clinical variables, preoperative MV (adjusted odds ratio [aOR], 1.78; 95% CI, 1.08-2.96; p = 0.03), receiving inhaled nitric oxide (iNO) at extubation (aOR, 2.22; 95% CI, 1.13-4.35; p = 0.02), and duration of postoperative MV (aOR, 1.03; 95% CI, 1.00-1.06; p = 0.03) were independently associated with EF. Seven hundred ninety-two patients (86%) had pre-extubation ID o2 data, 602 (65%) had pre-extubation IV co2 data, and 600 (65%) had both pre-extubation ID o2 and IV co2 data available. In multivariable analysis including these risk analytics algorithms, patients with either ID o2 greater than or equal to 5 or IV co2 greater than or equal to 50 before extubation had higher odds of EF (aOR, 2.06; 95% CI, 1.08-3.94; p = 0.03).</p><p><strong>Conclusions: </strong>The addition of risk analytics algorithms evaluating the probability of inadequate systemic oxygen delivery or inadequate ventilation to clinical factors (duration of ventilation or iNO delivery at extubation) is useful in assessing the risk for EF in children recovering from cardiac surgery.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1105-e1114"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144743965","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}