Pediatric Critical Care Medicine最新文献

{"title":"Kidney Outcomes in Children Receiving Extracorporeal Membrane Oxygenation: A Single-Center Acute Cohort From 2009 to 2019, Followed to 2021.","authors":"Amy E Strong, Spandana Makeneni, Diego Campos, Rosanna Fulchiero, Todd J Kilbaugh, James Connelly, Benjamin L Laskin, Jarcy Zee, Michelle R Denburg","doi":"10.1097/PCC.0000000000003650","DOIUrl":"10.1097/PCC.0000000000003650","url":null,"abstract":"<p><strong>Objectives: </strong>Long-term kidney outcomes after extracorporeal membrane oxygenation (ECMO) are little quantified and understood. We aimed to describe the frequency of kidney dysfunction screening during follow-up and the prevalence of long-term kidney disease.</p><p><strong>Design: </strong>Retrospective cohort of pediatric ECMO patients with estimated glomerular filtration rate (eGFR) (mL/min/1.73 m 2 ) using all post-discharge serum creatinine values to define three kidney outcomes: 1) acute kidney injury (AKI), with eGFR of less than 60 mL/min/1.73 m 2 , which subsequently improved to normal (≥ 90 mL/min/1.73 m 2 ); 2) abnormal eGFR of less than 90 mL/min/1.73 m 2 at last follow-up; and 3) chronic kidney disease (CKD) with eGFR of less than 90 mL/min/1.73 m 2 on at least two occasions separated by greater than or equal to 90 days, without an intervening or subsequently normal eGFR.</p><p><strong>Setting: </strong>Single-center tertiary care children's hospital system.</p><p><strong>Patients: </strong>All pediatric patients surviving ECMO from 2009 to 2019.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>In the 10-year cohort of 666 patients, 399 (60%) survived at least 3 months post-discharge. Of these, 382 of 399 (96%) were followed at our institution for a median of 5 years (interquartile range, 3-8 yr). Two hundred sixty-four of 382 (69%) had at least one creatinine value post-discharge, and 209 of 382 (55%) had at least two values three months apart. Of the 264 with at least one creatinine value, 61 (23%) had an abnormal eGFR; of the 209 with at least two values greater than or equal to 90 days apart, 18 (9%) met criteria for CKD. Of those with CKD, 12 of 18 had AKI during ECMO, and seven of 18 had AKI events post-discharge (range, 1-6 episodes).</p><p><strong>Conclusions: </strong>This 2009-2019 pediatric ECMO cohort of survivors, followed for a median of 5 years, shows the subsequent high burden of kidney disease. We found that monitoring and following kidney function was not complete in this population, which is a concern since the rate of later AKI events and CKD is significant. Further study is needed to mitigate this post-ECMO vulnerability.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e287-e293"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11885026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807592","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":"Patterns of Use of β-2 Agonists, Steroids, and Mucoactive Medications to Treat Bronchiolitis in the PICU: U.S. Pediatric Health Information System 2009-2022 Database Study.","authors":"Brian F Flaherty, Cody S Olsen, Eric R Coon, Rajendu Srivastava, Lawrence J Cook, Heather T Keenan","doi":"10.1097/PCC.0000000000003670","DOIUrl":"10.1097/PCC.0000000000003670","url":null,"abstract":"<p><strong>Objectives: </strong>Describe β2-agonists, steroids, hypertonic saline (HTS), n-acetylcysteine (NAC), and dornase alfa (DA) use to treat bronchiolitis, factors associated with use, and associations between use and PICU length of stay (LOS).</p><p><strong>Design: </strong>Retrospective, multicenter cohort study.</p><p><strong>Setting: </strong>PICUs in the Pediatric Health Information System database.</p><p><strong>Patients: </strong>PICU admitted children 24 months young or younger with bronchiolitis.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We analyzed 47,520 hospitalizations between July 1, 2018, and June 30, 2022. We calculated the rate of medication use overall and the median (range) rate for each hospital: β2-agonist (24,984/47,520 [52.6%]; median hospital, 51.7% [21.4-81.7%]), steroid (15,878/47,520 [33.4%]; median hospital, 33.4% [6.0-54.8%]), HTS (7,041/47,520 [14.8%]; median hospital, 10.5% [0-66.1%]), NAC (1,571/47,520 [3.3%]; median hospital, 0.8% [0-22.0%], and DA (840/47,520 [1.8%]; median hospital, 1.4% [0-13.6%]). Logistic regression using generalized estimating equations (GEEs) identified associations between concurrent asthma and β2-agonist (adjusted odds ratio [aOR], 8.68; 95% CI, 7.08-10.65; p < 0.001) and steroid (aOR, 10.10; 95% CI, 8.84-11.53; p < 0.001) use. Mechanical ventilation was associated with all medications: β2-agonists (aOR, 1.79; 95% CI, 1.57-2.04; p < 0.001), steroids (aOR, 2.33; 95% CI, 1.69-3.21; p < 0.001), HTS (aOR, 1.82; 95% CI, 1.47-2.25; p < 0.001), NAC (aOR, 3.29; 95% CI, 2.15-5.03; p < 0.001), and DA (aOR, 7.65; 95% CI, 4.30-13.61; p < 0.001). No medication was associated with decreased PICU LOS. To assess changes in medication use over time and associations with the 2014 American Academy of Pediatrics bronchiolitis guidelines, we expanded our analysis to 83,820 hospitalizations between July 1, 2009, and June 30, 2022. Logistic regression with GEEs found no change in β2-agonist use; steroid use increased after guideline publication (aOR, 1.05; 95% CI, 1.01-1.10; p = 0.02), HTS use changed from increasing prior to the guidelines (aOR, 1.32; 95% CI, 1.11-1.56; p = 0.001) to stable since guideline publication (aOR, 0.93; 95% CI, 0.81-1.07; p = 0.33).</p><p><strong>Conclusions: </strong>β2-agonists, steroids, and HTS are commonly, but variably used for PICU bronchiolitis treatment. Medication use appears relatively stable over the last decade.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 3","pages":"e294-e303"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573372","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 Kidney Injury, Extracorporeal Membrane Oxygenation, and the Need for Renal Follow-Up.","authors":"Zaccaria Ricci, David Selewski","doi":"10.1097/PCC.0000000000003684","DOIUrl":"10.1097/PCC.0000000000003684","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e386-e388"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952800","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":"Transpulmonary Pressure-Guided Mechanical Ventilation in Severe Acute Respiratory Distress Syndrome in the PICU: Single-Center Retrospective Study in North India, 2018-2021.","authors":"Anil Sachdev, Anil Kumar, Bharat Mehra, Neeraj Gupta, Dhiren Gupta, Suresh Gupta, Parul Chugh","doi":"10.1097/PCC.0000000000003609","DOIUrl":"10.1097/PCC.0000000000003609","url":null,"abstract":"<p><strong>Objectives: </strong>In this study, we have reviewed the association between esophageal pressure-guided positive end-expiratory pressure (PEEP) setting and oxygenation and lung mechanics with a conventional mechanical ventilation (MV) strategy in patient with moderate to severe pediatric acute respiratory distress syndrome (PARDS).</p><p><strong>Design: </strong>Retrospective cohort, 2018-2021.</p><p><strong>Setting: </strong>Tertiary PICU.</p><p><strong>Patients: </strong>Moderate to severe PARDS patients who required MV with PEEP of greater than or equal to 8 cm H 2 O.</p><p><strong>Interventions: </strong>Esophageal pressure (i.e., transpulmonary pressure [P TP ]) guided MV vs. not.</p><p><strong>Measurements and main results: </strong>We identified 26 PARDS cases who were divided into those who had been managed with P TP -guided MV (P TP group) and those managed with conventional ventilation strategy (non-P TP ). Oxygenation and lung mechanics were compared between groups at baseline (0 hr) and 24, 48, and 72 hours of MV. There were 13 patients in each group in the first 24 hours. At 48 and 72 hours, there were 11 in P TP group and 12 in non-P TP group. On comparing these groups, first, use of P TP monitoring was associated with higher median (interquartile range) mean airway pressure at 24 hours (18 hr [18-20 hr] vs. 15 hr [13-18 hr]; p = 0.01) and 48 hours (19 hr [17-19 hr] vs. 15 hr [13-17 hr]; p = 0.01). Second, use of P TP was associated with higher PEEP at 24, 48, and 72 hours (all p < 0.05). Third, use of P TP was associated with lower F io2 and greater Pa o2 to F io2 ratio at 72 hours. Last, there were 18 of 26 survivors, and we failed to identify an association between use of P TP monitoring and survival.</p><p><strong>Conclusions: </strong>In this cohort of moderate to severe PARDS cases undergoing MV with PEEP greater than or equal to 8 cm H 2 O, we have identified some favorable associations of oxygenation status when P TP -guided MV was used vs. not. Larger studies are required.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e354-e363"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292812","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":"Extubation Failure in the PICU: A Virtual Pediatric Systems Database Study, 2017-2021.","authors":"Francis Y Kim, Gerardo Soto-Campos, Jamie Palumbo, Christopher J L Newth, Tom B Rice","doi":"10.1097/PCC.0000000000003654","DOIUrl":"10.1097/PCC.0000000000003654","url":null,"abstract":"<p><strong>Objectives: </strong>Extubation failure (EF) in PICU patients is reintubation within 48, 72, or 96 hours of planned extubation (EF48, EF72, and EF96, respectively). Standardized sedation protocols, extubation readiness testing, and noninvasive respiratory support are used to improve efficient liberation from mechanical ventilation (MV). We therefore aimed to review EF rates, time to failure, and the use of noninvasive respiratory support after extubation, 2017-2021.</p><p><strong>Design: </strong>Retrospective analysis of patients admitted to PICUs contributing to the Virtual Pediatric Systems (VPS, LLC) database, 2017-2021.</p><p><strong>Setting: </strong>One hundred thirty-six participating PICUs.</p><p><strong>Patients: </strong>All patients admitted to participating PICUs between January 1, 2017, and December 31, 2021, who had MV and met inclusion criteria for planned extubation.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>There were 111,229 planned extubations with 5,143 reintubations within 48 hours. The EF48, EF72, and EF96 rates were 4.6%, 5.3%, and 5.8%, respectively. Higher rates of EF were associated with age younger than 6 months, underlying genetic conditions, medical comorbidities, or cardiac surgery. Failed extubation was also associated with higher Pediatric Risk of Mortality III scores, longer duration of MV, and longer PICU and hospital lengths of stay. From 2017 to 2021, there was an increase in the use of high-flow nasal cannula oxygen therapy after extubation from 16.6% to 20.2%.</p><p><strong>Conclusions: </strong>In the VPS 2017-2021 dataset, we have found that the overall EF rates (EF48-EF96) have improved over this 5-year period. We are not able to assess the clinical benefit of this change, but it is evident that over the same period, there has been a concomitant increase in the use of postextubation noninvasive respiratory support. Further work is needed to look at the interaction of these effects in contemporary PICU practice.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e364-e373"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681049","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":"Resuscitation in Paediatric Septic Shock Using Vitamin C and Hydrocortisone (RESPOND): The RESPOND Randomized Controlled Trial Protocol.","authors":"Sainath Raman, Kristen S Gibbons, Muralidharan Jayashree, A V Lalitha, Rinaldo Bellomo, Robin Blythe, David Buckley, Warwick Butt, Hwa Jin Cho, Michele Cree, Daniela C de Souza, Simon Erickson, Marino Festa, Subodh Ganu, Shane George, Ebor Jacob James, Kerry Johnson, Renate Le Marsney, Paula Lister, Trang M T Pham, Puneet Singh, Balasubramanian Venkatesh, Renee Wall, Debbie A Long, Luregn J Schlapbach","doi":"10.1097/PCC.0000000000003674","DOIUrl":"10.1097/PCC.0000000000003674","url":null,"abstract":"<p><strong>Objectives: </strong>Pediatric sepsis results in significant morbidity and mortality worldwide. There is an urgent need to investigate adjunctive therapies that can be administered early. We hypothesize that using vitamin C combined with hydrocortisone increases survival free of inotropes/vasopressors support until day 7 compared with standard care. Here we describe the Resuscitation in Paediatric Septic Shock using Vitamin C and Hydrocortisone (RESPOND) trial protocol, which aims to address this hypothesis.</p><p><strong>Design: </strong>Randomized, open label, controlled, parallel-group, three-arm trial with integrated economic evaluation.</p><p><strong>Setting: </strong>Nine Australia and New Zealand PICUs, with interest from additional international sites.</p><p><strong>Patients: </strong>Children between 7 days and younger than 18 years old who are treated for suspected or confirmed sepsis and receiving inotropes/vasopressors for greater than 1 hour.</p><p><strong>Interventions: </strong>IV vitamin C (100 mg/kg [maximum 5 g] every 6 hr) and hydrocortisone (1 mg/kg [maximum 50 mg] every 6 hr), or IV hydrocortisone alone (1 mg/kg [maximum 50 mg] every 6 hr) or standard care.</p><p><strong>Measurements and main results: </strong>Three hundred eighty-four children will be randomly assigned to receive the interventions, or standard care in a 1:1:1 ratio with stratification by steroid administration pre-randomization and hospital site. The primary outcome is time alive and free of inotropes/vasopressors, censored at 7 days. Secondary outcomes include 28-day mortality, survival free of organ support, PICU length of stay, quality of life, functional status and neurodevelopmental vulnerability at 6 months post-enrollment, and hospitalization-related costs. Statistical analysis will be based on an intention-to-treat principle. The study has ethical approval (HREC/20/QCHQ/69922, dated December 21, 2020), is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12621000247875), commenced recruitment on December 8, 2021, and is expected to finish recruitment by mid-2026.</p><p><strong>Conclusions: </strong>Dissemination of the results will occur through publication in peer-reviewed journals, presentations at international conferences, and additional consumer-informed pathways.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e374-e385"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896545","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":"Adolescents and Young Adults With Respiratory Failure in U.S. PICUs: A Pediatric Health Information System Database Study, 2011-2022.","authors":"Kevin S Gochenour, Melissa H Ross, Heidi R Flori, Joseph G Kohne","doi":"10.1097/PCC.0000000000003610","DOIUrl":"10.1097/PCC.0000000000003610","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the clinical characteristics, outcomes, and resource use of adolescents and young adults (AYAs) admitted to PICUs in the United States with respiratory failure.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>De-identified data from 48 U.S. children's hospitals contributing to the Pediatric Health Information System (PHIS) database.</p><p><strong>Patients: </strong>All patients older than 30 days old with respiratory failure, defined as encounters with clinical transaction codes for noninvasive or invasive mechanical ventilation, admitted to PHIS database PICUs from January 2011 to December 2022. Patients were categorized into five cohorts (< 15, 15-18, 19-21, 22-25, and > 25 yr old).</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>A total of 430,238 patients were identified. AYA (≥ 15 yr old) accounted for 15% (65,740) of all PICU admissions with respiratory failure. Forty-nine percent (32,232/65,740) of AYA older than 25 years had medical technology dependence compared with 39% in those younger than 15 years ( p < 0.001). Sixty-one percent of AYA older than 25 years had a cardiovascular comorbidity compared with 35% of those younger than 15 years ( p < 0.001). Forty percent of AYA older than 25 years had a neurologic comorbidity, and 27% a gastrointestinal comorbidity, compared with 27% and 31%, respectively, in those younger than 15 years (all p < 0.001). Compared with those younger than 15 years, AYA median hospital crude mortality rate was higher at 7.7% compared with 5.2%, as were median hospital charges per encounter at $163K (interquartile range [IQR], $77K-$350K) vs. $121K (IQR, $53K-$278K; all p < 0.001). Median ventilator days and hospital length of stay in survivors were similar for all age cohorts.</p><p><strong>Conclusions: </strong>AYA represent a substantial proportion of patients admitted to the PICU with respiratory failure. These individuals have unique comorbidities and are at risk for increased mortality and resource utilization compared with younger patients during hospitalization. Medical complexity and sequelae of pediatric illness may delay the transition of AYA to adult care, necessitating collaboration between adult and pediatric critical care physicians to increase research across the age spectrum and develop and implement appropriate evidence-based guidelines.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e344-e353"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11885052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292811","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":"Planning a Phased Guideline Implementation Strategy Across the Multicenter Ventilation Liberation for Kids (VentLib4Kids) Collaborative.","authors":"Jeremy M Loberger, Kristine R Hearld, Akira Nishisaki, Robinder G Khemani, Katherine M Steffen, Samer Abu-Sultaneh","doi":"10.1097/PCC.0000000000003673","DOIUrl":"10.1097/PCC.0000000000003673","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate contextual factors relevant to implementing pediatric ventilator liberation guidelines and to develop an implementation strategy for a multicenter collaborative.</p><p><strong>Design: </strong>Cross-sectional qualitative analysis of a 2023/2024 survey.</p><p><strong>Setting: </strong>International, multicenter Ventilation Liberation for Kids (VentLib4Kids) collaborative.</p><p><strong>Subjects: </strong>Physicians, advanced practice providers, respiratory therapists, and nurses.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The survey was distributed to 26 PICUs representing 18 unique centers (17 in North American)-14 general medical/surgical, eight cardiac, and four mixed (1935 solicitations). All 409 responses were analyzed (prescribers 39.8%, nursing 32.8%, and respiratory therapists 27.4%). Three implementation tiers were identified based on perceptions of evidence, feasibility, positive impact, and favorability constructs. Tier A (≥ 80% agreement for all constructs) included extubation readiness testing (ERT) screening, ERT bundle, spontaneous breathing trials (SBTs), upper airway obstruction (UAO) risk mitigation, and risk stratified noninvasive respiratory support (NRS). Tier B (50-79% agreement) included standard risk SBT method, risk stratified SBT duration, and UAO risk assessment. Tier C (< 50% agreement) included high-risk SBT method, respiratory muscle strength testing, and infant NRS. The smallest perceived practice gaps were noted in tier A and the largest in tier C. The smallest practice gap was risk stratified NRS (88% agreement). The largest practice gap was respiratory muscle strength (18% agreement). In regression analysis, independently significant differences in perceptions based on role and unit type for multiple constructs were identified for UAO risk assessment, UAO risk mitigation, risk stratified NRS, and infant NRS.</p><p><strong>Conclusions: </strong>This survey study of the VentLib4Kids collaborative lays the foundation for phased implementation of the 2023 pediatric ventilator liberation guidelines. Early phases should focus on the best implementation profiles and smallest practice gaps. Later phases should address those that are more challenging. Unit- and role-based tailoring of differences should be considered for some recommendations more than others.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e396-e407"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854083","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":"Clearing the Air: Data-Driven Insights Into Critical Bronchiolitis Pharmacotherapy.","authors":"Alexandre T Rotta, Andrew G Miller","doi":"10.1097/PCC.0000000000003691","DOIUrl":"10.1097/PCC.0000000000003691","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e389-e392"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979455","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":"Physical Activity Monitoring in Children in the 1-Year After 3 or More Days of Invasive Ventilation: Feasibility of Using Accelerometers.","authors":"Aline B Maddux, Kristen R Miller, Yamila L Sierra, Tellen D Bennett, R Scott Watson, Matthew Spear, Laura L Pyle, Peter M Mourani","doi":"10.1097/PCC.0000000000003657","DOIUrl":"10.1097/PCC.0000000000003657","url":null,"abstract":"<p><strong>Objectives: </strong>To measure physical activity in a cohort of children who survived greater than or equal to 3 days of invasive ventilation.</p><p><strong>Design: </strong>Prospective cohort study (2018-2021).</p><p><strong>Setting: </strong>Quaternary children's hospital PICU.</p><p><strong>Patients: </strong>Children (2-17 yr old) without a preexisting tracheostomy who were ambulatory pre-illness and received greater than or equal to 3 days of invasive ventilation.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We measured duration and intensity of physical activity using hip- (< 6 yr old) or wrist- (≥ 6 yr old) worn ActiGraph GT3XP-BTLE accelerometers (ActiGraph, Pensacola, FL) for 7 days at three timepoints: hospital discharge, 3 months, and 12 months post-discharge. We measured duration of moderate or vigorous physical activity (MVPA) and nonsedentary activity, both characterized as percent of total awake wear time and total minutes per day. We categorized participants based on when they first attained a \"high activity\" day defined as greater than or equal to 60 minutes of MVPA or a day with percent of MVPA in the top quartile of all days measured. We evaluated 55 children of whom 43 (78%) had data from greater than or equal to 1 timepoint including 19 (35%) with data from all timepoints. Maximum daily MVPA increased across the three post-discharge timepoints (median, 16.0 min [interquartile range (IQR), 8.0-42.8 min], 48.3 min [27.8-94.3 min], and 68.4 min [34.7-111.0 min], respectively) as did maximum daily percent of awake wear time in MVPA (median, 4.3% [IQR, 2.8-9.0%], 10.1% [5.7-14.4%], and 11.1% [7.1-17.5%], respectively). Of the 43 participants, 27 achieved a high activity day: nine of 43 during the hospital discharge period, 14 of 43 during the 3 months post-discharge period, and four of 43 during the 12 months post-discharge period; 16 of 43 did not demonstrate high activity during the post-discharge year.</p><p><strong>Conclusions: </strong>In the 1-year after PICU discharge measuring physical activity with accelerometers in children 2-17 years old is feasible. Furthermore, demonstration of variable recovery trajectories in our pilot cohort suggests it has potential to be an outcome measure in clinical trials.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 3","pages":"e324-e333"},"PeriodicalIF":4.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573594","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}