Pediatric Critical Care Medicine最新文献

{"title":"Trust, Advocacy, Inequity, and Information: A Qualitative Study of PICU Communication Experiences Among Low-Income Families in the United States.","authors":"Emily Kemper, Michelle N Eakin, Jinnesse Taylor, Sapna R Kudchadkar","doi":"10.1097/PCC.0000000000004053","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004053","url":null,"abstract":"<p><strong>Objectives: </strong>Communication challenges and barriers are common during PICU stays, but prior studies have rarely focused on historically marginalized groups such as families with low socioeconomic status and families of color. We aimed to characterize these experiences.</p><p><strong>Design: </strong>Semi-structured interviews were conducted from October 2023 to April 2025. Interviews were audio-recorded, transcribed verbatim, analyzed, and coded using a constant comparative method.</p><p><strong>Setting: </strong>A PICU at a tertiary-care academic center in the United States.</p><p><strong>Participants: </strong>Seventeen families, including 13 mothers, 7 fathers, and 2 grandparents of children with income-based Medicaid insurance admitted to the PICU for at least 5 days.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Thirteen of 22 interviewees were Black, African American, or Multiracial, 7 were White, and 2 did not indicate race. Major themes included 1) healthcare team behaviors that build or lose family trust; 2) importance of parental advocacy and valuing parent perspective; 3) intersection of race and healthcare experience; and 4) diverse preferences for obtaining information. Families' trust in their healthcare team was influenced by both medical and socioemotional behaviors. Parents desired recognition as experts in their child and trusted the team more when their perspective was included. For some families, experiences with discrimination impacted their trust levels and care experiences. Finally, families obtained information from PICU structures such as rounds but also sought a variety of other sources.</p><p><strong>Conclusions: </strong>This interview study characterized PICU communication experiences among low-income families with diverse representation. Our findings identified how communication behaviors can build and erode family trust in the healthcare team. We also elicited preferences for obtaining information, which could inform interventions to improve information sharing. Future research on how to develop and assess interventions that improve family trust and satisfaction in inpatient care is needed.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945477","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":"When the Kidney Is Not the Problem: Continuous Renal Replacement Therapy for Metabolic Detoxification.","authors":"Akash Deep","doi":"10.1097/PCC.0000000000004048","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004048","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945510","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":"Survival in Extracorporeal Cardiopulmonary Resuscitation for Pediatric In-Hospital Cardiac Arrest: Nationwide Cohort Study in Japan, 2011-2022.","authors":"Takanari Ikeyama, Yuko Shiima, Hiroshi Kurosawa, Yuichiro Matsuo, Hiroyuki Ohbe, Hiroki Matsui, Hideo Yasunaga","doi":"10.1097/PCC.0000000000004057","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004057","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the rate, characteristics, and outcomes of pediatric extracorporeal cardiopulmonary resuscitation (ECPR) for in-hospital cardiac arrest (IHCA) in Japan and evaluate temporal trends.</p><p><strong>Design: </strong>Retrospective cohort using the Japanese Diagnosis Procedure Combination database from April 2011 to March 2022.</p><p><strong>Setting: </strong>Nationwide dataset with approximately 50% of all acute care hospitalizations in Japan.</p><p><strong>Patients: </strong>Children of less than 18 years who received ECPR for IHCA.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The primary outcomes were temporal trends in ECPR utilization and survival to hospital discharge. Among the 8209 pediatric patients with IHCA, 312 received ECPR: the median (interquartile range [IQR]) age was 2 years (IQR, 0-13 yr); and 52% were male. Annual need for ECPR was 3.6 (IQR, 2.9-4.8) cases per 100 IHCA events, with a significant upward trend 2011-2022 (p = 0.0001). Annual need for ECPR was 0.038 (IQR, 0.031-0.046) per 1000 pediatric hospital admissions, and we failed to identify an associated upward trend over time (p = 0.056). Survival to hospital discharge increased from 17.6% in 2011 to 37.5% in 2022, with a significant upward trend over time in the unadjusted analysis (p = 0.036); however, the adjusted temporal analysis failed to show an associated upward trend over time. Survival varied by age and illness category. Secondary analyses showed that cardiac diagnoses, as opposed to noncardiac diagnoses, were associated with higher overall survival: 105 of 213 (49.3%) vs. 24 of 89 (27%); percentage difference, 22.3% (95% CI, 11.3-33.4%); p = 0.0002.</p><p><strong>Conclusions: </strong>In our national dataset from Japan 2011-2022, we have found that pediatric ECPR for IHCA was used infrequently. Survival to hospital discharge showed a temporal increase over time. These trends may reflect changes in patient volume, guideline implementation, or more refined patient selection for ECPR, as well as resuscitation processes and better systems of clinical practice.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945530","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":"Continuous Renal Replacement Therapy for Acute Decompensation in Inborn Errors of Metabolism: Single-Center, Pediatric Cohort, 2014-2025.","authors":"Merve Setenay Akyüzlüer Güneş, Engin Köse, Eda Eyduran, Doğan Kaymaz, Leyla Kaya, Merve Havan, Emel Okulu, Tanil Kendirli, Fatma Tuba Eminoğlu","doi":"10.1097/PCC.0000000000004043","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004043","url":null,"abstract":"<p><strong>Objectives: </strong>To review our use and outcomes of continuous renal replacement therapy (CRRT) for acute metabolic decompensation (hyperammonemia or hyperleucinemia) in infants and children with inborn errors of metabolism (i.e., M), and to identify factors associated with complications and mortality.</p><p><strong>Design: </strong>Retrospective cohort identified using local clinical databases.</p><p><strong>Setting: </strong>Single-center PICU and neonatal ICU in a tertiary pediatric center in Türkiye.</p><p><strong>Patients: </strong>Thirty-eight children (with 49 CRRT sessions) for urea cycle disorders, organic acidemias, or maple syrup urine disease undergoing treatment between August 2014 and June 2025.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The median (interquartile range, IQR) age at CRRT initiation was 1.4 months (IQR 0.16-33.90); CRRT resulted in substantial metabolite reduction (mean change 87.6% for ammonia and 74.8% for leucine). Younger age was associated with more hemodynamic and metabolic complications. Overall mortality was 11 of 38 (28.9% [95% CI, 17-44.8%]). In the 11 episodes of CRRT that ended in death vs. 38 CRRT episodes with survival to discharge, there was a greater proportion with hypophosphatemia: 6 of 11 vs. 8 of 38, percentage difference 33.4% (95% CI, 2.8-59.6%), p value of equals to 0.03. Last, we failed to identify an association between episodes of CRRT by technique (continuous venovenous hemodiafiltration [CVVHDF] vs. dialysis) and mortality: 6 of 21 vs. 5 of 28, mean difference 10.7% (95% CI, -12.4 to 34.3%), p value of equal to 0.38.</p><p><strong>Conclusions: </strong>In our single-center 11-year experience of using CRRT for metabolic detoxification in critically ill young infants with inborn errors of metabolism, we have found that substantial reductions in ammonia and leucine can be achieved in severe biochemical derangement, irrespective of whether continuous venovenous hemodialysis or CVVHDF was used. Taken together, for us, these findings reinforce our continued practice of timely CRRT as a critical component of acute metabolic crisis management.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945466","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 Second Apnea Test.","authors":"Weerapong Lilitwat","doi":"10.1097/PCC.0000000000004050","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004050","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945522","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":"Extracorporeal Membrane Oxygenation Duration as a Predictor of Outcome.","authors":"Graeme MacLaren","doi":"10.1097/PCC.0000000000004047","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004047","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900934","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":"Pediatric Respiratory Failure and Support With Prolonged Extracorporeal Membrane Oxygenation: Multicenter Cohort Using the Extracorporeal Life Support Organization Registry, 1989-2021.","authors":"Oshri Zaulan, Dylan C Ginter, Brigitte Mueller, Mariella Vargas-Gutierrez, Peter T Rycus, Ryan P Barbaro, Gail M Annich","doi":"10.1097/PCC.0000000000004035","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004035","url":null,"abstract":"<p><strong>Objectives: </strong>To characterize outcomes in children supported with 14 days or more of extracorporeal membrane oxygenation (ECMO) for respiratory indications.</p><p><strong>Design: </strong>Retrospective analysis of the Extracorporeal Life Support Organization (ELSO) registry.</p><p><strong>Setting: </strong>ECMO centers contributing to the ELSO registry from 1989 to 2021.</p><p><strong>Patients: </strong>Children of 1-18 years supported with ECMO for respiratory failure for 14 days or more.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>There were 7334 children supported with ECMO for respiratory failure, and 1863 (25%) needed 14 days or more. Median patient age was 6.8 years, weight 23 kg, and overall survival was 50%. The median (interquartile range [IQR]) duration of ECMO was 22.5 days (IQR, 17.3-32.8 d). Survival was associated with shorter ECMO runs (21 vs. 24 d; p < 0.001), and shorter time from intubation to ECMO initiation (78 vs. 102 hr; p = 0.009). By duration, survival was: 54% for 14-28 days; 40% for 29-56 days; and 43% for less than 8-56 days. By duration of ECMO support, there was a nonlinear association between time and mortality, with an increase in risk of death up to 60 days, and a plateau thereafter (p < 0.001). Multivariable regression showed a greater risk of death with primary diagnoses of neoplasms and hematologic diseases, pre-ECMO renal support, higher oxygenation index, and presence of multiple complications. Also, year of ECMO support was associated with hospital mortality.</p><p><strong>Conclusions: </strong>In children of 1-18 years with prolonged ECMO runs for respiratory indications, there was an associated decline in survival with increasing duration of ECMO up to 60 days, and thereafter mortality rate plateaued. Accruing multiple complications on ECMO is also associated with increased odds of mortality. We suggest that a new definition of prolonged ECMO be 28 days, based on survival trends in this 1989-2021 ELSO dataset, and future prospective studies should capture more clinical data throughout their ECMO course to better determine patient prognosis.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900912","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":"Tracheostomy Placement and Clinical Outcomes for Children Unable to Liberate From Mechanical Ventilation in the PICU.","authors":"Colin M Rogerson, Jeremy M Loberger, Samer Abu-Sultaneh","doi":"10.1097/PCC.0000000000004034","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004034","url":null,"abstract":"<p><strong>Objectives: </strong>Ventilator liberation is a priority for physicians in the PICU. Need for reintubation is associated with worse clinical outcomes and may culminate in tracheostomy tube placement for long-term invasive mechanical ventilation (IMV). We hypothesized that increasing number of extubation attempts were associated with increased likelihood of new tracheostomy tube placement, increased noninvasive respiratory support (NRS) use, and increased time between extubation and reintubation for children receiving IMV in the PICU.</p><p><strong>Design: </strong>Retrospective cohort study. We measured the frequency of new tracheostomy tube placement, number of reintubations, and use of NRS before reintubation. We also derived a mixed-effects logistic regression model to identify factors significantly associated with new tracheostomy tube placement.</p><p><strong>Setting: </strong>Virtual Pediatric Systems Database.</p><p><strong>Patients: </strong>All encounters younger than 19 years old, endotracheally intubated for greater than or equal to 24 hours, and required reintubation within 7 days of a planned extubation attempt in the PICU between January 1, 2013, and December 31, 2022.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We identified 14,085 encounters that met inclusion criteria, and 1,255 (8.9%) received a new tracheostomy tube. Increasing number of extubation attempts were significantly associated with increased odds of receiving a new tracheostomy tube (odds ratio, 1.42 [1.32-1.52]; p < 0.01). Mortality increased linearly with each unsuccessful extubation attempt from 8.1% with one attempt to 20.9% with five or more attempts. NRS use before reintubation increased from 45.6% after the first extubation attempt to a peak of 59.2% after the second extubation attempt. The time between extubation to reintubation increased from 0.8 days after the first extubation attempt to 3.5 days after the fourth extubation attempt. Younger age and renal and cardiac diagnoses were associated with lower odds of new tracheostomy tube placement. Respiratory, neurologic, oncologic, and traumatic diagnoses, as well as a longer total duration of IMV were associated with increased odds of new tracheostomy tube placement. Among encounters with two or more extubation attempts, tracheostomy placement was associated with longer IMV duration, longer length of stay, and lower mortality.</p><p><strong>Conclusions: </strong>We found that increasing numbers of extubation attempts was associated with new tracheostomy tube placement, increased NRS use before reintubation, and increased time between extubation and reintubation in children in the PICU.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900945","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 Nutrition Intolerance and Delivery Adequacy in Pediatric Critical Care: Development of a Score Using a 2018 Multinational Cohort Study Dataset.","authors":"Enid E Martinez, Alireza Akhondi-Asl, Dennis W Simon, Michael J Morowitz, Nilesh M Mehta","doi":"10.1097/PCC.0000000000004021","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004021","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the explanatory factors of enteral nutrition (EN) intolerance and EN delivery.</p><p><strong>Design: </strong>Secondary analysis of a 2018 multinational cohort study dataset.</p><p><strong>Setting: </strong>A total of 77 PICUs with eight or more beds from 17 countries.</p><p><strong>Patients: </strong>Children from 1 month to 18 years old requiring mechanical ventilation within 48 hours of PICU admission, with a PICU length of stay of 3 or more days.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We reviewed demographic, clinical, and nutrition data (e.g., EN adequacy), and gastrointestinal (GI) symptoms (i.e., abdominal distension, vomiting/emesis, high gastric residual volume (GRV), diarrhea, and subjective abdominal discomfort) during the first 10 days of PICU admission. Our primary outcome was time to reach 60% EN adequacy. Explanatory variables included clinical factors and GI symptoms. We performed an extended Cox multivariable regression analysis with frailty adjusted for confounders and developed an EN tolerance score. Of the 1844 patients in the dataset, 1838 patients received EN. Mean (sd) age was 4.36 years (5.21 y), and 55.4% were male. Abdominal distension, vomiting/emesis and high GRV were associated with a lower hazard (adjusted hazard ratio [aHR] with 95% CI) of achieving 60% EN goal: abdominal distension-aHR, 0.11 (95% CI, 0.03-0.45); p = 0.002; vomiting/emesis-aHR, 0.49 (95% CI, 0.27-0.90); p = 0.021; high GRV-aHR, 0.30 (95% CI, 0.15-0.59); p < 0.0001). The EN tolerance score components included age, opioid, vasopressor, and paralytic exposure, abdominal distention, vomiting/emesis, high GRV, continuous days of EN, and GI bleeding; for every 10 points on the score, the hazard of not achieving 60% EN adequacy doubled.</p><p><strong>Conclusions: </strong>In this 2018 dataset, GI symptoms, individually or as a composite, are associated with EN tolerance and adequacy. These symptoms, in conjunction with clinical factors, were used to develop a risk score that serves as a measure of EN tolerance.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900958","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":"Tracheostomy Placement in PICU Patients-What Is New, and What Should We Do?","authors":"Michael C McCrory, Kaitlyn Chatt McFarlane","doi":"10.1097/PCC.0000000000004039","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004039","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900967","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}