Pediatric Critical Care Medicine最新文献

{"title":"Evolution of Mechanical Ventilation Practices in Neonatal Cardiac Patients: Single-Center Retrospective Analysis of Three 1-Year Epochs During 2000-2020.","authors":"Luciana Rodriguez Guerineau, Mika Nonoyama, Veronique Masy, Bruno L Ferreyro, Alejandro Floh, Laurent Brochard","doi":"10.1097/PCC.0000000000003799","DOIUrl":"10.1097/PCC.0000000000003799","url":null,"abstract":"<p><strong>Objectives: </strong>We sought to better understand how mechanical ventilation (MV) practices have evolved in neonates after cardiac surgery and evaluate whether such changes were associated with outcomes.</p><p><strong>Design: </strong>Single-center, retrospective study of three different 1 year-long periods: 2001, 2011, and 2020.</p><p><strong>Setting: </strong>Quaternary institution with a dedicated cardiac PICU in Toronto, ON, Canada.</p><p><strong>Patients: </strong>Neonates (≤ 28 d) receiving MV after cardiac surgery.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Settings, modes, duration of MV, noninvasive ventilation (NIV), PICU, and hospital stay were compared across epochs. A competing risk analysis was performed to determine whether changes in MV delivery were associated with MV liberation. The study included 291 patients with 101 (35%), 96 (33%), and 94 (32%) in 2001, 2011, and 2020, respectively. We did not identify differences in baseline characteristics, diagnosis, and severity category across our epochs. We found the following practice changes by epoch. First, a decrease in tidal volume (V t ) from (mean ± sd ) 12.1 ± 3.1 in 2001 to 6-7 mL/kg in 2011 and 2020 ( p < 0.001). This practice was associated with chronological reduction in driving pressure (DP): 15.4 ± 2.5, 14.3 ± 2.2, and 13.0 ± 2.6 cm H 2 O ( p < 0.001). Second, postextubation NIV was used more frequently in 2020. Third, faster weaning was introduced by 2020 and an increase in ventilator-free days, including NIV days, was observed ( p < 0.001). Fourth, after adjusting for demographic characteristics, epoch, severity, MV pre-surgery, higher V t , and DP were associated with lower prevalence of MV liberation, with respective hazard ratios (HRs) 0.818 (95% CI, 0.699-0.957); p = 0.012 and HR 0.865 (95% CI, 0.825-0.907); p < 0.001.</p><p><strong>Conclusions: </strong>In neonates requiring MV after cardiac surgery, we have found that practices in our center changed over three 1-year epochs, from 2001, to 2011, and to 2020. Reduction in V t and early weaning when combined were associated with more ventilator-free days. Decrease in DP and V t were both associated with sooner MV liberation.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1154-e1164"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144743966","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":"Palliative Care Consultation Benefit, Cardiac Intensivist Failure, or a Bit of Both?","authors":"Roxanne E Kirsch","doi":"10.1097/PCC.0000000000003801","DOIUrl":"10.1097/PCC.0000000000003801","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1175-e1177"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760755","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":"Thromboprophylaxis for Critically Ill Adolescents: A Multicenter Case-Control Study From the Children's Healthcare Advancements in Thrombosis Consortium.","authors":"Nikhil Vallabhaneni, Julie Jaffray, Brian R Branchford, Marisol Betensky, Amy Stillings, Emily Krava, Maua M Alleyne, Dina Ashour, Neil A Goldenberg, Anthony A Sochet","doi":"10.1097/PCC.0000000000003788","DOIUrl":"10.1097/PCC.0000000000003788","url":null,"abstract":"<p><strong>Objectives: </strong>To determine if thromboprophylaxis, including pharmacologic, mechanical, or in combination, is associated with a hospital-acquired venous thromboembolism (HA-VTE) risk reduction among critically ill adolescents.</p><p><strong>Design: </strong>Multicenter case-control study from the Children's Healthcare Advancements in Thrombosis Consortium Registry and VTE risk-model validation study from January 2012 to July 2022.</p><p><strong>Setting: </strong>Thirty-two North American PICUs.</p><p><strong>Patients: </strong>Critically ill adolescents 12-19 years old including cases with radiographically confirmed HA-VTE (i.e., pulmonary embolism and deep venous thrombosis) and controls without HA-VTE.</p><p><strong>Interventions: </strong>Pharmacologic (i.e., prophylactic anticoagulation) and mechanical (i.e., intermittent pneumatic compression) thromboprophylaxis.</p><p><strong>Measurements and main results: </strong>Of 163 cases and 975 controls, 7.6% received pharmacologic, 23.5% mechanical, and 9.2% pharmacologic and mechanical thromboprophylaxis. Compared with controls, cases more frequently had central venous catheterization (89% vs. 21.1%), invasive ventilation (52.2% vs. 11.8%), longer median length of stay (29 d [interquartile range, 15-46 d] vs. 6 d [interquartile range, 3-10 d]), impaired mobility (72.6% vs. 22.1%), and infection (48.5% vs. 16%; all p < 0.001). Venous thromboembolism risk tiers (low, moderate, and high) were calculated using validated scoring criteria. Using multivariable logistic regression for HA-VTE risk accounting for additional prothrombotic covariates and among each VTE risk tier, pharmacologic and combined thromboprophylaxis, but not mechanical thromboprophylaxis alone, were independently associated with reduced HA-VTE risk.</p><p><strong>Conclusions: </strong>Among critically ill adolescents, pharmacologic thromboprophylaxis alone or in combination with mechanical thromboprophylaxis, but not mechanical thromboprophylaxis alone, was associated with an HA-VTE risk reduction.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1126-e1137"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144541820","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":"Is It the Right Time to Recommend a Liberal RBC Transfusion Strategy in Children With Severe Acute Brain Injury?","authors":"Jacques Lacroix","doi":"10.1097/PCC.0000000000003803","DOIUrl":"10.1097/PCC.0000000000003803","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1178-e1182"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795021","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":"Writing for Pediatric Critical Care Medicine: The Single-Center Retrospective Cohort Study.","authors":"Robert C Tasker","doi":"10.1097/PCC.0000000000003814","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003814","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 9","pages":"e1183-e1186"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992612","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":"Central or Peripheral Venoarterial Extracorporeal Membrane Oxygenation for Neonates and Children With Septic Shock.","authors":"Matteo Di Nardo, Ravi R Thiagarajan, Grace van Leeuwen","doi":"10.1097/PCC.0000000000003781","DOIUrl":"10.1097/PCC.0000000000003781","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1189-e1190"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497616","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":"Children With Severe Neurologic Impairment and Their Families in the PICU: A Secondary Qualitative Analysis to Assess Clinician-Family Collaboration and Mutuality.","authors":"Ryan F Sutyla, Jori F Bogetz, Saisha Dhar, Ellie Oslin, Victoria Parente, Sharron L Docherty, Monica Lemmon","doi":"10.1097/PCC.0000000000003796","DOIUrl":"10.1097/PCC.0000000000003796","url":null,"abstract":"<p><strong>Objectives: </strong>In children with severe neurologic impairment (SNI) admitted to the PICU, a trauma-informed approach to care may mitigate the effect of traumatic events on both parents and the child. We aimed to characterize the themes that impacted the trauma-informed care principle of collaboration and mutuality in the PICU.</p><p><strong>Design: </strong>This study is a post hoc secondary analysis of transcripts of interviews conducted for a prospective mixed methods cohort study examining the experiences of parents of children with SNI in the PICU and their clinicians in 2021-2023. Parents and clinicians had completed the semi-structured interviews peri-PICU discharge. Data were analyzed using a conventional content analysis approach. Two analysts coded all data independently, with differences resolved by consensus. Dedoose qualitative software was used to facilitate analysis, which followed Consolidated Criteria for Reporting Qualitative Research guidelines.</p><p><strong>Setting: </strong>Quaternary academic center children's hospital.</p><p><strong>Patients: </strong>The original study (2021-2023) recruited parents of children and young people (3 mo to 25 yr old) with SNI who were admitted to the PICU and their PICU clinicians.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>There were 34 transcribed interviews: 15 from parents and 19 from PICU clinicians of multiple disciplines. We identified facilitators of and barriers to collaboration and mutuality. Facilitators included: 1) knowing a patient beyond the medical chart; 2) understanding values; and 3) clinician(s)-family collaboration. Barriers included: 1) constraints of the PICU environment; 2) challenges when engaging fully with patients with SNI; 3) intrinsic variability among clinicians and parents; 4) families being overwhelmed amid critical illness; and 5) emotional toll on clinicians.</p><p><strong>Conclusions: </strong>Participants described the importance of and barriers to collaboration and mutuality in the PICU, which underscores the impact of valuing partnerships between clinicians and families.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1138-e1148"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675457","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":"The authors reply.","authors":"Abhinav Totapally, Elizabeth Zivick, Brian Bridges","doi":"10.1097/PCC.0000000000003798","DOIUrl":"10.1097/PCC.0000000000003798","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1191-e1192"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760756","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 Quiet Revolution Under My Vest.","authors":"Jenna L Essakow","doi":"10.1097/PCC.0000000000003816","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003816","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963988","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":"Antiseizure Medication Use and Continuous Electroencephalography in Pediatric Traumatic Brain Injury.","authors":"Mohamad-Hani Temsah, Eman Amin Ahmed, Fahad Bashiri","doi":"10.1097/PCC.0000000000003795","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003795","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855961","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}