Pediatric Critical Care Medicine最新文献

{"title":"Just Because I Can't Talk Doesn't Mean I Have Nothing to Say.","authors":"Ann Schrooten, Barry P Markovitz","doi":"10.1097/PCC.0000000000003741","DOIUrl":"10.1097/PCC.0000000000003741","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e860-e861"},"PeriodicalIF":4.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753780","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":"PRoMPTing Practice Change in Pediatric Sepsis: Is There a Role for Acute Kidney Injury Biomarkers in Early Fluid Resuscitation?","authors":"Imogen Clover-Brown, Natalja L Stanski","doi":"10.1097/PCC.0000000000003745","DOIUrl":"10.1097/PCC.0000000000003745","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e839-e841"},"PeriodicalIF":4.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811979","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":"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":"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":"e779-e787"},"PeriodicalIF":4.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140893/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diversity Engagement of Pediatric Critical Care Fellows: A U.S. Survey of 81 Fellows at 15 Fellowship Programs, 2022.","authors":"Cody-Aaron L Gathers, Anireddy R Reddy, Christine Joyce, Nonyerem Acholonu, Nadir Yehya, Neethi P Pinto, Margaret A Priestley, Adrian D Zurca, Donald L Boyer, Jessica C Fowler","doi":"10.1097/PCC.0000000000003750","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003750","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 6","pages":"e864-e866"},"PeriodicalIF":4.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226152","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":"Organ Procurement Organization Donation Requestors Describe Barriers to Pediatric Organ Donation.","authors":"Gretchen B Chapman, Mandy Lanyon, Justin Godown, Daniel J Lebovitz","doi":"10.1097/PCC.0000000000003742","DOIUrl":"10.1097/PCC.0000000000003742","url":null,"abstract":"<p><strong>Objectives: </strong>Organ procurement organization (OPO) donation requestor staff approach grieving families to discuss donating organs from their loved ones. We have carried out a qualitative study to explore the barriers that OPO donation requestor staff face in accessing pediatric families and requesting consent.</p><p><strong>Design and participants: </strong>Qualitative methods using structured interviews ( n = 31) and focus groups ( n = 33 participants) with donation requestor OPO personnel.</p><p><strong>Setting: </strong>Phone interviews were conducted from November 2022 to January 2023, and focus groups were held at an August 2023 conference for donation and transplant professionals.</p><p><strong>Subjects: </strong>64 donation requestor OPO personnel.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Content analysis was used to code transcribed responses. Participants described a lack of access to pediatric families and portrayed clinical care teams as sometimes protective of the family or even preventing OPO staff from talking with the family. Participants shared potential solutions to overcome barriers, including fostering teamwork between clinical care teams and OPO staff and developing bridging language for clinicians to use when introducing donation requestors.</p><p><strong>Conclusions: </strong>Donation requestors face unique challenges when approaching grieving pediatric families, and more multidisciplinary work is needed to improve communication.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e773-e778"},"PeriodicalIF":4.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772898","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":"10.1097/PCC.0000000000003753","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e842-e845"},"PeriodicalIF":4.0,"publicationDate":"2025-06-01","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":"Respiratory Support for Bronchiolitis Management in the PICU: What We Now Know and What We Want to Know.","authors":"Robert C Tasker","doi":"10.1097/PCC.0000000000003765","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003765","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 6","pages":"e827-e831"},"PeriodicalIF":4.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226153","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":"Prevalence and Associated Explanatory Factors for Augmented Renal Clearance in Early Sepsis: Single-Center, Retrospective PICU Cohort in China, 2022-2023.","authors":"Lili Xu, Jiayue Xu, Haoyun Mao, Wen Qian, Zhushengying Ma, Yuru Zhang, Yueniu Zhu, Xiaodong Zhu, Yaya Xu","doi":"10.1097/PCC.0000000000003727","DOIUrl":"10.1097/PCC.0000000000003727","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to 1) evaluate the prevalence of augmented renal clearance (ARC) in pediatric sepsis patients; 2) analyze potential explanatory factors associated with ARC out of hemodynamic, oxygenation, and inflammatory parameters; and 3) assess ARC outcomes.</p><p><strong>Design: </strong>Retrospective, single-center, cohort from January 2022 to June 2023.</p><p><strong>Setting: </strong>PICU at a tertiary care hospital in China.</p><p><strong>Patients: </strong>Children 28 days to 16 years of age admitted with sepsis defined using Phoenix Sepsis Criteria.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Among 69 patients, 34 (49.3%) were categorized as having ARC. Designation as having ARC, vs. not, was associated with being younger (median 2.4 vs. 7.2 years, p < 0.001), hemodynamic and intrarenal flow changes, and higher C-reactive protein levels (31.0 vs. 12.0 mg/L, p < 0.05). None of the 34 patients with ARC developed acute kidney injury, but 22 of 35 non-ARC patients did. ARC was associated with shorter PICU stays (median 7 vs. 11 days, p < 0.05). Univariate regression analyses identified fluid balance, cardiac function parameters, renal resistive index, and inflammatory markers as explanatory factors associated with ARC.</p><p><strong>Conclusions: </strong>In this retrospective cohort of pediatric sepsis patients admitted to the PICU, the prevalence of early-onset ARC is around 50%, and younger patients may be at risk. The presence of ARC is associated with hemodynamic and inflammatory responses. Taken together, more prospective work is needed, with an emphasis on drug-level targeting and a better understanding of interactions with intrarenal pathophysiology.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e788-e795"},"PeriodicalIF":4.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664014","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":"In-Hospital Mortality in Mechanically Ventilated Children With Severe Dengue Fever: Explanatory Factors in a Single-Center Retrospective Cohort From Vietnam, 2013-2022.","authors":"Luan Thanh Vo, Viet Chau Do, Tung Huu Trinh, Thanh Tat Nguyen","doi":"10.1097/PCC.0000000000003728","DOIUrl":"10.1097/PCC.0000000000003728","url":null,"abstract":"<p><strong>Objectives: </strong>Severe dengue fever complicated by critical respiratory failure requiring mechanical ventilation (MV) contributes to high mortality rates among PICU-admitted patients. This study aimed to identify key explanatory variables of fatality in mechanically ventilated children with severe dengue.</p><p><strong>Design: </strong>Retrospective cohort, from 2013 to 2022.</p><p><strong>Setting: </strong>PICU of the tertiary Children's Hospital No. 2, in Vietnam.</p><p><strong>Patients: </strong>Two hundred children with severe dengue fever who received MV.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We analyzed clinical and laboratory data during the PICU stay. The primary outcome was 28-day in-hospital mortality. Backward stepwise multivariable logistic regression was performed to identify the explanatory variables associated with dengue-associated mortality at the initiation of MV. The model performance was assessed using C-statistics, calibration plot, and Brier score. The patients had a median age of 7 years (interquartile range, 4-9). Overall, 47 (24%) of 200 patients died in the hospital. Five factors were associated with greater odds of mortality: severe transaminitis (aspartate aminotransferase or alanine aminotransferase ≥ 1000 IU/L), high blood lactate levels, vasoactive-inotropic score (> 30), dengue encephalitis, and peak inspiratory pressure on MV. The model performance in training (test) sets was a C-statistic of 0.86 (0.84), a good calibration slope 1.0 (0.89), and a Brier score of 0.08.</p><p><strong>Conclusions: </strong>In our center, from 2013 to 2022, MV-experienced patients with severe dengue had a high mortality rate. The main explanatory factors associated with greater odds of death (related to critical liver injury, shock, and MV) may inform future practice in such critically ill patients.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e796-e805"},"PeriodicalIF":4.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657957","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":"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":"10.1097/PCC.0000000000003754","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e832-e834"},"PeriodicalIF":4.0,"publicationDate":"2025-06-01","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}