Pediatric Critical Care Medicine最新文献

{"title":"The Phoenix Criteria for Pediatric Sepsis.","authors":"Christopher M Horvat, Johanna R Rosen, Joseph Carcillo","doi":"10.1097/PCC.0000000000003762","DOIUrl":"10.1097/PCC.0000000000003762","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1080-e1081"},"PeriodicalIF":4.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079212","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":"Long-Term Survival of Children Discharged From Pediatric Intensive Care: A Linked Data Cohort Study.","authors":"Anthony Slater, Shaila Chavan, Elizabeth Croston, Chong Tien Goh, Debbie Long, Johnny Millar, Breanna Pellegrini, Lahn Straney, Belinda Gabbe","doi":"10.1097/PCC.0000000000003760","DOIUrl":"10.1097/PCC.0000000000003760","url":null,"abstract":"<p><strong>Objectives: </strong>The long-term survival of children discharged from PICUs and factors associated with mortality following discharge have not been systematically studied. The objective was to describe the long-term survival of children discharged alive from Australian PICUs and identify factors associated with death after discharge.</p><p><strong>Design: </strong>A cohort data linkage study.</p><p><strong>Setting: </strong>The Australian and New Zealand Paediatric Intensive Care Registry linked with the Australian National Death Index.</p><p><strong>Patients: </strong>Children discharged from PICUs in Australia between 1997 and 2018.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Exposures included the time period of admission, demographic, social, and admission factors. A multivariable Cox proportional hazards model and Kaplan-Meier survival curves were used to investigate exposures associated with mortality. The records of 96,743 children were available for analysis. The risk of death reduced over time: compared with children admitted from 1997 to 2002, the hazard ratios for death after discharge for children admitted from 2003-2008, 2009-2013, to 2014-2018 were 0.92 (95% CI, 0.85-0.99), 0.69 (0.64-0.745), and 0.60 (0.55-0.65). The risk of death associated with low-risk underlying conditions, such as asthma, was 70% lower than the reference (standard risk) group, while there was a seven-fold increase in the risk of death with very-high-risk underlying conditions, such as malignancy. Residing in outer regional and very remote areas was associated with higher risk of death.</p><p><strong>Conclusions: </strong>The survival of children discharged from Australian PICUs has improved over time; the risk of death reduced by 40% over the study period. The underlying disease, age, and residing in locations with reduced access to healthcare were associated with reduced probability of survival after discharge.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e975-e986"},"PeriodicalIF":4.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234721","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":"Postsepsis Care Needs in Children and Families: Single-Center, Codesign Qualitative Research From Western Australia.","authors":"Natalie J Middleton, Kathleen Anastasas, Joanna White, Catherine Pienaar, Joanne Harvey, Tenielle Bale, Timothy Wakeling, Bernard McCarthy, Christopher C Blyth, Fenella J Gill","doi":"10.1097/PCC.0000000000003770","DOIUrl":"10.1097/PCC.0000000000003770","url":null,"abstract":"<p><strong>Objectives: </strong>Sepsis, for children and their parents, is a life-altering illness with far-reaching psychosocial and physical impacts. We aimed to explore the needs of such patients and their parents after hospital admission for sepsis to inform the development of a Western Australian postsepsis care service.</p><p><strong>Design: </strong>Qualitative study codesigned with four parents of children with personal experience of sepsis, which involved audio recording of interviews and focus groups of parents and healthcare and education professionals.</p><p><strong>Setting: </strong>Perth Children's Hospital, Western Australia.</p><p><strong>Patients and participants: </strong>Over a 2-month period in 2024, 15 parents of children who had recovered from sepsis were interviewed; four parents participated in a focus group. There were also 23 healthcare or education professionals who participated in two focus groups.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The audio-recorded focus groups were transcribed verbatim, anonymized, and analyzed using inductive descriptive thematic analysis. Across both groups of participants, two major themes and six subthemes were identified. The major themes were \"the impact of sepsis\" and \"supportive care after sepsis.\" The impact of sepsis varied between individuals with the potential to affect multiple aspects of family life. Parents highlighted the profound psychosocial and physical consequences of sepsis, emphasizing the need for individualized support, communication, and follow-up after discharge. Professionals outlined gaps in current postsepsis care practices and suggested additional support measures for children and their families. Care coordination, described as a holistic, cross-sector healthcare model, was identified as a key need to ensure seamless collaboration across health, education, disability, and community sectors, while providing families with education, information, and resources.</p><p><strong>Conclusions: </strong>This follow-up study of parents and healthcare or education professionals identified that in postsepsis care there is a need for coordinated, individualized follow-up, with ongoing clinical support for families after discharge.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e987-e996"},"PeriodicalIF":4.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248985","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":"Post-PICU Outcome: What We Now Know About the Chronology of PICU Survivorship and General Health Recovery.","authors":"Robert C Tasker","doi":"10.1097/PCC.0000000000003791","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003791","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 8","pages":"e1051-e1056"},"PeriodicalIF":4.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795024","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 Time is Now.","authors":"Emily Kemper, James Fackler","doi":"10.1097/PCC.0000000000003787","DOIUrl":"10.1097/PCC.0000000000003787","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1060-e1062"},"PeriodicalIF":4.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144541819","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":"Improving Access to Technology-Driven Critical Care Interventions in Children With Severe Neurological Impairment.","authors":"Jenny Kingsley, Jori Bogetz, Stefanie G Ames, Aaron Wightman, Katie Moynihan","doi":"10.1097/PCC.0000000000003775","DOIUrl":"10.1097/PCC.0000000000003775","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1070-e1074"},"PeriodicalIF":4.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234720","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":"A Conversation in the Delivery Room.","authors":"Carlo Bellini","doi":"10.1097/PCC.0000000000003774","DOIUrl":"10.1097/PCC.0000000000003774","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1075-e1076"},"PeriodicalIF":4.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174419","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":"Beyond Standby: The Impact of Powering Down Devices in Pediatric Intensive Care.","authors":"Eris van Twist, Mette Lindhout, Suzan Cochius-den Otter, Sascha C A T Verbruggen","doi":"10.1097/PCC.0000000000003777","DOIUrl":"10.1097/PCC.0000000000003777","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1077-e1079"},"PeriodicalIF":4.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302671","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":"Child and Family Outcomes After PICU Admission: Creation of an Open Access Literature Database Using a Global Team of PICU Specialists Integrated With Machine Learning.","authors":"Rebecca E Hay, David J Zorko, Katie O'Hearn, Cara McQuaid, Geneviève Du Pont Thibodeau, Gonzalo Garcia Guerra, Jeremy Olivier, Laurence Ducharme-Crevier, Laurie Lee, Michael J Del Bel, Karen Choong, James Dayre McNally","doi":"10.1097/PCC.0000000000003780","DOIUrl":"10.1097/PCC.0000000000003780","url":null,"abstract":"<p><strong>Objectives: </strong>As research examining child health outcomes after PICU admission grows, so does the need for the identification and synthesis of a large body of literature. We aimed to create an open-access scoping repository of literature describing longer-term health outcomes after PICU admission, using a large multinational team (crowdsourcing) and a machine learning (ML) algorithm.</p><p><strong>Data sources: </strong>We performed a registered scoping review (OSF DOI10.17605/OSF.IO/HE5VB; Registered November 21, 2022) using MEDLINE, Embase, CINAHL, and CENTRAL databases, 2000-2022, with no language restrictions.</p><p><strong>Study selection: </strong>Observational or interventional studies describing outcomes of children (0-17 yr old) and their families or caregivers measured greater than 2 weeks post-PICU discharge. Titles and abstracts and full texts were initially screened by a large team of PICU healthcare workers and researchers who were recruited as part of an Evidence Hackathon event at the 2022 World Federation of Pediatric Intensive and Critical Care Societies conference. Initial screening results from 5000 citations were used to develop and validate an ML algorithm, after which a hybrid human crowdsourcing and ML approach was used to screen the remaining 11,055 studies.</p><p><strong>Data extraction: </strong>Not applicable.</p><p><strong>Data synthesis: </strong>Of 16,055 eligible citations, 1,301 met the criteria at full text for inclusion in the database. The screening was completed in just under 2 months while adhering to the gold standard systematic review methodology. Sensitivity for the hybrid human crowdsourcing and ML was 98%.</p><p><strong>Conclusions: </strong>A collaborative, global PICU team integrated with ML was successful in efficient and accurate large data synthesis, producing a scoping open-access database of studies reporting on post-PICU outcomes. The development of this repository has implications for future reviews, providing opportunities for networking and collaborative engagement in research. The next steps should examine database maintenance, utilization, and dissemination of research findings.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1017-e1023"},"PeriodicalIF":4.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12323758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144485474","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":"Death One Hour After Terminal Extubation in Children: Validation of a Machine Learning Model to Predict Cardiac Death After Withdrawal of Life-Sustaining Treatment in a Multicenter Cohort, 2009-2021.","authors":"Meredith C Winter, Alice X Zhou, Eugene Laksana, Melissa D Aczon, David R Ledbetter, Michael Avesar, Kimberly Burkiewicz, Harsha K Chandnani, Nina Fainberg, Stephanie Hsu, Michael C McCrory, Katie R Morrow, Anna Noguchi, Caitlin E O'Brien, Apoorva Ojha, Charlene Pringle, Patrick A Ross, Jui Shah, Sareen Shah, Leonid Shpaner, Linda B Siegel, Sandeep Tripathi, Randall C Wetzel","doi":"10.1097/PCC.0000000000003772","DOIUrl":"10.1097/PCC.0000000000003772","url":null,"abstract":"<p><strong>Objectives: </strong>In the PICU, predicting death within 1 hour after terminal extubation (TE) is valuable in augmenting family counseling and in identifying suitable candidates for organ donation after circulatory determination of death (DCDD). The objective of this study was to train and validate a machine learning model to predict death within 1 hour after TE.</p><p><strong>Design: </strong>The Death One Hour After Terminal Extubation (DONATE) database was generated using multicenter retrospective data from 2009 to 2021. Data covering demographics, clinical features, vital signs, laboratory values, ventilator settings, medications, and procedures were collected. Machine learning models were trained to predict whether a pediatric patient would die within 1 hour after TE and evaluated on a holdout set.</p><p><strong>Setting: </strong>Ten U.S. PICUs.</p><p><strong>Patients: </strong>Children and adolescents, 0-21 years old, who died after TE ( n = 957).</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The final model was a parsimonious extra-trees model with 21 input features. It was trained on the 2009-2018 data from eight sites ( n = 634) and evaluated on a holdout set comprised of the 2019-2021 data of all ten sites ( n = 323), representing temporal and external validation. The area under the receiver operating characteristic curve and 95% CI was 0.84 (95% CI, 0.81-0.87). At a sensitivity of 90%, the positive predictive value (PPV) was 88%, the negative predictive value (NPV) was 70%, and the number needed to alert (NNA) was 1.14. Among potential organ donors, at the same sensitivity level, the PPV was 86%, the NPV was 74%, and the NNA was 1.17.</p><p><strong>Conclusions: </strong>Our model, trained and validated on multisite data, predicted whether a child will die within 1 hour of TE with high discrimination and a low false alarm rate. This finding has important applications to end-of-life counseling and institutional resource utilization when families wish to attempt DCDD.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e997-e1008"},"PeriodicalIF":4.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144485475","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}