Pediatric Critical Care Medicine最新文献

{"title":"Breaking Through.","authors":"Robert N Boyd","doi":"10.1097/PCC.0000000000004007","DOIUrl":"10.1097/PCC.0000000000004007","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1175-1176"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361925","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":"Neutrophil Gelatinase-Associated Lipocalin and Cystatin-C Require Clinical Context to Accurately Predict Acute Kidney Injury.","authors":"Kevin G Couloures","doi":"10.1097/PCC.0000000000004001","DOIUrl":"10.1097/PCC.0000000000004001","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1170-1171"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148332118","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":"Lung Recruitment Maneuvers During Invasive Mechanical Ventilation: Single-Center Retrospective PICU Cohort Study, 2016-2023.","authors":"Francis-Olivier Beauchamp, Julie Thériault, Guillaume Emeriaud, Michaël Sauthier","doi":"10.1097/PCC.0000000000004002","DOIUrl":"10.1097/PCC.0000000000004002","url":null,"abstract":"<p><strong>Objectives: </strong>Recruitment maneuvers (RMs) during invasive mechanical ventilation (IMV) for acute hypoxemic respiratory failure are not characterized in pediatrics. We aimed 1) to describe changes in oxygenation, dynamic compliance, and outcome related to RMs; and 2) to identify which patients may benefit from RMs using machine learning.</p><p><strong>Design: </strong>Single center, retrospective cohort study, 2016-2023.</p><p><strong>Setting: </strong>Quaternary PICU in Montreal, Canada.</p><p><strong>Patients: </strong>We included all IMV patients between May 2016 and May 2023 who received at least one RM.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We identified 479 patients who had a total of 8276 RMs. We studied change in Pa o2 to F io2 (Pa o2 /F io2 ) ratio and dynamic compliance data from before and 90 minutes after the RM. In a multivariable model, baseline Pa o2 /F io2 ratio (OR, 0.99 [95% CI, 0.99-1.00]; p = 0.004) and initial positive end-expiratory pressure (PEEP) level (OR, 1.14 [95% CI, 1.00-1.31]; p = 0.046) were independently associated with oxygenation response. Recruitment delta in pressure was associated with lower odds of compliance response (OR, 0.93 [95% CI, 0.90-0.97]; p < 0.001). Patients with PEEP lower than that described as \"low\" in the PEEP-F io2 tables, vs. those not in this category, had greater odds of oxygen response (OR, 3.33 [95% CI, 1.49-7.73]; p = 0.004). We failed to identify an association between improved oxygenation or dynamic compliance vs. not and ventilator-free days, duration of IMV or PICU length of stay, and PICU mortality.</p><p><strong>Conclusions: </strong>In our 2016-2023 PICU cohort of IMV pediatric cases, we found various associations following RMs. Importantly, there was more than a three-fold greater odds of responsiveness associated with having a lower PEEP relative to F io2 than that described in the recommended practice tables. These data may help decision-making during IMV when lower PEEP is used.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1127-1137"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361958","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 Third Day.","authors":"Rony Kurniawan Pratama","doi":"10.1097/PCC.0000000000004017","DOIUrl":"10.1097/PCC.0000000000004017","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1177-1178"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550095","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":"Health Professionals' Perceptions of End-of-Life Care in the PICU: Single-Center Survey in Spain.","authors":"Manuel Gijón-Mediavilla, Anna Canet Tarrés, Lidia Oviedo Melgares, Eduardo López Fernández, Pablo Rojo Conejo, Sylvia Belda Hofheinz","doi":"10.1097/PCC.0000000000003978","DOIUrl":"10.1097/PCC.0000000000003978","url":null,"abstract":"<p><strong>Objectives: </strong>To explore healthcare professionals' perceptions of end-of-life care in the PICU and identify unmet needs and modifiable barriers.</p><p><strong>Design: </strong>Post hoc analysis of quality of care staff surveys.</p><p><strong>Setting: </strong>Tertiary university hospital PICU in Spain.</p><p><strong>Subjects: </strong>Survey data from physicians and nurses directly involved in the care of children who died in the PICU, from January 2017 to February 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The primary outcome was based on the PICU Quality of Dying and Death (PICU-QODD) instrument. A total of 73 surveys were completed following 80 deaths (91.3% response rate) by 68 physicians and five nurses. The median (interquartile range) age at death was 7.5 months (2-84 mo). Death following limitation or withdrawal of life-sustaining treatment occurred in 33 of 73 cases (45.2%). Overall, median PICU-QODD scores were high across domains of symptom control, communication, emotional support, and decision-making. Anticipated deaths (42/73) were associated with higher ratings in areas including communication ( p = 0.002), shared decision-making ( p = 0.007), and emotional support ( p = 0.024), compared with unanticipated deaths. Qualitative survey comments identified positive practices such as respectful communication and coordinated team efforts, but also highlighted deficiencies including a lack of private spaces, emotional isolation, and insufficient institutional support. Respondents recommended improved bereavement follow-up, architectural enhancements, and routine debriefings. During the study period, 63% (95% CI, 51-73%) reported significant personal emotional impact, yet few had access to formal psychological support.</p><p><strong>Conclusions: </strong>Our review of surveys from healthcare professionals involved in pediatric deaths between 2017 and 2023 showed that end-of-life care was generally good but was limited by insufficient staff emotional support and shortcomings in the unit and hospital environment at that time. As part of an ongoing quality improvement process, these insights have led to the introduction of structured debriefings and initiatives to improve family spaces within our unit.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1054-1062"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163979","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":"Complex Chronic Conditions in the PICU: Single-Center Retrospective Study in Central-Southern China, 2020-2025.","authors":"Xun Li, Haipeng Yan, Xiao Li, Xinping Zhang, Jiaotian Huang, Jinpeng Gan, Ting Luo, Xiangyu Wang, Longlong Xie, Yufan Yang, Haohao Zou, Zhenghui Xiao","doi":"10.1097/PCC.0000000000003990","DOIUrl":"10.1097/PCC.0000000000003990","url":null,"abstract":"<p><strong>Objectives: </strong>Complex chronic conditions (CCCs) are increasingly prevalent in the PICU. Identifying high-risk patterns of CCC and comorbidities is essential for patient risk stratification and targeted management. In this study, we aimed to describe the distribution and patterns of CCCs among children admitted to our tertiary PICU in China and to identify the types and combinations of conditions associated with a higher risk of adverse outcomes.</p><p><strong>Design: </strong>Retrospective cohort study, January 2020 to February 2025.</p><p><strong>Setting: </strong>Single center, at a tertiary referral PICU in Central-Southern China.</p><p><strong>Patients: </strong>Children older than 28 days, up to 18 years old.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>CCCs were defined according to the Pediatric Complex Chronic Conditions Classification System Version 2. Of 9589 PICU admissions, 49% had one or more CCCs. Admissions with CCCs accounted for 69.8% of the adverse outcomes, 70.8% of in-hospital deaths, 58% of multiple organ dysfunction cases, and 57.6% of total patient days. Admissions with multiple CCC diagnoses were associated with higher odds of adverse outcomes compared with admissions with a single CCC diagnosis ( p < 0.0001). Transplantation and metabolic CCCs were associated with greater odds of adverse outcomes (odds ratios [OR], 6.06 and 5.27, respectively; p < 0.05). The most common co-occurring CCC categories were malignancy and hematologic/immunologic disorders. Among the most frequent combinations, the co-occurrence of metabolic and malignancy CCC was associated with greater odds of adverse outcomes (OR, 8.54 [95% CI, 4.48-16.29]). Admission with CCC was associated with pneumonia and sepsis ( p < 0.05).</p><p><strong>Conclusions: </strong>In our 2020-2025 experience, admission of patients with CCCs accounted for most of the adverse PICU outcomes. The odds of adverse outcomes varied across CCC types and combinations. Hence, incorporating CCCs into a stratified management approach across our healthcare system may support more effective planning and delivery of care.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1116-1126"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265369","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 Randomized Controlled Trial of No Routine Gastric Residual Monitoring to Guide Enteral Feeding in PICUs: Statistical Analysis Plan for the GASTRIC-PICU Trial.","authors":"Paloma Ferrando-Vivas, Julia M Broomhall, Zia Sadique, Paul Mouncey, David A Harrison, Mark J Peters, Lyvonne N Tume","doi":"10.1097/PCC.0000000000004008","DOIUrl":"10.1097/PCC.0000000000004008","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the prespecified statistical analysis plan for the GASTRIC-PICU, a trial to evaluate the clinical and cost-effectiveness of no routine gastric residual volume (GRV) measurement to guide enteral feeding in mechanically ventilated children admitted to a pediatric intensive care.</p><p><strong>Design: </strong>Multicenter, randomised, noninferiority, open-label trial with embedded economic evaluation.</p><p><strong>Setting: </strong>Twenty-three PICUs across England, Scotland, Northern Ireland, and Switzerland.</p><p><strong>Patients: </strong>Infants and children older than 38 weeks corrected gestational age to 16 years, accepted to a participating PICU, on mechanical ventilation and being fed enterally by the gastric route.</p><p><strong>Interventions: </strong>Standard PICU feeding protocols, but without regular GRV measurement to guide feeding.</p><p><strong>Measurements and main results: </strong>The primary clinical outcome is an ordinal composite of survival and days free from mechanical ventilation at 30 days (noninferiority). The primary effect estimate will be the adjusted odds ratio from a proportional odds logistic regression model with two-sided 95% CI. If the lower limit is not less than 1/1.2, we will declare noninferiority. The coprimary nutritional outcome is the percentage of the child's estimated energy requirements achieved by 72 hours, which will be tested for superiority.</p><p><strong>Conclusions: </strong>The GASTRIC-PICU trial will assess the noninferiority of no routine GRV measurements compared with standard at least 6-hourly GRV measurements. Prespecified statistical and health economic analysis plans for the GASTRIC-PICU study have been developed before trial completion to minimize analytical bias.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1159-1166"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361944","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 Association Between Obesity and ICU Duration in Pediatric Critical Asthma.","authors":"Tyler C Kingdon, Margaret J Klein, Christopher L Carroll, Benjamin R White, Jocelyn R Grunwell, Patrick A Ross, Anoopindar K Bhalla","doi":"10.1097/PCC.0000000000004032","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004032","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between obesity and ICU length of stay (LOS) in children with critical asthma and assess whether socioeconomic factors modify this relationship.</p><p><strong>Design: </strong>A multicenter retrospective cohort study using the Virtual PICU Systems (VPS) database of children 2-19 years old admitted to ICUs with asthma between 2010 and 2020. Patients were classified by body mass index (BMI) percentile. Children with chronic medical conditions and those missing relevant data were excluded. Multivariable Cox and logistic regression models were performed and adjusted for confounders.</p><p><strong>Setting: </strong>All PICUs in the VPS database.</p><p><strong>Patients: </strong>A total of 16,412 children from 53 centers with available data to assign BMI, race, and insurance type were included.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements: </strong>The primary outcome was hazard of ICU discharge among survivors, with ICU LOS as the time-to-event variable. Secondary outcomes included the use of invasive or noninvasive mechanical ventilation (NIV) within the first hour of ICU admission and after the first hour.</p><p><strong>Main results: </strong>Obesity was associated with a lower hazard of ICU discharge among survivors (hazard ratio [HR] 0.87 [95% CI, 0.83-0.91]), consistent with longer ICU LOS. Obesity was associated with higher odds of MV in the first hour (odds ratio [OR] 1.24 [95% CI, 1.12-1.39]) and after the first hour (OR 1.63 [95% CI, 1.39-1.92]). These associations remained after adjustment for age, sex, race, insurance type, pneumonia diagnosis, transfer status, and overall severity of illness (Pediatric Risk of Mortality III). Among Black children, obesity was not associated with longer ICU LOS (HR 0.95 [95% CI, 0.89-1.03], p = 0.22). Otherwise, race and insurance type did not significantly modify these associations.</p><p><strong>Conclusions: </strong>Obesity is independently associated with longer ICU stays and increased respiratory support in children with critical asthma. These findings are predominantly consistent across racial and socioeconomic groups.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713379","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 Risk Factors of Adverse Events in Procedural Sedation Outside the Operating Room for Pediatric Dental Procedures.","authors":"William Sanislow, Anne Stormorken, David K Ngendahimana, David Speicher, Kelly Kirtland, Maia Wiesenfeld, Steven L Shein","doi":"10.1097/PCC.0000000000004026","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004026","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the prevalence and risk factors of adverse events (AE) in pediatric patients undergoing procedural sedation outside of the operating room (PSOOR) for dental procedures.</p><p><strong>Design: </strong>A retrospective analysis of prospectively collected data using the Pediatric Sedation Research Consortium database, which collects multicenter, quality-controlled data on pediatric sedations.</p><p><strong>Setting: </strong>Twenty-five participating hospitals across the United States, with data collected from July 1, 2020, to June 30, 2024.</p><p><strong>Patients: </strong>Three thousand five hundred forty-eight pediatric patients undergoing PSOOR for dental procedures.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The primary outcome was the occurrence of one or more AEs, which were classified as either severe (including both critical and high-risk events) or low-risk based on severity. Thirty-one percent of dental sedations had an AE occur and 5% had a severe AE occur. The most prevalent severe events in dental sedations included complete airway obstruction (2.8%), hypoxia requiring major intervention (1.6%), and laryngospasm (0.8%). Multiple modeling approaches revealed that medication regimen, provider type, neurologic comorbidity, snoring, and obesity were associated with severe AEs after adjusting for confounding variables.</p><p><strong>Conclusions: </strong>While PSOOR is generally safe, children undergoing sedation for dental procedures experience high rates of AEs, most commonly airway-related complications. Patient-, provider-, and institution-level factors may increase the risk of AEs. These findings underscore the need for enhanced preprocedural risk assessment and provider training to ensure safety in pediatric dental sedation practices.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713385","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":"Neurological Pupil Index and Outcome After Cardiac Arrest in Children: Single-Center, Retrospective Cohort, 2018-2023.","authors":"Maya R Silver, Hongyan Liu, Alexis Z Tomlinson, Ayush Lacoul, Kathryn Graham, Ryan W Morgan, Danielle Traynor, Amy Kleinschmidt, Kenya Agarwal, Kristen Lourie, Robert A Berg, Nadir Yehya, Alexis Topjian, Matthew P Kirschen","doi":"10.1097/PCC.0000000000004015","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004015","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the association between abnormal pupillary reactivity using automated infrared pupillometry and unfavorable outcome after pediatric cardiac arrest (CA).</p><p><strong>Design: </strong>Single-center, retrospective, cohort study, 2018-2023.</p><p><strong>Setting: </strong>Large tertiary PICU in the United States.</p><p><strong>Patients: </strong>We identified 127 patients 18 years old or younger with 8464 pupillary assessments, greater than or equal to 2 measured within 72 hours after return of circulation (ROC).</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Abnormal pupillary reactivity was defined as greater than or equal to 2 neurological pupil index (NPi) values less than 3 in either eye. Unfavorable outcome was hospital discharge Pediatric Cerebral Performance Category of 4-6 and increase greater than or equal to 1 from pre-CA status. We explored the diagnostic performance of abnormal NPi for categorizing unfavorable outcome in the first 72 hours post-ROC, and at the time periods of 0-12, 12-24, 24-48, and 48-72 hours. We used a mixed-effects linear regression model to evaluate whether NPi values were associated with favorable vs. unfavorable outcome, after adjusting for clinical variables. Group-based trajectory modeling (GBTM) characterized NPi trajectories over time. Abnormal pupillary reactivity had a sensitivity of 66%, specificity 79%, positive predictive value of 82%, negative predictive value of 63%, and area under the receiver operating characteristic curve of 0.73 (95% CI, 0.65-0.80) for unfavorable outcome. Specificity did not differ between time periods. In the mixed-effects model, unfavorable outcome was associated with lower NPi values that decreased over time (interaction of time from ROC and outcome β = -0.02; p < 0.001). Through GBTM we identified a subgroup of patients with favorable outcome whose NPi was initially abnormal but subsequently improved over time.</p><p><strong>Conclusions: </strong>In our 2018-2023 experience, the presence of at least two NPi values less than 3 post-CA was associated with unfavorable outcome, with an acceptable level of diagnostic characterization. Of note, some patients with initially lower NPi values improved over time and had favorable outcome.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701960","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}