Pediatric Critical Care Medicine最新文献

{"title":"Durable Central Venous Access for Pediatric Cardiac Patients: Secondary Analysis of a Single-Center, Retrospective Cohort Study, 2015-2021.","authors":"Eran Shostak, Ovadia Dagan, Yelena Tzeitlin, Ori Goldberg, Gal Raz, Gabriel Amir, Yael Feinstein, Ofer Schiller","doi":"10.1097/PCC.0000000000003655","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003655","url":null,"abstract":"<p><strong>Objectives: </strong>There are several options for durable venous access for pediatric cardiac patients and the insertion techniques, locations, and complications potentially differ. The study aimed to evaluate our experience of upper extremity peripherally inserted central catheters (PICCs) and durable tunneled femoral central venous catheters (TF-CVCs) in young pediatric cardiac ICU (PCICU) patients.</p><p><strong>Design: </strong>Retrospective cohort study, 2015-2021.</p><p><strong>Setting: </strong>PCICU in a tertiary medical care center.</p><p><strong>Patients: </strong>All patients younger than 1.5 years old who underwent bedside insertion of TF-CVC or upper extremity PICC between December 2015 and December 2021.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The cohort included 226 durable lines, inserted in patients 2-550 days old, with 111 upper extremity PICCs and 115 TF-CVCs. In the two groups, receipt of PICC vs. TF-CVC placement was associated with older age (125.6 vs. 53.4 d; p = 0.005), and shorter duration of mechanical ventilation (9.0 vs. 25.5 d; p < 0.001). PICC vs. TF-CVC use was associated with a higher rate of central line-associated bloodstream infection (CLABSI) (7.14 vs. 2.38/1000 line days; p = 0.004) and more thrombosis events (5 vs. 0; p = 0.008). When adjusted for CLABSI-free line days, TF-CVCs (relative to upper limb PICCs) was associated with close to one-third of the odds of CLABSI (odds ratio [OR], 0.31 [95% CI, 0.13-0.78]); similarly, when adjusted for line days close to one-third of the odds of any complication, that is, CLABSI, dislodgment, occlusion, or thrombosis (OR, 0.31 [95% CI, 0.14-0.65]).</p><p><strong>Conclusions: </strong>In our 2015-2021 PCICU experience of using durable TF-CVC inserted at the bedside, vs. upper extremity PICCs, in neonates and infants, we found an associated one-third the odds of CLABSI and overall complications. A prospective study of subcutaneous tunneling in various locations of catheters on CLABSI and overall complication rates is needed.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 2","pages":"e137-e145"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468697","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":"Evaluation of Phoenix Sepsis Score Criteria: Exploratory Analysis of Characteristics and Outcomes in an Emergency Transport PICU Cohort From the United Kingdom, 2014-2016.","authors":"Michael J Carter, Joshua Hageman, Yael Feinstein, Jethro Herberg, Myrsini Kaforou, Mark J Peters, Simon Nadel, Naomi Edmonds, Nazima Pathan, Michael Levin, Padmanabhan Ramnarayan","doi":"10.1097/PCC.0000000000003682","DOIUrl":"10.1097/PCC.0000000000003682","url":null,"abstract":"<p><strong>Objectives: </strong>To assess characteristics and outcomes of children with suspected or confirmed infection requiring emergency transport and PICU admission and to explore the association between the 2024 Phoenix Sepsis Score (PSS) criteria and mortality.</p><p><strong>Design: </strong>Retrospective analysis of curated data from a 2014-2016 multicenter cohort study.</p><p><strong>Setting: </strong>PICU admission following emergency transport in South East England, United Kingdom, from April 2014 to December 2016.</p><p><strong>Patients: </strong>Children 0-16 years old ( n = 663) of whom 444 (67%) had suspected or confirmed infection.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The PSS was calculated as a sum of four individual organ subscores (respiratory, cardiovascular, neurological, and coagulation) using the worst values during transport (i.e., from referral until the time of PICU admission). A score cutoff of greater than or equal to 2 points was used to define sepsis; and septic shock was defined as sepsis plus 1 or more cardiovascular subscore points. Sepsis occurred in 260 of 444 children (58.6%) with suspected or confirmed infection, with septic shock occurring in 177 of 260 (68.1%) of those with sepsis. A PSS score greater than or equal to 2 points occurred in 37 of 67 bronchiolitis cases, 19 of 35 meningoencephalitis cases, 30 of 47 pneumonia/empyema cases, 38 of 46 septic/toxic shock cases, nine of 15 severe sepsis cases, and 58 of 118 definite viral infections. Overall, 14 of 444 children died (3.2%). There were 12 deaths in the 260 children with PSS greater than or equal to 2, and two deaths in the 184 children with PSS less than 2 (4.6% vs. 1.1%; absolute difference, 3.5%; 95% CI, 0.1-6.9%; p = 0.04).</p><p><strong>Conclusions: </strong>In 2014-2016, over half of the critically ill children undergoing emergency transport to PICU with presumed or confirmed infection, and meeting retrospectively applied PSS criteria for sepsis, had a range of clinical diagnoses including bronchiolitis, meningoencephalitis, and pneumonia/empyema. Furthermore, the PSS criteria for categorization of sepsis and septic shock were associated with outcome and may be of value in future risk-stratification in clinical trials.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e186-e196"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922431","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 2024 Phoenix Sepsis Score Criteria: Part 3, What About Using Stages of Sepsis in the Criteria?","authors":"Mark W Hall, Rakesh Lodha, Niranjan Kissoon, Adrienne G Randolph","doi":"10.1097/PCC.0000000000003662","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003662","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 2","pages":"e256-e261"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468731","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 2024 Phoenix Sepsis Score Criteria: Part 1, the Evolution in Definition of Sepsis and Septic Shock.","authors":"R Scott Watson, Andrew C Argent, Lauren R Sorce, Adrienne G Randolph, L Nelson Sanchez-Pinto, Tellen D Bennett, Niranjan Kissoon, Luregn J Schlapbach","doi":"10.1097/PCC.0000000000003664","DOIUrl":"10.1097/PCC.0000000000003664","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 2","pages":"e246-e251"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468711","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 2024 Phoenix Sepsis Score Criteria: Part 2, What About Using Interventions in the Criteria?","authors":"Claudio Flauzino de Oliveira, Idris Evans, Andrew C Argent, Rakesh Lodha, Kusum Menon","doi":"10.1097/PCC.0000000000003672","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003672","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 2","pages":"e252-e255"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468727","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 Resuscitation Skill of Bag-Tube Manual Ventilation: Developing and Using a Mobile Simulation Program to Assess Competency of a Multiprofessional PICU Team.","authors":"Anna E McCormick, Stuart H Friess, Kimberly S Quayle, John C Lin, Arushi Manga","doi":"10.1097/PCC.0000000000003612","DOIUrl":"10.1097/PCC.0000000000003612","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the skill of bag-tube manual ventilation with the flow-inflating bag in multiprofessional PICU team members using a mobile simulation unit.</p><p><strong>Design: </strong>Prospective observational study from January 2022 to April 2022.</p><p><strong>Setting: </strong>In situ mobile simulation using the flow-inflating bag in an academic PICU.</p><p><strong>Subjects: </strong>Multiprofessional PICU team members including nurses, respiratory therapists, nurse practitioners, fellows, and attendings.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We enrolled 129 participants who twice completed 1-minute tasks performing bag-tube manual ventilation with a flow-inflating bag. Sessions were video recorded; four could not be analyzed. Only 30% of participants reported being very to extremely confident, and the majority (62%) reported infrequent skill performance. Task success was defined as achieving target pressure ranges during 80% of the delivered breaths, respiratory rate (RR) of 25-35 breaths/min, and successful pop-off valve engagement. Only five of 129 participants (4%) achieved successful ventilation as defined. Overall, participants were more likely to deliver lower pressures and faster rate. Maintaining target positive end-expiratory pressure (PEEP) was least likely to be achieved (19% success), followed by RR (52%), pop-off valve (64%), then peak inspiratory pressure (71%). Nurses were less likely to achieve target pressures compared with all other professions.</p><p><strong>Conclusions: </strong>Multiprofessional PICU team members have highly variable self-confidence with bag-tube manual ventilation using a flow-inflating bag. Observed performance demonstrates rare success with achieving targeted ventilation parameters, in particular maintenance of PEEP. Future research should focus on developing mobile simulation units to facilitate profession-specific, real-time coaching to teach high-quality manual ventilation that can be translated to the bedside.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e206-e215"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471873","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":"Acute Mechanical Circulatory Support: Insight From a Cardiovascular Simulator.","authors":"Ronald A Bronicki, Sebastian C Tume, Saul Flores, Rohit S Loomba, Nirica M Borges, Daniel J Penny, Daniel Burkhoff","doi":"10.1097/PCC.0000000000003671","DOIUrl":"10.1097/PCC.0000000000003671","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e272-e277"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854997","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":"Application of Persistent Inflammation, Immunosuppression, and Catabolism Syndrome to Critically Ill Children: Single-Center Retrospective Cohort, 2019-2023.","authors":"Soichiro Tanimura, Norihiko Tsuboi, Saki Endo, Shin Tsubokura, Eisaku Nashiki, Shotaro Matsumoto, Satoshi Nakagawa","doi":"10.1097/PCC.0000000000003625","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003625","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 2","pages":"e281-e283"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468693","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 Pediatric Influence of Cooling Duration on Efficacy in Cardiac Arrest Patients (P-ICECAP): Statistical Methods Planned in the Bayesian, Adaptive, Duration Finding Trial.","authors":"John M VanBuren, Sharon D Yeatts, Richard Holubkov, Frank W Moler, Alexis Topjian, Kent Page, Robert G Clevenger, William J Meurer","doi":"10.1097/PCC.0000000000003667","DOIUrl":"10.1097/PCC.0000000000003667","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the optimal cooling duration for children after out-of-hospital cardiac arrest (OHCA) using an adaptive Bayesian trial design.</p><p><strong>Design: </strong>The Pediatric Influence of Cooling duration on Efficacy in Cardiac Arrest Patients (P-ICECAP) trial is a randomized, response-adaptive duration/dose-finding clinical trial with blinded outcome assessment. Participants are randomized to one of several cooling durations (0, 12, 18, 24, 36, 48, 60, 72, 84, or 96 hr). The first 150 participants are randomized 1:1:1 to 24-, 48-, and 72-hour durations. Response-adaptive randomization is used thereafter to allocate participants based on emerging duration-response data.</p><p><strong>Setting: </strong>PICUs.</p><p><strong>Patients: </strong>Up to 900 pediatric patients 2 days to younger than 18 years old who have survived OHCA and been admitted to an ICU.</p><p><strong>Interventions: </strong>Duration of targeted temperature management using a surface temperature control device.</p><p><strong>Measurements and main results: </strong>The primary outcome is the Vineland Adaptive Behavior Scales-Third Edition mortality composite score, assessed at 12 months. Secondary outcomes include changes in the Pediatric Cerebral Performance Category and Pediatric Resuscitation after Cardiac Arrest scores, as well as survival at 12 months. Bayesian modeling is employed to evaluate the duration-response curve and determine the optimal cooling duration. The trial is designed to adaptively update randomization probabilities every 10 weeks, maximizing the allocation of participants to potentially optimal cooling durations. Over 90% power is achieved for the hypothesized scenarios.</p><p><strong>Conclusions: </strong>The P-ICECAP trial aims to identify the shortest cooling duration that provides the maximum treatment effect for pediatric OHCA patients. The adaptive design allows for flexibility and efficiency in handling various clinical scenarios, potentially transforming pediatric cardiac arrest care by optimizing hypothermia treatment protocols.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e227-e236"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854369","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":"Reviewer Acknowledgment.","authors":"","doi":"10.1097/PCC.0000000000003704","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003704","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 2","pages":"e284-e286"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468710","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}