Pediatric Critical Care Medicine最新文献

{"title":"Parent-Reported Secondary Stressor Inventory Scores and Bedside Presence During PICU Admission.","authors":"Robert T Ohman, Iris Chan, Lisa DelSignore","doi":"10.1097/PCC.0000000000003652","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003652","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 2","pages":"e278-e280"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468704","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":"Phoenix Sepsis Criteria in Critically Ill Children: Retrospective Validation Using a United States Nine-Center Dataset, 2012-2018.","authors":"L Nelson Sanchez-Pinto, Latasha A Daniels, Mihir Atreya, E Vincent S Faustino, Reid W D Farris, Alon Geva, Robinder G Khemani, Colin Rogerson, Sareen S Shah, Scott L Weiss, Tellen D Bennett","doi":"10.1097/PCC.0000000000003675","DOIUrl":"10.1097/PCC.0000000000003675","url":null,"abstract":"<p><strong>Objectives: </strong>To perform: 1) external validation of the Phoenix Sepsis Score and Phoenix sepsis criteria in a multicenter cohort of critically ill children with infection and a comparison with the 2005 International Pediatric Sepsis Consensus Conference (IPSCC) criteria; 2) a study of Phoenix sepsis criteria performance in patient subgroups based on age and comorbidities; 3) an assessment of microbiological profile of children with Phoenix sepsis; and 4) a study of the performance of the Phoenix-8 score.</p><p><strong>Design: </strong>Secondary, retrospective analysis of a multicenter cohort study from 2012 to 2018.</p><p><strong>Setting: </strong>Nine PICUs in the United States.</p><p><strong>Patients: </strong>PICU admissions with suspected infection.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Among 25,680 encounters of children with suspected or confirmed infection on PICU admission (4.6% in-hospital mortality), 11,168 (43%) met Phoenix criteria for sepsis or septic shock (9% in-hospital mortality). The Phoenix criteria generally outperformed the IPSCC criteria at discriminating mortality in all critically ill children with infections and across all subgroup analyses, including age group, malignancy, or technology dependence. Of 11,168 patients who met Phoenix criteria, 28% were negative for IPSCC criteria for sepsis and these had higher in-hospital mortality than those who met IPSCC sepsis criteria but not Phoenix criteria (4.7% vs.1.7%; p < 0.001), which was similar to the mortality of patients without sepsis (1.3%). Sepsis was associated with respiratory or bloodstream infection, most commonly Pseudomonas aeruginosa or Staphylococcus aureus. The Phoenix-8 score had good discrimination of mortality in children with infections, comparable to or better than validated and widely used severity of illness and organ dysfunction scores.</p><p><strong>Conclusions: </strong>In 2012-2018, among U.S. patients with suspected or confirmed infection admitted to nine PICUs, those with the highest risk of mortality can be identified using the Phoenix sepsis criteria, including in children of different age groups and those with major comorbidities.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 2","pages":"e155-e165"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468709","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":"Experience for the \"Experts\": Maintenance of Airway Skills As a PICU Attending.","authors":"Teresa Lee, Sapna R Kudchadkar, Donald H Shaffner","doi":"10.1097/PCC.0000000000003666","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003666","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 2","pages":"e244-e245"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468700","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 4, What About Using World-Oriented Criteria?","authors":"Matthew O Wiens, Enitan D Carrol, Mohammod Jobayer Chisti, Daniela Carla de Souza, Rakesh Lodha, Suchitra Ranjit, Niranjan Kissoon","doi":"10.1097/PCC.0000000000003663","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003663","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 2","pages":"e262-e265"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468735","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 5, What About \"Parsimony\" in the Criteria-Is Less Really More?","authors":"Adrienne G Randolph, Mark W Hall, Niranjan Kissoon, Daniela Carla de Sousa, Mohammod Jobayer Chisti, Enitan D Carrol","doi":"10.1097/PCC.0000000000003665","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003665","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 2","pages":"e266-e271"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468738","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 Phoenix Sepsis Score in Pediatric Oncology Patients With Sepsis at PICU Admission: Test of Performance in a European Multicenter Cohort, 2018-2020.","authors":"Roelie M Wösten-van Asperen, Hannah M la Roi-Teeuw, Wim J E Tissing, Iolanda Jordan, Christian Dohna-Schwake, Gabriella Bottari, John Pappachan, Roman Crazzolara, Angela Amigoni, Agnieszka Mizia-Malarz, Andrea Moscatelli, María Sánchez-Martín, Jef Willems, Luregn J Schlapbach","doi":"10.1097/PCC.0000000000003683","DOIUrl":"10.1097/PCC.0000000000003683","url":null,"abstract":"<p><strong>Objectives: </strong>The Pediatric Sepsis Definition Task Force developed and validated a new organ dysfunction score, the Phoenix Sepsis Score (PSS), as a predictor of mortality in children with suspected or confirmed infection. The PSS showed improved performance compared with prior scores. However, the criteria were derived in a general pediatric population, in which only 10% had cancer. Given that pediatric cancer patients with sepsis have higher mortality compared with noncancer patients with sepsis, we aimed to assess the PSS in PICU patients with cancer and sepsis.</p><p><strong>Design: </strong>Retrospective multicenter cohort study.</p><p><strong>Setting: </strong>Twelve PICUs across Europe.</p><p><strong>Patients: </strong>Each PICU identified patients 18 years young or younger, with underlying malignancy and suspected or proven sepsis, and admission between January 1, 2018, and January 1, 2020.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The PSS and three other scores, including Phoenix-8, Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score, and pediatric Sequential Organ Failure Assessment (pSOFA) score, were calculated for comparison. The primary outcome was 90-day all-cause mortality. We compared score performance using area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC) analyses. Among 383 patients with proven or suspected sepsis, 90-day mortality was 19.3% (74/383). We failed to identify an association between a particular score and performance for 90-day mortality. The mean (95% CI) values for the AUROC of each score was: PSS 0.66 (0.59-0.72), Phoenix-8 0.65 (0.58-0.72), PELOD-2 0.64 (0.57-0.71), and pSOFA 0.67 (0.60-0.74) and for the AUPRC of each score: PSS 0.32 (0.23-0.42), Phoenix-8 0.32 (0.23-0.42), PELOD-2 0.32 (0.22-0.43), and pSOFA 0.36 (0.26-0.46). Similar results were obtained for PICU mortality or sepsis-related PICU mortality.</p><p><strong>Conclusions: </strong>Contrary to the general PICU population, our retrospective test of the PSS in a PICU oncology dataset with suspected or proved sepsis from European PICUs, 2018-2020, failed to identify improved performance in association with mortality. This unique patient population deserves development of organ dysfunction scores that reflect organ dysfunction and mortality data specifically from these patients and will require prospective validation in future studies.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 2","pages":"e177-e185"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468742","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":"What Do We Know About Pediatric Sepsis Scoring Post-Phoenix?","authors":"Robert C Tasker","doi":"10.1097/PCC.0000000000003690","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003690","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 2","pages":"e237-e240"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468748","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":"Citrate Anticoagulation in Continuous Renal Replacement Therapy: Multicenter PICU Study of Filter-Related Outcomes.","authors":"Hasan S Kihtir, Muhterem Duyu, Mehmet E Mementoglu, Ilknur Tolunay, Tanil Kendirli, Faruk Ekinci, Edin Botan, Ebru A Ongun, Ayse Asik, Emrah Gun, Hacer Ucmak, Esra Sevketoglu, Dincer Yildizdas","doi":"10.1097/PCC.0000000000003661","DOIUrl":"10.1097/PCC.0000000000003661","url":null,"abstract":"<p><strong>Objectives: </strong>To examine citrate anticoagulation in continuous renal replacement therapy (CRRT) in the PICU.</p><p><strong>Design: </strong>Post hoc analysis of a curated, multicenter dataset collected from January 1, 2022, to June 1, 2023.</p><p><strong>Setting: </strong>Seven PICUs in Turkey.</p><p><strong>Patients: </strong>PICU admissions in need of CRRT, 28 days to 18 years old.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>In 128 filters used in 73 patients, the effective filter life (EFL) restricted to 72 hours was a median (interquartile range [IQR]) of 40.5 hours (IQR, 21-58 hr); total EFL was a median of 59 hours (IQR, 28-89 hr). Analysis of the receiver operating characteristic curve for initial citrate infusion dose (CID) and whether EFL reached 72 hours identified a cutoff level for initial CID of greater than 2.64 mmol citrate per liter of patient blood flow (mmol/L-bf). As expected, the two filter groups categorized by initial CID (≥ 2.7 vs. < 2.7 mmol/L-bf) showed filters in children receiving higher initial dosing had longer total EFL (72 hr [IQR, 48-104 hr] vs. 38.5 hr [IQR, 18-84 hr]; p = 0.03). We failed to identify an association between CRRT for over 24 or 48 hours and greater odds (odds ratio [OR], 95% CI) of citrate accumulation (OR, 2.23; 95% CI, 0.82-6.13; p = 0.118 or OR, 1.78; 95% CI, 0.84-3.8; p = 0.134, respectively). However, we cannot exclude up to 6.1- or 3.8-fold odds of citrate accumulation; of note, CRRT over 72 hours was associated with greater odds of citrate accumulation (OR, 2.17; 95% CI, 1.01-4.68; p = 0.04). Citrate lock syndrome occurred in eight of 128 (6.3%; 95% CI, 3-11.4%) filters, and resolved without termination of CRRT. On multivariable analysis, a higher patient initial lactate concentration was associated with an 18% (95% CI, 7-30%) greater hazard of developing citrate accumulation.</p><p><strong>Conclusions: </strong>Citrate anticoagulation for CRRT is an option for children. Choosing an initial CID greater than or equal to 2.7 mmol/L-bf provides longer EFL but with the associated potential of citrate accumulation. Further studies are needed on initial CID and duration of EFL.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e216-e226"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855013","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":"Antithrombin and Activated Protein C in Pediatric Sepsis: Prospective Observational Study of Outcome.","authors":"Tran Dang Xoay, Ta Anh Tuan, Nguyen Thi Ha, Thieu Quang Quan, Nguyen Thi Duyen, Tran Thi Kieu My","doi":"10.1097/PCC.0000000000003677","DOIUrl":"10.1097/PCC.0000000000003677","url":null,"abstract":"<p><strong>Objectives: </strong>To assess antithrombin and activated protein C (aPC) levels in relation to disseminated intravascular coagulation (DIC) and severe outcomes in pediatric sepsis.</p><p><strong>Design: </strong>Prospective, observational study conducted between April 2023 and October 2024. Coagulation profiles including conventional coagulation, antithrombin activity, and aPC were obtained at PICU admission.</p><p><strong>Setting: </strong>PICU in the Vietnam National Children's Hospital, Hanoi, Vietnam.</p><p><strong>Subjects: </strong>PICU admissions, 1 month to 18 years old, with sepsis.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>One hundred thirty children (78 males; median age 7.5 mo) with mortality 23/130 (17.7%). The prevalence of overt DIC was 37 of 130 (28.5%). Nonsurvival at 28 days, compared with survival, was associated with hemorrhage and/or thrombosis at presentation, and higher number of dysfunctional organs, and overt DIC. Those with overt DIC, compared with not, had longer activated partial thromboplastin time, higher international normalized ratio and d -dimer, and lower antithrombin, and aPC. Activity of antithrombin and aPC correlated inversely with the Vasoactive-Inotropic Score in survivors ( p = 0.002 and 0.009, respectively). Patients with a cutoff value for antithrombin less than 63.5% had a mortality risk with area under the receiver operating characteristic (AUROC) curve 0.64, with sensitivity 0.51 and specificity 0.74, and positive predictive value 0.30. Regarding overt DIC, a cutoff value for antithrombin less than 55.5% had an AUROC 0.78, sensitivity 0.72 and specificity of 0.73, and positive predictive value 0.52.</p><p><strong>Conclusions: </strong>In this observational study of pediatric sepsis patients, first 24-hour coagulation data in those who did not-survive to 28 days, vs. survivors showed an associated prior lower level of antithrombin in nonsurvivors. Furthermore, using the outcome of overt DIC and nonovert DIC in the first 72 hours, we found that lower levels of antithrombin or aPC are each associated with overt DIC and nonovert DIC in pediatric sepsis. Further validation work is needed in larger case series of pediatric sepsis.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e197-e205"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882652","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":"Phoenix Rising: External Validation of the Phoenix Sepsis Criteria.","authors":"Lee A Polikoff","doi":"10.1097/PCC.0000000000003688","DOIUrl":"10.1097/PCC.0000000000003688","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e241-e243"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927590","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}