Pediatric Critical Care Medicine最新文献

{"title":"Massive Bleeding in Children With Cancer or Hematopoietic Cell Transplant: International, Multicenter Retrospective Study, 2017-2021.","authors":"Marianne E Nellis, Marie E Steiner, Saleh Bhar, Jennifer McArthur, Ali McMichael, April L Rahrig, Christine Leeper, Salvatore Perdichizzi, Fabrizio Chiusolo, Jacob Shamash, Nora Bruns, Hilary Schreiber, Matthew P Sharron, Laura Butragueño-Laiseca, James S Killinger, Charlene P Pringle, Samantha M Koenig, Cassandra Josephson, David Crawford, Briana L Scott, Kenneth E Remy, Christine Puthawala, Philip C Spinella","doi":"10.1097/PCC.0000000000003751","DOIUrl":"10.1097/PCC.0000000000003751","url":null,"abstract":"<p><strong>Objectives: </strong>To characterize the epidemiology and management of massive bleeding events in children with cancer and/or hematopoietic cell transplant (HCT).</p><p><strong>Design: </strong>Multicenter, retrospective cohort study.</p><p><strong>Setting: </strong>Nineteen pediatric hospitals in Europe and United States.</p><p><strong>Subjects: </strong>Children ages 0-21 years old with malignancy and/or HCT and massive bleeding admitted from January 1, 2017, to December 31, 2021.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Demographics, oncologic history, laboratory values, interventions, and PICU outcomes were collected. One hundred fifty-two bleeding episodes from 135 patients were analyzed. The median (interquartile range [IQR]) age was 7 years (2-14 yr). Forty-three percent (58/135) were female sex. Nineteen percent of children (26/135) had death attributable to hemorrhage. Forty percent had solid tumors and one-third had undergone at least one HCT. The majority of bleeding events occurred in the PICU (81/152, 53%). The median (IQR) platelet count at time of bleeding was 52 × 10 9 /L (24-115 × 10 9 /L), prothrombin time 18.5 seconds (15.2-24.8 s), activated partial thromboplastin time 42.2 seconds (33.2-56.0 s), and international normalized ratio 1.51 (1.21-2.11). To treat these bleeding events, 99% (148/152) of the time children received RBC transfusions, 84% (126/152) of the time plasma transfusions, 88% (132/152) of the time platelet transfusions, and less than one-fifth hemostatic medications. Half (77/152, 52%) of the time the children received high plasma ratios and half (73/152, 49%) received high platelet ratios. Pulmonary bleeding, oral/nasal bleeding, and receipt of prothrombin complex concentrate were each associated with greater odds of death attributed to hemorrhage: odds ratio (95% CI), respectively: 5.44 (2.250-13.171; p < 0.001); 3.30 (1.20-9.09; p = 0.021); and 3.24 (1.18-8.93; p = 0.023).</p><p><strong>Conclusions: </strong>Children with malignancy and/or HCT have a high mortality rate from hemorrhage despite being hospitalized at the time of their bleeding event. The majority of children received balanced resuscitation. Definitive trials are needed to determine optimal hemostatic resuscitation practice in this population.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e889-e899"},"PeriodicalIF":4.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12221796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013760","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 author replies.","authors":"Akhila Arcot Vadivelan","doi":"10.1097/PCC.0000000000003759","DOIUrl":"10.1097/PCC.0000000000003759","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e969-e970"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12221790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094343","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":"Point-of-Care Ultrasound in Pediatric Resuscitation? What's All the Rapid Ultrasound for Shock and Hypotension About?","authors":"Sebastian C Tume, Erik Su","doi":"10.1097/PCC.0000000000003761","DOIUrl":"10.1097/PCC.0000000000003761","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e935-e937"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047540","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":"Adjunctive Corticosteroids for Hypotension in the Pediatric Cardiac ICU: Single-Center Retrospective Study, 2020-2021.","authors":"Shreerupa Basu, Victoria Habet, Marlon Delgado, Peter Chiu, Dylan Knox, Emma Thibault, Akalpit Shukla, Emily Harrington, Valerie Bailey, Stuart Lipsitz, Yuanyuan Fu, Michael Agus, John Kheir, Jun Sasaki, Katie Moynihan","doi":"10.1097/PCC.0000000000003757","DOIUrl":"10.1097/PCC.0000000000003757","url":null,"abstract":"<p><strong>Objectives: </strong>To characterize adjunctive corticosteroid use and associations between any exposure or cumulative dose and outcomes in pediatric cardiac surgical cases.</p><p><strong>Design: </strong>A retrospective cohort was admitted over 24 months (from January 2020 to December 2021).</p><p><strong>Setting: </strong>Single-center cardiac ICU (CICU) in a quaternary hospital.</p><p><strong>Patients: </strong>Descriptive analyses of all patients receiving hydrocortisone for hypotension. Further comparative analyses were restricted to postoperative infants (< 12 mo) exposed to corticosteroids vs. not, including propensity-score inverse weighted and matched analyses.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We examined associations between cumulative hydrocortisone dose and outcomes, including severe infection. Overall, 154 patients of all ages received steroids (91 post-surgical). Median (interquartile range [IQR]) cumulative hydrocortisone dose was 10.0 mg/kg (IQR, 6.0-21.2 mg/kg). Greater cumulative dose was associated with higher adjusted odds (95% CI) of severe infection (1.08 [95% CI, 1.03-1.12]). For comparative analyses, we identified 403 infants, including 68 with postoperative corticosteroid exposure. Propensity scores based on multiple factors, including peak modified Vasoactive-Inotropic Score (mVIS, excluding milrinone), compared outcomes and hemodynamic response with quantification of rate of mVIS fall from peak among 55 matched pairs. We failed to identify a difference in rate of mVIS fall between nonsteroid and steroid recipients (-0.162 [IQR, -0.228 to -0.053] vs. -0.160 [IQR, -0.300 to -0.046]; p = 0.674).</p><p><strong>Conclusions: </strong>In our CICU cohort receiving adjunctive hydrocortisone for hypotension, we failed to identify a consistent signal regarding outcomes and rate of mVIS fall. Considering potential side effects, these data suggest prospective study is needed to better define the use of such treatment.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e877-e888"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005019","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":"Group Peer Mentoring: A Strategy to Promote Career Development and Improve Well-Being Among Early-Career Faculty in Pediatric Critical Care Medicine.","authors":"L Nelson Sanchez-Pinto, Colleen M Badke, Linda Pololi","doi":"10.1097/PCC.0000000000003763","DOIUrl":"10.1097/PCC.0000000000003763","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e952-e954"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079210","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":"To Give or Not to Give? Corticosteroid Therapy in the Pediatric Cardiac ICU Is the Question.","authors":"Madeline J Wozniak, Sarah L Mayer, Jerry J Zimmerman","doi":"10.1097/PCC.0000000000003767","DOIUrl":"10.1097/PCC.0000000000003767","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e938-e940"},"PeriodicalIF":4.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12360499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209108","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":"Iron Deficiency Anemia in Children During and After PICU Admission.","authors":"Laura Butragueño-Laiseca, Lucía Alonso Rodriguez, María José Santiago Lozano","doi":"10.1097/PCC.0000000000003738","DOIUrl":"10.1097/PCC.0000000000003738","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e967-e968"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031529","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 PICU Data Collaborative: A Novel, Multi-Institutional, Pediatric Critical Care Dataset.","authors":"Reid W D Farris, Sareen S Shah, Tellen D Bennett, Stephanie R Brown, Timothy T Cornell, Adam C Dziorny, Alysia Flynn, Jocelyn Grunwell, Julia A Heneghan, Curt E Kennedy, Aleksandra Kretsu, Eneida Mendonca, Akira Nishisaki, Colin Rogerson, Daniel S Tawfik, Randall C Wetzel, L Nelson Sanchez-Pinto","doi":"10.1097/PCC.0000000000003758","DOIUrl":"10.1097/PCC.0000000000003758","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e941-e951"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12221772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022920","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 authors reply.","authors":"Ashley M Bach, Nicole K McKinnon, Hongming Zhuang, Elizabeth Kaufman, Matthew P Kirschen","doi":"10.1097/PCC.0000000000003766","DOIUrl":"10.1097/PCC.0000000000003766","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e965-e966"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128306","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":"Writing for Pediatric Critical Care Medicine: Reporting Clinical Trials Primary Results, Information, and Secondary Content.","authors":"Robert C Tasker","doi":"10.1097/PCC.0000000000003784","DOIUrl":"10.1097/PCC.0000000000003784","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"26 7","pages":"e955-e960"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144541821","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}