Pediatric Critical Care Medicine最新文献

{"title":"Parental Resolution of Infant Congenital Heart Disease and Bonding in the Pediatric Cardiac Intensive Care.","authors":"Tamar Bernstein, Efrat Sher-Censor, Uri Pollak","doi":"10.1097/PCC.0000000000004025","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004025","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate whether parental resolution of infants' congenital heart disease (CHD) diagnosis contributes to parent-infant bonding above and beyond psychological distress during hospitalization in a pediatric cardiac ICU (PCICU). The study focused on an understudied population of ultra-Orthodox Jews and Muslim-Arabs.</p><p><strong>Design: </strong>A cross-sectional study.</p><p><strong>Setting: </strong>PCICU; Hadassah University Medical Center, Israel.</p><p><strong>Subjects: </strong>Fifty-eight parents (43% fathers; 72% ultra-Orthodox Jewish; 28% Muslim-Arab) of 37 infants (Mdays = 65.22; sd = 84.61) hospitalized after cardiac surgery or catheterization.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements: </strong>Parents completed the Reaction to Diagnosis Questionnaire, the Postpartum Bonding Questionnaire, the Edinburgh Postnatal Depression Scale, and the posttraumatic stress disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and responded to an open-ended question about how infants' birth and medical condition affected their lives. Responses' coding included affect, crisis, growth, religious faith, and social support. Clinical data were extracted from infants' medical records.</p><p><strong>Main results: </strong>Resolution was associated with healthier bonding (r = -0.55; p < 0.001; higher bonding scores indicate impaired bonding). Depressive and PTSD symptoms correlated with poorer resolution (r = -0.47; p < 0.001 and r = -0.51; p < 0.001) and more impaired bonding (r = 0.44; p = 0.001 and r = 0.48; p < 0.001). Controlling for depressive and PTSD symptoms and diagnosis timing (prenatally vs. postpartum), resolution predicted healthier bonding (β = -0.35;i p = 0.032; ΔR2 = 0.08). Parents who expressed less negative affect and addressed personal growth in the open-ended question demonstrated better resolution and healthier bonding (p's < 0.029). Lack of reference to religious faith and framing the experience as a crisis were associated with more impaired bonding (p's < 0.037).</p><p><strong>Conclusions: </strong>Parental resolution of infants' CHD diagnosis may contribute to the formation of nurturing parent-infant relationships. Findings highlight the need for early psychological interventions for families facing a CHD diagnosis.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679518","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":"Variation in Patient Characteristics Across Pediatric Intermediate Care Units.","authors":"Alla L Smith, Michael S D Agus, Ekua Cobbina, Nicholas A Ettinger, Mirna Giordano, Taylor Jackvony, Michael Northrop, Amee Patel, Paul Scalici, Nathan Serazin, Matthew Hall","doi":"10.1097/PCC.0000000000004028","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004028","url":null,"abstract":"<p><strong>Objectives: </strong>This study describes pediatric intermediate care unit (PIMCU) and patient-level characteristics and the association of different PIMCU models with key patient and hospitalization outcomes.</p><p><strong>Design: </strong>Retrospective analysis of hospital admissions.</p><p><strong>Setting: </strong>Registry data from six PIMCUs in the U.S. Pediatric Health Information Systems database.</p><p><strong>Patients: </strong>All PIMCU hospitalizations from January 2022 to December 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements: </strong>Key demographic data, clinical characteristics, and outcomes were extracted.</p><p><strong>Main results: </strong>There were 8397 PIMCU encounters included from six units. All included PIMCUs had similar nurse staffing models and commonly cared for patients with respiratory illness. They all cared for a large percentage of patients with complex chronic conditions (CCC), ranging from 31.4% to 94.8%. Compared to high-complexity units (>75% of patients with a CCC; n = 2), mixed-complexity units (25-75% of patients with a CCC; n = 4) were more likely to source patients from the ED (45.1% vs. 20.2%) and prioritize high-acuity/low-complexity diagnoses. Mixed-complexity units had shorter hospital length of stays (median 3 vs. 8 d), lower readmission rates (11% vs. 20.8%), and lower ICU transfer rates (3.9% vs. 7.3%).</p><p><strong>Conclusions: </strong>Although all PIMCUs had similarities in nurse staffing, unit structure, and a focus on respiratory illness, we observed two PIMCU models: high-complexity and mixed-complexity units. These two unit types had distinct patient populations, reflecting different admissions practices, with high-complexity units more likely to admit ICU patients and technology-dependent patients. Units with higher CCC patient burden had significantly higher ICU transfer rates, readmission rates, and longer length of stay, associations that we hypothesize are a product of unit complexity. Further investigation is needed to understand the impact of these two PIMCU models on clinical outcomes and appropriate ICU-bed utilization. In the meantime, PIMCU patient composition could be considered when selecting unit benchmarks.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679494","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":"Interprofessional Staffing in Pediatric Critical Care: Secondary Analysis of a National Cross-Sectional Survey From 2022 to 2023.","authors":"Elizabeth G Broden Arciprete, Rebecca L Ford, Shelby L Blalock, Hannah Wunsch, Allan Garland, Deena K Costa, Hayley B Gershengorn, Nadir Ijaz","doi":"10.1097/PCC.0000000000003970","DOIUrl":"10.1097/PCC.0000000000003970","url":null,"abstract":"<p><strong>Objectives: </strong>The 2019 American Academy of Pediatrics recommendations for PICU and pediatric cardiac ICU (PCICUs) staffing are that it include intensivists, advanced practice providers (APPs), medical trainees, nurses, respiratory therapists (RTs), and pharmacy consultation. We have examined interprofessional staffing in U.S. pediatric critical care units in 2022-2023.</p><p><strong>Design: </strong>Secondary analysis of 2022-2023 data from a national survey of ICUs merged with the 2019 American Hospital Association database. We compared tertiary and quaternary unit staffing.</p><p><strong>Setting: </strong>U.S. tertiary and quaternary PICUs/PCICUs in 2022-2023.</p><p><strong>Patients: </strong>Pediatric patients.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We included 49 PICUs/PCICUs (11 tertiary, 38 quaternary) across 26 states: 19 of 49 were in children's hospitals, all were teaching hospitals, and 24 of 49 were considered \"large\" (16-30 beds). Intensivists were available in 48 of 49 units: onsite 24-hr/d in 37 of 49, worked 7 consecutive days in 32 of 49, and had no other clinical responsibilities during pediatric critical care service in 36 of 49. APPs (31/49), fellows (38/49), and residents (44/49) were available in many units. Nurses were assigned to care for one patient receiving mechanical ventilation in 21 of 49 units or two patients in 26 of 49 units. For noninvasive mechanical ventilation, a ratio of one nurse to two patients was most common (45/49). In 48 of 49 units RTs were available on all shifts. Pharmacists participated in care during weekday shifts in 44 of 49 units. Pharmacists participated in care on weeknights in 18 of 49 units, on weekend days in 29 of 49 units, and on weekend nights in 16 of 49 units. Compared with tertiary units, quaternary unit practice was associated with having more of the following: 24-hour intensivist coverage, APPs, fellows, and residents, RTs throughout all shifts, and more RTs without responsibilities outside the ICU throughout all shifts ( p < 0.05 for all).</p><p><strong>Conclusions: </strong>In this 2022-2023 national sample, pediatric intensivists, APPs, registered nurses, pharmacists, and RTs were available to care for critically ill children. Intensivist, APP, and RT staffing varied by PICU level.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"915-926"},"PeriodicalIF":4.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148034046","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":"Transpulmonary Pressure-Guided Ventilation in Pediatric Acute Respiratory Distress Syndrome: Methodological Challenges on the Path to Clinical Implementation.","authors":"Yukie Ito, Justin C Hotz, Daniel Chang, Robinder G Khemani","doi":"10.1097/PCC.0000000000003971","DOIUrl":"10.1097/PCC.0000000000003971","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1038-1040"},"PeriodicalIF":4.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278312","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":"Individualizing Positive End-Expiratory Pressure After Pediatric Cardiac Surgery Using Cardiopulmonary Physiology.","authors":"Shun Maki, Keisuke Nishida, Nobuhisa Gommori, Tatsutoshi Shimatani, Muneyuki Takeuchi","doi":"10.1097/PCC.0000000000003972","DOIUrl":"10.1097/PCC.0000000000003972","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1029-1030"},"PeriodicalIF":4.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295660","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":"Structured Interfacility Handoffs: How Do We Define Success?","authors":"Alan G Woodruff, Michael C McCrory","doi":"10.1097/PCC.0000000000003999","DOIUrl":"10.1097/PCC.0000000000003999","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1018-1021"},"PeriodicalIF":4.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295710","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 Chest That Fell Into Shadows: A Surgeon's Reflection on Pectus Deformity.","authors":"Rajkamal Vishnu","doi":"10.1097/PCC.0000000000003983","DOIUrl":"10.1097/PCC.0000000000003983","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1027-1028"},"PeriodicalIF":4.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148252698","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 Opportunity Index and 30-Day Readmission Among Children Discharged With New Long-Term Mechanical Ventilation via Tracheostomy: A Pediatric Health Information System Database Study, 2014-2023.","authors":"Lindsey L Scheller, Abbey Alkon, Thomas J Hoffmann, Sandra Staveski, Carolyn C Foster, Christopher J Russell","doi":"10.1097/PCC.0000000000003989","DOIUrl":"10.1097/PCC.0000000000003989","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the association between neighborhood-level social determinants of health (SDOH), as measured by the Child Opportunity Index (COI), and 30-day all-cause same-hospital readmission among children newly discharged on long-term mechanical ventilation via tracheostomy (LTMV-T).</p><p><strong>Design: </strong>Multicenter, retrospective cohort study.</p><p><strong>Setting: </strong>Forty-seven pediatric hospitals contributing data to the Pediatric Health Information System (PHIS) database.</p><p><strong>Patients: </strong>Children of 0-18 years old with newly used LTMV-T between 2014 and 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The COI is a composite measure of neighborhood-level SDOH, reported in quintiles (very low to very high opportunity). The primary outcome was 30-day all-cause same-hospital readmission, defined as the first observation or inpatient unit readmission to the index hospital where tracheostomy and ventilator initiation had occurred. Other clinical characteristics and demographic data were collected. Of the 5927 children identified in the PHIS database, 26% of children ( n = 1521) were readmitted within 30 days. Half of the cohort lived in very low- to low-opportunity neighborhoods. Multivariable mixed-effects models did not identify an association between 30-day readmission and living in lower compared with very high COI neighborhoods. Factors associated with lower odds (adjusted odds ratio [aOR; 95% CI]) of readmission were older age at discharge (e.g., ≥ 11 yr vs. < 6 mo; aOR, 0.64 [95% CI, 0.49-0.84]) and discharge to other health care facilities (vs. home discharge aOR, 0.64 [95% CI, 0.54-0.76]). Regarding length of stay, there was a 3% greater odds of readmission for every additional 30 days (aOR, 1.03 [95% CI, 1.01-1.04]).</p><p><strong>Conclusions: </strong>The PHIS database (2014-2023) shows that around one-in-four admissions discharged with new LTMV-T were readmitted within 30 days. However, we failed to identify an association between residence in lower compared with very high COI neighborhoods and 30-day readmission. Given the early readmission burden, future efforts should prioritize interventions to reduce hospital returns.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"976-985"},"PeriodicalIF":4.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265374","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":"Feasibility of Early Mobility During Pediatric Extracorporeal Membrane Oxygenation: Single-Center Retrospective Cohort Study, 2018-2024.","authors":"Alyssa Mueller, Brian Bridges, Melissa Danko, Daphne C Hardison, Katherine Hedden, Kristina A Betters","doi":"10.1097/PCC.0000000000003957","DOIUrl":"10.1097/PCC.0000000000003957","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the feasibility of a progressive early mobility (EM) protocol in PICU patients requiring support with extracorporeal membrane oxygenation (ECMO).</p><p><strong>Design: </strong>Single-center retrospective analysis of data from the 6-year period post-implementation of an EM protocol.</p><p><strong>Setting: </strong>Medical-surgical PICU within a standalone academic children's hospital in the United States.</p><p><strong>Patients: </strong>All PICU patients 0-18 years old supported on ECMO post-implementation of a unit-wide EM protocol (from June 2018 to July 2024).</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Sixty-two patients met inclusion criteria. Overall, 52 of 62 patients (84%) underwent EM while on ECMO, with 18 of 52 patients (35%) undergoing EM achieving at least level II or III activity. Of 23 long-duration ECMO patients (i.e., requiring ECMO for ≥ 10 d), 14 of 23 patients achieved level II or III activity. Of 297 unique EM sessions, signs of intolerance occurred in 18 of 297 sessions (6.1% [95% CI, 3.9-9.4%]); these occurred in ten of 52 unique patients (19.2% [95% CI, 10.8-31.9%). There were no serious adverse events attributable to EM (0/297; upper limit of the 95% CI, 1.0%). However, an EM session in one patient was followed by recognition of neurologic changes on examination and a new diagnosis of stroke.</p><p><strong>Conclusions: </strong>Over 6 years in our PICU (2018-2024), we found that implementation of a progressive multidisciplinary EM protocol during ECMO was feasible. Our data also provide local metrics for rate of mobilization and level of activity achieved, signs of intolerance, and serious adverse events.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"951-956"},"PeriodicalIF":4.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869100","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 authors reply.","authors":"Anil Sachdev, Anil Kumar, Bharat Mehra, Neeraj Gupta, Dhiren Gupta, Suresh Gupta","doi":"10.1097/PCC.0000000000003998","DOIUrl":"10.1097/PCC.0000000000003998","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1041-1042"},"PeriodicalIF":4.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295707","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}