Pediatric Critical Care Medicine最新文献

{"title":"Focal Cerebral Injury in Pediatric Extracorporeal Life Support: Timing in Relation to Cannulation or Other Circuit Events in a Single-Center Retrospective Series, 2015-2023.","authors":"Mauro Caffarelli, Yi Li, Edilberto Amorim, Kathryn Finlay, Elan L Guterman, Giulia Benedetti, Craig A Press, Dana Harrar, Ajay X Thomas, Martina Steurer, Loren D Sacks, Christine K Fox","doi":"10.1097/PCC.0000000000003736","DOIUrl":"10.1097/PCC.0000000000003736","url":null,"abstract":"<p><strong>Objectives: </strong>To review the timing of extracorporeal life support (ECLS)-related focal cerebral injury (FCI) in relation to circuit interruptions in children and young adults.</p><p><strong>Design: </strong>Retrospective study from January 1, 2015, to December 31, 2023.</p><p><strong>Setting: </strong>Single-center academic children's hospital.</p><p><strong>Patients: </strong>Children and young adults younger than 21 years old who had neuroimaging during or after ECLS. Multiple ECLS runs in individual patients were analyzed as distinct runs.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>FCI was radiographically defined as lateralized ischemia or hemorrhagic parenchymal brain injury greater than 1 cm 3 or as subdural hemorrhage causing midline shift. Timing of clinical FCI documentation was abstracted from chart review and based on times of new-onset focal neurologic examination findings, focal electroencephalography findings, or incidental discovery on imaging. In instances of FCI, electroencephalography reports and inpatient progress notes were reviewed to identify electroencephalography-related timing of FCI. Institutional ECLS registry data were used to identify times of circuit events (i.e., cannulation, decannulation, and circuit interruptions). The probable time course of FCI after circuit events was evaluated in the ECLS runs with an imaging diagnosis of FCI, and summarized using cumulative distribution with 95% CI. In 101 ECLS runs in 94 patients with brain imaging, 20 had FCI: ischemic stroke in 12, intraparenchymal hemorrhage in six, and subdural hemorrhage with midline shift in two. Eighteen FCIs were documented within 48 hours of a circuit event. Among 13 FCIs with electroencephalography recording at the time of FCIs, eight had new-onset subclinical electroencephalography abnormality as the initial documented sign of FCI. The presence of FCI vs. not was associated with lower survival to decannulation ( p = 0.007).</p><p><strong>Conclusions: </strong>In this single-center retrospective series, 2015-2023, the majority of ECLS-related FCIs were evident within 48 hours of ECLS cannulation, decannulation, or circuit interruption. These events warrant increased surveillance for neurologic complications.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e900-e908"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753776","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":"Nuclear Medicine Cerebral Perfusion Studies as an Ancillary Test to Support Evaluation of Brain Death/Death by Neurologic Criteria.","authors":"Lionel S Zuckier","doi":"10.1097/PCC.0000000000003747","DOIUrl":"10.1097/PCC.0000000000003747","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e963-e964"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041828","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":"\"Just Take the Two Minutes\".","authors":"May Shum","doi":"10.1097/PCC.0000000000003768","DOIUrl":"10.1097/PCC.0000000000003768","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e961-e962"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019556","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 Rapid Ultrasound for Shock and Hypotension Phenotype Differentiation in the Emergency Department: Evaluation of Feasibility and Reliability in a Malawi Cohort.","authors":"Roxanne Assies, Yamikani Chimalizeni, Mercy Kumwenda, Harriet Khofi, Josephine Langton, Job B M van Woensel, Job C J Calis","doi":"10.1097/PCC.0000000000003735","DOIUrl":"10.1097/PCC.0000000000003735","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the feasibility, reliability, and diagnostic implications of performing the pediatric Rapid Ultrasound for Shock and Hypotension (p-RUSH) in children with undifferentiated shock upon hospital presentation in a low-resource setting (LRS).</p><p><strong>Design: </strong>Prospective observational study from February 2019 to December 2019.</p><p><strong>Setting: </strong>Pediatric emergency department (ED) of a large academic referral hospital in Blantyre, Malawi.</p><p><strong>Patients: </strong>Children (2 mo to 16 yr old) with shock upon presentation to the pediatric ED.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Thirty children with shock were enrolled, of whom 14 died. The p-RUSH was performed upon admission to the ED, before administration of an IV fluid bolus. The p-RUSH was performed within a median time of 11.5 minutes, and 92.3% of the image frames in 4-second video clips were interpretable. Images were scored by two independent reviewers and the qualitative and quantitative assessments were compared and showed positive correlations as follows: 1) qualitative assessments of cardiac performance vs. left ventricle ejection fraction and fractional shortening measurements ( r = 0.684 and r = 0.616, respectively, both p < 0.05) and 2) qualitative assessment of inferior vena cava (IVC) collapsibility vs. IVC collapsibility index ( r = 0.470; p < 0.05). The interobserver agreement between cardiac and IVC qualitative assessments yielded a kappa statistic of up to 0.850 (cardiac views) and 0.275 (IVC collapsibility). Both reviewers applied a novel algorithmic flow diagram to diagnose the shock phenotype. In 23 of 30 children, the flowchart could be completed, which suggested either hypovolemic or distributive shock as the most common phenotype.</p><p><strong>Conclusions: </strong>In a Malawian pediatric ED, the p-RUSH was feasible and qualitative assessments were reliable. This 2019 proof-of-concept test provides a basis for further external validation of the p-RUSH and our algorithm for identifying shock phenotypes, which may lead to individualizing care of children presenting with shock in LRSs.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e867-e876"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12212470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753807","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":"External Validation of the Phoenix Sepsis Score in a Single Pediatric Cardiac ICU.","authors":"Marie C Baker, Michael C Spaeder","doi":"10.1097/PCC.0000000000003748","DOIUrl":"10.1097/PCC.0000000000003748","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e862-e863"},"PeriodicalIF":4.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803915","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":"Use of the Area Under the Precision-Recall Curve to Evaluate Prediction Models of Rare Critical Illness Events.","authors":"Blake Martin, Tellen D Bennett, Peter E DeWitt, Seth Russell, L Nelson Sanchez-Pinto","doi":"10.1097/PCC.0000000000003752","DOIUrl":"10.1097/PCC.0000000000003752","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e855-e859"},"PeriodicalIF":4.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025324","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":"Time Course of Kidney Injury Biomarkers in Children With Septic Shock: Nested Cohort Study Within the Pragmatic Pediatric Trial of Balanced Versus Normal Saline Fluid in Sepsis Trial.","authors":"Scott L Weiss, Julie C Fitzgerald, Benjamin L Laskin, Ruchi Singh, Amanda S Artis, Ananya Vohra, Elena Tsemberis, Emem Kierian, Kristen C Lau, Atzael B Campos, Christopher Hickey, Katie L Hayes, Daniel Singleton, Elliot Long, Franz E Babl, Stuart R Dalziel, Graham C Thompson, Stephen B Freedman, Michelle Eckerle, Robert W Hickey, Jing Huang, Nathan Kuppermann, Fran Balamuth","doi":"10.1097/PCC.0000000000003737","DOIUrl":"10.1097/PCC.0000000000003737","url":null,"abstract":"<p><strong>Objective: </strong>Severe acute kidney injury (AKI) portends poor outcomes in pediatric sepsis. We evaluated the trajectory and prognostic utility of AKI biomarkers in pediatric septic shock using a subset of participants in the ongoing Pragmatic Pediatric Trial of Balanced vs. Normal Saline Fluid in Sepsis (PRoMPT BOLUS) trial, NCT04102371. We tested whether fluid volume is associated with persistent elevation of urine neutrophil gelatinase-associated lipocalin (Ur-NGAL).</p><p><strong>Design: </strong>Prospective, non-prespecified cohort study within the PRoMPT BOLUS trial.</p><p><strong>Setting: </strong>Three children's hospitals in the United States.</p><p><strong>Patients: </strong>Four hundred seventy-eight patients aged 2 months to younger than 18 years old with septic shock.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Ur-NGAL, kidney injury molecule-1, liver fatty acid binding protein, and interleukin-18 and plasma cystatin C were collected at presentation (T1), days 2-3 (T2), and before discharge/death (T3). At presentation, 418 (88%) had no or only stage 1 AKI and 60 (12%) had stage 2/3 AKI defined using Kidney Disease Improving Global Outcomes creatinine thresholds. All biomarkers were higher with stage 2/3 compared with no/stage 1 AKI at T1 and T2, but only cystatin C remained higher at T3. Among patients with no/stage 1 AKI at presentation, those with Ur-NGAL greater than or equal to 150 vs. less than 150 ng/mL had fewer hospital-free days (21 [interquartile range (IQR) 15-24] vs. 23 d [IQR 19-25], p = 0.05). After applying inverse probability treatment weighting to balance covariates, 14% of patients who received greater than 100 mL/kg within 48 hours had persistently elevated Ur-NGAL over time compared with 6% who received 40-100 mL/kg (odds ratio 2.7 [95% CI, 1.1-6.2]). Hospital-free days were no different across fluid volume groups.</p><p><strong>Conclusions: </strong>Although kidney injury biomarkers mirrored serum creatinine in children with septic shock, elevated Ur-NGAL identified a subset with subclinical AKI with fewer hospital-free days despite no/stage 1 AKI by creatinine. Children receiving greater than 100 mL/kg fluid had greater odds of early and persistently elevated Ur-NGAL, suggesting high fluid volumes may perpetuate initial kidney damage.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e816-e826"},"PeriodicalIF":4.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764037","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":"Sodium Bicarbonate in Cardiac Arrest: A True Harm or a Bystander of Prolonged Resuscitation?","authors":"Lindsay N Shepard, Justine Shults, Akira Nishisaki","doi":"10.1097/PCC.0000000000003755","DOIUrl":"10.1097/PCC.0000000000003755","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e835-e838"},"PeriodicalIF":4.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011623","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 Prevalence and Outcome of Acute Hypoxemic Respiratory Failure (PANDORA) Study in Mechanically Ventilated Children: Prospective Multicenter Epidemiology in Spain, 2019-2021.","authors":"Yolanda M López-Fernández, Amelia Martínez-de-Azagra, Susana B Reyes-Domínguez, Ana Gómez-Zamora, Laura Herrera-Castillo, Ana Coca-Pérez, Julio Parrilla-Parrilla, Alberto Medina, Juan P García-Iñiguez, Marta Brezmes-Raposo, Alexandra Hernández-Yuste, Ana M Llorente de la Fuente, Ignacio Ibarra de la Rosa, José S León-González, Javier Trastoy-Quintela, David Arjona-Villanueva, Jesús M González-Martín, Tamas Szakmany, Jesús Villar","doi":"10.1097/PCC.0000000000003743","DOIUrl":"10.1097/PCC.0000000000003743","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the epidemiology and outcome of children with acute hypoxemic respiratory failure (AHRF) and/or pediatric acute respiratory distress syndrome (PARDS).</p><p><strong>Design: </strong>Prospective, observational study in six nonconsecutive 2-month blocks form October 2019 to September 2021.</p><p><strong>Setting: </strong>A network of 22 PICUs in Spain.</p><p><strong>Patients: </strong>Consecutive children (7 d to 15 yr old) with a diagnosis of AHRF, defined by Pa o2 /F io2 ratio less than or equal to 300 mm Hg, who needed invasive mechanical ventilation (IMV) using positive end-expiratory pressure (PEEP) greater than or equal to 5 cm H 2 O and F io2 greater than or equal to 0.3.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The primary outcomes were AHRF prevalence and PICU mortality. The secondary outcomes were the prevalence of IMV with PARDS (IMV-PARDS) and the use of adjunctive therapies. There were 6545 PICU admissions: 1374 (21%) underwent IMV and 181 (2.8%) had AHRF. Ninety-one patients (1.4% of PICU admissions, 6.6% of IMV cases, and 50.3% of AHRF cases) met the Second Pediatric Acute Lung Injury Consensus Conference IMV-PARDS criteria. At baseline, mean (± sd ) tidal volume was 7.4 ± 1.8 mL/kg ideal body weight, PEEP 8.4 ± 3.1 cm H 2 O, F io2 0.68 ± 0.23, and plateau pressure 25.7 ± 6.3 cm H 2 O. Unlike patients with PARDS, adjunctive therapies were used infrequently in non-PARDS AHRF patients. AHRF patients without PARDS had more ventilator-free days than PARDS patients (16.4 ± 9.4 vs. 11.2 ± 10.5; p = 0.002). All-cause PICU mortality in AHRF cases was higher in PARDS vs. non-PARDS patients (30.8% [95% CI, 21.5-41.3] vs. (14.4% [95% CI, 7.9-23.4]; p = 0.01).</p><p><strong>Conclusions: </strong>In our 2019-2021 PICU population, the prevalence of AHRF is 2.8% of IMV cases. Of such patients, the prevalence of PARDS was 50.3%, and there was a 30.8% mortality, which was higher than in cases of AHRF without PARDS.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e759-e772"},"PeriodicalIF":4.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018642","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":"Themes in the Management of Pediatric Brain Death Contestation: Exploratory Qualitative Work From Multidisciplinary Health Professionals in the United States.","authors":"Erica Andrist, Janice I Firn, Matthew P Kirschen, Nneka O Sederstrom, Alexander A Kon, Jessica C Fowler, Amy H J Wolfe, Mary E McIlroy, Andrew Kiragu, Wynne E Morrison, Ken Tegtmeyer, Kenya Agarwal, Thaddeus M Pope, Christian J Vercler, Denise Winiarski, Nancy McGowan, Steven M Leber, Christopher L Carroll, Heidi R Flori","doi":"10.1097/PCC.0000000000003744","DOIUrl":"10.1097/PCC.0000000000003744","url":null,"abstract":"<p><strong>Objectives: </strong>To explore health professionals' experiences of contested pediatric brain death/death by neurologic criteria (BD/DNC) cases, including factors contributing to conflict, resource needs and utilization, perceived utility of supports available, and case resolution and aftermath.</p><p><strong>Design and methods: </strong>Inductive thematic analysis of semistructured interviews with members of the Society of Critical Care Medicine (SCCM) Contestation of Pediatric Brain Death Task Force.</p><p><strong>Setting: </strong>Ten institutions across seven U.S. states and the District of Columbia.</p><p><strong>Participants: </strong>Nineteen Task Force members were interviewed in 2023, including pediatric intensivists, neurologists, nurses, respiratory therapists, attorneys, palliative care clinicians, social workers, ethicists, and hospital leadership. Task Force members were recruited primarily because of their experience with contested BD/DNC, although some were recruited because of expertise in other relevant topics, such as communication, information acquisition in BD/DNC, and health equity.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We identified five themes relevant to managing pediatric BD/DNC contestation: 1) personnel to consider involving, including subspecialty consultation, social work, hospital leadership and administration, ethics teams, legal counsel, and security; 2) timelines to maintain, including factors to consider when deciding the most appropriate family accommodations; 3) support for families and patients, including strategies to enhance communication, identifying and mitigating mistrust, and connecting families with support both within and outside the hospital; 4) support for staff, including disseminating information throughout the care team, staff support for one another, and establishing written documentation and policies; and 5) complementary strategies that may augment approaches to BD/DNC contestation, such as policies addressing requests for potentially inappropriate treatment.</p><p><strong>Conclusions: </strong>Family contestation of pediatric BD/DNC challenges all parties involved. The five themes identified from our qualitative analysis of interviews with experienced professionals do not constitute SCCM clinical practice guidance, but they will be used to inform the development of approaches to BD/DNC contestation through further scholarship and community consultation.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e846-e854"},"PeriodicalIF":4.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011626","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}