Pediatric Critical Care Medicine最新文献

{"title":"Writing for Pediatric Critical Care Medicine: Explanation of Authorship.","authors":"Robert C Tasker","doi":"10.1097/PCC.0000000000004014","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004014","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"27 8","pages":"1022-1026"},"PeriodicalIF":4.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679464","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":"Inflammatory Markers for Nosocomial Infections in Pediatric Extracorporeal Membrane Oxygenation: Single-Center Retrospective Cohort, 2017-2022.","authors":"Ethan L Gillett, Esma Birisci, J Blake Frazier, Michael H Stroud, Matthew P Malone","doi":"10.1097/PCC.0000000000003979","DOIUrl":"10.1097/PCC.0000000000003979","url":null,"abstract":"<p><strong>Objectives: </strong>To explore the diagnostic performance of WBC count, C-reactive protein (CRP), and procalcitonin in identifying nosocomial infections in pediatric patients supported with extracorporeal membrane oxygenation (ECMO).</p><p><strong>Design: </strong>Single-center retrospective cohort of pediatric patients supported with ECMO, from November 2017 to December 2022.</p><p><strong>Setting: </strong>PICU, neonatal ICU, and cardiac ICU in a Quaternary Children's Hospital.</p><p><strong>Patients: </strong>Critically ill patients age younger than 18 years supported with ECMO for greater than 24 hours.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We identified 154 ECMO runs involving 151 pediatric patients. New infections were detected in 63 of 154 ECMO runs (41%). There were eight of 1442 positive blood cultures (0.5%), nine of 617 positive urine cultures (1.4%), and 60 of 722 positive respiratory cultures (8.3%). Antibiotics were administered on 1217 ECMO days (84.7%), and 98.7% of the patients received more than 48 hours of antibiotics. On evaluating the diagnostic performance of tests for distinguishing new infection, using the area under the receiver operating characteristic curve (AUC, with 95% CI), we found that both CRP and procalcitonin had poor diagnostic accuracy, respectively (AUC, 0.66; 95% CI, 0.60-0.72 and AUC, 0.62; 95% CI, 0.53-0.72). The WBC showed no discrimination with AUC 0.51 (95% CI, 0.44-0.57). Notably, a procalcitonin value less than 1.77 ng/mL had a 95% negative predictive value (NPV), CRP less than 36.5 mg/L had a 97% NPV, and WBC less than 11.02 K/µL had a 95% NPV.</p><p><strong>Conclusions: </strong>In our retrospective, exploratory evaluation of nosocomial infection in ECMO patients (2017-2022), no laboratory marker demonstrated adequate discriminative ability for indicating the presence of infection. However, normal values for these markers may help clinicians decide whether unnecessary antibiotic treatment can be reduced and whether surveillance cultures can be eliminated in pediatric patients on ECMO.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"967-975"},"PeriodicalIF":4.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212073","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":"I-PASS-to-PICU: A Structured Handoff Program to Improve Interfacility Referral Communication for PICU Transfer.","authors":"Nehal R Parikh, Madhuradhar Chegondi, Jessica P Liu, Shilpa C Balikai, Mitchell A Luangrath, Kimberly L Beasley, Irene Pantekidis, Heather R Elmore, Jennifer Erdahl, Aditya Badheka, Heather Schacht Reisinger, Kathryn P Gray, Christopher P Landrigan, Christina L Cifra","doi":"10.1097/PCC.0000000000003988","DOIUrl":"10.1097/PCC.0000000000003988","url":null,"abstract":"<p><strong>Objectives: </strong>Interfacility transfers from frontline settings to the PICU can place children at risk for harm due to handoff miscommunication. We aimed to evaluate the effectiveness of a structured interfacility handoff program in improving communication between referring and receiving clinicians and across the PICU admitting team.</p><p><strong>Design: </strong>Prospective intervention study using a mixed-methods approach (surveys, chart review, and semistructured interviews) before and after I-PASS-to-PICU implementation.</p><p><strong>Setting: </strong>Academic tertiary referral PICU.</p><p><strong>Patients: </strong>Children of 0-18 years old referred by external hospitals for urgent PICU admission.</p><p><strong>Intervention: </strong>Structured handoff program (I-PASS-to-PICU) based on elements of high-quality handoffs adapted for interfacility PICU transfers.</p><p><strong>Measurements and main results: </strong>A total of 220 patients were included (110 preintervention and 110 postintervention). Multivariable regression analysis adjusting for potential confounders showed no association between use of I-PASS-to-PICU and receiving PICU physician reports of key handoff information omissions (OR, 0.92; 95% CI, 0.30-2.82; p = 0.88 ). However, there was a decrease in the proportion of admitting PICU staff per patient who did not receive key handoff information (mean, 16% [ sd , 21%]; preintervention, 10% [ sd , 16%] vs. postintervention; p = 0.032). There were also more patients for whom receiving PICU physicians reported being well-prepared before admission (95% preintervention vs. 100% postintervention; p = 0.026). Postintervention, 94 patients (86%) had a completed I-PASS-to-PICU note; however, only a median of 50% (IQR, 34-66%) of admitting PICU staff per patient viewed the note before admission. Stakeholders identified barriers and facilitators of I-PASS-to-PICU implementation.</p><p><strong>Conclusions: </strong>A structured interfacility handoff program improved communication of key information across PICU admitting team members and increased reported preparedness of receiving PICU physicians. Identified barriers and facilitators of implementation can be used to inform, redesign, and adapt this program for uptake and use in other PICUs.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"939-950"},"PeriodicalIF":4.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295734","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":"Extracorporeal-Cardiopulmonary Resuscitation Deployment in the Pediatric Emergency Department Setting: 2000-2023 Report For the American Heart Association's Get With the Guidelines®-Resuscitation Investigators.","authors":"Gurpreet S Dhillon, Tia T Raymond, Aarti C Bavare, Kyle S Bilodeau, Priscilla Yu, Monique M Gardner, Cara Doughty, Aaron Donoghue, Saket Girotra, Javier J Lasa","doi":"10.1097/PCC.0000000000003987","DOIUrl":"10.1097/PCC.0000000000003987","url":null,"abstract":"<p><strong>Objectives: </strong>Pediatric in-hospital cardiac arrest (IHCA) events leading to extracorporeal cardiopulmonary resuscitation (E-CPR) most often occur in the ICU in cardiac patients. Since there is little information about using E-CPR for pediatric IHCA in the emergency department (ED), we aimed to describe this population.</p><p><strong>Design: </strong>The American Heart Association's Get With the Guidelines-Resuscitation (GWTG-R) registry of pediatric IHCA, 2000-2023, a retrospective study.</p><p><strong>Setting: </strong>EDs in hospitals contributing to the GWTG-R registry.</p><p><strong>Patients: </strong>Children less than 18 years old experiencing index IHCA events in the ED where E-CPR was deployed to achieve return of circulation (ROC). Only cardiac and noncardiac illness categories were included.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We identified 51 children with a median (interquartile range [IQR]) age of 2 years (IQR, 0.3-5 yr). Pulseless electrical activity was the initial pulseless rhythm in 24 of 46 patients (52%), and pulseless ventricular tachycardia in four of 46 patients (9%). Median CPR duration was 68 minutes (IQR, 48-92 min), with a median number of epinephrine doses being 12 (IQR, 7-19). Nonsurvival vs. survival was associated with greater use of IV calcium (28/30 vs. 8/12; difference 35% [95% CI, 8.2-58.2%]; p = 0.01). Overall survival was 17 of 51 (33.3% [95% CI, 22.0-47.0%]). Cardiac, as opposed to noncardiac underlying diagnosis, was associated with a higher percentage of successful E-CPR with ROC (26/27 vs. 18/24; difference, 21% [95% CI, 1.8-45%]; p = 0.025).</p><p><strong>Conclusions: </strong>In the GWTG-R registry of pediatric IHCA, covering 23 years, E-CPR deployment for IHCA in the ED was reported 51 times. Overall survival to discharge occurred in one-third of cases. We also noted that an underlying cardiac disorder was associated with higher proportions achieving ROC and discharge survival. Further studies are needed to better understand this population and see whether there are missed opportunities in the ED, beyond the median of one case per year, when E-CPR could have been deployed.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"927-938"},"PeriodicalIF":4.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361993","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":"Validation of Minimally Invasive and Noninvasive Hemodynamic Monitoring in Adolescents: The Pediatric Cardiac Output Monitoring Observational (POGO) Study.","authors":"Sebastian C Tume, Michael L O'Byrne, Curt Fudge, Marc M Anders, Dipankar Gupta","doi":"10.1097/PCC.0000000000003986","DOIUrl":"10.1097/PCC.0000000000003986","url":null,"abstract":"<p><strong>Objectives: </strong>Minimally invasive cardiac output (CO) monitoring technologies lack validation in the adolescent population. We aimed to test the accuracy and precision of the FloTrac arterial pressure cardiac output (APCO) and ClearSight photoplethysmography cardiac output (PPGCO; Edwards Lifesciences, Irvine, CA) technologies in adolescents undergoing elective cardiac catheterization.</p><p><strong>Design: </strong>Prospective, single-arm, nonrandomized, observational study.</p><p><strong>Setting: </strong>Cardiac catheterization laboratory at three freestanding pediatric hospitals in the United States.</p><p><strong>Patients: </strong>Adolescent patients 12-18 years of age undergoing surveillance cardiac catheterization after heart transplantation.</p><p><strong>Interventions: </strong>Swan-Ganz pulmonary artery catheterization with the intermittent thermodilution CO (iCO) technique was used as the gold standard for CO measurements. APCO was measured using an existing femoral arterial sheath, and PPGCO was measured utilizing a volumetric cuff placed on the finger of the upper extremities. Two sets of simultaneous iCO, APCO, and PPGCO measurements were compared. Bias and level of concordance were assessed using Bland-Altman analysis.</p><p><strong>Measurements and main results: </strong>Out of the 89 subjects enrolled, 73 underwent measurements and provided a total of 60 sets of measurements for each device. The median age was 16 years (interquartile range [IQR], 14-17 yr) with a median body surface area of 1.6 m2 (IQR, 1.5-1.8 m2). The median averaged intermittent cardiac index was 2.7 L/min/m2 (IQR, 2.3-3.1 L/min/m2). FloTrac APCO mean bias was 0.32 L/min/m2 (IQR, 0.20-0.44 L/min/m2) with a precision of 0.70 L/min/m2 (IQR, 0.58-0.82 L/min/m2). ClearSight PPGCO mean bias was 0.28 L/min/m2 (95% CI, 0.16-0.41 L/min/m2) with a precision of 0.71 L/min/m2 (95% CI, 0.59-0.84 L/min/m2). No serious adverse events were reported related to the devices.</p><p><strong>Conclusions: </strong>The minimally and noninvasive CO measurements with FloTrac and ClearSight APCO show acceptable bias and precision under standardized elective clinical conditions in an adolescent pediatric population, making them useful tools in the routine clinical management of critically ill children.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"27 8","pages":"986-997"},"PeriodicalIF":4.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679458","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":"Ventricular Arrhythmias During Extracorporeal Circulatory Support for Cardiac Indications: Outcomes in a Single-Center Retrospective Cohort, 2020-2023.","authors":"William F Patten, Eric S Silver, Eva W Cheung","doi":"10.1097/PCC.0000000000003958","DOIUrl":"10.1097/PCC.0000000000003958","url":null,"abstract":"<p><strong>Objectives: </strong>Venoarterial extracorporeal membrane oxygenation (ECMO) can be used for pediatric patients in heart failure because of congenital or acquired heart disease. Even though these patients are at risk of arrhythmias, data are limited regarding the prevalence and types of arrhythmias, and their association with adverse outcomes. We present our single-center experience of arrhythmia during pediatric cardiac ECMO support, and the associated outcomes.</p><p><strong>Design: </strong>Single-center, retrospective cohort, 2020-2023.</p><p><strong>Setting: </strong>Cardiac ICU in a quaternary care center in New York.</p><p><strong>Patients: </strong>Pediatric patients requiring ECMO for cardiac indications, including extracorporeal cardiopulmonary resuscitation, cardiogenic shock, hypoxemia secondary to lack of pulmonary blood flow, or inability to wean from cardiopulmonary bypass.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We identified 74 patients undergoing 83 ECMO runs during 2020-2023. Arrhythmias occurred in 27 of 83 ECMO runs (33% [95% CI, 23-44%]), including ventricular arrhythmias in 14 of 83 runs (17%). We did not identify an association between any arrhythmia while on ECMO support and death or heart transplantation. However, ventricular arrhythmias were associated with greater hazard (using hazard ratio [HR]) of death or heart transplantation (HR, 5.7 [95% CI, 1.2-27.8]; p = 0.03). Similarly, we failed to identify an association between any arrhythmia on ECMO and wean failure ( p = 0.09); however, ventricular arrhythmias on ECMO were associated with greater hazard of wean failure (HR, 18.8 [95% CI, 2.9-121]; p = 0.002). Any arrhythmia on ECMO was also associated with longer ECMO duration (189 vs. 90.1 hr; p < 0.001), particularly ventricular arrhythmias (335 vs. 94 hr; p < 0.001).</p><p><strong>Conclusions: </strong>In our 2020-2023, single-center experience in pediatric cardiac cases requiring venoarterial ECMO support for cardiac failure, the prevalence of arrhythmias was substantial (one-in-three ECMO runs). Of note, ventricular arrhythmias on ECMO were associated with greater hazard of transplant-free survival, ECMO wean failure, and prolonged ECMO duration.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"957-966"},"PeriodicalIF":4.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840733","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":"Cecilia Korb, Polyxeni Mantziari, Janos Schnur, Veronika Maraczi, Barbara Szasz, Jon Lillie","doi":"10.1097/PCC.0000000000003997","DOIUrl":"10.1097/PCC.0000000000003997","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1036-1037"},"PeriodicalIF":4.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405391","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":"But First, We Must Understand the Need.","authors":"Lauren R Sorce","doi":"10.1097/PCC.0000000000003991","DOIUrl":"10.1097/PCC.0000000000003991","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1011-1013"},"PeriodicalIF":4.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148219219","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":"Correspondence About: Multisite Venovenous Extracorporeal Membrane Oxygenation in Pediatric Patients Under 15 kg: Three-Center, Analysis of Surgical Versus Percutaneous Approach and Thrombosis Risk, 2017-2024.","authors":"Fevzi Kahveci, Tanil Kendirli","doi":"10.1097/PCC.0000000000003973","DOIUrl":"10.1097/PCC.0000000000003973","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1034-1035"},"PeriodicalIF":4.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405410","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":"Jan C Clausen, Michael Emeis, Richard Hollander, Robert G T Blokpoel, Martin C J Kneyber","doi":"10.1097/PCC.0000000000003996","DOIUrl":"10.1097/PCC.0000000000003996","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1031-1033"},"PeriodicalIF":4.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295866","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}