Journal of Pediatric Intensive Care最新文献

{"title":"Kindergarten Readiness Assessment Scores in Children who Received Early Life Mechanical Ventilation in the Pediatric Intensive Care Unit","authors":"Steven L. Shein, Alena D'Alessio, Lena Baker, Meredith Fischer, Robert Fischer, D. Wilson-Costello, A. Maddux, Francisca Garcia-Cobian Richter","doi":"10.1055/s-0044-1787671","DOIUrl":"https://doi.org/10.1055/s-0044-1787671","url":null,"abstract":"The impact of prolonged sedative medication usage on cognitive outcomes of young pediatric intensive care unit (PICU) patients has been incompletely assessed. We aim to assess the feasibility of linking an electronic medical record (EMR) system and a regional database to evaluate performance on standardized testing among PICU survivors. This is a single-center data-linkage study between EMR records and the Child and Household Integrated Longitudinal Data (CHILD) system, which links individual-level data across 35 administrative systems including Kindergarten Readiness Assessment (KRA) scores. The study was performed at a tertiary PICU in Cleveland, Ohio, United States with children born in 2011 or 2012 who received invasive mechanical ventilation and sedation before the age of 3 years in our PICU. We evaluated rate of “on-track” KRA scores, chronic absenteeism, and repeat kindergarten in the study population compared with a propensity score matched cohort from CHILD. Of 182 eligible PICU patients, 98 (54%) had a record identified in CHILD, and 32 had KRA scores available and sufficient data for propensity score matching. Compared with 160 matched controls, PICU patients had a lower rate of “on-track” scores (7/32 [22%] vs 102/160 [64%], p < 0.001) and more chronic absenteeism (14/32 [44%] vs. 34/160 [22%], p = 0.007). There was no difference in rates of repeat kindergarten (8/32 [25%] vs. 36/160 [23%], p  =  ;−0.759). We determined that linking hospital EMR records to regional databases is a feasible method to explore PICU outcomes. Additional studies are needed to confirm our preliminary finding of poor performance compared with matched controls.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141661718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harms Associated with Tracheal Reintubation After Unplanned Extubation: A Retrospective Cohort Study","authors":"Mathew P. Malone, I. Harwayne-Gidansky, Ron C Sanders, N. Napolitano, Jennifer Pham, L. Polikoff, Melinda Register, Keiko M. Tarquinio, Justine Shults, Conrad Krawiec, Palen M Mallory, Ryan K. Breuer, Asha N. Shenoi, K. Wollny, S. Parsons, Sarah B Kandil, M. Pinto, K. Gladen, Maya Dewan, A. L. Graciano, S. Nett, John S. Giuliano, Ashwin S. Krishna, Laurence Ducharme-Crevier, Andrea Talukdar, Jan Hau Lee, Michael Miksa, Anthony Y. Lee, Aziez Ahmed, Christopher Page-goertz, Philipp Jung, Briana L. Scott, Serena P. Kelly, Awni M. Al-Subu, Debbie Spear, Lauren Allen, Johnna Sizemore, Mioko Kasagi, Yuki Nagai, M. Toal, K. Biagas, Vinay Nadkarni, A. Nishisaki","doi":"10.1055/s-0044-1787858","DOIUrl":"https://doi.org/10.1055/s-0044-1787858","url":null,"abstract":"\u0000 Objective This study evaluates the clinical harm associated with tracheal intubation (TI) after unplanned extubation (UE) in the pediatric intensive care unit (ICU). We hypothesized that TI after UE is associated with a higher risk of adverse airway outcomes (AAOs), including peri-intubation hypoxia.\u0000 Methods A total of 23,320 TIs from 59 ICUs in patients aged 0 to 17 years from 2014 to 2020 from the National Emergency Airway Registry for Children (NEAR4KIDS) database were evaluated. AAO was defined as any adverse TI-associated event and/or peri-intubation hypoxia (SpO2 < 80%). UE trends were assessed over time. A multivariable logistic regression model was developed to evaluate the association between UE and AAO, while controlling for patient, provider, and practice confounders.\u0000 Results UE was reported as TI indication in 373 (1.6%) patients, with the proportion increasing over time: 0.1% in 2014 to 2.8% in 2020 (p < 0.001). TIs after UE versus TIs without preceding UE were more common in infants (62 vs. 48%, p < 0.001), males (63 vs. 56%, p = 0.003), and children with a history of difficult airway (17 vs. 13%, p = 0.03). After controlling for potential confounders, TI after UE was not significantly associated with AAO (adjusted odds ratio [aOR]: 1.26, 95% confidence interval [CI]: 0.99–1.62, p = 0.06). However, TI after UE was significantly associated with peri-intubation hypoxia (aOR: 1.35, 95% CI: 1.02–1.79, p = 0.03).\u0000 Conclusions UE is increasing as an indication for TI, and is more common in infants and children with a history of difficult airway. As TI after UE was associated with increased peri-intubation hypoxia, future study should focus on identifying causality and mitigating peri-intubation risk.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141661665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“It Would Be All-Consuming”: Community Parents' Perceptions of the Pediatric Intensive Care Unit","authors":"Kathryn A. Balistreri, Julia B Tager, Paulina S. Lim, W. H. Davies, S. Lerret, Kristin K. Magner, Matthew C. Scanlon, Charles B. Rothschild","doi":"10.1055/s-0044-1786768","DOIUrl":"https://doi.org/10.1055/s-0044-1786768","url":null,"abstract":"Parents of children hospitalized in the pediatric intensive care unit (PICU) may have expectations which could contribute to their emotional experiences both during and after hospitalization. This study aimed to evaluate community parents' knowledge and perceptions of the PICU to enhance understanding of preexisting concerns that may influence PICU experiences. English-speaking parents who had a child between the ages of 6 and 12 years old participated. Participants (n = 211) were mostly female (77%), white (72%), and married (72%). Participants completed an online survey regarding demographics and PICU knowledge. Participants were randomized to read a vignette in which a friend disclosed their child's PICU hospitalization either due to surgery, an accident, or chronic health condition. After reading the vignette, participants reported on the expected length of stay (LOS), survival expectations, and expected level of distress. Parents responded to open-ended questions regarding anticipated stressors, parent needs, and PICU resources. Parents overestimated the LOS and underestimated the survival rate. They expected PICU hospitalization to be highly distressing, primarily due to concerns about their hospitalized child, and that parents would need and have emotional support available to them. Parents may come into the PICU with preexisting concerns regarding medical outcomes. It is important that PICU providers assess for and address any parent misperceptions about their child's illness immediately upon admission and frequently throughout hospitalization. It is important to offer and encourage the use of psychosocial support services.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140963462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal Membrane Oxygenation: Rescue Therapy in Pediatric Bupropion Cardiotoxicity","authors":"T. Olives, Christopher N. Sweat, Lauren Dorsey-Spitz, Farbod Bahadori-Esfahani, A. Arens, Jon B. Cole, Arif Somani","doi":"10.1055/s-0044-1786769","DOIUrl":"https://doi.org/10.1055/s-0044-1786769","url":null,"abstract":"\u0000 Objective Our objective was to describe clinical characteristics and course of pediatric bupropion ingestions requiring extracorporeal membrane oxygenation (ECMO) life support.\u0000 Desgin The study included a retrospective cohort of patients ≤18 years of age reported to a regional poison control (PC) system covering three states in the upper Midwest United States. All bupropion exposures ≤18 years of age, coded as receiving ECMO to treat toxicity, were included. Clinical presentation and management including ECMO are presented as descriptive statistics.\u0000 Results During the study period, 4,951 bupropion exposures were reported; 1,145 (23.1%) were children. Nine patients were coded as undergoing ECMO; four (44.4%) were ≤18 years of age (median 16, range 14–17). All were treated with venoarterial ECMO. The median time from ingestion to presentation was 2.25 hours (range: 1–3.5). Median first systolic blood pressure and pulse were 100 mm Hg (range: 70–124) and 119.5 (range: 70–175). The median time from ingestion to ECMO was 17.63 hours (range: 7.25–33.75); median number of vasopressors was 2.5 (range: 2–3). All experienced multiple seizures, ventricular dysrhythmias, and hypotension. Three of four sustained cardiac arrest. All but one required transfer to an ECMO-capable facility for definitive care. Three patients survived with full neurologic recovery; one died.\u0000 Conclusion Pediatric bupropion cases requiring ECMO were rare in this study. Time to initiation and duration of EMCO suggest that the variable onset of hemodynamic instability may delay ECMO initiation. It is incumbent on PCs and medical toxicologists to educate prescribers and pediatricians about bupropion's potential lethality and to consider early transfer to an ECMO center.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140966094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social Disadvantage and Inequity in Access to Pediatric Critical Care Services for Children Living Remote from a Children's Hospital","authors":"Jordan L. Klein, M. Spaeder, Ayush Doshi, Gary Y. Fang, Deborah Jeannean Carver","doi":"10.1055/s-0044-1785668","DOIUrl":"https://doi.org/10.1055/s-0044-1785668","url":null,"abstract":"Regionalization of health care has created geographical distance between pediatric specialty services and children, with the potential for disparities in access to care. We investigated the association of state-level area deprivation index (S-ADI), a measure of socioeconomic disadvantage, and characteristics and outcomes in a cohort of children requiring unplanned hospital transfer to a quaternary care pediatric intensive care unit (PICU). We conducted a single-center retrospective cohort study of children requiring unplanned hospital transfer to the PICU at the University of Virginia Children's Hospital from July 1, 2019 to December 31, 2020, excluding planned transfers, transfers from another intensive care unit, and patients whose address could not be associated with an S-ADI. We collected demographic and clinical data as well as the S-ADI, an ordinal variable ranging from 1 to 10 with 10 representing the most disadvantage. We observed no differences in S-ADI based on patient sex, age, history of chronic medical conditions, or need for a medical device (tracheostomy, home ventilator, surgical feeding tube, cerebrospinal fluid shunt). We also did not observe differences in PICU or hospital length of stay based on S-ADI. We did observe for every one-point increase in S-ADI there was an associated increase of 8.6 miles (p < 0.001) in patient travel distance. Among patients from a higher S-ADI area, we observed increased severity of illness on PICU admission (p = 0.02) and case fatality as compared with patients from a lower S-ADI area (11 vs. 1.9%, p = 0.038). Children traveling the farthest for subspeciality pediatric critical care at our hospital had higher measures of socioeconomic disadvantage and severity of illness.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140661822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contributing Reviewers in 2023.","authors":"","doi":"10.1055/s-0044-1779501","DOIUrl":"https://doi.org/10.1055/s-0044-1779501","url":null,"abstract":"","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10987212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retraction Note: The Spiritual Dimension of Death: A Mini Review.","authors":"Hüseyin Çaksen","doi":"10.1055/s-0043-1774713","DOIUrl":"https://doi.org/10.1055/s-0043-1774713","url":null,"abstract":"<p><p>The above article published in <i>Journal of Pediatric Intensive Care</i> on November 21, 2022 (DOI: 10.1055/s-0042-1758739), has been retracted as it is lacking scientific base.</p>","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141451827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: A Clinical Mathematical Model Estimating Postoperative Urine Output in Children Underwent Cardiopulmonary By-pass for Congenital Heart Surgery","authors":"O. Baloglu, Shawn D Ryan, Ali M. Onder, David Rosen, Charles J. Mullett, Daniel S Munther","doi":"10.1055/s-0043-1776409","DOIUrl":"https://doi.org/10.1055/s-0043-1776409","url":null,"abstract":"","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138977031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Multicenter Retrospective Evaluation of Social Determinant of Health Z Code Usage among Pediatric Patients with Critical Care Visits during Pediatric Critical Care","authors":"Lisa Yoder, Duane Williams, Zizhong Tian, Chan Shen, Shouhao Zhou, Neal J. Thomas, Conrad Krawiec","doi":"10.1055/s-0043-1774719","DOIUrl":"https://doi.org/10.1055/s-0043-1774719","url":null,"abstract":"Abstract Social determinants of health (SDOH) diagnostic codes may facilitate the deployment of appropriate resources to improve patient outcomes, but their use in critically ill pediatric populations is unknown. Our study aims to examine SDOH codes usage hypothesizing that it is underutilized. This is a retrospective observational cohort study utilizing the TriNetX electronic health record database. We included subjects aged less than 18 years with critical care services billing codes and analyzed demographics, International Classification of Diseases, 10th edition diagnostic codes, and SDOH diagnostic codes 1 year before, during (7 days before and after), and 1 year after critical care services. We included 73,444 subjects (1,150 [1.6%] SDOH codes present during; 1,015 [1.4%] 1 year before; and 1,710 [2.3%] 1 year after critical care services) from 39 health care organizations. The most common SDOH diagnostic code utilized was “problems related to upbringing” (50.4%). SDOH diagnostic codes were consistently significantly associated with diagnostic codes related to seizures. SDOH diagnostic code presence was infrequent in critically ill pediatric patients. These findings may indicate not only the underutilization of SDOH diagnostic code but also the underrepresentation of SDOH prevalence in this patient population.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135059277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Central Venous Catheter Placement Skill Acquisition Through Apprenticeship Training in Clinical Context during Pediatric Critical Care Medicine Fellowship: A Longitudinal Study","authors":"Ryan J. Good, Kristen R. Miller, John L. Kendall, Angela S. Czaja","doi":"10.1055/s-0043-1775567","DOIUrl":"https://doi.org/10.1055/s-0043-1775567","url":null,"abstract":"Abstract Pediatric critical care medicine (PCCM) fellows must develop competence in central venous catheter (CVC) placement. The impact of experiential learning opportunities in the clinical context on PCCM fellow CVC placement skill acquisition remains unknown. We sought to measure femoral CVC placement skill acquisition during fellowship and compare fellow to attending skill. We performed a prospective observational cohort study of PCCM fellows at the University of Colorado from 2019 to 2021. Femoral CVC placement skill was measured by attending evaluation of level of the supervision (LOS) required for the fellow, and hand motion analysis (HMA) on simulation task trainer. Competence in femoral CVC placement was defined as LOS ≥ 4 (can perform this skill independently) on a 5-point Likert scale. We compared fellow skill in femoral CVC placement to years of training and number of femoral CVCs placed. We also compared third-year fellow and attending HMA measurements. We recruited 13 fellows and 6 attendings. Fellows placed a median of 8 (interquartile range 7, 11) femoral CVCs during the study period. All fellows who reached third-year of fellowship during the study period achieved competence. Longitudinal analysis demonstrated improvement in CVC placement skill by both LOS and HMA as years of fellowship and number of femoral CVCs placed increased. Few third-year fellows achieved attending level skill in femoral CVC placement as measured by HMA. PCCM fellows acquired skill in CVC placement during fellowship and achieved competence in the procedure, but most did not reach attending level of skill.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135059279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}