Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies最新文献

{"title":"Understanding Detrimental Host Response to Infection-The Promise of Transcriptomics.","authors":"Luregn J Schlapbach, Lachlan Coin","doi":"10.1097/PCC.0000000000002870","DOIUrl":"https://doi.org/10.1097/PCC.0000000000002870","url":null,"abstract":"","PeriodicalId":520744,"journal":{"name":"Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies","volume":" ","pages":"133-135"},"PeriodicalIF":4.1,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39586428","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":"The March of the Normoxics: Hyperoxemia and Hemolysis During Cardiopulmonary Bypass.","authors":"John Glazebrook, Gail Annich","doi":"10.1097/PCC.0000000000002891","DOIUrl":"https://doi.org/10.1097/PCC.0000000000002891","url":null,"abstract":"","PeriodicalId":520744,"journal":{"name":"Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies","volume":" ","pages":"146-148"},"PeriodicalIF":4.1,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39586430","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":"Establishing Entrustable Professional Activities in Pediatric Cardiac Critical Care.","authors":"David K Werho,&nbsp;Aaron G DeWitt,&nbsp;Sonal T Owens,&nbsp;Mary E McBride,&nbsp;Sandrijn van Schaik,&nbsp;Stephen J Roth","doi":"10.1097/PCC.0000000000002833","DOIUrl":"https://doi.org/10.1097/PCC.0000000000002833","url":null,"abstract":"<p><strong>Objectives: </strong>Define a set of entrustable professional activities for pediatric cardiac critical care that are recognized as the core activities of the subspecialty by a diverse group of pediatric cardiac critical care physicians and that can be broadly and consistently applied irrespective of training pathway.</p><p><strong>Design: </strong>Mixed methods study with sequential integration of qualitative and quantitative data.</p><p><strong>Setting: </strong>Structured telephone interviews of pediatric cardiac critical care medical directors at Pediatric Cardiac Critical Care Consortium centers followed by an electronic survey of pediatric cardiac critical care physician members of the Pediatric Cardiac Intensive Care Society from across the United States and internationally.</p><p><strong>Subjects: </strong>Pediatric cardiac intensive care physicians.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Twenty-four of 26 eligible Pediatric Cardiac Critical Care Consortium medical directors participated in the interviews. Based on qualitative analyses of interview data, we identified an initial set of nine entrustable professional activities. Fifty-eight of 185 eligible physicians completed a subsequent survey asking them to rate their agreement with the entrustable professional activities. It showed consensus (> 80% agreement) with the entire initial set of entrustable professional activities, with greater than 96% agreement in most cases. The feedback from free-text survey responses was incorporated to generate a final set of entrustable professional activities.</p><p><strong>Conclusions: </strong>We generated a set of nine entrustable professional activities, which we believe can be broadly applied to any physician training in pediatric cardiac critical care, irrespective of individual training pathway. Next steps include incorporation of these entrustable professional activities into curriculum design and trainee assessment tools.</p>","PeriodicalId":520744,"journal":{"name":"Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies","volume":" ","pages":"54-59"},"PeriodicalIF":4.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39441510","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":"Temperature Management and Health-Related Quality of Life in Children 3 Years After Cardiac Arrest.","authors":"Aidan Magee,&nbsp;Rachel Deschamps,&nbsp;Carmel Delzoppo,&nbsp;Kevin C Pan,&nbsp;Warwick Butt,&nbsp;Misha Dagan,&nbsp;Anri Forrest,&nbsp;Siva P Namachivayam","doi":"10.1097/PCC.0000000000002821","DOIUrl":"https://doi.org/10.1097/PCC.0000000000002821","url":null,"abstract":"<p><strong>Objectives: </strong>Therapeutic hypothermia minimizes neuronal injury in animal models of hypoxic-ischemic encephalopathy with greater effect when used sooner after the insult. Clinical trials generally showed limited benefit but are difficult to perform in a timely manner. In this clinical study, we evaluated the association between the use of hypothermia (or not) and health-related quality of life among survivors of pediatric cardiac arrest as well as overall mortality.</p><p><strong>Design: </strong>Single-center, retrospectively identified cohort with prospective assessment of health-related quality of life.</p><p><strong>Setting: </strong>PICU of a pediatric hospital.</p><p><strong>Patients: </strong>Children with either out-of-hospital or in-hospital cardiac arrest from January 2012 to December 2017.</p><p><strong>Interventions: </strong>Patients were assigned into two groups: those who received therapeutic hypothermia at less than or equal to 35°C and those who did not receive therapeutic hypothermia but who had normothermia targeted (36-36.5°C). The primary outcome was health-related quality of life assessment and the secondary outcome was PICU mortality.</p><p><strong>Measurements and main results: </strong>We studied 239 children, 112 (47%) in the therapeutic hypothermia group. The median (interquartile range) of lowest temperature reached in the 48 hours post cardiac arrest in the therapeutic hypothermia group was 33°C (32.6-33.6°C) compared with 35.4°C (34.7-36.2°C) in the no therapeutic hypothermia group (p < 0.001). At follow-up, 152 (64%) were alive and health-related quality of life assessments were completed in 128. Use of therapeutic hypothermia was associated with higher lactate and lower pH at baseline. After regression adjustment, therapeutic hypothermia (as opposed to no therapeutic hypothermia) was associated with higher physical (mean difference, 15.8; 95% CI, 3.5-27.9) and psychosocial scores (13.6 [5.8-21.5]). These observations remained even when patients with a temperature greater than 37.5°C were excluded. We failed to find an association between therapeutic hypothermia and lower mortality.</p><p><strong>Conclusions: </strong>Out-of-hospital or in-hospital cardiac arrest treated with therapeutic hypothermia was associated with higher health-related quality of life scores despite having association with higher lactate and lower pH after resuscitation. We failed to identify an association between use of therapeutic hypothermia and lower mortality.</p>","PeriodicalId":520744,"journal":{"name":"Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies","volume":" ","pages":"13-21"},"PeriodicalIF":4.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39425569","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":"When Mission Is the Mission.","authors":"Kari Guffey","doi":"10.1097/PCC.0000000000002817","DOIUrl":"https://doi.org/10.1097/PCC.0000000000002817","url":null,"abstract":"","PeriodicalId":520744,"journal":{"name":"Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies","volume":" ","pages":"52-53"},"PeriodicalIF":4.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39275117","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":"Derivation and Validation of the Critical Bronchiolitis Score for the PICU.","authors":"Michael C Mount,&nbsp;Xinge Ji,&nbsp;Michael W Kattan,&nbsp;Katherine N Slain,&nbsp;Jason A Clayton,&nbsp;Alexandre T Rotta,&nbsp;Steven L Shein","doi":"10.1097/PCC.0000000000002808","DOIUrl":"https://doi.org/10.1097/PCC.0000000000002808","url":null,"abstract":"<p><strong>Objectives: </strong>To derive and internally validate a bronchiolitis-specific illness severity score (the Critical Bronchiolitis Score) that out-performs mortality-based illness severity scores (e.g., Pediatric Risk of Mortality) in measuring expected duration of respiratory support and PICU length of stay for critically ill children with bronchiolitis.</p><p><strong>Design: </strong>Retrospective database study using the Virtual Pediatric Systems (VPS, LLC; Los Angeles, CA) database.</p><p><strong>Setting: </strong>One-hundred twenty-eight North-American PICUs.</p><p><strong>Patients: </strong>Fourteen-thousand four-hundred seven children less than 2 years old admitted to a contributing PICU with primary diagnosis of bronchiolitis and use of ICU-level respiratory support (defined as high-flow nasal cannula, noninvasive ventilation, invasive mechanical ventilation, or negative pressure ventilation) at 12 hours after PICU admission.</p><p><strong>Interventions: </strong>Patient-level variables available at 12 hours from PICU admission, duration of ICU-level respiratory support, and PICU length of stay data were extracted for analysis. After randomly dividing the cohort into derivation and validation groups, patient-level variables that were significantly associated with the study outcomes were selected in a stepwise backward fashion for inclusion in the final score. Score performance in the validation cohort was assessed using root mean squared error and mean absolute error, and performance was compared with that of existing PICU illness severity scores.</p><p><strong>Measurements and main results: </strong>Twelve commonly available patient-level variables were included in the Critical Bronchiolitis Score. Outcomes calculated with the score were similar to actual outcomes in the validation cohort. The Critical Bronchiolitis Score demonstrated a statistically significantly stronger association with duration of ICU-level respiratory support and PICU length of stay than mortality-based scores as measured by root mean squared error and mean absolute error.</p><p><strong>Conclusions: </strong>The Critical Bronchiolitis Score performed better than PICU mortality-based scores in measuring expected duration of ICU-level respiratory support and ICU length of stay. This score may have utility to enrich interventional trials and adjust for illness severity in observational studies in this very common PICU condition.</p>","PeriodicalId":520744,"journal":{"name":"Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies","volume":" ","pages":"e45-e54"},"PeriodicalIF":4.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39183718","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":"Characteristics and Physiologic Changes After 4% Albumin Fluid Boluses in a PICU.","authors":"Ben Gelbart,&nbsp;Nick Fulkoski,&nbsp;David Stephens,&nbsp;Rinaldo Bellomo","doi":"10.1097/PCC.0000000000002809","DOIUrl":"https://doi.org/10.1097/PCC.0000000000002809","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the characteristics, hemodynamic, and physiologic changes after 4% albumin fluid boluses in critically ill children.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>Single-center PICU.</p><p><strong>Patients: </strong>Children in a cardiac and general PICU.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Between January 2017 and May 2019, there were 1,003 fluid boluses of 4% albumin during 420 of 5,731 admissions (7.8%), most commonly in children with congenital/acquired heart disease (71.2%) and sepsis (7.9%). The median fluid bolus dose was 10 mL/kg (interquartile range, 5.8-14.6 mL/kg), and its duration 30 minutes (interquartile range, 14.0-40.0 min; n = 223). After the fluid bolus, a significant change in mean arterial pressure (2.3 mm Hg [5.1%], 2.7 mm Hg [5.8%], 2.9 mm Hg [6.1%], and 3.8 mm Hg [8.0%] at 1, 2, 3, and 4 hr, respectively [p ≤ 0.001]) only occurred in children less than or equal to 12 months old. A mean arterial pressure response, defined by an increase greater than or equal to 10% from baseline, occurred in 290 of 887 patients (33%) with maximal response at 1 hour. Hypotension at baseline predicted the magnitude of mean arterial pressure increase at 60 (coefficient 24.3 [95% CI, 0.79-7.87]; p = 0.04) and 120 minutes (coefficient 26.1 [95% CI, 2.75-48.2]; p = 0.02). There were no biochemical or hematocrit changes within 4 hours of the fluid bolus. Urine output for the entire cohort was 2 mL/kg/hr at baseline and did not change with the fluid bolus.</p><p><strong>Conclusions: </strong>Fluid boluses of 4% albumin were common and predominantly in children with cardiac disease and sepsis with a median dose of 10 mL/kg given over half an hour. Such treatment was associated with significant hemodynamic changes only in children less than 12 months old, and we failed to identify an association with urine output.</p>","PeriodicalId":520744,"journal":{"name":"Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies","volume":" ","pages":"e10-e19"},"PeriodicalIF":4.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39184155","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":"Editor's Choice Articles for January.","authors":"Robert C Tasker","doi":"10.1097/PCC.0000000000002871","DOIUrl":"https://doi.org/10.1097/PCC.0000000000002871","url":null,"abstract":"","PeriodicalId":520744,"journal":{"name":"Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies","volume":" ","pages":"1-3"},"PeriodicalIF":4.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39791364","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 Is Time to Raise the Bar With a Board.","authors":"Paul A Checchia","doi":"10.1097/PCC.0000000000002864","DOIUrl":"https://doi.org/10.1097/PCC.0000000000002864","url":null,"abstract":"","PeriodicalId":520744,"journal":{"name":"Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies","volume":" ","pages":"74-75"},"PeriodicalIF":4.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39791366","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":"Editor's Choice Articles for December.","authors":"Robert C Tasker","doi":"10.1097/PCC.0000000000002867","DOIUrl":"https://doi.org/10.1097/PCC.0000000000002867","url":null,"abstract":"","PeriodicalId":520744,"journal":{"name":"Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies","volume":" ","pages":"1011-1012"},"PeriodicalIF":4.1,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39797098","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}