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":"Fibrinolysis in Pediatric Sepsis: A Viable Target for Therapy or Merely an Indicator of Outcome?","authors":"Robert I Parker","doi":"10.1097/PCC.0000000000002784","DOIUrl":"https://doi.org/10.1097/PCC.0000000000002784","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":"1005-1007"},"PeriodicalIF":4.1,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39842785","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 October.","authors":"Robert C Tasker","doi":"10.1097/PCC.0000000000002839","DOIUrl":"https://doi.org/10.1097/PCC.0000000000002839","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":"857-858"},"PeriodicalIF":4.1,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39483501","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":"Online Abstract Translations.","authors":"","doi":"10.1097/PCC.0000000000002827","DOIUrl":"https://doi.org/10.1097/PCC.0000000000002827","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":"e540-e545"},"PeriodicalIF":4.1,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39483505","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":"Did the Effect of the Guidelines eVAPorate? The Need for Improved Antimicrobial Stewardship Continues.","authors":"Nobuaki Shime","doi":"10.1097/PCC.0000000000002825","DOIUrl":"https://doi.org/10.1097/PCC.0000000000002825","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":"925-927"},"PeriodicalIF":4.1,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39483502","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":"Driving Pressure and Mechanical Power: The Return of Physiology in Pediatric Mechanical Ventilation.","authors":"Martin C J Kneyber","doi":"10.1097/PCC.0000000000002829","DOIUrl":"https://doi.org/10.1097/PCC.0000000000002829","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":"927-929"},"PeriodicalIF":4.1,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39483503","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":"Case 1-2021: A 10-Year-Old Male With Respiratory Failure, Pleural Effusions, and Renal Failure 60 Days After Hematopoietic Stem Cell Transplant.","authors":"Michele M Loi, Hesham Eissa, Jason P Weinman, Steve H Abman, Csaba Galambos, Todd C Carpenter","doi":"10.1097/PCC.0000000000002792","DOIUrl":"https://doi.org/10.1097/PCC.0000000000002792","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":"e524-e531"},"PeriodicalIF":4.1,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39483504","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":"Decision-Making, Ethics, and End-of-Life Care in Pediatric Extracorporeal Membrane Oxygenation: A Comprehensive Narrative Review.","authors":"Katie M Moynihan,&nbsp;Anna Dorste,&nbsp;Bryan D Siegel,&nbsp;Edon J Rabinowitz,&nbsp;Andrew McReynolds,&nbsp;Tessie W October","doi":"10.1097/PCC.0000000000002766","DOIUrl":"https://doi.org/10.1097/PCC.0000000000002766","url":null,"abstract":"<p><strong>Objectives: </strong>Pediatric extracorporeal membrane oxygenation is associated with significant morbidity and mortality. We sought to summarize literature on communication and decision-making, end-of-life care, and ethical issues to identify recommended approaches and highlight knowledge gaps.</p><p><strong>Data sources: </strong>PubMed, Embase, Web of Science, and Cochrane Library.</p><p><strong>Study selection: </strong>We reviewed published articles (1972-2020) which examined three pediatric extracorporeal membrane oxygenation domains: 1) decision-making or communication between clinicians and patients/families, 2) ethical issues, or 3) end-of-life care.</p><p><strong>Data extraction: </strong>Two reviewers independently assessed eligibility using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology.</p><p><strong>Data synthesis: </strong>Of 2,581 publications screened, we identified one systematic review and 35 descriptive studies. No practical guides exist for communication and decision-making in pediatric extracorporeal membrane oxygenation. Conversation principles and parent/clinician perspectives are described. Ethical issues related to consent, initiation, discontinuation, resource allocation, and research. No patient-level synthesis of ethical issues or end-of-life care in pediatric extracorporeal membrane oxygenation was identified.</p><p><strong>Conclusions: </strong>Despite numerous ethical issues reported surrounding pediatric extracorporeal membrane oxygenation, we found limited patient-level research and no practical guides for communicating with families or managing extracorporeal membrane oxygenation discontinuation.</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":"806-812"},"PeriodicalIF":4.1,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38982502","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 September.","authors":"Robert C Tasker","doi":"10.1097/PCC.0000000000002824","DOIUrl":"https://doi.org/10.1097/PCC.0000000000002824","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":"769-770"},"PeriodicalIF":4.1,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39378063","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":"Prediction of Nociception in Children Using the Nociceptive Flexion Reflex Threshold and the Bispectral Index-A Prospective Exploratory Observational Study.","authors":"Maximilian D Mauritz,&nbsp;Felix Uhlenberg,&nbsp;Dario Bashir-Elahi,&nbsp;Tobias Werther,&nbsp;Urda Gottschalk,&nbsp;Chinedu Ulrich Ebenebe,&nbsp;Marlies Bergers,&nbsp;Vito Giordano,&nbsp;Eik Vettorazzi,&nbsp;Dominique Singer,&nbsp;Philipp Deindl","doi":"10.1097/PCC.0000000000002701","DOIUrl":"https://doi.org/10.1097/PCC.0000000000002701","url":null,"abstract":"<p><strong>Objectives: </strong>The prediction of patient responses to potentially painful stimuli remains a challenge in PICUs. We investigated the ability of the paintracker analgesia monitor (Dolosys GmbH, Berlin, Germany) measuring the nociceptive flexion reflex threshold, the cerebral sedation monitor bispectral index (Medtronic, Dublin, Ireland), the COMFORT Behavior, and the modified Face, Legs, Activity, Cry, Consolability Scale scores to predict patient responses following a noxious stimulus.</p><p><strong>Design: </strong>Single-center prospective exploratory observational study.</p><p><strong>Setting: </strong>Fourteen-bed multidisciplinary PICU at the University Children's Hospital, University Medical Center Hamburg Eppendorf, Germany.</p><p><strong>Patients: </strong>Children on mechanical ventilation receiving analgesic and sedative medications.</p><p><strong>Interventions: </strong>Noxious stimulation by way of endotracheal suctioning.</p><p><strong>Measurements and main results: </strong>Two independent observers assessed modified Face, Legs, Activity, Cry, Consolability and COMFORT Behavior Scales scores during noxious stimulation (n = 59) in 26 patients. Vital signs were recorded immediately before and during noxious stimulation; bispectral index and nociceptive flexion reflex threshold were recorded continuously. Mean prestimulation bispectral index (55.5; CI, 44.2-66.9 vs 39.9; CI, 33.1-46.8; p = 0.007), and COMFORT Behavior values (9.5; CI, 9.2-13.2 vs 7.5; CI, 6.7-8.5; p = 0.023) were significantly higher in observations with a response than in those without a response. Prediction probability (Pk) values for patient responses were high when the bispectral index was used (Pk = 0.85) but only fair when the nociceptive flexion reflex threshold (Pk = 0.69) or COMFORT Behavior Scale score (Pk = 0.73) was used. A logistic mixed-effects model confirmed the bispectral index as a significant potential predictor of patient response (p = 0.007).</p><p><strong>Conclusions: </strong>In our sample of ventilated children in the PICU, bispectral index and nociceptive flexion reflex threshold provided good and fair prediction accuracy for patient responses to endotracheal suctioning.</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":"e461-e470"},"PeriodicalIF":4.1,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25468295","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":"Parent and Physician Report of Discussions About Prognosis for Critically Ill Children.","authors":"Lauren Rissman,&nbsp;Sabrina Derrington,&nbsp;Karen Rychlik,&nbsp;Kelly N Michelson","doi":"10.1097/PCC.0000000000002764","DOIUrl":"https://doi.org/10.1097/PCC.0000000000002764","url":null,"abstract":"<p><strong>Objectives: </strong>Parents value clear communication with PICU clinicians about possible patient and family outcomes (prognostic conversations). We describe PICU parent and attending physician reports and agreement regarding the occurrence of prognostic conversations. We queried parents and physicians about prognostic conversation content, which healthcare providers had prognostic conversations, and whether parents wanted more prognostic information.</p><p><strong>Design: </strong>Prospective cross-sectional survey study.</p><p><strong>Setting: </strong>University-based 40-bed PICU.</p><p><strong>Participants: </strong>Parents and attending physicians of PICU patients with multiple organ dysfunction within 24 hours of PICU admission.</p><p><strong>Interventions: </strong>Surveys administered to parents and attending PICU physicians 5-10 days after PICU admission.</p><p><strong>Measurements and main results: </strong>Surveys asked parents and physicians to report the occurrence of prognostic conversations related to PICU length of stay, risk of PICU mortality, and anticipated post-PICU physical, neurologic, and psychologic morbidities for patients and post-PICU psychologic morbidities for parents. Of 101 participants, 87 parents and 83 physicians reported having prognostic conversations. Overall concordance between parents and physicians was fair (Kappa = 0.22). Parents and physicians most commonly reported prognostic conversations about PICU length of stay (67.3% and 63.3%, respectively) and patient post-PICU physical morbidity (n = 48; 48.5% and n = 45; 44.5% respectively). Conversations reported less often by parents and physicians were about patient post-PICU psychologic morbidity (n = 13; 12.9% and n = 20; 19.8%, respectively). Per parent report, bedside nurses and physicians provided most prognostic information. Chaplains (n = 14; 50%) and social workers (n = 17; 60%) were more involved in conversations regarding parent psychologic morbidities. Most commonly, parents requested more information about length of stay and their child's physical morbidities. Parents less frequently wanted information about their own psychologic morbidities.</p><p><strong>Conclusions: </strong>Most parents and physicians report having prognostic conversations, primarily about length of stay and post-ICU physical morbidities. Concordance between parents and physicians is suboptimal. Future studies should evaluate prognostic conversations at other timepoints, how information is delivered, and how these conversations impact the PICU experience.</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":"785-794"},"PeriodicalIF":4.1,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39020785","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}