Monique Radman, John McGuire, Paul Sharek, Harris Baden, Andy Koth, Robert DiGeronimo, Darren Migita, Dwight Barry, James B Johnson, Lori Rutman, Surabhi Vora
OBJECTIVES: Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator. It is expensive, frequently used, and not without risk. There is limited evidence supporting a standard approach to initiation and weaning. Our objective was to optimize the use of iNO in the cardiac ICU (CICU), PICU, and neonatal ICU (NICU) by establishing a standard approach to iNO utilization. DESIGN: A quality improvement study using a prospective cohort design with historical controls...
May 24, 2024: Pediatric Critical Care Medicine
Julia A Heneghan, Manzilat Y Akande, Sriram Ramgopal, Michael D Evans, Madhura Hallman, Denise M Goodman
OBJECTIVES: To describe change in Functional Status Scale (FSS) associated with critical illness and assess associated development of new morbidities with PICU readmission. DESIGN: Retrospective, cross-sectional cohort study using the Virtual Pediatric Systems (VPS; Los Angeles, CA) database. SETTING: One hundred twenty-six U.S. PICUs participating in VPS. SUBJECTS: Children younger than 21 years old admitted 2017-2020 and followed to December 2022...
May 23, 2024: Pediatric Critical Care Medicine
Anoopindar K Bhalla, Margaret J Klein, Justin Hotz, Jeni Kwok, Jennifer E Bonilla-Cartagena, David A Baron, Kristen Kohler, Dinnel Bornstein, Daniel Chang, Kennedy Vu, Anabel Armenta-Quiroz, Lara P Nelson, Christopher J L Newth, Robinder G Khemani
OBJECTIVES: We sought to evaluate the association between the carbon dioxide (co2) ventilatory equivalent (VEqco2 = minute ventilation/volume of co2 produced per min), a marker of dead space that does not require a blood gas measurement, and mortality risk. We compared the strength of this association to that of physiologic dead space fraction (VD/Vt = [Paco2-mixed-expired Pco2]/Paco2) as well as to other commonly used markers of dead space (i.e., the end-tidal alveolar dead space fraction [AVDSf = (Paco2-end-tidal Pco2)/Paco2], and ventilatory ratio [VR = (minute ventilation × Paco2)/(age-adjusted predicted minute ventilation × 37...
May 21, 2024: Pediatric Critical Care Medicine
Alicia M Alcamo, Andrew E Becker, Gregory J Barren, Katie Hayes, Jeffrey W Pennington, Martha A Q Curley, Robert C Tasker, Fran Balamuth, Scott L Weiss, Julie C Fitzgerald, Alexis A Topjian
OBJECTIVES: Acute brain dysfunction (ABD) in pediatric sepsis has a prevalence of 20%, but can be difficult to identify. Our previously validated ABD computational phenotype (CPABD) used variables obtained from the electronic health record indicative of clinician concern for acute neurologic or behavioral change. We tested whether the CPABD has better diagnostic performance to identify confirmed ABD than other definitions using the Glasgow Coma Scale or delirium scores. DESIGN: Diagnostic testing in a curated cohort of pediatric sepsis/septic shock patients...
May 13, 2024: Pediatric Critical Care Medicine
Rachel C Ashworth, Jay R Malone, Dana Franklin, Lauren R Sorce, Marla L Clayman, Joel Frader, Douglas B White, Kelly N Michelson
OBJECTIVES: To identify self-reported meaningful decisions made by parents in the PICU and to determine patient and parent characteristics associated with the development of parental decision regret, a measurable, self-reported outcome associated with psychologic morbidity. DESIGN: Secondary analysis of the Navigate randomized comparative trial (NCT02333396). SETTING: Two tertiary, academic PICUs. PATIENTS: Spanish- or English-speaking parents of PICU patients aged less than 18 years who were expected to remain in the PICU for greater than 24 hours from time of enrollment or who had a risk of mortality greater than 4% based on Pediatric Index of Mortality 2 score...
May 10, 2024: Pediatric Critical Care Medicine
Nasim Ahmed, Larissa Russo, Yen-Hong Kuo
OBJECTIVES: To compare levetiracetam and phenytoin as prophylaxis for the short-term development of status epilepticus (SE) during care of pediatric patients with acute severe traumatic brain injury (TBI). DESIGN: Nonprespecified secondary analysis using propensity score matching. SETTING: We used the Approaches and Decisions in Acute Pediatric TBI Trial (ADAPT NCT04077411) dataset (2014-2017). SUBJECTS: Patients less than 18 years old with Glasgow Coma Scale Score less than or equal to 8 who received levetiracetam or phenytoin as a prophylactic anticonvulsant therapy...
May 8, 2024: Pediatric Critical Care Medicine
Elissa R Engel, Tanya Perry, Mary Block, Joseph S Palumbo, Angela Lorts, Lori Luchtman-Jones
OBJECTIVES: The activated partial thromboplastin time (aPTT) is the most frequently used monitoring assay for bivalirudin in children and young adults on mechanical circulatory support including ventricular assist devices (VADs) and extracorporeal membrane oxygenation (ECMO). However, intrinsic variability of the aPTT complicates management and risks bleeding or thrombotic complications. We evaluated the utility and reliability of a bivalirudin-calibrated dilute thrombin time (Bival dTT) assay for bivalirudin monitoring in this population...
May 7, 2024: Pediatric Critical Care Medicine
Christopher W Mastropietro, Peter Sassalos, Christine M Riley, Kurt Piggott, Kiona Y Allen, Elizabeth Prentice, Raya Safa, Jason R Buckley, David K Werho, Martin Wakeham, Arthur Smerling, Andrew R Yates, Ilias Iliopoulos, Hitesh Sandhu, Saurabh Chiwane, Asaad Beshish, David M Kwiatkowski, Saul Flores, Sukumar Suguna Narashimhulu, Rohit Loomba, Christine A Capone, Francis Pike, John M Costello
OBJECTIVES: Multicenter studies reporting outcomes following tracheostomy in children with congenital heart disease are limited, particularly in patients with single ventricle physiology. We aimed to describe clinical characteristics and outcomes in a multicenter cohort of patients with single ventricle physiology who underwent tracheostomy before Fontan operation. DESIGN: Multicenter retrospective cohort study.SETTING: Twenty-one tertiary care pediatric institutions participating in the Collaborative Research from the Pediatric Cardiac Intensive Care Society...
April 29, 2024: Pediatric Critical Care Medicine
Katherine M Rodriguez, Jordan Vaught, Lisa Salz, Jennifer Foley, Zaineb Boulil, Heather M Van Dongen-Trimmer, Drewann Whalen, Okonkwo Oluchukwu, Kuang Chuen Liu, Jennifer Burton, Prachi Syngal, Ofelia Vargas-Shiraishi, Stephen F Kingsmore, Erica Sanford Kobayashi, Nicole G Coufal
OBJECTIVES: Analysis of the clinical utility of rapid whole-genome sequencing (rWGS) outside of the neonatal period is lacking. We describe the use of rWGS in PICU and cardiovascular ICU (CICU) patients across four institutions. DESIGN: Ambidirectional multisite cohort study. SETTING: Four tertiary children's hospitals. PATIENTS: Children 0-18 years old in the PICU or CICU who underwent rWGS analysis, from May 2016 to June 2023...
April 26, 2024: Pediatric Critical Care Medicine
Jaime Fernández-Sarmiento, Ana María Bejarano-Quintero, Jose Daniel Tibaduiza, Karen Moreno-Medina, Rosalba Pardo, Luz Marina Mejía, Jose Luis Junco, Jorge Rojas, Oscar Peña, Yomara Martínez, Ledys Izquierdo, Maria Claudia Guzmán, Pablo Vásquez-Hoyos, Milton Molano, Carlos Gallon, Carolina Bonilla, Maria Carolina Fernández-Palacio, Valentina Merino, Christian Bernal, Juan Pablo Fernández-Sarta, Estefanía Hernandez, Isabela Alvarez, Juan Camilo Tobo, Maria Camila Beltrán, Juanita Ortiz, Laura Botia, Jose Manuel Fernández-Rengifo, Rocio Del Pilar Pereira-Ospina, Alexandra Blundell, Andres Nieto, Catalina Duque-Arango
OBJECTIVES: High driving pressure (DP, ratio of tidal volume (Vt) over respiratory system compliance) is a risk for poor outcomes in patients with pediatric acute respiratory distress syndrome (PARDS). We therefore assessed the time course in level of DP (i.e., 24, 48, and 72 hr) after starting mechanical ventilation (MV), and its association with 28-day mortality. DESIGN: Multicenter, prospective study conducted between February 2018 and December 2022. SETTING: Twelve tertiary care PICUs in Colombia...
April 26, 2024: Pediatric Critical Care Medicine
Malini Maya, Ramachandran Rameshkumar, Tamil Selvan, Chinnaiah Govindhareddy Delhikumar
OBJECTIVES: To compare high-flow nasal cannula (HFNC) versus nasal prong bubble continuous positive airway pressure (b-CPAP) in children with moderate to severe acute bronchiolitis. DESIGN: A randomized controlled trial was carried out from August 2019 to February 2022. (Clinical Trials Registry of India number CTRI/2019/07/020402). SETTING: Pediatric emergency ward and ICU within a tertiary care center in India. PATIENTS: Children 1-23 months old with moderate to severe acute bronchiolitis...
April 19, 2024: Pediatric Critical Care Medicine
Wakato Matsuoka, Soichi Mizuguchi, Noriyuki Kaku, Kanako Higashi, Kenichi Tetsuhara, Tomohiko Akahoshi, Shouichi Ohga
OBJECTIVES: To develop an equation for defining a low skeletal muscle mass (SMM) in children and to investigate risk factors and outcomes associated with low SMM in critically ill pediatric patients. DESIGN: Single-center retrospective pediatric cohorts, 2011-2018. SETTING: Tertiary Emergency and Critical Care Center of Kyushu University Hospital in Japan. PATIENTS: We studied two cohorts of pediatric patients 1-15 years old who underwent abdominal CT at the level of the third lumbar vertebra (L3)...
April 17, 2024: Pediatric Critical Care Medicine
Robert Darnell, Alanna Brown, Emma Laing, Julia Edwards, David A Harrison, Joseph C Manning, Mark J Peters, Padmanabhan Ramnarayan, Samiran Ray, Zia Sadique, Barnaby R Scholefield, Dermot Shortt, Lamprini Lampro, Carly Au, Kathy M Rowan, Paul Mouncey, David P Inwald
OBJECTIVES: Management of hypotension is a fundamental part of pediatric critical care, with cardiovascular support in the form of fluids or vasoactive drugs offered to every hypotensive child. However, optimal blood pressure (BP) targets are unknown. The PRotocolised Evaluation of PermiSSive BP Targets Versus Usual CaRE (PRESSURE) trial aims to evaluate the clinical and cost-effectiveness of a permissive mean arterial pressure (MAP) target of greater than a fifth centile for age compared with usual care...
April 17, 2024: Pediatric Critical Care Medicine
Tanya Perry, David N Rosenthal, Angela Lorts, Farhan Zafar, Wenying Zhang, Christina VanderPluym, Aaron G Dewitt, Garrett Reichle, Mousumi Banerjee, Kurt R Schumacher
OBJECTIVES: Placement of a ventricular assist device (VAD) improves outcomes in children with advanced heart failure, but adverse events remain important consequences. Preoperative mechanical ventilation (MV) increases mortality, but it is unknown what impact prolonged postoperative MV has. DESIGN: Advanced Cardiac Therapies Improving Outcomes Network (ACTION) and Pediatric Cardiac Critical Care Consortium (PC4) registries were used to identify and link children with initial VAD placement admitted to the cardiac ICU (CICU) from August 2014 to July 2020...
April 15, 2024: Pediatric Critical Care Medicine
Rebeca Mozun, Luregn J Schlapbach
No abstract text is available yet for this article.
April 11, 2024: Pediatric Critical Care Medicine
Doug W Gould, Mark J Peters
No abstract text is available yet for this article.
April 11, 2024: Pediatric Critical Care Medicine
Takanari Ikeyama, Takunori Hozumi, Kazuki Kikuyama, Dana Niles, Vinay Nadkarni, Komei Ito
OBJECTIVES: Current resuscitation guidelines recommend target chest compression depth (CCd) of approximately 4cm for infants and 5cm for children. Previous reports based on chest CT suggest these recommended CCd targets might be too deep for younger children. Our aim was to examine measurements of anterior-posterior chest diameter (APd) with a laser distance meter and calculate CCd targets in critically ill infants and children. DESIGN: A retrospective descriptive study...
April 11, 2024: Pediatric Critical Care Medicine
Jane E Whitney, Grace M Johnson, Brian M Varisco, Benjamin A Raby, Nadir Yehya
OBJECTIVES: The Pediatric Acute Respiratory Distress Syndrome Biomarker Risk Model (PARDSEVERE) used age and three plasma biomarkers measured within 24 hours of pediatric acute respiratory distress syndrome (ARDS) onset to predict mortality in a pilot cohort of 152 patients. However, longitudinal performance of PARDSEVERE has not been evaluated, and it is unclear whether the risk model can be used to prognosticate after day 0. We, therefore, sought to determine the test characteristics of PARDSEVERE model and population over the first 7 days after ARDS onset...
April 9, 2024: Pediatric Critical Care Medicine
Pui Yin Florence Ip, Uvaraj Periasamy, Steven J Staffa, David Zurakowski, David B Kantor
OBJECTIVES: To evaluate management changes and outcomes in critically ill children after formal echocardiography. DESIGN: Retrospective cohort study between January 1, 2011, and December 31, 2020. SETTING: Tertiary care children's hospital. PATIENTS: Patients from 1 to 18 years who had formal echocardiography within 72 hours of ICU admission and who were intubated and on vasoactive infusions at the time of the study...
April 9, 2024: Pediatric Critical Care Medicine
Todd Karsies, Steven L Shein, Franco Diaz, Pablo Vasquez-Hoyos, Robin Alexander, Steven Pon, Sebastián González-Dambrauskas
OBJECTIVES: To determine the prevalence of respiratory bacterial codetection in children younger than 2 years intubated for acute lower respiratory tract infection (LRTI), primarily viral bronchiolitis, and identify the association of codetection with mechanical ventilation duration. DESIGN: Prospective observational study evaluating the prevalence of bacterial codetection (moderate/heavy growth of pathogenic bacterial plus moderate/many polymorphonuclear neutrophils) and the impact of codetection on invasive mechanical ventilation (IMV) duration...
March 26, 2024: Pediatric Critical Care Medicine
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