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Pediatric Critical Care Medicine

Hector R Valdivia, Kristen E Carlin
OBJECTIVES: To determine the interrater reliability of the Cornell Assessment of Pediatric Delirium Screening Tool amount PICU nurses. DESIGN: The design was setup as a cross-sectional study and conducted over the course of a year. SETTING: This study setting was a PICU and a pediatric cardiac ICU at Seattle Children's Hospital, a tertiary freestanding university-affiliated hospital in Seattle, Washington. PATIENTS: A total sample of 108 patients were included in this study...
February 5, 2019: Pediatric Critical Care Medicine
Toshikazu Abe, Makoto Aoki, Gautam Deshpande, Takehiro Sugiyama, Masao Iwagami, Masatoshi Uchida, Isao Nagata, Daizoh Saitoh, Nanako Tamiya
OBJECTIVES: We aimed to investigate whether whole-body CT for children with trauma is associated with a different mortality than only selective CT. DESIGN: A multicenter, retrospective cohort study. SETTING: Nationwide trauma registry from 183 tertiary emergency medical centers in Japan. PATIENTS: We enrolled pediatric trauma patients less than 16 years old who underwent whole-body CT or selective CT from 2004 to 2014...
February 5, 2019: Pediatric Critical Care Medicine
Elizabeth Y Killien, Reid W D Farris, R Scott Watson, Leslie A Dervan, Jerry J Zimmerman
OBJECTIVES: Mortality from pediatric sepsis has steadily declined over the past several decades; however, little is known about morbidity among survivors. We aimed to determine the prevalence of and risk factors for failure to recover to baseline health-related quality of life following community-acquired pediatric sepsis. DESIGN: Retrospective cohort study. SETTING: Seattle Children's Hospital. PATIENTS: Children aged 1 month to 21 years admitted to the inpatient wards or ICUs from 2012 to 2015 who met 2005 consensus sepsis criteria within 4 hours of hospitalization and were enrolled in the hospital's Outcomes Assessment Program with baseline, admission, and post-discharge health-related quality of life data available...
February 1, 2019: Pediatric Critical Care Medicine
Rachel Anne Pulham, Jo Wray, Yael Feinstein, Katherine Brown, Christine Pierce, Simon Nadel, Nazima Pathan, Elena Garralda, Padmanabhan Ramnarayan
OBJECTIVES: To evaluate the feasibility and acceptability of different methods of collecting follow-up data from parents 12 months after their child's emergency admission to a PICU. DESIGN: Mixed-methods explanatory sequential design. SETTING: One regional PICU transport service and three PICUs in England. PATIENTS: Children undergoing emergency transport to PICU recruited to an ongoing biomarker study whose parents consented to be contacted for follow-up 12 months after PICU admission...
February 1, 2019: Pediatric Critical Care Medicine
Melinda J Cory, Nora Colman, Courtney E McCracken, Kiran B Hebbar
OBJECTIVES: Rapid cycle deliberate practice is a simulation training method that cycles between deliberate practice and directed feedback to create perfect practice; in contrast to reflective debriefing where learners are asked to reflect on their performance to create change. The aim of this study is to compare the impact of rapid cycle deliberate practice versus reflective debriefing training on resident application and retention of the pediatric sepsis algorithm. DESIGN: Prospective, randomized-control study...
January 30, 2019: Pediatric Critical Care Medicine
Ericka L Fink, Sue R Beers, Amy J Houtrow, Rudolph Richichi, Cheryl Burns, Lesley Doughty, Roberto Ortiz-Aguayo, Catherine A Madurski, Cynthia Valenta, Maddie Chrisman, Lynn Golightly, Michelle Kiger, Cheryl Patrick, Amery Treble-Barna, Dorothy Pollon, Craig M Smith, Patrick Kochanek
OBJECTIVES: Few feasibility, safety, and efficacy data exist regarding ICU-based rehabilitative services for children. We hypothesized that early protocolized assessment and therapy would be feasible and safe versus usual care in pediatric neurocritical care patients. DESIGN: Randomized controlled trial. SETTING: Three tertiary care PICUs in the United States. PATIENTS: Fifty-eight children between the ages of 3-17 years with new traumatic or nontraumatic brain insult and expected ICU admission greater than 48 hours...
January 30, 2019: Pediatric Critical Care Medicine
Barbara-Jo Achuff, Brady S Moffett, Sebastian Acosta, Javier J Lasa, Paul A Checchia, Craig G Rusin
OBJECTIVES: Acetaminophen is ubiquitously used as antipyretic/analgesic administered IV to patients undergoing surgery and to critically ill patients when enteral routes are not possible. Widely believed to be safe and free of adverse side effects, concerns have developed in adult literature regarding the association of IV acetaminophen and transient hypotension. We hypothesize that there are hemodynamic effects after IV acetaminophen in the PICU and assess the prevalence of such in a large pediatric cardiovascular ICU population using high-fidelity data...
January 22, 2019: Pediatric Critical Care Medicine
Julia A Heneghan, Ron W Reeder, J Michael Dean, Kathleen L Meert, Robert A Berg, Joseph Carcillo, Christopher J L Newth, Heidi Dalton, Robert Tamburro, Murray M Pollack
OBJECTIVES: Children with dependence on respiratory or feeding technologies are frequently admitted to the PICU, but little is known about their characteristics or outcomes. We hypothesized that they are at increased risk of critical illness-related morbidity and mortality compared with children without technology dependence. DESIGN: Secondary analysis of prospective, probability-sampled cohort study of children from birth to 18 years old. Demographic and clinical characteristics were assessed...
January 22, 2019: Pediatric Critical Care Medicine
Vinzenz Boos, Anna Tietze, Felix Berger, Christoph Bührer
OBJECTIVES: Patients with severe congenital heart disease and cardiac anomalies such as restrictive foramen ovale, intact atrial septum, or narrowing of ductus arteriosus are at risk for perinatal asphyxia, leading to hypoxic-ischemic encephalopathy. We hypothesize that therapeutic hypothermia can be applied to these patients and seek to investigate feasibility and safety of this method. DESIGN: A retrospective observational study. SETTING: The Department of Neonatology of Charité, University Hospital, Berlin, Germany...
January 22, 2019: Pediatric Critical Care Medicine
Ahmad Kaddourah, Rajit K Basu, Stuart L Goldstein, Scott M Sutherland
OBJECTIVES: Consensus definitions for acute kidney injury are based on changes in serum creatinine and urine output. Although the creatinine criteria have been widely applied, the contribution of the urine output criteria remains poorly understood. We evaluated these criteria individually and collectively to determine their impact on the diagnosis and outcome of severe acute kidney injury. DESIGN AND SETTING: Post hoc analysis of Assessment of Worldwide Acute Kidney Injury, Renal Angina, and Epidemiology study-a prospective international observational multicenter study...
January 22, 2019: Pediatric Critical Care Medicine
Tia T Raymond, Amy Praestgaard, Robert A Berg, Vinay M Nadkarni, Chris S Parshuram
OBJECTIVES: To evaluate the variation of hospital rates of delayed epinephrine administration in pediatric patients with nonshockable in-hospital cardiac arrest, and the association of those rates with event, 24-hour, and overall survival to hospital discharge. DESIGN: A retrospective evaluation was performed. Delayed epinephrine was defined as greater than 5 minutes between the time the need for chest compressions was identified and epinephrine was administered...
January 21, 2019: Pediatric Critical Care Medicine
Amy Donnellan, Jaclyn Sawyer, Anne Peach, Sandra Staveski, David P Nelson, J Nick Pratap
OBJECTIVES: To evaluate the effect of implementation of a comfort algorithm on infusion rates of opioids and benzodiazepines in postneonatal postoperative pediatric cardiac surgery patients. DESIGN: A quality improvement project, using statistical process control methodology. SETTING: Twenty-five-bed tertiary care pediatric cardiac ICU in an urban academic Children's hospital. PATIENTS: Postoperative pediatric cardiac surgery patients...
January 21, 2019: Pediatric Critical Care Medicine
Christopher J O'Conor, Huifang Zhou, Jon Ritter, Louis Dehner, Mai He
OBJECTIVES: Identify and characterize pediatric pulmonary emboli present at autopsy. DESIGN: Retrospective single institution observational study with clinicopathologic correlation. SETTING: Tertiary medical center. PATIENTS: All autopsy cases performed at Washington University from 1997 to 2017 in pediatric patients (≤ 18 yr old). MAIN RESULTS: Of 1,763 pediatric autopsies, 13 cases of pulmonary emboli were identified, including thromboemboli (6/13, 46...
January 21, 2019: Pediatric Critical Care Medicine
Matt S Zinter, Aaron C Spicer, Kathleen D Liu, Benjamin E Orwoll, Mustafa F Alkhouli, Paul R Brakeman, Carolyn S Calfee, Michael A Matthay, Anil Sapru
OBJECTIVES: As acute kidney injury and elevated cumulative fluid balance commonly co-occur in pediatric acute respiratory distress syndrome, we aimed to identify risk factors for their development and evaluate their independent relationships with mortality. We hypothesized that acute kidney injury and elevated cumulative fluid balance would be associated with markers of inflammation and that children with elevated cumulative fluid balance and concomitant acute kidney injury would have worse outcomes than other children...
January 21, 2019: Pediatric Critical Care Medicine
Robert J Graham, Laura R Amar-Dolan, Christopher J Roussin, Peter H Weinstock
OBJECTIVES: Introduce an expanding role for pediatric critical care and medical simulation to optimize the care for children with technology dependence. DATA SOURCES: Limited review of literature and practice for current teaching paradigms, vulnerability of the patient population, and efficacy of simulation as a medical educational tool. CONCLUSIONS: In accordance with new care models and patient need, critical care requires parallel evolution of care practices, including new educational and care models, in order to maximally reduce risk, fear, and anxiety and to insure quality and consistent care in the community for patients and families transitioning between the ICU and home environments...
January 18, 2019: Pediatric Critical Care Medicine
Rocío Rodríguez-Rey, Alba Palacios, Jesús Alonso-Tapia, Elena Pérez, Elena Álvarez, Ana Coca, Santiago Mencía, Ana Marcos, Juan Mayordomo-Colunga, Francisco Fernández, Fernando Gómez, Jaime Cruz, Victoria Ramos, Marta Olmedilla
OBJECTIVES: Staff in PICUs shows high burnout, posttraumatic stress disorder symptoms, and posttraumatic growth levels. However, their levels of satisfaction with life and how positive and negative posttrauma outcomes relate to each other and contribute to predict satisfaction with life remain unknown. Thus, we attempted to explore these aspects and to compare the findings with data from pediatric professionals working in noncritical units. DESIGN: This is an observational multicentric, cross-sectional study...
January 18, 2019: Pediatric Critical Care Medicine
David K Bailly, Ron W Reeder, Melissa Winder, Ryan P Barbaro, Murray M Pollack, Frank W Moler, Kathleen L Meert, Robert A Berg, Joseph Carcillo, Athena F Zuppa, Christopher Newth, John Berger, Michael J Bell, Michael J Dean, Carol Nicholson, Pamela Garcia-Filion, David Wessel, Sabrina Heidemann, Allan Doctor, Rick Harrison, Susan L Bratton, Heidi Dalton
OBJECTIVES: To develop a prognostic model for predicting mortality at time of extracorporeal membrane oxygenation initiation for children which is important for determining center-specific risk-adjusted outcomes. DESIGN: Multivariable logistic regression using a large national cohort of pediatric extracorporeal membrane oxygenation patients. SETTING: The ICUs of the eight tertiary care children's hospitals of the Collaborative Pediatric Critical Care Research Network...
January 18, 2019: Pediatric Critical Care Medicine
Maarja Hallik, Mari-Liis Ilmoja, Tõnis Tasa, Joseph F Standing, Kalev Takkis, Rūta Veigure, Karin Kipper, Tiiu Jalas, Maila Raidmäe, Karin Uibo, Joel Starkopf, Tuuli Metsvaht
OBJECTIVES: The postoperative course of patent ductus arteriosus ligation is often complicated by postligation cardiac syndrome, occurring in 10-45% of operated infants. Milrinone might prevent profound hemodynamic instability and improve the recovery of cardiac function in this setting. The present study aimed to describe the population pharmacokinetics of milrinone in premature neonates at risk of postligation cardiac syndrome and give dosing recommendations. DESIGN: A prospective single group open-label pharmacokinetics study...
January 18, 2019: Pediatric Critical Care Medicine
Andrew G Wu, Uzma Samadani, Tina M Slusher, Lei Zhang, Andrew W Kiragu
OBJECTIVE: To explore the effect of 23.4% hypertonic saline for management of elevated intracranial pressure in children admitted to our institution for severe traumatic brain injury. DESIGN: Single-center, retrospective medical chart analysis. SETTING: A PICU at a level 1 pediatric trauma center in the United States. PATIENTS: Children admitted for severe traumatic brain injury from 2006 to 2016 who received 23.4% hypertonic saline and whose intracranial pressures were measured within 5 hours of receiving 23...
January 18, 2019: Pediatric Critical Care Medicine
Jose C Flores-González, Cristina Montero Valladares, Cristina Yun Castilla, Juan Mayordomo-Colunga, Sonia Pérez Quesada, Carmen María Martín Delgado, Concha Goñi-Orayen, Francisco Fernández Carrión, Alicia Miras Veiga, Marta Olmedilla-Jodar, Andrés J Alcaraz Romero, Miren Eizmendi-Bereciartua, Carmen Santiago Gutierrez, Esther Aleo Luján, Álvaro Navarro-Mingorance, Iolanda Jordán
OBJECTIVES: Increasing evidence supports the association of fluid overload with adverse outcomes in different diseases. To our knowledge, few studies have examined the impact of fluid balance on clinical outcome in severe bronchiolitis. Our aim was to determine whether fluid overload was associated with adverse clinical outcomes in critically ill children with severe bronchiolitis. DESIGN: Descriptive, prospective, multicenter study. SETTING: Sixteen Spanish PICUs...
January 17, 2019: Pediatric Critical Care Medicine
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