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JOURNAL ARTICLE
Manzilat Y Akande, Sriram Ramgopal, Robert J Graham, Denise M Goodman, Julia A Heneghan
OBJECTIVES: To examine the association between a validated composite measure of neighborhood factors, the Child Opportunity Index (COI), and emergent PICU readmission during the year following discharge for survivors of pediatric critical illness. DESIGN: Retrospective cross-sectional study. SETTING: Forty-three U.S. children's hospitals contributing to the Pediatric Health Information System administrative dataset. PATIENTS: Children (< 18 yr) with at least one emergent PICU admission in 2018-2019 who survived an index admission...
March 10, 2023: Pediatric Critical Care Medicine
#2
JOURNAL ARTICLE
Heather Lambert, Shaun Hiu, Malcolm G Coulthard, John N S Matthews, Eva-Maria Holstein, Jean Crosier, Rachel Agbeko, Thomas Brick, Heather Duncan, David Grant, Quen Mok, Andrew Gustaf Nyman, John Pappachan, Chris Boucher, Joe Bulmer, Denise Chisholm, Kirsten Cromie, Victoria Emmet, Richard G Feltbower, Arunoday Ghose, Michael Grayling, Rebecca Harrison, Ciara A Kennedy, Elaine McColl, Kevin Morris, Lee Norman, Julie Office, Roger Parslow, Christine Pattinson, Shriya Sharma, Jonathan Smith, Alison Steel, Rachel Steel, Jayne Straker, Lamprini Vrana, Jenn Walker, Paul Wellman, Mike Whitaker, Jim Wightman, Nina Wilson, Lucy Wirz, Ruth Wood
OBJECTIVES: Renal replacement therapy (RRT) options are limited for small babies because of lack of available technology. We investigated the precision of ultrafiltration, biochemical clearances, clinical efficacy, outcomes, and safety profile for a novel non-Conformité Européenne-marked hemodialysis device for babies under 8 kg, the Newcastle Infant Dialysis Ultrafiltration System (NIDUS), compared with the current options of peritoneal dialysis (PD) or continuous venovenous hemofiltration (CVVH)...
March 9, 2023: Pediatric Critical Care Medicine
#3
JOURNAL ARTICLE
Edon J Rabinowitz, Megan T Danzo, Mark J Anderson, Michael Wallendorf, Pirooz Eghtesady, Ahmed S Said
OBJECTIVES: To analyze hemorrhage and thrombosis data related to anticoagulation-free pediatric extracorporeal membrane oxygenation (ECMO). DESIGN: Retrospective cohort study. SETTINGS: High-volume ECMO single institution data. PATIENTS: Children (0-18 yr) supported with ECMO (>24 hr) with initial anticoagulation-free period of greater than or equal to 6 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Utilizing consensus American Thoracic Society definitions for hemorrhage and thrombosis on ECMO, we evaluated thrombosis and associated patient and ECMO characteristics during anticoagulation-free period...
March 8, 2023: Pediatric Critical Care Medicine
#4
JOURNAL ARTICLE
Andrew G Percy, Mark V Mai, Anoopindar K Bhalla, Nadir Yehya
OBJECTIVES: Mechanical power (MP) transferred from the ventilator to the lungs has been proposed as a summary variable that may impact mortality in children with acute respiratory distress syndrome (ARDS). To date, no study has shown an association between higher MP and mortality in children with ARDS. DESIGN: Secondary analysis of a prospective observational study. SETTING: Single-center, tertiary, academic PICU. PATIENTS: Five hundred forty-six intubated children with ARDS enrolled between January 2013 and December 2019 receiving pressure-controlled ventilation...
March 8, 2023: Pediatric Critical Care Medicine
#5
JOURNAL ARTICLE
Virginie Plante, Clarice Poirier, Hélène Guay, Carla Said, Michael Sauthier, Sally Al-Omar, Karen Harrington, Guillaume Emeriaud
OBJECTIVES: Tonic diaphragmatic activity (tonic Edi, i.e., sustained diaphragm activation throughout expiration) reflects diaphragmatic effort to defend end-expiratory lung volumes. Detection of such elevated tonic Edi may be useful in identifying patients who need increased positive end-expiratory pressure. We aimed to: 1) identify age-specific definitions for elevated tonic Edi in ventilated PICU patients and 2) describe the prevalence and factors associated with sustained episodes of high tonic Edi...
March 8, 2023: Pediatric Critical Care Medicine
#6
JOURNAL ARTICLE
Pauline de Jager, Martha A Q Curley, Ira M Cheifetz, Martin C J Kneyber
OBJECTIVES: To study the hemodynamic consequences of an open-lung high-frequency oscillatory ventilation (HFOV) strategy in patients with an underlying cardiac anomaly with or without intracardiac shunt or primary pulmonary hypertension with severe lung injury. DESIGN: Secondary analysis of prospectively collected data. SETTING: Medical-surgical PICU. PATIENTS: Children less than 18 years old with cardiac anomalies (± intracardiac shunt) or primary pulmonary hypertension...
March 6, 2023: Pediatric Critical Care Medicine
#7
JOURNAL ARTICLE
Sandeep Tripathi, Eugene Laksana, Michael C McCrory, Stephanie Hsu, Alice X Zhou, Kimberly Burkiewicz, David R Ledbetter, Melissa D Aczon, Sareen Shah, Linda Siegel, Nina Fainberg, Katie R Morrow, Michael Avesar, Harsha K Chandnani, Jui Shah, Charlene Pringle, Meredith C Winter
OBJECTIVES: To describe the doses of opioids and benzodiazepines administered around the time of terminal extubation (TE) to children who died within 1 hour of TE and to identify their association with the time to death (TTD). DESIGN: Secondary analysis of data collected for the Death One Hour After Terminal Extubation study. SETTING: Nine U.S. hospitals. PATIENTS: Six hundred eighty patients between 0 and 21 years who died within 1 hour after TE (2010-2021)...
March 6, 2023: Pediatric Critical Care Medicine
#8
JOURNAL ARTICLE
Ian G R Jones, Shayne Friedman, Michael Vu, Saif Awladthani, Cathy Watts, Andrea Simpson, Ahmed A Al-Farsi, Ronish Gupta, Cynthia Cupido, Karen Choong
OBJECTIVES: To develop and implement a tool to improve daily patient goal setting, team collaboration and communication. DESIGN: Quality improvement implementation project. SETTING: Tertiary-level PICU. PATIENTS: Inpatient children less than 18 years old requiring ICU level care. INTERVENTION: A "Glass Door" daily goals communication tool located in the door front of each patient room. MEASUREMENTS AND MAIN RESULTS: We used Pronovost's 4 E's model to implement the Glass Door...
March 6, 2023: Pediatric Critical Care Medicine
#9
JOURNAL ARTICLE
Neel Shah, Xilong Li, Prashanth Shanmugam, Eddy Fan, Ravi R Thiagarajan, Ramgopal Venkataraman, Lakshmi Raman
OBJECTIVE: Neurologic complications in pediatric patients supported by extracorporeal membrane oxygenation (ECMO) are common and lead to morbidity and mortality; however, few modifiable factors are known. DESIGN: Retrospective study of the Extracorporeal Life Support Organization registry (2010-2019). SETTING: Multicenter international database. PATIENTS: Pediatric patients receiving ECMO (2010-2019) for all indications and any mode of support...
March 6, 2023: Pediatric Critical Care Medicine
#10
JOURNAL ARTICLE
Mirjam A de Visser, Diana Kululanga, Singatiya S Chikumbanje, Emma Thomson, Tiyamike Kapalamula, Eric S Borgstein, Josephine Langton, Precious Kadzamira, Jenala Njirammadzi, Job B M van Woensel, Gunnar Bentsen, Patricia M Weir, Job C J Calis
OBJECTIVES: Dedicated PICUs are slowly starting to emerge in sub-Saharan Africa. Establishing these units can be challenging as there is little data from this region to inform which populations and approaches should be prioritized. This study describes the characteristics and outcome of patients admitted to the first PICU in Malawi, with the aim to identify factors associated with increased mortality. DESIGN: Review of a prospectively constructed PICU database. Univariate analysis was used to assess associations between demographic, clinical and laboratory factors, and mortality...
March 1, 2023: Pediatric Critical Care Medicine
#11
JOURNAL ARTICLE
Saviga Sethasathien, Theerapon Jariyasakoolroj, Suchaya Silvilairat, Manit Srisurapanont
OBJECTIVES: This meta-analysis aimed to determine the accuracy of the respiratory variations in aortic peak flow velocity (delta Vpeak) in predicting fluid responsiveness and the moderators of that accuracy. DATA SOURCES: We performed searches for studies that used delta Vpeak as a predictor of fluid responsiveness in mechanically ventilated children in PubMed, Embase, Scopus, and CINAHL from inception to June 20, 2022. STUDY SELECTION AND DATA EXTRACTION: Fifteen studies (n = 452) were included in this meta-analysis...
March 1, 2023: Pediatric Critical Care Medicine
#12
JOURNAL ARTICLE
Fabio Savorgnan, Adel Hassan, Nirica Borges, Sebastian Acosta
OBJECTIVES: Pulse oximetry (Spo2) may overestimate arterial oxygen saturation (Sao2) in blood laboratory testing. This study aimed to assess Spo2-Sao2 difference in relation to race (i.e., patient self-reporting as Black or White), occult hypoxemia, and length of stay (LOS) in pediatric patients with COVID-19. DESIGN: Single-center retrospective study in pediatric COVID-19 patients. We used multivariable linear regressions to examine the association between race and oximetry measurements and between occult hypoxemia and LOS...
February 24, 2023: Pediatric Critical Care Medicine
#13
JOURNAL ARTICLE
William N Sveen, Armand H Matheny Antommaria, Stephen J Gilene, Erika L Stalets
OBJECTIVES: To report the prevalence of adverse events in children undergoing apnea testing as part of the determination of death by neurologic criteria (DNC). DESIGN: Single-center, retrospective study. SETTING: Academic children's hospital that is a Level I Trauma Center. PATIENTS: All children who underwent apnea testing to determine DNC from July 2013 to June 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We abstracted the medical history, blood gases, ventilator settings, blood pressures, vasoactive infusions, intracranial pressures, chest radiographs, and echocardiograms for all apnea tests as well as any ancillary test...
February 23, 2023: Pediatric Critical Care Medicine
#14
JOURNAL ARTICLE
Carly Warren, Mark Chignell, Sonia J Pinkney, Bonnie A Armstrong, Anne-Marie Guerguerian, Peter C Laussen, Patricia L Trbovich
OBJECTIVES: PICU teams adapt the duration of patient rounding discussions to accommodate varying contextual factors, such as unit census and patient acuity. Although studies establish that shorter discussions can lead to the omission of critical patient information, little is known about how teams adapt their rounding discussions about essential patient topics (i.e., introduction/history, acute clinical status, care plans) in response to changing contexts. To fill this gap, we examined how census and patient acuity impact time spent discussing essential topics during individual patient encounters...
February 23, 2023: Pediatric Critical Care Medicine
#15
JOURNAL ARTICLE
Nathan P Dean, Sopnil Bhattarai, Sara Rooney, Christy P Gaskell
OBJECTIVES: To increase the number of nights without sleep interruptions for routine tasks in recovering PICU patients. DESIGN: Prospective quality improvement project. SETTING: Single-center, free-standing, tertiary children's hospital. PATIENTS: Patients admitted to the PICU for greater than 72 hours and eligible for early mobilization. INTERVENTIONS: A multidisciplinary sleep hygiene team was created to improve sleep hygiene in critically ill patients eligible for early mobilization...
February 20, 2023: Pediatric Critical Care Medicine
#16
JOURNAL ARTICLE
Eleonore S V de Sonnaville, Job B M van Woensel, Johannes B van Goudoever, Marieke H Otten, Lorynn Teela, Cornelieke S H Aarnoudse-Moens, Suzanne W J Terheggen-Lagro, Annelies E van der Hulst, Marc Engelen, Marsh Kӧnigs, Jaap Oosterlaan, Hennie Knoester
OBJECTIVES: Morbidity after PICU admission for critical illness is a growing concern. Sequelae may occur in various domains of functioning and can only appropriately be determined through structured follow-up. Here, we describe the process of designing and implementing a structured multidisciplinary follow-up program for patients and their parents after PICU admission and show the first results illustrating the significance of our program. DESIGN: Prospective observational cohort study...
February 17, 2023: Pediatric Critical Care Medicine
#17
JOURNAL ARTICLE
Tyler N Brown, Lindsey Justice, Farhan Malik, David Lehenbauer, Alan O'Donnell, James M Brown, Tricia Powers, Smriti Neogi, David S Cooper, Kenneth E Mah
OBJECTIVES: Provider-only, combined surgical, and medical multidisciplinary rounds ("surgical rounds") are essential to achieve optimal outcomes in large pediatric cardiac ICUs. Lean methodology was applied with the aims of identifying areas of waste and nonvalue-added work within the surgical rounds process. Thereby, the goals were to improve rounding efficiency and reduce rounding duration while not sacrificing critical patient care discussion nor delaying bedside rounds or surgical start times...
February 17, 2023: Pediatric Critical Care Medicine
#18
JOURNAL ARTICLE
Erwin Ista, Chani Traube, Marjorie de Neef, Jan Schieveld, Hennie Knoester, Marja Molag, Sapna R Kudchadkar, Jacqueline Strik
OBJECTIVES: Pediatric delirium (PD) is a neuropsychiatric syndrome caused by a complex interplay between predisposing factors (e.g., age, cognitive impairment), acute illness, and environmental triggers. PD is associated with substantial morbidity and mortality. The objective of this study is to systematically review and evaluate factors associated with PD in hospitalized pediatric patients. DATA SOURCES: A systematic search of PubMed, Embase, Ovid Medline, Web- of-Science, Cochrane, CIHNAL, and Google Scholar databases was conducted for relevant studies (1990-2022)...
February 15, 2023: Pediatric Critical Care Medicine
#19
JOURNAL ARTICLE
Sami Gendler, Shaul Gelikas, Tomer Talmy, Ari M Lipsky, Guy Avital, Roy Nadler, Irina Radomislensky, Alon Ahimor, Elon Glassberg, Yael Mozer Glassberg, Ofer Almog, Mark H Yazer, Avi Benov
OBJECTIVES: Tranexamic acid (TXA) administration confers a survival benefit in bleeding trauma patients; however, data regarding its use in pediatric patients are limited. This study evaluates the prehospital treatment with TXA in pediatric trauma patients treated by the Israel Defense Forces Medical Corps (IDF-MC). DESIGN: Retrospective, cohort study using the Israel Defense Forces registry, 2011-2021. PATIENTS: Pediatric trauma patients less than 18 years old...
February 8, 2023: Pediatric Critical Care Medicine
#20
JOURNAL ARTICLE
Takafumi Obara, Tetsuya Yumoto, Tsuyoshi Nojima, Takashi Hongo, Kohei Tsukahara, Naomi Matsumoto, Takashi Yorifuji, Atsunori Nakao, Jonathan Elmer, Hiromichi Naito
OBJECTIVES: To examine the association of prehospital physician presence with neurologic outcomes of pediatric patients with out-of-hospital cardiac arrest (OHCA). DESIGN: Retrospective cohort study. SETTING: Data from the Japanese Association for Acute Medicine-OHCA Registry. INTERVENTIONS: None. PATIENTS: Pediatric patients (age 17 yr old or younger) registered in the database between June 2014 and December 2019...
February 8, 2023: Pediatric Critical Care Medicine
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