Pub Date : 2024-11-01Epub Date: 2024-08-06DOI: 10.1097/PCC.0000000000003589
Natalja L Stanski, Bin Zhang, Natalie Z Cvijanovich, Julie C Fitzgerald, Michael T Bigham, Parag N Jain, Adam J Schwarz, Riad Lutfi, Geoffrey L Allen, Neal J Thomas, Torrey Baines, Bereketeab Haileselassie, Scott L Weiss, Mihir R Atreya, Andrew J Lautz, Basilia Zingarelli, Stephen W Standage, Jennifer Kaplan, Stuart L Goldstein
Objectives: We previously derived the updated Pediatric Sepsis Biomarker Risk for Acute Kidney Injury (PERSEVERE-II AKI) prediction model, which had robust diagnostic test characteristics for severe AKI on day 3 (D3 severe AKI) of septic shock. We now sought to validate this model in an independent cohort of children to the one in which the model was developed.
Design: A secondary analysis of a multicenter, prospective, observational study carried out from January 2019 to December 2022.
Setting: Ten PICUs in the United States.
Patients: Children with septic shock 1 week to 18 years old admitted to the PICU.
Interventions: None.
Measurements and main results: Seventy-nine of 363 patients (22%) had D3 severe AKI, defined as Kidney Disease Improving Global Outcomes stage 2 or higher. Patients were assigned a probability of D3 severe AKI using the PERSEVERE-II AKI model. The model predicted D3 severe AKI with an area under the receiver operating characteristic curve of 0.89 (95% CI, 0.85-0.93), sensitivity of 77% (95% CI, 66-86%), specificity of 88% (95% CI, 84-92%), positive predictive value of 65% (95% CI, 54-74%), and negative predictive value of 93% (95% CI, 89-96%). These data represent an increase in post-test probability of D3 severe AKI with a positive test from 22% to 65%, and a prevalence threshold of 28%. On multivariable regression, the PERSEVERE-II AKI prediction model demonstrated greater adjusted odds ratio (aOR) for D3 severe AKI (aOR, 11.2; 95% CI, 4.9-25.3) and lesser aOR for failure of D3 renal recovery from early AKI (aOR, 0.31; 95% CI, 0.13-0.69).
Conclusions: The PERSEVERE-II AKI model demonstrates consistently robust performance for prediction of new or persistent D3 severe AKI in children with septic shock. A major limitation is that actual D3 severe AKI prevalence is below the prevalence threshold for the test, and thus future work should focus on evaluating use in enriched populations.
目标:我们之前建立了最新的儿科脓毒症急性肾损伤生物标志物风险(PERSEVERE-II AKI)预测模型,该模型对脓毒性休克第3天的重度AKI(D3重度AKI)具有可靠的诊断测试特征。现在,我们试图在一个独立的儿童队列中验证这一模型:对 2019 年 1 月至 2022 年 12 月期间开展的一项多中心、前瞻性观察研究进行二次分析:美国十所儿童重症监护病房:干预措施:无:无干预措施:363名患者中有79名(22%)患有D3重度AKI,定义为肾病改善全球结果2期或更高。采用 PERSEVERE-II AKI 模型对患者的 D3 重度 AKI 概率进行了分配。该模型预测 D3 重度 AKI 的接收者操作特征曲线下面积为 0.89(95% CI,0.85-0.93),灵敏度为 77%(95% CI,66-86%),特异性为 88%(95% CI,84-92%),阳性预测值为 65%(95% CI,54-74%),阴性预测值为 93%(95% CI,89-96%)。这些数据表明,检测结果呈阳性时,D3 重度 AKI 的检测后概率从 22% 增加到 65%,患病率阈值为 28%。在多变量回归中,PERSEVERE-II AKI 预测模型显示 D3 重度 AKI 的调整赔率 (aOR) 较大(aOR,11.2;95% CI,4.9-25.3),而 D3 早期 AKI 肾功能恢复失败的 aOR 较小(aOR,0.31;95% CI,0.13-0.69):结论:PERSEVERE-II AKI模型在预测脓毒性休克患儿新发或持续性D3重度AKI方面一直表现稳健。一个主要的局限性是,D3重度AKI的实际发病率低于该测试的发病率阈值,因此未来的工作应侧重于评估在丰富人群中的使用情况。
{"title":"Diagnostic Validation of the Updated Pediatric Sepsis Biomarker Risk II for Acute Kidney Injury Prediction Model in Pediatric Septic Shock.","authors":"Natalja L Stanski, Bin Zhang, Natalie Z Cvijanovich, Julie C Fitzgerald, Michael T Bigham, Parag N Jain, Adam J Schwarz, Riad Lutfi, Geoffrey L Allen, Neal J Thomas, Torrey Baines, Bereketeab Haileselassie, Scott L Weiss, Mihir R Atreya, Andrew J Lautz, Basilia Zingarelli, Stephen W Standage, Jennifer Kaplan, Stuart L Goldstein","doi":"10.1097/PCC.0000000000003589","DOIUrl":"10.1097/PCC.0000000000003589","url":null,"abstract":"<p><strong>Objectives: </strong>We previously derived the updated Pediatric Sepsis Biomarker Risk for Acute Kidney Injury (PERSEVERE-II AKI) prediction model, which had robust diagnostic test characteristics for severe AKI on day 3 (D3 severe AKI) of septic shock. We now sought to validate this model in an independent cohort of children to the one in which the model was developed.</p><p><strong>Design: </strong>A secondary analysis of a multicenter, prospective, observational study carried out from January 2019 to December 2022.</p><p><strong>Setting: </strong>Ten PICUs in the United States.</p><p><strong>Patients: </strong>Children with septic shock 1 week to 18 years old admitted to the PICU.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Seventy-nine of 363 patients (22%) had D3 severe AKI, defined as Kidney Disease Improving Global Outcomes stage 2 or higher. Patients were assigned a probability of D3 severe AKI using the PERSEVERE-II AKI model. The model predicted D3 severe AKI with an area under the receiver operating characteristic curve of 0.89 (95% CI, 0.85-0.93), sensitivity of 77% (95% CI, 66-86%), specificity of 88% (95% CI, 84-92%), positive predictive value of 65% (95% CI, 54-74%), and negative predictive value of 93% (95% CI, 89-96%). These data represent an increase in post-test probability of D3 severe AKI with a positive test from 22% to 65%, and a prevalence threshold of 28%. On multivariable regression, the PERSEVERE-II AKI prediction model demonstrated greater adjusted odds ratio (aOR) for D3 severe AKI (aOR, 11.2; 95% CI, 4.9-25.3) and lesser aOR for failure of D3 renal recovery from early AKI (aOR, 0.31; 95% CI, 0.13-0.69).</p><p><strong>Conclusions: </strong>The PERSEVERE-II AKI model demonstrates consistently robust performance for prediction of new or persistent D3 severe AKI in children with septic shock. A major limitation is that actual D3 severe AKI prevalence is below the prevalence threshold for the test, and thus future work should focus on evaluating use in enriched populations.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141902579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-06-21DOI: 10.1097/PCC.0000000000003556
Charly Huxford, Alireza Rafiei, Vuong Nguyen, Matthew O Wiens, J Mark Ansermino, Niranjan Kissoon, Elias Kumbakumba, Stephen Businge, Clare Komugisha, Mellon Tayebwa, Jerome Kabakyenga, Nathan Kenya Mugisha, Rishikesan Kamaleswaran
The aim of this "Technical Note" is to inform the pediatric critical care data research community about the "2024 Pediatric Sepsis Data Challenge." This competition aims to facilitate the development of open-source algorithms to predict in-hospital mortality in Ugandan children with sepsis. The challenge is to first develop an algorithm using a synthetic training dataset, which will then be scored according to standard diagnostic testing criteria, and then be evaluated against a nonsynthetic test dataset. The datasets originate from admissions to six hospitals in Uganda (2017-2020) and include 3837 children, 6 to 60 months old, who were confirmed or suspected to have a diagnosis of sepsis. The synthetic dataset was created from a random subset of the original data. The test validation dataset closely resembles the synthetic dataset. The challenge should generate an optimal model for predicting in-hospital mortality. Following external validation, this model could be used to improve the outcomes for children with proven or suspected sepsis in low- and middle-income settings.
{"title":"The 2024 Pediatric Sepsis Challenge: Predicting In-Hospital Mortality in Children With Suspected Sepsis in Uganda.","authors":"Charly Huxford, Alireza Rafiei, Vuong Nguyen, Matthew O Wiens, J Mark Ansermino, Niranjan Kissoon, Elias Kumbakumba, Stephen Businge, Clare Komugisha, Mellon Tayebwa, Jerome Kabakyenga, Nathan Kenya Mugisha, Rishikesan Kamaleswaran","doi":"10.1097/PCC.0000000000003556","DOIUrl":"10.1097/PCC.0000000000003556","url":null,"abstract":"<p><p>The aim of this \"Technical Note\" is to inform the pediatric critical care data research community about the \"2024 Pediatric Sepsis Data Challenge.\" This competition aims to facilitate the development of open-source algorithms to predict in-hospital mortality in Ugandan children with sepsis. The challenge is to first develop an algorithm using a synthetic training dataset, which will then be scored according to standard diagnostic testing criteria, and then be evaluated against a nonsynthetic test dataset. The datasets originate from admissions to six hospitals in Uganda (2017-2020) and include 3837 children, 6 to 60 months old, who were confirmed or suspected to have a diagnosis of sepsis. The synthetic dataset was created from a random subset of the original data. The test validation dataset closely resembles the synthetic dataset. The challenge should generate an optimal model for predicting in-hospital mortality. Following external validation, this model could be used to improve the outcomes for children with proven or suspected sepsis in low- and middle-income settings.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141432519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-08-12DOI: 10.1097/PCC.0000000000003595
Martha A Q Curley, Onella S Dawkins-Henry, Laura Beth Kalvas, Mallory A Perry-Eaddy, Georgia Georgostathi, Ian Yuan, David Wypij, Lisa A Asaro, Athena F Zuppa, Sapna R Kudchadkar
Objectives: Pilot test the nurse-led chronotherapeutic bundle in critically ill children, RESTORE Resilience (R 2 ).
Design: A two-phase cohort study was carried out from 2017 to 2021.
Setting: Two similarly sized and organized PICUs in the United States.
Patients: Children 6 months to 17 years old who were mechanically ventilated for acute respiratory failure.
Interventions: R 2 seven-item chronotherapeutic bundle, including: 1) replication of child's pre-hospital daily routine (i.e., sleep/wake, feeding, activity patterns); 2) cycled day-night light/sound modulation; 3) minimal effective sedation; 4) night fasting with bolus enteral daytime feedings; 5) early progressive mobility; 6) nursing care continuity; and 7) parent diaries.
Measurements and main results: Children underwent environmental (light, sound) and patient (actigraphy, activity log, salivary melatonin, electroencephalogram) monitoring. Parents completed the Child's Daily Routine and Sleep Survey (CDRSS) and Family-Centered Care Scale. The primary outcome was post-extubation daytime activity consolidation (Daytime Activity Ratio Estimate [DARE]). Twenty baseline-phase (2017-2019) and 36 intervention-phase (2019-2021) participants were enrolled. During the intervention phase, nurses used the CDRSS to construct children's PICU schedules. Overall compliance with nurse-implemented R 2 elements 1-5 increased from 18% (interquartile range, 13-30%) at baseline to 63% (53-68%) during the intervention phase ( p < 0.001). Intervention participants were exposed to their pre-hospitalization daily routine ( p = 0.002), cycled day-night light/sound modulation ( p < 0.001), and early progressive mobility on more PICU days ( p = 0.02). Sedation target identification, enteral feeding schedules, and nursing care continuity did not differ between phases. Parent diaries were seldom used. DARE improved during the intervention phase and was higher pre-extubation (median 62% vs. 53%; p = 0.04) but not post-extubation (62% vs. 57%; p = 0.56).
Conclusions: In the PICU, implementation of an individualized nurse-implemented chronotherapeutic bundle is feasible. Children who received the R 2 bundle had increased pre-extubation daytime activity consolidation compared to children receiving usual care. Given variation in protocol adherence, further R 2 testing should include interprofessional collaboration, pragmatic trial design, and implementation science strategies.
{"title":"The Nurse-Implemented Chronotherapeutic Bundle in Critically Ill Children, RESTORE Resilience (R 2 ): Pilot Testing in a Two-Phase Cohort Study, 2017-2021.","authors":"Martha A Q Curley, Onella S Dawkins-Henry, Laura Beth Kalvas, Mallory A Perry-Eaddy, Georgia Georgostathi, Ian Yuan, David Wypij, Lisa A Asaro, Athena F Zuppa, Sapna R Kudchadkar","doi":"10.1097/PCC.0000000000003595","DOIUrl":"10.1097/PCC.0000000000003595","url":null,"abstract":"<p><strong>Objectives: </strong>Pilot test the nurse-led chronotherapeutic bundle in critically ill children, RESTORE Resilience (R 2 ).</p><p><strong>Design: </strong>A two-phase cohort study was carried out from 2017 to 2021.</p><p><strong>Setting: </strong>Two similarly sized and organized PICUs in the United States.</p><p><strong>Patients: </strong>Children 6 months to 17 years old who were mechanically ventilated for acute respiratory failure.</p><p><strong>Interventions: </strong>R 2 seven-item chronotherapeutic bundle, including: 1) replication of child's pre-hospital daily routine (i.e., sleep/wake, feeding, activity patterns); 2) cycled day-night light/sound modulation; 3) minimal effective sedation; 4) night fasting with bolus enteral daytime feedings; 5) early progressive mobility; 6) nursing care continuity; and 7) parent diaries.</p><p><strong>Measurements and main results: </strong>Children underwent environmental (light, sound) and patient (actigraphy, activity log, salivary melatonin, electroencephalogram) monitoring. Parents completed the Child's Daily Routine and Sleep Survey (CDRSS) and Family-Centered Care Scale. The primary outcome was post-extubation daytime activity consolidation (Daytime Activity Ratio Estimate [DARE]). Twenty baseline-phase (2017-2019) and 36 intervention-phase (2019-2021) participants were enrolled. During the intervention phase, nurses used the CDRSS to construct children's PICU schedules. Overall compliance with nurse-implemented R 2 elements 1-5 increased from 18% (interquartile range, 13-30%) at baseline to 63% (53-68%) during the intervention phase ( p < 0.001). Intervention participants were exposed to their pre-hospitalization daily routine ( p = 0.002), cycled day-night light/sound modulation ( p < 0.001), and early progressive mobility on more PICU days ( p = 0.02). Sedation target identification, enteral feeding schedules, and nursing care continuity did not differ between phases. Parent diaries were seldom used. DARE improved during the intervention phase and was higher pre-extubation (median 62% vs. 53%; p = 0.04) but not post-extubation (62% vs. 57%; p = 0.56).</p><p><strong>Conclusions: </strong>In the PICU, implementation of an individualized nurse-implemented chronotherapeutic bundle is feasible. Children who received the R 2 bundle had increased pre-extubation daytime activity consolidation compared to children receiving usual care. Given variation in protocol adherence, further R 2 testing should include interprofessional collaboration, pragmatic trial design, and implementation science strategies.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-08-23DOI: 10.1097/PCC.0000000000003598
Judith Ju Ming Wong, Qalab Abbas, Justin Qi Yuee Wang, Wei Xu, Hongxing Dang, Phuc Huu Phan, Liang Guo, Pei Chuen Lee, Xuemei Zhu, Suresh Kumar Angurana, Minchaya Pukdeetraipop, Pustika Efar, Saptadi Yuliarto, Insu Choi, Lijia Fan, Alvin Wun Fung Hui, Chin Seng Gan, Chunfeng Liu, Rujipat Samransamruajkit, Hwa Jin Cho, Jacqueline Soo May Ong, Jan Hau Lee
Objectives: Mortality from pneumonia is three times higher in Asia compared with industrialized countries. We aimed to determine the epidemiology, microbiology, and outcome of severe pneumonia in PICUs across the Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN).
Design: Prospective multicenter observational study from June 2020 to September 2022.
Setting: Fifteen PICUs in PACCMAN.
Patients: All children younger than 18 years old diagnosed with pneumonia and admitted to the PICU.
Interventions: None.
Measurements and main results: Clinical, microbiologic, and outcome data were recorded. The primary outcome was PICU mortality. Univariate and multivariable logistic regression was performed to investigate associations between PICU mortality and explanatory risk factors on presentation to the PICU. Among patients screened, 846 of 11,778 PICU patients (7.2%) with a median age of 1.2 years (interquartile range, 0.4-3.7 yr) had pneumonia. Respiratory syncytial virus was detected in 111 of 846 cases (13.1%). The most common bacteria were Staphylococcus species (71/846 [8.4%]) followed by Pseudomonas species (60/846 [7.1%]). Second-generation cephalosporins (322/846 [38.1%]) were the most common broad-spectrum antibiotics prescribed, followed by carbapenems (174/846 [20.6%]). Invasive mechanical ventilation and noninvasive respiratory support was provided in 438 of 846 (51.8%) and 500 of 846 (59.1%) patients, respectively. PICU mortality was 65 of 846 (7.7%). In the multivariable logistic regression model, age (adjusted odds ratio [aOR], 1.08; 95% CI, 1.00-1.16), Pediatric Index of Mortality 3 score (aOR, 1.03; 95% CI, 1.02-1.05), and drowsiness (aOR, 2.73; 95% CI, 1.24-6.00) were associated with greater odds of mortality.
Conclusions: In the PACCMAN contributing PICUs, pneumonia is a frequent cause for admission (7%) and is associated with a greater odds of mortality.
{"title":"Severe Pneumonia in PICU Admissions: The Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) Observational Cohort Study, 2020-2022.","authors":"Judith Ju Ming Wong, Qalab Abbas, Justin Qi Yuee Wang, Wei Xu, Hongxing Dang, Phuc Huu Phan, Liang Guo, Pei Chuen Lee, Xuemei Zhu, Suresh Kumar Angurana, Minchaya Pukdeetraipop, Pustika Efar, Saptadi Yuliarto, Insu Choi, Lijia Fan, Alvin Wun Fung Hui, Chin Seng Gan, Chunfeng Liu, Rujipat Samransamruajkit, Hwa Jin Cho, Jacqueline Soo May Ong, Jan Hau Lee","doi":"10.1097/PCC.0000000000003598","DOIUrl":"10.1097/PCC.0000000000003598","url":null,"abstract":"<p><strong>Objectives: </strong>Mortality from pneumonia is three times higher in Asia compared with industrialized countries. We aimed to determine the epidemiology, microbiology, and outcome of severe pneumonia in PICUs across the Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN).</p><p><strong>Design: </strong>Prospective multicenter observational study from June 2020 to September 2022.</p><p><strong>Setting: </strong>Fifteen PICUs in PACCMAN.</p><p><strong>Patients: </strong>All children younger than 18 years old diagnosed with pneumonia and admitted to the PICU.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Clinical, microbiologic, and outcome data were recorded. The primary outcome was PICU mortality. Univariate and multivariable logistic regression was performed to investigate associations between PICU mortality and explanatory risk factors on presentation to the PICU. Among patients screened, 846 of 11,778 PICU patients (7.2%) with a median age of 1.2 years (interquartile range, 0.4-3.7 yr) had pneumonia. Respiratory syncytial virus was detected in 111 of 846 cases (13.1%). The most common bacteria were Staphylococcus species (71/846 [8.4%]) followed by Pseudomonas species (60/846 [7.1%]). Second-generation cephalosporins (322/846 [38.1%]) were the most common broad-spectrum antibiotics prescribed, followed by carbapenems (174/846 [20.6%]). Invasive mechanical ventilation and noninvasive respiratory support was provided in 438 of 846 (51.8%) and 500 of 846 (59.1%) patients, respectively. PICU mortality was 65 of 846 (7.7%). In the multivariable logistic regression model, age (adjusted odds ratio [aOR], 1.08; 95% CI, 1.00-1.16), Pediatric Index of Mortality 3 score (aOR, 1.03; 95% CI, 1.02-1.05), and drowsiness (aOR, 2.73; 95% CI, 1.24-6.00) were associated with greater odds of mortality.</p><p><strong>Conclusions: </strong>In the PACCMAN contributing PICUs, pneumonia is a frequent cause for admission (7%) and is associated with a greater odds of mortality.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142036561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-11-04DOI: 10.1097/PCC.0000000000003616
Avital Ludomirsky, Maryam Y Naim
{"title":"A Breath of Fresh Air: The Role of Airway Anomalies on Outcomes in Congenital Heart Disease.","authors":"Avital Ludomirsky, Maryam Y Naim","doi":"10.1097/PCC.0000000000003616","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003616","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-11-04DOI: 10.1097/PCC.0000000000003604
Mark D Weber, Adam S Himebauch, Jeremy C Zuckerberg, Karla Resendiz, Thomas Conlon
{"title":"Effects of Ethanol Locks on Burst Pressure for Small Caliber Nonpower Injectable Peripherally Inserted Central Catheters.","authors":"Mark D Weber, Adam S Himebauch, Jeremy C Zuckerberg, Karla Resendiz, Thomas Conlon","doi":"10.1097/PCC.0000000000003604","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003604","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-11-04DOI: 10.1097/PCC.0000000000003606
Brenda M Morrow
{"title":"Prioritizing Childhood Pneumonia to Achieve Global Health Targets-Insights From the Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) Cohort.","authors":"Brenda M Morrow","doi":"10.1097/PCC.0000000000003606","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003606","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Airway anomalies increase risk of morbidity and mortality in postoperative pediatric patients with congenital heart disease (CHD). We aimed to identify airway anomalies and the association with intermediate outcomes in patients undergoing surgery for CHD.
Design: Single-center, hospital-based retrospective study in Taiwan, 2017-2020.
Setting: A tertiary referral hospital in Taiwan.
Patients: All pediatric patients who underwent surgery for CHD and were admitted to the PICU and had data about airway evaluation by cardiopulmonary CT scan or bronchoscopy.
Interventions: None.
Measurements and main results: Among 820 CHD patients identified as having undergone airway evaluation in the PICU, 185 (22.6%) were diagnosed with airway anomalies, including structural lesions in 146 of 185 (78.9%), and dynamic problems were seen in 87 of 185 (47.0%). In this population, the explanatory factors associated with greater odds (odds ratio [OR]) of airway anomaly were premature birth (OR, 1.90; p = 0.002), genetic syndromes (OR, 2.60; p < 0.001), and in those with preoperative ventilator use (OR, 4.28; p < 0.001). In comparison to those without airway anomalies, the presence of airway anomalies was associated with higher hospital mortality (11.4% vs. 2.7%; p < 0.001), prolonged intubation days (8 d [1-27 d] vs. 1 d [1-5 d]; p < 0.001), longer PICU length of stay (23 d [8-81 d] vs. 7 d [4-18 d]; p < 0.001), and greater hazard of intermediate mortality (adjusted hazard ratio, 2.60; p = 0.001).
Conclusions: In our single-center retrospective study, 2017-2020, between one-in-five and one-in-four of our postoperative CHD patients undergoing an airway evaluation had airway anomalies. Factors associated with greater odds of airway anomaly included, those with premature birth, or genetic syndromes, and preoperative ventilator use. Overall, in patients undergoing airway evaluation, the finding of an airway anomalies was associated with longer postoperative intubation duration and greater hazard of intermediate mortality.
目的:气道异常会增加先天性心脏病(CHD)儿科患者术后的发病率和死亡率。我们旨在确定气道异常以及气道异常与先天性心脏病手术患者中期预后的关系:2017-2020年在台湾进行的基于医院的单中心回顾性研究:台湾一家三级转诊医院:所有接受CHD手术并入住PICU的儿科患者,且有心肺CT扫描或支气管镜检查气道评估数据:测量和主要结果在PICU接受气道评估的820名CHD患者中,185人(22.6%)被诊断为气道异常,其中146人(78.9%)存在结构性病变,87人(47.0%)存在动态问题。在这一人群中,与气道异常几率(几率比 [OR])较大相关的解释性因素有早产(OR,1.90;P = 0.002)、遗传综合征(OR,2.60;P < 0.001)以及术前使用呼吸机者(OR,4.28;P < 0.001)。与无气道异常的患者相比,气道异常与较高的住院死亡率(11.4% vs. 2.7%;P < 0.001)、较长的插管天数(8 天 [1-27 天] vs. 1 天 [1-5 天];P < 0.001)、较低的死亡率(1.5% vs. 1.5%;P < 0.001)、较高的插管天数(1 天 [1-27 天] vs. 1 天 [1-5 天];P < 0.001)相关。1天 [1-5 天];p < 0.001)、PICU住院时间延长(23天 [8-81 天] vs. 7天 [4-18 天];p < 0.001)以及中度死亡风险增加(调整后危险比为2.60;p = 0.001):在我们的单中心回顾性研究(2017-2020年)中,接受气道评估的CHD术后患者中,有五分之一到四分之一存在气道异常。与气道异常几率增大相关的因素包括:早产、遗传综合征以及术前使用呼吸机。总体而言,在接受气道评估的患者中,发现气道异常与术后插管时间延长和中度死亡率增加有关。
{"title":"Airway Anomalies in Pediatric Patients After Surgery for Congenital Heart Disease: Single-Center Retrospective Cohort Study, Taiwan, 2017-2020.","authors":"Jeng-Hung Wu, En-Ting Wu, Heng-Wen Chou, Ching-Chia Wang, Frank Leigh Lu, Yi-Chia Wang, Chi-Hisang Huang, Shyh-Jye Chen, Yih-Sharng Chen, Shu-Chien Huang","doi":"10.1097/PCC.0000000000003592","DOIUrl":"10.1097/PCC.0000000000003592","url":null,"abstract":"<p><strong>Objectives: </strong>Airway anomalies increase risk of morbidity and mortality in postoperative pediatric patients with congenital heart disease (CHD). We aimed to identify airway anomalies and the association with intermediate outcomes in patients undergoing surgery for CHD.</p><p><strong>Design: </strong>Single-center, hospital-based retrospective study in Taiwan, 2017-2020.</p><p><strong>Setting: </strong>A tertiary referral hospital in Taiwan.</p><p><strong>Patients: </strong>All pediatric patients who underwent surgery for CHD and were admitted to the PICU and had data about airway evaluation by cardiopulmonary CT scan or bronchoscopy.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Among 820 CHD patients identified as having undergone airway evaluation in the PICU, 185 (22.6%) were diagnosed with airway anomalies, including structural lesions in 146 of 185 (78.9%), and dynamic problems were seen in 87 of 185 (47.0%). In this population, the explanatory factors associated with greater odds (odds ratio [OR]) of airway anomaly were premature birth (OR, 1.90; p = 0.002), genetic syndromes (OR, 2.60; p < 0.001), and in those with preoperative ventilator use (OR, 4.28; p < 0.001). In comparison to those without airway anomalies, the presence of airway anomalies was associated with higher hospital mortality (11.4% vs. 2.7%; p < 0.001), prolonged intubation days (8 d [1-27 d] vs. 1 d [1-5 d]; p < 0.001), longer PICU length of stay (23 d [8-81 d] vs. 7 d [4-18 d]; p < 0.001), and greater hazard of intermediate mortality (adjusted hazard ratio, 2.60; p = 0.001).</p><p><strong>Conclusions: </strong>In our single-center retrospective study, 2017-2020, between one-in-five and one-in-four of our postoperative CHD patients undergoing an airway evaluation had airway anomalies. Factors associated with greater odds of airway anomaly included, those with premature birth, or genetic syndromes, and preoperative ventilator use. Overall, in patients undergoing airway evaluation, the finding of an airway anomalies was associated with longer postoperative intubation duration and greater hazard of intermediate mortality.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11527375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141902578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-08-12DOI: 10.1097/PCC.0000000000003590
Yeu Sanz Wu, Tania Gennell, Chloe Porigow, Weijia Fan, Jeanne Rubsam, Nicolino Valerio Dorrello, Steven Stylianos, Vincent P Duron
Objective: Injury and surgery both represent well-defined starting points of a predictable inflammatory response, but the consequent response to IV fluids has not been studied. We aimed to review and compare our single-center fluid management strategies in these two populations.
Design: Retrospective cohort study from January 2020 to July 2022. The primary outcome was total IV fluid volume administered. Net fluid balances and select clinical outcomes were also evaluated.
Setting: Single tertiary academic center and level 1 pediatric trauma center in New York.
Patients: A dataset of critically ill trauma and surgical patients aged 0-18 years who were admitted to the PICU, 2020-2022. Trauma patients had at least moderate traumatic injuries (Injury Severity Score ≥ 9) and surgical patients had at least a 1-hour operation time.
Interventions: None.
Measurements and main results: We identified 25 trauma and 115 surgical patients. During the first 5 days of hospitalization, we did not identify an association between grouping and total IV fluids administered and fluid balance in the prehospital, emergency department, and operating room ( p = 0.90 and p = 0.79), even when adjusted for weight ( p = 0.96). Time trend graphs of net fluid balance and IV fluid administered illustrated analogous fluid requirement and response with the transition from net positive to net negative fluid balance between 48 and 72 hours. There was an association between total IV fluid and ventilator requirement ( p = 0.003).
Conclusions: Critically ill pediatric trauma and postoperative patients seem to have similar fluid management and balance after injury or surgery. In our opinion, these two critically ill populations could be combined in large prospective studies on optimal fluid therapy in critically ill children.
{"title":"Fluid Management in Critically Ill Children: Single-Center Retrospective Comparison of Trauma and Postoperative Patients, 2020-2022.","authors":"Yeu Sanz Wu, Tania Gennell, Chloe Porigow, Weijia Fan, Jeanne Rubsam, Nicolino Valerio Dorrello, Steven Stylianos, Vincent P Duron","doi":"10.1097/PCC.0000000000003590","DOIUrl":"10.1097/PCC.0000000000003590","url":null,"abstract":"<p><strong>Objective: </strong>Injury and surgery both represent well-defined starting points of a predictable inflammatory response, but the consequent response to IV fluids has not been studied. We aimed to review and compare our single-center fluid management strategies in these two populations.</p><p><strong>Design: </strong>Retrospective cohort study from January 2020 to July 2022. The primary outcome was total IV fluid volume administered. Net fluid balances and select clinical outcomes were also evaluated.</p><p><strong>Setting: </strong>Single tertiary academic center and level 1 pediatric trauma center in New York.</p><p><strong>Patients: </strong>A dataset of critically ill trauma and surgical patients aged 0-18 years who were admitted to the PICU, 2020-2022. Trauma patients had at least moderate traumatic injuries (Injury Severity Score ≥ 9) and surgical patients had at least a 1-hour operation time.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We identified 25 trauma and 115 surgical patients. During the first 5 days of hospitalization, we did not identify an association between grouping and total IV fluids administered and fluid balance in the prehospital, emergency department, and operating room ( p = 0.90 and p = 0.79), even when adjusted for weight ( p = 0.96). Time trend graphs of net fluid balance and IV fluid administered illustrated analogous fluid requirement and response with the transition from net positive to net negative fluid balance between 48 and 72 hours. There was an association between total IV fluid and ventilator requirement ( p = 0.003).</p><p><strong>Conclusions: </strong>Critically ill pediatric trauma and postoperative patients seem to have similar fluid management and balance after injury or surgery. In our opinion, these two critically ill populations could be combined in large prospective studies on optimal fluid therapy in critically ill children.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11527379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-11-04DOI: 10.1097/PCC.0000000000003615
Gail M Annich, Dylan Ginter, Melissa Reynolds
{"title":"Unraveling the Blood Biomaterial Interaction During Extracorporeal Membrane Oxygenation.","authors":"Gail M Annich, Dylan Ginter, Melissa Reynolds","doi":"10.1097/PCC.0000000000003615","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003615","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}