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Antibiotic Target Attainment: What Are We Aiming for? 抗生素目标实现:我们的目标是什么?
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-12-01 Epub Date: 2024-12-04 DOI: 10.1097/PCC.0000000000003630
Cheryl L Sargel
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引用次数: 0
Extracorporeal Life Support: Making Ethically Sound Allocation Decisions for a Limited Resource. 体外生命支持:为有限资源做出合乎伦理的合理分配决策。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-12-01 Epub Date: 2024-09-18 DOI: 10.1097/PCC.0000000000003608
Mithya Lewis-Newby, Aaron G Wightman, Katherine A Banker, Denise M Dudzinski, Sarah J Handley, Robert L Mazor, John K McGuire, David M McMullan, Samuel E Rice-Townsend, Eunice Soh, Larissa Yalon, Douglas S Diekema, Emily R Berkman
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引用次数: 0
Writing for Pediatric Critical Care Medicine : A Checklist When Using Administrative and Clinical Databases for Research. 儿科重症医学写作:使用行政和临床数据库进行研究时的核对表》。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-12-01 Epub Date: 2024-10-24 DOI: 10.1097/PCC.0000000000003631
Robert C Tasker
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引用次数: 0
Beta-Lactam Antibiotic Exposure During Pediatric Extracorporeal Membrane Oxygenation: Retrospective Cohort Analysis of Drug Levels Using Standard Dosing, 2018-2020. 儿童体外膜氧合过程中β -内酰胺类抗生素暴露:2018-2020年标准剂量药物水平的回顾性队列分析
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-12-01 Epub Date: 2024-10-07 DOI: 10.1097/PCC.0000000000003605
Alice Marsaux, Pierre-Louis Léger, Jérôme Rambaud, Emmanuelle Bille, Sylvain Renolleau, Jean Marc Tréluyer, Inès Gana, Matthie Lorrot, Marion Grimaud, Julie Toubiana, Agathe Béranger, Sihem Benaboud, Mehdi Oualha

Objectives: Children on extracorporeal membrane oxygenation (ECMO) are at high risk of infection that may worsen prognosis. Even though treatment with beta-lactam antibiotics is frequent, dosing is not adapted to altered pharmacokinetic and pharmacodynamic characteristics of children on ECMO. There is, therefore, a risk of inadequate drug levels when using standard dosing. In this study, we aimed to describe beta-lactam exposures of children on ECMO using current dosing and to identify factors associated with inadequate exposure. The optimal pharmacokinetic/pharmacodynamic target was considered as a plasma concentration four times above the minimum inhibitory concentration throughout the dosing interval target.

Design: Two-center retrospective cohort study.

Setting: Two PICUs in Paris, France.

Patients: Children (from birth to 18 yr) undergoing venovenous or venoarterial ECMO, from 2018 to 2020.

Interventions: None.

Measurements and main results: There were 57 patients who received 11 different beta-lactams, with 226 plasma concentrations analyzed. A total of 32 infections were documented. Overall, 133 of 226 concentrations (58.8%) were insufficient, primarily in samples from children younger than 28 days (p = 0.035), with low body weight (p = 0.013), or in instances of hypoalbuminemia (p = 0.011) and increased renal clearance (p = 0.032). Supratherapeutic concentrations were observed in 25 of 226 samples (11.1%), associated with being taken from patients with renal impairment (p < 0.01).

Conclusions: In this retrospective cohort of pediatric ECMO cases, there is an associated risk of underexposure when prescribing conventional dosing of beta-lactams, which are likely associated with renal impairment and fluid overload. Prospective testing of therapeutic drug monitoring combined with pharmacokinetic/pharmacodynamic models should be tested as a risk-reduction strategy in this vulnerable population.

目的:接受体外膜氧合(ECMO)治疗的儿童感染风险高,预后可能恶化。尽管经常使用β -内酰胺类抗生素治疗,但其剂量并不适应ECMO患儿药代动力学和药效学特征的改变。因此,在使用标准剂量时,存在药物水平不足的风险。在这项研究中,我们旨在描述使用当前剂量的ECMO儿童β -内酰胺暴露情况,并确定与暴露不足相关的因素。最佳药代动力学/药效学靶点被认为是整个给药间隔靶点的血浆浓度比最低抑制浓度高4倍。设计:双中心回顾性队列研究。背景:法国巴黎的两个picu。患者:2018年至2020年接受静脉静脉或静脉动脉ECMO的儿童(出生至18岁)。干预措施:没有。测量和主要结果:57例患者接受了11种不同的β -内酰胺,分析了226例血浆浓度。总共记录了32例感染。总体而言,226个样本中133个(58.8%)浓度不足,主要来自28天以下儿童(p = 0.035)、体重低(p = 0.013)或低白蛋白血症(p = 0.011)和肾清除率增高(p = 0.032)的样本。226份样本中有25份(11.1%)检测到超治疗浓度,与肾损害患者相关(p < 0.01)。结论:在这项儿科ECMO病例的回顾性队列研究中,当处方常规剂量的β -内酰胺时,存在暴露不足的相关风险,这可能与肾脏损害和液体超载有关。治疗药物监测结合药代动力学/药效学模型的前瞻性测试应该作为降低这一弱势群体风险的策略进行测试。
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引用次数: 0
Navigating the Road "Less Traveled": Death by Neurologic Criteria. 在“人迹罕至”的道路上航行:神经学标准下的死亡。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-12-01 Epub Date: 2024-12-04 DOI: 10.1097/PCC.0000000000003634
Thomas A Nakagawa, Joe Brierley
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引用次数: 0
Pediatric Burn Referrals: Comparisons of Apples and Oranges. 儿科烧伤转诊:苹果和橙子的比较。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-12-01 Epub Date: 2024-12-04 DOI: 10.1097/PCC.0000000000003628
David G Greenhalgh
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引用次数: 0
Extubation Failure in the PICU: A Virtual Pediatric Systems Database Study, 2017-2021. PICU 拔管失败:虚拟儿科系统数据库研究,2017-2021 年。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-21 DOI: 10.1097/PCC.0000000000003654
Francis Y Kim, Gerardo Soto-Campos, Jamie Palumbo, Christopher J L Newth, Tom B Rice

Objectives: Extubation failure (EF) in PICU patients is reintubation within 48, 72, or 96 hours of planned extubation (EF48, EF72, and EF96, respectively). Standardized sedation protocols, extubation readiness testing, and noninvasive respiratory support are used to improve efficient liberation from mechanical ventilation (MV). We therefore aimed to review EF rates, time to failure, and the use of noninvasive respiratory support after extubation, 2017-2021.

Design: Retrospective analysis of patients admitted to PICUs contributing to the Virtual Pediatric Systems (VPS, LLC) database, 2017-2021.

Setting: One hundred thirty-six participating PICUs.

Patients: All patients admitted to participating PICUs between January 1, 2017, and December 31, 2021, who had MV and met inclusion criteria for planned extubation.

Interventions: None.

Measurements and main results: There were 111,229 planned extubations with 5,143 reintubations within 48 hours. The EF48, EF72, and EF96 rates were 4.6%, 5.3%, and 5.8%, respectively. Higher rates of EF were associated with age younger than 6 months, underlying genetic conditions, medical comorbidities, or cardiac surgery. Failed extubation was also associated with higher Pediatric Risk of Mortality III scores, longer duration of MV, and longer PICU and hospital lengths of stay. From 2017 to 2021, there was an increase in the use of high-flow nasal cannula oxygen therapy after extubation from 16.6% to 20.2%.

Conclusions: In the VPS 2017-2021 dataset, we have found that the overall EF rates (EF48-EF96) have improved over this 5-year period. We are not able to assess the clinical benefit of this change, but it is evident that over the same period, there has been a concomitant increase in the use of postextubation noninvasive respiratory support. Further work is needed to look at the interaction of these effects in contemporary PICU practice.

目的:PICU 患者的拔管失败(EF)是指在计划拔管后 48、72 或 96 小时内再次插管(分别为 EF48、EF72 和 EF96)。标准化镇静方案、拔管准备测试和无创呼吸支持可用于提高机械通气(MV)的有效率。因此,我们旨在回顾 2017-2021 年拔管后的 EF 率、失败时间和无创呼吸支持的使用情况:对虚拟儿科系统(VPS,LLC)数据库中收治的 2017-2021 年 PICU 患者进行回顾性分析:136 个参与的 PICU:2017年1月1日至2021年12月31日期间,参与的PICU收治的所有患有MV且符合计划拔管纳入标准的患者:无干预措施:共有 111,229 例计划拔管,其中 5,143 例在 48 小时内再次插管。EF48、EF72和EF96率分别为4.6%、5.3%和5.8%。较高的EF率与年龄小于6个月、潜在遗传病、合并症或心脏手术有关。拔管失败还与较高的儿科死亡率风险 III 评分、较长的 MV 持续时间以及较长的 PICU 和住院时间有关。从 2017 年到 2021 年,拔管后使用高流量鼻插管氧疗的比例从 16.6% 增加到 20.2%:在 VPS 2017-2021 数据集中,我们发现总体 EF 率(EF48-EF96)在这 5 年间有所改善。我们无法评估这一变化带来的临床益处,但同期拔管后无创呼吸支持的使用明显增加。我们需要进一步研究这些影响在当代 PICU 实践中的相互作用。
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引用次数: 0
Diagnostic Validation of the Updated Pediatric Sepsis Biomarker Risk II for Acute Kidney Injury Prediction Model in Pediatric Septic Shock. 小儿脓毒症生物标志物风险 II 用于小儿脓毒性休克急性肾损伤预测模型的最新诊断验证。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-01 Epub Date: 2024-08-06 DOI: 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":" ","pages":"1005-1016"},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534533/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Severe Pneumonia in PICU Admissions: The Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) Observational Cohort Study, 2020-2022. 儿童重症监护病房收治的重症肺炎患者:儿科急重症医学亚洲网络(PACCMAN)观察性队列研究,2020-2022 年。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-01 Epub Date: 2024-08-23 DOI: 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.

目标:亚洲的肺炎死亡率是工业化国家的三倍。我们旨在确定亚洲儿科急危重症医学网络(PACCMAN)PICU 重症肺炎的流行病学、微生物学和治疗效果:设计:2020年6月至2022年9月的前瞻性多中心观察研究:地点:PACCMAN 的 15 个 PICU:干预措施:无:测量和主要结果记录临床、微生物学和结果数据。主要结果是 PICU 死亡率。进行了单变量和多变量逻辑回归,以研究 PICU 死亡率与入住 PICU 时的解释性风险因素之间的关联。在接受筛查的 11,778 名 PICU 患者中,有 846 人(7.2%)患有肺炎,中位年龄为 1.2 岁(四分位间范围为 0.4-3.7 岁)。846 例患者中有 111 例(13.1%)检测到呼吸道合胞病毒。最常见的细菌是葡萄球菌(71/846 [8.4%]),其次是假单胞菌(60/846 [7.1%])。第二代头孢菌素(322/846 [38.1%])是最常见的广谱抗生素,其次是碳青霉烯类(174/846 [20.6%])。846 位患者中有 438 位(51.8%)接受了有创机械通气,846 位患者中有 500 位(59.1%)接受了无创呼吸支持。846 例患者中,65 例(7.7%)出现 PICU 死亡率。在多变量逻辑回归模型中,年龄(调整后几率比 [aOR],1.08;95% CI,1.00-1.16)、儿科死亡率指数 3 评分(aOR,1.03;95% CI,1.02-1.05)和嗜睡(aOR,2.73;95% CI,1.24-6.00)与更高的死亡几率相关:结论:在 PACCMAN 提供数据的 PICU 中,肺炎是入院的常见原因(7%),并与较高的死亡率相关。
{"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":" ","pages":"1035-1044"},"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}
引用次数: 0
The Nurse-Implemented Chronotherapeutic Bundle in Critically Ill Children, RESTORE Resilience (R 2 ): Pilot Testing in a Two-Phase Cohort Study, 2017-2021. 重症儿童的护士实施慢性治疗捆绑疗法,RESTORE Resilience (R2):2017-2021年两阶段队列研究试点测试》。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-01 Epub Date: 2024-08-12 DOI: 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.

目标在重症儿童中试点测试由护士主导的慢性治疗捆绑疗法--RESTORE Resilience (R2):设计:从2017年至2021年分两个阶段进行队列研究:美国两家规模和组织相似的重症监护病房:因急性呼吸衰竭接受机械通气的 6 个月至 17 岁儿童:干预措施:R2 七项慢性治疗捆绑疗法,包括干预措施:R2 七项慢性治疗包,包括:1)复制患儿入院前的日常生活(即睡眠/觉醒、喂食、活动模式);2)昼夜循环光/声调节;3)最低有效镇静;4)夜间禁食,日间栓剂肠内喂食;5)早期渐进式移动;6)护理连续性;7)家长日记:对儿童进行环境(光、声)和患者(行动计、活动记录、唾液褪黑激素、脑电图)监测。家长填写儿童日常作息和睡眠调查表(CDRSS)和以家庭为中心的护理量表。主要结果是拔管后日间活动巩固率(日间活动比率估计值 [DARE])。20名基线阶段(2017-2019年)和36名干预阶段(2019-2021年)参与者入选。在干预阶段,护士使用 CDRSS 制定儿童 PICU 计划表。对护士实施的 R2 要素 1-5 的总体依从性从基线时的 18%(四分位间范围,13-30%)提高到干预阶段的 63%(53-68%)(p < 0.001)。干预参与者在更多的 PICU 日间接触到了入院前的日常工作(p = 0.002)、昼夜循环灯光/声音调节(p < 0.001)和早期渐进式移动(p = 0.02)。各阶段的镇静目标识别、肠道喂养计划和护理连续性没有差异。家长日记很少使用。干预阶段的 DARE 有所改善,拔管前的 DARE 更高(中位数 62% 对 53%;p = 0.04),但拔管后的 DARE 不高(62% 对 57%;p = 0.56):结论:在重症监护病房,实施由护士执行的个体化慢性治疗捆绑方案是可行的。与接受常规护理的患儿相比,接受R2治疗包的患儿拔管前的日间活动巩固率有所提高。鉴于方案遵守情况的差异,进一步的 R2 测试应包括跨专业合作、实用试验设计和实施科学策略。
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引用次数: 0
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Pediatric Critical Care Medicine
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