首页 > 最新文献

Pediatric Critical Care Medicine最新文献

英文 中文
Chest Compression Depth Targets in Critically Ill Infants and Children Measured With a Laser Distance Meter: Single-Center Retrospective Study From Japan, 2019-2022. 用激光测距仪测量重症婴幼儿的胸外按压深度目标:2019-2022年日本单中心回顾性研究。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-08-01 Epub Date: 2024-04-11 DOI: 10.1097/PCC.0000000000003515
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.

Setting: Single-center PICU, using data from May 2019 to May 2022.

Patients: All critically ill children admitted to PICU and under 8 years old were eligible to be included in the retrospective cohort.

Interventions: None.

Measurements and main results: The chest APd measurements using a laser distance meter are part of our usual practice on the PICU. Target CCd and the over-compression threshold CCd for each age group was calculated as 1/3 and 1/2 of APd, respectively. In 555 patients, the median (interquartile range) of the calculated target CCd for each age group was: 2.7 cm (2.5-2.9 cm), 2.9 cm (2.7-3.2 cm), 3.2 cm (3-3.5 cm), 3.4 cm (3.2-3.6 cm), 3.4 cm (3.2-3.6 cm), 3.6 cm (3.4-3.8 cm), 3.6 cm (3.4-4 cm), and 4 cm (3.5-4.2 cm), for 0, 2, 3-5, 6-8, 9-11, 12-17, 18-23, 24 to less than 60, and 60 to less than 96 months, respectively. Using guideline-recommended absolute CCd targets, 4 cm for infants and 5 cm for children, 49% of infants between 0 and 2 months, and 45.5% of children between 12 and 17 months would be over-compressed during cardiopulmonary resuscitation.

Conclusions: In our cohort, the 1/3 CCd targets calculated from APd measured by laser meter were shallower than the guideline-recommended CCd. Further studies including evaluating hemodynamics during cardiopulmonary resuscitation with these shallower CCd targets are needed.

目标:目前的复苏指南建议婴儿的目标胸外按压深度 (CCd) 约为 4 厘米,儿童约为 5 厘米。之前基于胸部 CT 的报告显示,这些推荐的 CCd 目标对于年幼儿童来说可能过深。我们的目的是使用激光测距仪检查重症婴儿和儿童的胸廓前后直径 (APd) 测量值,并计算 CCd 目标值:设计:回顾性描述性研究:单中心 PICU,使用 2019 年 5 月至 2022 年 5 月的数据:所有入住 PICU 且年龄在 8 岁以下的重症患儿均有资格纳入回顾性队列:测量和主要结果使用激光测距仪测量胸部APd是我们在PICU的常规做法之一。每个年龄组的目标 CCd 和过压阈值 CCd 分别按 APd 的 1/3 和 1/2 计算。4 厘米(3.2-3.6 厘米)、3.6 厘米(3.4-3.8 厘米)、3.6 厘米(3.4-4 厘米)和 4 厘米(3.5-4.2 厘米),分别为 0、2、3-5、6-8、9-11、12-17、18-23、24 至小于 60 和 60 至小于 96 个月。根据指南推荐的绝对CCd目标(婴儿为4厘米,儿童为5厘米),49%的0至2个月婴儿和45.5%的12至17个月儿童在心肺复苏过程中会过度受压:在我们的队列中,根据激光测量仪测量的 APd 计算出的 1/3 CCd 目标值比指南推荐的 CCd 要浅。有必要开展进一步研究,包括评估心肺复苏期间使用这些较浅 CCd 目标的血液动力学情况。
{"title":"Chest Compression Depth Targets in Critically Ill Infants and Children Measured With a Laser Distance Meter: Single-Center Retrospective Study From Japan, 2019-2022.","authors":"Takanari Ikeyama, Takunori Hozumi, Kazuki Kikuyama, Dana Niles, Vinay Nadkarni, Komei Ito","doi":"10.1097/PCC.0000000000003515","DOIUrl":"10.1097/PCC.0000000000003515","url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Design: </strong>A retrospective descriptive study.</p><p><strong>Setting: </strong>Single-center PICU, using data from May 2019 to May 2022.</p><p><strong>Patients: </strong>All critically ill children admitted to PICU and under 8 years old were eligible to be included in the retrospective cohort.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The chest APd measurements using a laser distance meter are part of our usual practice on the PICU. Target CCd and the over-compression threshold CCd for each age group was calculated as 1/3 and 1/2 of APd, respectively. In 555 patients, the median (interquartile range) of the calculated target CCd for each age group was: 2.7 cm (2.5-2.9 cm), 2.9 cm (2.7-3.2 cm), 3.2 cm (3-3.5 cm), 3.4 cm (3.2-3.6 cm), 3.4 cm (3.2-3.6 cm), 3.6 cm (3.4-3.8 cm), 3.6 cm (3.4-4 cm), and 4 cm (3.5-4.2 cm), for 0, 2, 3-5, 6-8, 9-11, 12-17, 18-23, 24 to less than 60, and 60 to less than 96 months, respectively. Using guideline-recommended absolute CCd targets, 4 cm for infants and 5 cm for children, 49% of infants between 0 and 2 months, and 45.5% of children between 12 and 17 months would be over-compressed during cardiopulmonary resuscitation.</p><p><strong>Conclusions: </strong>In our cohort, the 1/3 CCd targets calculated from APd measured by laser meter were shallower than the guideline-recommended CCd. Further studies including evaluating hemodynamics during cardiopulmonary resuscitation with these shallower CCd targets are needed.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"720-727"},"PeriodicalIF":4.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860275","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
Prevalence, Associated Factors, and Outcomes of Severe Acute Kidney Injury in Pediatric Acute Liver Failure: Single-Center Retrospective Study, 2003-2017. 小儿急性肝衰竭中严重急性肾损伤的患病率、相关因素和预后:单中心回顾性研究,2003-2017 年。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-08-01 Epub Date: 2024-06-07 DOI: 10.1097/PCC.0000000000003547
Emma C Alexander, Romit Saxena, Raman Singla, Abdel Douiri, Akash Deep

Objectives: Our aim was to determine the prevalence and explanatory factors associated with outcomes in children with acute liver failure (ALF) admitted to the PICU, who also develop severe acute kidney injury (AKI).

Design: Retrospective cohort, 2003 to 2017.

Setting: Sixteen-bed PICU in a university-affiliated tertiary care hospital.

Patients: Admissions to the PICU with ALF underwent data review of the first week and at least 90-day follow-up. Patients with stages 2-3 AKI using the British Association of pediatric Nephrology definitions, or receiving continuous renal replacement therapy (CRRT) for renal indications, were defined as severe AKI. We excluded ALF cases on CRRT for hepatic-only indications.

Interventions: None.

Measurements and main results: Baseline characteristics, proportion with severe AKI, illness severity and interventions, and outcomes (i.e., transplant, survival with native liver, overall survival, duration of PICU stay, and mechanical ventilation). Ninety-four children with ALF admitted to the PICU were included. Over the first week, 29 had severe AKI, and another eight received CRRT for renal/mixed reno-hepatic indications; hence, the total severe AKI cohort was 37 of 94 (39.4%). In a multivariable logistic regression model, peak aspartate aminotransferase (AST) and requirement for inotropes on arrival were associated with severe AKI. Severe AKI was associated with longer PICU stay and duration of ventilation, and lower spontaneous survival with native liver. In another model, severe AKI was associated with greater odds of mortality (odds ratio 7.34 [95% CI, 1.90-28.28], p = 0.004). After 90 days, 3 of 17 survivors of severe AKI had serum creatinine greater than the upper limit of normal for age.

Conclusions: Many children with ALF in the PICU develop severe AKI. Severe AKI is associated with the timecourse of PICU admission and outcome, including survival with native liver. Future work should look at ALF goal directed renoprotective strategies at the time of presentation.

目的我们的目的是确定入住重症监护病房(PICU)的急性肝功能衰竭(ALF)患儿中同时出现严重急性肾损伤(AKI)的患儿的患病率及其与治疗结果相关的解释性因素:设计:回顾性队列,2003年至2017年:地点:一所大学附属三级医院的 16 张病床的 PICU:PICU收治的ALF患者均接受了第一周的数据回顾和至少90天的随访。根据英国儿科肾脏病学会的定义,AKI 为 2-3 期的患者或因肾脏疾病接受持续肾脏替代治疗 (CRRT) 的患者被定义为重度 AKI。我们排除了仅因肝脏适应症而接受CRRT的ALF病例:干预措施:无:基线特征、重度 AKI 比例、病情严重程度和干预措施以及结果(即移植、原肝存活率、总存活率、PICU 住院时间和机械通气)。在第一周内,有29名患儿出现了严重的AKI,另有8名患儿因肾脏/肝肾混合适应症接受了CRRT治疗;因此,在94名患儿中,有37名患儿出现了严重的AKI(39.4%)。在多变量逻辑回归模型中,天门冬氨酸氨基转移酶(AST)峰值和到达时肌注需求与严重 AKI 相关。重度 AKI 与更长的 PICU 住院时间和通气时间以及更低的原肝自发存活率有关。在另一个模型中,重度 AKI 与更高的死亡几率相关(几率比 7.34 [95% CI, 1.90-28.28],P = 0.004)。90天后,17名重度AKI幸存者中有3人的血清肌酐超过了年龄的正常上限:结论:PICU中的许多ALF患儿会出现严重的AKI。结论:PICU中的许多ALF患儿都会出现严重的AKI,严重的AKI与PICU的入院时间和预后有关,包括原肝存活率。未来的工作应着眼于ALF发病时的肾保护目标策略。
{"title":"Prevalence, Associated Factors, and Outcomes of Severe Acute Kidney Injury in Pediatric Acute Liver Failure: Single-Center Retrospective Study, 2003-2017.","authors":"Emma C Alexander, Romit Saxena, Raman Singla, Abdel Douiri, Akash Deep","doi":"10.1097/PCC.0000000000003547","DOIUrl":"10.1097/PCC.0000000000003547","url":null,"abstract":"<p><strong>Objectives: </strong>Our aim was to determine the prevalence and explanatory factors associated with outcomes in children with acute liver failure (ALF) admitted to the PICU, who also develop severe acute kidney injury (AKI).</p><p><strong>Design: </strong>Retrospective cohort, 2003 to 2017.</p><p><strong>Setting: </strong>Sixteen-bed PICU in a university-affiliated tertiary care hospital.</p><p><strong>Patients: </strong>Admissions to the PICU with ALF underwent data review of the first week and at least 90-day follow-up. Patients with stages 2-3 AKI using the British Association of pediatric Nephrology definitions, or receiving continuous renal replacement therapy (CRRT) for renal indications, were defined as severe AKI. We excluded ALF cases on CRRT for hepatic-only indications.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Baseline characteristics, proportion with severe AKI, illness severity and interventions, and outcomes (i.e., transplant, survival with native liver, overall survival, duration of PICU stay, and mechanical ventilation). Ninety-four children with ALF admitted to the PICU were included. Over the first week, 29 had severe AKI, and another eight received CRRT for renal/mixed reno-hepatic indications; hence, the total severe AKI cohort was 37 of 94 (39.4%). In a multivariable logistic regression model, peak aspartate aminotransferase (AST) and requirement for inotropes on arrival were associated with severe AKI. Severe AKI was associated with longer PICU stay and duration of ventilation, and lower spontaneous survival with native liver. In another model, severe AKI was associated with greater odds of mortality (odds ratio 7.34 [95% CI, 1.90-28.28], p = 0.004). After 90 days, 3 of 17 survivors of severe AKI had serum creatinine greater than the upper limit of normal for age.</p><p><strong>Conclusions: </strong>Many children with ALF in the PICU develop severe AKI. Severe AKI is associated with the timecourse of PICU admission and outcome, including survival with native liver. Future work should look at ALF goal directed renoprotective strategies at the time of presentation.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e358-e366"},"PeriodicalIF":4.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141284412","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
Rapid Whole-Genome Sequencing and Clinical Management in the PICU: A Multicenter Cohort, 2016-2023. 快速全基因组测序与重症监护病房的临床管理:多中心队列,2016-2023 年。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-08-01 Epub Date: 2024-04-26 DOI: 10.1097/PCC.0000000000003522
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.

Interventions: None.

Measurements and main results: A total of 133 patients underwent clinical, phenotype-driven rWGS analysis, 36 prospectively. A molecular diagnosis was identified in 79 patients (59%). Median (interquartile range [IQR]) age was 6 months (IQR 1.2 mo-4.6 yr). Median time for return of preliminary results was 3 days (IQR 2-4). In 79 patients with a molecular diagnosis, there was a change in ICU management in 19 patients (24%); and some change in clinical management in 63 patients (80%). Nondiagnosis changed management in 5 of 54 patients (9%). The clinical specialty ordering rWGS did not affect diagnostic rate. Factors associated with greater odds ratio (OR [95% CI]; OR [95% CI]) of diagnosis included dysmorphic features (OR 10.9 [95% CI, 1.8-105]) and congenital heart disease (OR 4.2 [95% CI, 1.3-16.8]). Variables associated with greater odds of changes in management included obtaining a genetic diagnosis (OR 16.6 [95% CI, 5.5-62]) and a shorter time to genetic result (OR 0.8 [95% CI, 0.76-0.9]). Surveys of pediatric intensivists indicated that rWGS-enhanced clinical prognostication ( p < 0.0001) and contributed to a decision to consult palliative care ( p < 0.02).

Conclusions: In this 2016-2023 multiple-PICU/CICU cohort, we have shown that timely genetic diagnosis is feasible across institutions. Application of rWGS had a 59% (95% CI, 51-67%) rate of diagnostic yield and was associated with changes in critical care management and long-term patient management.

目的:目前还缺乏对新生儿期以外的快速全基因组测序(rWGS)临床实用性的分析。我们介绍了四家医疗机构在重症监护病房(PICU)和心血管重症监护病房(CICU)患者中使用 rWGS 的情况:环境:四家三级儿童医院:四所三级儿童医院:2016年5月至2023年6月期间在PICU或CICU接受rWGS分析的0-18岁儿童:无干预措施:共有 133 名患者接受了临床、表型驱动的 rWGS 分析,其中 36 名为前瞻性分析。79名患者(59%)确定了分子诊断。中位(四分位数间距 [IQR])年龄为 6 个月(IQR 1.2 个月-4.6 年)。返回初步结果的中位时间为 3 天(IQR 2-4)。在 79 名获得分子诊断的患者中,19 名患者(24%)的重症监护室管理发生了变化;63 名患者(80%)的临床管理发生了一些变化。54 例患者中有 5 例(9%)因未确诊而改变了治疗方案。下达 rWGS 命令的临床专科并不影响诊断率。与诊断几率(OR [95% CI];OR [95% CI])较大相关的因素包括畸形特征(OR 10.9 [95% CI, 1.8-105])和先天性心脏病(OR 4.2 [95% CI, 1.3-16.8])。与改变管理相关的变量包括获得基因诊断(OR 16.6 [95% CI, 5.5-62])和更短的基因结果时间(OR 0.8 [95% CI, 0.76-0.9])。对儿科重症监护医师的调查显示,rWGS可增强临床预后(p < 0.0001),并有助于做出姑息治疗的决定(p < 0.02):在这组 2016-2023 年多重症监护病房/重症监护病房队列中,我们发现及时的基因诊断在不同机构间是可行的。应用 rWGS 的诊断率为 59%(95% CI,51-67%),并与重症监护管理和长期患者管理的变化相关。
{"title":"Rapid Whole-Genome Sequencing and Clinical Management in the PICU: A Multicenter Cohort, 2016-2023.","authors":"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","doi":"10.1097/PCC.0000000000003522","DOIUrl":"10.1097/PCC.0000000000003522","url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Design: </strong>Ambidirectional multisite cohort study.</p><p><strong>Setting: </strong>Four tertiary children's hospitals.</p><p><strong>Patients: </strong>Children 0-18 years old in the PICU or CICU who underwent rWGS analysis, from May 2016 to June 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>A total of 133 patients underwent clinical, phenotype-driven rWGS analysis, 36 prospectively. A molecular diagnosis was identified in 79 patients (59%). Median (interquartile range [IQR]) age was 6 months (IQR 1.2 mo-4.6 yr). Median time for return of preliminary results was 3 days (IQR 2-4). In 79 patients with a molecular diagnosis, there was a change in ICU management in 19 patients (24%); and some change in clinical management in 63 patients (80%). Nondiagnosis changed management in 5 of 54 patients (9%). The clinical specialty ordering rWGS did not affect diagnostic rate. Factors associated with greater odds ratio (OR [95% CI]; OR [95% CI]) of diagnosis included dysmorphic features (OR 10.9 [95% CI, 1.8-105]) and congenital heart disease (OR 4.2 [95% CI, 1.3-16.8]). Variables associated with greater odds of changes in management included obtaining a genetic diagnosis (OR 16.6 [95% CI, 5.5-62]) and a shorter time to genetic result (OR 0.8 [95% CI, 0.76-0.9]). Surveys of pediatric intensivists indicated that rWGS-enhanced clinical prognostication ( p < 0.0001) and contributed to a decision to consult palliative care ( p < 0.02).</p><p><strong>Conclusions: </strong>In this 2016-2023 multiple-PICU/CICU cohort, we have shown that timely genetic diagnosis is feasible across institutions. Application of rWGS had a 59% (95% CI, 51-67%) rate of diagnostic yield and was associated with changes in critical care management and long-term patient management.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"699-709"},"PeriodicalIF":4.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140874765","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
High-Flow Nasal Cannula Versus Nasal Prong Bubble Continuous Positive Airway Pressure in Children With Moderate to Severe Acute Bronchiolitis: A Randomized Controlled Trial. 中度至重度急性支气管炎患儿使用高流量鼻导管与鼻刺气泡持续气道正压疗法的随机对照试验:随机对照试验。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-08-01 Epub Date: 2024-04-19 DOI: 10.1097/PCC.0000000000003521
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.

Intervention: Comparison of HFNC with b-CPAP, using a primary outcome of treatment failure within 24 hours of randomization, as defined by any of: 1) a 1-point increase in modified Wood's clinical asthma score (m-WCAS) above baseline, 2) a rise in respiratory rate (RR) greater than 10 per minute from baseline, and 3) escalation in respiratory support. The secondary outcomes were success rate after crossover, if any, need for mechanical ventilation (invasive/noninvasive), local skin lesions, length of hospital stay, and complications.

Results: In 118 children analyzed by intention-to-treat, HFNC ( n = 59) versus b-CPAP ( n = 59) was associated with a lower failure rate (23.7% vs. 42.4%; relative risk [95% CI], RR 0.56 [95% CI, 0.32-0.97], p = 0.031). The Cox proportion model confirmed a lower hazard of treatment failure in the HFNC group (adjusted hazard ratio 0.48 [95% CI, 0.25-0.94], p = 0.032). No crossover was noted. A lower proportion escalated to noninvasive ventilation in the HFNC group (15.3%) versus the b-CPAP group (15.3% vs. 39% [RR 0.39 (95% CI, 0.20-0.77)], p = 0.004). The HFNC group had a longer median (interquartile range) duration of oxygen therapy (4 [3-6] vs. 3 [3-5] d; p = 0.012) and hospital stay (6 [5-8.5] vs. 5 [4-7] d, p = 0.021). No significant difference was noted in other secondary outcomes.

Conclusion: In children aged one to 23 months with moderate to severe acute bronchiolitis, the use of HFNC therapy as opposed to b-CPAP for early respiratory support is associated with a lower failure rate and, secondarily, a lower risk of escalation to mechanical ventilation.

目的:比较高流量鼻插管(HFNC)与鼻锥气泡持续气道正压(b-CPAP)对中度严重急性支气管炎患儿的治疗效果:比较高流量鼻插管(HFNC)与鼻锥气泡持续气道正压(b-CPAP)在中重度急性支气管炎患儿中的应用:随机对照试验于2019年8月至2022年2月进行。(印度临床试验注册中心编号:CTRI/2019/07/020402):印度一家三级医疗中心的儿科急诊病房和重症监护室:干预措施:干预措施:比较 HFNC 和 b-CPAP,主要结果为随机分配后 24 小时内治疗失败,其定义为以下任一情况1)改良伍德临床哮喘评分(m-WCAS)比基线上升 1 分;2)呼吸频率(RR)比基线上升超过 10 次/分钟;3)呼吸支持升级。次要结果是交叉后的成功率(如有)、机械通气需求(有创/无创)、局部皮肤损伤、住院时间和并发症:在按意向治疗分析的 118 名儿童中,HFNC(59 人)与 b-CPAP (59 人)相比,失败率较低(23.7% 对 42.4%;相对风险 [95% CI],RR 0.56 [95% CI,0.32-0.97],P = 0.031)。Cox 比例模型证实,HFNC 组治疗失败的风险较低(调整后的风险比为 0.48 [95% CI, 0.25-0.94],p = 0.032)。未发现交叉治疗。与 b-CPAP 组(15.3% 对 39% [RR 0.39 (95% CI, 0.20-0.77)], p = 0.004)相比,HFNC 组(15.3%)升级到无创通气的比例较低。HFNC 组的氧疗中位数(四分位数间距)持续时间(4 [3-6] d vs. 3 [3-5] d;p = 0.012)和住院时间(6 [5-8.5] d vs. 5 [4-7] d;p = 0.021)更长。其他次要结果无明显差异:结论:对于 1 到 23 个月大的中度到重度急性支气管炎患儿,在早期呼吸支持中使用 HFNC 治疗与使用 b-CPAP 治疗相比,失败率更低,其次,升级到机械通气的风险也更低。
{"title":"High-Flow Nasal Cannula Versus Nasal Prong Bubble Continuous Positive Airway Pressure in Children With Moderate to Severe Acute Bronchiolitis: A Randomized Controlled Trial.","authors":"Malini Maya, Ramachandran Rameshkumar, Tamil Selvan, Chinnaiah Govindhareddy Delhikumar","doi":"10.1097/PCC.0000000000003521","DOIUrl":"10.1097/PCC.0000000000003521","url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Design: </strong>A randomized controlled trial was carried out from August 2019 to February 2022. (Clinical Trials Registry of India number CTRI/2019/07/020402).</p><p><strong>Setting: </strong>Pediatric emergency ward and ICU within a tertiary care center in India.</p><p><strong>Patients: </strong>Children 1-23 months old with moderate to severe acute bronchiolitis.</p><p><strong>Intervention: </strong>Comparison of HFNC with b-CPAP, using a primary outcome of treatment failure within 24 hours of randomization, as defined by any of: 1) a 1-point increase in modified Wood's clinical asthma score (m-WCAS) above baseline, 2) a rise in respiratory rate (RR) greater than 10 per minute from baseline, and 3) escalation in respiratory support. The secondary outcomes were success rate after crossover, if any, need for mechanical ventilation (invasive/noninvasive), local skin lesions, length of hospital stay, and complications.</p><p><strong>Results: </strong>In 118 children analyzed by intention-to-treat, HFNC ( n = 59) versus b-CPAP ( n = 59) was associated with a lower failure rate (23.7% vs. 42.4%; relative risk [95% CI], RR 0.56 [95% CI, 0.32-0.97], p = 0.031). The Cox proportion model confirmed a lower hazard of treatment failure in the HFNC group (adjusted hazard ratio 0.48 [95% CI, 0.25-0.94], p = 0.032). No crossover was noted. A lower proportion escalated to noninvasive ventilation in the HFNC group (15.3%) versus the b-CPAP group (15.3% vs. 39% [RR 0.39 (95% CI, 0.20-0.77)], p = 0.004). The HFNC group had a longer median (interquartile range) duration of oxygen therapy (4 [3-6] vs. 3 [3-5] d; p = 0.012) and hospital stay (6 [5-8.5] vs. 5 [4-7] d, p = 0.021). No significant difference was noted in other secondary outcomes.</p><p><strong>Conclusion: </strong>In children aged one to 23 months with moderate to severe acute bronchiolitis, the use of HFNC therapy as opposed to b-CPAP for early respiratory support is associated with a lower failure rate and, secondarily, a lower risk of escalation to mechanical ventilation.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"748-757"},"PeriodicalIF":4.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140865859","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
Applying Genomic Medicine to Critically Ill Children, Science and Fiction. 将基因组医学应用于重症儿童,科学与虚构。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-08-01 Epub Date: 2024-08-05 DOI: 10.1097/PCC.0000000000003548
Ricardo G Branco, Manu S Sundaram
{"title":"Applying Genomic Medicine to Critically Ill Children, Science and Fiction.","authors":"Ricardo G Branco, Manu S Sundaram","doi":"10.1097/PCC.0000000000003548","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003548","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"25 8","pages":"761-764"},"PeriodicalIF":4.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889879","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
Editor's Choice Articles for August. 八月编辑推荐文章。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-08-01 Epub Date: 2024-08-05 DOI: 10.1097/PCC.0000000000003568
Robert C Tasker
{"title":"Editor's Choice Articles for August.","authors":"Robert C Tasker","doi":"10.1097/PCC.0000000000003568","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003568","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"25 8","pages":"685-688"},"PeriodicalIF":4.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889881","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
Management Changes After Echocardiography Are Associated With Improved Outcomes in Critically Ill Children. 重症儿童接受超声心动图检查后的管理改变与预后改善有关。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-08-01 Epub Date: 2024-04-09 DOI: 10.1097/PCC.0000000000003513
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. Patients were stratified into two cardiac function groups: 1) near-normal cardiac function and 2) depressed cardiac function.

Methods: Clinical variables were abstracted from the electronic medical record and placed in time sequence relative to echocardiography. Vasoactive and fluid management strategies in place before echocardiography were associated with markers of tissue perfusion and volume overload. Management changes after echocardiography were characterized and associated with outcomes.

Interventions: None.

Measurements and main results: Among patients eventually found to have depressed cardiac function, the use of vasoconstrictors was associated with worse lactate clearance and oxygen extraction ratio. Use of vasoconstrictors in this cohort was also associated with a more liberal fluid management strategy, evidence of increased lung water, and a worse Sp o2 /F io2 . An echocardiogram demonstrated depressed cardiac function was likely to be followed by management changes that favored inotropes and more conservative fluid administration. Patients with depressed cardiac function who were switched to inotropes were more likely to be extubated and to wean off vasoactive support compared with those patients who remained on vasoconstrictors.

Conclusions: Among patients with depressed cardiac function, alterations in management strategy after echocardiography are associated with shortened duration of intensive care interventions.

目的评估重症儿童在接受正规超声心动图检查后的管理变化和治疗效果:设计:2011 年 1 月 1 日至 2020 年 12 月 31 日期间的回顾性队列研究:地点:三级儿童医院:患者:1 至 18 岁,在入住重症监护室 72 小时内接受过正规超声心动图检查,且在研究时插管和输注血管活性药物。患者被分为两个心功能组:1)心功能接近正常组;2)心功能减退组:方法:从电子病历中抽取临床变量,并按时间顺序排列与超声心动图检查相对应的变量。超声心动图检查前的血管活性和液体管理策略与组织灌注和容量超负荷的指标相关。超声心动图检查后的管理变化具有特征性并与结果相关:测量和主要结果在最终发现心功能减退的患者中,使用血管收缩剂与乳酸清除率和氧萃取率降低有关。在这组患者中,血管收缩剂的使用还与更宽松的液体管理策略、肺水分增加的证据以及更差的Spo2/Fio2有关。超声心动图显示心功能减退的患者很可能会改变管理策略,转而使用肌注药物和更保守的输液管理。与仍在使用血管收缩剂的患者相比,心功能减退的患者改用肌注药物后更有可能拔管和脱离血管活性支持:结论:在心功能减退的患者中,超声心动图检查后管理策略的改变与重症监护干预时间的缩短有关。
{"title":"Management Changes After Echocardiography Are Associated With Improved Outcomes in Critically Ill Children.","authors":"Pui Yin Florence Ip, Uvaraj Periasamy, Steven J Staffa, David Zurakowski, David B Kantor","doi":"10.1097/PCC.0000000000003513","DOIUrl":"10.1097/PCC.0000000000003513","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate management changes and outcomes in critically ill children after formal echocardiography.</p><p><strong>Design: </strong>Retrospective cohort study between January 1, 2011, and December 31, 2020.</p><p><strong>Setting: </strong>Tertiary care children's hospital.</p><p><strong>Patients: </strong>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. Patients were stratified into two cardiac function groups: 1) near-normal cardiac function and 2) depressed cardiac function.</p><p><strong>Methods: </strong>Clinical variables were abstracted from the electronic medical record and placed in time sequence relative to echocardiography. Vasoactive and fluid management strategies in place before echocardiography were associated with markers of tissue perfusion and volume overload. Management changes after echocardiography were characterized and associated with outcomes.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Among patients eventually found to have depressed cardiac function, the use of vasoconstrictors was associated with worse lactate clearance and oxygen extraction ratio. Use of vasoconstrictors in this cohort was also associated with a more liberal fluid management strategy, evidence of increased lung water, and a worse Sp o2 /F io2 . An echocardiogram demonstrated depressed cardiac function was likely to be followed by management changes that favored inotropes and more conservative fluid administration. Patients with depressed cardiac function who were switched to inotropes were more likely to be extubated and to wean off vasoactive support compared with those patients who remained on vasoconstrictors.</p><p><strong>Conclusions: </strong>Among patients with depressed cardiac function, alterations in management strategy after echocardiography are associated with shortened duration of intensive care interventions.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"689-698"},"PeriodicalIF":4.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866332","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
Changes in Inhaled Nitric Oxide Use Across ICUs After Implementation of a Standard Pathway. 实施标准路径后重症监护病房吸入一氧化氮使用量的变化。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-08-01 Epub Date: 2024-05-24 DOI: 10.1097/PCC.0000000000003544
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.

Setting: Four hundred seven-bed free standing quaternary care academic children's hospital.

Patients: All patients on iNO in the CICU, PICU, and NICU from January 1, 2017 to December 31, 2022.

Interventions: Unit-specific standard approaches to iNO initiation and weaning.

Measurements and main results: Sixteen thousand eighty-seven patients were admitted to the CICU, PICU, and NICU with 9343 in the pre-iNO pathway era (January 1, 2017 to June 30, 2020) and 6744 in the postpathway era (July 1, 2020 to December 31, 2022). We found a decrease in the percentage of CICU patients initiated on iNO from 17.8% to 11.8% after implementation of the iNO utilization pathway. We did not observe a change in iNO utilization between the pre- and post-iNO pathway eras in either the PICU or NICU. Based on these data, we estimate 564 total days of iNO (-24%) were saved over 24 months in association with the standard pathway in the CICU, with associated cost savings.

Conclusions: Implementation of a standard pathway for iNO use was associated with a statistically discernible reduction in total iNO usage in the CICU, but no change in iNO use in the NICU and PICU. These differential results likely occurred because of multiple contextual factors in each care setting.

目的:吸入一氧化氮(iNO)是一种选择性肺血管扩张剂。它价格昂贵,使用频繁,而且并非没有风险。支持启动和断奶标准方法的证据有限。我们的目标是通过建立 iNO 使用的标准方法,优化 iNO 在心脏重症监护病房 (CICU)、重症监护病房 (PICU) 和新生儿重症监护病房 (NICU) 的使用:设计:采用前瞻性队列设计和历史对照的质量改进研究:环境:拥有四百七十张床位的独立四级儿童学术医院:患者:2017 年 1 月 1 日至 2022 年 12 月 31 日期间在 CICU、PICU 和 NICU 使用 iNO 的所有患者:测量和主要结果:CICU、PICU和NICU共收治了1687名患者,其中9343人在iNO路径前(2017年1月1日至2020年6月30日),6744人在路径后(2020年7月1日至2022年12月31日)。我们发现,在实施 iNO 使用路径后,CICU 患者开始使用 iNO 的比例从 17.8% 降至 11.8%。我们没有观察到 iNO 使用途径实施前和实施后 PICU 或 NICU 中 iNO 使用率的变化。根据这些数据,我们估计在 CICU 实施标准路径后,24 个月内共节省了 564 天的 iNO(-24%),并节省了相关费用:结论:采用标准路径使用 iNO,CICU 中 iNO 的总使用量在统计学上有明显减少,但 NICU 和 PICU 中 iNO 的使用量没有变化。这些不同的结果很可能是由于每个护理环境的多种背景因素造成的。
{"title":"Changes in Inhaled Nitric Oxide Use Across ICUs After Implementation of a Standard Pathway.","authors":"Monique Radman, John McGuire, Paul Sharek, Harris Baden, Andy Koth, Robert DiGeronimo, Darren Migita, Dwight Barry, James B Johnson, Lori Rutman, Surabhi Vora","doi":"10.1097/PCC.0000000000003544","DOIUrl":"10.1097/PCC.0000000000003544","url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Design: </strong>A quality improvement study using a prospective cohort design with historical controls.</p><p><strong>Setting: </strong>Four hundred seven-bed free standing quaternary care academic children's hospital.</p><p><strong>Patients: </strong>All patients on iNO in the CICU, PICU, and NICU from January 1, 2017 to December 31, 2022.</p><p><strong>Interventions: </strong>Unit-specific standard approaches to iNO initiation and weaning.</p><p><strong>Measurements and main results: </strong>Sixteen thousand eighty-seven patients were admitted to the CICU, PICU, and NICU with 9343 in the pre-iNO pathway era (January 1, 2017 to June 30, 2020) and 6744 in the postpathway era (July 1, 2020 to December 31, 2022). We found a decrease in the percentage of CICU patients initiated on iNO from 17.8% to 11.8% after implementation of the iNO utilization pathway. We did not observe a change in iNO utilization between the pre- and post-iNO pathway eras in either the PICU or NICU. Based on these data, we estimate 564 total days of iNO (-24%) were saved over 24 months in association with the standard pathway in the CICU, with associated cost savings.</p><p><strong>Conclusions: </strong>Implementation of a standard pathway for iNO use was associated with a statistically discernible reduction in total iNO usage in the CICU, but no change in iNO use in the NICU and PICU. These differential results likely occurred because of multiple contextual factors in each care setting.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e347-e357"},"PeriodicalIF":4.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141088061","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
Biomarker-Based Risk Stratification Tool in Pediatric Acute Respiratory Distress Syndrome: Single-Center, Longitudinal Validation in a 2014-2019 Cohort. 基于生物标志物的儿科急性呼吸窘迫综合征风险分层工具:在 2014-2019 年队列中进行单中心纵向验证。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-07-01 Epub Date: 2024-04-09 DOI: 10.1097/PCC.0000000000003512
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.

Design: Secondary unplanned post hoc analysis of data from a prospective observational cohort study carried out 2014-2019.

Setting: University-affiliated PICU.

Patients: Mechanically ventilated children with ARDS.

Interventions: None.

Measurements and main results: Between July 2014 and December 2019, 279 patients with ARDS had plasma collected at day 0, 266 at day 3 (11 nonsurvivors, two discharged between days 0 and 3), and 207 at day 7 (27 nonsurvivors, 45 discharged between days 3 and 7). The actual prevalence of mortality on days 0, 3, and 7, was 23% (64/279), 14% (38/266), and 13% (27/207), respectively. The PARDSEVERE risk model for mortality on days 0, 3, and 7 had area under the receiver operating characteristic curve (AUROC [95% CI]) of 0.76 (0.69-0.82), 0.68 (0.60-0.76), and 0.74 (0.65-0.83), respectively. The AUROC data translate into prevalence thresholds for the PARDSEVERE model for mortality (i.e., using the sensitivity and specificity values) of 37%, 27%, and 24% on days 0, 3, and 7, respectively. Negative predictive value (NPV) was high throughout (0.87-0.90 for all three-time points).

Conclusions: In this exploratory analysis of the PARDSEVERE model of mortality risk prediction in a population longitudinal series of data from days 0, 3, and 7 after ARDS diagnosis, the diagnostic performance is in the "acceptable" category. NPV was good. A major limitation is that actual mortality is far below the prevalence threshold for such testing. The model may, therefore, be more useful in cohorts with higher mortality rates (e.g., immunocompromised, other countries), and future enhancements to the model should be explored.

研究目的儿科急性呼吸窘迫综合征生物标志物风险模型(PARDSEVERE)利用年龄和儿科急性呼吸窘迫综合征(ARDS)发病 24 小时内测定的三种血浆生物标志物来预测 152 例试点队列患者的死亡率。然而,PARDSEVERE 的纵向性能尚未得到评估,目前尚不清楚该风险模型是否可用于第 0 天后的预后。因此,我们试图确定 PARDSEVERE 模型和人群在 ARDS 发病后前 7 天的测试特征:对 2014-2019 年开展的前瞻性观察队列研究数据进行二次非计划性事后分析:大学附属PICU:干预措施:无:测量和主要结果:2014年7月至2019年12月期间,279名ARDS患者在第0天、266名在第3天(11名非存活者,2名在第0天和第3天之间出院)、207名在第7天(27名非存活者,45名在第3天和第7天之间出院)采集了血浆。第 0、3 和 7 天的实际死亡率分别为 23%(64/279)、14%(38/266)和 13%(27/207)。PARDSEVERE针对第0、3和7天死亡率的风险模型的接收者操作特征曲线下面积(AUROC [95% CI])分别为0.76(0.69-0.82)、0.68(0.60-0.76)和0.74(0.65-0.83)。根据 AUROC 数据,PARDSEVERE 模型的死亡率阈值(即使用灵敏度和特异性值)在第 0、3 和 7 天分别为 37%、27% 和 24%。阴性预测值(NPV)始终很高(所有三个时间点均为 0.87-0.90):结论:在对 PARDSEVERE 死亡风险预测模型进行的这项探索性分析中,从 ARDS 诊断后第 0 天、第 3 天和第 7 天的人群纵向数据系列来看,其诊断性能属于 "可接受 "类别。净现值(NPV)良好。一个主要的局限是,实际死亡率远低于此类测试的流行阈值。因此,该模型在死亡率较高的人群(如免疫力低下者、其他国家)中可能更有用,未来应探索对模型进行改进。
{"title":"Biomarker-Based Risk Stratification Tool in Pediatric Acute Respiratory Distress Syndrome: Single-Center, Longitudinal Validation in a 2014-2019 Cohort.","authors":"Jane E Whitney, Grace M Johnson, Brian M Varisco, Benjamin A Raby, Nadir Yehya","doi":"10.1097/PCC.0000000000003512","DOIUrl":"10.1097/PCC.0000000000003512","url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Design: </strong>Secondary unplanned post hoc analysis of data from a prospective observational cohort study carried out 2014-2019.</p><p><strong>Setting: </strong>University-affiliated PICU.</p><p><strong>Patients: </strong>Mechanically ventilated children with ARDS.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Between July 2014 and December 2019, 279 patients with ARDS had plasma collected at day 0, 266 at day 3 (11 nonsurvivors, two discharged between days 0 and 3), and 207 at day 7 (27 nonsurvivors, 45 discharged between days 3 and 7). The actual prevalence of mortality on days 0, 3, and 7, was 23% (64/279), 14% (38/266), and 13% (27/207), respectively. The PARDSEVERE risk model for mortality on days 0, 3, and 7 had area under the receiver operating characteristic curve (AUROC [95% CI]) of 0.76 (0.69-0.82), 0.68 (0.60-0.76), and 0.74 (0.65-0.83), respectively. The AUROC data translate into prevalence thresholds for the PARDSEVERE model for mortality (i.e., using the sensitivity and specificity values) of 37%, 27%, and 24% on days 0, 3, and 7, respectively. Negative predictive value (NPV) was high throughout (0.87-0.90 for all three-time points).</p><p><strong>Conclusions: </strong>In this exploratory analysis of the PARDSEVERE model of mortality risk prediction in a population longitudinal series of data from days 0, 3, and 7 after ARDS diagnosis, the diagnostic performance is in the \"acceptable\" category. NPV was good. A major limitation is that actual mortality is far below the prevalence threshold for such testing. The model may, therefore, be more useful in cohorts with higher mortality rates (e.g., immunocompromised, other countries), and future enhancements to the model should be explored.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"599-608"},"PeriodicalIF":4.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11222043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140850867","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
Anticoagulation Monitoring and Targets: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference. 抗凝监测和目标:小儿体外膜氧合抗凝协作共识会议。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-07-01 Epub Date: 2024-07-03 DOI: 10.1097/PCC.0000000000003494
Caroline Ozment, Peta M A Alexander, Wayne Chandler, Sitaram Emani, Robert Hyslop, Paul Monagle, Jennifer A Muszynski, Ariane Willems, Alison Gehred, Elizabeth Lyman, Katherine Steffen, Ravi R Thiagarajan

Objectives: To derive systematic-review informed, modified Delphi consensus regarding anticoagulation monitoring assays and target levels in pediatric extracorporeal membrane oxygenation (ECMO) for the Pediatric ECMO Anticoagulation CollaborativE.

Data sources: A structured literature search was performed using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021.

Study selection: Anticoagulation monitoring of pediatric patients on ECMO.

Data extraction: Two authors reviewed all citations independently, with a third independent reviewer resolving any conflicts. Evidence tables were constructed using a standardized data extraction form.

Data synthesis: Risk of bias was assessed using the Quality in Prognosis Studies tool or the revised Cochrane risk of bias for randomized trials, as appropriate and the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation system. Forty-eight experts met over 2 years to develop evidence-based recommendations and, when evidence was lacking, expert-based consensus statements for clinical recommendations focused on anticoagulation monitoring and targets, using a web-based modified Delphi process to build consensus (defined as > 80% agreement). One weak recommendation, two consensus statements, and three good practice statements were developed and, in all, agreement greater than 80% was reached. We also derived some resources for anticoagulation monitoring for ECMO clinician use at the bedside.

Conclusions: There is insufficient evidence to formulate optimal anticoagulation monitoring during pediatric ECMO, but we propose one recommendation, two consensus and three good practice statements. Overall, the available pediatric evidence is poor and significant gaps exist in the literature.

目标:就儿科体外膜肺氧合(ECMO)中的抗凝监测化验和目标水平达成系统性审查知情的改良德尔菲共识,供儿科 ECMO 抗凝协作组使用:数据来源:使用 PubMed、EMBASE 和 Cochrane Library (CENTRAL) 数据库对 1988 年 1 月至 2021 年 5 月期间的文献进行了结构化检索:ECMO儿科患者的抗凝监测:两位作者独立审阅所有引文,由第三位独立审阅者解决任何冲突。使用标准化数据提取表构建证据表:酌情使用预后研究质量工具或修订版 Cochrane 随机试验偏倚风险进行评估,并使用建议分级评估、发展和评价系统对证据进行评价。48 位专家历时 2 年召开会议,制定了以证据为基础的建议,并在缺乏证据的情况下,采用基于网络的改良德尔菲流程达成共识(定义为 > 80% 的一致意见),为临床建议制定了以专家为基础的共识声明,重点关注抗凝监测和目标。我们制定了一项弱建议、两项共识声明和三项良好实践声明,所有声明均达成了 80% 以上的一致意见。我们还获得了一些抗凝监测资源,供 ECMO 临床医师在床旁使用:结论:目前还没有足够的证据来制定儿科 ECMO 期间的最佳抗凝监测方法,但我们提出了一项建议、两项共识和三项良好实践声明。总体而言,现有的儿科证据并不充分,文献中也存在重大空白。
{"title":"Anticoagulation Monitoring and Targets: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference.","authors":"Caroline Ozment, Peta M A Alexander, Wayne Chandler, Sitaram Emani, Robert Hyslop, Paul Monagle, Jennifer A Muszynski, Ariane Willems, Alison Gehred, Elizabeth Lyman, Katherine Steffen, Ravi R Thiagarajan","doi":"10.1097/PCC.0000000000003494","DOIUrl":"10.1097/PCC.0000000000003494","url":null,"abstract":"<p><strong>Objectives: </strong>To derive systematic-review informed, modified Delphi consensus regarding anticoagulation monitoring assays and target levels in pediatric extracorporeal membrane oxygenation (ECMO) for the Pediatric ECMO Anticoagulation CollaborativE.</p><p><strong>Data sources: </strong>A structured literature search was performed using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021.</p><p><strong>Study selection: </strong>Anticoagulation monitoring of pediatric patients on ECMO.</p><p><strong>Data extraction: </strong>Two authors reviewed all citations independently, with a third independent reviewer resolving any conflicts. Evidence tables were constructed using a standardized data extraction form.</p><p><strong>Data synthesis: </strong>Risk of bias was assessed using the Quality in Prognosis Studies tool or the revised Cochrane risk of bias for randomized trials, as appropriate and the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation system. Forty-eight experts met over 2 years to develop evidence-based recommendations and, when evidence was lacking, expert-based consensus statements for clinical recommendations focused on anticoagulation monitoring and targets, using a web-based modified Delphi process to build consensus (defined as > 80% agreement). One weak recommendation, two consensus statements, and three good practice statements were developed and, in all, agreement greater than 80% was reached. We also derived some resources for anticoagulation monitoring for ECMO clinician use at the bedside.</p><p><strong>Conclusions: </strong>There is insufficient evidence to formulate optimal anticoagulation monitoring during pediatric ECMO, but we propose one recommendation, two consensus and three good practice statements. Overall, the available pediatric evidence is poor and significant gaps exist in the literature.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"25 7 Suppl 1","pages":"e14-e24"},"PeriodicalIF":4.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11216399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498601","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
期刊
Pediatric Critical Care Medicine
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1