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":"25 11","pages":"e447-e448"},"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":"25 11","pages":"1073-1076"},"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}
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":"25 11","pages":"1079-1081"},"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}
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":" ","pages":"e438-e446"},"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":" ","pages":"e429-e437"},"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":"25 11","pages":"1070-1072"},"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}
Pub Date : 2024-11-01Epub Date: 2024-08-13DOI: 10.1097/PCC.0000000000003591
Tengyi Cai, Samantha J Emery-Corbin, Conor McCafferty, Suelyn Van Den Helm, Natasha Letunica, Chantal Attard, Rebecca Barton, Stephen Horton, Steve Bottrell, Bradley Schultz, Graeme MacLaren, Roberto Chiletti, Derek Best, Amy Johansen, Fiona Newall, Warwick Butt, Yves d'Udekem, Laura F Dagley, Jumana M Yousef, Paul Monagle, Vera Ignjatovic
Objective: To characterize surface-bound proteins and to measure the thickness of fibrin fibers bound to extracorporeal membrane oxygenation (ECMO) circuits used in children.
Design: Single-center observational prospective study, April to November 2021.
Setting: PICU, Royal Children's Hospital, Melbourne, Australia.
Patients: Patients aged less than 18 years on venoarterial ECMO and without preexisting disorder.
Interventions: None.
Measurements and main results: ECMO circuits were collected from six patients. Circuit samples were collected from five different sites, and subsequently processed for proteomic and scanning electron microscopy (SEM) studies. The concentration of proteins bound to ECMO circuit samples was measured using a bicinchoninic acid protein assay, whereas characterization of the bound proteome was performed using data-independent acquisition mass spectrometry. The Reactome Over-representation Pathway Analyses tool was used to identify functional pathways related to bound proteins. For the SEM studies, ECMO circuit samples were prepared and imaged, and the thickness of bound fibrin fibers was measured using the Fiji ImageJ software, version 1.53c ( https://imagej.net/software/fiji/ ). Protein binding to ECMO circuit samples and fibrin networks showed significant intra-circuit and interpatient variation. The median (range) total protein concentration was 19.0 (0-76.9) μg/mL, and the median total number of proteins was 2011 (1435-2777). A total of 933 proteins were commonly bound to ECMO circuit samples from all patients and were functionally involved in 212 pathways, with signal transduction, cell cycle, and metabolism of proteins being the top three pathway categories. The median intra-circuit fibrin fiber thickness was 0.20 (0.15-0.24) μm, whereas the median interpatient fibrin fiber thickness was 0.18 (0.15-0.21) μm.
Conclusions: In this report, we have characterized proteins and fiber fibrin thickness bound to ECMO circuits in six children. The techniques and approaches may be useful for investigating interactions between blood, coagulation, and the ECMO circuit and have the potential for circuit design.
{"title":"Comprehensive Characterization of Surface-Bound Proteins and Measurement of Fibrin Fiber Thickness on Extracorporeal Membrane Oxygenation Circuits Collected From Patients.","authors":"Tengyi Cai, Samantha J Emery-Corbin, Conor McCafferty, Suelyn Van Den Helm, Natasha Letunica, Chantal Attard, Rebecca Barton, Stephen Horton, Steve Bottrell, Bradley Schultz, Graeme MacLaren, Roberto Chiletti, Derek Best, Amy Johansen, Fiona Newall, Warwick Butt, Yves d'Udekem, Laura F Dagley, Jumana M Yousef, Paul Monagle, Vera Ignjatovic","doi":"10.1097/PCC.0000000000003591","DOIUrl":"10.1097/PCC.0000000000003591","url":null,"abstract":"<p><strong>Objective: </strong>To characterize surface-bound proteins and to measure the thickness of fibrin fibers bound to extracorporeal membrane oxygenation (ECMO) circuits used in children.</p><p><strong>Design: </strong>Single-center observational prospective study, April to November 2021.</p><p><strong>Setting: </strong>PICU, Royal Children's Hospital, Melbourne, Australia.</p><p><strong>Patients: </strong>Patients aged less than 18 years on venoarterial ECMO and without preexisting disorder.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>ECMO circuits were collected from six patients. Circuit samples were collected from five different sites, and subsequently processed for proteomic and scanning electron microscopy (SEM) studies. The concentration of proteins bound to ECMO circuit samples was measured using a bicinchoninic acid protein assay, whereas characterization of the bound proteome was performed using data-independent acquisition mass spectrometry. The Reactome Over-representation Pathway Analyses tool was used to identify functional pathways related to bound proteins. For the SEM studies, ECMO circuit samples were prepared and imaged, and the thickness of bound fibrin fibers was measured using the Fiji ImageJ software, version 1.53c ( https://imagej.net/software/fiji/ ). Protein binding to ECMO circuit samples and fibrin networks showed significant intra-circuit and interpatient variation. The median (range) total protein concentration was 19.0 (0-76.9) μg/mL, and the median total number of proteins was 2011 (1435-2777). A total of 933 proteins were commonly bound to ECMO circuit samples from all patients and were functionally involved in 212 pathways, with signal transduction, cell cycle, and metabolism of proteins being the top three pathway categories. The median intra-circuit fibrin fiber thickness was 0.20 (0.15-0.24) μm, whereas the median interpatient fibrin fiber thickness was 0.18 (0.15-0.21) μm.</p><p><strong>Conclusions: </strong>In this report, we have characterized proteins and fiber fibrin thickness bound to ECMO circuits in six children. The techniques and approaches may be useful for investigating interactions between blood, coagulation, and the ECMO circuit and have the potential for circuit design.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1017-1025"},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141982951","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: 2024-07-19DOI: 10.1097/PCC.0000000000003582
Matthew S Linz, Lauren D Booth, Aaron M Milstone, David C Stockwell, Anna C Sick-Samuels
Objectives: Previously, we implemented a comprehensive decision support tool, a "New Fever Algorithm," to support the evaluation of PICU patients with new fever or instability. This tool was associated with a decline in culture rates without safety concerns. We assessed the impact of the algorithm on testing practices by identifying the proportion of cultures pre- vs. post-implementation that were discordant with algorithm guidance and may have been avoidable.
Design: Retrospective evaluation 12 months pre- vs. post-quality improvement intervention.
Setting: Single-center academic PICU and pediatric cardiac ICU.
Subjects: All admitted patients.
Interventions: Implementing the "New Fever Algorithm" in July 2020.
Measurements and main results: Patient medical records were reviewed to categorize indications for all blood, respiratory, and urine cultures. Among cultures obtained for new fever or new clinical instability, we assessed specific testing patterns that were discordant from the algorithm's guidance such as blood cultures obtained without documented concern for sepsis without initiation of antibiotics, respiratory cultures without respiratory symptoms, urine cultures without a urinalysis or pyuria, and pan-cultures (concurrent blood, respiratory, and urine cultures). Among 2827 cultures, 1950 (69%) were obtained for new fever or instability. The proportion of peripheral blood cultures obtained without clinical concern for sepsis declined from 18.6% to 10.4% ( p < 0.0007). Respiratory cultures without respiratory symptoms declined from 41.5% to 27.4% ( p = 0.01). Urine cultures without a urinalysis did not decline (from 27.6% to 25.1%). Urine cultures without pyuria declined from 83.0% to 73.7% ( p = 0.04). Pan-cultures declined from 22.4% to 10.6% ( p < 0.0001). Overall, algorithm-discordant testing declined from 39% to 30% ( p < 0.0001).
Conclusions: The majority of cultures obtained were for new fever or instability and introduction of the "New Fever Algorithm" was associated with reductions in algorithm-discordant testing practices and pan-cultures. There remain opportunities for improvement and additional strategies are warranted to optimize testing practices for in this complex patient population.
{"title":"Evaluation of a Comprehensive Algorithm for PICU Patients With New Fever or Instability: Association of Clinical Decision Support With Testing Practices.","authors":"Matthew S Linz, Lauren D Booth, Aaron M Milstone, David C Stockwell, Anna C Sick-Samuels","doi":"10.1097/PCC.0000000000003582","DOIUrl":"10.1097/PCC.0000000000003582","url":null,"abstract":"<p><strong>Objectives: </strong>Previously, we implemented a comprehensive decision support tool, a \"New Fever Algorithm,\" to support the evaluation of PICU patients with new fever or instability. This tool was associated with a decline in culture rates without safety concerns. We assessed the impact of the algorithm on testing practices by identifying the proportion of cultures pre- vs. post-implementation that were discordant with algorithm guidance and may have been avoidable.</p><p><strong>Design: </strong>Retrospective evaluation 12 months pre- vs. post-quality improvement intervention.</p><p><strong>Setting: </strong>Single-center academic PICU and pediatric cardiac ICU.</p><p><strong>Subjects: </strong>All admitted patients.</p><p><strong>Interventions: </strong>Implementing the \"New Fever Algorithm\" in July 2020.</p><p><strong>Measurements and main results: </strong>Patient medical records were reviewed to categorize indications for all blood, respiratory, and urine cultures. Among cultures obtained for new fever or new clinical instability, we assessed specific testing patterns that were discordant from the algorithm's guidance such as blood cultures obtained without documented concern for sepsis without initiation of antibiotics, respiratory cultures without respiratory symptoms, urine cultures without a urinalysis or pyuria, and pan-cultures (concurrent blood, respiratory, and urine cultures). Among 2827 cultures, 1950 (69%) were obtained for new fever or instability. The proportion of peripheral blood cultures obtained without clinical concern for sepsis declined from 18.6% to 10.4% ( p < 0.0007). Respiratory cultures without respiratory symptoms declined from 41.5% to 27.4% ( p = 0.01). Urine cultures without a urinalysis did not decline (from 27.6% to 25.1%). Urine cultures without pyuria declined from 83.0% to 73.7% ( p = 0.04). Pan-cultures declined from 22.4% to 10.6% ( p < 0.0001). Overall, algorithm-discordant testing declined from 39% to 30% ( p < 0.0001).</p><p><strong>Conclusions: </strong>The majority of cultures obtained were for new fever or instability and introduction of the \"New Fever Algorithm\" was associated with reductions in algorithm-discordant testing practices and pan-cultures. There remain opportunities for improvement and additional strategies are warranted to optimize testing practices for in this complex patient population.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"998-1004"},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724120","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.0000000000003614
Tara M Neumayr
{"title":"Enriching the Field: The Ongoing Story of Acute Kidney Injury Diagnosis and Prognostication in Children With Septic Shock.","authors":"Tara M Neumayr","doi":"10.1097/PCC.0000000000003614","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003614","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"25 11","pages":"1068-1070"},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576753","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.0000000000003617
Vidit Bhargava, David B Kantor, Erik Su
{"title":"Making Waves With Point-of-Care Ultrasound; Investment Begets Impact at the ICU Bedside?","authors":"Vidit Bhargava, David B Kantor, Erik Su","doi":"10.1097/PCC.0000000000003617","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003617","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"25 11","pages":"1065-1068"},"PeriodicalIF":4.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576754","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}