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Pediatric Hematology and Oncology Patients on Extracorporeal Membrane Oxygenation: Outcomes in a Multicenter, Retrospective Cohort, 2009-2021. 使用体外膜氧合的小儿血液病和肿瘤患者:2009-2021年多中心、回顾性队列的结果。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-01 Epub Date: 2024-07-19 DOI: 10.1097/PCC.0000000000003584
Michael Colin Mowrer, Lisa Lima, Rohit Nair, Xilong Li, Hitesh Sandhu, Brian Bridges, Ryan P Barbaro, Saleh Bhar, Raymond Nkwantabisa, Saad Ghafoor, Agnes Reschke, Taylor Olson, Matthew P Malone, Neel Shah, Matt S Zinter, Jon Gehlbach, Laura Hollinger, Briana L Scott, Reut Kassif Lerner, Thomas V Brogan, Lakshmi Raman, Renee M Potera

Objective: To describe characteristics associated with survival for pediatric patients with an oncologic diagnosis or hematopoietic cell transplant (HCT) supported with extracorporeal membrane oxygenation (ECMO).

Design: Multicenter, retrospective study.

Setting: Sixteen PICUs in the United States and Israel.

Patients: We included patients aged younger than 19 years with an oncologic diagnosis or HCT who required ECMO support between 2009 and 2021.

Interventions: None.

Measurements and main results: A total of 149 patients were included in the study cohort. There were 118 patients with an oncologic diagnosis and 31 that received HCT. The indications for ECMO were respiratory failure (46%), combined respiratory and cardiac failure (28%), and cardiac failure (25%). Venovenous (V-V) ECMO was used in 45% of patients, with 53% of patients being placed on venoarterial (V-A) ECMO. For oncologic and HCT groups, survival to ECMO decannulation was 52% (62/118) and 64% (20/31), and survival to hospital discharge was 36% (43/118) and 42% (13/31), respectively. After adjusting for other factors, requiring cardiopulmonary resuscitation was associated with greater odds ratio of mortality (3.0 [95% CI, 1.2-7.7]).

Conclusions: Survival to ECMO decannulation of pediatric oncologic and HCT patients in this study was 52-64%, depending upon diagnosis. However, survival to hospital discharge remains poor. Future research should prioritize understanding factors contributing to this survival gap within these patient populations.

目的描述与肿瘤诊断或体外膜氧合(ECMO)支持造血细胞移植(HCT)的儿科患者存活率相关的特征:设计:多中心、回顾性研究:背景:美国和以色列的 16 个 PICU:我们纳入了年龄小于 19 岁、在 2009 年至 2021 年期间需要 ECMO 支持的肿瘤诊断或 HCT 患者:无干预措施:共有 149 名患者被纳入研究队列。其中 118 名患者接受了肿瘤诊断,31 名患者接受了 HCT。ECMO 的适应症为呼吸衰竭(46%)、合并呼吸衰竭和心力衰竭(28%)以及心力衰竭(25%)。45%的患者使用静脉(V-V)ECMO,53%的患者使用静脉动脉(V-A)ECMO。就肿瘤组和 HCT 组而言,ECMO 拔管后的存活率分别为 52%(62/118)和 64%(20/31),出院后的存活率分别为 36%(43/118)和 42%(13/31)。在调整了其他因素后,需要心肺复苏与更大的死亡几率相关(3.0 [95% CI, 1.2-7.7]):本研究中,儿科肿瘤和 HCT 患者从 ECMO 解除到出院的存活率为 52-64%,具体取决于诊断。然而,出院后的存活率仍然很低。未来的研究应优先了解造成这些患者群体生存率差距的因素。
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引用次数: 0
Editor's Choice Articles for November. 十一月编辑推荐文章。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-01 Epub Date: 2024-11-04 DOI: 10.1097/PCC.0000000000003629
Robert C Tasker
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引用次数: 0
The Power of Goodbyes. 告别的力量
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-01 Epub Date: 2024-06-24 DOI: 10.1097/PCC.0000000000003560
Cecilia Gállego Suárez
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引用次数: 0
The Impact of Injury-Induced Inflammation on Postoperative Fluid Resuscitation in Pediatric Surgical Patients. 损伤引发的炎症对小儿外科患者术后液体复苏的影响。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-01 Epub Date: 2024-11-04 DOI: 10.1097/PCC.0000000000003607
Walter J Chwals
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引用次数: 0
Evolution and Impact of a Diagnostic Point-of-Care Ultrasound Program in a PICU. 重症监护病房护理点超声诊断项目的发展和影响。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-11-01 Epub Date: 2024-07-18 DOI: 10.1097/PCC.0000000000003581
David R Baker, Christie L Glau, Adam S Himebauch, Sara Arnoldi, Sam Rosenblatt, Garrett Keim, Steven M Loscalzo, Mark D Weber, Meryl Cohen, Michael D Quartermain, Summer L Kaplan, Robert M Sutton, Akira Nishisaki, Thomas W Conlon

Objectives: To evaluate the impact of point-of-care ultrasound (POCUS) use on clinicians within a PICU and to assess infrastructural elements of our POCUS program development.

Design: Retrospective observational study.

Setting: Large academic, noncardiac PICU in the United States.

Subjects: Patients in a PICU who had diagnostic POCUS performed.

Interventions: None.

Measurements and main results: Between January 1, 2017, and December 31, 2022, 7201 diagnostic POCUS studies were ordered; 1930 (26.8%) had a quality assurance (QA) record generated in an independent POCUS QA database. The cardiac domain was most frequently imaged (81.0% of ordered studies, 81.2% of reviewed studies). POCUS images changed clinician understanding of pathophysiology in 563 of 1930 cases (29.2%); when this occurred, management was changed in 318 of 563 cases (56.5%). Cardiac POCUS studies altered clinician suspected pathophysiology in 30.1% of cases (472/1568), compared with 21.5% (91/362) in noncardiac studies ( p = 0.06). Among cases where POCUS changed clinician understanding, management changed more often following cardiac than noncardiac POCUS ( p = 0.02). Clinicians identified a need for cardiology consultation or complete echocardiograms in 294 of 1568 cardiac POCUS studies (18.8%). Orders for POCUS imaging increased by 94.9%, and revenue increased by 159.4%, from initial to final study year. QA database use by both clinicians and reviewers decreased annually as QA processes evolved in the setting of technologic growth and unit expansion.

Conclusions: Diagnostic POCUS imaging in the PICU frequently yields information that alters diagnosis and changes management. As PICU POCUS use increased, QA processes evolved resulting in decreased use of our initial QA database. Modifications to QA processes are likely necessary as clinical contexts change over time.

目的评估床旁超声波(POCUS)的使用对 PICU 临床医生的影响,并评估 POCUS 项目发展的基础设施要素:设计:回顾性观察研究:环境:美国大型非心脏病学术性 PICU:干预措施:无:测量和主要结果2017年1月1日至2022年12月31日期间,共进行了7201例诊断性POCUS检查;其中1930例(26.8%)在独立的POCUS QA数据库中生成了质量保证(QA)记录。心脏领域的成像最为频繁(81.0% 的订购研究,81.2% 的审查研究)。在 1930 例病例中,有 563 例(29.2%)的 POCUS 图像改变了临床医生对病理生理学的理解;在 563 例病例中,有 318 例(56.5%)的 POCUS 图像改变了治疗方法。在 30.1% 的病例(472/1568 例)中,心脏 POCUS 研究改变了临床医生怀疑的病理生理学,而在非心脏研究中,这一比例为 21.5%(91/362 例)(p = 0.06)。在 POCUS 改变了临床医生认识的病例中,心脏科 POCUS 比非心脏科 POCUS 更常改变处理方法(p = 0.02)。在 1568 次心脏 POCUS 检查中,有 294 次(18.8%)临床医生发现需要心脏科会诊或完整的超声心动图检查。从最初研究年到最后研究年,POCUS 成像订单增加了 94.9%,收入增加了 159.4%。临床医生和审查人员对质量保证数据库的使用逐年减少,因为质量保证流程是在技术发展和单位扩张的背景下演变而来的:结论:PICU 的 POCUS 成像诊断经常会产生改变诊断和管理的信息。随着 PICU POCUS 使用量的增加,质量保证流程也在不断发展,导致我们最初的质量保证数据库使用量减少。随着临床环境的不断变化,有必要对质量保证流程进行修改。
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引用次数: 0
Pediatric Burn Care for Burn Injury: Outcomes by Timing of Referral Using a U.S. Single-Center Retrospective Cohort, 2005-2019. 小儿烧伤的烧伤护理:2005-2019年美国单中心回顾性队列转诊时间的结果。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-25 DOI: 10.1097/PCC.0000000000003623
Hannah L Gale, Steven J Staffa, Matthew A DePamphilis, Sarah Tsay, Jeffrey Burns, Robert Sheridan

Objectives: Burn centers offer specialized care to pediatric patients with burn injuries. However, data about outcome in relation to timing of transfer are limited. We examined these timings and outcomes among burn-injured pediatric patients.

Design: Single-center, retrospective cohort study of U.S. national and international practice.

Setting: Shriners ESO Trauma Burn Registry, 2005-2019.

Patients: Patients 0-17 years old admitted to a pediatric burn center with 10-80% total body surface area (TBSA) burn between 2005 and 2019.

Interventions: None.

Measurements and main results: The cohort of 761 patients was subcategorized according to timing of referral: early presentation (EP) (0-7 d), delayed presentation (DP) (8-60 d), and very delayed presentation (VDP) (> 60 d). Primary outcomes included hospital length of stay (LOS), ICU LOS, percent TBSA (%TBSA)/LOS ratio, mortality, and disposition. Dichotomous outcomes were analyzed using logistic regression and continuous outcomes were compared using median regression, both utilizing multivariable analysis adjusting for a priori confounders and presented as adjusted coefficients (ACs) with 95% CI. Delayed referral (DP and VDP) was associated with higher %TBSA burn and with fewer referrals from high-income countries. Compared with EP, VDP was associated with higher LOS/%TBSA (AC, 0.2 [0.01-0.4]). On univariate analysis, in comparison with EP, DP and VDP were associated with higher ICU (DP 16 [6-29]; VDP 8 [0-18]) and hospital LOS (DP 34 [21-55]; VDP 32 [18-58]). Overall, ten of 761 patients died (1.3%), and we found no association between timing of referral and mortality. Also, in 751 survivors, 635 patients (84.6%) were discharged home without home health, and we found no association with timing of referral on multivariable analysis.

Conclusions: In this report, we have reviewed our single-center, international burn-injured pediatric cohort, operating in the United States (2005-2019). We find that referral with VDP as opposed to EP was associated with increased LOS/%TBSA.

目标:烧伤中心为儿科烧伤患者提供专业护理。然而,与转院时机相关的治疗效果数据却很有限。我们对烧伤儿科患者的转院时间和转院效果进行了研究:设计:对美国国内和国际惯例的单中心回顾性队列研究:背景:2005-2019年Shriners ESO创伤烧伤登记处:2005年至2019年期间儿科烧伤中心收治的烧伤总体表面积(TBSA)为10%-80%的0-17岁患者:测量和主要结果根据转诊时间对761名患者进行了分类:早期转诊(EP)(0-7 d)、延迟转诊(DP)(8-60 d)和非常延迟转诊(VDP)(> 60 d)。主要结果包括住院时间(LOS)、ICU LOS、TBSA 百分比(%TBSA)/LOS 比率、死亡率和处置。二分结果采用逻辑回归进行分析,连续结果采用中位回归进行比较,二者均采用多变量分析,对先验混杂因素进行调整,并以调整系数(AC)和 95% CI 表示。延迟转诊(DP 和 VDP)与烧伤的 TBSA 百分比较高和来自高收入国家的转诊较少有关。与 EP 相比,VDP 与较高的 LOS/%TBSA 相关(AC,0.2 [0.01-0.4])。单变量分析显示,与 EP 相比,DP 和 VDP 与较高的 ICU(DP 16 [6-29];VDP 8 [0-18])和住院时间(DP 34 [21-55];VDP 32 [18-58])相关。总体而言,761 名患者中有 10 人死亡(1.3%),我们发现转诊时间与死亡率之间没有关联。此外,在 751 名幸存者中,有 635 名患者(84.6%)在没有家庭医疗服务的情况下出院回家,我们在多变量分析中没有发现转诊时间与死亡率之间的关系:在这份报告中,我们回顾了在美国开展业务的单中心国际烧伤儿科队列(2005-2019 年)。我们发现,与 EP 相比,VDP 的转诊与 LOS/%TBSA 的增加有关。
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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 : 2024-10-24 DOI: 10.1097/PCC.0000000000003631
Robert C Tasker
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引用次数: 0
Dexmedetomidine Withdrawal Syndrome in the PICU. 儿童重症监护病房中的右美托咪定戒断综合征。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-01 Epub Date: 2024-10-03 DOI: 10.1097/PCC.0000000000003514
Abinaya Kannan, Atul Jindal
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引用次数: 0
The Need to Screen: Unpacking Acute on Chronic Social Risks for Our Patients and Families in Critical Need. 筛查的必要性:为急需帮助的患者和家庭揭开慢性社会风险的神秘面纱。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-01 Epub Date: 2024-10-03 DOI: 10.1097/PCC.0000000000003593
Anjali Garg, Sapna R Kudchadkar
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引用次数: 0
Extracorporeal Cardiopulmonary Resuscitation Use Among Children With Cardiac Disease in the ICU: A Meta-Analysis and Meta-Regression of Data Through March 2024. 重症监护室心脏病患儿使用体外心肺复苏术的情况:截至 2024 年 3 月的数据的元分析和元回归。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-01 Epub Date: 2024-08-23 DOI: 10.1097/PCC.0000000000003594
Francesca Sperotto, Marco Daverio, Angela Amigoni, Dario Gregori, Anna Dorste, Ryan L Kobayashi, Ravi R Thiagarajan, Nicola Maschietto, Peta M Alexander

Objective: Epidemiologic data on extracorporeal cardiopulmonary resuscitation (ECPR) use in children with cardiac disease after in-hospital cardiac arrest (IHCA) are lacking. We aimed to investigate trends in ECPR use over time in critically ill children with cardiac disease.

Data sources: We performed a secondary analysis of a recent systematic review (PROSPERO CRD42020156247) to investigate trends in ECPR use in children with cardiac disease. PubMed, Web of Science, Embase, and Cumulative Index to Nursing and Allied Health Literature were screened (inception to September 2021). For completeness of this secondary analysis, PubMed was also rescreened (September 2021 to March 2024).

Study selection: Observational studies including epidemiologic data on ECPR use in children with cardiac disease admitted to an ICU.

Data extraction: Data were extracted by two independent investigators. The risk of bias was assessed using the National Heart Lung and Blood Institutes Quality Assessment Tools. Random-effects meta-analysis was used to compute a pooled proportion of subjects undergoing ECPR; meta-regression was used to assess trends in ECPR use over time.

Data synthesis: Of the 2664 studies identified, 9 (17,669 patients) included data on ECPR use in children with cardiac disease. Eight were cohort studies, 1 was a case-control, 8 were retrospective, 1 was prospective, 6 were single-center, and 3 were multicenter. Seven studies were included in the meta-analysis; all were judged of good quality. By meta-analysis, we found that a pooled proportion of 21% (95% CI, 15-29%) of pediatric patients with cardiac disease experiencing IHCA were supported with ECPR. By meta-regression adjusted for category of patients (surgical vs. general cardiac), we found that the use of ECPR in critically ill children with cardiac disease significantly increased over time ( p = 0 .026).

Conclusions: About one-fifth of critically ill pediatric cardiac patients experiencing IHCA were supported with ECPR, and its use significantly increased over time. This may partially explain the increased trends in survival demonstrated for this population.

目的:院内心脏骤停(IHCA)后的心脏病患儿使用体外心肺复苏(ECPR)的流行病学数据尚缺。我们旨在调查患有心脏病的重症儿童使用体外心肺复苏术的长期趋势:我们对最近的一篇系统综述(PROSPERO CRD42020156247)进行了二次分析,以调查心脏病患儿使用 ECPR 的趋势。我们对 PubMed、Web of Science、Embase 和 Cumulative Index to Nursing and Allied Health Literature 进行了筛选(从开始到 2021 年 9 月)。为使二次分析更加完整,还重新筛选了 PubMed(2021 年 9 月至 2024 年 3 月):观察性研究,包括在重症监护室收治的心脏病患儿中使用 ECPR 的流行病学数据:数据由两名独立调查人员提取。采用美国国家心肺和血液研究所质量评估工具对偏倚风险进行评估。随机效应荟萃分析用于计算接受 ECPR 的受试者的汇总比例;荟萃回归用于评估随着时间推移 ECPR 的使用趋势:在已确定的 2664 项研究中,有 9 项(17669 名患者)包含了儿童心脏病患者使用 ECPR 的数据。其中 8 项为队列研究,1 项为病例对照研究,8 项为回顾性研究,1 项为前瞻性研究,6 项为单中心研究,3 项为多中心研究。7项研究被纳入荟萃分析;所有研究均被评为质量良好。通过荟萃分析,我们发现有 21% (95% CI,15%-29%)的经历 IHCA 的心脏病儿科患者接受了 ECPR 支持。通过对患者类别(外科与普通心脏病)进行元回归调整,我们发现随着时间的推移,重症儿童心脏病患者使用 ECPR 的比例显著增加(p = 0.026):结论:约有五分之一的 IHCA 儿科心脏病重症患者使用了 ECPR,而且随着时间的推移,其使用率显著增加。结论:约有五分之一的 IHCA 重症小儿心脏病患者接受了 ECPR 支持,而且随着时间的推移,其使用率明显增加,这可能部分解释了该人群生存率增加的趋势。
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引用次数: 0
期刊
Pediatric Critical Care Medicine
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