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Patterns of Use of β-2 Agonists, Steroids, and Mucoactive Medications to Treat Bronchiolitis in the PICU: U.S. Pediatric Health Information System 2009-2022 Database Study. 在PICU中使用β-2激动剂、类固醇和粘膜活性药物治疗毛细支气管炎的模式:美国儿科健康信息系统2009-2022数据库研究
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-12-17 DOI: 10.1097/PCC.0000000000003670
Brian F Flaherty, Cody S Olsen, Eric R Coon, Rajendu Srivastava, Lawrence J Cook, Heather T Keenan

Objectives: Describe β2-agonists, steroids, hypertonic saline (HTS), n-acetylcysteine (NAC), and dornase alfa (DA) use to treat bronchiolitis, factors associated with use, and associations between use and PICU length of stay (LOS).

Design: Retrospective, multicenter cohort study.

Setting: PICUs in the Pediatric Health Information System database.

Patients: PICU admitted children 24 months young or younger with bronchiolitis.

Interventions: None.

Measurements and main results: We analyzed 47,520 hospitalizations between July 1, 2018, and June 30, 2022. We calculated the rate of medication use overall and the median (range) rate for each hospital: β2-agonist (24,984/47,520 [52.6%]; median hospital, 51.7% [21.4-81.7%]), steroid (15,878/47,520 [33.4%]; median hospital, 33.4% [6.0-54.8%]), HTS (7,041/47,520 [14.8%]; median hospital, 10.5% [0-66.1%]), NAC (1,571/47,520 [3.3%]; median hospital, 0.8% [0-22.0%], and DA (840/47,520 [1.8%]; median hospital, 1.4% [0-13.6%]). Logistic regression using generalized estimating equations (GEEs) identified associations between concurrent asthma and β2-agonist (adjusted odds ratio [aOR], 8.68; 95% CI, 7.08-10.65; p < 0.001) and steroid (aOR, 10.10; 95% CI, 8.84-11.53; p < 0.001) use. Mechanical ventilation was associated with all medications: β2-agonists (aOR, 1.79; 95% CI, 1.57-2.04; p < 0.001), steroids (aOR, 2.33; 95% CI, 1.69-3.21; p < 0.001), HTS (aOR, 1.82; 95% CI, 1.47-2.25; p < 0.001), NAC (aOR, 3.29; 95% CI, 2.15-5.03; p < 0.001), and DA (aOR, 7.65; 95% CI, 4.30-13.61; p < 0.001). No medication was associated with decreased PICU LOS. To assess changes in medication use over time and associations with the 2014 American Academy of Pediatrics bronchiolitis guidelines, we expanded our analysis to 83,820 hospitalizations between July 1, 2009, and June 30, 2022. Logistic regression with GEEs found no change in β2-agonist use; steroid use increased after guideline publication (aOR, 1.05; 95% CI, 1.01-1.10; p = 0.02), HTS use changed from increasing prior to the guidelines (aOR, 1.32; 95% CI, 1.11-1.56; p = 0.001) to stable since guideline publication (aOR, 0.93; 95% CI, 0.81-1.07; p = 0.33).

Conclusions: β2-agonists, steroids, and HTS are commonly, but variably used for PICU bronchiolitis treatment. Medication use appears relatively stable over the last decade.

目的:描述β2激动剂、类固醇、高渗透性生理盐水(HTS)、n-乙酰半胱氨酸(NAC)和dornase α (DA)用于治疗毛细支气管炎,与使用相关的因素,以及使用与PICU住院时间(LOS)之间的关系。设计:回顾性、多中心队列研究。设置:儿童健康信息系统数据库中的picu。患者:PICU收治的24个月以下的毛细支气管炎患儿。干预措施:没有。测量和主要结果:我们分析了2018年7月1日至2022年6月30日期间的47,520例住院病例。我们计算了各医院的总体药物使用率和中位(范围)使用率:β2激动剂(24,984/47,520 [52.6%];中位数医院,51.7%[21.4-81.7%]),类固醇(15,878/47,520 [33.4%];平均医院,33.4%[6.0 - -54.8%])、高温超导(7041/47520 [14.8%];平均医院,10.5%[0 - 66.1%])、南京(1571/47520 [3.3%];中位医院为0.8% [0-22.0%],DA为840/47,520 [1.8%];中位医院,1.4%[0-13.6%])。使用广义估计方程(GEEs)的Logistic回归确定了并发哮喘与β2激动剂之间的关联(校正优势比[aOR], 8.68;95% ci, 7.08-10.65;p < 0.001)和类固醇(aOR, 10.10;95% ci, 8.84-11.53;P < 0.001)。机械通气与所有药物相关:β2激动剂(aOR, 1.79;95% ci, 1.57-2.04;p < 0.001),类固醇(aOR, 2.33;95% ci, 1.69-3.21;p < 0.001), HTS (aOR, 1.82;95% ci, 1.47-2.25;p < 0.001), NAC (aOR, 3.29;95% ci, 2.15-5.03;p < 0.001), DA (aOR, 7.65;95% ci, 4.30-13.61;P < 0.001)。没有药物与PICU LOS降低相关。为了评估药物使用随时间的变化以及与2014年美国儿科学会细支气管炎指南的关联,我们将分析扩展到2009年7月1日至2022年6月30日期间的83820例住院病例。用GEEs进行Logistic回归发现β2激动剂的使用没有变化;指南发布后类固醇使用增加(aOR, 1.05;95% ci, 1.01-1.10;p = 0.02),指南出台前HTS的使用由增加变为增加(aOR, 1.32;95% ci, 1.11-1.56;p = 0.001)至稳定(aOR, 0.93;95% ci, 0.81-1.07;P = 0.33)。结论:β2激动剂、类固醇和HTS是PICU治疗毛细支气管炎的常用方法,但有差异。在过去十年中,药物使用似乎相对稳定。
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引用次数: 0
Status Asthmaticus: Approaches in Mechanical Ventilation. 哮喘现状:机械通气方法。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-12-11 DOI: 10.1097/PCC.0000000000003618
Pablo Cruces
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引用次数: 0
Kidney Outcomes in Children Receiving Extracorporeal Membrane Oxygenation: A Single-Center Acute Cohort From 2009 to 2019, Followed to 2021. 接受体外膜氧合的儿童肾脏结局:2009年至2019年的单中心急性队列,随访至2021年
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-12-11 DOI: 10.1097/PCC.0000000000003650
Amy E Strong, Spandana Makeneni, Diego Campos, Rosanna Fulchiero, Todd J Kilbaugh, James Connelly, Benjamin L Laskin, Jarcy Zee, Michelle R Denburg

Objectives: Long-term kidney outcomes after extracorporeal membrane oxygenation (ECMO) are little quantified and understood. We aimed to describe the frequency of kidney dysfunction screening during follow-up and the prevalence of long-term kidney disease.

Design: Retrospective cohort of pediatric ECMO patients with estimated glomerular filtration rate (eGFR) (mL/min/1.73 m2) using all post-discharge serum creatinine values to define three kidney outcomes: 1) acute kidney injury (AKI), with eGFR of less than 60 mL/min/1.73 m2, which subsequently improved to normal (≥ 90 mL/min/1.73 m2); 2) abnormal eGFR of less than 90 mL/min/1.73 m2 at last follow-up; and 3) chronic kidney disease (CKD) with eGFR of less than 90 mL/min/1.73 m2 on at least two occasions separated by greater than or equal to 90 days, without an intervening or subsequently normal eGFR.

Setting: Single-center tertiary care children's hospital system.

Patients: All pediatric patients surviving ECMO from 2009 to 2019.

Interventions: None.

Measurements and main results: In the 10-year cohort of 666 patients, 399 (60%) survived at least 3 months post-discharge. Of these, 382 of 399 (96%) were followed at our institution for a median of 5 years (interquartile range, 3-8 yr). Two hundred sixty-four of 382 (69%) had at least one creatinine value post-discharge, and 209 of 382 (55%) had at least two values three months apart. Of the 264 with at least one creatinine value, 61 (23%) had an abnormal eGFR; of the 209 with at least two values greater than or equal to 90 days apart, 18 (9%) met criteria for CKD. Of those with CKD, 12 of 18 had AKI during ECMO, and seven of 18 had AKI events post-discharge (range, 1-6 episodes).

Conclusions: This 2009-2019 pediatric ECMO cohort of survivors, followed for a median of 5 years, shows the subsequent high burden of kidney disease. We found that monitoring and following kidney function was not complete in this population, which is a concern since the rate of later AKI events and CKD is significant. Further study is needed to mitigate this post-ECMO vulnerability.

目的:体外膜氧合(ECMO)后肾脏的长期预后很少被量化和了解。我们的目的是描述随访期间肾功能障碍筛查的频率和长期肾脏疾病的患病率。设计:采用所有出院后血清肌酐值对估计肾小球滤过率(eGFR) (mL/min/1.73 m2)的儿科ECMO患者进行回顾性队列研究,以确定三种肾脏结局:1)急性肾损伤(AKI), eGFR小于60 mL/min/1.73 m2,随后改善为正常(≥90 mL/min/1.73 m2);2)末次随访时eGFR异常小于90 mL/min/1.73 m2;3)慢性肾脏疾病(CKD), eGFR小于90 mL/min/1.73 m2,至少两次间隔大于或等于90天,没有干预或随后的eGFR正常。环境:单中心三级保健儿童医院系统。患者:所有2009年至2019年ECMO存活的儿科患者。干预措施:没有。测量和主要结果:在666例患者的10年队列中,399例(60%)出院后存活至少3个月。其中,399例患者中有382例(96%)在我院随访中位数为5年(四分位数间距为3-8年)。382例患者中有264例(69%)出院后至少有一个肌酐值,382例中有209例(55%)出院后三个月至少有两个肌酐值。在264例至少有一个肌酐值的患者中,有61例(23%)eGFR异常;在209例至少有两个值大于或等于间隔90天的患者中,18例(9%)符合CKD标准。在CKD患者中,18人中有12人在ECMO期间有AKI, 18人中有7人在出院后有AKI事件(范围,1-6次)。结论:2009-2019年儿童ECMO幸存者队列,随访中位数为5年,显示随后肾脏疾病的高负担。我们发现在这一人群中监测和跟踪肾功能不完全,这是一个值得关注的问题,因为后期AKI事件和CKD的发生率很高。需要进一步的研究来减轻这种ecmo后的脆弱性。
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引用次数: 0
Physical Activity Monitoring in Children in the 1-Year After 3 or More Days of Invasive Ventilation: Feasibility of Using Accelerometers. 有创通气3天或以上后1岁儿童的身体活动监测:使用加速度计的可行性
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-12-05 DOI: 10.1097/PCC.0000000000003657
Aline B Maddux, Kristen R Miller, Yamila L Sierra, Tellen D Bennett, R Scott Watson, Matthew Spear, Laura L Pyle, Peter M Mourani

Objectives: To measure physical activity in a cohort of children who survived greater than or equal to 3 days of invasive ventilation.

Design: Prospective cohort study (2018-2021).

Setting: Quaternary children's hospital PICU.

Patients: Children (2-17 yr old) without a preexisting tracheostomy who were ambulatory pre-illness and received greater than or equal to 3 days of invasive ventilation.

Interventions: None.

Measurements and main results: We measured duration and intensity of physical activity using hip- (< 6 yr old) or wrist- (≥ 6 yr old) worn ActiGraph GT3XP-BTLE accelerometers (ActiGraph, Pensacola, FL) for 7 days at three timepoints: hospital discharge, 3 months, and 12 months post-discharge. We measured duration of moderate or vigorous physical activity (MVPA) and nonsedentary activity, both characterized as percent of total awake wear time and total minutes per day. We categorized participants based on when they first attained a "high activity" day defined as greater than or equal to 60 minutes of MVPA or a day with percent of MVPA in the top quartile of all days measured. We evaluated 55 children of whom 43 (78%) had data from greater than or equal to 1 timepoint including 19 (35%) with data from all timepoints. Maximum daily MVPA increased across the three post-discharge timepoints (median, 16.0 min [interquartile range (IQR), 8.0-42.8 min], 48.3 min [27.8-94.3 min], and 68.4 min [34.7-111.0 min], respectively) as did maximum daily percent of awake wear time in MVPA (median, 4.3% [IQR, 2.8-9.0%], 10.1% [5.7-14.4%], and 11.1% [7.1-17.5%], respectively). Of the 43 participants, 27 achieved a high activity day: nine of 43 during the hospital discharge period, 14 of 43 during the 3 months post-discharge period, and four of 43 during the 12 months post-discharge period; 16 of 43 did not demonstrate high activity during the post-discharge year.

Conclusions: In the 1-year after PICU discharge measuring physical activity with accelerometers in children 2-17 years old is feasible. Furthermore, demonstration of variable recovery trajectories in our pilot cohort suggests it has potential to be an outcome measure in clinical trials.

目的:测量有创通气存活大于或等于3天的一组儿童的身体活动。设计:前瞻性队列研究(2018-2021)。工作地点:第四儿童医院PICU。患者:儿童(2-17岁),既往无气管切开术,病前可走动,接受≥3天有创通气。干预措施:没有。测量和主要结果:我们使用髋部(< 6岁)或腕部(≥6岁)佩戴的ActiGraph GT3XP-BTLE加速度计(ActiGraph, Pensacola, FL)在出院、出院后3个月和出院后12个月三个时间点测量7天的体力活动持续时间和强度。我们测量了中度或剧烈身体活动(MVPA)和非久坐活动的持续时间,两者都以每天总清醒穿着时间和总分钟数的百分比为特征。我们根据参与者首次达到“高活动”日的时间对他们进行了分类,“高活动”日的定义是MVPA大于或等于60分钟,或者MVPA的百分比在所有测量日的前四分之一。我们评估了55名儿童,其中43名(78%)的数据大于或等于1个时间点,其中19名(35%)的数据来自所有时间点。最大每日MVPA在三个出院后时间点增加(中位数,16.0分钟[四分位间距(IQR), 8.0-42.8分钟],48.3分钟[27.8-94.3分钟]和68.4分钟[34.7-111.0分钟]),最大每日清醒磨损时间百分比在MVPA中增加(中位数,4.3% [IQR, 2.8-9.0%], 10.1%[5.7-14.4%]和11.1%[7.1-17.5%])。在43名参与者中,27人达到了高活动日:43人中有9人在出院期间,43人中有14人在出院后3个月期间,43人中有4人在出院后12个月期间;43例中有16例在出院后一年没有表现出高活性。结论:在PICU出院后1年内,用加速度计测量2-17岁儿童的身体活动是可行的。此外,在我们的试点队列中,变量恢复轨迹的证明表明它有可能成为临床试验的结果衡量标准。
{"title":"Physical Activity Monitoring in Children in the 1-Year After 3 or More Days of Invasive Ventilation: Feasibility of Using Accelerometers.","authors":"Aline B Maddux, Kristen R Miller, Yamila L Sierra, Tellen D Bennett, R Scott Watson, Matthew Spear, Laura L Pyle, Peter M Mourani","doi":"10.1097/PCC.0000000000003657","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003657","url":null,"abstract":"<p><strong>Objectives: </strong>To measure physical activity in a cohort of children who survived greater than or equal to 3 days of invasive ventilation.</p><p><strong>Design: </strong>Prospective cohort study (2018-2021).</p><p><strong>Setting: </strong>Quaternary children's hospital PICU.</p><p><strong>Patients: </strong>Children (2-17 yr old) without a preexisting tracheostomy who were ambulatory pre-illness and received greater than or equal to 3 days of invasive ventilation.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We measured duration and intensity of physical activity using hip- (< 6 yr old) or wrist- (≥ 6 yr old) worn ActiGraph GT3XP-BTLE accelerometers (ActiGraph, Pensacola, FL) for 7 days at three timepoints: hospital discharge, 3 months, and 12 months post-discharge. We measured duration of moderate or vigorous physical activity (MVPA) and nonsedentary activity, both characterized as percent of total awake wear time and total minutes per day. We categorized participants based on when they first attained a \"high activity\" day defined as greater than or equal to 60 minutes of MVPA or a day with percent of MVPA in the top quartile of all days measured. We evaluated 55 children of whom 43 (78%) had data from greater than or equal to 1 timepoint including 19 (35%) with data from all timepoints. Maximum daily MVPA increased across the three post-discharge timepoints (median, 16.0 min [interquartile range (IQR), 8.0-42.8 min], 48.3 min [27.8-94.3 min], and 68.4 min [34.7-111.0 min], respectively) as did maximum daily percent of awake wear time in MVPA (median, 4.3% [IQR, 2.8-9.0%], 10.1% [5.7-14.4%], and 11.1% [7.1-17.5%], respectively). Of the 43 participants, 27 achieved a high activity day: nine of 43 during the hospital discharge period, 14 of 43 during the 3 months post-discharge period, and four of 43 during the 12 months post-discharge period; 16 of 43 did not demonstrate high activity during the post-discharge year.</p><p><strong>Conclusions: </strong>In the 1-year after PICU discharge measuring physical activity with accelerometers in children 2-17 years old is feasible. Furthermore, demonstration of variable recovery trajectories in our pilot cohort suggests it has potential to be an outcome measure in clinical trials.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786402","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
Esophageal Manometry in Pediatric Acute Respiratory Distress Syndrome: Necessity or Simply a Neighbor of the Pulmonary Artery Catheter? 儿童急性呼吸窘迫综合征食管测压:是否需要肺动脉导管?
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-12-03 DOI: 10.1097/PCC.0000000000003627
Natalie Napolitano, Nadir Yehya, Garrett Keim
{"title":"Esophageal Manometry in Pediatric Acute Respiratory Distress Syndrome: Necessity or Simply a Neighbor of the Pulmonary Artery Catheter?","authors":"Natalie Napolitano, Nadir Yehya, Garrett Keim","doi":"10.1097/PCC.0000000000003627","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003627","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780493","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
Peripheral Perfusion Index in Ugandan Children With Plasmodium falciparum Severe Malaria: Secondary Analysis of Outcomes in a 2014-2017 Cohort Study. 乌干达恶性疟原虫重症疟疾患儿的外周灌注指数:2014-2017 年队列研究结果的二次分析。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-12-01 Epub Date: 2024-09-26 DOI: 10.1097/PCC.0000000000003624
Wesley Boland, Dibyadyuti Datta, Ruth Namazzi, Caitlin Bond, Andrea L Conroy, Kagan A Mellencamp, Robert O Opoka, Chandy C John, Michael Lintner Rivera

Objectives: Continuous, noninvasive tools to monitor peripheral perfusion, such as perfusion index (PI), can detect hemodynamic abnormalities and assist in the management of critically ill children hospitalized with severe malaria. In this study of hospitalized children with severe malaria, we aimed to assess whether PI correlates with clinical markers of perfusion and to determine whether combining PI with these clinical measures improves identification of children with greater odds of mortality.

Design: Post hoc analysis of a prospective, multicenter, cohort study conducted between 2014 and 2017.

Setting: Two referral hospitals in Central and Eastern Uganda.

Patients: Six hundred children younger than 5 years old with severe malaria and 120 asymptomatic community children.

Interventions: None.

Measurements and main results: PI was measured at 6-hour intervals for the first 24 hours of hospitalization. We compared PI to standard clinical perfusion measures such as capillary refill time, presence of cold peripheral limbs, or temperature gradient. Admission PI was highly correlated with clinical measures of perfusion. Admission PI was lower in children with severe malaria compared with asymptomatic community children; and, among the children with severe malaria, PI was lower in those with clinical features of poor perfusion or complications of severe malaria, such as shock and hyperlactatemia (all p < 0.02). Among children with severe malaria, lower admission PI was associated with greater odds of mortality after adjustment for age, sex, and severe malaria criteria (adjusted odds ratio, 2.4 for each log decrease in PI [95% CI, 1.0-5.9]; p = 0.045). Diagnostically, the presence of two consecutive low PI measures (< 1%) predicted mortality, with a sensitivity of 50% and a specificity of 76%.

Conclusions: In severe malaria, PI correlates with clinical complications (including shock and elevated serum lactate) and may be useful as an objective, continuous explanatory variable associated with greater odds of later in-hospital mortality.

目的:连续、无创的外周灌注监测工具(如灌注指数(PI))可检测血液动力学异常,并有助于重症疟疾住院患儿的治疗。在这项针对重症疟疾住院患儿的研究中,我们旨在评估灌注指数是否与临床灌注指标相关,并确定将灌注指数与这些临床指标相结合是否能更好地识别死亡率较高的患儿:对2014年至2017年间进行的一项前瞻性多中心队列研究进行事后分析:乌干达中部和东部的两家转诊医院:600名5岁以下的重症疟疾患儿和120名无症状的社区儿童:测量和主要结果在住院的头 24 小时内,每隔 6 小时测量一次 PI。我们将 PI 与毛细血管再充盈时间、外周肢体是否冰冷或温度梯度等标准临床灌注测量指标进行了比较。入院 PI 与临床灌注测量结果高度相关。与无症状的社区儿童相比,重症疟疾患儿入院时的血流灌注指数较低;在重症疟疾患儿中,有血流灌注不良临床特征或重症疟疾并发症(如休克和高乳酸血症)的患儿的血流灌注指数较低(均 p <0.02)。在重症疟疾患儿中,在对年龄、性别和重症疟疾标准进行调整后,较低的入院 PI 与较高的死亡几率相关(调整后的几率比,PI 每下降 1 个对数,死亡几率为 2.4 [95% CI,1.0-5.9];P = 0.045)。在诊断上,连续两次出现低 PI(< 1%)可预测死亡率,灵敏度为 50%,特异度为 76%:结论:在重症疟疾中,PI 与临床并发症(包括休克和血清乳酸升高)相关,可作为一个客观、连续的解释变量,与较高的后期院内死亡率相关。
{"title":"Peripheral Perfusion Index in Ugandan Children With Plasmodium falciparum Severe Malaria: Secondary Analysis of Outcomes in a 2014-2017 Cohort Study.","authors":"Wesley Boland, Dibyadyuti Datta, Ruth Namazzi, Caitlin Bond, Andrea L Conroy, Kagan A Mellencamp, Robert O Opoka, Chandy C John, Michael Lintner Rivera","doi":"10.1097/PCC.0000000000003624","DOIUrl":"10.1097/PCC.0000000000003624","url":null,"abstract":"<p><strong>Objectives: </strong>Continuous, noninvasive tools to monitor peripheral perfusion, such as perfusion index (PI), can detect hemodynamic abnormalities and assist in the management of critically ill children hospitalized with severe malaria. In this study of hospitalized children with severe malaria, we aimed to assess whether PI correlates with clinical markers of perfusion and to determine whether combining PI with these clinical measures improves identification of children with greater odds of mortality.</p><p><strong>Design: </strong>Post hoc analysis of a prospective, multicenter, cohort study conducted between 2014 and 2017.</p><p><strong>Setting: </strong>Two referral hospitals in Central and Eastern Uganda.</p><p><strong>Patients: </strong>Six hundred children younger than 5 years old with severe malaria and 120 asymptomatic community children.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>PI was measured at 6-hour intervals for the first 24 hours of hospitalization. We compared PI to standard clinical perfusion measures such as capillary refill time, presence of cold peripheral limbs, or temperature gradient. Admission PI was highly correlated with clinical measures of perfusion. Admission PI was lower in children with severe malaria compared with asymptomatic community children; and, among the children with severe malaria, PI was lower in those with clinical features of poor perfusion or complications of severe malaria, such as shock and hyperlactatemia (all p < 0.02). Among children with severe malaria, lower admission PI was associated with greater odds of mortality after adjustment for age, sex, and severe malaria criteria (adjusted odds ratio, 2.4 for each log decrease in PI [95% CI, 1.0-5.9]; p = 0.045). Diagnostically, the presence of two consecutive low PI measures (< 1%) predicted mortality, with a sensitivity of 50% and a specificity of 76%.</p><p><strong>Conclusions: </strong>In severe malaria, PI correlates with clinical complications (including shock and elevated serum lactate) and may be useful as an objective, continuous explanatory variable associated with greater odds of later in-hospital mortality.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1117-1126"},"PeriodicalIF":4.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351488","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
It's Not Invisible. 它不是隐形的。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-12-01 Epub Date: 2024-07-01 DOI: 10.1097/PCC.0000000000003569
Martha A Q Curley
{"title":"It's Not Invisible.","authors":"Martha A Q Curley","doi":"10.1097/PCC.0000000000003569","DOIUrl":"10.1097/PCC.0000000000003569","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1168"},"PeriodicalIF":4.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141469927","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
Caregiver Perspectives on Provider Continuity During Prolonged PICU Hospitalizations: A Single-Center Qualitative Study, 2021-2022. 护理人员对长期PICU住院期间提供者连续性的看法:一项单中心定性研究,2021-2022。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-12-01 Epub Date: 2024-12-04 DOI: 10.1097/PCC.0000000000003626
Patricia Peña Jiménez, Wendy Leatherman Phipps, Elizabeth Jacob-Files, Elizabeth Lindo, Lauren C Rakes, Joan S Roberts, Jonna D Clark, Emily R Berkman, Katie R Nielsen

Objectives: To improve continuity of care, some PICUs assign a continuity attending (CA) physician for children with prolonged hospitalizations. Little is known about how this intervention impacts familial caregivers' experiences. The objective of this study was to provide in-depth descriptions of family perspectives about continuity of care during prolonged PICU hospitalizations for children with and without a PICU CA.

Design: Qualitative semi-structured interviews.

Setting: Single center cohort, from October 2021 to December 2022, at an academic PICU in the United States.

Participants: Familial caregivers (n = 39) of critically ill children hospitalized in the PICU for greater than or equal to 14 days were purposively sampled, stratified by group: 18 with a PICU CA and 21 without a PICU CA.

Interventions: None.

Measurements and main results: Semi-structured interviews were audio recorded, transcribed, coded, and analyzed in the context of the continuity of care model using a realist thematic approach. Familial caregivers described six themes related to relational, informational, and management continuity: 1) familiar providers who demonstrate empathy for the child improve family members' comfort and trust (Relational); 2) providers who know and use a child's baseline health status to inform clinical decision-making alleviate family members' stress (Relational, Management); 3) information loss during care team transitions frustrates families (Informational, Management); 4) known providers enhance caregiver communication (Informational); 5) familiar providers who value a family's expertise about their child's care (Relational, Management); and 6) take responsibility for the child's long-term care plan (Management) decrease parental stress.

Conclusions: As PICU patient medical complexity and length of stay increase, familial caregivers' needs transition from understanding day-to-day management to navigating care team transitions and partnering with providers to develop long-term care plans. Targeted interventions to increase provider continuity that consider relational, informational, and management continuity are needed to optimize patient outcomes and family experiences.

目的:为了提高护理的连续性,一些picu为长期住院的儿童分配了一名连续性主治医师。人们对这种干预如何影响家庭照顾者的经历知之甚少。本研究的目的是深入描述有和没有PICU ca的儿童在PICU长期住院期间护理连续性的家庭观点。设计:定性半结构化访谈。环境:单中心队列,2021年10月至2022年12月,在美国的一个学术PICU。参与者:有目的地对在PICU住院大于等于14天的危重儿童的家庭照顾者(n = 39)进行抽样,按组分层:18人有PICU CA, 21人没有PICU CA。干预措施:无。测量和主要结果:半结构化访谈录音,转录,编码,并在护理模型的连续性背景下使用现实主义主题方法进行分析。家庭照护者描述了与关系、信息和管理连续性相关的六个主题:1)对儿童表现出同理心的熟悉的照护者提高了家庭成员的舒适度和信任度(关系);2)了解并使用儿童基线健康状况为临床决策提供信息的提供者减轻了家庭成员的压力(关系,管理);3)护理团队过渡过程中的信息丢失会使家庭感到沮丧(information, Management);4)已知提供者加强照顾者沟通(信息);5)熟悉的提供者,他们重视家庭在照顾孩子方面的专业知识(关系,管理);6)负责孩子的长期护理计划(管理)减轻父母的压力。结论:随着PICU患者医疗复杂性和住院时间的增加,家庭护理人员的需求从理解日常管理转变为引导护理团队过渡并与提供者合作制定长期护理计划。有针对性的干预措施,以提高提供者的连续性,考虑关系,信息和管理的连续性,需要优化患者的结果和家庭的经验。
{"title":"Caregiver Perspectives on Provider Continuity During Prolonged PICU Hospitalizations: A Single-Center Qualitative Study, 2021-2022.","authors":"Patricia Peña Jiménez, Wendy Leatherman Phipps, Elizabeth Jacob-Files, Elizabeth Lindo, Lauren C Rakes, Joan S Roberts, Jonna D Clark, Emily R Berkman, Katie R Nielsen","doi":"10.1097/PCC.0000000000003626","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003626","url":null,"abstract":"<p><strong>Objectives: </strong>To improve continuity of care, some PICUs assign a continuity attending (CA) physician for children with prolonged hospitalizations. Little is known about how this intervention impacts familial caregivers' experiences. The objective of this study was to provide in-depth descriptions of family perspectives about continuity of care during prolonged PICU hospitalizations for children with and without a PICU CA.</p><p><strong>Design: </strong>Qualitative semi-structured interviews.</p><p><strong>Setting: </strong>Single center cohort, from October 2021 to December 2022, at an academic PICU in the United States.</p><p><strong>Participants: </strong>Familial caregivers (n = 39) of critically ill children hospitalized in the PICU for greater than or equal to 14 days were purposively sampled, stratified by group: 18 with a PICU CA and 21 without a PICU CA.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Semi-structured interviews were audio recorded, transcribed, coded, and analyzed in the context of the continuity of care model using a realist thematic approach. Familial caregivers described six themes related to relational, informational, and management continuity: 1) familiar providers who demonstrate empathy for the child improve family members' comfort and trust (Relational); 2) providers who know and use a child's baseline health status to inform clinical decision-making alleviate family members' stress (Relational, Management); 3) information loss during care team transitions frustrates families (Informational, Management); 4) known providers enhance caregiver communication (Informational); 5) familiar providers who value a family's expertise about their child's care (Relational, Management); and 6) take responsibility for the child's long-term care plan (Management) decrease parental stress.</p><p><strong>Conclusions: </strong>As PICU patient medical complexity and length of stay increase, familial caregivers' needs transition from understanding day-to-day management to navigating care team transitions and partnering with providers to develop long-term care plans. Targeted interventions to increase provider continuity that consider relational, informational, and management continuity are needed to optimize patient outcomes and family experiences.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"25 12","pages":"1159-1167"},"PeriodicalIF":4.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770887","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
Starting From Scratch. 从零开始。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-12-01 Epub Date: 2024-12-04 DOI: 10.1097/PCC.0000000000003633
Suzanne R Gouda, K Sarah Hoehn
{"title":"Starting From Scratch.","authors":"Suzanne R Gouda, K Sarah Hoehn","doi":"10.1097/PCC.0000000000003633","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003633","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"25 12","pages":"1189-1191"},"PeriodicalIF":4.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771023","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
Pharmacokinetic Factors Associated With Early Meropenem Target Attainment in Pediatric Severe Sepsis. 与小儿严重败血症早期达到美罗培南目标相关的药代动力学因素
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-12-01 Epub Date: 2024-08-20 DOI: 10.1097/PCC.0000000000003599
Kelli Paice, Sonya Tang Girdwood, Tomoyuki Mizuno, Kathryn Pavia, Nieko Punt, Peter Tang, Min Dong, Calise Curry, Rhonda Jones, Abigayle Gibson, Alexander A Vinks, Jennifer Kaplan

Objectives: To determine the frequency of early meropenem concentration target attainment (TA) in critically ill children with severe sepsis; to explore clinical, therapeutic, and pharmacokinetic factors associated with TA; and to assess how fluid resuscitation and volume status relate to early TA.

Design: Retrospective analysis of prospective observational cohort study.

Setting: PICU in a single academic quaternary care children's hospital.

Patients: Twenty-nine patients starting meropenem for severe sepsis (characterized as need for positive pressure ventilation, vasopressors, or ≥ 40 mL/kg bolused fluid), of which 17 were newly escalated to PICU level care.

Interventions: None.

Measurements and main results: Concentration-time profiles were analyzed using modeling software employing opportunistic sampling, Bayesian estimation, and a population pharmacokinetic model. Time above four times minimum inhibitory concentration (T > 4×MIC), using the susceptibility breakpoint of 1 µg/mL, was determined for each patient over the first 24 hours of meropenem therapy, as well as individual clearance and volume of distribution (Vd) estimates. Twenty-one of 29 patients met a target of 40%T > MIC 4 μg/mL. Reaching TA, vs. not, was associated with lower meropenem clearance. We failed to identify a difference in Vd or an association between the TA group and age, weight, creatinine-based estimated glomerular filtration rate (eGFR), or the amount of fluid administered. eGFR was, however, negatively correlated with overall T > MIC.

Conclusions: Eight of 29 pediatric patients with early severe sepsis did not meet the selected TA threshold within the first 24 hours of meropenem therapy. Higher clearance was associated with failure to meet targets. Identifying patients likely to have higher meropenem clearance could help with dosing regimens.

研究目的确定重症脓毒症患儿早期美罗培南浓度达标(TA)的频率;探讨与TA相关的临床、治疗和药代动力学因素;评估液体复苏和容量状态与早期TA的关系:设计:前瞻性观察队列研究的回顾性分析:患者:29名开始使用美罗培南的患者:29例因重症脓毒症(需要正压通气、血管加压或≥40 mL/kg补液)而开始使用美罗培南的患者,其中17例新升级为PICU级护理:测量和主要结果使用建模软件分析了浓度-时间曲线,该软件采用了机会取样、贝叶斯估计和群体药代动力学模型。在美罗培南治疗的最初 24 小时内,根据 1 µg/mL 的易感性断点,确定了每位患者超过四倍最低抑菌浓度(T > 4×MIC)的时间,以及个体清除率和分布容积(Vd)估计值。29 名患者中有 21 名达到了 40%T > MIC 4 μg/mL 的目标。达标与否与美罗培南清除率较低有关。我们没有发现Vd的差异,也没有发现TA组与年龄、体重、基于肌酐的估计肾小球滤过率(eGFR)或输液量之间的关联:29例早期重症脓毒症儿科患者中,有8例在美罗培南治疗的头24小时内未达到所选的TA阈值。较高的清除率与未能达标有关。识别可能具有较高美罗培南清除率的患者有助于制定给药方案。
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Pediatric Critical Care Medicine
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