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Decrypting Sepsis-Associated Brain Dysfunction: A Computational Phenotype That Can Hack It. 解密败血症相关脑功能障碍:能破解它的计算表型。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-08-01 Epub Date: 2024-08-05 DOI: 10.1097/PCC.0000000000003549
Sydney Rooney, Christopher M Horvat
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引用次数: 0
Randomized Trials to Reduce Clinical Uncertainty: Gold Standard or Fool's Gold? 减少临床不确定性的随机试验:黄金标准还是傻瓜黄金?
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-08-01 Epub Date: 2024-08-05 DOI: 10.1097/PCC.0000000000003533
Mark J Peters, Padmanabhan Ramnarayan
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引用次数: 0
Is Rapid Bedside Echocardiography in Septic Shock Possible? 脓毒性休克时可以进行快速床旁超声心动图检查吗?
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-08-01 Epub Date: 2024-08-05 DOI: 10.1097/PCC.0000000000003538
Suchitra Ranjit
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引用次数: 0
A Conspicuously Absent Commandment: Thou Shall Not Tracheotomize. 一条明显缺失的戒律:不得进行气管切开术。
IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-08-01 Epub Date: 2024-08-05 DOI: 10.1097/PCC.0000000000003537
Sinead L Murphy Salem, Robert J Graham
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引用次数: 0
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。
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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。
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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":null,"pages":null},"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
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":null,"pages":null},"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":null,"pages":null},"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
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":null,"pages":null},"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
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Pediatric Critical Care Medicine
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