Online Abstract Translations
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Online Abstract Translations Source Type: research

Clinical Features of Critical Coronavirus Disease 2019 in Children*
Conclusions: Severe, protracted coronavirus disease 2019 is seen in pediatric patients, including those without significant comorbidities. We observed a greater proportion of hospitalized children requiring mechanical ventilation than has been reported to date. Older children, African-American or Hispanic children, and males may be at risk for severe coronavirus disease 2019 requiring hospitalization. Hypoxia, thrombocytopenia, and elevated C-reactive protein may be useful markers of critical illness. Data regarding optimal management and therapies for pediatric coronavirus disease 2019 are urgently needed. (Source: Pedi...
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Online Brief Reports Source Type: research

Mirrored Ribs: A Sign for Pneumothorax in Neonates*
Conclusions: The occurrence of “mirrored ribs” in lung ultrasound in combination with absence of lung sliding, absence of B-lines and lung point might facilitate the rapid recognition of pneumothorax in neonates. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Online Brief Reports Source Type: research

Pediatric Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review*
Objectives: This systematic review aims to summarize the body of available literature on pediatric extracorporeal cardiopulmonary resuscitation in order to delineate current utilization, practices, and outcomes, while highlighting gaps in current knowledge. Data Sources: PubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov databases. Study Selection: We searched for peer-reviewed original research publications on pediatric extracorporeal cardiopulmonary resuscitation (patients (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Online Review Articles Source Type: research

A Systematic Review of Neuromonitoring Modalities in Children Beyond Neonatal Period After Cardiac Arrest*
Conclusions: The appropriate application and precise interpretation of available modalities still need to be determined in relation to the individual patient. International collaboration in standardized data collection during the (acute) clinical course together with detailed long-term outcome measurements (including functional outcome, neuropsychologic assessment, and health-related quality of life) are the first steps toward more precise, patient-specific neuroprognostication after pediatric cardiac arrest. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Online Review Articles Source Type: research

Paved With Good Intentions: Hospital Visitation Restrictions in the Age of Coronavirus Disease 2019*
Hospital visitation restrictions have been widely implemented during the coronavirus disease 2019 pandemic as a means of decreasing the transmission of coronavirus. While decreasing transmission is an important goal, it is not the only goal that quality healthcare must aim to achieve. Severely restricted visitation policies undermine our ability to provide humane, family-centered care, particularly during critical illness and at the end of life. The enforcement of these policies consequently increases the risk of moral distress and injury for providers. Using our experience in a PICU, we survey the shortcomings of current ...
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Online PCCM Perspectives Source Type: research

Protecting It*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Online PCCM Perspectives Source Type: research

Influence of Early Extubation Location on Outcomes Following Pediatric Cardiac Surgery*
Objectives: Early extubation following pediatric cardiac surgery is common, but debate exists whether location affects outcome, with some centers performing routine early extubations in the operating room (odds ratio) and others in the cardiac ICU. We aimed to define early extubation practice variation across hospitals and assess impact of location on hospital length-of-stay and other outcomes. Design: Secondary analysis of the Pediatric Cardiac Critical Care Consortium registry. Setting: Twenty-eight Pediatric Cardiac Critical Care Consortium hospitals. Patients: Patients undergoing Society of Thoracic Surgeons...
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Online Cardiac Intensive Care Source Type: research

Pediatric Critical Care Medicine Fellowship Simulation Use Survey*
Conclusions: Nearly, all responding U.S. Accreditation Council for Graduate Medical Education–accredited Pediatric Critical Care Medicine fellowship programs use simulation-based education to train Pediatric Critical Care Medicine fellows with the majority perceiving simulation as absolutely necessary to Pediatric Critical Care Medicine fellow training. The reported types of simulation used in fellow training varied, as did training theories and concepts in the simulation programs. More research is needed to understand how to optimize and perhaps standardize parts of Pediatric Critical Care Medicine fellowship simu...
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Deployment of a Clinical Pathway to Improve Postcardiac Arrest Care: A Before-After Study*
Objectives: Postcardiac arrest care bundles following adult cardiac arrest are associated with improved survival to discharge. We aimed to evaluate whether a clinical pathway and computerized order entry were associated with improved pediatric postcardiac arrest care and discharge outcomes. Design: Single-center retrospective before-after study. Setting: Academic PICU. Patients: Patients who suffered an in- or out-of-hospital cardiac arrest from January 2008 to December 2015 cared for in the PICU within 12 hours of sustained return of circulation. Intervention: Deployment of a postcardiac arrest clinical path...
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

An Assessment of Clinical and System Drivers of Family Satisfaction in the PICU*
Conclusions: High capture rates of family satisfaction in the PICU can be obtained with a PICU-specific survey, limiting barriers to completion by including family preferences, and distributing in the PICU setting. Less than two-third of PICU families are highly satisfied; patients of Hispanic ethnicity and those with high social stressors predict low satisfaction, whereas illness severity, age, and PICU length of stay did not have statistical significance. Local improvement teams can use this approach to drive enhanced satisfaction. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Outcomes of Children With Cystic Fibrosis Admitted to PICUs*
Conclusions: The mortality rate during PICU admissions for patients with cystic fibrosis is lower than has been reported in prior studies, both in the overall cohort and in the subset requiring invasive mechanical ventilation. These data provide updated insight into the prognosis for cystic fibrosis patients requiring critical care. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

The authors reply
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Letters to the Editor Source Type: research

Pediatric Sepsis: Subphenotypes to Enrich Clinical Trial Entry Criteria
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Letters to the Editor Source Type: research

The authors reply
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Letters to the Editor Source Type: research

The Role of the Pediatric Intensivist in the Coronavirus Disease 2019 Pandemic
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Letters to the Editor Source Type: research

The authors reply
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Letters to the Editor Source Type: research

Noninvasive Surfactant Use in the Treatment of Respiratory Distress Syndrome
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Letters to the Editor Source Type: research

The authors reply
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Letters to the Editor Source Type: research

Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Letters to the Editor Source Type: research

The authors reply
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Letters to the Editor Source Type: research

Ferritin Levels in Children With Sepsis in Low-Middle Income Countries: Do We Need Lower Threshold?
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Letters to the Editor Source Type: research

Coronavirus Disease 2019: A Tsunami of Data and a Plethora of Unanswered Questions*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Where Does Innovation in Critical Care Ultrasound Come From? Perhaps a Look in the Mirror*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Extracorporeal Cardiopulmonary Resuscitation: So Many Questions, How Much Time Have You Got?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Underpowered and Too Heterogenous: A Humbling Assessment of the Literature Supporting Neuroprognostication After Pediatric Cardiac Arrest*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Less Is More!*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

To Feel or Not to Feel?—That Is the Question*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Extubation After Neonatal and Pediatric Cardiac Surgery: Where and When?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Emerging Prevalence of Simulation-Based Education in Pediatric Critical Care Medicine Fellowship Training: We Have Come a Long Way, (Sim)baby!*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Postcardiac Arrest Care: Streamlining and Personalizing Our Approach*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Prioritizing the Assessment of Patient and Family Experience in the Evaluation of Healthcare Quality*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Cystic Fibrosis in the PICU—More of a Zebra Than a Horse*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Surveying the Scene: Timing Is Everything*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

How Residents Learn During Emergent Situations May Be Different Than How We Were Taught*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

The After Shock—Reduced Health-Related Quality of Life Following Sepsis*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

The Needle Is Not Moving*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Extracorporeal Membrane Oxygenation for Pediatric Patients With Coronavirus Disease 2019–Related Illness*
Conclusions: The majority of pediatric extracorporeal membrane oxygenation centers have proactively established guidelines for the use of extracorporeal membrane oxygenation for coronavirus disease 2019–related illnesses. Further work is needed to help guide the fair allocation of extracorporeal membrane oxygenation resources and to determine the appropriateness of extracorporeal cardiopulmonary resuscitation. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Extracorporeal Support Source Type: research

Learning in Pediatric Emergency Situations: A Qualitative Study of Residents’ Perspectives*
Conclusions: Resident participation in emergency situations is complex and informed by the context. Learning in emergency situations is influenced by residents’ level of mental engagement. Supervisors may positively guide resident participation, foster engagement, and enable them to reach their learning goals in emergency situations. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Education Source Type: research

Cerebral Hemodynamic Profile in Ischemic and Hemorrhagic Brain Injury Acquired During Pediatric Extracorporeal Membrane Oxygenation
Conclusions: This study outlines distinct differences in underlying cerebral hemodynamics associated with ischemic and hemorrhagic brain injury acquired during extracorporeal membrane oxygenation. Real-time monitoring of cerebral hemodynamics in patients acquiring brain injury during extracorporeal membrane oxygenation can help optimize their management. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Neurocritical Care Source Type: research

Trajectories and Risk Factors for Altered Physical and Psychosocial Health-Related Quality of Life After Pediatric Community-Acquired Septic Shock*
Objectives: To evaluate the physical and psychosocial domains of health-related quality of life among children during the first year following community-acquired septic shock, and explore factors associated with poor physical and psychosocial health-related quality of life outcomes. Design: Secondary analysis of the Life After Pediatric Sepsis Evaluation. Setting: Twelve academic PICUs in the United States. Patients: Children greater than or equal to 1 month and less than 18 years old who were perceived to be without severe developmental disability by their family caregiver at baseline and who survived hospitali...
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Feature Articles Source Type: research

Racial/Ethnic Minority Children With Cancer Experience Higher Mortality on Admission to the ICU in the United States*
This study details the analysis of 23,128 PICU admissions of 12,232 unique oncology patients representing 3% of all PICU admissions with 1,610 deaths (7.0% case fatality). African American (8.5%) and Hispanic children (8.1%) had significantly higher mortality (p (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2020 Category: Pediatrics Tags: Feature Articles Source Type: research

Associations of Plasma Angiopoietins-1 and -2 and Angiopoietin-2/-1 Ratios With Measures of Organ Injury and Clinical Outcomes in Children With Sepsis: A Preliminary Report
Conclusions: In the acute phase of sepsis in children, plasma angiopoietin-2/-1 ratios rise significantly above control levels and correlate with measures of organ injury and worse clinical outcomes after 24 hours. Our findings suggest that angiopoietin dysregulation begins early in sepsis and, if sustained, may promote greater organ injury that can lead to worse clinical outcomes. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2020 Category: Pediatrics Tags: Online Brief Reports Source Type: research

Delirium Detection Based on the Clinical Experience of Pediatric Intensivists
Conclusions: The low frequency of delirium detection and the insufficient criteria used for the diagnosis in these units suggest flaws in the recognition of delirium and probably the occurrence of underdiagnosis/misdiagnosis when it is based only on clinical experience, without the use of a valid and reliable tool. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2020 Category: Pediatrics Tags: Online Brief Reports Source Type: research

Ultrasonographic Optic Nerve Sheath Diameter Measurement to Detect Intracranial Hypertension in Children With Neurological Injury: A Systematic Review
Conclusions: We are unable to identify a threshold value in ultrasound measured optic nerve sheath diameter for the determination of intracranial hypertension in children. Even though the ultrasound measured optic nerve sheath diameter measurement is highly sensitive to the presence of increased intracranial pressure, the test has only moderate specificity. Therefore, other confirmatory methods and further investigation is necessary in the clinical care of children. The technique is likely not sufficiently precise for clinical use in the absence of other confirmatory methods, and further investigation is necessary to det...
Source: Pediatric Critical Care Medicine - September 1, 2020 Category: Pediatrics Tags: Online Review Article Source Type: research

Standardization of the Perioperative Management for Neonates Undergoing the Norwood Operation for Hypoplastic Left Heart Syndrome and Related Heart Defects
Conclusions: This initiative successfully implemented a standardized perioperative care guideline for neonates undergoing the Norwood operation at a large center. Positive statistical process control centerline shifts in Guideline Adherence Score, length of postoperative mechanical ventilation, and cardiac ICU length of stay were demonstrated. A higher percentage were successfully extubated by postoperative day 2. Establishment of standard processes can lead to best practices to decrease major adverse events. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2020 Category: Pediatrics Tags: Online Cardiac Intensive Care Source Type: research

Factors That Contribute to Cost Differences Based on ICU of Admission in Neonates Undergoing Congenital Heart Surgery: A Novel Decomposition Analysis
Objectives: We leveraged decomposition analysis, commonly used in labor economics, to understand determinants of cost differences related to location of admission in children undergoing neonatal congenital heart surgery. Design: A retrospective cohort study. Setting: Pediatric Health Information Systems database. Patients: Neonates ( (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2020 Category: Pediatrics Tags: Online Cardiac Intensive Care Source Type: research

Skin-to-Skin Care Is a Safe and Effective Comfort Measure for Infants Before and After Neonatal Cardiac Surgery
Objectives: To determine the effect of skin-to-skin care on stress, pain, behavioral organization, and physiologic stability of infants with critical congenital heart disease before and after neonatal cardiac surgery. Design: A baseline response-paired design was used, with infants acting as their own controls before, during, and after skin-to-skin care at two distinct time points: once in the preoperative period (T1) and once in the postoperative period (T2). Setting: Cardiac ICU and step-down unit in a large metropolitan freestanding children’s hospital. Subjects: Convenience sample of 30 infants admitte...
Source: Pediatric Critical Care Medicine - September 1, 2020 Category: Pediatrics Tags: Online Cardiac Intensive Care Source Type: research

Rise in Angiopoietin-2 Following Neonatal Cardiac Surgery Is Associated With Adverse Clinical Outcomes
Objectives: Neonatal cardiac surgery for congenital cardiac defects is associated with significant morbidity and mortality, and there is a need for early identification of patients at highest risk of adverse outcomes. Because vascular endothelial injury mediates damage across organ systems, we measured serum biomarkers of endothelial injury in neonates following cardiopulmonary bypass and examined their associations with short-term outcomes. Design: Prospective cohort study. Setting: Pediatric cardiac ICU. Patients: Thirty neonates less than 2 weeks old undergoing repair of congenital cardiac defects with cardio...
Source: Pediatric Critical Care Medicine - September 1, 2020 Category: Pediatrics Tags: Online Cardiac Intensive Care Source Type: research

Eliminating Catheter-Associated Urinary Tract Infections in a Pediatric Cardiac ICU
Conclusions: Utilization of quality improvement methodology allowed us to identify components of care that contributed to catheter-associated urinary tract infections. After addressing these issues, we noted a substantial reduction and then elimination of catheter-associated urinary tract infections in our pediatric cardiac ICU. Widely disseminating these interventions across multiple pediatric hospitals to determine the ability to achieve similar results are important next steps. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2020 Category: Pediatrics Tags: Online Cardiac Intensive Care Source Type: research