Dexmedetomidine for Prolonged Sedation in the PICU: A Systematic Review and Meta-Analysis*
Conclusions: High-quality data on dexmedetomidine use for prolonged sedation and a consensus on correct dosing and weaning protocols in children are currently missing. Infusion of dexmedetomidine can be considered relatively safe in pediatrics even when longer than 24 hours. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Online Review Article Source Type: research

Dose-Response Study on Surfactant Nebulization Therapy During Nasal Continuous Positive Airway Pressure Ventilation in Spontaneously Breathing Surfactant-Deficient Newborn Piglets*
Conclusions: In newborn piglets with severe bronchoalveolar lavage–induced respiratory distress syndrome, our results demonstrate that the administration of nebulized poractant alfa using an investigational customized eFlow-Neos nebulizer is an effective and safe noninvasive surfactant administration technique. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Online Laboratory Investigations Source Type: research

Spontaneous Breathing and Imposed Work During Pediatric Mechanical Ventilation: A Bench Study*
Conclusions: Calculated imposed work of breathing were not different across the range of endotracheal tube sizes. The low imposed work of breathing values found in this study might be appreciated as clinically irrelevant. Our findings add to the change in reasoning that it is appropriate to perform spontaneous breathing trials without pressure support. Nonetheless, our findings on the measured imposed work of breathing values need to be confirmed in a clinical study. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Online Laboratory Investigations Source Type: research

Rapid Advancement in Enteral Nutrition Does Not Affect Systemic Inflammation and Insulin Homeostasis Following Pediatric Cardiopulmonary Bypass Surgery*
Conclusions: A FF strategy was not associated with changes to early enteral nutrition delivery. Inflammation, insulin resistance, and morbidity were similar, but FF may modify the relationship between inflammation and adverse event. Multicenter nutrition studies are possible and necessary in this vulnerable population. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Online Cardiac Intensive Care Source Type: research

Viral Respiratory Infection, a Risk in Pediatric Cardiac Surgery: A Propensity-Matched Analysis*
Objectives: 1) To describe the postoperative course and outcomes of cardiac surgery in children with perioperative viral respiratory infection, 2) to evaluate optimal surgical timing for preoperative viral respiratory infection patients, and 3) to define risk stratification. Design: Retrospective study of children undergoing cardiac surgery. Children were tested using a multiplex polymerase chain reaction (respiratory virus polymerase chain reaction) panel capturing seven respiratory viruses. Respiratory virus polymerase chain reaction testing was routinely performed in patients under 2 years old. Those with negative ...
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Online Cardiac Intensive Care Source Type: research

Assessing Frequency of Respiratory Complications in Children Undergoing Adenotonsillectomy
Objectives: To determine the frequency of respiratory complications in children admitted to the ICU after adenotonsillectomy and to identify factors associated with the risk of respiratory complications in this cohort. Design: Retrospective observational study. Setting: PICU. Patient Population: All children admitted to the ICU following adenotonsillectomy from September 30, 2009, to March 30, 2014. Measurements and Main Results: Of the 165 children included in the study, 150 (91%) received no respiratory support other than oxygen in the first 2 hours postoperatively. Of the 15 who required support following ...
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Short- and Long-Term Outcome in Critically Ill Children After Acute Interhospital Transport to a PICU in Sweden*
Conclusions: This is the first report on long-term survival after acute pediatric interhospital transport. For the entire cohort, there was significant mortality after PICU discharge, especially in multiple transported patients. In contrast, survival in the subgroup of neonatal patients was high after PICU discharge. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Prehospital Life-Saving Interventions Performed on Pediatric Patients in a Combat Zone: A Multicenter Prospective Study
Objectives: We aimed to describe and evaluate prehospital life-saving interventions performed in a pediatric population in the Afghanistan theater of operations. Design: Our study was a post hoc, subanalysis of a larger multicenter, prospective, observational study. Setting: We evaluated casualties enrolled upon admission to one of the nine military medical facilities in Afghanistan between January 2009 and March 2014. Patients: Adult and pediatric ( (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

The Course of Posttraumatic Stress in Children: Examination of Symptom Trajectories and Predictive Factors Following Admission to Pediatric Intensive Care*
Conclusions: Children with elevated trauma symptoms postintensive care need timely and effective intervention. The majority of children with high levels of acute symptoms will continue to have chronic, ongoing posttraumatic stress symptoms. In addition, acute maternal distress and preexisting internalizing child behavior predict ongoing psychologic distress after discharge from the PICU. Screening in the acute period post-PICU admission may identify children likely to experience ongoing chronic posttraumatic distress symptoms and enable targeted treatment of children at risk. This is the first study to examine symptom tr...
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Point-of-Care Ultrasound in Sternal Notch Confirms Depth of Endotracheal Tube in Children*
Conclusions: Visualization of the cuff at the suprasternal notch by ultrasound demonstrates potential as a means of confirming correct depth of the endotracheal tube following endotracheal intubation. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Dexmedetomidine: A Multipurpose Tool Which Is Difficult to Analyze*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Surfactant Replacement and the Search for a Noninvasive Method of Administration: Are There New Perspectives on the Horizon?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Gasping at Straws: Role of Pressure Support During Spontaneous Breathing Trials in Children*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Enteral Feeding in Postoperative Cardiac Surgical Infants—How Fast Should We Go?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Childhood Viral Respiratory Infection and Congenital Heart Disease: Many Questions Remain Unanswered*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Over the River and Through the Wood, to the Tertiary PICU We Go…But Then What?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

The Role of Mothers in Resilience During PICU Recovery*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Airway Ultrasound: Once Again, Challenging Our Current Standards*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

How Do We Teach and Practice Pediatric Critical Care Medicine?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Coronavirus Disease 2019 in Children: An Invisible Threat Which We Cannot Ignore*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Neurofilament Light Chain—It Is Not Just About Concussions*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Dexmedetomidine Applications in Pediatric Critical Care: Closer but There Is Still Work to Do*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Should Nasal Approach Be the New Routine for Nonemergent Intubation?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Caring for Critically Ill Adults in PICUs Is Not “Child’s Play”*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

The Pediatric Critical Care Trauma Scientist Development: Building a Community of Scientists for the Fields of Pediatric Critical Care and Trauma Surgery
Conclusions: The Pediatric Critical Care Trauma Scientist Development Program is reaching its programmatic goals of buildin g a community of scientists in pediatric critical care and trauma surgery as shown by the qualitative analysis. Key challenges include increasing the diversity of applicants, encouraging applicants who are not funded, increasing the rate of K- to R-conversion, and preserving National Institute of Child Health and Human Development Program priorities for national K12 programs and individual K-awards. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Special Articles Source Type: research

Establishing the Knowledge and Skills Necessary in Pediatric Critical Care Medicine: A Systematic Approach to Practice Analysis*
Conclusions: A systematic approach to practice analysis, with stakeholder engagement, is essential for an accurate definition of Pediatric Critical Care Medicine practice in its totality. This collaborative process resulted in a dynamic document useful in guiding curriculum development for training programs, maintenance of certification, and lifetime professional development to enable safe and efficient patient care. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Special Articles Source Type: research

Coronavirus Disease 2019 in Critically Ill Children: A Narrative Review of the Literature*
Coronavirus disease 2019 has spread around the world. In the 3 months since its emergence, we have learned a great deal about its clinical management and its relevance to the pediatric critical care provider. In this article, we review the available literature and provide valuable insight into the clinical management of this disease, as well as information on preparedness activities that every PICU should perform. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Special Articles Source Type: research

Circulating Neurofilament Light Chain Is Associated With Survival After Pediatric Cardiac Arrest*
Objectives: To characterize neurofilament light levels in children who achieved return of spontaneous circulation following cardiac arrest compared with healthy controls and determine an association between neurofilament light levels and clinical outcomes. Design: Retrospective cohort study. Setting: Academic quaternary PICU. Patients: Children with banked plasma samples from an acute respiratory distress syndrome biomarker study who achieved return of spontaneous circulation after a cardiac arrest and healthy controls. Interventions: None. Measurements and Main Results: Neurofilament light levels were det...
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Neurocritical Care Source Type: research

Hypothermia Plus Melatonin in Asphyctic Newborns: A Randomized-Controlled Pilot Study
Conclusions: The early addition of IV melatonin to asphyctic neonates is feasible and may improve long-term neurodevelopment. To our knowledge, this is the first clinical trial to analyze the administration of IV melatonin as an adjuvant therapy to therapeutic hypothermia. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Neonatal Intensive Care Source Type: research

Early Left Ventricular Dysfunction and Severe Pulmonary Hypertension Predict Adverse Outcomes in “Low-Risk” Congenital Diaphragmatic Hernia
Conclusions: Early left ventricular dysfunction and severe pulmonary hypertension are independent predictors of adverse outcomes among “low-risk” congenital diaphragmatic hernia infants. Early recognition may lead to interventions that can improve outcome in this at-risk cohort. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Neonatal Intensive Care Source Type: research

Efficacy and Safety of Dexmedetomidine for Prolonged Sedation in the PICU: A Prospective Multicenter Study (PROSDEX)*
Objectives: We sought to evaluate dexmedetomidine efficacy in assuring comfort and sparing conventional drugs when used for prolonged sedation (≥24 hr) in critically ill patients, by using validated clinical scores while systematically collecting drug dosages. We also evaluated the safety profile of dexmedetomidine and the risk factors associated with adverse events. Design: Observational prospective study. Setting: Nine tertiary-care PICUs. Patients: Patients less than 18 years who received dexmedetomidine for greater than or equal to 24 hours between January 2016 and December 2017. Interventions: None. ...
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Feature Articles Source Type: research

Use and Outcomes of Nasotracheal Intubation Among Patients Requiring Mechanical Ventilation Across U.S. PICUs*
Objectives: The use and outcomes of nasotracheal intubation in pediatric patients requiring mechanical ventilation have not been quantified. Our goal is to identify prevalence of use, associated factors, and outcomes of nasotracheal versus orotracheal intubation in patients requiring mechanical ventilation. Design: Retrospective cohort study using deidentified data from the Virtual Pediatric Systems database. Data from PICU admissions from January 1, 2015, to December 31, 2016 were analyzed. Setting: One hundred twenty-one PICUs located within the United States. Patients: PICU admissions requiring an endotrachea...
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Feature Articles Source Type: research

Caring for Critically Ill Adults With Coronavirus Disease 2019 in a PICU: Recommendations by Dual Trained Intensivists*
Conclusions: This concise scientific statement includes references to the most recent and relevant guidelines and clinical trials that shape management decisions. The intention is to assist PICUs and intensivists in rapidly preparing for care of adult coronavirus disease 2019 patients should the need arise. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2020 Category: Pediatrics Tags: Feature Articles Source Type: research

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

Methylene Blue for Refractory Shock in Children: A Systematic Review and Survey Practice Analysis
Conclusions: Methylene blue appears safe and may benefit children with refractory shock. There is a stark divide in familiarity and practice patterns regarding its use among physicians. Studies to formally assess safety and efficacy of methylene blue in treating pediatric shock are warranted. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - June 1, 2020 Category: Pediatrics Tags: Online Review Article Source Type: research

Implementation of an Evidence-Based Guideline of Enteral Nutrition for Infants With Congenital Heart Disease: A Controlled Before-and-After Study*
Objectives: To describe the implementation process of a nutrition risk screening and assessment guideline for infants with congenital heart disease and to assess the impact of nurses’ behavior and the effect on infants’ outcomes. Design: A controlled before-and-after implementation study. The three dimensions of the integrated-Promoting Action on Research Implementation in Health Services framework were used to assess barriers and promoting factors. Setting: Cardiac center at Children’s Hospital of Fudan University, Shanghai, China. Patients: Infants with congenital heart disease (n = 142) and ...
Source: Pediatric Critical Care Medicine - June 1, 2020 Category: Pediatrics Tags: Online Cardiac Intensive Care Source Type: research

Hospital-Associated Venous Thromboembolism in a Pediatric Cardiac ICU: A Multivariable Predictive Algorithm to Identify Children at High Risk
Objectives: Critically ill children with cardiac disease are at significant risk for hospital-associated venous thromboembolism, which is associated with increased morbidity, hospital length of stay, and cost. Currently, there are no widely accepted guidelines for prevention of hospital-associated venous thromboembolism in pediatrics. We aimed to develop a predictive algorithm for identifying critically ill children with cardiac disease who are at increased risk for hospital-associated venous thromboembolism as a first step to reducing hospital-associated venous thromboembolism in this population. Design: This is a pr...
Source: Pediatric Critical Care Medicine - June 1, 2020 Category: Pediatrics Tags: Online Cardiac Intensive Care Source Type: research

Platelet Inhibition With IV Glycoprotein IIb/IIIa Inhibitor to Prevent Thrombosis in Pediatric Patients Undergoing Aortopulmonary Shunting*
Objectives: Shunt thrombosis, a potential complication of aortopulmonary shunting, is associated with high mortality. Commonly used oral antiplatelet drugs such as aspirin demonstrate variable absorption and inconsistent antiplatelet effect in critically ill patients early after surgery. IV glycoprotein IIb/IIIa inhibitors are antiplatelet agents with rapid and reproducible effect that may be beneficial as a bridge to oral therapy. Design: Retrospective review of pediatric patients undergoing treatment with IV tirofiban. Discarded blood samples were used to determine pharmacokinetic parameters. Setting: Pediatric c...
Source: Pediatric Critical Care Medicine - June 1, 2020 Category: Pediatrics Tags: Online Cardiac Intensive Care Source Type: research

How 217 Pediatric Intensivists Manage Anemia at PICU Discharge: Online Responses to an International Survey*
Objective: To describe the management of anemia at PICU discharge by pediatric intensivists. Design: Self-administered, online, scenario-based survey. Setting: PICUs in Australia/New Zealand, Europe, and North America. Subjects: Pediatric intensivists. Interventions: None. Measurements and Main Results: Respondents were asked to report their decisions regarding RBC transfusions, iron, and erythropoietin prescription to children ready to be discharged from PICU, who had been admitted for hemorrhagic shock, cardiac surgery, craniofacial surgery, and polytrauma. Clinical and biological variables were altered ...
Source: Pediatric Critical Care Medicine - June 1, 2020 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Testing for Common Respiratory Viruses in Children Admitted to Pediatric Intensive Care: Epidemiology and Outcomes
Objectives: Viral infections are common in children, but there is a lack of data on severe viral infections in critically ill children. We investigated testing for viral infections in children requiring PICU admission and describe the epidemiology and outcomes. Design: Multicenter retrospective study. Results of viral testing for nine respiratory viruses using polymerase chain reaction were collected. Participants: Children less than 16 years old nonelectively admitted to PICU over a 6-year period. Setting: Two tertiary PICUs in Queensland, Australia. Interventions: None. Main Outcome Measures: Primary out...
Source: Pediatric Critical Care Medicine - June 1, 2020 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Epidemiology of Community-Onset Severe Bacterial Infections in Children and Its Evolution: A Population-Based Study in France*
Conclusions: The incidence and mortality rate of community-onset severe bacterial infections, except for S. aureus infection, have decreased in France. N. meningitidis and S. pneumoniae continue to account for many infections, which indicates the need for better vaccination coverage and spectrum. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - June 1, 2020 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Survival and Mid-Term Neurologic Outcome After Extracorporeal Cardiopulmonary Resuscitation in Children
Conclusions: Extracorporeal cardiopulmonary resuscitation is a valuable tool for the treatment of children with refractory cardiac arrest and a favorable neurologic outcome can be achieved in the majority of survivors even after prolonged resuscitation. Mortality after extracorporeal cardiopulmonary resuscitation in postcardiac surgery children is associated with procedural complexity. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - June 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 - June 1, 2020 Category: Pediatrics Tags: Letters to the Editor Source Type: research

Tracheostomy: Shortcut or Real Necessity?
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - June 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 - June 1, 2020 Category: Pediatrics Tags: Letters to the Editor Source Type: research

Stress Ulcer Prophylaxis Remains a Controversial Management in the PICU
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - June 1, 2020 Category: Pediatrics Tags: Letters to the Editor Source Type: research

Successful Implementation of Nutritional Screening and Assessment in Infants With Congenital Heart Disease…Check! Now What?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - June 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

A Novel Strategy to Prevent Shunt Thrombosis After a Modified Blalock–Taussig or Central Aorto-Pulmonary Shunts 75 Years After the Original Blalock–Taussig–Thomas Shunt*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - June 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Anemia at PICU Discharge: Is It a Problem?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - June 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research

Updating the Epidemiology of Severe Bacterial Infections Reveals Old Truths: Vaccination Saves Life and Limb*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - June 1, 2020 Category: Pediatrics Tags: Editorials Source Type: research