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Online Abstract Translations
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Online Abstract Translations Source Type: research

Interhospital Transport of Children Undergoing Cardiopulmonary Resuscitation: A Practical and Ethical Dilemma*
Conclusions: Transporting children in cardiac arrest with ongoing cardiopulmonary resuscitation between hospitals is potentially lifesaving if it enables access to resources such as extracorporeal support, but may risk transport personnel safety. Research is needed to optimize outcomes of patients transported with ongoing cardiopulmonary resuscitation and reduce risks to the staff caring for them. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Online PCCM Perspectives Source Type: research

Correlation Between PaO2/FIO2 and Peripheral Capillary Oxygenation/FIO2 in Burned Children With Smoke Inhalation Injury
Conclusions: PaO2/FIO2 and peripheral capillary oxygenation/FIO2 strongly correlate in burned children with smoke inhalation injury, with a peripheral capillary oxygenation of less than 92% providing the strongest correlation. Thus, peripheral capillary oxygenation/FIO2 ratio may be able to serve as surrogate for PaO2/FIO2, especially when titrating FIO2 to achieve a peripheral capillary oxygenation of 90–95% (i.e., in the acute respiratory distress syndrome range). (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

An Interprofessional Quality Improvement Initiative to Standardize Pediatric Extubation Readiness Assessment
Conclusions: An interprofessionally developed respiratory therapist–led extubation readiness protocol can be successfully implemented in a busy tertiary care PICU without adverse events. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

A Prospective Study of the Association Between Clinically Significant Bleeding in PICU Patients and Thrombocytopenia or Prolonged Coagulation Times*
Conclusions: There is a statistically significant association in PICU patients between decrease in platelet count and clinically significant bleeding, and this association is stronger with lower platelet counts. Further study is required to determine whether platelet transfusion can reduce bleeding risk. International normalized ratio and activated partial thromboplastin time do not predict clinically significant bleeding, and these tests should not be used for this purpose in a general PICU patient population. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Identifying Risk for Acute Kidney Injury in Infants and Children Following Cardiac Arrest*
Conclusions: This study is the first to identify risk factors for acute kidney injury in children after cardiac arrest. Our findings regarding the impact of epinephrine dosing are of particular interest and suggest potential for epinephrine toxicity with regard to acute kidney injury. The ability to identify and potentially modify risk factors for acute kidney injury after cardiac arrest may lead to improved morbidity and mortality in this population. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Fluid Bolus Over 15–20 Versus 5–10 Minutes Each in the First Hour of Resuscitation in Children With Septic Shock: A Randomized Controlled Trial*
Objectives: To compare the effect of administration of 40–60 mL/kg of fluids as fluid boluses in aliquots of 20 mL/kg each over 15–20 minutes with that over 5–10 minutes each on the composite outcome of need for mechanical ventilation and/or impaired oxygenation—increase in oxygenation index by 5 from baseline in the initial 6 and 24 hours in children with septic shock. Design: Randomized controlled trial. Setting: Pediatric emergency and ICU of a tertiary care institute. Patients: Children ( (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

New Clinical Criteria for Sepsis in Children—Finally, What Is the Most Important Thing: Sensitivity or Specificity?
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 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, 2017 Category: Pediatrics Tags: Letters to the Editor Source Type: research

Does Timing, Duration, Dose, and Route of Corticosteroids Matter in Prevention of Postextubation Stridor?
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 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, 2017 Category: Pediatrics Tags: Letters to the Editor Source Type: research

Vasoactive-Inotropic Score: Is It Reliable in Pediatric Sepsis as a Predictive Outcome Measure?
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Letters to the Editor Source Type: research

Transporting Children Undergoing Cardiopulmonary Resuscitation: What’s the Right Thing to Do?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Editorials Source Type: research

Predicting Risk of Bleeding in Critically Ill Children*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Editorials Source Type: research

“I Saw the Light” (1): Hank Williams Sr, Acute Kidney Injury, and Cardiopulmonary Arrest*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Editorials Source Type: research

Fluid Resuscitation in Pediatric Septic Shock: The Case Against Haste*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Editorials Source Type: research

Clinical Quality—Unpacking the Bundle*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Editorials Source Type: research

They Are Not Just Little Tracheostomy Tubes…or Are They?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Editorials Source Type: research

Noninvasive Ventilation in the Cardiac ICU: Understanding What We Are Doing as a Foundation for Studying What We Should Be Doing*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Editorials Source Type: research

Cardiac Arrest in Pediatric Cardiac ICUs: What Are the Differences?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Editorials Source Type: research

An Additional Risk of Transesophageal Echocardiography in Infants*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Editorials Source Type: research

Is Time of ICU Admission a Surrogate for System Factors Impacting Patient Mortality?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Editorials Source Type: research

Population Pharmacokinetics and Pharmacodynamic Target Attainment of Vancomycin in Neonates on Extracorporeal Life Support
Conclusions: To our knowledge, this is the first pharmacokinetic and pharmacodynamic study of neonates receiving vancomycin with a contemporary ¼-inch extracorporeal life support circuit including the Quadrox-iD Pediatric oxygenator (Maquet Cardiovascular, LLC). The data suggest differences in vancomycin pharmacokinetics compared with previous extracorporeal life support data, notably a more rapid clearance, which could result in lower vancomycin concentrations. Considering this, a more aggressive initial dosing regimen may need to be employed in infants on extracorporeal life support. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Extracorporeal Support Source Type: research

Creating a Controlled Arterio-Venous Shunt by Reversing the Extracorporeal Membrane Oxygenation Blood Flow: A Strategy for Weaning Patients Off Veno-Arterial Extracorporeal Membrane Oxygenation
Conclusions: Pump controlled retrograde flow trial off is an easy to use and easily reversible technique to assess patient readiness for separation from extracorporeal membrane oxygenation. Given pump controlled retrograde flow trial off can easily be stopped and—in our experience—is not associated with complications, it lowers the threshold to attempt coming off extracorporeal membrane oxygenation and facilitates accurate assessment of whether a patient will need further ongoing extracorporeal membrane oxygenation support. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Extracorporeal Support Source Type: research

Promoters and Barriers to Implementation of Tracheal Intubation Airway Safety Bundle: A Mixed-Method Analysis*
Conclusions: Implementation of an airway safety quality improvement bundle with high compliance takes a long time across diverse ICUs. Both early and late adopters identified similar promoter and barrier themes. Early adopter sites customized the quality improvement bundle and had an interdisciplinary quality improvement team approach. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Quality and Safety Source Type: research

National Variation in the Use of Tracheostomy in Patients With Congenital Heart Disease*
We describe multicenter variation in the use of tracheostomy in children undergoing congenital heart surgery. Design: We retrospectively analyzed a multicenter cohort. Setting: Pediatric Health Information Systems database retrospective cohort. Patients: Children less than 18 years who underwent both tracheostomy and cardiac surgery (1/04–6/14). Interventions: Univariate and multivariate statistics were performed, stratifying by high (≥ 75th percentile) and low (≤ 25th percentile) tracheostomy volume and adjusting for patient characteristics in multivariate models. Measurements and Main Results: Out of 123...
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Cardiac Intensive Care Source Type: research

Epidemiology of Noninvasive Ventilation in Pediatric Cardiac ICUs*
Objective: To describe the epidemiology of noninvasive ventilation therapy for patients admitted to pediatric cardiac ICUs and to assess practice variation across hospitals. Design: Retrospective cohort study using prospectively collected clinical registry data. Setting: Pediatric Cardiac Critical Care Consortium clinical registry. Patients: Patients admitted to cardiac ICUs at PC4 hospitals. Interventions: None. Measurements and Main Results: We analyzed all cardiac ICU encounters that included any respiratory support from October 2013 to December 2015. Noninvasive ventilation therapy included high flow nasal cannula...
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Cardiac Intensive Care Source Type: research

Traditional Long-Term Central Venous Catheters Versus Transhepatic Venous Catheters in Infants and Young Children
Conclusions: Without compromising future central venous access sites, transhepatic venous lines had superior duration of service without increased thrombosis, thrombolytic use, or insertion site complications relative to central venous lines. Transhepatic venous catheters had a higher infection rate, and further investigation into the etiology is warranted. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Cardiac Intensive Care Source Type: research

Epidemiology and Outcomes of Cardiac Arrest in Pediatric Cardiac ICUs*
Conclusions: We provide contemporary epidemiologic and outcome data for cardiac arrest occurring in the cardiac ICU from a multicenter clinical registry. As detailed above, we highlight high-risk patient cohorts and periods of time that may serve as targets for research and quality improvement initiatives aimed at cardiac arrest prevention. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Cardiac Intensive Care Source Type: research

Altered Carnitine Homeostasis in Children With Increased Pulmonary Blood Flow Due to Ventricular Septal Defects
The objective of this study was to test the hypothesis that children with increased pulmonary blood flow will have evidence of altered carnitine homeostasis, mitochondrial dysfunction, decreased nitric oxide levels, and increased reactive oxygen species generation. Design: A prospective single-center cohort study. Setting: A tertiary care cardiac ICU/PICU. Patients: Arterial blood samples from 18 patients with congenital heart disease associated with increased pulmonary blood flow (ventricular septal defect), 20 with congenital heart disease without increased pulmonary blood flow (tetralogy of Fallot), and 10 without he...
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Cardiac Intensive Care Source Type: research

Severe Upper Airway Obstruction After Intraoperative Transesophageal Echocardiography in Pediatric Cardiac Surgery: A Retrospective Analysis*
Conclusions: Although the benefits of intraoperative transesophageal echocardiography during pediatric cardiac surgery are undisputed, it may be one factor which could increase the rate of severe upper airway obstruction after extubation with the need for reintubation. We suggest to take precautions before extubating high-risk patients, especially in young male children with genetic abnormalities after cardiac surgery with cardiopulmonary bypass. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Cardiac Intensive Care Source Type: research

Time of Admission to the PICU and Mortality*
Conclusions: Admission to the PICU during the morning period from 06:00 to 09:59 on weekdays and admission throughout the day on weekends (06:00–17:59) were independently associated with PICU death as compared to admission during weekday afternoons. Potential contributing factors deserving further study include handoffs of care, rounds, delays related to resource availability, or unrecognized patient deterioration prior to transfer. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Feature Article Source Type: research

Breaking Into the Top Ten
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2017 Category: Pediatrics Tags: Foreword Source Type: research

Supraglottic Atomization of Surfactant in Spontaneously Breathing Lambs Receiving Continuous Positive Airway Pressure
Objectives: To determine the short-term tolerance, efficacy, and lung deposition of supraglottic atomized surfactant in spontaneously breathing lambs receiving continuous positive airway pressure. Design: Prospective, randomized animal study. Setting: Animal research laboratory. Subjects: Twenty-two preterm lambs on continuous positive airway pressure (132 ± 1 d gestational age). Interventions: Animals receiving continuous positive airway pressure via binasal prongs at 8 cm H2O were randomized to receive atomized surfactant at approximately 60-minute of life (atom; n = 15) or not (control; n = 7). The atom group...
Source: Pediatric Critical Care Medicine - September 1, 2017 Category: Pediatrics Tags: Online Laboratory Investigation Source Type: research

Workload of Team Leaders and Team Members During a Simulated Sepsis Scenario
Objectives: Crisis resource management principles dictate appropriate distribution of mental and/or physical workload so as not to overwhelm any one team member. Workload during pediatric emergencies is not well studied. The National Aeronautics and Space Administration-Task Load Index is a multidimensional tool designed to assess workload validated in multiple settings. Low workload is defined as less than 40, moderate 40–60, and greater than 60 signify high workloads. Our hypothesis is that workload among both team leaders and team members is moderate to high during a simulated pediatric sepsis scenario and that te...
Source: Pediatric Critical Care Medicine - September 1, 2017 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Professional Responsibility, Consensus, and Conflict: A Survey of Physician Decisions for the Chronically Critically Ill in Neonatal and Pediatric Intensive Care Units*
Conclusions: ICU physicians do not agree about their responsibilities when approaching difficult decisions for chronically critically ill children. Although most physicians feel a professional responsibility to provide personal recommendations or defer to families, most physicians report offering consensus recommendations. Nearly all physicians embrace a sense of responsibility to disclose disagreement to families. More research is needed to understand physician responsibilities for making recommendations in the care of chronically critically ill children. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2017 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Hydrocortisone Therapy in Catecholamine-Resistant Pediatric Septic Shock: A Pragmatic Analysis of Clinician Practice and Association With Outcomes*
Objectives: The 2012 Surviving Sepsis Campaign pediatric guidelines recommend stress dose hydrocortisone in children experiencing catecholamine-dependent septic shock with suspected or proven absolute adrenal insufficiency. We evaluated whether stress dose hydrocortisone therapy in children with catecholamine dependent septic shock correlated with random serum total cortisol levels and was associated with improved outcomes. Design: Retrospective cohort study. Setting: Non-cardiac PICU. Patients: Critically ill children (1 mo to 18 yr) admitted between January 1, 2013, and December 31, 2013, with catecholamine dependent ...
Source: Pediatric Critical Care Medicine - September 1, 2017 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Determinants of Antibiotic Tailoring in Pediatric Intensive Care: A National Survey*
Conclusions: Decisions about antibiotic management for PICU patients are complex and involve the assessment of several different variables. With the exception of a positive viral polymerase chain reaction, our findings suggest that physicians rarely consider reducing the duration of antibiotics despite clinical improvement. In contrast, they will prolong the duration when faced with a nonreassuring characteristic. The development of objective and evidence-based criteria to guide antibiotic therapy in critically ill children is crucial to ensure the rational use of these agents in PICUs. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2017 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Augmented Renal Clearance Using Population-Based Pharmacokinetic Modeling in Critically Ill Pediatric Patients*
The objectives of this study were to: 1) evaluate the prevalence of augmented renal clearance in critically ill pediatric patients using vancomycin clearance; 2) derive the pharmacokinetic model that best describes vancomycin clearance in critically ill pediatric patients; and 3) correlate vancomycin clearance with creatinine clearance estimated by modified Schwartz or Cockcroft-Gault. Design: Retrospective, two-center, cohort study from 2003 to 2016. Setting: Clinical drug monitoring services in the PICUs at two tertiary care, teaching hospitals. Patients: Children from 1 to 21 years old. Interventions: None. Measure...
Source: Pediatric Critical Care Medicine - September 1, 2017 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Nebulized Fluticasone for Preventing Postextubation Stridor in Intubated Children: A Randomized, Double-Blind Placebo-Controlled Trial: Erratum
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2017 Category: Pediatrics Tags: Erratum Source Type: research

The authors reply
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2017 Category: Pediatrics Tags: Letters to the Editor Source Type: research

High-Flow Nasal Cannula Weaning Protocol: Is It Relevant?
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2017 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 - September 1, 2017 Category: Pediatrics Tags: Letters to the Editor Source Type: research

Nebulized Fluticasone for Preventing Postextubation Stridor—Is It Really Effective?
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2017 Category: Pediatrics Tags: Letters to the Editor Source Type: research

Caring for Long Length of Stay Patients in the Neonatal ICU and PICU: How Do We Ensure Coherent Decisions When the Physicians Are Continuously Rotating?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2017 Category: Pediatrics Tags: Editorials Source Type: research

Thomas Jefferson, Steroids, and Sepsis*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2017 Category: Pediatrics Tags: Editorials Source Type: research

How Can We Optimize Antibiotic Use in the PICU?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2017 Category: Pediatrics Tags: Editorials Source Type: research

Augmented Renal Clearance in Critically Ill Pediatric Patients: Does It Impact the Outcome of Pharmacotherapy?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2017 Category: Pediatrics Tags: Editorials Source Type: research

Does Birth at Early-Term Gestation Increase Mortality for Neonates on Extracorporeal Life Support After Cardiac Surgery?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2017 Category: Pediatrics Tags: Editorials Source Type: research

Mothers’ Milk—Can We Improve the Neonatal Immunity Response With the Oldest Recipe in the Mammal’s Cookbook?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2017 Category: Pediatrics Tags: Editorials Source Type: research