Online Abstract Translations
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2021 Category: Pediatrics Tags: Online Abstract Translations Source Type: research

Assessment of Vocal Cord Motion Using Laryngeal Ultrasound in Children: A Systematic Review and Meta-Analysis
CONCLUSIONS: Laryngeal ultrasound demonstrates high sensitivity and specificity for detecting vocal cord motion in children in a wide range of clinical settings. Laryngeal ultrasound offers a low-risk imaging option for assessing vocal cord function in children compared with the current gold standard of laryngoscopy. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2021 Category: Pediatrics Tags: Online Review Article Source Type: research

Case 1-2021: A 10-Year-Old Male With Respiratory Failure, Pleural Effusions, and Renal Failure 60 Days After Hematopoietic Stem Cell Transplant
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2021 Category: Pediatrics Tags: Online Case Conference Records Source Type: research

Implementation of an Analgesia-Sedation Protocol Is Associated With Reduction in Midazolam Usage in the PICU
OBJECTIVES: Examine the association of a revised analgesia-sedation protocol with midazolam usage in the PICU. DESIGN: A single-center nonrandomized before-after study. SETTING: PICU at a quaternary pediatric hospital (Boston Children’s Hospital, Boston, MA). PATIENTS: Children admitted to the PICU who were mechanically ventilated for greater than 24 hours. The preimplementation cohort included 190 eligible patients admitted between July 29, 2017, and February 28, 2018, and the postimplementation cohort included 144 patients admitted between July 29, 2019, and February 28, 2020. INTERVENTI...
Source: Pediatric Critical Care Medicine - October 1, 2021 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Subglottic Post-Extubation Upper Airway Obstruction Is Associated With Long-Term Airway Morbidity in Children
CONCLUSIONS: Post-extubation subglottic upper airway obstruction is associated with a three-fold greater odds of long-term airway morbidity. These patients may represent an at-risk population that should be monitored closely after leaving the ICU. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2021 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

A Sonographic Answer to “What Have They Been Feeding You?”*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Driving Pressure and Mechanical Power: The Return of Physiology in Pediatric Mechanical Ventilation*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Did the Effect of the Guidelines eVAPorate? The Need for Improved Antimicrobial Stewardship Continues*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Neurally Adjusted Ventilator Assist in Infants With Acute Respiratory Failure: A Literature Scoping Review
CONCLUSIONS: This review highlights a lack of standardized strategies for neurally adjusted ventilatory assist ventilation and sedation practices among infants with acute respiratory failure. Studies were limited by small sample sizes and a lack of focus on specific patient groups. Robust studies are needed to provide evidence-based clinical recommendations for the use of neurally adjusted ventilatory assist in infants with acute respiratory failure. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2021 Category: Pediatrics Tags: Review Article Source Type: research

Neurological Complications Acquired During Pediatric Critical Illness: Exploratory “Mixed Graphical Modeling” Analysis Using Serum Biomarker Levels
CONCLUSIONS: Graphical models that include biomarkers in addition to clinical data are promising methods to evaluate direct relationships in the development of neurologic complications in critically ill children. Future work is required to validate and refine these models further, to determine if they can be used to predict which patients are at risk for/or with early neurologic complications. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2021 Category: Pediatrics Tags: Neurocritical Care Source Type: research

eSIMPLER: A Dynamic, Electronic Health Record–Integrated Checklist for Clinical Decision Support During PICU Daily Rounds
OBJECTIVES: Design, implement, and evaluate a rounding checklist with deeply embedded, dynamic electronic health record integration. DESIGN: Before-after quality-improvement study. SETTING: Quaternary PICU in an academic, free-standing children’s hospital. PATIENTS: All patients in the PICU during daily morning rounds. INTERVENTIONS: Implementation of an updated dynamic checklist (eSIMPLER) providing clinical decision support prompts with display of relevant data automatically pulled from the electronic health record. MEASUREMENTS AND MAIN RESULTS: The prior daily rounding check...
Source: Pediatric Critical Care Medicine - October 1, 2021 Category: Pediatrics Tags: Clinical Investigations Source Type: research

Ultrasound Assessment of Quadriceps Femoris Muscle Thickness in Critically Ill Children*
OBJECTIVES: Evaluate the reliability of ultrasound to measure quadriceps femoris muscle thickness in critically ill children and to describe serial changes in quadriceps femoris muscle thickness in relation to fluid balance and nutritional intake. DESIGN: Prospective observational study. SETTING: Tertiary care children’s hospital. PATIENTS: Inpatients age 3 months to 18 years recently admitted to the ICU who were sedated and mechanically ventilated at the time of the first ultrasound scan. METHODS: Prospective observational study to examine the reliability of averaged ultrasound measur...
Source: Pediatric Critical Care Medicine - October 1, 2021 Category: Pediatrics Tags: Clinical Investigations Source Type: research

A Cross-Sectional Study of the Clinical Metrics of Functional Status Tools in Pediatric Critical Illness
OBJECTIVES: To determine the clinical metrics of functional assessments in pediatric critical illness survivors. DESIGN: Cross-sectional observational study. SETTING: PICU follow-up clinic. PATIENTS: Forty-four PICU survivors 6–12 months post PICU stay, and 52 healthy controls 0–18 years old. INTERVENTIONS: Nil. MEASUREMENTS AND MAIN RESULTS: Function was assessed using the Pediatric Quality of Life Inventory 4.0 generic scales and infant scales, the Pediatric Evaluation of Disability Inventory–Computer Adaptive Test, and the Functional Status Scale. Muscle strength ...
Source: Pediatric Critical Care Medicine - October 1, 2021 Category: Pediatrics Tags: Clinical Investigations Source Type: research

Driving Pressure and Normalized Energy Transmission Calculations in Mechanically Ventilated Children Without Lung Disease and Pediatric Acute Respiratory Distress Syndrome*
CONCLUSIONS: Driving pressure is the variable that better discriminates pediatric acute respiratory distress syndrome from nonpediatric acute respiratory distress syndrome in children than the calculations derived from the equation of motion, even when indexed by ideal body weight. Unindexed mechanical power was useless to differentiate against both groups. Future studies should determine the threshold for variables of the energy dissipated by the lungs and their association with clinical outcomes. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2021 Category: Pediatrics Tags: Feature Articles Source Type: research

Compliance With an Antibiotic Guideline for Suspected Ventilator-Associated Infection: The Ventilator-Associated INfection (VAIN2) Study*
CONCLUSIONS: Antibiotic guideline efficacy and safety remain uncertain due to clinician failure to follow the guideline, instead primarily relying on respiratory culture results. Strategies to overcome clinician perceptions of respiratory cultures and other barriers will be vital for improving guideline adherence and antibiotic use in suspected ventilator-associated infection in future studies. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2021 Category: Pediatrics Tags: Feature Articles Source Type: research

Editor’s Choice Articles for October
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2021 Category: Pediatrics Tags: Editor’s Choice Source Type: research

The Value of Interleukin-10 in the Early Diagnosis of Neonatal Sepsis: A Meta-Analysis
Conclusions: Based on the results of the meta-analysis, interleukin-10 is a useful biomarker in the early diagnosis of neonatal sepsis. Its sensitivity, specificity, and diagnostic ability are excellent. However, it needs to be combined with clinical history data for comprehensive judgment and should not be used alone for diagnosis. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2021 Category: Pediatrics Tags: Online Review Articles Source Type: research

Levetiracetam Versus Phenytoin or Fosphenytoin for Second-Line Treatment of Pediatric Status Epilepticus: A Meta-Analysis
Conclusions: The efficacy of levetiracetam is comparable with phenytoin or fosphenytoin in children with benzodiazepine-refractory status epilepticus (low certainty evidence). Levetiracetam may cause less respiratory depression. Clinicians and guideline developers should weigh safety profiles when choosing between these agents. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2021 Category: Pediatrics Tags: Online Review Articles Source Type: research

Pertussis Infants Needing Mechanical Ventilation and Extracorporeal Membrane Oxygenation: Single-Center Retrospective Series in Vietnam
Conclusions: In this study, around one third of mechanically ventilated patients with pertussis died. Those who received extracorporeal membrane oxygenation had higher leukocyte counts, a higher prevalence of pulmonary hypertension, and advanced stages of acute kidney injury. Higher Vasoactive-Inotropic Score and advanced stages of acute kidney injury were associated with a greater risk of mortality. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2021 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Prediction of Nociception in Children Using the Nociceptive Flexion Reflex Threshold and the Bispectral Index—A Prospective Exploratory Observational Study*
Conclusions: In our sample of ventilated children in the PICU, bispectral index and nociceptive flexion reflex threshold provided good and fair prediction accuracy for patient responses to endotracheal suctioning. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2021 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Quantification of Pain and Distress*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Early Identification of Myocardial Reperfusion Injury After Cardiopulmonary Bypass: Toward the Final Frontier of Congenital Heart Surgery*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Monitoring the Outcome of Children Admitted to Intensive Care in Middle-Income Countries: What Will It Take?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Questions About Fluid Management in Pediatric Acute Respiratory Distress Syndrome and the Design of Clinical Trials*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Prognostic Conversations in the PICU: Are We Even Coming Close?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Relentless Improvement: Overcoming the “Active Resisters and Organizational Constipators” to Drive Change*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

A Communication Guide for Pediatric Extracorporeal Membrane Oxygenation
Decision-making surrounding extracorporeal membrane oxygenation initiation and decannulation has become a key challenge in critical care. Nuanced communication skills and transparent discussions about prognosis are imperative during this lifesaving, yet high-risk and burdensome intervention. Serious illness conversation guides are proving beneficial for patients, families and staff to communicate uncertainty and facilitate shared decision-making toward goal-concordant care. While the literature emphasizes the imperative to provide guidance for clinicians, no practical guide exists for communicating serious illness and prog...
Source: Pediatric Critical Care Medicine - September 1, 2021 Category: Pediatrics Tags: PCCM Perspectives Source Type: research

Cardiopulmonary Bypass–Induced Inflammation and Myocardial Ischemia and Reperfusion Injury Stimulates Accumulation of Soluble MER*
Conclusions: Soluble MER concentrations increase with cardiopulmonary bypass–induced inflammation and myocardial ischemia and reperfusion injury in pediatric patients. The utility of soluble MER as a clinical biomarker to identify pediatric patients at risk for exacerbated postoperative outcomes after bypass-induced myocardial ischemia and reperfusion injury requires further investigation. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2021 Category: Pediatrics Tags: Cardiovascular Critical Care Source Type: research

Pediatric Index of Mortality 3—An Evaluation of Function Among ICUs In South Africa*
Objectives: To evaluate the performance of the Pediatric Index of Mortality 3 as mortality risk assessment model. Design: This prospective study included all admissions 30 days to 18 years old for 12 months during 2016 and 2017. Data gathered included the following: age and gender, diagnosis and reason for PICU admission, data specific for the Pediatric Index of Mortality 3 calculation, PICU outcomes (death or survival), and length of PICU stay. Setting: Nine units that care for children within tertiary or quaternary academic hospitals in South Africa. Patients: All admissions 30 days to 18 years o...
Source: Pediatric Critical Care Medicine - September 1, 2021 Category: Pediatrics Tags: Clinical Investigation Source Type: research

Decision-Making, Ethics, and End-of-Life Care in Pediatric Extracorporeal Membrane Oxygenation: A Comprehensive Narrative Review
Conclusions: Despite numerous ethical issues reported surrounding pediatric extracorporeal membrane oxygenation, we found limited patient-level research and no practical guides for communicating with families or managing extracorporeal membrane oxygenation discontinuation. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2021 Category: Pediatrics Tags: Review Article Source Type: research

Timing and Clinical Significance of Fluid Overload in Pediatric Acute Respiratory Distress Syndrome*
Conclusions: Fluid overload after day 4 of acute respiratory distress syndrome, but not before, was associated with worse outcomes. Higher angiopoietin-2 predicted subsequent fluid overload. Our results suggest that future interventions aimed at managing fluid overload may have differential efficacy depending on when in the time-course of acute respiratory distress syndrome they are initiated. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2021 Category: Pediatrics Tags: Feature Articles Source Type: research

Parent and Physician Report of Discussions About Prognosis for Critically Ill Children*
Conclusions: Most parents and physicians report having prognostic conversations, primarily about length of stay and post-ICU physical morbidities. Concordance between parents and physicians is suboptimal. Future studies should evaluate prognostic conversations at other timepoints, how information is delivered, and how these conversations impact the PICU experience. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2021 Category: Pediatrics Tags: Feature Articles Source Type: research

Consensus Recommendations for Blood Culture Use in Critically Ill Children Using a Modified Delphi Approach*
Conclusions: Using a modified Delphi process, we created consensus recommendations on when to avoid blood cultures and prevent overuse in the PICU. These recommendations are a critical step in disseminating diagnostic stewardship on a wider scale in critically ill children. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2021 Category: Pediatrics Tags: Feature Articles Source Type: research

Bradley Peterson (1944−2021): A Pioneer in Pediatric Critical Care Medicine
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2021 Category: Pediatrics Tags: In Memoriam Source Type: research

Editor’s Choice Articles for September
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2021 Category: Pediatrics Tags: Editor’s Choice Source Type: research

Online Abstract Translations
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - August 1, 2021 Category: Pediatrics Tags: Online Abstract Translations Source Type: research

The Editor Responds
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - August 1, 2021 Category: Pediatrics Tags: Online Correspondence Source Type: research

Outcome of Early Hemostatic Intervention in Children With Sepsis and Nonovert Disseminated Intravascular Coagulation: Few Concerns
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - August 1, 2021 Category: Pediatrics Tags: Online Correspondence Source Type: research

Variability in the Hemodynamic Response to Fluid Bolus in Pediatric Septic Shock
CONCLUSIONS: The hemodynamic response to fluid bolus in pediatric septic shock was variable and unpredictable. We failed to find a relationship between mean arterial pressure and cardiac index changes. The adverse effects of fluid bolus extended beyond fluid overload and, in some cases, was associated with reduced mean arterial pressure, perfusion pressures and higher vasoactive support. Mean arterial pressure-nonresponders had increased mortality. The response to the initial fluid bolus may be helpful to understand each patient’s individualized physiologic response and guide continued hemodynamic management. (So...
Source: Pediatric Critical Care Medicine - August 1, 2021 Category: Pediatrics Tags: Online Cardiac Intensive Care Source Type: research

Development of a Heart Rate Variability Risk Score to Predict Organ Dysfunction and Death in Critically Ill Children
CONCLUSIONS: The Heart Rate Variability Dysfunction score, an age-adjusted proxy for autonomic nervous system dysregulation derived from bedside monitor data is independently associated with new or progressive multiple organ dysfunction syndrome and mortality in PICU patients. The Heart Rate Variability Dysfunction score could potentially be used as a single continuous physiologic biomarker or as part of a multivariable prediction model to increase awareness of at-risk patients and augment clinical decision-making. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - August 1, 2021 Category: Pediatrics Tags: Online Clinical Investigation Source Type: research

Virtual Communication Embedded Bedside ICU Rounds: A Hybrid Rounds Practice Adapted to the Coronavirus Pandemic
CONCLUSIONS: Hybrid rounds employed during pandemic facilitated social distancing while retaining patient-centered multidisciplinary ICU rounds but compromised teaching during rounds. A change to ingrained rounding habits needs team commitment and ongoing optimization. The hybrid rounds model has potential for generalizability to other settings. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - August 1, 2021 Category: Pediatrics Tags: Online Clinical Investigation Source Type: research

Parental Attitudes Toward Clinical Genomic Sequencing in Children With Critical Cardiac Disease
CONCLUSIONS: Families’ perceptions of genomic sequencing uses in critical cardiac disease appear to strain their overall trust in the health system. Erosion of trust is concerning because the potential of genomic sequencing in critical cardiac disease will be unrealized if families are unwilling to undergo genomic sequencing, let alone to participate in the ongoing research needed to link genomic sequencing variants to clinical outcomes. Our findings may have implications for genomic sequencing use in children with other critical, high-acuity diseases. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - August 1, 2021 Category: Pediatrics Tags: Online Clinical Investigation Source Type: research

Large-Sized Vascular Access in Continuous Renal Replacement Therapy: Balancing Filter Life With Risk of Vascular Thrombosis*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - August 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

What Taiwan Teaches Us: Palliative Care Should Be As Integral to the PICU As the Code Cart*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - August 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Pathophysiology Versus Etiology Using Lung Ultrasound: Clinical Correlation Required*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - August 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Diagnosis: A Tricky, Never-Ending Business*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - August 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Expanding Extracorporeal Membrane Oxygenation Cannulation Strategies in Neonatal Respiratory Failure*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - August 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Workload in the Cardiac ICU: You Down With APPs?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - August 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Thromboembolic Complications of Vascular Catheters Used for Pediatric Continuous Renal Replacement Therapy: Prevalence in a Single-Center, Retrospective Cohort*
OBJECTIVES: Pediatric venous thromboembolic events are commonly associated with in situ central venous catheters. The risk for severe venous thromboembolism increases if a larger portion of the vessel lumen is occupied by the central venous catheter. A functioning vascular catheter is required when the continuous renal replacement therapy is used in critically ill children. Due to the high blood flow required for continuous renal replacement therapy, the external diameter of the catheter needs to be larger than a conventional central venous catheter used for venous access, potentially increasing the risk of venous thro...
Source: Pediatric Critical Care Medicine - August 1, 2021 Category: Pediatrics Tags: Renal Critical Care Source Type: research

End-of-Life Care in Taiwan: Single-Center Retrospective Study of Modes of Death*
This study describes change in modes of death and end-of-life care in a single center, 2011–2017. SETTING: Multidisciplinary PICU in a tertiary referral Children’s Hospital in Taiwan. PATIENTS: There were 316 deaths in PICU patients. INTERVENTIONS: Palliative care consultation in the PICU service occurred after the 2013 “Hospice Palliative Care Act” revision. MEASUREMENTS AND MAIN RESULTS: In the whole cohort, 22 of 316 patients (7%) were determined as “death by neurologic criteria”. There were 94 of 316 patients (30%) who had an event needing cardiopulmonary ...
Source: Pediatric Critical Care Medicine - August 1, 2021 Category: Pediatrics Tags: Clinical Investigations Source Type: research