Pediatric Pulmonary Emboli at Autopsy: An Update and Case Series Review
Conclusions: Pulmonary embolus is a relatively rare but potentially fatal cause of death in pediatric age patients and is often associated with congenital abnormalities, malignancy, or recent surgical procedures. Half of the fatal pulmonary emboli found in our series (3/6) show microscopic and diffuse, rather than large central or saddle emboli, potentially make a clinicoradiographic diagnosis more difficult. This series is also the first to report a case of hemostatic matrix pulmonary embolism in a pediatric age patient. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Online Brief Report Source Type: research

Choice of Catheter Size for Infants in Continuous Renal Replacement Therapy: Bigger Is Not Always Better*
Conclusions: Small size central vascular catheters display optimal rheologic performances in terms of pressures and flows particularly when the renal replacement therapy device is equipped with pumps proportional to central vascular catheters sizes, and even when relatively high blood flows are set. This is achieved at the risk of a higher hemolysis rate. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Online Laboratory Investigation Source Type: research

Are Pediatric Critical Personnel Satisfied With Their Lives? Prediction of Satisfaction With Life From Burnout, Posttraumatic Stress, and Posttraumatic Growth, and Comparison With Noncritical Pediatric Staff
Conclusions: Posttraumatic growth can moderate the negative effect of traumatic work-related experiences in satisfaction with life. PICU and non-PICU workers were equally satisfied with their lives. Positive and negative impact of work-related potentially traumatic events can coexist in the same person. Interventions aimed at reducing distress and fostering posttraumatic growth could impact in an improvement in pediatric health professionals’ satisfaction with life. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Extremity Arterial Thromboses in Hospitalized Children: A National Database Analysis of Prevalence and Therapeutic Interventions
Objectives: The purpose of this study was to evaluate the prevalence, demographics, predisposing conditions, therapeutic interventions, and outcomes of extremity arterial thrombosis in hospitalized children. Design: Retrospective cohort study. Patients: National discharge database analysis. Measurements and Main Results: Cases of extremity arterial thrombosis in children and neonates were extracted from the Kids’ Inpatient Database 2012. These were analyzed and compared with other discharges for prevalence, demographics, treatments, outcomes, and further analyzed by age group and select predisposing condit...
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Association Between Tidal Volumes Adjusted for Ideal Body Weight and Outcomes in Pediatric Acute Respiratory Distress Syndrome*
Objectives: The impact of tidal volume on outcomes in mechanically ventilated children with pediatric acute respiratory distress syndrome remains unclear. To date, observational investigations have failed to calculate tidal volume based on standardized corrections of weight. We investigated the impact of tidal volume on mortality and probability of extubation in pediatric acute respiratory distress syndrome using ideal body weight–adjusted tidal volume. Design: Retrospective analysis of an ongoing prospective cohort of pediatric acute respiratory distress syndrome patients. Tidal volume was calculated based on a...
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Criteria for Clinically Relevant Bleeding in Critically Ill Children: An International Survey*
Conclusions: This international survey provides a better understanding of the factors that influence the pediatric intensivists’ assessment of the clinical relevance of bleeding in critically ill children. It provides the foundation for the development of a validated, diagnostic definition of clinically relevant bleeding in this population. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Association of Fluid Overload With Clinical Outcomes in Critically Ill Children With Bronchiolitis: Bronquiolitis en la Unidad de Cuidados Intensivos Pediátricos (BRUCIP) Study*
Objectives: Increasing evidence supports the association of fluid overload with adverse outcomes in different diseases. To our knowledge, few studies have examined the impact of fluid balance on clinical outcome in severe bronchiolitis. Our aim was to determine whether fluid overload was associated with adverse clinical outcomes in critically ill children with severe bronchiolitis. Design: Descriptive, prospective, multicenter study. Setting: Sixteen Spanish PICUs. Patients: Severe acute bronchiolitis who required admission from October 2014 to May 2015 were included. Interventions: None. Measurements and Ma...
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Comparison of International Pediatric Sepsis Consensus Conference Versus Sepsis-3 Definitions for Children Presenting With Septic Shock to a Tertiary Care Center in India: A Retrospective Study*
Conclusions: Less than half of children with septic shock identified by International Pediatric Sepsis Consensus Conference definitions were observed to fulfill the criteria for shock as per “Sepsis-3” definitions. Lack of difference in the risk of mortality between children who fulfilled “Sepsis-3” definition and those who did not fulfill the definition raises questions on the appropriateness of using this definition for diagnosis of septic shock in children. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

The author replies
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Letters to the Editor Source Type: research

Attitudes of Pediatric Critical Care Staff Toward the Concept of “Resilience”: The “Glass Half Full” Project
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Letters to the Editor Source Type: research

The author replies
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Letters to the Editor Source Type: research

Long-Term Sequelae of Pediatric Delirium
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Letters to the Editor Source Type: research

Vascular Access for Extracorporeal Therapies: How Do We Evaluate Them?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Editorials Source Type: research

What Is Weighing Us Down From Elucidating Ideal Ventilation Strategies in Pediatric Acute Respiratory Distress Syndrome?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Editorials Source Type: research

What Is in a Word?? Defining Bleeding as the First Step…*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Editorials Source Type: research

Fluid Overload in Children With Bronchiolitis*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Editorials Source Type: research

Applying Sepsis-3 Criteria for Septic Shock to Children—Not As Shocking As at First Sight?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Editorials Source Type: research

A Rare Cause of Cardiac Arrest in the Era of Genetic Testing*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Editorials Source Type: research

Our Survey Says…Pediatric Procedural Sedation Training Should Not Be a Postscript!*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Editorials Source Type: research

Getting Excited About Paroxysms: Why Treating Sympathetic Hyperarousal After Traumatic Brain Injury May Be More Important Than We Appreciated*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Editorials Source Type: research

Pediatric In-Hospital Cardiac Arrest—Can We Do Better?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Editorials Source Type: research

High Flow, High Flow: It’s Off to Work We Go*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Editorials Source Type: research

Are We “Burned Out” or Just “Burned”…on Burnout Research?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Editorials Source Type: research

Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: Update of the Brain Trauma Foundation Guidelines, Executive Summary
Conclusions: New level II and level III evidence-based recommendations and an algorithm provide additional guidance for the development of local protocols to treat pediatric patients with severe traumatic brain injury. Our intention is to identify and institute a sustainable process to update these Guidelines as new evidence becomes available. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Special Articles Source Type: research

Management of Pediatric Severe Traumatic Brain Injury: 2019 Consensus and Guidelines-Based Algorithm for First and Second Tier Therapies
Conclusions: This article provides an algorithm of clinical practice for the bedside practitioner based on the available evidence, treatment protocols described in the articles included in the 2019 guidelines, and consensus that reflects a logical approach to mitigate intracranial hypertension, optimize cerebral perfusion, and improve outcomes in the setting of pediatric severe traumatic brain injury. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Special Articles Source Type: research

Catecholaminergic Polymorphic Ventricular Tachycardia: The Cardiac Arrest Where Epinephrine Is Contraindicated*
Conclusions: Those involved in resuscitation of young people should be aware of catecholaminergic polymorphic ventricular tachycardia and be suspicious of persistent ventricular ectopy, polymorphic, or bidirectional ventricular tachycardia during resuscitation. Appropriate management is avoidance of epinephrine, administration of general anesthesia, IV opiates, and consideration of flecainide. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Review Article Source Type: research

Evaluating the Need for Pediatric Procedural Sedation Training in Pediatric Critical Care Medicine Fellowship*
Conclusions: Pediatric procedural sedation lacks a clearly defined training pathway. Most fellows find pediatric procedural sedation a valuable skill set. We propose that all Pediatric Critical Care Medicine fellows receive training that includes pediatric procedural sedation critical incident simulation and cases performed outside the PICU to establish proficiency. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Education Source Type: research

Paroxysmal Sympathetic Hyperactivity After Severe Traumatic Brain Injury in Children: Prevalence, Risk Factors, and Outcome*
Conclusions: Our study suggests that the rate of paroxysmal sympathetic hyperactivity in patients with severe traumatic brain injury is higher than previously reported. Older age was associated with an increased risk for developing paroxysmal sympathetic hyperactivity, but severity of the trauma and the brain injury were not. For survivors of severe traumatic brain injury beyond 24 hours who developed paroxysmal sympathetic hyperactivity, there was a lower PICU mortality but also greater PICU length of stay and a lower likelihood of discharge home from the admitting hospital, suggesting that functional outcome in survivo...
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Neurocritical Care Source Type: research

Procalcitonin and Other Common Biomarkers Do Not Reliably Identify Patients at Risk for Bacterial Infection After Congenital Heart Surgery
This study examined the predictive value of the biomarkers; procalcitonin, C-reactive protein, lactate, neutrophils, lymphocytes, platelets, and the biphasic activated partial thromboplastin time waveform in diagnosing bacterial infection following cardiac surgery. Design: Prospective, observational study. Setting: A regional, PICU in the United Kingdom. Patients: Three-hundred sixty-eight children under the age of 16 admitted to the PICU for elective cardiac surgery were enrolled in the study. Interventions: All biomarker measurements were determined daily until postoperative day 7. Children were assessed for ...
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Cardiac Intensive Care Source Type: research

Cardiac Arrest in the Pediatric Cardiac ICU: Is Medical Congenital Heart Disease a Predictor of Survival?*
Conclusions: Although trends in first documented rhythm, neurologic sequelae, and inotropic support prior to cardiopulmonary arrest were noted between groups, no significant differences in survival after cardiac arrest were seen. Larger scale studies are needed to better describe factors associated with cardiopulmonary arrest as well as survival in heterogeneous medical cardiac populations. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Cardiac Intensive Care Source Type: research

Patterns of Use of Heated Humidified High-Flow Nasal Cannula Therapy in PICUs in the United Kingdom and Republic of Ireland*
Conclusions: The use of high-flow nasal cannula is common in PICUs in the United Kingdom and Republic of Ireland. Variation in the choice of first-line respiratory support mode (high-flow nasal cannula or noninvasive ventilation) between PICUs reflects the need for clinical trial evidence to guide future practice. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Feature Articles Source Type: research

A Cross-Sectional Analysis of Compassion Fatigue, Burnout, and Compassion Satisfaction in Pediatric Critical Care Physicians in the United States*
Conclusions: In our population, chronic exposure to distress in patients and families puts pediatric critical care physicians at risk for compassion fatigue and low compassion satisfaction. Awareness of compassion fatigue, burnout, and compassion satisfaction and their predictors may benefit providers both personally and professionally by allowing them to proactively manage their distress. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2019 Category: Pediatrics Tags: Feature Articles Source Type: research

Online Abstract Translations
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - February 1, 2019 Category: Pediatrics Tags: Online Abstract Translations Source Type: research

Abstracts from the 25th Pediatric Critical Care Colloquium: Baltimore, Maryland October 5–7, 2018
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - February 1, 2019 Category: Pediatrics Tags: Online Pediatric Critical Care Colloquium Abstracts Source Type: research

Self-Reported Fatigue in Children Following Intensive Care Treatment*
Conclusions: The Pediatric Quality of Life Inventory Multidimensional Fatigue Scale appears to be a promising tool for use in outcomes research with PICU survivors. These results highlight the need to bear in mind the heterogeneity of PICU patients and the multidimensional nature of fatigue symptoms. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - February 1, 2019 Category: Pediatrics Tags: Online Brief Report Source Type: research

Benefits of Early Mobilization After Pediatric Liver Transplantation*
Objective: To evaluate the impact of early mobilization after pediatric liver transplantation in the PICU. Design: A 70-month retrospective before-after study. Setting: Medical and surgical PICU with 20 beds at a tertiary children’s hospital. Patients: Seventy-five patients 2–18 years old who underwent liver transplantation and could walk before surgery. Intervention: We meticulously planned and implemented an early mobilization intervention, a multifaceted framework for early mobilization practice in the PICU focusing on a multidisciplinary team approach. Measurements and Main Results: There w...
Source: Pediatric Critical Care Medicine - February 1, 2019 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Feasibility and Perceptions of PICU Diaries*
Conclusions: The use of ICU diaries in the PICU setting is feasible and perceived as beneficial by families of critically ill children. Future studies are needed to better understand if PICU diaries may objectively improve psychologic outcomes of patients and family members after PICU admission. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - February 1, 2019 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Effectiveness of Two Targeted Temperature Management Methods After Pediatric Postcardiac Arrest: A Multicenter International Study*
Objectives: It is currently recommended that after return of spontaneous circulation following cardiac arrest, fever should be prevented using TTM through a servo-controlled system. This technology is not yet available in many global settings, where manual physical measures without servo-control is the only option. Our aim was to compare feasibility, safety and quality assurance of servo-controlled system versus no servo-controlled system cooling, TTM protocols for cooling, maintenance and rewarming following return of spontaneous circulation after cardiac arrest in children. Design: Prospective, multicenter, nonrando...
Source: Pediatric Critical Care Medicine - February 1, 2019 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Outcomes of Children With Critical Bronchiolitis Meeting at Risk for Pediatric Acute Respiratory Distress Syndrome Criteria*
Objectives: New definitions of pediatric acute respiratory distress syndrome include criteria to identify a subset of children “at risk for pediatric acute respiratory distress syndrome.” We hypothesized that, among PICU patients with bronchiolitis not immediately requiring invasive mechanical ventilation, those meeting at risk for pediatric acute respiratory distress syndrome criteria would have worse clinical outcomes, including higher rates of pediatric acute respiratory distress syndrome development. Design: Single-center, retrospective chart review. Setting: Mixed medical-surgical PICU within a ter...
Source: Pediatric Critical Care Medicine - February 1, 2019 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Effects of ABO Matching of Platelet Transfusions in Critically Ill Children*
Conclusions: No differences were seen in the incremental change in platelet count nor in transfusion reactions when comparing major ABO incompatible platelet transfusions with ABO compatible transfusions in a large study of critically ill children. Studies in larger, prospectively enrolled cohorts should be performed to validate whether ABO matching for platelet transfusions in critically ill children is necessary. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - February 1, 2019 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

A Pilot Study of the Association of Amino-Terminal Pro-B-Type Natriuretic Peptide and Severity of Illness in Pediatric Septic Shock*
Conclusions: This pilot study shows an association between emergency department amino-terminal pro-B-type natriuretic peptide on presentation and worse septic shock outcomes and amino-terminal pro-B-type natriuretic peptide levels correlates with an ICU severity score. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - February 1, 2019 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Why Follow-Up Matters: Fatigue and Function After PICU Stay*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - February 1, 2019 Category: Pediatrics Tags: Editorials Source Type: research

Return to Ambulation After Pediatric Liver Transplantation: A First “Step” in Assessing the Impact of Early Mobility*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - February 1, 2019 Category: Pediatrics Tags: Editorials Source Type: research

PICU Diaries: A Simple and Promising Family-Centered Intervention*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - February 1, 2019 Category: Pediatrics Tags: Editorials Source Type: research

Targeted Temperature Management for Everyone: A Call for Tailoring Guidelines Based on Resource Availability*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - February 1, 2019 Category: Pediatrics Tags: Editorials Source Type: research

Can We Prevent the Progression to Pediatric Acute Respiratory Distress Syndrome? Let’s Start With Identifying Those “At Risk”*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - February 1, 2019 Category: Pediatrics Tags: Editorials Source Type: research

Detecting No Signal From ABO Mismatch in the Quiet Riot of Platelet Transfusions in Critically Ill Children*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - February 1, 2019 Category: Pediatrics Tags: Editorials Source Type: research

New Kid on the Block? Is Amino-Terminal Pro-B-Type Natriuretic Peptide Ready for the Big Time?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - February 1, 2019 Category: Pediatrics Tags: Editorials Source Type: research

The Need to Understand Brain Health and Improve Brain Outcomes for Children and Adolescents Warrants Adoption of a More Proactive Approach to Brain Monitoring*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - February 1, 2019 Category: Pediatrics Tags: Editorials Source Type: research

Pediatric Rapid Response Systems Beyond Tertiary Facilities: Is There a Role for Telemedicine?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - February 1, 2019 Category: Pediatrics Tags: Editorials Source Type: research