Suicide and Self-Harm in Children and Adolescents Admitted to PICUs in the United States
CONCLUSIONS: PICU admissions due to self-harm increased for all age groups during the study period. Females accounted for most of these admissions, whereas males accrued most of the in-hospital deaths. Intentional drug ingestion was the most common mode of self-harm and was rarely fatal, whereas asphyxia and firearms were the mechanisms associated with the highest mortality. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - January 1, 2022 Category: Pediatrics Tags: Online Brief Reports Source Type: research

The Use of Extracorporeal Life Support in Children With Immune-Mediated Diseases
CONCLUSIONS: Children with immune-mediated conditions can be successfully supported with extracorporeal membrane oxygenation. Extracorporeal membrane oxygenation use has increased over time, and survival varies considerably by diagnosis. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - January 1, 2022 Category: Pediatrics Tags: Online Brief Reports Source Type: research

Transport Medical Control Education for Pediatric Critical Care Fellows: A National Needs Assessment Study
CONCLUSIONS: Transport medical control responsibilities are common for Pediatric Critical Care Medicine fellows, but training is inconsistent, assessment is not standardized, and supervision may be lacking. Fellow performance in transport medical control may help inform assessment in multiple domains of competencies. Further study is needed to identify effective methods for transport medical control education. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - January 1, 2022 Category: Pediatrics Tags: Online Brief Reports Source Type: research

Derivation and Validation of the Critical Bronchiolitis Score for the PICU
CONCLUSIONS: The Critical Bronchiolitis Score performed better than PICU mortality-based scores in measuring expected duration of ICU-level respiratory support and ICU length of stay. This score may have utility to enrich interventional trials and adjust for illness severity in observational studies in this very common PICU condition. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - January 1, 2022 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Prediction Model Performance With Different Imputation Strategies: A Simulation Study Using a North American ICU Registry
CONCLUSIONS: Analyses of large observational studies are likely to encounter the issue of missing data, which are likely not missing at random. Researchers should always consider multiple imputation by chained equations (or similar imputation approaches) when encountering even only small proportions of missing data in their work. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - January 1, 2022 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Pediatric Sepsis Biomarker Risk Model Biomarkers and Estimation of Myocardial Dysfunction in Pediatric Septic Shock
CONCLUSIONS: A newly derived Pediatric Sepsis Biomarker Risk Model biomarker-based model reliably estimates risk of sepsis-associated myocardial dysfunction in pediatric septic shock, but independent prospective validation is needed. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - January 1, 2022 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Characteristics and Physiologic Changes After 4% Albumin Fluid Boluses in a PICU
CONCLUSIONS: Fluid boluses of 4% albumin were common and predominantly in children with cardiac disease and sepsis with a median dose of 10 mL/kg given over half an hour. Such treatment was associated with significant hemodynamic changes only in children less than 12 months old, and we failed to identify an association with urine output. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - January 1, 2022 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

A New Risk Assessment Model for Hospital-Acquired Venous Thromboembolism in Critically Ill Children: A Report From the Children’s Hospital-Acquired Thrombosis Consortium
CONCLUSIONS: Using the multicenter Children’s Hospital-Acquired Thrombosis registry, we identified five independent risk factors for hospital-acquired venous thromboembolism in critically ill children, deriving a new hospital-acquired venous thromboembolism risk assessment model. A prospective validation study is underway to define a high-risk group for risk-stratified interventional trials investigating the efficacy and safety of prophylactic anticoagulation in critically ill children. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - January 1, 2022 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

It Is Time to Raise the Bar With a Board*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - January 1, 2022 Category: Pediatrics Tags: Editorials Source Type: research

Should We Embrace Mechanical Power to Understand the Risk of Ventilator-Induced Lung Injury in Children?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - January 1, 2022 Category: Pediatrics Tags: Editorials Source Type: research

Playing the Long Game: Therapeutic Hypothermia’s Impact on Quality-of-Life After Pediatric Cardiac Arrest*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - January 1, 2022 Category: Pediatrics Tags: Editorials Source Type: research

Optimizing Human Performance in ICUs*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - January 1, 2022 Category: Pediatrics Tags: Editorials Source Type: research

Standardized Training for Physicians Practicing Pediatric Cardiac Critical Care
CONCLUSIONS: In the current era of increasing specialized care in pediatric cardiac critical care, standardized training for pediatric cardiac critical care is paramount to optimizing outcomes. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - January 1, 2022 Category: Pediatrics Tags: Special Article Source Type: research

Establishing Entrustable Professional Activities in Pediatric Cardiac Critical Care*
CONCLUSIONS: We generated a set of nine entrustable professional activities, which we believe can be broadly applied to any physician training in pediatric cardiac critical care, irrespective of individual training pathway. Next steps include incorporation of these entrustable professional activities into curriculum design and trainee assessment tools. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - January 1, 2022 Category: Pediatrics Tags: Brief Report Source Type: research

When Mission Is the Mission
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - January 1, 2022 Category: Pediatrics Tags: PCCM Narrative Source Type: research

Executive Summary of Recommendations and Expert Consensus for Plasma and Platelet Transfusion Practice in Critically Ill Children: From the Transfusion and Anemia EXpertise Initiative—Control/Avoidance of Bleeding (TAXI-CAB)
CONCLUSIONS: The TAXI-CAB program provides expert-based consensus for pediatric intensivists for the administration of plasma and/or platelet transfusions in critically ill pediatric patients. There is a pressing need for primary research to provide more evidence to guide practitioners. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - January 1, 2022 Category: Pediatrics Tags: Executive Summary Source Type: research

Oxygenation Defects, Ventilatory Ratio, and Mechanical Power During Severe Pediatric Acute Respiratory Distress Syndrome: Longitudinal Time Sequence Analyses in a Single-Center Retrospective Cohort*
CONCLUSIONS: Mortality after severe pediatric acute respiratory distress syndrome is associated with the severity of organ dysfunction, oxygenation defects, and pulmonary metrics including dead space and theoretical mechanical energy load. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - January 1, 2022 Category: Pediatrics Tags: Feature Articles Source Type: research

Temperature Management and Health-Related Quality of Life in Children 3 Years After Cardiac Arrest
OBJECTIVES: Therapeutic hypothermia minimizes neuronal injury in animal models of hypoxic-ischemic encephalopathy with greater effect when used sooner after the insult. Clinical trials generally showed limited benefit but are difficult to perform in a timely manner. In this clinical study, we evaluated the association between the use of hypothermia (or not) and health-related quality of life among survivors of pediatric cardiac arrest as well as overall mortality. DESIGN: Single-center, retrospectively identified cohort with prospective assessment of health-related quality of life. SETTING: PICU of a pedi...
Source: Pediatric Critical Care Medicine - January 1, 2022 Category: Pediatrics Tags: Feature Articles Source Type: research

Assessment of a Situation Awareness Quality Improvement Intervention to Reduce Cardiac Arrests in the PICU
CONCLUSIONS: Interprofessional teams using shared situation awareness may reduce cardiopulmonary resuscitation events and, thereby, improve outcomes. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - January 1, 2022 Category: Pediatrics Tags: Feature Articles Source Type: research

Editor’s Choice Articles for January
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - January 1, 2022 Category: Pediatrics Tags: Editor’s Choice Source Type: research

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

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

Application of Multiplex Polymerase Chain Reaction for Pathogen Identification and Antibiotic Use in Children With Respiratory Infections in a PICU
OBJECTIVES: To compare the pathogen identification rate and use of antibiotics before and after the implementation of multiplex polymerase chain reaction testing in children with respiratory infections in a PICU. DESIGN: Single-center, pre-post study. SETTING: PICU of Osaka Women’s and Children’s Hospital, Osaka, Japan. PATIENTS: Consecutive children with respiratory infections who were admitted to the PICU between December 2017 and November 2018 (premultiplex polymerase chain reaction period) and between March 2019 and February 2020 (postmultiplex polymerase chain reaction period). ...
Source: Pediatric Critical Care Medicine - December 1, 2021 Category: Pediatrics Tags: Online Brief Reports Source Type: research

Characteristics and Outcomes of Children With Necrotizing Pneumonia
CONCLUSIONS: Bacterial etiology of necrotizing pneumonia in children varied with the presence or absence of a complex chronic condition. Bacterial isolation is associated with increased invasive procedures and complications. The mortality rate is higher in children with complex chronic conditions. This study provides national data on necrotizing pneumonia among hospitalized children. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - December 1, 2021 Category: Pediatrics Tags: Online Brief Reports Source Type: research

Pediatric Chronic Critical Illness: Validation, Prevalence, and Impact in a Children’s Hospital
CONCLUSIONS: Pediatric chronic critical illness patients occupied more than one third of the ICU beds and have five times longer stay. This mounting load needs to be uniformly defined, addressed at regional and national levels, and considered in the current pandemic planning. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - December 1, 2021 Category: Pediatrics Tags: Online Brief Reports Source Type: research

Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery: A Retrospective Multicenter Study
OBJECTIVES: We aimed to describe characteristics and operative outcomes from a multicenter cohort of infants who underwent repair of anomalous left coronary artery from the pulmonary artery. We also aimed to identify factors associated with major adverse cardiovascular events following anomalous left coronary artery from the pulmonary artery repair. DESIGN: Retrospective chart review. SETTING: Twenty-one tertiary-care referral centers. PATIENTS: Infants less than 365 days old who underwent anomalous left coronary artery from the pulmonary artery repair. INTERVENTIONS: None. MEASUREMENTS A...
Source: Pediatric Critical Care Medicine - December 1, 2021 Category: Pediatrics Tags: Online Cardiac Intensive Care Source Type: research

Super-Refractory Status Epilepticus in Children: A Retrospective Cohort Study
OBJECTIVES: To characterize the pediatric super-refractory status epilepticus population by describing treatment variability in super-refractory status epilepticus patients and comparing relevant clinical characteristics, including outcomes, between super-refractory status epilepticus, and nonsuper-refractory status epilepticus patients. DESIGN: Retrospective cohort study with prospectively collected data between June 2011 and January 2019. SETTING: Seventeen academic hospitals in the United States. PATIENTS: We included patients 1 month to 21 years old presenting with convulsive refractory status ...
Source: Pediatric Critical Care Medicine - December 1, 2021 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Continuous Renal-Replacement Therapy in Critically Ill Children: Practice Changes and Association With Outcome
This study was designed to evaluate practice changes and outcomes over a 10-year period in a large single-center PICU cohort that received continuous renal-replacement therapy. DESIGN: Retrospective study design. SETTING: A multidisciplinary tertiary PICU of a university-affiliated hospital in Guangzhou, China. PATIENTS: All critically ill children who were admitted to our PICU from January 2010 to December 2019 and received continuous renal-replacement therapy were included in this study. MEASUREMENTS AND MAIN RESULTS: A total of 289 patients were included in the study. Of the two study periods...
Source: Pediatric Critical Care Medicine - December 1, 2021 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Left Heart Decompression on Extracorporeal Membrane Oxygenation Support and Cardiopulmonary Bypass
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - December 1, 2021 Category: Pediatrics Tags: Online PCCM Concise Physiology Review Source Type: research

Collateral Damage*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - December 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Restoring Justice: Affluence Should Not Determine Children’s Access to Critical Care Services*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - December 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Causal Inference From Observational Data: It Is Complicated*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - December 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Learning From an Association Analysis Using Propensity Scores
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - December 1, 2021 Category: Pediatrics Tags: PCCM Notes, Methods, and Statistics Source Type: research

Association Between Anticholinergic Drug Burden and Adequacy of Enteral Nutrition in Critically Ill, Mechanically Ventilated Pediatric Patients
We examined the association between the anticholinergic burden of administered medications using the Anticholinergic Drug Scale and adequacy of enteral nutrition delivery. DESIGN: Secondary analysis of data from a previously characterized PICU cohort. SETTING: Multidisciplinary PICU in a quaternary academic medical center. PATIENTS: Younger than or equal to 18 years, on mechanical ventilation and received enteral nutrition within the first 3 days of PICU admission. MEASUREMENTS AND MAIN RESULTS: Daily Anticholinergic Drug Scale score, demographic data, and clinical data were obtained from the pr...
Source: Pediatric Critical Care Medicine - December 1, 2021 Category: Pediatrics Tags: Brief Reports Source Type: research

Relationship Distress at Home and Burnout Among 254 Pediatric Intensive Care Nurses*
CONCLUSIONS: This study reflects the prevalence of relationship distress and its association with burnout and other practice and personal factors among PICU nurses. Nurses with high depersonalization experienced significantly higher distress in relationship satisfaction, and nurses who reported high personal satisfaction had significantly higher distress in relationship consensus. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - December 1, 2021 Category: Pediatrics Tags: Brief Reports Source Type: research

A Hard Learned Lesson on What It’s Like to Be a Patient
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - December 1, 2021 Category: Pediatrics Tags: PCCM Narrative Source Type: research

Overall Health Following Pediatric Critical Illness: A Scoping Review of Instruments and Methodology
CONCLUSIONS: Overall health was commonly assessed post-PICU discharge, especially in the traumatic brain injury population, using a heterogenous array of measures. Evaluation and consensus are imperative to identify the most appropriate method to measure overall health with the goal of improving care efficacy and facilitating recovery across populations of critically ill children. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - December 1, 2021 Category: Pediatrics Tags: Review Article Source Type: research

ICU Admission in Children With Acute Lymphoblastic Leukemia in Sweden: Prevalence, Outcome, and Risk Factors
CONCLUSIONS: The need for intensive care in children with acute lymphoblastic leukemia, especially for children with T cell acute lymphoblastic leukemia and CNS leukemia, is high with most admissions occurring during early treatment. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - December 1, 2021 Category: Pediatrics Tags: Clinical Investigation Source Type: research

Outcomes of Catheter-Related Arterial and Venous Thrombosis After Enoxaparin Therapy in Neonates and Infants With Congenital Heart Disease
CONCLUSIONS: A high proportion of vascular catheter-related thrombi identified in infants with congenital heart disease resolve with enoxaparin treatment. In all patients with thrombosis, arterial versus venous thrombosis is associated with greater odds of resolution. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - December 1, 2021 Category: Pediatrics Tags: Cardiac Intensive Care Source Type: research

Socioeconomic Disadvantage and Distance to Pediatric Critical Care*
OBJECTIVES: To describe the geography of pediatric critical care services and the relationship between poverty and distance to these services across the United States. DESIGN: Retrospective, cross-sectional study. SETTING: Contiguous United States. PATIENTS: Children less than 18 years as represented in the 2016 American Community Survey. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Pediatric critical care services were geographically concentrated within urban areas, with half of all PICUs located within 9.5 miles of another (interquartile range, 3.4–51.5 miles). Median d...
Source: Pediatric Critical Care Medicine - December 1, 2021 Category: Pediatrics Tags: Feature Articles Source Type: research

Left Heart Decompression on Veno-Arterial Extracorporeal Membrane Oxygenation in Children With Dilated Cardiomyopathy and Myocarditis: An Extracorporeal Life Support Organization Registry Review
OBJECTIVES: To describe the association between left heart decompression on veno-arterial extracorporeal membrane oxygenation and survival in patients with myocarditis and dilated cardiomyopathy. The secondary outcome is to study association of left heart decompression with survival in children with myocarditis compared with those with dilated cardiomyopathy. DESIGN: Retrospective study of a multicenter registry database. SETTING: Data reported to Extracorporeal Life Support Organization from international extracorporeal membrane oxygenation centers. PATIENTS: Patients less than or equal to 18 year...
Source: Pediatric Critical Care Medicine - December 1, 2021 Category: Pediatrics Tags: Feature Articles Source Type: research

Long-Term Increases in Mental Disorder Diagnoses After Invasive Mechanical Ventilation for Severe Childhood Respiratory Disease: A Propensity Matched Observational Cohort Study*
We examined rates of International Classification of Diseases, 9th revision–coded mental disorder diagnoses and psychotropic medication use following discharge among children requiring invasive mechanical ventilation for severe respiratory illness, compared with general hospital patients propensity score matched on sociodemographic and clinical characteristics prior to admission. Children admitted to the PICU for respiratory illness not necessitating invasive mechanical ventilation were also compared with matched general hospital patients as a negative control exposure. MEASUREMENTS AND MAIN RESULTS: Of 115,33...
Source: Pediatric Critical Care Medicine - December 1, 2021 Category: Pediatrics Tags: Feature Articles Source Type: research

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

2021 in Review
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - December 1, 2021 Category: Pediatrics Tags: Foreword Source Type: research

Geographic Distance to Extracorporeal Life Support Centers for Pediatric Patients Within the Continental United States
CONCLUSIONS: Disparities in proximity to extracorporeal life support centers were present and persistent across states. Children in rural areas have less access to extracorporeal life support centers based upon geographic distance alone. These findings may affect practice patterns and treatment decisions and are important to the development of regionalization strategies to ensure all children have subspecialty surgical care available to them, including extracorporeal life support. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - November 1, 2021 Category: Pediatrics Tags: Online Brief Reports Source Type: research

Prolonged Mechanical Ventilation in Children: Review of the Definition
CONCLUSIONS: There is limited evidence to determine the definition of prolonged mechanical ventilation in children. The variety of definitions is a sign of the need for a consensus definition of pediatric prolonged mechanical ventilation. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - November 1, 2021 Category: Pediatrics Tags: Online Brief Reports Source Type: research

Mortality and Neurologic Sequelae in Influenza-Associated Encephalopathy: Retrospective Multicenter PICU Cohort in France
CONCLUSIONS: Children requiring PICU admission for influenza-associated encephalopathy/encephalitis have high mortality and morbidity rates. The management remains highly variable due to the lack of guidelines. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - November 1, 2021 Category: Pediatrics Tags: Online Brief Reports Source Type: research

Degradation of the Endothelial Glycocalyx Contributes to Metabolic Acidosis in Children Following Cardiopulmonary Bypass Surgery
CONCLUSIONS: Our data show that metabolic acidosis (increased strong ion gap) is associated with plasma concentration of heparan sulfate, a negatively charged glycosaminoglycan cleaved from the endothelial glycocalyx during cardiopulmonary bypass. In addition, cleavage of heparan sulfate was associated with renal dysfunction, capillary leak, and global markers of cardiovascular dysfunction. These data highlight the importance of designing translational therapies to protect the glycocalyx in cardiopulmonary bypass. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - November 1, 2021 Category: Pediatrics Tags: Online Cardiac Intensive Care Source Type: research

Frequency of Extracorporeal Membrane Oxygenation Support and Outcomes After Implementation of a Structured PICU Network in Neonates and Children: A Prospective Population-Based Study in the West of France
CONCLUSIONS: Our local results suggest that a structured referral network for neonatal and pediatric ECMO in the region of Western France facilitated escalation of care with noninferior (or similar) early mortality outcome. Our data support establishing referral networks in other equivalent regions. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - November 1, 2021 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Age-Specific Dose Regimens of Dexmedetomidine for Pediatric Patients in Intensive Care Following Elective Surgery: A Phase 3, Multicenter, Open-Label Clinical Trial in Japan
This study included 61 patients at 13 tertiary hospitals in Japan. PATIENTS: Pediatric patients (≥ 45 wk corrected gestational age to (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - November 1, 2021 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research