Online Abstract Translations
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Online Abstract Translations Source Type: research

Self-Reported Management of IV Fluids and Fluid Accumulation in Children With Acute Respiratory Failure*
Conclusions: Pediatric intensivists agree that acting on 10% fluid overload in children with pediatric acute respiratory distress syndrome is important. Decisions are being made largely using intake and output documentation, not central venous pressure. These findings are important for future pediatric acute respiratory distress syndrome interventional trials. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Online Brief Reports Source Type: research

Longer Duration of Urinary Catheterization Increases Catheter-Associated Urinary Tract Infection in PICU
Conclusions: Longer duration of catheterization increased the risk of catheter-associated urinary tract infection by 5% each day at the PICU. Prompt removal of the urethral catheter is strongly recommended whenever feasible. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Online Brief Reports Source Type: research

Postextubation Dysphagia in Children: The Role of Speech-Language Pathologists*
Objectives: Postextubation dysphagia is common and associated with worse outcomes in the PICU. Although there has been an increased participation of speech-language pathologists in its treatment, there is limited evidence to support speech-language pathologists as core PICU team member. We aimed to assess the impact of speech-language pathologists interventions on the treatment of postextubation dysphagia. Design: A quasi-experimental prospective study. In the historical group (controls), patients received a standard care management for dysphagia whereas the intervention group was routinely treated by speech-language ...
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Cognitive and Behavioral Consequences of Pediatric Delirium: A Pilot Study*
Conclusions: Contrary to the findings in adults, there was no clear association between pediatric delirium and long-term cognition or behavior in this cohort. However, this is a first pilot study with several limitations that should promote more comprehensive prospective trials. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Hepatobiliary Dysfunction and Disseminated Intravascular Coagulation Increase Risk of Mortality in Pediatric Hemophagocytic Lymphohistiocytosis*
Objectives: Hemophagocytic lymphohistiocytosis poses significant challenges due to limited tools to guide clinical decisions in a population at high risk of death. We sought to assess whether disseminated intravascular coagulation and hepatobiliary dysfunction, significant comorbidities seen in critical care settings, would identify hemophagocytic lymphohistiocytosis patients with increased risk of mortality. Design: Retrospective chart review. Setting: Single-center PICU. Patients: All patients admitted to a tertiary care children’s hospital diagnosed with hemophagocytic lymphohistiocytosis from 2005 to 2...
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Risk Factors for the Development of Postoperative Delirium in Pediatric Intensive Care Patients
Objectives: To determine and quantify risk factors for postoperative pediatric delirium. Design: Single-center prospective cohort study. Setting: Twenty-two bed PICU in a tertiary care academic medical center in Germany. Patients: All children admitted after major elective surgery (n = 93; 0–17 yr). Interventions: After awakening, children were screened for delirium using the Cornell Assessment of Pediatric Delirium bid over a period of 5 days. Demographic and clinical data were collected from the initiation of general anesthesia. Measurements and Main Results: A total of 61 patients (66%) were delir...
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Differences Between Pulmonary and Extrapulmonary Pediatric Acute Respiratory Distress Syndrome: A Multicenter Analysis
Conclusions: Patients with extrapulmonary pediatric acute respiratory distress syndrome were sicker and had poorer clinical outcomes. However, after adjusting for confounders, it was not an independent risk factor for mortality. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Applying Artificial Intelligence to Identify Physiomarkers Predicting Severe Sepsis in the PICU*
Conclusions: Artificial intelligence can be used to predict the onset of severe sepsis using physiomarkers in critically ill children. Further, it may detect severe sepsis as early as 8 hours prior to a real-time electronic severe sepsis screening algorithm. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Physician Awareness and Management Practices of Fluid Overload in Critically Ill Children*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Editorials Source Type: research

Food for Thought—Pediatric Critical Illness and Feeding Outcomes*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Editorials Source Type: research

All Delirium May Not Be Created Equal: Consideration of Differential Effects of Delirium Based Upon Underlying Etiology*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Editorials Source Type: research

Understanding Disseminated Intravascular Coagulation and Hepatobiliary Dysfunction Multiple Organ Failure in Hyperferritinemic Critical Illness*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Editorials Source Type: research

Artificial Intelligence: An Inkling of Caution*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Editorials Source Type: research

Vancomycin Pharmacokinetics During Extracorporeal Membrane Oxygenation and Dosing Targets—A Constantly Moving Target?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Editorials Source Type: research

Venoarterial Extracorporeal Membrane Oxygenation in Severe Pediatric Septic Shock*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Editorials Source Type: research

Phenotyping in Pediatric Traumatic Brain Injury*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Editorials Source Type: research

Artificial Intelligence in Pediatric Critical Care Medicine: Are We (Finally) Ready?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Editorials Source Type: research

The SCARF Trial: A Veiled Statement on the PICU?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Editorials Source Type: research

Interleukin-1 Receptor Antagonist and Interleukin-1β: Risk Marker or Risk Factor for Pediatric Acute Respiratory Distress Syndrome?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Editorials Source Type: research

Pediatric Delirium: Where Do We Go From Here?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Editorials Source Type: research

Comparing Percutaneous to Open Access for Extracorporeal Membrane Oxygenation in Pediatric Respiratory Failure
Objectives: Evaluate trends in method of access (percutaneous cannulation vs open cannulation) for pediatric extracorporeal membrane oxygenation and determine the effects of cannulation method on morbidity and mortality. Design: Retrospective cohort study. Setting and Subjects: The Extracorporeal Life Support Organization’s registry was queried for pediatric patients on extracorporeal membrane oxygenation for respiratory failure from 2007 to 2015. Inverventions: None. Measurements and Main Results: Of 3,501 patients identified, 77.2% underwent open cannulation, with the frequency of open cannulation dec...
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Extracorporeal Support Source Type: research

Population Pharmacokinetics of Vancomycin in Pediatric Extracorporeal Membrane Oxygenation*
Conclusions: A vancomycin dose of 25–30 mg/kg/dose every 12–24 hours with serum concentration monitoring is a reasonable empiric dosing strategy to obtain an area under the curve for 24 hours greater than 400 in pediatric extracorporeal membrane oxygenation patients. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Extracorporeal Support Source Type: research

Venoarterial Extracorporeal Membrane Oxygenation Versus Conventional Therapy in Severe Pediatric Septic Shock*
Objectives: The role of venoarterial extracorporeal membrane oxygenation in the treatment of severe pediatric septic shock continues to be intensely debated. Our objective was to determine whether the use of venoarterial extracorporeal membrane oxygenation in severe septic shock was associated with altered patient mortality, morbidity, and/or length of ICU and hospital stay when compared with conventional therapy. Design: International multicenter, retrospective cohort study using prospectively collected data of children admitted to intensive care with a diagnosis of severe septic shock between the years 2006 and 2014...
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Extracorporeal Support Source Type: research

Presenting Characteristics Associated With Outcome in Children With Severe Traumatic Brain Injury: A Secondary Analysis From a Randomized, Controlled Trial of Therapeutic Hypothermia*
Objectives: To identify injury patterns and characteristics associated with severe traumatic brain injury course and outcome, within a well-characterized cohort, which may help guide new research and treatment initiatives. Design: A secondary analysis of a phase 3, randomized, controlled trial that compared therapeutic hypothermia versus normothermia following severe traumatic brain injury in children. Setting: Fifteen sites in the United States, Australia, and New Zealand. Patients: Children ( (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Neurocritical Care Source Type: research

Accurate Prediction of Congenital Heart Surgical Length of Stay Incorporating a Procedure-Based Categorical Variable*
Conclusions: Using a model comprised of basic patient characteristics, we developed a robust prediction tool for patients who will remain in the ICU longer than 7 days after cardiac surgery, at the time of postoperative ICU admission. This model may assist in patient counseling, case scheduling, and capacity management. Further examination in external settings is needed to establish generalizability. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Cardiac Intensive Care Source Type: research

Randomized Study of Early Continuous Positive Airways Pressure in Acute Respiratory Failure in Children With Impaired Immunity (SCARF) ISRCTN82853500*
Conclusions: This study provided no evidence to support early PICU admission for continuous positive airways pressure in children with acute respiratory failure and impaired immunity. There was a trend toward increased endotracheal intubation and a higher early mortality in the early continuous positive airways pressure group. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Feature Articles Source Type: research

Interleukin-1 Receptor Antagonist Is Associated With Pediatric Acute Respiratory Distress Syndrome and Worse Outcomes in Children With Acute Respiratory Failure*
Objectives: To test whether plasma interleukin-1 receptor antagonist or variants within the gene encoding for interleukin-1ra (IL1RN), or proteins involved in regulating interleukin-1β levels or interleukin-1β response, are associated with pediatric acute respiratory distress syndrome or outcomes in mechanically ventilated children with parenchymal lung disease. Design: Prospective cohort study. Setting: Twenty-two PICUs participating in the multisite clinical trial, Randomized Evaluation of Sedation Titration for Respiratory Failure (U01 HL086622). Subjects: Children 2 weeks to 17 years old treated wi...
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Feature Articles Source Type: research

Association Between Transfusion of RBCs and Subsequent Development of Delirium in Critically Ill Children*
Conclusions: In this cohort of critically ill children, there is an independent association between the receipt of an RBC transfusion and the subsequent development of delirium. Further prospective studies are warranted to replicate this finding and investigate possible pathophysiologic mechanisms for this association. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Feature Articles Source Type: research

Anticholinergic Medication Burden in Pediatric Prolonged Critical Illness: A Potentially Modifiable Risk Factor for Delirium
Conclusions: A high number of medications with anticholinergic effects are administered to PICU patients receiving prolonged mechanical ventilation. These exposures are much higher than those reported in adult intensive care patients. Since anticholinergic drug exposure is associated with delirium, further study of this exposure in PICU patients is needed. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Feature Articles Source Type: research

Pediatric Critical Care Medicine: Serving Our Missions While Maintaining Excellence
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - October 1, 2018 Category: Pediatrics Tags: Foreword Source Type: research

Mitral Annular Plane Systolic Excursion as a Predictor of Mortality in Children With Septic Shock
Objectives: Myocardial dysfunction is well recognized in severe sepsis and septic shock. Echocardiography provides rapid, noninvasive, and bedside evaluation of cardiac function in patients with hemodynamic instability. Mitral annular plane systolic excursion is an M-mode–derived echocardiographic variable used to assess longitudinal left ventricular systolic function. No data are available about the uses of mitral annular plane systolic excursion in children with septic shock. Therefore, we aimed to assess the prognostic significance of mitral annular plane systolic excursion in children with septic shock and to c...
Source: Pediatric Critical Care Medicine - September 1, 2018 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Risk Factors for Mortality in Children Admitted for Suspected Malaria to a Pediatric Emergency Ward in a Low-Resource Setting: A Case-Control Study
Conclusions: Risk factors for mortality in children with suspected malaria include cerebral malaria and severe clinical conditions at admission. Being referred from peripheral health units, as proxy of logistics issue, was also associated with increased risk of mortality. These findings suggest that appropriate interventions should focus on training and resources, including the increase of dedicated personnel and available equipment. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2018 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Platelet Transfusions in the PICU: Does Disease Severity Matter?*
In this study, we evaluated the current platelet transfusion practice and platelet transfusion–related outcomes in the PICU. Design: Institutional review board–approved, retrospective cohort study from January 2010 to March 2016. Setting: Tertiary-level PICU. Patients: Children less than 19 years old who received platelet transfusions in the PICU. Interventions: None. Measurements and Main Results: Thirty-six percent (1,547/4,339) of platelet transfusions in the institution were given to 2.4% of PICU patients (232/9,659). The patients who received a platelet transfusion (platelet transfusions, n ...
Source: Pediatric Critical Care Medicine - September 1, 2018 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Pulmonary Functions in Children Ventilated for Acute Hypoxemic Respiratory Failure*
Conclusions: Significant number of children ventilated for acute hypoxemic respiratory failure had subclinical pulmonary function abnormality, without limiting physical activity, which improved over time. Further research on this topic with a larger sample size and patient categorization according to recent pediatric acute respiratory distress syndrome definition is needed. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2018 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Multiple Micronutrient Plasma Level Changes Are Related to Oxidative Stress Intensity in Critically Ill Children*
Objectives: Micronutrient supplementation in critically ill adults remains controversial. In the pediatric setting, the impact of oxidative stress on the overall micronutrient status has been poorly explored, due to the limited number of studies and to confounding factors (i.e., malnutrition or extra losses). In order to better understand this phenomenon, we aim to describe micronutrient status, focusing on seven micronutrients, in well-nourished critically ill children presenting with severe oxidative stress. Design: Prospective, transversal, observational, single-center study. Setting: PICU, and anesthesiology de...
Source: Pediatric Critical Care Medicine - September 1, 2018 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Multicenter Review of Current Practices Associated With Venous Thromboembolism Prophylaxis in Pediatric Patients After Trauma
Conclusions: Pharmacologic venous thromboembolism prophylaxis is not common in critically ill children after trauma. Patient age, orthopedic and vascular procedures, and higher injury severity are associated with pharmacologic venous thromboembolism prophylaxis. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2018 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

The authors reply
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2018 Category: Pediatrics Tags: Letters to the Editor Source Type: research

Probing Deeper Into the Diaphragm in Children
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2018 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 - September 1, 2018 Category: Pediatrics Tags: Letters to the Editor Source Type: research

Low-Dose Epinephrine Boluses for Acute Hypotension in the PICU: Are They Needed?
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2018 Category: Pediatrics Tags: Letters to the Editor Source Type: research

When Should We Transfuse Platelets in the PICU?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2018 Category: Pediatrics Tags: Editorials Source Type: research

Long-Term Outcomes of Children After Acute Respiratory Distress Syndrome: Probably Favorable but Much More to Learn*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2018 Category: Pediatrics Tags: Editorials Source Type: research

Micronutrients in Critical Illness: Essential and Enigmatic*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2018 Category: Pediatrics Tags: Editorials Source Type: research

Extracorporeal Membrane Oxygenation Survival—More Than Just Decannulation*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2018 Category: Pediatrics Tags: Editorials Source Type: research

PICU Safety Surveillance: How Much Is Enough?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2018 Category: Pediatrics Tags: Editorials Source Type: research

What About Leaks! (During Ventilation)*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2018 Category: Pediatrics Tags: Editorials Source Type: research

Crystalloids Versus Colloids After Pediatric Heart Surgery: Is One Better Than the Other?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2018 Category: Pediatrics Tags: Editorials Source Type: research

Seeing Is Believing: Revealing Cardiopulmonary Resuscitation Quality Through Video Monitoring
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2018 Category: Pediatrics Tags: Editorials Source Type: research

Consensus Recommendations for RBC Transfusion Practice in Critically Ill Children From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative
Conclusions: The Transfusion and Anemia Expertise Initiative recommendations provide important clinical guidance and applicable tools to avoid unnecessary RBC transfusions. Research recommendations identify areas of focus for future investigation to improve outcomes and safety for RBC transfusion. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2018 Category: Pediatrics Tags: Special Article Source Type: research