The authors reply
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - May 1, 2021 Category: Pediatrics Tags: Online Correspondence Source Type: research

Ultrasound Options for Measuring Optic Nerve Sheath Diameter in Children
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - May 1, 2021 Category: Pediatrics Tags: Online Correspondence Source Type: research

Ultrasound-Guided Postpyloric Feeding Tube Placement in Critically Ill Pediatric Patients*
The objective of this study was to evaluate the effect of ultrasound-guided postpyloric feeding tube placement in critically ill children. DESIGN: Single-center retrospective observational study. SETTING: PICU of tertiary children’s hospital. PATIENTS: Children under the age of 16 who underwent postpyloric feeding tube placement in our PICU between September 2017 and August 2019. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 115 patients were included in this study: 30 patients underwent ultrasound-guided postpyloric feeding tube placement and 85 patients underwent ...
Source: Pediatric Critical Care Medicine - May 1, 2021 Category: Pediatrics Tags: Online Brief Report Source Type: research

Decreased Human Leukocyte Antigen DR on Circulating Monocytes Expression After Severe Pediatric Trauma: An Exploratory Report
CONCLUSIONS: Pediatric severe trauma induced an early and dramatic decrease in human leukocyte antigen-DR on circulating monocytes expression. This alteration of innate immunity was not associated with the occurrence of secondary infection, possibly due to a lack of statistical power. However, human leukocyte antigen-DR on circulating monocytes at Day 3 is a potential indicator of those at high risk of secondary infection and worse outcomes. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - May 1, 2021 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Health-Related Quality of Life After Community-Acquired Septic Shock in Children With Preexisting Severe Developmental Disabilities
OBJECTIVES: To serially evaluate health-related quality of life during the first year after community-acquired septic shock in children with preexisting severe developmental disabilities and explore factors associated with health-related quality of life changes in these children. DESIGN: Secondary analysis of the Life after Pediatric Sepsis Evaluation investigation. SETTING: Twelve academic PICU in the United States. PATIENTS: Children greater than or equal to 1 month and less than 18 years old identified by their family caregiver (e.g., parent/guardian) as having severe developmental disability pr...
Source: Pediatric Critical Care Medicine - May 1, 2021 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Research Priorities for U.K. Pediatric Critical Care in 2019: Healthcare Professionals’ and Parents’ Perspectives
CONCLUSIONS: This is the first research prioritization exercise within U.K. PICU setting to include parents’ and families’ perspectives and compare these with healthcare professional. Results will guide both funders and future researchers. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - May 1, 2021 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Association Between Treatments and Short-Term Biochemical Improvements and Clinical Outcomes in Post-Severe Acute Respiratory Syndrome Coronavirus-2 Inflammatory Syndrome
OBJECTIVES: To 1) analyze the short-term biochemical improvements and clinical outcomes following treatment of children with post-severe acute respiratory syndrome coronavirus-2 inflammatory syndrome (multisystem inflammatory syndrome in children/pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2) admitted to U.K. PICUs and 2) collate current treatment guidance from U.K. PICUs. DESIGN: Multicenter observational study. SETTING: Twenty-one U.K. PICUs. PATIENTS: Children ( (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - May 1, 2021 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Postpyloric Feeding Tube Placement Under Ultrasound Guidance: Is It Moving Forward?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - May 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Improving “Neuro Checks” in Neonatal ICU and PICU Is a Serial Neurologic Assessment in Pediatrics*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - May 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Postextubation Respiratory Support: Is High-Flow Oxygen Therapy the Answer?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - May 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Screening Criteria for Palliative Care Consultation? Leave It to the PICU Team*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - May 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

There’s No Place Like Home*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - May 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Linking Hyperoxia and Harm: Consequence or Merely Subsequence?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - May 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

The Words We Say
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - May 1, 2021 Category: Pediatrics Tags: PCCM Narrative Source Type: research

Statistical Note: Confounding and Causality in Observational Studies
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - May 1, 2021 Category: Pediatrics Tags: PCCM Notes, Methods, and Statistics Source Type: research

Serial Neurologic Assessment in Pediatrics (SNAP): A New Tool for Bedside Neurologic Assessment of Critically Ill Children*
OBJECTIVES: We developed a tool, Serial Neurologic Assessment in Pediatrics, to screen for neurologic changes in patients, including those who are intubated, are sedated, and/or have developmental disabilities. Our aims were to: 1) determine protocol adherence when performing Serial Neurologic Assessment in Pediatrics, 2) determine the interrater reliability between nurses, and 3) assess the feasibility and acceptability of using Serial Neurologic Assessment in Pediatrics compared with the Glasgow Coma Scale. DESIGN: Mixed-methods, observational cohort. SETTING: Pediatric and neonatal ICUs. SUBJECTS: ...
Source: Pediatric Critical Care Medicine - May 1, 2021 Category: Pediatrics Tags: Feature Articles Source Type: research

Prevalence of Reintubation Within 24 Hours of Extubation in Bronchiolitis: Retrospective Cohort Study Using the Virtual Pediatric Systems Database*
CONCLUSIONS: In this secondary analysis of a multicenter database of children with bronchiolitis, extubation to high-flow nasal cannula was associated with a lower prevalence of reintubation within 24 hours compared with noninvasive positive pressure ventilation in both unmatched and propensity-matched analysis. Prospective trials are needed to determine if post-extubation support modality can mitigate the risk of extubation failure. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - May 1, 2021 Category: Pediatrics Tags: Feature Articles Source Type: research

Variation in Pediatric Palliative Care Allocation Among Critically Ill Children in the United States*
The objectives are as follows: 1) estimate palliative care consult rates and trends among critically ill children and 2) characterize which children receive palliative care consults, including those meeting previously proposed ICU-specific palliative care screening criteria. DESIGN: Retrospective cohort. SETTING: Fifty-two United States children’s hospitals participating in the Pediatric Health Information Systems database. PATIENTS: Hospitalized children with nonneonatal ICU admissions from 2007 to 2018. MEASUREMENTS AND MAIN RESULTS: The primary outcome was palliative care consultation, ...
Source: Pediatric Critical Care Medicine - May 1, 2021 Category: Pediatrics Tags: Feature Articles Source Type: research

A Framework for Pediatric Intensivists Providing Compassionate Extubation at Home*
For families facing end-of-life decisions for their critically ill children, compassionate extubation at home is a valuable service that pediatric intensivists can provide. Compassionate extubation at home is resource intensive and can be logistically challenging. Discouragingly, guidance on compassionate extubation at home in the literature is limited. We developed an evidence- and experience-based framework for compassionate extubation at home addressing common planning challenges and resource management. Our objective is to share this framework and an accompanying checklist, so that pediatric intensivists in other insti...
Source: Pediatric Critical Care Medicine - May 1, 2021 Category: Pediatrics Tags: Feature Articles Source Type: research

Hyperoxia During Cardiopulmonary Bypass Is Associated With Mortality in Infants Undergoing Cardiac Surgery*
OBJECTIVES: Patients undergoing cardiac surgery using cardiopulmonary bypass have variable degrees of blood oxygen tension during surgery. Hyperoxia has been associated with adverse outcomes in critical illness. Data are not available regarding the association of hyperoxia and outcomes in infants undergoing cardiopulmonary bypass. We hypothesize that among infants undergoing cardiac surgery, hyperoxia during cardiopulmonary bypass is associated with greater odds of morbidity and mortality. DESIGN: Retrospective study. SETTING: Single center at an academic tertiary children’s hospital. PATIENTS: ...
Source: Pediatric Critical Care Medicine - May 1, 2021 Category: Pediatrics Tags: Feature Articles Source Type: research

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

The Role of Therapeutic Plasma Exchange in the Treatment of Childhood Intoxication: A Single-Center Experience: Erratum
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - April 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 - April 1, 2021 Category: Pediatrics Tags: Online Abstract Translations Source Type: research

Food Insecurity in Families With Critically Ill Children: A Single-Center Observational Study in Pittsburgh
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - April 1, 2021 Category: Pediatrics Tags: Online Letters to the Editor Source Type: research

Traumatic Brain Injury Practice Guidelines: Variability in U.K. PICUs
Conclusions: Significant variability in pediatric traumatic brain injury management guidelines exists. Despite the heterogeneity, we have highlighted a few points of consistency within the key topic areas of pediatric traumatic brain injury management. We anticipate that this provides impetus for further work around standardization. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - April 1, 2021 Category: Pediatrics Tags: Online Brief Report Source Type: research

Sedation With Midazolam After Cardiac Surgery in Children With and Without Down Syndrome: A Pharmacokinetic-Pharmacodynamic Study
Conclusions: The majority of children with and without Down syndrome required additional sedation after cardiac surgery. This pharmacokinetic and pharmacodynamic analysis does not provide evidence for different dosing of midazolam in children with Down syndrome after cardiac surgery. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - April 1, 2021 Category: Pediatrics Tags: Online Cardiac Intensive Care Source Type: research

Regulating Critical Care Ultrasound, It Is All in the Interpretation
Point-of-care ultrasound (POCUS) use is rapidly expanding as a practice in adult and pediatric critical care environments. In January 2020, the Joint Commission endorsed a statement from the Emergency Care Research Institute citing point-of-care ultrasound as a potential hazard to patients for reasons related to training and skill verification, oversight of use, and recordkeeping and accountability mechanisms for clinical use; however, no evidence was presented to support these concerns. Existing data on point-of-care ultrasound practices in pediatric critical care settings verify that point-of-care ultrasound use continue...
Source: Pediatric Critical Care Medicine - April 1, 2021 Category: Pediatrics Tags: Online PCCM Perspectives Source Type: research

Therapeutic Alliance Between Bereaved Parents and Physicians in the PICU
Conclusions: Among parents bereaved in the PICU, therapeutic alliance with physicians is moderately high. Future research should identify strategies to strengthen therapeutic alliance with Black parents and examine the role of alliance on bereaved parents’ health outcomes. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - April 1, 2021 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Early Mobilization in a PICU: A Qualitative Sustainability Analysis of PICU Up!*
Conclusions: Three years after implementation, PICU Up! remains well-received by staff, positively influencing role satisfaction and PICU team dynamics. Furthermore, patients and family members are perceived to be enthusiastic about mobility efforts, driving staff support. Through an ongoing focus on stakeholder buy-in, interprofessional engagement, and bundled care to promote mobility, the program has become part of the culture in the Johns Hopkins Hospital PICU. However, several barriers remain that prevent consistent execution of early mobility, including challenges with resource management, sedation decisions, and ...
Source: Pediatric Critical Care Medicine - April 1, 2021 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Quality Improvement Versus Evidence-Based Practice in Early Mobilization Programs—Must We Choose?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - April 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Long-Term Follow-Up After Pediatric Acute Kidney Injury: The Rates, They Are Not A-Changin’*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - April 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Let Us Not Forget Early Mortality in Pediatric Sepsis*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - April 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Can We Finally Agree: How We Round Really Matters?*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - April 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

Put Me in, Coach!...INSPIRE-ing Choreography of Cardiopulmonary Resuscitation*
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - April 1, 2021 Category: Pediatrics Tags: Editorials Source Type: research

The Many Ways to Answer a Question
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - April 1, 2021 Category: Pediatrics Tags: PCCM Narrative Source Type: research

PCCM Narratives, Letters, and Correspondence
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - April 1, 2021 Category: Pediatrics Tags: PCCM Notes, Methods, and Statistics Source Type: research

Serum Creatinine Monitoring After Acute Kidney Injury in the PICU*
Conclusions: Half of PICU acute kidney injury survivors have serum creatinine measured within 1-year postdischarge and follow-up is suboptimal for children developing long-term kidney sequelae. Knowledge translation strategies should emphasize the importance of serum creatinine monitoring after childhood acute kidney injury. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - April 1, 2021 Category: Pediatrics Tags: Renal Critical Care Source Type: research

Traumatic Brain Injury Outcomes in 10 Asian Pediatric ICUs: A Pediatric Acute and Critical Care Medicine Asian Network Retrospective Study
Conclusions: Poor functional outcomes are prevalent after pediatric traumatic brain injury in Asia. There is an urgent need for further research in these high-risk groups. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - April 1, 2021 Category: Pediatrics Tags: Neurocritical Care Source Type: research

Avoidable Serum Potassium Testing in the Cardiac ICU: Development and Testing of a Machine-Learning Model
Conclusions: Machine-learning methods can be used to predict avoidable blood tests accurately for serum potassium in critically ill pediatric patients. A median of 27.2% of samples could have been saved, with decreased costs and risk of infection or anemia. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - April 1, 2021 Category: Pediatrics Tags: Feature Cardiac Intensive Care Source Type: research

Respiratory Variation in Aortic Blood Flow Velocity in Hemodynamically Unstable, Ventilated Neonates: A Pilot Study of Fluid Responsiveness
Objectives: To assess whether respiratory variation in aortic blood flow peak velocity can predict preload responsiveness in mechanically ventilated and hemodynamically unstable neonates. Design: Prospective observational diagnostic accuracy study. Setting: Third-level neonatal ICU. Patients: Hemodynamically unstable neonates under mechanical ventilation. Interventions: Fluid challenge with 10 mL/kg of normal saline over 20 minutes. Measurements and Main Results: Respiratory variation in aortic blood flow peak velocity and superior vena cava flow were measured at baseline (T0), immedi...
Source: Pediatric Critical Care Medicine - April 1, 2021 Category: Pediatrics Tags: Feature Cardiac Intensive Care Source Type: research

Characteristics and Timing of Mortality in Children Dying With Infections in North American PICUs*
Objectives: To investigate the characteristics and timing of death of children with severe infections who die during PICU admission. Design: We analyzed demographics, timing of death, diagnoses, and common procedures in a large cohort obtained from the Virtual Pediatrics Systems database, focusing on early deaths ( (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - April 1, 2021 Category: Pediatrics Tags: Feature Articles Source Type: research

Standardized Work Rounds Enhance Teaming, Comprehensiveness, Shared Mental Model Development, and Achievement Rate of End-of-Shift Goals*
Objectives: To determine the impact of standardized PICU work rounds on the frequency of ideal teaming behaviors, rounds comprehensiveness, shared mental model index development, and rate of completed end-of-shift goals. Design: A single-center, pre-post, prospective cohort study. Setting: A 259-bed, quaternary, pediatric referral center. Patients: Children 0–18 years old from November 2018 to January 2020. Interventions: Standardized, bedside, nurse-led PICU work rounds, emphasizing ideal teaming behaviors using a collaboratively developed rounding script and quality/safety checklist....
Source: Pediatric Critical Care Medicine - April 1, 2021 Category: Pediatrics Tags: Feature Articles Source Type: research

Influence of Cardiopulmonary Resuscitation Coaching on Interruptions in Chest Compressions During Simulated Pediatric Cardiac Arrest*
Objectives: To determine the impact of a cardiopulmonary resuscitation coach on the frequency and duration of pauses during simulated pediatric cardiac arrest. Design: This is a secondary analysis of video data collected from a prospective multicenter trial. Forty simulated pediatric cardiac arrest scenarios (20 noncoach and 20 coach teams), each lasting 18 minutes in duration, were reviewed by three clinical experts to document events surrounding each pause in chest compressions. Setting: Four pediatric academic medical centers from Canada and the United States. Subjects: Two-hundred healthcare pr...
Source: Pediatric Critical Care Medicine - April 1, 2021 Category: Pediatrics Tags: Feature Articles Source Type: research

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

Use of Prospective Audit and Feedback to Reduce Antibiotic Exposure in a Pediatric Cardiac ICU
Conclusions: There was a significant reduction in antibiotic use following implementation of a prospective audit and feedback program in our pediatric cardiac ICU. Over one-third of antibiotics audited in our cardiac ICU were associated with a prospective audit and feedback recommendation, revealing important targets for future antimicrobial stewardship efforts in this population. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2021 Category: Pediatrics Tags: Online Cardiac Intensive Care Source Type: research

Percutaneous Endoscopic Gastrostomy Enhances Interstage Growth in Infants With Hypoplastic Left Heart Syndrome
Objectives: Infants with hypoplastic left heart syndrome undergoing staged palliation commonly experience chronic growth failure and malnutrition. Greater patient weight at stage 2 palliation (Glenn) is thought to be associated with improved perioperative outcomes. We aimed to compare weight for age z score and interstage growth velocity in children with and without a percutaneous endoscopic gastrostomy prior to Glenn and hypothesize that those with a percutaneous endoscopic gastrostomy experience-enhanced interstage growth and reduced malnutrition rates. Design: Single-center, retrospective cohort study. Set...
Source: Pediatric Critical Care Medicine - March 1, 2021 Category: Pediatrics Tags: Online Cardiac Intensive Care Source Type: research

Twenty-Four–Hour Esophageal pH Measurement in Mechanically Ventilated Children: A Prospective Cohort Study*
Conclusions: The current study shows high incidence of gastroesophageal reflux on 24-hour esophageal pH-metry in mechanically ventilated children with medical diagnoses. The significance of this finding and its impact on ventilator-associated pneumonia and other ventilator-associated events need to be examined in larger studies. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2021 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Enteral Feeding of Children on Noninvasive Respiratory Support: A Four-Center European Study*
Objectives: To explore enteral feeding practices and the achievement of energy targets in children on noninvasive respiratory support, in four European PICUs. Design: A four-center retrospective cohort study. Setting: Four PICUs: Bristol, United Kingdom; Lyon, France; Madrid, Spain; and Rotterdam, The Netherlands. Patients: Children in PICU who required acute noninvasive respiratory support in the first 7 days. The primary outcome was achievement of standardized kcal/goal. Interventions: None. Measurements and Main Results: A total of 325 children were included (Bristol 104; Lyon 99; ...
Source: Pediatric Critical Care Medicine - March 1, 2021 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Multisystem Inflammatory Syndrome in Children Associated With Coronavirus Disease 2019 in a Children’s Hospital in New York City: Patient Characteristics and an Institutional Protocol for Evaluation, Management, and Follow-Up
Conclusions: This report provides guidance to clinicians on evaluation, management, and follow-up of patients with a novel hyperinflammatory syndrome related to coronavirus disease 2019 known as multisystem inflammatory syndrome in children. It is based on the relevant literature and our experience. Instituting such a protocol during a global pandemic is feasible and is associated with patients receiving treatment and returning home more quickly. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2021 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Outcome of Early Hemostatic Intervention in Children With Sepsis and Nonovert Disseminated Intravascular Coagulation Admitted to PICU: A Randomized Controlled Trial
Objectives: Evaluation of the outcome of early hemostatic management of disseminated intravascular coagulopathy in patients with severe sepsis/septic shock admitted to PICU, before the development of clinically overt disseminated intravascular coagulopathy. Design: Prospective interventional, open label randomized controlled clinical trial. Setting: PICU at Alexandria University Children’s Hospital. Patients: The study included 80 patients with proven severe sepsis/septic shock in nonovert disseminated intravascular coagulopathy stage. They were randomly assigned into two groups (group 1 and ...
Source: Pediatric Critical Care Medicine - March 1, 2021 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research