Trends in Time to Extubation for Pediatric Postoperative Cardiac Patients and Its Correlation With Changes in Clinical Outcomes: A Virtual PICU Database Study*
OBJECTIVES:
Mechanical ventilation is often used in children after cardiac surgery but can impair hemodynamics and cause lung injury. Early extubation may improve ICU length of stay and survival. We aimed to describe trends in early extubation rates and evaluate if centers that more commonly practice early extubation have better severity-adjusted outcomes.
DESIGN:
Retrospective analysis was performed of admissions in the Virtual Pediatric Systems (VPS, LLC) database from 2009 to 2018. Early extubation was defined as patients extubated in the operating room or within 6 hours of PICU admission.
SETTING:
PIC...
Source: Pediatric Critical Care Medicine - July 1, 2022 Category: Pediatrics Tags: Cardiac Intensive Care Source Type: research
School Closures in the United States and Severe Respiratory Illnesses in Children: A Normalized Nationwide Sample
CONCLUSIONS:
School closures are associated with a dramatic reduction in the prevalence of severe respiratory disease requiring PICU admission. School closure may be an effective tool to mitigate future pandemics but should be balanced with potential academic, economic, mental health, and social consequences. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2022 Category: Pediatrics Tags: Clinical Investigations Source Type: research
Epidemiology of Neonatal Acute Respiratory Distress Syndrome: Prospective, Multicenter, International Cohort Study
CONCLUSIONS:
Prevalence and survival of neonatal ARDS are similar to those of pediatric ARDS. The neonatal ARDS subtypes used in the current definition may be associated with distinct clinical outcomes and a different distribution for term and preterm neonates. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2022 Category: Pediatrics Tags: Clinical Investigations Source Type: research
Development and External Validation of a Machine Learning Model for Prediction of Potential Transfer to the PICU
OBJECTIVES:
Unrecognized clinical deterioration during illness requiring hospitalization is associated with high risk of mortality and long-term morbidity among children. Our objective was to develop and externally validate machine learning algorithms using electronic health records for identifying ICU transfer within 12 hours indicative of a child’s condition.
DESIGN:
Observational cohort study.
SETTING:
Two urban, tertiary-care, academic hospitals (sites 1 and 2).
PATIENTS:
Pediatric inpatients (age (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2022 Category: Pediatrics Tags: Clinical Investigations Source Type: research
A Clinical and Physiological Prospective Observational Study on the Management of Pediatric Shock in the Post-Fluid Expansion as Supportive Therapy Trial Era*
CONCLUSIONS:
Maintenance-only fluid therapy normalized clinical and myocardial perturbations in shock without compromising cardiac or hemodynamic function whereas fluid-bolus management of WHO shock resulted in high fatality. Troponin and lactate biomarkers of cardiac dysfunction could be promising outcome predictors in pediatric septic shock in resource-limited settings. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2022 Category: Pediatrics Tags: Feature Articles Source Type: research
Prevalence of Cardiac Dysfunction in Malawian Children With Severe Febrile Illness*
CONCLUSIONS:
Cardiac dysfunction may be present in one in four Malawian children with severe febrile illness, and mortality in these patients is especially high. Larger studies are needed to further clarify the role cardiac dysfunction plays in mortality and integrate practical bedside assessments for decision support around individualized resuscitation strategies. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2022 Category: Pediatrics Tags: Feature Articles Source Type: research
Epidemiology of Pediatric Critical Care Admissions in 43 United States Children’s Hospitals, 2014–2019*
OBJECTIVES:
To identify trends in the population of patients in PICUs over time.
DESIGN:
Cross-sectional, retrospective cohort study using the Pediatric Health Information System database.
SETTING:
Forty-three U.S. children’s hospitals.
PATIENTS:
All patients admitted to Pediatric Health Information System-participating hospitals from January 2014 to December 2019. Individuals greater than 65 years old and normal newborns were excluded.
INTERVENTIONS:
None.
MEASUREMENTS AND MAIN RESULTS:
PICU care occurred in 13.8% of all pediatric hospital encounters and increased over the study pe...
Source: Pediatric Critical Care Medicine - July 1, 2022 Category: Pediatrics Tags: Feature Articles Source Type: research
Editor’s Choice Articles for July
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - July 1, 2022 Category: Pediatrics Tags: Editor’s Choice Source Type: research
Online Abstract Translations
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - June 1, 2022 Category: Pediatrics Tags: Online Abstract Translations Source Type: research
The authors reply
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - June 1, 2022 Category: Pediatrics Tags: Online Correspondence Source Type: research
Moderate Pediatric Traumatic Brain Injury: What Is the Best Way Forward?
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - June 1, 2022 Category: Pediatrics Tags: Online Correspondence Source Type: research
Vasoplegic Shock Represents a Dominant Hemodynamic Profile of Multisystem Inflammatory Syndrome Following COVID-19 in Children and Adolescents
CONCLUSIONS:
Further studies are needed to evaluate the difference between the use of vasoconstrictor versus vasodilators in pediatric patients with MIS-C because a phenotype with high CI and low SVRi may be important. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - June 1, 2022 Category: Pediatrics Tags: Online Brief Reports Source Type: research
Association Between Heart Rate Variability and Inflammatory Biomarkers in Critically Ill Children*
OBJECTIVES:
The autonomic nervous system (ANS) can both modulate and be modulated by the inflammatory response during critical illness. We aimed to determine whether heart rate variability (HRV), a measure of ANS function, is associated with proinflammatory biomarker levels in critically ill children.
DESIGN
Two cohorts were analyzed. The first was a prospective observational cohort from August 2018 to August 2020 who had plasma proinflammatory cytokine measurements within 72 hours of admission, including tumor necrosis factor-α, interleukin (IL)-1β, IL-6, and IL-8. The second was a retrospective cohort from J...
Source: Pediatric Critical Care Medicine - June 1, 2022 Category: Pediatrics Tags: Online Brief Reports Source Type: research
Health Resource Use in Survivors of Pediatric Septic Shock in the United States
CONCLUSIONS:
Children with septic shock represent a high-risk cohort with high-resource needs after discharge. Interventions and targeted outcomes to mitigate postdischarge resource use may differ based on patients’ preexisting conditions. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - June 1, 2022 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research
Lactate, Base Excess, and the Pediatric Index of Mortality: Exploratory Study of an International, Multicenter Dataset
OBJECTIVES:
To investigate the relationship between ICU admission blood lactate, base excess, and ICU mortality and to explore the effect of incorporating blood lactate into the Pediatric Index of Mortality.
DESIGN
Retrospective cohort study based on data prospectively collected on every PICU admission submitted to the U.K. Pediatric Intensive Care Audit Network and to the Australia and New Zealand Pediatric Intensive Care Registry.
SETTING:
Thirty-three PICUs in the United Kingdom/Republic of Ireland and nine PICUs and 20 general ICUs in Australia and New Zealand.
PATIENTS:
All ICU admissions betw...
Source: Pediatric Critical Care Medicine - June 1, 2022 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research
