Screening for Factors Influencing Parental Psychological Vulnerability During a Child’s PICU Admission*
OBJECTIVES:
To identify the risks of developing post-traumatic stress disorder (PTSD) and/or depression in parents following their child’s PICU admission using a brief screening instrument and to examine the associations with these risks.
DESIGN:
A cross-sectional parental survey.
SETTING:
A general 13-bed PICU at a large teaching hospital.
SUBJECTS:
One hundred and seven parents of 75 children admitted to the PICU.
INTERVENTIONS:
None.
MEASUREMENTS AND MAIN RESULTS:
All parents completed the 10-item Posttraumatic Adjustment Screen (PAS) before discharge. The PAS assesses risk facto...
Source: Pediatric Critical Care Medicine - April 1, 2022 Category: Pediatrics Tags: Clinical Investigations Source Type: research
Peripheral IV Administration of Hypertonic Saline: Single-Center Retrospective PICU Study*
CONCLUSIONS:
HTS administered through a PIVC infrequently infiltrates in critically ill pediatric patients. The infiltration rate was low when HTS is administered as a bolus but higher when given as a continuous infusion. However, no patient suffered an extravasation injury or long-term morbidity from any infiltration. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - April 1, 2022 Category: Pediatrics Tags: Clinical Investigations Source Type: research
Tracheostomy Practices and Outcomes in Children During Respiratory Extracorporeal Membrane Oxygenation
CONCLUSIONS:
Tracheostomies during ECMO were uncommon in children. One in four patients who received a tracheostomy on ECMO had surgical site bleeding. Children who had tracheostomies placed after 14 days were younger and had worse outcomes, potentially representing tracheostomy as a “secondary” strategy for prolonged ECMO support. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - April 1, 2022 Category: Pediatrics Tags: Clinical Investigations Source Type: research
Critical Care Unit Organizational and Personnel Factors Impact Cardiac Arrest Prevention and Rescue in the Pediatric Cardiac Population
OBJECTIVES:
Patient-level factors related to cardiac arrest in the pediatric cardiac population are well understood but may be unmodifiable. The impact of cardiac ICU organizational and personnel factors on cardiac arrest rates and outcomes remains unknown. We sought to better understand the association between these potentially modifiable organizational and personnel factors on cardiac arrest prevention and rescue.
DESIGN:
Retrospective analysis of the Pediatric Cardiac Critical Care Consortium registry.
SETTING:
Pediatric cardiac ICUs.
PATIENTS:
All cardiac ICU admissions were evaluated for cardi...
Source: Pediatric Critical Care Medicine - April 1, 2022 Category: Pediatrics Tags: Cardiac Intensive Care Source Type: research
Characterization of Inhaled Nitric Oxide Use for Cardiac Indications in Pediatric Patients*
OBJECTIVES:
Characterize the use of inhaled nitric oxide (iNO) for pediatric cardiac patients and assess the relationship between patient characteristics before iNO initiation and outcomes following cardiac surgery.
DESIGN:
Observational cohort study.
SETTING:
PICU and cardiac ICUs in seven Collaborative Pediatric Critical Care Research Network hospitals.
PATIENTS:
Consecutive patients, less than 18 years old, mechanically ventilated before or within 24 hours of iNO initiation. iNO was started for a cardiac indication and excluded newborns with congenital diaphragmatic hernia, meconium aspiration s...
Source: Pediatric Critical Care Medicine - April 1, 2022 Category: Pediatrics Tags: Feature Articles Source Type: research
Transfusion Ratios and Deficits in Injured Children With Life-Threatening Bleeding*
CONCLUSIONS:
In injured children, balanced resuscitation may improve early survival according to this hypothesis generating study. Multicenter clinical trials are needed to assess whether clinicians should target ratios and deficits as optimal pediatric hemostatic resuscitation practice. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - April 1, 2022 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, 2022 Category: Pediatrics Tags: Editor’s Choice Source Type: research
Anthropology in the PICU: Addressing the Local Worlds of Families in an Otherwise Foreign Land
Critical illness is a scary, and often previously unknown, experience for children and their families. To best assist pediatric critically ill patients and their caregivers, it is imperative to understand their local worlds outside of the PICU and what matters to them most. Anthropology, and its ethnographic lens and mode of inquiry, is an underutilized aspect of multidisciplinary care and research in pediatric critical care but has much to offer as exemplified herein. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2022 Category: Pediatrics Tags: Online PCCM Perspectives Source Type: research
Developmental Care Practice and Documentation Variability in the Cardiac ICU
CONCLUSIONS:
There are significant, quantifiable variations in documented developmental care practices at both the individual and site level. More reliable documentation of developmental care practices is required to associate these variables with later outcomes and investigate disparities in individualized developmental care practices. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2022 Category: Pediatrics Tags: Online Cardiac Intensive Care Source Type: research
Oral Aversion in Infants With Congenital Heart Disease: A Single-Center Retrospective Cohort Study*
OBJECTIVES:
Neonates undergoing cardiac surgery are at risk for oral aversion (OA). OA is not well described outside of the index hospitalization and impacts patients and families. We evaluated the prevalence of OA at 1 year old after neonatal cardiopulmonary bypass (CPB) surgery.
DESIGN:
Retrospective cohort study.
SETTING:
Single quaternary care hospital.
SUBJECTS:
Our cohort included 157 neonates who underwent CPB surgery from 2014 to 2017 and had follow-up data available at 1 year old.
INTERVENTIONS:
None.
MEASUREMENTS AND MAIN RESULTS:
Three feeding experts reviewed the medical r...
Source: Pediatric Critical Care Medicine - March 1, 2022 Category: Pediatrics Tags: Online Cardiac Intensive Care Source Type: research
Postoperative Acute Kidney Injury in Williams Syndrome Compared With Matched Controls
CONCLUSIONS:
The OR of CS-AKI is increased in pediatric patients with WS compared with controls. CS-AKI was associated with VIS at the sixth postoperative hour. Increases in RPP and mean arterial pressure were associated with decreased odds of CS-AKI. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2022 Category: Pediatrics Tags: Online Cardiac Intensive Care Source Type: research
Prevalence of and Associations With Avascular Necrosis After Pediatric Sepsis: A Single-Center Retrospective Study
OBJECTIVES:
Avascular necrosis (AVN) is a rare, but serious, complication after sepsis in adults. We sought to determine if sepsis is associated with postillness diagnosis of AVN, as well as potential-associated risk factors for AVN in children with sepsis.
DESIGN:
Retrospective observational study.
SETTING:
Single academic children’s hospital.
PATIENTS:
Patients less than 18 years treated for sepsis or suspected bacterial infection from 2011 to 2017. Patients who developed AVN within 3 years after sepsis were compared with patients who developed AVN after suspected bacterial infection and with p...
Source: Pediatric Critical Care Medicine - March 1, 2022 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research
Strain Echocardiography and Myocardial Dysfunction in Critically Ill Children With Multisystem Inflammatory Syndrome Unrecognized by Conventional Echocardiography: A Retrospective Cohort Analysis
This study compares the strengths of conventional and strain echocardiography in identifying cardiac dysfunction in critically ill children with multisystem inflammatory syndrome in children and their association with ICU therapeutic needs and clinical outcomes.
DESIGN:
Retrospective, observational cohort study.
SETTING:
A large, quaternary care PICU.
PATIENTS:
Sixty-five pediatric patients admitted to the PICU with the diagnosis of multisystem inflammatory syndrome in children from March 2020 to March 2021.
INTERVENTIONS:
Global longitudinal strain four chamber was measured retrospectively by s...
Source: Pediatric Critical Care Medicine - March 1, 2022 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research
Driving Pressure Is Associated With Outcome in Pediatric Acute Respiratory Failure
OBJECTIVES:
Driving pressure (ratio of tidal volume over respiratory system compliance) is associated with mortality in acute respiratory distress syndrome. We sought to evaluate if such association could be identified in critically ill children.
DESIGN:
We studied the association between driving pressure on day 1 of mechanical ventilation and ventilator-free days at day 28 through secondary analyses of prospectively collected physiology data.
SETTING:
Medical-surgical university hospital PICU.
PATIENTS:
Children younger than 18 years (stratified by Pediatric Mechanical Ventilation Consensus Confer...
Source: Pediatric Critical Care Medicine - March 1, 2022 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research
Clinical Reasoning Behind Antibiotic Use in PICUs: A Qualitative Study*
CONCLUSIONS:
Antibiotic-related decisions for critically ill children are complex, and pediatric intensivists use several clinical reasoning strategies to decrease the uncertainty around the bacterial etiology of infections. However, disease severity and patient safety concerns may overrule decisions based on clinical evidence and lead to antibiotic use. Several cognitive biases were identified in the clinical reasoning processes. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - March 1, 2022 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research
