The Unequal Fight
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2022 Category: Pediatrics Tags: PCCM Narrative Source Type: research

Protocol for a Randomized Multiple Center Trial of Conservative Versus Liberal Oxygenation Targets in Critically Ill Children (Oxy-PICU): Oxygen in Pediatric Intensive Care
OBJECTIVES: Oxygen administration is a fundamental part of pediatric critical care, with supplemental oxygen offered to nearly every acutely unwell child. However, optimal targets for systemic oxygenation are unknown. Oxy-PICU aims to evaluate the clinical effectiveness and cost-effectiveness of a conservative peripheral oxygen saturation (Spo2) target of 88–92% compared with a liberal target of more than 94%. DESIGN: Pragmatic, open, multiple-center, parallel group randomized control trial with integrated economic evaluation. SETTING: Fifteen PICUs across England, Wales, and Scotland. PATIENTS: ...
Source: Pediatric Critical Care Medicine - September 1, 2022 Category: Pediatrics Tags: PCCM Trials Source Type: research

Exploratory Use of Glycoprotein IIb/IIIa Inhibition in Prevention of Blalock-Taussig Shunt Thrombosis*
OBJECTIVES: Morbidity and mortality related to modified Blalock-Taussig shunt (mBTTS) thrombosis remain a significant risk. Platelet inhibition following mBTTS may reduce this risk. However, oral antiplatelet agents have variable absorption following surgery. We determine risk factors for mBTTS thrombosis and hypothesize that IV glycoprotein IIb/IIIa inhibitor (tirofiban) as a bridge to oral aspirin reduces the rate of shunt thrombosis in the immediate postoperative period. End points within the 14-day follow-up period include mBTTS thrombosis, overall thrombosis, bleeding, length of stay, and mortality. DESIGN: ...
Source: Pediatric Critical Care Medicine - September 1, 2022 Category: Pediatrics Tags: Cardiovascular Critical Care Source Type: research

Outcomes for Children With Pulmonary Hypertension Undergoing Tracheostomy Placement: A Multi-Institutional Analysis*
CONCLUSIONS: In the context of expanding utilization of tracheostomy and long-term ventilation, children with PH are among the highest risk cohorts for extended and repeated hospitalization and death. Tracheostomy placement during the index encounter was associated with fewer 30-day readmissions over the 2-year follow-up period. Further understanding of which subgroups may benefit from earlier intervention and which subgroups are at highest risk may offer important clinical insight when considering optimal timing of tracheostomy and may enhance informed decision-making for all stakeholders. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2022 Category: Pediatrics Tags: Cardiovascular Critical Care Source Type: research

Is Parental Presence in the Ambulance Associated With Parental Satisfaction During Emergency Pediatric Intensive Care Retrieval? A Cross-Sectional Questionnaire Study
CONCLUSIONS: Most parents who completed questionnaires rated their experience with their PCCT team highly. Parental presence and choice to travel in the ambulance were associated with a more positive experience. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2022 Category: Pediatrics Tags: Clinical Investigation Source Type: research

Monocyte Distribution Width in Children With Systemic Inflammatory Response: Retrospective Cohort Examining Association With Early Sepsis*
OBJECTIVES: To investigate the association between increased monocyte distribution width (MDW) and pediatric sepsis in the emergency department (ED). DESIGN: Retrospective cohort study. SETTING: A single academic hospital study. PATIENTS: Patients from birth to the age of 18 years who presented at the ED of an academic hospital with systemic inflammatory response syndrome (SIRS) were consecutively enrolled. Sepsis was diagnosed using the International Pediatric Surviving Sepsis Campaign criteria. INTERVENTIONS: Antibiotic treatment was administrated once infection was suspected. MEASUREME...
Source: Pediatric Critical Care Medicine - September 1, 2022 Category: Pediatrics Tags: Feature Articles Source Type: research

The Association of Early Corticosteroid Therapy With Clinical and Health-Related Quality of Life Outcomes in Children With Septic Shock*
CONCLUSIONS: This study examined the association of early corticosteroid therapy with mortality and morbidity among children encountering septic shock. After adjusting for variables with the potential to confound the relationship between early corticosteroid administration and clinically meaningful end points, there was no improvement in outcomes associated with this therapy. Results from this propensity analysis provide additional justification for equipoise regarding corticosteroid therapy for pediatric septic shock and ascertain the need for a well-designed clinical trial to examine benefit/risk for this interventio...
Source: Pediatric Critical Care Medicine - September 1, 2022 Category: Pediatrics Tags: Feature Articles Source Type: research

The Utilization of Critical Care Resources in Pediatric Neurocritical Care Patients*
CONCLUSIONS: In children admitted to a VPS-contributing PICU, a diagnosis of acute neurologic disease was associated with greater use of resources. We have identified the most common etiologies of acute neurologic disease in the 2016 VPS cohort, and such admissions were associated with significant decrease in functional status, as well as an increase in mortality. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - September 1, 2022 Category: Pediatrics Tags: Feature Articles Source Type: research

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

Missing Data in Systematic Reviews and Meta-Analysis
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - August 1, 2022 Category: Pediatrics Tags: Online Correspondence Source Type: research

Persistence Matters! Hurdles and High Points of PICU Follow-Up Clinic
No abstract available (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - August 1, 2022 Category: Pediatrics Tags: Online Letters to the Editor Source Type: research

Clinical Decision Support in the PICU: Implications for Design and Evaluation*
CONCLUSIONS: Although providers share some consensus over CDS utility, we identified specific priority areas of research focus. Consensus across practitioners exists around the importance of evidence-based CDS tools having a proven impact on patient safety. Despite broad presence of CDS tools in PICUs, practitioners continue to view them as intrusive and with concern for diminished critical thinking. Deimplementing ineffective CDS may mitigate this burden, though postimplementation evaluation of CDS is rare. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - August 1, 2022 Category: Pediatrics Tags: Online Brief Reports Source Type: research

Polymyxin B Hemoperfusion in Pediatric Septic Shock: Single-Center Observational Case Series
CONCLUSIONS: In this case series of treatment with PMX-DHP as adjunctive therapy in children with refractory septic shock and high baseline severity, we have shown that patient recruitment is feasible. We have also found that clinical hemodynamic and severity of illness scores at 72 hours may be potential end points for testing in future randomized controlled trials. (Source: Pediatric Critical Care Medicine)
Source: Pediatric Critical Care Medicine - August 1, 2022 Category: Pediatrics Tags: Online Brief Reports Source Type: research