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Isolated Traumatic Subarachnoid Hemorrhage: An Evaluation of Critical Care Unit Admission Practices and Outcomes From a North American Perspective
The objective of this investigation is to evaluate the association between hospital-level ICU admission practices and clinically important outcomes for patients with isolated traumatic subarachnoid hemorrhage and mild clinical traumatic brain injury. Design: Multicenter observational cohort. Setting: Trauma centers participating in the American College of Surgeons Trauma Quality Improvement Program spanning January 2012 to March 2014. Patients: A total of 14,146 subjects, 16 years old and older, admitted to 215 trauma centers with isolated traumatic subarachnoid hemorrhage and Glasgow Coma Scale score 13 or greate...
Source: Critical Care Medicine - February 23, 2018 Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research

Racial and Ethnic Differences in Inpatient Palliative Care for Pediatric Stem Cell Transplant Patients*
CONCLUSIONS: Racial and ethnic differences exist in the likelihood of receiving palliative care consultations among hospitalized pediatric stem cell transplant recipients. Evaluating the impact of systemic racism and social determinants on palliative care medicine as well as standardizing early integration of IPCC may potentially mitigate disparities in this population.
Source: Pediatric Critical Care Medicine - June 1, 2022 Category: Pediatrics Tags: Feature Articles Source Type: research

Feasibility and Perceptions of PICU Diaries*
Conclusions: The use of ICU diaries in the PICU setting is feasible and perceived as beneficial by families of critically ill children. Future studies are needed to better understand if PICU diaries may objectively improve psychologic outcomes of patients and family members after PICU admission.
Source: Pediatric Critical Care Medicine - February 1, 2019 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Scaling the Measurement of Pediatric Acuity Using the Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO II) Tool.
This study used a modified Delphi technique. RESULTS: Through a series of 3 Delphi rounds, the expert panel identified care items not characterized in the original CAMEO and assigned each of these items a cognitive workload scale of 1 to 5. The expert panel identified 4 additional Domains of Care while confirming the original 14 Domains of Care in the first CAMEO version. The panel agreed that a number of care items could be classified as "Standard of Care," reducing items in the CAMEO and generating a baseline score. The panel, serving as ambassadors and unit-based experts, then implemented the refined CAMEO II in eac...
Source: Dimensions in Critical Care Nursing - April 6, 2019 Category: Nursing Tags: Dimens Crit Care Nurs Source Type: research

Risk Factors for Peri-Intubation Cardiac Arrest in Pediatric Cardiac Intensive Care Patients: A Multicenter Study*
Conclusions: Our most significant finding was a peri-intubation cardiac arrest rate which was much higher than previously published rates for both cardiac and noncardiac children who underwent endotracheal intubation in ICUs. Peri-intubation mortality was also high in our cohort. Regarding risk factors for peri-intubation arrest, significant systolic dysfunction of the systemic ventricle was strongly associated with cardiac arrest in this cohort.
Source: Pediatric Critical Care Medicine - December 1, 2020 Category: Pediatrics Tags: Online Cardiac Intensive Care 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, as i...
Source: Pediatric Critical Care Medicine - May 1, 2021 Category: Pediatrics Tags: Feature Articles 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 - July 1, 2022 Category: Pediatrics Tags: Clinical Investigations Source Type: research

PICU Autopsies: Rates, Patient Characteristics, and the Role of the Medical Examiner*
Objectives: Autopsy rates in North American Children’s hospitals have not been recently evaluated. Our objectives were 1) to determine the autopsy rates from patients cared for in PICUs during a portion of their hospital stay, 2) to identify patient characteristics associated with autopsies, and 3) to understand the relative role of medical examiner cases. Design: Secondary analysis of data prospectively collected from a sample of patients (n = 10,078) admitted to PICUs affiliated with the Collaborative Pediatric Critical Care Research Network between December 2011 and April 2013. Setting: Eight quaternary care P...
Source: Pediatric Critical Care Medicine - December 1, 2018 Category: Pediatrics Tags: Feature Articles Source Type: research

Relationship Between Time to Left Atrial Decompression and Outcomes in Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation Support: A Multicenter Pediatric Interventional Cardiology Early-Career Society Study*
Conclusions: In this multicenter study of pediatric patients receiving venoarterial extracorporeal membrane oxygenation, late left atrial decompression (≥ 18 hr) was associated with longer duration of extracorporeal membrane oxygenation support and mechanical ventilation. Although no survival benefit was demonstrated, the known morbidities associated with prolonged extracorporeal membrane oxygenation use may justify a recommendation for early left atrial decompression.
Source: Pediatric Critical Care Medicine - August 1, 2019 Category: Pediatrics Tags: Cardiac Intensive Care Source Type: research

Rapid Whole Genome Sequencing Has Clinical Utility in Children in the PICU*
Conclusions: This study demonstrates a retrospective evaluation for undiagnosed genetic disease in the PICU and clinical utility of rapid whole genome sequencing in a portion of critically ill children. Further studies are needed to identify PICU patients who will benefit from rapid whole genome sequencing early in PICU admission when the underlying etiology is unclear.
Source: Pediatric Critical Care Medicine - November 1, 2019 Category: Pediatrics Tags: Feature Articles Source Type: research

Evaluation of Pediatric Cardiac ICU Advanced Practice Provider Education and Practice Variation*
Conclusions: Orientation for cardiac ICU advanced practice providers is highly variable, content depends on the institution/preceptor, and competency is not objectively defined or measured. A cardiac ICU advanced practice provider curriculum is needed to standardize education and promote the highest level of advanced practice provider practice.
Source: Pediatric Critical Care Medicine - December 1, 2019 Category: Pediatrics Tags: Cardiac Intensive Care Source Type: research

Abusive Head Trauma and Mortality–An Analysis From an International Comparative Effectiveness Study of Children With Severe Traumatic Brain Injury
Objectives: Small series have suggested that outcomes after abusive head trauma are less favorable than after other injury mechanisms. We sought to determine the impact of abusive head trauma on mortality and identify factors that differentiate children with abusive head trauma from those with traumatic brain injury from other mechanisms. Design: First 200 subjects from the Approaches and Decisions in Acute Pediatric Traumatic Brain Injury Trial—a comparative effectiveness study using an observational, cohort study design. Setting: PICUs in tertiary children’s hospitals in United States and abroad. Patients: Consecutive children (age
Source: Critical Care Medicine - July 15, 2017 Category: Emergency Medicine Tags: Pediatric Critical Care Source Type: research

Strategies for Prevention and Management of Bleeding Following Pediatric Cardiac Surgery on Cardiopulmonary Bypass: A Scoping Review
Conclusions: Overall, this review demonstrates small trial sizes, low level of evidence, and marked heterogeneity of reported endpoints in the included studies. The need for more, higher quality studies reporting clinically relevant, comparable outcomes is highlighted. Emerging fields such as the use of coagulation factor concentrates, goal-directed guidelines, and anti-inflammatory therapies appear to be of particular interest. This scoping review can potentially guide future trial design and form the basis for therapy-specific systematic reviews.
Source: Pediatric Critical Care Medicine - January 1, 2018 Category: Pediatrics Tags: Cardiac Intensive Care Source Type: research

Extracorporeal Cardiopulmonary Resuscitation: One-Year Survival and Neurobehavioral Outcome Among Infants and Children With In-Hospital Cardiac Arrest*
Conclusions: About one third of children survived with good neurobehavioral outcome 1 year after receiving extracorporeal cardiopulmonary resuscitation for in-hospital arrest. Open-chest cardiac massage and minimum postarrest lactate were associated with survival with good neurobehavioral outcome at 1 year.
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Pediatric Critical Care Source Type: research