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Fluid Overload in Pediatric Severe Traumatic Brain Injury*
Conclusions: Patients with severe traumatic brain injury do have high rates of fluid overload. However, fluid overload did not contribute to mortality, longer days on the ventilator, increased risk of acute kidney injury, or increased PICU length of stay.
Source: Pediatric Critical Care Medicine - February 1, 2020 Category: Pediatrics Tags: Neurocritical Care Source Type: research

Pediatric Cardiac Intensive Care Distribution, Service Delivery, and Staffing in the United States in 2018*
Objectives: To assess the distribution, service delivery, and staffing of pediatric cardiac intensive care in the United States. Design: Based on a 2016 national PICU survey, and verified through online searching and clinician networking, medical centers were identified with a separate cardiac ICU or mixed ICU. These centers were sent a structured web-based survey up to four times, with follow-up by mail and phone for nonresponders. Setting: Cardiac ICUs were defined as specialized units, specifically for the treatment of children with life-threatening primary cardiac conditions. Mixed ICUs were defined as separate...
Source: Pediatric Critical Care Medicine - September 1, 2020 Category: Pediatrics Tags: Cardiac Intensive Care Source Type: research

Association Between Elevated RBC Distribution Width and Multiple Organ Dysfunction in Pediatric Critical Illness
Objectives: RBC distribution width, a part of the complete blood count, has been shown in several published studies to be a strong biomarker of adverse outcomes. We sought to determine the association between admission RBC distribution width value and clinical outcomes including multiple organ dysfunction, mechanical ventilation days, PICU length of stay, and hospital length of stay in children admitted to the PICU. Design: Single center, retrospective study. Setting: A tertiary pediatric hospital in the United States. Patients: All subjects admitted to the PICU from 2016 to 2017. Exclusions: Greater than 21 yea...
Source: Pediatric Critical Care Medicine - September 1, 2020 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Impact of Failure of Noninvasive Ventilation on the Safety of Pediatric Tracheal Intubation*
The objective of this study was to assess whether noninvasive ventilation failure was associated with severe tracheal intubation-associated events and severe oxygen desaturation during tracheal intubation. Design: Prospective multicenter cohort study of consecutive intubated patients using the National Emergency Airway Registry for Children registry. Setting: Thirteen PICUs (in 12 institutions) in the United States and Canada. Patients: All patients undergoing tracheal intubation in participating sites were included. Noninvasive ventilation failure group included children with any use of high-flow nasal cannula, c...
Source: Critical Care Medicine - September 12, 2020 Category: Emergency Medicine Tags: Pediatric Critical Care Source Type: research

Life-Threatening Bleeding in Children: A Prospective Observational Study
CONCLUSIONS: Patient characteristics and outcomes among children with life-threatening bleeding varied by cause of bleeding. Mortality was high, and death from hemorrhage in this population occurred rapidly.
Source: Critical Care Medicine - October 25, 2021 Category: Emergency Medicine Tags: Pediatric Critical Care Source Type: research

Mortality Risk in Pediatric Sepsis Based on C-reactive Protein and Ferritin Levels
CONCLUSIONS: Bedside CRP and ferritin levels can be used together to distinguish groups of children with sepsis who have different systemic inflammation cytokine responses and mortality risks. These data suggest future potential value in personalized clinical trials with specific targets for anti-inflammatory therapies.
Source: Pediatric Critical Care Medicine - December 1, 2022 Category: Pediatrics Tags: Feature Articles Source Type: research

Development of an Undergraduate Medical Education Critical Care Content Outline Utilizing the Delphi Method
Conclusions: This study provides a national consensus undergraduate medical education critical care content outline. By including experts from multiple specialties, this content outline is meaningful for medical student education, independent of medical specialty. The content outline represents a first step in the development of a national undergraduate medical education critical care curriculum.
Source: Critical Care Medicine - December 14, 2019 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Geospatial Analysis of Social Determinants of Health Identifies Neighborhood Hot Spots Associated With Pediatric Intensive Care Use for Acute Respiratory Failure Requiring Mechanical Ventilation*
CONCLUSIONS: Social determinants of health identified by geospatial analyses are associated with acute respiratory failure requiring invasive mechanical ventilation in critically ill children. Interventions addressing the neighborhood social vulnerability and child opportunity are needed to decrease disparities in intensive care admissions for acute respiratory failure requiring mechanical ventilation.
Source: Pediatric Critical Care Medicine - August 1, 2022 Category: Pediatrics Tags: Feature Articles Source Type: research

Screening for Social Determinants of Health in the Pediatric Intensive Care Unit
Social determinants of health (SDoH) play a significant role in the health and well-being of children in the United States. Disparities in the risk and outcomes of critical illness have been extensively documented but are yet to be fully explored through the lens of SDoH. In this review, we provide justification for routine SDoH screening as a critical first step toward understanding the causes of, and effectively addressing health disparities affecting critically ill children. Second, we summarize important aspects of SDoH screening that need to be considered before implementing this practice in the pediatric critical care setting.
Source: Critical Care Clinics - November 17, 2022 Category: Intensive Care Authors: Manzilat Akande, Erin T. Paquette, Paula Magee, Mallory A. Perry-Eaddy, Ericka L. Fink, Katherine N. Slain Source Type: research

Choosing Wisely in Critical Care: Results of a National Survey From the Critical Care Societies Collaborative*
Conclusions: The results provide information on the application of the Choosing Wisely recommendations to clinical practice from a small sample of critical care clinicians. However, as only half of the respondents report implementation, additional strategies are needed to promote the Choosing Wisely recommendations to make impactful change to improve care in ICU settings.
Source: Critical Care Medicine - February 16, 2019 Category: Emergency Medicine Tags: Feature Article Source Type: research

Workforce, Workload, and Burnout in Critical Care Organizations: Survey Results and Research Agenda*
Conclusions: The variability of current approaches suggests that systematic comparative analyses could identify best organizational practices. The research agenda for the study of critical care organizations should include studies that provide insights regarding the effects of the integrative structure of critical care organizations on outcomes at the levels of our patients, our workforce, our work practices, and sustainability.
Source: Critical Care Medicine - October 14, 2020 Category: Emergency Medicine Tags: Feature Articles Source Type: research

Quick Sequential Organ Failure Assessment and Systemic Inflammatory Response Syndrome Criteria as Predictors of Critical Care Intervention Among Patients With Suspected Infection*
In this study, we introduce the novel outcome of “received critical care intervention” and investigate the related predictive performance of both the quick Sequential Organ Failure Assessment and the Systemic Inflammatory Response Syndrome criteria. Design: Design:This was a single-center, retrospective analysis of electronic health records. Setting: Setting:Tertiary care hospital in the United States. Patients: Patients:Patients with suspected infection who presented to the emergency department and were admitted to the hospital between January 2010 and December 2014. Interventions: Interventions:Systemic Inflammat...
Source: Critical Care Medicine - October 17, 2017 Category: Emergency Medicine Tags: Feature Articles Source Type: research

Critical Care Response to COVID-19 Pandemic: Building on the Past to Bridge to the Future
At the end of 2021, the COVID-19 pandemic led to more than 286 million cases and over 5.4 million deaths worldwide. COVID-19 is now the deadliest pandemic in the history of the United States. As we reflect on the last 2 years, it is also clear that the pandemic was a pivotal moment for critical care medicine. Never before have the availability and delivery of intensive care medicine been so crucial in a health care crisis. Common critical care issues like acute respiratory distress syndrome (ARDS), ventilators, proning, dialysis, sepsis, and respiratory failure were commonly discussed in the press and social media.
Source: Critical Care Clinics - March 20, 2022 Category: Intensive Care Authors: Michelle Ng Gong, Gregory S. Martin Tags: Preface Source Type: research

Certified and Advanced Degree Critical Care Nurses Improve Patient Outcomes
The need for highly skilled and knowledgeable critical care nurses continues to evolve today and will in the future. Demands in critical care medicine for nurses with advanced degrees (master's in nursing: clinical nurse specialist; or doctorate in nursing: doctorate of philosophy in nursing or doctor of nursing practice) working in intensive care units or progressive care units can help meet these challenges. Nurses with certification and advanced degrees in nursing can be employed to work in 1 or combined roles such as nurse leaders and nurse researcher or intermittently fulfill roles as bedside nurses. These nurses work...
Source: Dimensions of Critical Care Nursing - February 1, 2019 Category: Nursing Tags: Leadership DIMENSION Source Type: research

SCCM Pod-483 Clinicians, Patient Outcomes, and Implicit Bias
Implicit bias is a form of automatic and unintentional bias that affects judgments, decisions, and behaviors. Implicit bias can pose a barrier to the diagnosis and treatment of critical illness. Ludwig H. Lin, MD, is joined by Varun U. Shetty, MD, to discuss ways that critical care professionals can mitigate diagnostic delays and errors by being aware of their own implicit biases. Dr. Shetty is an adult intensivist who focuses on caring for critically ill patients in global health settings. He has worked both in the United States and abroad in resource-limited settings and has presented several lectures on healthcare dispa...
Source: SCCM PodCast - iCritical Care - July 5, 2023 Category: Intensive Care Authors: The Society of Critical Care Medicine (SCCM) Tags: Medicine Source Type: podcasts