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Looking Forward: Contemporary and Emerging Issues in Pediatric Critical Care Medicine
We are delighted to present this Pediatric issue of Critical Care Clinics. In this issue, you will find a variety of topics that address current and evolving issues relevant to the pediatric critical care team. This issue contains a few landscape reviews of old and new therapies, including a review of cardiovascular monitoring, advances in extracorporeal membrane oxygenation, and the application of CAR-T cell therapy for pediatric malignancies. To provide new perspectives on existing issues, we include content focused on transfusion medicine, experiences delivering critical care to adults during early waves of the pandemic...
Source: Critical Care Clinics - March 9, 2023 Category: Intensive Care Authors: Lauren R. Sorce, Joy D. Howell Tags: Preface Source Type: research

A Hybrid Model of Pediatric and Adult Critical Care During the Coronavirus Disease 2019 Surge: The Experience of Two Tertiary Hospitals in London and New York
Conclusions: This hybrid model successfully allowed for the expansion into adult critical care while maintaining essential services for critically ill children. Simultaneous care of adults and children in the ICU can be sustained if healthcare professionals work collaboratively, show proactive insight into anticipated issues, and exhibit clear leadership.
Source: Pediatric Critical Care Medicine - February 1, 2021 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

A point-of-care ultrasound education curriculum for pediatric critical care medicine
We describe a single center ’s approach to POCUS education with improvement in knowledge, self-reported comfort, and attitudes towards procedural and diagnostic POCUS. The curricular resources for adaptation in a similar educational context are provided.
Source: Critical Ultrasound Journal - October 31, 2022 Category: Radiology Source Type: research

Rigorous scoping review of randomized trials in pediatric critical care highlights need for a rigorous rethink
The randomized controlled trial (RCT) remains the highest-ranked study design when grading recommendations for clinical practice. In the previous issue of Critical Care, Duffett and colleagues published a scoping review of RCTs in pediatric critical care medicine and identified some serious gaps in the body of research underlying the field. Relatively few published RCTs were identified, and they were mostly small and potentially susceptible to bias. High patient heterogeneity, relatively low prevalence of specific disorders such as acute respiratory distress syndrome or septic shock, along with relatively low mortality rat...
Source: Critical Care - December 20, 2013 Category: Intensive Care Authors: Adrienne Randolph Source Type: research

Downward Trend in Pediatric Resident Laryngoscopy Participation in PICUs
Objectives: As of July 2013, pediatric resident trainee guidelines in the United States no longer require proficiency in nonneonatal tracheal intubation. We hypothesized that laryngoscopy by pediatric residents has decreased over time, with a more pronounced decrease after this guideline change. Design: Prospective cohort study. Setting: Twenty-five PICUs at various children’s hospitals across the United States. Patients: Tracheal intubations performed in PICUs from July 2010 to June 2016 in the multicenter tracheal intubation database (National Emergency Airway Registry for Children). Intervention: None. ...
Source: Pediatric Critical Care Medicine - May 1, 2018 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Pain and Sedation Management: 2018 Update for the: Rogers’ Textbook of Pediatric Intensive Care
Conclusions: Recent research into pediatric pain and sedation management has focused on optimizing the choice of sedative medications, in particular by increasing the use and understanding of nonopioid and nonbenzodiazepine options such as ketamine and alpha-2 agonists. Delirium has emerged as a significant morbidity in the critically ill pediatric patient, and recent articles have concentrated on the use of validated screening tools to determine the epidemiology and risk factors in specific populations, including patients with cardiac disease and those receiving extracorporeal membrane oxygenation. A consistent theme in...
Source: Pediatric Critical Care Medicine - January 1, 2019 Category: Pediatrics Tags: Rogers’ Update Source Type: research

Postdischarge Outcome Domains in Pediatric Critical Care and the Instruments Used to Evaluate Them: A Scoping Review
Conclusions: A comprehensive, generalizable understanding of outcomes after pediatric critical illness is limited by heterogeneity in methodology, populations, domains, and instruments. Developing assessment standards may improve understanding of postdischarge outcomes and support development of interventions after pediatric critical illness.
Source: Critical Care Medicine - November 22, 2020 Category: Emergency Medicine Tags: Online Review Article Source Type: research

SCCM Pod-95 PCCM: Is the Endotracheal Tube Next to Go
James D. Fortenberry, MD, FCCM, discusses his editorial published in the September 2008 issue of Pediatric Critical Care Medicine, titled "8-Tracks, Betamax... Is the endotracheal tube next to go?" Fortenberry is a pediatric intensivist at Children's Healthcare of Atlanta in Georgia, where he also is the medical director of the system's clinical research. Dr. Fortenberry also is director, division of critical care medicine in the department of pediatrics at Emory University School of Medicine. The editorial was in response to an article published in the same issue by Leticia J. Yanez et al., "A prospective, randomized, con...
Source: SCCM PodCast - iCritical Care - November 19, 2008 Category: Intensive Care Authors: The Society of Critical Care Medicine (SCCM) Tags: Medicine Source Type: podcasts

The Impact of Critical Care Nursing Certification on Pediatric Patient Outcomes*
Conclusions: Bachelor of Science in Nursing education and Critical Care Registered Nurse certification significantly impact pediatric patient outcomes. Recognition of nursing and organizational characteristics that are associated with improved pediatric patient outcomes is important to patients, their families, and society. Clinical leaders must commit to facilitating pathways for hiring candidates with Bachelor of Science in Nursing as a minimum to practice in PICUs and supporting a culture of professional certification.
Source: Pediatric Critical Care Medicine - August 1, 2018 Category: Pediatrics Tags: Cardiac Intensive Care Source Type: research

SCCM Pod-95 PCCM: Is the Endotracheal Tube Next to Go
James D. Fortenberry, MD, FCCM, discusses his editorial published in the September 2008 issue of Pediatric Critical Care Medicine, titled "8-Tracks, Betamax... Is the endotracheal tube next to go?" Fortenberry is a pediatric intensivist at Children's Healthcare of Atlanta in Georgia, where he also is the medical director of the system's clinical research. Dr. Fortenberry also is director, division of critical care medicine in the department of pediatrics at Emory University School of Medicine. The editorial was in response to an article published in the same issue by Leticia J. Yanez et al., "A prospective, randomized, con...
Source: SCCM PodCast - iCritical Care - November 19, 2008 Category: Intensive Care Authors: The Society of Critical Care Medicine (SCCM) Tags: Medicine Source Type: podcasts

A Single Nucleotide Polymorphism in the Corticotropin Receptor Gene Is Associated With a Blunted Cortisol Response During Pediatric Critical Illness*
Conclusions: The A allele at rs1941088 in the MC2R gene, which encodes the adrenocorticotropic hormone (corticotropin, ACTH) receptor, is associated with a low cortisol response in critically ill children. These data provide evidence for a genetic basis for a portion of the variability in cortisol production during critical illness. Independent replication of these findings will be important and could facilitate development of personalized treatment for patients with a low cortisol response to severe illness.
Source: Pediatric Critical Care Medicine - October 1, 2014 Category: Pediatrics Tags: Feature Articles Source Type: research

Clinical Epidemiology of Extubation Failure in the Pediatric Cardiac ICU: A Report From the Pediatric Cardiac Critical Care Consortium*
Objective: To describe the clinical epidemiology of extubation failure in a multicenter cohort of patients treated in pediatric cardiac ICUs. Design: Retrospective cohort study using prospectively collected clinical registry data. Setting: Pediatric Cardiac Critical Care Consortium registry. Patients: All patients admitted to the CICU at Pediatric Cardiac Critical Care Consortium hospitals. Interventions: None. Measurements and Main Results: Analysis of all mechanical ventilation episodes in the registry from October 1, 2013, to July 31, 2014. The primary outcome of extubation failure was reintubation less than 48 hours af...
Source: Pediatric Critical Care Medicine - November 1, 2015 Category: Pediatrics Tags: Cardiac Intensive Care Source Type: research

Characteristics, Risk Factors, and Outcomes of Extracorporeal Membrane Oxygenation Use in Pediatric Cardiac ICUs: A Report From the Pediatric Cardiac Critical Care Consortium Registry
Objectives: Cardiopulmonary failure in children with cardiac disease differs from the general pediatric critical care population, yet the epidemiology of extracorporeal membrane oxygenation support in cardiac ICUs has not been described. We aimed to characterize extracorporeal membrane oxygenation utilization and outcomes across surgical and medical patients in pediatric cardiac ICUs. Design: Retrospective analysis of the Pediatric Cardiac Critical Care Consortium registry to describe extracorporeal membrane oxygenation frequency and outcomes. Within strata of medical and surgical hospitalizations, we identified risk ...
Source: Pediatric Critical Care Medicine - June 1, 2018 Category: Pediatrics Tags: WFPICCS Late Breaker Articles Source Type: research

New Insights Into Multicenter PICU Mortality Among Pediatric Hematopoietic Stem Cell Transplant Patients*
Objectives: Over 2,500 children undergo hematopoietic stem cell transplantation in the United States each year, and up to 35% require PICU support for life-threatening complications. PICU mortality has dropped from 85% to 44%, but interpretation is confounded by significant cohort heterogeneity. Reports conflict regarding outcomes for patients with different underlying hematopoietic stem cell transplantation indications, and the burden of infectious complications for these patients has not been evaluated. We aim to describe infections, critical care interventions, and mortality for pediatric hematopoietic stem cell transpl...
Source: Critical Care Medicine - August 15, 2015 Category: Emergency Medicine Tags: Pediatric Critical Care Source Type: research

Impact of 24/7 In-Hospital Intensivist Coverage on Outcomes in Pediatric Intensive Care: A Multi-Center Study.
CONCLUSIONS: In this large observational study, we demonstrated that pediatric critical care provided in the ICUs staffed by 24/7 intensivist presence is associated with improved overall patient survival and survival after cardiac arrest as compared to patients treated in ICUs staffed by discretionary attending coverage. However, results from a few sensitivity analyses leave some ambiguity in these results. PMID: 27367580 [PubMed - as supplied by publisher]
Source: American Journal of Respiratory and Critical Care Medicine - June 30, 2016 Category: Respiratory Medicine Authors: Gupta P, Rettiganti M, Rice TB, Wetzel RC Tags: Am J Respir Crit Care Med Source Type: research