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Pediatric Critical Care Medicine

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https://www.readbyqxmd.com/read/29782390/suspecting-hyperferritinemic-sepsis-in-iron-deficient-population-do-we-need-a-lower-plasma-ferritin-threshold
#1
Swarup Ghosh, Arun K Baranwal, Prateek Bhatia, Karthi Nallasamy
OBJECTIVES: Hyperferritinemia is being suggested to identify patients with sepsis-induced macrophage activation syndrome for early intervention. However, data among iron-deficient children are scarce. This study was planned to explore the biological behavior of plasma ferritin in children from communities with a high frequency of iron deficiency with septic shock and its association with the outcome. DESIGN: Prospective observational study. SETTING: Tertiary care teaching hospital in a low-middle income economy of South Asia...
May 18, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29781955/involvements-of-parents-in-the-care-of-preterm-infants-a-pilot-study-evaluating-a-family-centered-care-intervention-in-a-chinese-neonatal-icu
#2
Rong Zhang, Rui-Wena Huang, Xi-Ronga Gao, Xiao-Minga Peng, Li-Hui Zhu, Ramanathan Rangasamy, Jos M Latour
OBJECTIVES: To evaluate the effectiveness and safety of a family-centered care intervention in a Chinese neonatal ICU. DESIGN: Pilot study using a randomized controlled trial design to inform a main randomized controlled trial study. SETTING: Stand-alone tertiary children's hospital in China with a 60-bed neonatal ICU serving as a regional neonatal ICU center. PATIENTS: Premature infants (n = 61) and their parents (n = 110)...
May 17, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29727354/applying-machine-learning-to-pediatric-critical-care-data
#3
Jon B Williams, Debjit Ghosh, Randall C Wetzel
OBJECTIVES: To explore whether machine learning applied to pediatric critical care data could discover medically pertinent information, we analyzed clinically collected electronic medical record data, after data extraction and preparation, using k-means clustering. DESIGN: Retrospective analysis of electronic medical record ICU data. SETTING: Tertiary Children's Hospital PICU. PATIENTS: Anonymized electronic medical record data from PICU admissions over 10 years...
April 30, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29677033/characterization-of-the-glucocorticoid-receptor-in-children-undergoing-cardiac-surgery
#4
Saul Flores, David S Cooper, Amy M Opoka, Ilias Iliopoulos, Sarah Pluckebaum, Matthew N Alder, Kelli A Krallman, Rashmi D Sahay, Lin Fei, Hector R Wong
OBJECTIVES: Postoperative administration of corticosteroids is common practice for managing catecholamine refractory low cardiac output syndrome. Since corticosteroid activity is dependent on the glucocorticoid receptor, we sought to characterize glucocorticoid receptor levels in children undergoing cardiac surgery and examined the association between glucocorticoid receptor levels and cardiovascular dysfunction. DESIGN: Prospective observational cohort study. SETTING: Large, tertiary pediatric cardiac center...
April 19, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29677032/landiolol-hydrochloride-rapidly-controls-junctional-ectopic-tachycardia-after-pediatric-heart-surgery
#5
Fumiya Yoneyama, Chiho Tokunaga, Hideyuki Kato, Tomomi Nakajima, Bryan J Mathis, Hiroaki Sakamoto, Yuji Hiramatsu
OBJECTIVES: Junctional ectopic tachycardia is a supraventricular tachyarrhythmia with atrioventricular dissociation that causes life-threatening postsurgical conditions in pediatric heart patients. This study evaluates the efficacy of landiolol hydrochloride for managing junctional ectopic tachycardia. DESIGN: A single-center retrospective study. SETTING: PICU at the university hospital. PATIENTS: Of 561 pediatric patients who underwent open-heart surgery between 2006 and 2017, 10 patients developed sustained junctional ectopic tachycardia and were selected for landiolol treatment...
April 19, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29664875/do-not-resuscitate-orders-in-the-neonatal-icu-experiences-and-beliefs-among-staff
#6
Bonnie H Arzuaga, C Lydia Wraight, Christy L Cummings, Wenyang Mao, David Miedema, Dara D Brodsky
OBJECTIVES: Studies in adult patients have shown that do-not-resuscitate orders are often associated with decreased medical intervention. In neonatology, this phenomenon has not been investigated, and how do-not-resuscitate orders potentially affect clinical care is unknown. DESIGN: Retrospective medical record data review and staff survey responses about neonatal ICU do-not-resuscitate orders. SETTING: Four academic neonatal ICUs. SUBJECTS: Clinical staff members working in each neonatal ICU...
April 16, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29664874/traumatic-brain-injury-and-infectious-encephalopathy-in-children-from-four-resource-limited-settings-in-africa
#7
Ericka L Fink, Amelie von Saint Andre-von Arnim, Rashmi Kumar, Patrick T Wilson, Tigist Bacha, Abenezer Tirsit Aklilu, Tsegazeab Laeke Teklemariam, Shubhada Hooli, Lisine Tuyisenge, Easmon Otupiri, Anthony Fabio, John Gianakas, Patrick M Kochanek, Derek C Angus, Robert C Tasker
OBJECTIVES: To assess the frequency, interventions, and outcomes of children presenting with traumatic brain injury or infectious encephalopathy in low-resource settings. DESIGN: Prospective study. SETTING: Four hospitals in Sub-Saharan Africa. PATIENTS: Children age 1 day to 17 years old evaluated at the hospital with traumatic brain injury or infectious encephalopathy. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We evaluated the frequency and outcomes of children presenting consecutively over 4 weeks to any hospital department with traumatic brain injury or infectious encephalopathy...
April 16, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29664873/effects-of-a-picu-status-asthmaticus-de-escalation-pathway-on-length-of-stay-and-albuterol-use
#8
Steven Brennan, Lia Lowrie, Jamie Wooldridge
OBJECTIVES: Evaluate the effects of an asthma de-escalation clinical pathway on selected outcomes for patients admitted to a PICU with status asthmaticus. DESIGN: Time series quality improvement trial. SETTING: PICU in a tertiary care children's hospital. PATIENTS: Children age 2-18 years old with a known diagnosis of asthma presenting with status asthmaticus. INTERVENTION: One-hundred five admissions to a PICU for status asthmaticus were treated according to a new de-escalation pathway between August 15, 2015, and August 30, 2016...
April 16, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29659416/a-pilot-randomized-controlled-trial-of-an-intervention-to-promote-psychological-well-being-in-critically-ill-children-soothing-through-touch-reading-and-music
#9
Janet E Rennick, Robyn Stremler, Linda Horwood, Marilyn Aita, Tanya Lavoie, Annette Majnemer, Marie Antonacci, Alyssa Knox, Evelyn Constantin
OBJECTIVES: To examine the feasibility and acceptability of a PICU Soothing intervention using touch, reading, and music. DESIGN: Nonblinded, pilot randomized controlled trial. SETTING: The PICU and medical-surgical wards of one Canadian pediatric hospital. PATIENTS: Twenty PICU patients age 2-14 years old and their parents, randomized to an intervention group (n = 10) or control group (n = 10). INTERVENTION: PICU Soothing consisted of: 1) parental comforting (touch and reading), followed by 2) a quiet period with music via soft headbands, administered once daily throughout hospitalization...
April 13, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29659415/functional-status-change-among-children-with-extracorporeal-membrane-oxygenation-to-support-cardiopulmonary-resuscitation-in-a-pediatric-cardiac-icu-a-single-institution-report
#10
Asaad G Beshish, Mathew R Baginski, Thomas J Johnson, Barry K Deatrick, Ryan P Barbaro, Gabe E Owens
OBJECTIVES: The purpose of this study is to describe the functional status of survivors from extracorporeal cardiopulmonary resuscitation instituted during in-hospital cardiac arrest using the Functional Status Scale. We aimed to determine risk factors leading to the development of new morbidity and unfavorable functional outcomes. DESIGN: This was a single-center retrospective chart review abstracting patient characteristics/demographic data, duration of cardiopulmonary resuscitation, duration of extracorporeal membrane oxygenation support, as well as maximum lactate levels within 2 hours before and after extracorporeal cardiopulmonary resuscitation...
April 13, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29652753/hybrid-extracorporeal-therapies-as-a-bridge-to-pediatric-liver-transplantation
#11
Ayse Akcan Arikan, Poyyapakkam Srivaths, Ryan W Himes, Naile Tufan Pekkucuksen, Fong Lam, Trung Nguyen, Tamir Miloh, Michael Braun, John Goss, Moreshwar S Desai
OBJECTIVES: Standard intensive care treatment is inadequate to keep children with liver failure alive without catastrophic complications to ensure successful transplant, as accumulation of endogenous protein-bound toxins often lead to hepatic encephalopathy, hepatorenal syndrome, cardiovascular instability, and multiple organ failure. Given paucity of proven treatment modalities for liver failure, blood purification using different extracorporeal treatments as a bridge to transplantation is used, but studies evaluating the safety and efficacy of combination of these therapies, especially in pediatric liver failure, are lacking...
April 12, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29652752/practice-change-from-intermittent-medication-boluses-to-bolusing-from-a-continuous-infusion-in-pediatric-critical-care-a-quality-improvement-project
#12
Jessica L Hochstetler, A Jill Thompson, Natalie M Ball, Melissa C Evans, Shaun C Frame, A Lauren Haney, Amelia K Little, Jaime L O'Donnell, Bryna M Rickett, Elizabeth H Mack
OBJECTIVES: To determine whether implementing a guideline to bolus medications from continuous infusions in PICUs affects nursing satisfaction, patient safety, central line entries, medication utilization, or cost. DESIGN: This is a pre- and postimplementation quality improvement study. SETTING: An 11-bed ICU and 14-bed cardiac ICU in a university-affiliated children's hospital. PATIENTS: Patients less than 18 years old admitted to the PICU or pediatric cardiac ICU receiving a continuous infusion of dexmedetomidine, midazolam, fentanyl, morphine, vecuronium, or cisatracurium from May 2015 to May 2016, excluding November 2015 (washout period), were eligible for inclusion...
April 12, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29652751/igniting-innovation-in-healthcare-a-novel-collaborative-multidisciplinary-approach-in-a-picu
#13
Marcelo R Malakooti
Generating innovation in the healthcare setting faces a number of challenges when compared with industry counterparts. More than ever, innovation occupies a critical element for healthcare organizations aspiring toward clinical, research and strategic excellence, although it may not exist as a priority due to a number of barriers. There are several strategies in other industries from which healthcare organizations can borrow, such as using nontraditional methods of problem solving, group ideation, and cross-pollination...
April 12, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29652750/a-needs-assessment-of-brain-death-education-in-pediatric-critical-care-medicine-fellowships
#14
Andrew M Ausmus, Pippa M Simpson, Liyun Zhang, Tara L Petersen
OBJECTIVES: To assess the current training in brain death examination provided during pediatric critical care medicine fellowship. DESIGN: Internet-based survey. SETTING: United States pediatric critical care medicine fellowship programs. SUBJECTS: Sixty-four pediatric critical care medicine fellowship program directors and 230 current pediatric critical care medicine fellows/recent graduates were invited to participate...
April 12, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29652749/sera-from-children-after-cardiopulmonary-bypass-reduces-permeability-of-capillary-endothelial-cell-barriers
#15
Richard W Pierce, Riad Abou Zahr, Sarah Kandil, E Vincent S Faustino, Jordan S Pober
OBJECTIVES: Children undergoing cardiopulmonary bypass develop clinically impactful capillary leak of unclear etiology. A widely held hypothesis that exposure of circulating cells to the cardiopulmonary bypass circuit induces the release of inflammatory mediators that act to disrupt intercellular junctions of capillary endothelial cells inducing paracellular capillary leak either directly or through new gene expression. DESIGN: Cohort study. SETTING: Tertiary pediatric hospital...
April 12, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29649021/impressions-of-early-mobilization-of-critically-ill-children-clinician-patient-and-family-perspectives
#16
Katina Zheng, Aimee Sarti, Sama Boles, Saoirse Cameron, Robert Carlisi, Heather Clark, Adeeb Khawaji, Saif Awladthani, Samah Al-Harbi, Karen Choong
OBJECTIVES: To understand patient, family caregiver, and clinician impressions of early mobilization, the perceived barriers and facilitators to its implementation, and the use of in-bed cycling as a method of mobilization. DESIGN: A qualitative study, conducted as part of the Early Exercise in Critically ill Youth and Children, a preliminary Evaluation (wEECYCLE) Pilot randomized controlled trial. SETTING: McMaster Children's Hospital PICU, Hamilton, ON, Canada...
April 11, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29557840/an-exploratory-study-of-sevoflurane-as-an-alternative-for-difficult-sedation-in-critically-ill-children
#17
Santiago Mencía, Alba Palacios, Miriam García, Ana M Llorente, Olga Ordóñez, Blanca Toledo, Jesús López-Herce
OBJECTIVES: To analyze the effectiveness of inhaled sevoflurane in critically ill children with challenging sedation. DESIGN: Prospective case series. SETTING: Two PICUs of university hospitals in Spain. INTERVENTIONS: Prospective observational study and exploratory investigation conducted in two PICUs in Madrid, Spain, over a 6-year period. Children treated with inhaled sevoflurane due to difficult sedation were included...
March 19, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29547457/retrospective-application-of-new-pediatric-ventilator-associated-pneumonia-criteria-identifies-a-high-risk-population
#18
Ashley Gionfriddo, Mika L Nonoyama, Peter C Laussen, Peter N Cox, Megan Clarke, Alejandro A Floh
OBJECTIVES: To promote standardization, the Centers for Disease Control and Prevention introduced a new ventilator-associated pneumonia classification, which was modified for pediatrics (pediatric ventilator-associated pneumonia according to proposed criteria [PVAP]). We evaluated the frequency of PVAP in a cohort of children diagnosed with ventilator-associated pneumonia according to traditional criteria and compared their strength of association with clinically relevant outcomes. DESIGN: Retrospective cohort study...
March 15, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29543684/effect-of-a-sepsis-educational-intervention-on-hospital-stay
#19
Jaime Fernández-Sarmiento, Joseph A Carcillo, Claudia M Salinas, Edgar F Galvis, Paula A López, Andrés Jagua-Gualdrón
OBJECTIVES: To evaluate adherence to the sepsis bundle before and after an educational strategy and its impact on hospital stay. DESIGN: A prospective, analytic, before-and-after study of children with severe sepsis and septic shock who presented to the emergency department. SETTING: Carried out from January to December 2014 in the emergency department of a quaternary care hospital. PATIENTS: Of a total of 19,836 children who presented to the emergency department, 4,383 had an infectious pathology, with 203 of these showing severe sepsis and septic shock (124 pre intervention, and 79 post intervention)...
March 14, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29538053/prevention-of-low-cardiac-output-syndrome-after-pediatric-cardiac-surgery-a-double-blind-randomized-clinical-pilot-study-comparing-dobutamine-and-milrinone
#20
Anna Cavigelli-Brunner, Maja I Hug, Hitendu Dave, Oskar Baenziger, Christoph Buerki, Dominique Bettex, Vincenzo Cannizzaro, Christian Balmer
OBJECTIVES: Dobutamine and milrinone are commonly used after open-heart surgery to prevent or treat low cardiac output syndrome. We sought to compare efficacy and safety of these drugs in pediatric patients. DESIGN: Prospective, single-center, double-blinded, randomized clinical pilot study. SETTING: Tertiary-care university children's hospital postoperative pediatric cardiac ICU. PATIENTS: After written consent, 50 consecutive patients (age, 0...
March 13, 2018: Pediatric Critical Care Medicine
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