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Pediatric Critical Care Medicine

Baljit Cheema, Tyson Welzel, Beyra Rossouw
OBJECTIVES: Noninvasive ventilation is increasingly used in neonatal and pediatric patients, but the intensive care transport setting is lagging in terms of availability of noninvasive ventilation for children. The objective of this systematic review of the literature was to answer the question: In children 0 days to 18 years old, who are hospitalized with acute respiratory distress and require critical care transport, is noninvasive ventilation effective and safe during transport? DATA SOURCES: MEDLINE via PubMed, EMBASE (via Scopus), Cochrane Central Register of Controlled Trials, African Index Medicus, Web of Science Citation Index, and the World Health Organization Trials Registry...
November 15, 2018: Pediatric Critical Care Medicine
Athena F Zuppa, Nicole R Zane, Ganesh Moorthy, Heidi J Dalton, Alan Abraham, Ron W Reeder, Joseph A Carcillo, Andrew R Yates, Kathleen L Meert, Robert A Berg, Anil Sapru, Peter Mourani, Daniel A Notterman, J Michael Dean, Marc R Gastonguay
OBJECTIVES: Limited data exist on the effects of extracorporeal membrane oxygenation on pharmacokinetics of cefepime in critically ill pediatric patients. The objective was to describe cefepime disposition in children treated with extracorporeal membrane oxygenation using population pharmacokinetic modeling. DESIGN: Multicenter, prospective observational study. SETTING: The pediatric and cardiac ICUs of six sites of the Collaborative Pediatric Critical Care Research Network...
November 13, 2018: Pediatric Critical Care Medicine
Gerard Cortina, Rosemary McRae, Monsurul Hoq, Susan Donath, Roberto Chiletti, Marjan Arvandi, Raffaella M Gothe, Michael Joannidis, Warwick Butt
OBJECTIVE: To identify risk factors associated with mortality in critically ill children requiring continuous renal replacement therapy. DESIGN: Retrospective observational study based on a prospective registry. SETTING: Tertiary and quaternary referral 30-bed PICU. PATIENTS: Critically ill children undergoing continuous renal replacement therapy were included in the study. INTERVENTIONS: Continuous renal replacement therapy...
November 13, 2018: Pediatric Critical Care Medicine
Michael C Hooper, Pradip P Kamat, Kevin G Couloures
OBJECTIVES: Pediatric procedural sedation has been increasingly performed by pediatric intensivists over the past decade. Pediatric Critical Care Medicine fellowship guidelines do not specify how fellows obtain proficiency in pediatric procedural sedation. We sought to survey the state of pediatric procedural sedation training during fellowship and whether fellows thought it was sufficient. DESIGN: A 21-question survey gathered data on pediatric procedural sedation training provided to Pediatric Critical Care Medicine fellows...
November 13, 2018: Pediatric Critical Care Medicine
Marianne E Nellis, Ruchika Goel, Oliver Karam, Melissa M Cushing, Peter J Davis, Marie E Steiner, Marisa Tucci, Simon J Stanworth, Philip C Spinella
OBJECTIVES: To determine if transfusing ABO compatible platelets has a greater effect on incremental change in platelet count as compared to ABO incompatible platelets in critically ill children. DESIGN: Secondary analysis of a prospective, observational study. Transfusions were classified as either ABO compatible, major incompatibility, or minor incompatibility. The primary outcome was the incremental change in platelet count. Transfusion reactions were analyzed as a secondary outcome...
November 12, 2018: Pediatric Critical Care Medicine
Jeanie L Gribben, Samuel M Kase, Elisha D Waldman, Andrea S Weintraub
OBJECTIVES: To determine the prevalence of compassion fatigue, burnout, and compassion satisfaction and identify potential personal and professional predictors of these phenomena in pediatric critical care providers. DESIGN: Cross-sectional, online survey. SETTING: Pediatric critical care practices in the United States. SUBJECTS: Pediatric critical care fellows and attending physicians. INTERVENTIONS: None...
November 9, 2018: Pediatric Critical Care Medicine
Lauren M Yagiela, Ryan P Barbaro, Michael W Quasney, Marie A Pfarr, Dan C Ursu, Lisa A Prosser, Fola O Odetola
OBJECTIVES: To quantify home care needs, healthcare utilization, and 2-year mortality after pediatric critical illness due to respiratory failure, and evaluate the impact of new morbidity and abnormal function at hospital discharge on resource use and outcomes. DESIGN: Retrospective cohort study. SETTING: Quaternary care PICU. PATIENTS: Patients less than or equal to 18 years with respiratory failure from January 1, 2013, to December 31, 2014...
November 9, 2018: Pediatric Critical Care Medicine
Robert P Richter, Jeffrey A Alten, R Wilson King, Asaf D Gans, Fazlur Rahman Akm, Yuvraj Kalra, Santiago Borasino
OBJECTIVES: Compare the impact of initial extubation to positive airway pressure versus high-flow nasal cannula on postoperative outcomes in neonates and infants after congenital heart surgery. DESIGN: Retrospective cohort study with propensity-matched analysis. SETTING: Cardiac ICU within a tertiary care children's hospital. PATIENTS: Patients less than 6 months old initially extubated to either high-flow nasal cannula or positive airway pressure after cardiac surgery with cardiopulmonary bypass were included (July 2012 to December 2015)...
November 7, 2018: Pediatric Critical Care Medicine
Jan Hau Lee, Gabrielle Nuthall, Takanari Ikeyama, Osamu Saito, Yee Hui Mok, Michael Shepherd, Philipp Jung, Rakshay Shetty, Sujatha Thyagarajan, Sholeen Nett, Natalie Napolitano, Vinay Nadkarni, Akira Nishisaki
OBJECTIVES: It is unknown if variation in tracheal intubation practice and outcomes exist across PICUs in different geographical regions. We hypothesized there would be differences in the process of care and adverse outcomes for tracheal intubation across PICUs in six different geographical regions (New Zealand, Japan, Singapore, Germany, India, and North America). DESIGN: Prospective multicenter pediatric tracheal intubation database (National Emergency Airway Registry for Children) SETTING:: Six non-North American (International) and 36 North American PICUs...
November 7, 2018: Pediatric Critical Care Medicine
Siva P Namachivayam, Warwick Butt, Johnny Millar, Igor E Konstantinov, Cattram Nguyen, Yves d'Udekem
OBJECTIVES: Early peritoneal dialysis may have a role in modulating the inflammatory response after cardiopulmonary bypass. This study sought to test the effect of early peritoneal dialysis on major adverse events after pediatric cardiac surgery involving cardiopulmonary bypass. DESIGN: In this observational study, the outcomes in infants post cardiac surgery who received early peritoneal dialysis (within 6 hr of completing cardiopulmonary bypass) were compared with those who received late peritoneal dialysis...
November 5, 2018: Pediatric Critical Care Medicine
Katie M Moynihan, Andrew Barlow, Claire Heney, Julia E Clark, Sanmarié Schlebusch, Luregn J Schlapbach
OBJECTIVES: Reduction of nosocomial infections represents an increasingly recognized aspect of PICU benchmarking. We investigated the prevalence and outcomes of viral respiratory infections acquired during admission to PICU. DESIGN: Multicenter, statewide retrospective linkage study. SETTING: Tertiary PICU. PATIENTS: All children less than 16 years requiring PICU admission for greater than 48 hours from January 1, 2008, until December 31, 2013...
November 5, 2018: Pediatric Critical Care Medicine
Steven L Shein, Justin Hotz, Robinder G Khemani
OBJECTIVES: To derive and validate a score that correlates with an objective measurement of a child's effort of breathing. DESIGN: Secondary analysis of a previously conducted observational study. SETTING: The pediatric and cardiothoracic ICUs of a quaternary-care children's hospital. PATIENTS: Patients more than 37 weeks gestational age to age 18 years who were undergoing extubation. INTERVENTIONS: Effort of breathing was measured in patients following extubation using esophageal manometry to calculate pressure rate product...
November 2, 2018: Pediatric Critical Care Medicine
Jenny V Morris, Melpo Kapetanstrataki, Roger C Parslow, Peter J Davis, Padmanabhan Ramnarayan
OBJECTIVES: To 1) describe patterns of use of high-flow nasal cannula therapy, 2) examine differences between patients started on high-flow nasal cannula and those started on noninvasive ventilation, and 3) explore whether patients who failed high-flow nasal cannula therapy were different from those who did not. DESIGN: Retrospective analysis of data collected prospectively by the Paediatric Intensive Care Audit Network. SETTING: All PICUs in the United Kingdom and Republic of Ireland (n = 34)...
November 2, 2018: Pediatric Critical Care Medicine
Phillip S Adams, Diana Vargas, Tracy Baust, Lucas Saenz, Wonshill Koh, Brian Blasiole, Patrick M Callahan, Aparna S Phadke, Khoa N Nguyen, Yuliya Domnina, Mahesh Sharma, John A Kellum, Joan Sanchez-de-Toledo
OBJECTIVES: Examine the relationship between perioperative renal regional tissue oximetry, urinary biomarkers, and acute kidney injury in infants after congenital cardiac surgery with cardiopulmonary bypass. DESIGN: Prospective, observational. SETTING: Cardiac operating room and cardiac ICU. PATIENTS: Neonates and infants without history of kidney injury or anatomic renal abnormality. INTERVENTIONS: None...
November 2, 2018: Pediatric Critical Care Medicine
Tanya Mokhateb-Rafii, Adnan Bakar, Sandeep Gangadharan, Eleanor A Gradidge, David Tellez, Michael Ruppe, Sarah Tallent, Geoffrey Bird, Natasha Lavin, Anthony Lee, Natalie Napolitano, Vinay Nadkarni, Justine Shults, Akira Nishisaki
OBJECTIVES: To determine a level of oxygen desaturation from baseline that is associated with increased risk of tracheal intubation associated events in children with cyanotic and noncyanotic heart disease. DESIGN: Retrospective analysis of prospectively collected data from the National Emergency Airway Registry for Children, an international multicenter quality improvement collaborative for airway management in critically ill children. SETTING: Thirty-eight PICUs from July 2012 to December 2016...
November 1, 2018: Pediatric Critical Care Medicine
Nicole F O'Brien, Sandra D W Buttram, Tensing Maa, Marlina E Lovett, Karin Reuter-Rice, Kerri L LaRovere
OBJECTIVES: To explore changes to expected, age-related transcranial Doppler ultrasound variables during pediatric extracorporeal membrane oxygenation. DESIGN: Prospective, observational, multicenter study. SETTING: Tertiary care PICUs. PATIENTS: Children 1 day to 18 years old requiring veno arterial extracorporeal membrane oxygenation. METHODS: Participants underwent daily transcranial Doppler ultrasound measurement of bilateral middle cerebral artery flow velocities...
November 1, 2018: Pediatric Critical Care Medicine
Zachary J Berrens, Craig H Gosdin, Patrick W Brady, Ken Tegtmeyer
OBJECTIVES: Satellite inpatient facilities of larger children's hospitals often do not have on-site intensivist support. In-house rapid response teams and code teams may be difficult to operationalize in such facilities. We developed a system using telemedicine to provide pediatric intensivist involvement in rapid response team and code teams at the satellite facility of our children's hospital. Herein, we compare this model with our in-person model at our main campus. DESIGN: Cross-sectional...
November 1, 2018: Pediatric Critical Care Medicine
Corina Noje, Melania M Bembea, Kristen L Nelson McMillan, Marissa A Brunetti, Meghan L Bernier, Philomena M Costabile, Bruce L Klein, Jordan Duval-Arnould, Elizabeth A Hunt, Donald H Shaffner
OBJECTIVES: To describe the U.S. experience with interhospital transport of children in cardiac arrest undergoing cardiopulmonary resuscitation. DESIGN: Self-administered electronic survey. SETTING: Pediatric transport teams listed with the American Academy of Pediatrics Section on Transport Medicine. SUBJECTS: Leaders of U.S. pediatric transport teams. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Sixty of the 88 teams surveyed (68%) responded...
November 1, 2018: Pediatric Critical Care Medicine
Elliot Melendez, Jane E Whitney, Jackson S Norton, Melanie Silverman, Michael C Monuteaux, Richard G Bachur
OBJECTIVES: Biomarkers that can measure illness severity and predict the risk of delayed recovery may be useful in guiding pediatric septic shock. Amino-terminal pro-B-type natriuretic peptide has not been assessed in pediatric septic patients at the time of presentation to the emergency department prior to any interventions. The primary aim was to assess if emergency department amino-terminal pro-B-type natriuretic peptide is associated with worse outcomes and severity of illness. DESIGN: Prospective observational pilot study...
November 1, 2018: Pediatric Critical Care Medicine
Santiago Campos-Miño, Jesús López-Herce Cid, Artur Figueiredo Delgado, Eliana Muñoz Benavides, Jorge A Coss-Bu
OBJECTIVE: To characterize the practices of nutritional support in Latin American and Spanish PICUs. DESIGN: Survey with a questionnaire sent to Latin American Society of Pediatric Intensive Care members. SETTING: PICUs of participant hospitals. PATIENTS: Critically ill children between 1 month and 18 years old. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Forty-seven surveys from 17 countries were analyzed...
November 1, 2018: Pediatric Critical Care Medicine
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