Impact of Continuous Renal Replacement Therapy Initiation Time, Kidney Injury, and Hypervolemia in Critically Ill Children.

Background: The mortality rate of pediatric patients who require continuous renal replacement therapy is approximately 42%, and outcomes vary considerably depending on underlying disease, illness severity, and time of dialysis initiation. Delay in the initiation of such therapy may increase mortality risk, prolong intensive care unit stay, and worsen clinical outcomes.

Local Problem: In the pediatric intensive care unit of an urban level I trauma children's hospital, continuous renal replacement therapy initiation times and factors associated with delays in therapy were unknown.

Vascular thrombosis after pediatric liver transplantation: Is prevention achievable?

Background: Vascular thromboses (VT) are life-threatening events after pediatric liver transplantation (LT). Single-center studies have identified risk factors for intra-abdominal VT, but large-scale pediatric studies are lacking.

Methods: This multicenter retrospective cohort study of isolated pediatric LT recipients assessed pre- and perioperative variables to determine VT risk factors and anticoagulation-associated bleeding complications.

A multicenter study of ICU resource utilization in pediatric, adolescent and young adult patients post CAR-T therapy.

Tisagenlecleucel is associated with remarkable outcomes in treating patients up to the age of 25 years with refractory B-cell acute lymphoblastic leukemia (ALL). Yet, due to unique and potentially life-threatening complications, access remains limited to higher-resource and certified centers. Reports of inequity and related disparities in care are emerging.

Critical Care and Mechanical Ventilation Practices Surrounding Liver Transplantation in Children: A Multicenter Collaborative.

Objectives: We aimed to determine which characteristics and management approaches were associated with postoperative invasive mechanical ventilation (IMV) and with a prolonged course of IMV in children post liver transplant as well as describing the utilization of critical care resources.

Design: Retrospective, multicenter, cohort study of children who underwent an isolated liver transplantation between January 2017 and December 2018.

Setting: Twelve U.

A Phase II randomized controlled trial for lung and diaphragm protective ventilation (Real-time Effort Driven VENTilator management).

Lung Protective Mechanical Ventilation (MV) of critically ill adults and children is lifesaving but it may decrease diaphragm contraction and promote Ventilator Induced Diaphragm Dysfunction (VIDD). An ideal MV strategy would balance lung and diaphragm protection. Building off a Phase I pilot study, we are conducting a Phase II controlled clinical trial that seeks to understand the evolution of VIDD in critically ill children and test whether a novel computer-based approach (Real-time Effort Driven ventilator management (REDvent)) can balance lung and diaphragm protective ventilation to reduce time on MV.

Definition and global epidemiology of pediatric acute respiratory distress syndrome.

Acute respiratory distress syndrome (ARDS) has been known to occur in children since early descriptions of the disease, but pediatric specific diagnostic criteria were first established in 2015 with the Pediatric Acute Lung Injury Consensus Conference (PALICC) definition of pediatric ARDS (PARDS). There were substantial changes proposed with the PALICC definition, including simplification of radiographic criteria, use of pulse oximetry based metrics to define PARDS, specific criteria for non-invasive ventilation, and the use of oxygenation index (OI) instead of PaO2/FiO2 ratio for those on invasive ventilation. While these changes could potentially result in major changes in the reported incidence and outcome of PARDS, review of the recent literature since publication of the PALICC definitions highlight that major elements regarding the contemporary epidemiology of PARDS have remained stable over the past 20 years.

Renal Replacement Therapy Modalities in Critically Ill Children.

Objectives: The objective of this study is to describe the relative frequency of use of continuous renal replacement therapy, intermittent hemodialysis, and peritoneal dialysis and to analyze characteristics and outcomes of critically ill children receiving renal replacement therapies admitted to PICUs that participate in the Virtual PICU (VPS LLC, Los Angeles, CA) registry.

Design: Retrospective, database analysis.

Setting: PICUs that participate in the Virtual PICU (VPS LLC) registry.

Cardiac output and systemic vascular resistance: Clinical assessment compared with a noninvasive objective measurement in children with shock.

Purpose: To evaluate physician assessment of cardiac output and systemic vascular resistance in patients with shock compared with an ultrasonic cardiac output monitor (USCOM). To explore potential changes in therapy decisions if USCOM data were available using physician intervention answers.

Study Design: Double-blinded, prospective, observational study in a tertiary hospital pediatric intensive care unit.

Epidemiology and outcomes of children with accidental hypothermia: A propensity-matched study.

Background: The purpose of this study was to explore the epidemiology and outcomes of hospitalized children with a diagnosis of accidental hypothermia.

Methods: The 2012 Kids' Inpatient Database, detailing discharge diagnoses in children admitted to US hospitals, was analyzed using International Classification of Diseases, Ninth Revision, Clinical Modification codes to filter out relevant patients. Children ages 1 month to 17 years were included in the analysis.

Validation of an Ultrasound Cardiac Output Monitor as a Bedside Tool for Pediatric Patients.

The aim of our study was to determine the validity of cardiac output (CO) measurements taken with the ultrasonic cardiac output monitor (USCOM) by comparing to CO measured by pulmonary arterial catheter (PAC) thermodilution during cardiac catheterization. We enrolled thirty-one children (<18 years) undergoing cardiac catheterization in this double-blinded, prospective, observational study. The median CO measured by USCOM was 4.

Evidence of early impairments in both right and left ventricular inotropic reserves in children with Duchenne's muscular dystrophy.

In Duchenne's muscular dystrophy (DMD), cardiac function deteriorates with time and heart failure is one of the major causes of death. The aim of the study was to determine if a decrease in the ventricular inotropic reserves could be an early sign of cardiac dysfunction in these children. Nineteen children with DMD (aged 9 to 18 years, mean age 13.

Effect on balance and gait secondary to removal of the second toe for digital reconstruction: 5-year follow-up.

Foot anatomy and lower limb function were analyzed in 11 children (aged 6.5-12.5 y) 5 years after removal of one or two second toes for digital reconstruction.

[Domiciliary assisted ventilation in children].

The concept of assisted ventilation in the home setting has greatly progressed as a routine practice. This technique was used from 1990 to 2000 in 16 children cared for at our center. Ten children had neuromuscular disease (infantile spinal amyotrophy 6, Duchenne myopathy 3, and mitochondrial myopathy 1) or other conditions including central hypoventilation (n = 2), traumatic tetraplegia (n = 2), encephalopathy with chronic bronchitis (n = 1) and bronchopulmonary dysplasia (n = 1).

[Rehabilitation of children with chronic inflammatory arthritis].

All children with chronic arthritis require rehabilitation. Indications of the various techniques are mainly dependent upon the stage of the disease. The choice of the most appropriate technique (preservation of articular mobility, preservation of the muscular strength, orthoses) are based on an accurate assessment of each joint and on imaging.

Juvenile hyaline fibromatosis: a report of two severe cases.

Two unrelated children with a severe form of juvenile hyaline fibromatosis are described. In addition to painful flexion contractures of all of the large joints, oral and skin lesions, and typical radiologic appearance of osteolytic defects, both girls had marked growth retardation and recurrent infections. Both children died in early infancy of overwhelming infection.

[A computer-assisted study of the surgical treatment of talipes equinovarus].

One-hundred-and-eleven club feet were treated surgically and followed up for more than three years. A computer analysis of the results, compared with the information contained in the operative notes, provided a better assessment of the effectiveness of each surgical procedure. Resection of capsular structures did not give better results than simple division.

[Legg-Perthes-Calvé disease. Plea for an original ambulatory orthosis].

Legg-Perthes-Calvé disease is a local disease which should be treated by non-iatrogenic means. The authors have designed a new ambulatory orthosis allowing containment in abduction, flexion and medial rotation, with relief of weight-bearing on the femoral head. It was tested in thirty six hips.