Airway microbiome dynamics and relationship to ventilator-associated infection in intubated pediatric patients.

Background: Little is known about the airway microbiome in intubated mechanically ventilated children. We sought to characterize the airway microbiome longitudinally and in association with clinical variables and possible ventilator-associated infection (VAI).

Methods: Serial tracheal aspirate samples were prospectively obtained from mechanically ventilated subjects under 3 years old from eight pediatric intensive care units in the United States from June 2017 to July 2018.

Evaluation of antibiotic treatment decisions in pediatric intensive care units in Saudi Arabia: A national survey.

Objective: To describe variables used by Saudi pediatric intensivists to make antibiotic-related decisions for children with suspected severe bacterial infections.

Methods: We conducted a cross-sectional survey, which was developed using a multi-step methodological approach. The survey included 4 clinical scenarios of the most relevant bacterial infections in pediatric critical care (pneumonia, sepsis, meningitis and intra-abdominal infection).

Compliance With an Antibiotic Guideline for Suspected Ventilator-Associated Infection: The Ventilator-Associated INfection (VAIN2) Study.

Objectives: To evaluate a guideline for antibiotic decisions in children with suspected ventilator-associated infection.

Design: Prospective, observational cohort study conducted in 22 PICUs in the United States and Canada.

Setting: PICUs in 22 hospitals from April 2017 to January 2019.

Development of Persistent Respiratory Morbidity in Previously Healthy Children After Acute Respiratory Failure.

Objectives: Acute respiratory failure is a common reason for admission to PICUs. Short- and long-term effects on pulmonary health in previously healthy children after acute respiratory failure requiring mechanical ventilation are unknown. The aim was to determine if clinical course or characteristics of mechanical ventilation predict persistent respiratory morbidity at follow-up.

International Survey on Determinants of Antibiotic Duration and Discontinuation in Pediatric Critically Ill Patients.

Objectives: We hypothesized that antibiotic use in PICUs is based on criteria not always supported by evidence. We aimed to describe determinants of empiric antibiotic use in PICUs in eight different countries.

Design: Cross-sectional survey.

Erratum: All in Your Mind? New-Onset Dysphagia in a Previously Healthy Adolescent Child.

[This corrects the article DOI: 10.1055/s-0039-3401008.].

All in Your Mind? New-Onset Dysphagia in a Previously Healthy Adolescent Child.

A healthy 11-year-old male develops fear of choking secondary to progressive dysphagia that began in early childhood. No organic cause is found, and the patient is diagnosed with psychiatric oral aversion. The child is eventually transferred to a psychiatric facility, where a month later he has a possible aspiration event and is transferred to the local emergency room for respiratory distress before being admitted to the intensive care unit.

Development of an Antibiotic Guideline for Children With Suspected Ventilator-Associated Infections.

Objectives: To develop a guideline for the decision to continue or stop antibiotics at 48-72 hours after their initiation in children with suspected ventilator-associated infection.

Design: Prospective, multicenter observational data collection and subsequent development of an antibiotic guideline.

Setting: Twenty-two PICUs.

Estimating the probability of abusive head trauma after abuse evaluation.

Background: Evidence-based, patient-specific estimates of abusive head trauma probability can inform physicians' decisions to evaluate, confirm, exclude, and/or report suspected child abuse.

Objective: To derive a clinical prediction rule for pediatric abusive head trauma that incorporates the (positive or negative) predictive contributions of patients' completed skeletal surveys and retinal exams.

Participants And Setting: 500 acutely head-injured children under three years of age hospitalized for intensive care at one of 18 sites between 2010 and 2013.

Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study.

Background: Paediatric acute respiratory distress syndrome (PARDS) is associated with high mortality in children, but until recently no paediatric-specific diagnostic criteria existed. The Pediatric Acute Lung Injury Consensus Conference (PALICC) definition was developed to overcome limitations of the Berlin definition, which was designed and validated for adults. We aimed to determine the incidence and outcomes of children who meet the PALICC definition of PARDS.

Pediatric Ventilator-Associated Events: Analysis of the Pediatric Ventilator-Associated Infection Data.

Objectives: To compare the prevalence of infection applying the proposed pediatric ventilator-associated events criteria versus clinician-diagnosed ventilator-associated infection to subjects in the pediatric ventilator-associated infection study.

Design: Analysis of prospectively collected data from the pediatric ventilator-associated infection study.

Setting: PICUs of 47 hospitals in the United States, Canada, and Australia.

Cognitive Development One Year After Infantile Critical Pertussis.

Objectives: Pertussis can cause life-threatening illness in infants. Data regarding neurodevelopment after pertussis remain scant. The aim of this study was to assess cognitive development of infants with critical pertussis 1 year after PICU discharge.

Determinants of Antibiotic Tailoring in Pediatric Intensive Care: A National Survey.

Objectives: To describe the criteria that currently guide empiric antibiotic treatment in children admitted to Canadian PICUs.

Design: Cross-sectional survey.

Setting: Canadian PICUs.

The intensive care medicine clinical research agenda in paediatrics.

Background: Intensive Care Medicine set us the task of outlining a global clinical research agenda for paediatric intensive care (PIC). In line with the clinical focus of this journal, we have limited this to research that may directly influence patient care.

Methods: Clinician researchers from PIC research networks of varying degrees of formality from around the world were invited to answer two main questions: (1) What have been the major recent advances in paediatric critical care research? (2) What are the top 10 studies for the next 10 years?

Results: (1) Inclusive databases are well established in many countries.

Pediatric Ventilator-Associated Infections: The Ventilator-Associated INfection Study.

Objective: Suspected ventilator-associated infection is the most common reason for antibiotics in the PICU. We sought to characterize the clinical variables associated with continuing antibiotics after initial evaluation for suspected ventilator-associated infection and to determine whether clinical variables or antibiotic treatment influenced outcomes.

Design: Prospective, observational cohort study conducted in 47 PICUs in the United States, Canada, and Australia.

Inherent Risk Factors for Nosocomial Infection in the Long Stay Critically Ill Child Without Known Baseline Immunocompromise: A Post Hoc Analysis of the CRISIS Trial.

Background: Nosocomial infection remains an important health problem in long stay (>3 days) pediatric intensive care unit (PICU) patients. Admission risk factors related to the development of nosocomial infection in long stay immune competent patients in particular are not known.

Methods: Post-hoc analysis of the previously published Critical Illness Stress induced Immune Suppression (CRISIS) prevention trial database, to identify baseline risk factors for nosocomial infection.

Impact of Weight Extremes on Clinical Outcomes in Pediatric Acute Respiratory Distress Syndrome.

Objectives: To determine whether weight extremes impact clinical outcomes in pediatric acute respiratory distress syndrome.

Design: Post hoc analysis of a cohort created by combining five multicenter pediatric acute respiratory distress syndrome studies.

Setting: Forty-three academic PICUs worldwide.

Interaction Between 2 Nutraceutical Treatments and Host Immune Status in the Pediatric Critical Illness Stress-Induced Immune Suppression Comparative Effectiveness Trial.

Background And Aims: The pediatric Critical Illness Stress-induced Immune Suppression (CRISIS) trial compared the effectiveness of 2 nutraceutical supplementation strategies and found no difference in the development of nosocomial infection and sepsis in the overall population. We performed an exploratory post hoc analysis of interaction between nutraceutical treatments and host immune status related to the development of nosocomial infection/sepsis.

Methods: Children from the CRISIS trial were analyzed according to 3 admission immune status categories marked by decreasing immune competence: immune competent without lymphopenia, immune competent with lymphopenia, and previously immunocompromised.

Poor Adherence to Lung-Protective Mechanical Ventilation in Pediatric Acute Respiratory Distress Syndrome.

Objectives: To determine the frequency of low-tidal volume ventilation in pediatric acute respiratory distress syndrome and assess if any demographic or clinical factors improve low-tidal volume ventilation adherence.

Design: Descriptive post hoc analysis of four multicenter pediatric acute respiratory distress syndrome studies.

Setting: Twenty-six academic PICU.

Diagnosis and Treatment of Ventilator-Associated Infection: Review of the Critical Illness Stress-Induced Immune Suppression Prevention Trial Data.

Objectives: The Critical Illness Stress-Induced Immune Suppression prevention trial was a randomized, masked trial of zinc, selenium, glutamine, and metoclopramide compared with whey protein in delaying nosocomial infection in PICU patients. One fourth of study subjects were diagnosed with nosocomial lower respiratory infection, which contributed to subjects receiving antibiotics 74% of all patient days in the PICU. We analyzed diagnostic and treatment variability among the participating institutions and compared outcomes between nosocomial lower respiratory infection subjects (n = 74) and intubated subjects without nosocomial infection (n = 1 55).