Epidemiology of Acute Respiratory Failure in US Children: Outcomes and Resource Use.

Objective: Acute respiratory failure recalcitrant to conventional management often requires specialized organ-supportive technologies to optimize outcomes. Variation in the availability of these technologies prompted testing of the hypothesis that outcomes and resource use will vary by not only patient characteristics but also hospital characteristics and receipt of organ-supportive technology.

Methods: Retrospective study of children 0 to 20 years old hospitalized for acute respiratory failure using the 2019 Kids' Inpatient Database.

A Tale of 8 Cities: Pediatric Critical Care Redeployment to Adult Care During Wave 1 of COVID-19.

Background: Pediatric hospital resources including critical care faculty (intensivists) redeployed to provide care to adults in adult ICUs or repurposed PICUs during wave 1 of the coronavirus disease 2019 (COVID-19) pandemic.

Objectives: To determine the magnitude of pediatric hospital resource redeployment and the experience of pediatric intensivists who redeployed to provide critical care to adults with COVID-19.

Methods: A mixed methods study was conducted at 9 hospitals in 8 United States cities where pediatric resources were redeployed to provide care to critically ill adults with COVID-19.

Patterns of Organ Dysfunction in Critically Ill Children Based on PODIUM Criteria.

Objectives: The goal of this study was to determine the incidence, prognostic performance, and generalizability of the Pediatric Organ Dysfunction Information Update Mandate (PODIUM) organ dysfunction criteria using electronic health record (EHR) data. Additionally, we sought to compare the performance of the PODIUM criteria with the organ dysfunction criteria proposed by the 2005 International Pediatric Sepsis Consensus Conference (IPSCC).

Methods: Retrospective observational cohort study of critically ill children at 2 medical centers in the United States between 2010 and 2018.

Venogram before long-interval repeat cannulation for pediatric extracorporeal membrane oxygenation.

It is rare for children to receive more than one course of support with extracorporeal membrane oxygenation, and in those who do undergo multiple episodes, the interval is usually days to weeks between events. Little data exists on re-cannulation years after an initial extracorporeal membrane oxygenation run, and late repeat cannulation can pose unique challenges. We report the case of a 10-year-old male patient with right jugular vein occlusion due to a previous course of extracorporeal membrane oxygenation as a neonate, who was successfully supported via central cannulation.

Establishing the Knowledge and Skills Necessary in Pediatric Critical Care Medicine: A Systematic Approach to Practice Analysis.

Objectives: To describe the practice analysis undertaken by a task force convened by the American Board of Pediatrics Pediatric Critical Care Medicine Sub-board to create a comprehensive document to guide learning and assessment within Pediatric Critical Care Medicine.

Design: An in-depth practice analysis with a mixed-methods design involving a descriptive review of practice, a modified Delphi process, and a survey.

Setting: Not applicable.

Resource Use and Outcomes for Children Hospitalized With Severe Sepsis or Septic Shock.

Objective: To describe patient and hospital characteristics associated with in-hospital mortality, length of stay (LOS), and charges for children with severe sepsis or septic shock who often require specialized organ-supportive technology to enhance outcomes, availability of which might vary across hospitals.

Design: Retrospective study among children hospitalized for severe sepsis or septic shock, using the 2012 Kids' Inpatient Database. Multivariate regression methods identified factors associated with mortality, LOS, and charges.

Transfer hospitalizations for pediatric severe sepsis or septic shock: resource use and outcomes.

Background: Sepsis is a major cause of child mortality and morbidity. To enhance outcomes, children with severe sepsis or septic shock often require escalated care for organ support, sometimes necessitating interhospital transfer. The association between transfer admission for the care of pediatric severe sepsis or septic shock and in-hospital patient survival and resource use is poorly understood.

Interhospital Transfer of Children in Septic Shock: A Clinician Interview Qualitative Study.

Objective:: To determine the factors that influence the decision to transfer children in septic shock from level II to level I pediatric intensive care unit (PICU) care.

Design:: Interviews with level II PICU physicians in Michigan and Northwest Ohio. A hypothetical scenario of a 14-year-old boy in septic shock was presented.

Outcomes and Resource Use Among Overweight and Obese Children With Sepsis in the Pediatric Intensive Care Unit.

Objective: To evaluate the effect of overweight and obesity on outcomes and resource use among patients with sepsis in the pediatric intensive care unit (PICU).

Design: Retrospective analysis of clinical characteristics, resource use, and mortality among children 0 to 20 years of age admitted to the C.S.

In-Hospital Quality-of-Care Measures for Pediatric Sepsis Syndrome.

Background And Objectives: Sepsis syndrome, comprising sepsis, severe sepsis, and septic shock, is a leading cause of child mortality and morbidity, for which the delivery of time-sensitive care leads to improved survival. We aimed to describe the development and testing of quality measures for in-hospital care of pediatric sepsis syndrome.

Methods: Seven measures of quality of care for children hospitalized with sepsis syndrome were developed by using an iterative process including literature review, development of concepts and candidate measures, and selection of measures for feasibility and importance by 2 panels of experts.

Epidemiology and Outcomes of Pediatric Multiple Organ Dysfunction Syndrome.

Objective: To summarize the epidemiology and outcomes of children with multiple organ dysfunction syndrome as part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development multiple organ dysfunction syndrome workshop (March 26-27, 2015).

Data Sources: Literature review, research data, and expert opinion.

Study Selection: Not applicable.

High School Cardiac Emergency Response Plans and Sudden Cardiac Death in the Young.

Unlabelled: Introduction Sudden cardiac death (SCD) is responsible for 5%-10% of all deaths among children 5-19 years-of-age. The incidence of SCD in youth in Michigan (USA) and nationwide is higher in racial/ethnic minorities and in certain geographic areas. School cardiac emergency response plans (CERPs) increase survival after cardiac arrest.

Should Extracorporeal Membrane Oxygenation Be Offered? An International Survey.

Objectives: To assess the current attitudes of extracorporeal membrane oxygenation (ECMO) program directors regarding eligibility for ECMO among children with cardiopulmonary failure.

Study Design: Electronic cross-sectional survey of ECMO program directors at ECMO centers worldwide within the Extracorporeal Life Support Organization directory (October 2015-December 2015).

Results: Of 733 eligible respondents, 226 (31%) completed the survey, 65% of whom routinely cared for pediatric patients.

Interhospital transfer of children in respiratory failure: a clinician interview qualitative study.

Purpose: To investigate the decision making underlying transfer of children with respiratory failure from level II to level I pediatric intensive care unit care.

Methods: Interviews with 19 eligible level II pediatric intensive care unit physicians about a hypothetical scenario of a 2-year-old girl in respiratory failure: RESULTS: At baseline, indices critical to management were as follows: OI (53%), partial pressure of oxygen in arterial blood (Pao)/Fio (32%), and inflation pressure (16%). Poor clinical response was signified by high OI, inflation pressure, and Fio, and low Pao/Fio.

Availability of Automated External Defibrillators in Public High Schools.

Objectives: To assess automated external defibrillator (AED) distribution and cardiac emergency preparedness in Michigan secondary schools and investigate for association with school sociodemographic characteristics.

Study Design: Surveys were sent via electronic mail to representatives from all public high schools in 30 randomly selected Michigan counties, stratified by population. Association of AED-related factors with school sociodemographic characteristics were evaluated using Wilcoxon rank sum test and χ(2) test, as appropriate.

Variation in patterns of hospitalization and associated resource use among children with spinal cord injury in the U.S.

Introduction: Trauma is a leading cause of mortality and morbidity among children in the U.S. There is paucity of data on the triage of children with spinal cord injury (SCI) to definitive trauma care, and it is unknown if clinical outcomes and resource utilization for children hospitalized with SCI vary according to the settings where trauma care is provided.

An Innovative Framework to Improve Efficiency of Interhospital Transfer of Children in Respiratory Failure.

Rationale: High mortality and resource use burden are associated with hospitalization of critically ill children transferred from level II pediatric intensive care units (PICUs) to level I PICUs for escalated care. Guidelines urge transfer of the most severely ill children to level I PICUs without specification of either the criteria or the best timing of transfer to achieve good outcomes.

Objectives: To identify factors associated with transfer, develop a modeling framework that uses those factors to determine thresholds to guide transfer decisions, and test these thresholds against actual patient transfer data to determine if delay in transfer could be reduced.

Factors Associated with Time to Arrival at a Regional Pediatric Trauma Center.

Objective: The goal of this study was to test the hypothesis that the prehospital time between injury and arrival at a trauma center for critically injured children is associated with patient injury severity and mode of transport.

Methods: Secondary analysis of prospectively collected data on children 0-17 years of age admitted with traumatic injuries to a designated Level I pediatric trauma center from January 1, 2006 through September 30, 2007 was conducted. Multivariate regression methods were used to assess for factors independently associated with prehospital time.