Executive Summary: Criteria for Critical Care of Infants and Children: PICU Admission, Discharge, and Triage Practice Statement and Levels of Care Guidance.

This is an executive summary of the 2019 update of the 2004 guidelines and levels of care for PICU. Since previous guidelines, there has been a tremendous transformation of Pediatric Critical Care Medicine with advancements in pediatric cardiovascular medicine, transplant, neurology, trauma, and oncology as well as improvements of care in general PICUs. This has led to the evolution of resources and training in the provision of care through the PICU.

Criteria for Critical Care Infants and Children: PICU Admission, Discharge, and Triage Practice Statement and Levels of Care Guidance.

Objectives: To update the American Academy of Pediatrics and Society of Critical Care Medicine's 2004 Guidelines and levels of care for PICU.

Design: A task force was appointed by the American College of Critical Care Medicine to follow a standardized and systematic review of the literature using an evidence-based approach. The 2004 Admission, Discharge and Triage Guidelines served as the starting point, and searches in Medline (Ovid), Embase (Ovid), and PubMed resulted in 329 articles published from 2004 to 2016.

An evaluation of vancomycin dosing for complicated infections in pediatric patients.

Objective: To determine the incidence with which a vancomycin dosing regimen of 15 mg/kg per dose every 6 hours achieves steady-state trough concentrations of 15 to 20 mg/L in pediatric patients with complicated infections.

Methods: We performed a retrospective chart review for patients admitted to our children's hospital between July 1, 2009, and June 30, 2011. Patients were included if they were between 1 month and 18 years of age, had at least 1 steady-state vancomycin trough obtained, received an initial vancomycin dose of 15 mg/kg per dose every 6 hours, and were being treated for a diagnosis of meningitis, pneumonia, osteomyelitis, bacteremia/sepsis, or endocarditis.

Public awareness of genetic nondiscrimination laws in four states and perceived importance of life insurance protections.

Genetic testing has grown dramatically in the past decade and is becoming an integral part of health care. Genetic nondiscrimination laws have been passed in many states, and the Genetic Information Nondiscrimination Act (GINA) was passed at the federal level in 2008. These laws generally protect individuals from discrimination by health insurers or employers based on genetic information, including test results.

Public awareness and use of direct-to-consumer personal genomic tests from four state population-based surveys, and implications for clinical and public health practice.

Purpose: Direct-to-consumer personal genomic tests are widely available, but population-based data are limited on awareness and use of these tests among the general public in the United States.

Methods: We assessed awareness and use of direct-to-consumer personal genomic tests in Connecticut, Michigan, Oregon, and Utah using the 2009 Behavioral Risk Factor Surveillance System and compared the state results to the 2008 national HealthStyles survey results.

Results: Awareness was the highest in Oregon (29.

Enhanced fluid management with continuous venovenous hemofiltration in pediatric respiratory failure patients receiving extracorporeal membrane oxygenation support.

Background/purpose: Children receiving extracorporeal membrane oxygenation (ECMO) for respiratory failure can have significant fluid overload and renal insufficiency. Addition of inline continuous venovenous hemofiltration (CVVH) could provide additional benefits in fluid management compared to use of standard medical therapies with ECMO.

Methods: Patients with pediatric respiratory failure receiving ECMO with CVVH were case-matched to similar patients receiving ECMO without CVVH to compare fluid balance, medication use, and clinical outcomes.

Tracking racial and ethnic disparities of knee replacement rates in Connecticut.

Objective: Determine knee replacement rates among white, black, and Hispanic men and women in Connecticut.

Methods: Connecticut population estimates and hospital discharge data were obtained. Race and ethnicity were identified by hospital personnel.

Fluid overload before continuous hemofiltration and survival in critically ill children: a retrospective analysis.

Objective: Continuous venovenous hemofiltration (CVVH) is used for renal replacement and fluid management in critically ill children. A previous small study suggested that survival was associated with less percent fluid overload (%FO) in the intensive care unit (ICU) before hemofiltration. We reviewed our experience with a large series of pediatric CVVH patients to evaluate factors associated with outcome.

The use of the air leak test and corticosteroids in intubated children: a survey of pediatric critical care fellowship directors.

Introduction: Uncertainties exist regarding the value of the air leak test or use of steroids for preventing post-extubation stridor and extubation failure in children.

Objective: Determine the practice preferences of pediatric critical care physicians regarding the air leak test and administration of glucocorticosteroids to prevent airway edema.

Methods: A 14-question survey regarding the value of the air leak test, use of glucocorticosteroids, and management of airway edema in intubated children was sent to all North American pediatric critical care fellowship directors affiliated with medical school teaching hospitals.

Airway pressure release ventilation with a short release time in a child with acute respiratory distress syndrome.

Airway pressure release ventilation (APRV) allows ventilation and oxygenation to occur at lower peak and mean airway pressures than conventional positive pressure ventilation. The use of APRV in adults is an effective method of ventilation for patients with acute lung injury and acute respiratory distress syndrome. However, the use of APRV in children is less established.

Ecthyma gangrenosum as a very early herald of acute lymphoblastic leukaemia.

Ecthyma gangrenosum is a manifestation of cutaneous infection by Pseudomonas aeruginosa. The lesion may be associated with immunocompromise, in particular neutropenia. We present a case of ecthyma gangrenosum in a previously healthy child who 3 months later developed acute lymphoblastic leukaemia; we use this to illustrate the lack of information on the growth rate of malignant and premalignant leukaemic cells in children.

Health-care-seeking behaviors related to bowel complaints. Hispanics versus non-Hispanic whites.

Health-care-seeking behaviors related to bowel complaints may vary between ethnic groups. A survey of a nonpatient population in El Paso, Texas, was conducted in order to examine differences in health care behavior related to bowel dysfunction, and in the perception of health and bowel function, in Hispanics and non-Hispanic whites. Data from 905 subjects who were either Hispanic (580) or non-Hispanic white (325) given a forced-choice, self-report questionnaire were used for analysis.

Comparison of bowel patterns in Hispanics and non-Hispanic whites.

Survey questionnaires can be used to characterize normal bowel habits and the prevalence of bowel dysfunction. To determine whether ethnic and sex-related differences in bowel patterns exist between Hispanics and non-Hispanics whites, we conducted a survey of a nonpatient population in El Paso, on the U.S.

Effect of betamethasone and exercise on equine carpal joints with osteochondral fragments.

Osteochondral fragments were created arthroscopically on the distal aspect of both radial carpal bones in 12 horses. On day 14 after surgery, one middle carpal joint of each horse was injected with 2.5 mL Betavet Soluspan (3.

Effect of sodium hyaluronate in collagenase-induced superficial digital flexor tendinitis in horses.

Superficial digital flexor tendinitis was induced in each forelimb of 8 horses by injecting 4,000 U of collagenase into the midmetacarpal region of the tendon. In each horse, each tendon was treated 24 and 96 hours after the collagenase injection with SC injections of sodium hyaluronate (treated limbs) or an equal volume of 0.9% NaCl solution (control limbs).

Arthroscopic surgery for osteochondritis dissecans of the femoropatellar joint of the horse.

Arthroscopic surgery for the treatment of osteochondritis dissecans was undertaken on 252 femoropatellar joints in 161 horses (82 Thoroughbreds, 39 Quarter Horses, 16 Arabians, 9 Warmbloods and 15 others of various breeds). There were 53 females and 108 males. Twenty-two horses were 1 year of age at the time of surgery, 68 were yearlings, 36 were 2-year-olds, 21 were 3-year-olds, and 14 were > or = 4 years old.

Traumatic injuries involving tendons of the distal limbs in horses: a retrospective study of 55 cases.

Fifty-five horses were presented to Colorado State University Veterinary Teaching Hospital between 1st of January 1980 and 31st of December 1989 for treatment of distal limb lacerations involving flexor tendons (n = 35) or extensor tendons (n = 20). Of the 35 flexor tendon lacerations, 11 horses were killed without treatment and 24 horses were treated. Twenty-two horses were included in determining outcome.

Iron deficiency anemia. How to diagnose and correct.

The prevalence of iron deficiency anemia has decreased in recent years because of improved dietary habits. Yet, iron deficiency anemia is still the most common anemia. Among mature adults, anemia of chronic disease is probably more common.

Disseminated Salmonella arizona infection associated with rattlesnake meat ingestion.

Salmonella arizona is an uncommon enteric pathogen. We report a case of a woman with systemic lupus erythematosus, receiving prednisone therapy, who developed fatal disseminated S. arizona infection after ingesting raw dried rattlesnake meat as a form of treatment for her illness.