Sociodemographic Factors are Associated with Care Delivery and Outcomes in Pediatric Severe Sepsis.

Importance: Sepsis is a leading cause of morbidity and mortality in the United States and disparate outcomes exist between racial/ethnic groups despite improvements in sepsis management. These observed differences are often related to social determinants of health (SDoH). Little is known about the role of SDoH on outcomes in pediatric sepsis.

Implementing the Pediatric Ventilator Liberation Guidelines Using the Most Current Evidence.

Invasive mechanical ventilation is prevalent and associated with considerable morbidity. Pediatric critical care teams must identify the best timing and approach to liberating (extubating) children from this supportive care modality. Unsurprisingly, practice variation varies widely.

Cardiac dysfunction in severe pediatric acute respiratory distress syndrome: the right ventricle in search of the right therapy.

Severe acute respiratory distress syndrome in children, or PARDS, carries a high risk of morbidity and mortality that is not fully explained by PARDS severity alone. Right ventricular (RV) dysfunction can be an insidious and often under-recognized complication of severe PARDS that may contribute to its untoward outcomes. Indeed, recent evidence suggest significantly worse outcomes in children who develop RV failure in their course of PARDS.

Predicting Duration of Invasive Mechanical Ventilation in the Pediatric ICU.

Background: Timely ventilator liberation can prevent morbidities associated with invasive mechanical ventilation in the pediatric ICU (PICU). There currently exists no standard benchmark for duration of invasive mechanical ventilation in the PICU. This study sought to develop and validate a multi-center prediction model of invasive mechanical ventilation duration to determine a standardized duration of invasive mechanical ventilation ratio.

Prevalence, Risk Factors, and Outcomes of Airway Versus Non-Airway Pediatric Extubation Failure.

Background: Pediatric extubation failure is associated with morbidity and mortality. The most common cause is upper-airway obstruction. Subglottic edema is common, but upper-airway obstruction can occur from the oral cavity to the trachea.

Unique Complications of MIS-C and Its Treatment: Encephalopathy in a Child with MIS-C Who Developed Life-Threatening Gastrointestinal Hemorrhage.

In this case report, we describe a previously healthy eleven-year-old male diagnosed with multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019. The patient presented with shock and neurologic symptoms including altered mental status and dysarthria. Brain magnetic resonance imaging, obtained to rule out thromboembolic injury, demonstrated cytotoxic edema of the corpus callosum, an imaging finding similar in nature to several previous reports of MRI abnormalities in children with MIS-C.

Predicting High-Flow Nasal Cannula Therapy Outcomes Using the ROX-HR Index in the Pediatric ICU.

Background: High-flow nasal cannula (HFNC) use is increasing in pediatric patients. Objective measures that predict HFNC outcomes are lacking. The respiratory rate-oxygenation (ROX) and ROX heart rate (ROX-HR) indices are validated to predict HFNC therapy failure in adults.

Pediatric Ventilation Liberation: Bundled Extubation Readiness and Analgosedation Pathways Decrease Mechanical Ventilation Duration and Benzodiazepine Exposure.

Background: Recent studies reported that children on mechanical ventilation who were managed with an analgosedation approach and standardized extubation readiness testing experienced better outcomes, including decreased delirium and invasive mechanical ventilation duration.

Methods: This was a quality improvement project in a 24-bed pediatric ICU within a single center, including subjects ≤ 18 years old who required invasive mechanical ventilation via an oral or nasal endotracheal tube. The aim was to decrease the invasive mechanical ventilation duration for all the subjects by 25% within 9 months through the development and implementation of bundled benzodiazepine-sparing analgosedation and extubation readiness testing clinical pathways.

Ventilation Liberation Practices Among 380 International PICUs.

Unlabelled: 1) Characterize the prevalence of ventilator liberation protocol use in international PICUs, 2) identify the most commonly used protocol elements, and 3) estimate an international extubation failure rate and use of postextubation noninvasive respiratory support modes.

Design: International cross-sectional study.

Subjects: Nontrainee pediatric medical and cardiac critical care physicians.

Pediatric ventilation liberation: evaluating the role of endotracheal secretions in an extubation readiness bundle.

Background: An evidence gap exists regarding the role of endotracheal secretions in pediatric extubation decisions. This study aims to evaluate whether endotracheal secretion burden independently correlates with pediatric extubation failure.

Methods: This is a single-center, prospective cohort study of children aged <19 years requiring intubation.

Diurnal Variation and Nursing Perspectives in Analgesic and Sedation Medication Administration to Mechanically Ventilated Children in a Single Pediatric ICU.

The primary objective of this study was to determine whether there was diurnal variation in the amount of analgesic and sedation medication administered to mechanically ventilated children in a single pediatric intensive care unit (PICU). The secondary objective was to evaluate nursing attitudes and practices regarding administration of these medications. This was a prospective, longitudinal cohort study of mechanically ventilated patients admitted to a single PICU.

Exploration of Sepsis-Associated Coagulopathy Severity and Pediatric Septic Shock Outcomes.

The objective of this study was to explore correlations between sepsis-associated coagulopathy (SAC) in pediatric septic shock and clinical outcomes. This was a retrospective cohort study of all children admitted to a single, academic pediatric intensive care unit with septic shock over 6 years. The prevalence of SAC was 93.

Challenging Convention: Daytime Versus Nighttime Extubation in the Pediatric ICU.

Background: The majority of pediatric extubations occur during day shift hours. There is a time-dependent relationship between mechanical ventilation duration and complications. It is not known if extubation shift (day vs night) correlates with pediatric extubation outcomes.

A Respiratory Therapist-Driven Pathway Improves Timeliness of Extubation Readiness Assessment in a Single PICU.

Objectives: Our smart aim was to decrease the time between when a mechanically ventilated patient was eligible for and when they underwent their first extubation readiness test (delta time) by 50% within 3 months through the development and implementation of a respiratory therapist-driven extubation readiness test pathway.

Design: Quality improvement project.

Setting: Single, tertiary care, 24-bed, academic PICU.

Clinically-relevant cardiopulmonary interactions for the pediatric intensivist.

A thorough understanding of cardiorespiratory interactions is essential when caring for critically ill children. These interactions are linked to changes in intrathoracic pressure and their impact on cardiac preload and afterload. The predominant effect of positive-pressure ventilation in children with normal cardiac function is to decrease preload to the right heart with an eventual decrease in left ventricular stroke volume.

The experience of headaches in health care workers: opportunity for care improvement.

Objective/background: This study assessed the relationship between health care workers' self-reported experience of headaches/migraines, their overall quality of life, and treatment outcomes.

Methods: The study sample consisted of adults employed by a self-insured hospital system located in the Southeast United States. Study participants responded to a web-based survey disseminated via work email accounts.