Understanding Disparities in the Pediatric ICU: A Scoping Review.

Background And Objectives: Health disparities are pervasive in pediatrics. We aimed to describe disparities among patients who are likely to be cared for in the PICU and delineate how sociodemographic data are collected and categorized.

Methods: Using MEDLINE as a data source, we identified studies which included an objective to assess sociodemographic disparities among PICU patients in the United States.

Race, Ethnicity, and Intensive Care Utilization for Common Pediatric Diagnoses: U.S. Pediatric Health Information System 2019 Database Study.

Objectives: Racial and ethnic disparities in healthcare delivery for acutely ill children are pervasive in the United States; it is unknown whether differential critical care utilization exists.

Design: Retrospective study of the Pediatric Health Information System (PHIS) database.

Setting: Multicenter database of academic children's hospitals in the United States.

Child Opportunity Index and Pediatric Intensive Care Outcomes: A Multicenter Retrospective Study in the United States.

Objectives: To evaluate for associations between a child's neighborhood, as categorized by Child Opportunity Index (COI 2.0), and 1) PICU mortality, 2) severity of illness at PICU admission, and 3) PICU length of stay (LOS).

Design: Retrospective cohort study.

Association of Interventions With Outcomes in Children At-Risk for Pediatric Acute Respiratory Distress Syndrome: A Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Study.

Objectives: Describe the frequency with which transfusion and medications that modulate lung injury are administered to children meeting at-risk for pediatric acute respiratory distress syndrome (ARF-PARDS) criteria and evaluate for associations of transfusion, fluid balance, nutrition, and medications with unfavorable clinical outcomes.

Design: Secondary analysis of the Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology study, a prospective point prevalence study. All enrolled ARF-PARDS patients were included unless they developed subsequent pediatric acute respiratory distress syndrome (PARDS) within 24 hours of PICU admission or PICU length of stay was less than 24 hours.

Machine learning models to predict and benchmark PICU length of stay with application to children with critical bronchiolitis.

Objective: To create models for prediction and benchmarking of pediatric intensive care unit (PICU) length of stay (LOS) for patients with critical bronchiolitis.

Hypothesis: We hypothesize that machine learning models applied to an administrative database will be able to accurately predict and benchmark the PICU LOS for critical bronchiolitis.

Design: Retrospective cohort study.

Screening for Social Determinants of Health in the Pediatric Intensive Care Unit: Recommendations for Clinicians.

Social determinants of health (SDoH) play a significant role in the health and well-being of children in the United States. Disparities in the risk and outcomes of critical illness have been extensively documented but are yet to be fully explored through the lens of SDoH. In this review, we provide justification for routine SDoH screening as a critical first step toward understanding the causes of, and effectively addressing health disparities affecting critically ill children.

Nutritional Support in Children Meeting the At-Risk for Pediatric Acute Respiratory Distress Syndrome Criteria.

Unlabelled: Pediatric acute respiratory distress syndrome (PARDS) is a prevalent condition in the PICU with a high morbidity and mortality, but effective preventative strategies are lacking.

Objectives: To examine associations between early enteral nutrition (EN) and PICU outcomes in a cohort of children meeting the 2015 Pediatric Acute Lung Injury Consensus Conference "at-risk" for pediatric acute respiratory distress syndrome (ARF-PARDS) criteria.

Design Setting And Participants: This was a single-center, electronic health record-based retrospective chart review.

Measuring Social Health Following Pediatric Critical Illness: A Scoping Review and Conceptual Framework.

Objective: Social health is an important component of recovery following critical illness as modeled in the pediatric Post-Intensive Care Syndrome framework. We conducted a scoping review of studies measuring social outcomes (measurable components of social health) following pediatric critical illness and propose a conceptual framework of the social outcomes measured in these studies.

Data Sources: PubMed, EMBASE, PsycINFO, CINAHL, and the Cochrane Registry.

Acute Neuro-Functional Morbidity Upon Discharge From the Pediatric Intensive Care Unit After Critical Bronchiolitis.

Background And Objective: Improved survival has shifted research focus toward understanding alternate PICU outcomes, including neurocognitive and functional changes. Bronchiolitis is a common PICU diagnosis, but its neuro-functional outcomes have not been adequately described in contemporary literature. The objective of the study is to describe the epidemiology and associated clinical characteristics of acute neuro-functional morbidity (ANFM) in critical bronchiolitis.

Human Trafficking ICD-10 Code Utilization in Pediatric Tertiary Care Centers Within the United States.

Background: Human trafficking is a global public health issue that affects pediatric patients widely. The International Labor Organization estimates children comprise approximately 25% of the identified trafficked persons globally, with domestic estimates including over 2000 children a year. Trafficked children experience a broad range of health consequences leading to interface with healthcare systems during their exploitation.

High flow nasal cannula in the pediatric intensive care unit.

Introduction: The use of high flow nasal cannula (HFNC) has become widely used in pediatric intensive care units (PICUs) throughout the world. The rapid adoption has outpaced the number of studies evaluating the safety and efficacy in a variety of pediatric diseases/conditions.

Areas Covered: This scoping review begins with the definition and mechanisms of action of HFNC and then follows with a review of the literature focused on studies performed on critically ill children cared for in the PICU.

Hospital Charges Associated With Critical Bronchiolitis From 2009 to 2019.

Objectives: To evaluate the contribution of PICU care to increasing hospital charges for patients with bronchiolitis over a 10-year study period.

Design: In this retrospective multicenter study, changes in annual hospital charges (adjusted for inflation) were analyzed using linear regression for subjects admitted to the PICU with invasive mechanical ventilation (PICU + IMV) and without IMV (PICU - IMV), and for children not requiring PICU care.

Setting: Free-standing children's hospitals contributing to the Pediatric Health Information System (PHIS) database.

Social Factors Predictive of Intensive Care Utilization in Technology-Dependent Children, a Retrospective Multicenter Cohort Study.

Technology-dependent children with medical complexity (CMC) are frequently admitted to the pediatric intensive care unit (PICU). The social risk factors for high PICU utilization in these children are not well described. The objective of this study was to describe the relationship between race, ethnicity, insurance status, estimated household income, and PICU admission following the placement of a tracheostomy and/or gastrostomy (GT) in CMC.

Derivation and Validation of the Critical Bronchiolitis Score for the PICU.

Objectives: To derive and internally validate a bronchiolitis-specific illness severity score (the Critical Bronchiolitis Score) that out-performs mortality-based illness severity scores (e.g., Pediatric Risk of Mortality) in measuring expected duration of respiratory support and PICU length of stay for critically ill children with bronchiolitis.

Use of Negative Pressure Ventilation in Pediatric Critical Care: Experience in 56 PICUs in the Virtual Pediatric Systems Database (2009-2019).

Objectives: Negative pressure ventilation may be more physiologic than positive pressure ventilation, but data describing negative pressure ventilation use in the PICU are limited. We aimed to describe the epidemiology and outcomes of PICU patients receiving negative pressure ventilation.

Design: Descriptive analysis of a large, quality-controlled multicenter database.

Resources and Costs Associated With Repeated Admissions to PICUs.

Objective: To determine the costs and hospital resource use from all PICU patients readmitted with a PICU stay within 12 months of hospital index discharge.

Design: Cross-sectional, retrospective cohort study using Pediatric Health Information System.

Setting: Fifty-two tertiary children's hospitals.

Prevalence of Reintubation Within 24 Hours of Extubation in Bronchiolitis: Retrospective Cohort Study Using the Virtual Pediatric Systems Database.

Objectives: High-flow nasal cannula and noninvasive positive pressure ventilation are used to support children following liberation from invasive mechanical ventilation. Evidence comparing extubation failure rates between patients randomized to high-flow nasal cannula and noninvasive positive pressure ventilation is available for adult and neonatal patients; however, similar pediatric trials are lacking. In this study, we employed a quality controlled, multicenter PICU database to test the hypothesis that high-flow nasal cannula is associated with higher prevalence of reintubation within 24 hours among patients with bronchiolitis.

The Relationship Between Estimated Median Household Income and Critical Care Length of Stay in Children With Diabetic Ketoacidosis.

Diabetic ketoacidosis (DKA) is an important diagnosis in the pediatric intensive care unit (PICU) and is associated with significant morbidity. We hypothesized children with DKA living in poorer communities would have unfavorable outcomes while critically ill. This single-center retrospective study included children with DKA admitted to a PICU over a 27-month period.

Long-Term Neurodevelopmental and Functional Outcomes of Normally Developing Children Requiring PICU Care for Bronchiolitis.

Bronchiolitis is a common pediatric intensive care unit (PICU) illness and often affects generally healthy children, making it a promising disease in which to study long-term neurodevelopmental outcomes. We previously found that approximately 15% of critical bronchiolitis patients have evidence of post-PICU morbidity using coarse definitions available in administrative data sets. In this study, we measured neurodevelopmental outcomes using four more precise tools.

The Effects of Furosemide on Oxygenation in Mechanically Ventilated Children with Bronchiolitis.

Fluid balance management, including diuretic administration, may influence outcomes among mechanically ventilated children. We retrospectively compared oxygenation saturation index (OSI) before and after the initial furosemide bolus among 65 mechanically ventilated children. Furosemide was not associated with a significant change in median OSI (6.