Publications by authors named "Keim G"
Background: Racial disparities in the outcomes of adult community-acquired pneumonia are well described. However, the presence of racial and ethnic disparities in paediatric community-acquired pneumonia and the mechanisms underlying these disparities remain unclear. Motivated by disparities related to age and geography in paediatric sepsis, we evaluated the association between the joint exposure of race/ethnicity, age, and geographic region and mortality for community-acquired pneumonia to provide opportunities for assessment of future interventions that provide equitable healthcare.
View Article and Find Full Text PDFBackground: Firearm injury is the leading cause of pediatric death in the United States (US), but few investigations have focused on the healthcare cost and burden of hospitalized survivors. We aimed to delineate the landscape of pediatric firearm hospitalizations, with a focus on sociodemographic characteristics and on acquired morbidity among survivors.
Methods: We performed a retrospective cohort study of hospitalized children (<21 years old) with firearm injuries using the 2019 Kids' Inpatient Database, representing 80% of pediatric hospitalizations nationally.
Article Synopsis
- Systemic corticosteroids for acute respiratory failure have mixed results due to side effects, but inhaled corticosteroids (ICSs) might help prevent respiratory failure in children with direct lung injury (DLI).* -
- The study analyzed data from 35,220 pediatric patients and found that those who received ICSs had significantly lower rates of intubation and the need for noninvasive respiratory support compared to those who did not.* -
- The protective effect of ICSs was particularly strong in children with a history of asthma, suggesting that ICSs may be more effective in this subgroup.*
Impact of a tracheal aspirate culture diagnostic test stewardship intervention in a tertiary care PICU.
Infect Control Hosp Epidemiol
September 2024
Article Synopsis
- * The intervention involved creating guidelines to reduce unnecessary cultures, resulting in a decline from 4.3 to 2.3 cultures per 100 ventilator days after implementation, alongside a decrease in antibiotic treatments for infections.
- * Overall, the intervention was deemed safe, showing no negative impact on patient outcomes such as mortality or readmissions while successfully lowering the rates of cultures and antibiotic usage.
Article Synopsis
- The study investigates the difference in mechanical power during ventilation in children with acute respiratory distress syndrome (ARDS) when using square flow versus decelerating flow modes.
- It involves a secondary analysis of data from 185 pediatric patients, revealing that mechanical power is statistically lower in square flow (0.46 J · min-1 · kg-1) compared to decelerating flow (0.49 J · min-1 · kg-1).
- The findings suggest that while mechanical power is slightly lower in square flow, the clinical significance remains uncertain, with a notable portion (30%) attributed to overcoming resistance in both modes.
Evolution and Impact of a Diagnostic Point-of-Care Ultrasound Program in a PICU.
Pediatr Crit Care Med
November 2024
Article Synopsis
- The study aimed to assess how point-of-care ultrasound (POCUS) impacts clinicians in a pediatric intensive care unit (PICU) and to evaluate the development of the POCUS program.
- Over the study period from 2017 to 2022, nearly 7,201 POCUS studies were performed, with a significant number leading to changes in clinician understanding and management of patient care, especially in cardiac cases.
- The findings showed an increase in POCUS orders and revenue, while also highlighting the need to adapt quality assurance processes as technology and clinical practices evolve.
Article Synopsis
- A study found a potential link between the use of noninvasive positive pressure ventilation (NIPPV) in children with bronchiolitis and the occurrence of in-hospital cardiac arrest (IHCA).
- In a retrospective analysis of over 4,600 ICU admissions, only 1.2% experienced IHCA, with most cases involving invasive mechanical ventilation (IMV) rather than NIPPV.
- The data suggested that NIPPV might actually lower the odds of IHCA compared to IMV, indicating it could be a safer option for managing respiratory support in these patients.
Article Synopsis
- The study investigates the molecular characteristics of pediatric ARDS, focusing on the relationship between inflammation, tissue injury, and patient outcomes such as mortality and persistent organ dysfunction.
- It involved analyzing plasma samples from intubated pediatric patients over the first week of ARDS, measuring various biomarkers related to inflammation and injury.
- Results showed that nonsurvivors had significantly higher levels of certain cytokines and injury markers, with different trajectories compared to survivors, indicating these biomarkers may help predict mortality and persistent complications in ARDS.
Improving Noninvasive Ventilation for Bronchiolitis: It Is Here to Stay!
Pediatr Crit Care Med
March 2024
Article Synopsis
- Acute kidney injury (AKI) in critically ill children is linked to high mortality, and the timing of starting continuous kidney replacement therapy (CKRT) during hospitalization is crucial but not well understood.
- In a study of 99 pediatric patients, those who started CKRT more than 2 days after stage 3 AKI onset had a significantly higher mortality rate (65%) compared to those who started within 2 days (5%).
- The findings suggest that initiating CKRT earlier may reduce mortality and enhance kidney recovery, although there is still uncertainty around the best timing for treatment.
Article Synopsis
- Ultrasound assessments of the diaphragm in healthy children under 18 were studied to establish baseline thickness and contractility values, highlighting the need for pediatric-specific data in acute care.
- Measurements included diaphragm thickness during breathing and ventilation, with outcomes compared across different age groups and conditions (spontaneous vs. mechanical ventilation).
- Results showed no significant age-related differences in diaphragm thickness and thickening fraction, but diaphragm excursion and strain improved with age; however, all contractility measures decreased significantly during mechanical ventilation.
Article Synopsis
- - The study examined the 1-year readmission rates for children who survived acute respiratory distress syndrome (ARDS), finding that about 30% of the 13,505 children included were readmitted within a year after discharge.
- - Key factors influencing readmissions included the presence of complex chronic conditions and the receipt of a tracheostomy, both of which were linked to significantly higher risks of returning to the hospital.
- - The research used data from insurance databases and analyzed diagnoses and outcomes to understand the long-term impacts on pediatric ARDS survivors, with a follow-up extending into 2018.
Article Synopsis
- - The study aimed to evaluate how starting venovenous extracorporeal membrane oxygenation (VV-ECMO) affects vasoactive-inotropic scores (VIS) in kids with acute respiratory distress syndrome and cardiovascular issues.
- - Conducted at a pediatric ECMO center, the retrospective study analyzed data from 32 children, revealing significant pre- and post-ECMO changes in various medical metrics, including VIS, oxygenation levels, and blood gas measurements.
- - Findings showed that VIS decreased shortly after VV-ECMO initiation, alongside improvements in oxygen saturation, blood pH, and carbon dioxide levels, suggesting positive immediate effects of the treatment.
Article Synopsis
- The study aimed to analyze respiratory failure characteristics in children before experiencing in-hospital cardiac arrest (IHCA) and how these factors relate to survival rates.
- It involved reviewing data from a cohort of children under 18 who received CPR while on invasive mechanical ventilation in ICUs between January 2017 and June 2021, focusing on their respiratory conditions just before the arrest.
- Findings indicated that many patients had severe respiratory issues leading up to the arrest, and those with higher oxygen needs and more significant oxygenation failure had poorer chances of survival.
Article Synopsis
- - The study investigates the unknown risks of excess mortality in children suffering from acute respiratory failure, specifically in cases involving pediatric sepsis.
- - Researchers created and validated new ICD10-based algorithms to identify a form of acute respiratory distress syndrome (ARDS), achieving a high specificity of 96.7% and a sensitivity of 70.5%.
- - The findings reveal that children with mechanically ventilated ARDS face a 24.4% higher risk of mortality compared to those without, indicating that this condition contributes to a modest increase in mortality risk among septic pediatric patients.
Mixed-methods process evaluation of a respiratory-culture diagnostic stewardship intervention.
Infect Control Hosp Epidemiol
February 2023
Objective: To conduct a process evaluation of a respiratory culture diagnostic stewardship intervention.
Design: Mixed-methods study.
Setting: Tertiary-care pediatric intensive care unit (PICU).
Article Synopsis
- Neonates undergoing cardiopulmonary bypass surgery face high risks of death and complications, leading to the proposal of "ICU-30" as a combined measure of poor outcomes, including mortality and prolonged ICU stays.
- A study analyzing 887 neonates found that 26.2% experienced the ICU-30 outcome, which correlated with higher rates of mortality at 6 and 12 months.
- The ICU-30 measure effectively predicted long-term mortality, highlighting its potential as a valuable tool for assessing patient outcomes using standard data collection methods.
Article Synopsis
- The study investigated how certain genetic variations (SNPs) in surfactant protein genes relate to long-term respiratory problems in children after experiencing acute respiratory failure (ARF).
- Of the 250 children enrolled, 155 and 127 were assessed for respiratory morbidity at 6 and 12 months post-ARF, respectively, using complex statistical models.
- Results indicated that specific SNPs, like rs1124_A and rs4715_A, were linked to an increased risk of respiratory issues at both time points, while others showed varying risks depending on the combination of SNPs in the analysis.
Article Synopsis
- - The American Thoracic Society Core Curriculum regularly updates healthcare professionals on pulmonary diseases, critical care, and sleep medicine for both adults and children every 3 to 4 years.
- - At the 2020 International Conference, key pediatric pulmonary topics include managing pediatric hypoxemic respiratory failure and chronic respiratory failure, among others.
- - Other topics discussed will cover surgical management of congenital lung issues, updates on smoke inhalation injuries, electronic smoking devices, and the pulmonary effects of conditions like sarcoidosis and congenital heart disease.