The incidence of atrial fibrillation and its impact on the length of stay following valvular heart surgery.

Aim: There is minimal evidence regarding predictors, preventative measures and treatments of new onset of post-operative atrial fibrillation (POAF) in patients undergoing valvular heart surgery. This study aimed to determine the incidence of new onset atrial fibrillation (AF) and its impact on outcomes and length of stay (LOS) for patients following valvular heart surgery.

Methods: A single-centre, retrospective study was conducted.

Association of Blood-Based Brain Injury Biomarker Concentrations With Outcomes After Pediatric Cardiac Arrest.

Importance: Families and clinicians have limited validated tools available to assist in estimating long-term outcomes early after pediatric cardiac arrest. Blood-based brain-specific biomarkers may be helpful tools to aid in outcome assessment.

Objective: To analyze the association of blood-based brain injury biomarker concentrations with outcomes 1 year after pediatric cardiac arrest.

Use of Magnetic Resonance Imaging in Neuroprognostication After Pediatric Cardiac Arrest: Survey of Current Practices.

Background: Use of magnetic resonance imaging (MRI) as a tool to aid in neuroprognostication after cardiac arrest (CA) has been described, yet details of specific indications, timing, and sequences are unknown. We aim to define the current practices in use of brain MRI in prognostication after pediatric CA.

Methods: A survey was distributed to pediatric institutions participating in three international studies.

The impact of postgraduate education in transition to practice programmes on new graduate nurses' knowledge and skills: A pre- post survey design.

Background: Research indicates that nurses perceive postgraduate education to have a positive effect on their knowledge and practice. Many jurisdictions offer/require new graduate nurses to undertake postgraduate coursework however the consequences of this are not clear.

Objectives: This research aims to determine the impact of completing a postgraduate course in clinical assessment on the capabilities of new graduate nurses.

Serum Biomarkers of Regeneration and Plasticity are Associated with Functional Outcome in Pediatric Neurocritical Illness: An Exploratory Study.

Background/objective: Pediatric neurocritical care survivorship is frequently accompanied by functional impairments. Lack of prognostic biomarkers is a barrier to early identification and management of impairment. We explored the association between blood biomarkers and functional impairment in children with acute acquired brain injury.

Early Protocolized Versus Usual Care Rehabilitation for Pediatric Neurocritical Care Patients: A Randomized Controlled Trial.

Objective: s: Few feasibility, safety, and efficacy data exist regarding ICU-based rehabilitative services for children. We hypothesized that early protocolized assessment and therapy would be feasible and safe versus usual care in pediatric neurocritical care patients.

Design: Randomized controlled trial.

Pathophysiology of Pediatric Multiple Organ Dysfunction Syndrome.

Objective: To describe the pathophysiology associated with multiple organ dysfunction syndrome in children.

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

Study Selection: Not applicable.

Adaptive immune function in critical illness.

Purpose Of Review: This review is being published to update the literature on the function of the adaptive immune system in critical illness, specifically sepsis and acute lung injury. We have focused on the role of T cells in these syndromes.

Recent Findings: The adaptive immune response becomes dysfunctional during sepsis and acute lung injury in very similar ways.

Reaching their potential: Perceived impact of a collaborative academic-clinical partnership programme for early career nurses in New Zealand.

Background: The dynamic nature of healthcare ensures that early career nurses enter an uncertain and complex world of practice and consequently require support to develop their practice, build confidence and reach their potential. The New Zealand Nurse Entry to Practice programme for registered nurses in their first year of practice has been operating since 2005 to enable safe and confident practice, improve the quality of care, and positively impact on recruitment and retention. This academic and clinical programme was offered as a partnership between a university and a clinical provider with postgraduate academic credits gained.

Acute renal replacement therapy in pediatrics.

Acute kidney injury (AKI) independently increases morbidity and mortality in children admitted to the hospital. Renal replacement therapy (RRT) is an essential therapy in the setting of AKI and fluid overload. The decision to initiate RRT is complex and often complicated by concerns related to patient hemodynamic and thermodynamic instability.

Validation of a gene expression-based subclassification strategy for pediatric septic shock.

Objective: Septic shock heterogeneity has important implications for clinical trial implementation and patient management. We previously addressed this heterogeneity by identifying three putative subclasses of children with septic shock based exclusively on a 100-gene expression signature. Here we attempted to prospectively validate the existence of these gene expression-based subclasses in a validation cohort.

Toward a clinically feasible gene expression-based subclassification strategy for septic shock: proof of concept.

Objective: To develop a clinically feasible stratification strategy for pediatric septic shock, using gene expression mosaics and a 100-gene signature representing the first 24 hrs of admission to the pediatric intensive care unit.

Design: Prospective, observational study involving microarray-based bioinformatics.

Setting: Multiple pediatric intensive care units in the United States.

Admission angiopoietin levels in children with septic shock.

Angiopoietin (angpt) 1 and angpt-2 are circulating proteins first ascribed opposing roles in embryonic angiogenesis. Both bind the tyrosine kinase with immunoglobulin-like loop and epidermal growth factor homology domains (Tie) 2 receptor on endothelial cells, but angpt-1 is a Tie-2 agonist, whereas angpt-2 antagonizes Tie-2 signaling. In the developed vasculature, angpt-1 protects against vascular leak, whereas angpt-2 promotes increased vascular permeability.

SOCS-1 is a central mediator of steroid-increased thymocyte apoptosis and decreased survival following sepsis.

Suppressor of Cytokine Signaling (SOCS) proteins are recently identified inhibitors/regulators of cytokine/growth factor signaling pathways. We have previously shown that SOCS-3 is upregulated in mice after sepsis induced by cecal ligation and puncture; however, the contribution of SOCS-1 to septic morbidity and mortality is unclear. In the present study, we characterized SOCS-1 expression in different tissues and delineated putative mechanisms effecting SOCS-1 expression in thymus from septic mice.

Activation of common antiviral pathways can potentiate inflammatory responses to septic shock.

Induction of the antiviral cytokine interferon alpha/beta (IFN-alpha/beta) is common in many viral infections. The impact of ongoing antiviral responses on subsequent bacterial infection is not well understood. In human disease, bacterial superinfection complicating a viral infection can result in significant morbidity and mortality.

In vivo delivery of caspase-8 or Fas siRNA improves the survival of septic mice.

Although studies have shown increased evidence of death receptor-driven apoptosis in intestinal lymphoid cells, splenocytes, and the liver following the onset of polymicrobial sepsis, little is known about the mediators controlling this process or their pathologic contribution. We therefore attempted to test the hypothesis that the hydrodynamic administration of small interfering RNA (siRNA) against the death receptor, Fas or caspase-8, should attenuate the onset of morbidity and mortality seen in sepsis, as produced by cecal ligation and puncture (CLP). We initially show that in vivo administration of green fluorescent protein (GFP) siRNA in GFP transgenic mice results in a decrease in GFP fluorescence in most tissues.

Cytochrome P450 mediated-drug metabolism is reduced in children with sepsis-induced multiple organ failure.

Objective: Antipyrine metabolism is a "gold standard" measure of mixed cytochrome P450 (CYP) mediated drug metabolism in humans. Cytokines (e.g.

Differential effects of macrophage inflammatory chemokine-2 and keratinocyte-derived chemokine on hemorrhage-induced neutrophil priming for lung inflammation: assessment by adoptive cells transfer in mice.

Prior studies have shown that hemorrhage (Hem) can serve as a priming stimulus for acute lung injury (ALI) triggered by subsequent septic challenge (cecal ligation and puncture, CLP). Furthermore, we have reported that in vivo antibody neutralization of the chemokines, macrophage inflammatory chemokine-2 (MIP-2) and keratinocyte-derived chemokine (KC), immediately after Hem appears to differentially effect the onset of ALI. However, although we hypothesize that this is due to divergent effects of MIP-2 and KC on Hem-induced neutrophil (PMN) priming, this has not been tested.

Procalcitonin is persistently increased among children with poor outcome from bacterial sepsis.

Objective: To examine the relationships between procalcitonin, bacterial infection, sepsis-induced multiple organ failure, and mortality rate in children.

Design: Cohort study.

Setting: A multidisciplinary, tertiary-care pediatric intensive care unit.

PATHOLOGICAL ASPECTS OF THE ANTI-INFLAMMATORY/IMMUNE SUPPRESSIVE RESPONSE IN SEPSIS AND SHOCK.

Despite the recent advances in contemporary therapeutic, operative as well as supportive care sepsis and its associated co-morbidity/mortality are still a common occurrence in the critically ill trauma/surgical patient. Thus, it remains important to continue to expand our understanding of pathological components which drive the development of immune dysfunction contributing to subsequent multiple organ failure. Here we overview some of the immuno-pathological processes, cells and mediators which may play a role in the development of this immune dysfunctional condition.

Shock-induced neutrophil mediated priming for acute lung injury in mice: divergent effects of TLR-4 and TLR-4/FasL deficiency.

Acute lung injury (ALI) leading to respiratory distress is a common sequela of shock/trauma, however, modeling this process in mice with a single shock or septic event is inconsistent. One explanation is that hemorrhage is often just a "priming insult," thus, secondary stimuli may be required to "trigger" ALI. To test this we carried out studies in which we assessed the capacity of hemorrhage alone or hemorrhage followed by septic challenge (CLP) to induce ALI.

sFas and sFas ligand and pediatric sepsis-induced multiple organ failure syndrome.

The Fas-Fas ligand system is important for apoptosis of activated immune cells. Perturbation of this system occurs in diseases with dysregulated inflammation. Increased soluble Fas (sFas) occurs in systemic inflammatory response syndrome (SIRS) and can block apoptosis.