Nurses' perception of pediatric pain and pain assessment in the Japanese PICU.

Background: Nurses play an essential role in pain management in the pediatric intensive care unit (PICU). However, their perceptions regarding pediatric pain and current practice of pain assessment in Japanese PICUs remain unknown.

Methods: In January 2021, we conducted a multicenter, cross-sectional survey across 35 PICUs in Japan.

Trajectory of kidney recovery in pediatric patients requiring continuous kidney replacement therapy for acute kidney injury.

Background: Acute kidney injury (AKI) is commonly seen in the PICU and is associated with poor short-term and long-term outcomes, especially in patients who required continuous kidney replacement therapy (CKRT). However, as the trajectory of kidney recovery in these patients remain uncertain, determination of the timing to convert to permanent kidney replacement therapy (KRT) remains a major challenge. We aimed to examine the frequency and timing of kidney recovery in pediatric AKI survivors that required CKRT.

Early therapeutic plasma exchange may lead to complete neurological recovery in moderate to severe influenza-associated acute necrotizing encephalopathy.

Background: Acute necrotizing encephalopathy (ANE) is a pediatric neurological disease, presumably caused by cytokine storms, with a poor prognosis. Immunomodulatory therapy, including therapeutic plasma exchange (TPE), could be an effective treatment.

Cases: Two patients with influenza-associated ANE were treated.

Impact of extensive negative pressure wound therapy on neonatal respiration: A case report.

An extensive topical negative pressure wound therapy (NPWT) from the abdominal to chest walls in neonates may decrease the compliance of the chest wall. Therefore, it is important to monitor respiratory function carefully during the procedure.

Airway Management and Risk Factors for Prolonged Intubation in Patients with Severe Croup.

Croup is a common respiratory illness in children with a substantial variation in the severity of symptoms. Most of the patients present with mild symptoms, but patients with severe croup require intensive care unit (ICU) management. The aim of this study was to investigate the airway management of patients with severe croup who required intubation and determine the risk factors for prolonged intubation.

Unplanned admission to pediatric intensive care after general anesthesia: A seven-year retrospective cohort study in a tertiary children's hospital.

Background: Thorough preoperative risk assessment and planning is key to improving patient safety in the perioperative period. Analysis of unplanned ICU admissions after general anesthesia has been validated as a measure of patient safety and its use as a quality initiative is recommended in many countries.

Aims: The aims of this study were to determine the reasons for unplanned ICU admission, required interventions, and outcomes after general anesthesia in our hospital, as well as predictability and preventability of the events that led to admission with a view to improving anesthetic management.

Dexmedetomidine for patients with croup.

Agitation exacerbates symptoms in patients with croup, but the reports on the therapeutic effects of sedation in these patients without intubation are scarce. We describe a typical case of croup wherein light sedation with dexmedetomidine was effective in treating and discuss how agitation exacerbates and sedation improves symptoms from the viewpoint of fluid dynamics theory in addition to the conventional explanation. The mechanism of dynamic airway collapse during inspiration in these patients supports the effectiveness of sedation with dexmedetomidine.

Chloride Reduction Therapy with Furosemide: Short-Term Effects in Children with Acute Respiratory Failure.

From the perspective of the Stewart approach, it is known that expansion of the sodium chloride ion difference (SCD) induces alkalosis. We investigated the role of SCD expansion by furosemide-induced chloride reduction in pediatric patients with acute respiratory failure. We included patients admitted to our pediatric intensive care unit intubated for acute respiratory failure without underlying diseases, and excluded patients receiving extracorporeal circulation therapy (extracorporeal membrane oxygenation and/or renal replacement therapy).

Effect of sodium-chloride ion difference on pH regulation.

Background: In the Stewart approach, the difference between the cation and anion concentrations, especially between sodium, accounting for the majority of cations, and chloride, comprising the majority of anions, is an important factor in pH regulation. This study investigated the effect of sodium-chloride ion difference (SCD) on pH regulation comparing with those of PaCO and lactate.

Methods: Arterial blood gas samples measured at our pediatric intensive care unit of a tertiary children's hospital between January and June 2020 were included.

Life-threatening oral mucositis following chemotherapy in a pediatric patient.

Severe oral mucositis as a complication of chemotherapy may lead to airway obstruction and require prolonged intubation. As its course is consistent with the course of neutropenia, airway management strategies should be determined individually.

Ultrasound-Guided Postpyloric Feeding Tube Placement in Critically Ill Pediatric Patients.

Objectives: Various methods to insert postpyloric feeding tubes at the bedside have been reported, but the optimal method remains controversial. The objective of this study was to evaluate the effect of ultrasound-guided postpyloric feeding tube placement in critically ill children.

Design: Single-center retrospective observational study.

The Ventilatory Strategy to Minimize Expiratory Flow Rate in Ventilated Patients with Chronic Obstructive Pulmonary Disease.

Although the pathophysiology of chronic obstructive pulmonary disease (COPD) is multifactorial, central airway collapse is reported to have a great impact on symptom severity. In COPD patients, positive pressure formed by hyperinflated lungs compressing the tracheal wall and negative changes in intratracheal static pressure due to rapid expiratory flow velocity at the beginning of expiration collapse the trachea. This phenomenon can be explained by fluid dynamics theory.

Extracorporeal Life Support as a Treatment of Supraventricular Tachycardia in a Newborn.

Supraventricular tachycardia (SVT) is the most common symptomatic tachyarrhythmia in children and requires medical treatment. Thus far, there have been few reports of the use of extracorporeal life support (ECLS) to provide cardiac support in children with low cardiac output resulting from arrhythmia. We present a case of a newborn in whom ECLS was used to provide support for cardiogenic shock secondary to intractable SVT.

Fluid dynamics approach to airway obstruction.

Background: Fluid dynamics theory, which is a fundamental underlying concept applied to fluid management, has not been introduced to analyze the human respiratory system. We hypothesized that one of the potential mechanisms that promotes airflow limitation in patients with airway obstructive disease would be elucidated by using fluid dynamics theory.

Methods: We calculated the values of pressure loss and static pressure change under virtual tracheal stenotic conditions using the fluid dynamics approach.

Benefits of Early Mobilization After Pediatric Liver Transplantation.

Objective: To evaluate the impact of early mobilization after pediatric liver transplantation in the PICU.

Design: A 70-month retrospective before-after study.

Setting: Medical and surgical PICU with 20 beds at a tertiary children's hospital.

Continuous Monitoring and Feedback Optimizes Blood Volume Inoculated Into Culture Bottles in the Pediatric Intensive Care Unit.

In this quasi-experimental study that included 3489 blood culture bottles, interventions that included the distribution of simple weight-stratified guidelines for recommended blood volume and monthly feedback to physicians were effective in optimizing blood volume for culture in a pediatric intensive care unit.

The Effect of Clinical Experience on the Learning Curve of Pediatric Intensive Care Unit Residents for the Central Venous Catheter Placement Procedure.

The objective of this study is to ascertain the effect of clinical experience on pediatric intensive care unit (PICU) residents' learning curve for central venous catheter placement in critically ill children. It was a 58-month retrospective observational study. The setting was multivalent PICU with 20 beds at a tertiary children's hospital.

Early Mobilization after Pediatric Liver Transplantation.

 This study aims to evaluate the impact of early mobilization (EM) after pediatric liver transplantation in the pediatric intensive care unit (PICU).  A 14-month prospective before and after study.  Multivalent PICU with 20 beds at a tertiary children's hospital.

Pediatric tracheostomy: Survival and long-term outcomes.

Objectives: The objective of this study was to investigate if there were any differences in survival and long-term outcomes between pediatric patients with and without neurological impairment who underwent tracheostomy.

Methods: A retrospective chart review of pediatric patients (age 0-15 years) who underwent tracheostomy between March 2002 and December 2013 was conducted. Patients were categorized into two groups: those who were neurologically impaired (NI) (pediatric cerebral performance category, 3-6) and those who were not neurologically impaired (NN) (pediatric cerebral performance category, 1-2).