Veno-venous extracorporeal membrane oxygenation for COVID-19-associated pediatric acute respiratory distress syndrome.

Background: The SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) coronavirus has emerged as a highly contagious respiratory pathogen causing severe acute lung injury. Extracorporeal membrane oxygenation is a standard tool for the management of life-threatening acute respiratory distress syndrome, but the use of this resource-intensive therapy has come into question due to strained medical systems and limited proven treatments for COVID-19.

Case Summary: A 16-year-old female with obesity presented with fever, myalgias, cough, and tachypnea and was diagnosed with COVID-19.

Impact of monitoring endotracheal tube cuff leak pressure on postextubation stridor in children.

Purpose: To determine if implementing a protocol maintaining an air leak when using cuffed endotracheal tubes (ETT) throughout the course of mechanical ventilation (MV) in children would decrease the rate of postextubation stridor (PES).

Methods: All children requiring MV through a cuffed ETT were included, except those with (1) upper airway anomaly, (2) died while on MV, (3) received tracheostomy before extubation, and (4) transferred before extubation. We implemented a protocol limiting the volume of air instilled into the cuff, allowing an air leak by 25 cm HO pressure or by peak inspiratory pressure, whichever was higher.

Using Pleth Variability as a Triage Tool for Children With Obstructive Airway Disease in a Pediatric Emergency Department.

Objectives: Patients with obstructive airway disease have varying degrees of pulsus paradoxus that correlate with illness severity. Pulsus paradoxus can be measured using plethysmography. We investigated whether plethysmograph (pleth) variability on admission to the pediatric emergency department (ED) could predict patient disposition.

An Analysis of the Daily Work-Rounding Process in a Pediatric Intensive Care Unit.

Objective: To complete an objective analysis of the activities that occur during the course of daily rounds in a high acuity academic tertiary care pediatric intensive care unit (PICU).

Design: Prospective observational work sampling design.

Setting: Tertiary care academic Children's Hospital Pediatric Intensive Care Unit.

The Impact and Statistical Analysis of a Multifaceted Anticoagulation Strategy in Children Supported on ECMO: Performance and Pitfalls.

Background: We sought to determine whether the introduction of a new anticoagulation protocol improved the frequency with which target anticoagulation parameters were met in children supported with extracorporeal membrane oxygenation (ECMO). Additionally, we sought to correlate the results of various tests of anticoagulation with the heparin infusion dose (HID) for patients on ECMO and to evaluate the utility of these anticoagulation monitoring tests for the titration of the HID.

Methods: A retrospective chart review of 18 patients who received ECMO at an academic tertiary care children's hospital.

Characterization of caspofungin susceptibilities by broth and agar in Candida albicans clinical isolates with characterized mechanisms of azole resistance.

Caspofungin (CSP) susceptibilities of Candida albicans, as determined by broth microdilution methods, have not been found to be related to azole susceptibilities or resistance. In contrast, it has been observed that azole-resistant clinical isolates that overexpress the efflux pump gene CDR2 are less susceptible to CSP when tested using an agar dilution method commonly employed with Saccharomyces cerevisiae. The goal of this study was to further understand the effects of azole resistance mechanisms on CSP susceptibility testing.

Polyene susceptibility is dependent on nitrogen source in the opportunistic pathogen Candida albicans.

Objectives: Polyene antifungal drugs, including amphotericin B or nystatin, target ergosterol in the fungal plasma membrane and are used to treat systemic, vaginal and oral fungal infections. In the oral cavity, the available nitrogen sources are primarily in the form of proteins, which are poor nitrogen sources. This study evaluates the effect of protein as a nitrogen source on drug susceptibilities.

Tetracycline alters drug susceptibility in Candida albicans and other pathogenic fungi.

The tetracycline (TET) promoter has been used in several systems as an inducible regulator of gene expression. In control analyses, the standard Candida albicans laboratory strain SC5314 was found to have altered susceptibility to a variety of antifungal drugs in the presence of relatively high concentrations (50-200 microg ml(-1)) of TET. Altered susceptibility was most notable with exposure to amphotericin B (AMB), with a 32-fold increase in susceptibility, and terbinafine (TRB), with a 32-fold decrease in susceptibility.

Concomitant assessment of depth of sedation by changes in bispectral index and changes in autonomic variables (heart rate and/or BP) in pediatric critically ill patients receiving neuromuscular blockade.

Objective: We evaluated whether or not changes in bispectral index (BIS) are associated with concomitant changes in autonomic variables that are in agreement with the different level of sedation that the changes in BIS indicate.

Design: A retrospective chart review.

Setting: A pediatric ICU of a children's hospital.

Drug-induced regulation of the MDR1 promoter in Candida albicans.

Resistance of Candida albicans to azole antifungal drugs is mediated by two types of efflux pumps, encoded by the MDR1 gene and the CDR gene family. MDR1 mRNA levels in a susceptible clinical isolate are induced by benomyl (BEN) but not by other drugs previously shown to induce MDR1. To monitor MDR1 expression under several conditions, the MDR1 promoter was fused to the Renilla reniformis luciferase reporter gene (RLUC).

Role of Candida albicans transcription factor Upc2p in drug resistance and sterol metabolism.

In Candida albicans, drug resistance to clinically important antifungal drugs may be regulated through the action of transcription factors in a manner that may or may not be similar to regulation in Saccharomyces cerevisiae. A search of the C. albicans genome identified a single homolog of the S.

Prone positioning of pediatric patients with ARDS results in improvement in oxygenation if maintained > 12 h daily.

Objectives: To evaluate changes in oxygenation index (OI) in pediatric patients with ARDS during the first 24 h of prone positioning (PP), and to determine whether or not longer periods of PP (> 12 h) result in a more pronounced improvement in oxygenation.

Design: A retrospective chart review of patients with ARDS who had been placed in PP for their management.

Setting: Pediatric ICU of a children's hospital.

Cephalad movement of endotracheal tubes caused by prone positioning pediatric patients with acute respiratory distress syndrome.

Objective: To test the hypothesis that prone positioning of patients with acute respiratory distress syndrome results in significant cephalad movement of their endotracheal tubes (ETT).

Design: A retrospective review of chest radiographs and patient information.

Setting: Pediatric intensive care unit of a children's hospital.