Clinical Outcomes of Acute Respiratory Failure Associated With Noninvasive and Invasive Ventilation in a Pediatric ICU.

Background: It remains unknown if pediatric patients failing initial noninvasive ventilation (NIV) experience worse clinical outcomes than those successfully treated with NIV or those primarily intubated.

Methods: This was a single-center, retrospective review of patients admitted with acute respiratory failure to the University of Michigan pediatric intensive care or cardiothoracic ICUs and receiving NIV or invasive mechanical ventilation as first-line therapy.

Results: One hundred seventy subjects met inclusion criteria and were enrolled: 65 NIV success, 55 NIV failure, and 50 invasive mechanical ventilation alone.

Brainstem hypoxic-ischemic lesions on MRI in infants treated with therapeutic cooling: effects on the length of stay and mortality.

Objective: To test the hypothesis that brainstem hypoxic-ischemic injury on magnetic resonance imaging (MRI) would be independently associated with short-term outcomes in cooled asphyxiated infants.

Methods: A total of 90 consecutively cooled asphyxiated infants who survived to have brain MRI were reviewed. A neuroradiologist who was masked to outcomes evaluated MRI images for brainstem involvement.

Predicting the need for home gavage or g-tube feeds in asphyxiated neonates treated with therapeutic hypothermia.

Background: Asphyxiated infants treated with therapeutic cooling can have persistent oral feeding difficulty because of involvement of neural pathways in the brainstem, cortex, and basal ganglia. The goal is to predict the composite adverse outcome of death or persistent oral feeding difficulty using precooling/cooling attributes, and the severity and distribution of hypoxic-ischemic lesions, especially brainstem lesions on post-cooling brain magnetic resonance imaging (MRI).

Methods: Retrospective review of 86 asphyxiated infants cooled from January 2006 to August 2014.

Assessment of association between rapid fluctuations in serum sodium and intraventricular hemorrhage in hypernatremic preterm infants.

Aim: This study aims to determine the association between the rapid fluctuations in serum sodium and intraventricular hemorrhage (IVH) or death in hypernatremic preterm infants.

Study Design: Single center observational study including 216 infants < 1,000 g birth weight and <29 weeks gestational age, who had serum sodium levels monitored at least every 12 hours. Logistic regression analyses were used to identify which of the commonly cited risk factors for IVH, including the rapid (to the extent of ≥10 and ≥15 mmol/L/d) rise or fall in serum sodium, was associated with the primary outcome of any IVH, or the secondary composite outcome of severe IVH or death during the first 10 days of life in hypernatremic infants.

Validation of the V(max) metabolic cart in a simulated pediatric model.

Background: The ability to accurately measure resting energy expenditure (REE) using indirect calorimetry, often referred to as the "gold standard" in nutrition needs assessment, is important given the well-established positive correlation between patient outcome and proportion of the nutrition goal met. While many studies have been done to compare various metabolic carts with one another, the literature lacks a large simulator-based validation of any metabolic cart system.

Materials And Methods: In the present study, 8 specifically trained staff members independently conducted 10 simulation trials each using the V(max) Encore metabolic analyzer in conjunction with a metabolic calibration system, which simulates patient metabolic activity, to validate the accuracy of the V(max) Encore across a wide range of simulated metabolic conditions.

Evaluation of the oxygenation index in adult respiratory failure.

Background: The oxygenation index (mean airway pressure × FIO2 divided by PaO2) was originally devised to measure severity of illness and predict outcome in neonatal respiratory failure. We evaluated the discrimination of a modified oxygenation index (modified with age) for predicting 28-day mortality in adults with respiratory failure (adult respiratory distress syndrome [ARDS]) using the ALVEOLI section of the ARDSNet database and validated the results in the full ARDSNet database.

Methods: We compared age-adjusted oxygenation index (AOI) on ventilator Days 1 to 4 with 28-day mortality.

Relationship between acute kidney injury and brain MRI findings in asphyxiated newborns after therapeutic hypothermia.

Background: We hypothesized that acute kidney injury (AKI) in asphyxiated neonates treated with therapeutic hypothermia would be associated with hypoxic-ischemic lesions on brain magnetic resonance imaging (MRI).

Methods: Medical records of 88 cooled neonates who had had brain MRI were reviewed. All neonates had serum creatinine assessed before the start of cooling; at 24, 48, and 72 h through cooling; and then on day 5 or 7 of life.

Acute kidney injury in asphyxiated newborns treated with therapeutic hypothermia.

Objective: To test the hypothesis that acute kidney injury (AKI) would be independently associated with increased morbidity and mortality.

Study Design: A total of 96 consecutively cooled infants were reviewed retrospectively. Modified Acute Kidney Injury Network criteria were used to classify AKI based on absolute rise in serum creatinine (SCr) level from a previous trough (stage I, rise in SCr of 0.

Esophageal and rectal temperatures as estimates of core temperature during therapeutic whole-body hypothermia.

We monitored whole-body cooling concurrently by both esophageal and rectal probes. Esophageal temperature was significantly higher compared with simultaneous rectal temperature during cooling, with a temperature gradient ranging from 0.46 to 1.

Current knowledge of acute lung injury and acute respiratory distress syndrome.

Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) continues to be a major cause of mortality in adult and pediatric critical care medicine. This article discusses the pulmonary sequelae associated with ALI and ARDS, the support of ARDS with mechanical ventilation, available adjunctive therapies, and experimental therapies currently being tested. It is hoped that further understanding of the fundamental biology, improved identification of the patient's inflammatory state, and application of therapies directed at multiple sites of action may ultimately prove beneficial for patients suffering from ALI/ARDS.

The effect of late preterm birth on mortality of infants with hypoplastic left heart syndrome.

Objectives: We evaluated the effect of late preterm (34 to 36 weeks' gestation) delivery on hospital mortality of infants with hypoplastic left heart syndrome (HLHS).

Study Design: Retrospective review of records of infants born at or after 34 weeks with no other lethal anomalies, cared for in a single tertiary perinatal center between 2002 and 2009. Factors associated with death prior to discharge from the hospital were ascertained using univariate and multivariate analyses.

A randomized trial of recombinant human granulocyte-macrophage colony stimulating factor for patients with acute lung injury.

Rationale: Despite recent advances in critical care and ventilator management, acute lung injury and acute respiratory distress syndrome continue to cause significant morbidity and mortality. Granulocyte-macrophage colony stimulating factor may be beneficial for patients with acute respiratory distress syndrome.

Objectives: To determine whether intravenous infusion of granulocyte-macrophage colony stimulating factor would improve clinical outcomes for patients with acute lung injury/acute respiratory distress syndrome.

Rebound in ventilator-associated pneumonia rates during a prevention checklist washout period.

OBJECTIVE To describe the washout effect after stopping a prevention checklist for ventilator-associated pneumonia (VAP). METHODS VAP rates were prospectively monitored for special cause variation over 42 months in a paediatric intensive care unit. A VAP prevention bundle was implemented, consisting of head of bed elevation, oral care, suctioning device management, ventilator tubing care, and standard infection control precautions.

Nutrition in critical care.

Critical care has evolved from a prolonged recovery room stay for cardiac surgery patients to a full medical and nursing specialty in the last 5 decades. The ability to feed patients who cannot eat has evolved from impossible to routine clinical practice in the last 4 decades. Nutrition in critically ill patients based on measurement of metabolism has evolved from a research activity to clinical practice in the last 3 decades.

The relationship between clinically identifiable intrapartum sentinel events and short-term outcome after therapeutic hypothermia.

Objective: To determine the impact of intrapartum sentinel events on short-term outcome post-hypothermia.

Study Design: Records of 77 infants of 36 weeks' gestation or more, who received therapeutic hypothermia, were reviewed. Some were delivered after a clinically identifiable intrapartum sentinel event (IISE).

Predicting death despite therapeutic hypothermia in infants with hypoxic-ischaemic encephalopathy.

Objective: To determine precooling attributes possibly predicting death in infants with hypoxic-ischaemic encephalopathy (HIE) despite therapeutic cooling.

Methods: Eighty-five consecutive infants of ≥36 weeks' gestation who received cooling for HIE were reviewed. Logistic regression analysis was performed using precooling clinical and laboratory variables with death related to HIE during the first 9 months of life as the primary outcome.

Effect of interhospital transfer on resource utilization and outcomes at a tertiary pediatric intensive care unit.

Purpose: The study aimed to examine the effect of interhospital transfer on resource utilization and clinical outcomes at a tertiary pediatric intensive care unit (PICU) among patients with sepsis or respiratory failure.

Materials And Methods: Data on 2146 consecutive admissions with respiratory failure or sepsis to the PICU were analyzed. Data included demographics, admission source, and outcomes.

Review of a large clinical series: association of cumulative fluid balance on outcome in acute lung injury: a retrospective review of the ARDSnet tidal volume study cohort.

Objective: To evaluate the independent influence of fluid balance on outcomes for patients with acute lung injury.

Design: Secondary analysis of a prospective cohort study conducted between March 1996 and March 1999.

Setting: The study involved 10 academic clinical centers (with 24 hospitals and 75 Intensive Care Units).

Do outcomes vary according to the source of admission to the pediatric intensive care unit?

Objective: To examine associations between mortality, length of stay, and the sources of admission to tertiary pediatric intensive care.

Design: A retrospective analysis of prospectively collected data.

Setting: A tertiary medical center with a 16-bed medical-surgical intensive care unit and a 15-bed cardiac pediatric intensive care unit (PICU).