Hepatic vein Doppler ultrasound to estimate central venous pressure in mechanically ventilated children.

Monitoring central venous pressure (CVP) is crucial for managing critically ill patients yet poses challenges in pediatric cases. This study aimed to correlate CVP with hepatic vein Doppler and IVC ultrasound variables in children. Mechanically ventilated children underwent simultaneous ultrasound and CVP measurements.

The impact of PEEP on mechanical power and driving pressure in children with pediatric acute respiratory distress syndrome.

Background: Positive end-expiratory pressure (PEEP) is widely used to improve oxygenation and avoid alveolar collapse in mechanically ventilated patients with pediatric acute respiratory distress syndrome (PARDS). However, its improper use can be harmful, impacting variables associated with ventilation-induced lung injury, such as mechanical power (MP) and driving pressure (∆P). Our main objective was to assess the impact of increasing PEEP on MP and ∆P in children with PARDS.

The Impact of Increased PEEP on Hemodynamics, Respiratory Mechanics, and Oxygenation in Pediatric ARDS.

Background: PEEP is a cornerstone treatment for children with pediatric ARDS. Unfortunately, its titration is often performed solely by evaluating oxygen saturation, which can lead to inadequate PEEP level settings and consequent adverse effects. This study aimed to assess the impact of increasing PEEP on hemodynamics, respiratory system mechanics, and oxygenation in children with ARDS.

Acute kidney injury in children undergoing cardiac surgery: predictive value of kidney arterial Doppler-based variables.

Background: Acute kidney injury (AKI) is a common condition in critically ill children and is associated with increased morbidity and mortality. This study aimed to assess the performance of point-of-care ultrasonography to predict AKI in children undergoing cardiac surgery.

Methods: In this prospective study, consecutive children underwent kidney Doppler ultrasound examination within 24 h following cardiac surgery, and an experienced operator obtained both renal resistive index (RRI) and renal pulsatility index (RPI).

Estimated continuous cardiac output based on pulse wave transit time in critically ill children: a report of two cases.

Cardiac output is an essential determinant of oxygen delivery, although unreliably measured on clinical examination and routine monitoring. Unfortunately, cardiac output monitoring is rarely performed in pediatric critical care medicine, with a limited availability of accurate methods for children. Herein, we report two pediatric cases in which noninvasive pulse-wave transit time-based cardiac output monitoring (esCCO, Nihon Kohden, Tokyo, Japan) was used.

Accuracy of Respiratory Variation in Inferior Vena Cava Diameter to Predict Fluid Responsiveness in Children Under Mechanical Ventilation.

Proper assessment of fluid responsiveness using accurate predictors is crucial to guide fluid therapy and avoid the serious adverse effects of fluid overload. The main objective of this study was to investigate the accuracy of respiratory variations in inferior vena cava diameter (∆IVC) to predict fluid responsiveness in mechanically ventilated children. This prospective single-center study included 32 children (median age and weight of 17 months and 10 kg, respectively) who received a fluid infusion of 10 ml kg of crystalloid solutions over 10 min.

Point-of-care ultrasonography to predict fluid responsiveness in children: A systematic review and meta-analysis.

Background: Point-of-care ultrasonography (POCUS) is proposed as a valuable method for hemodynamic monitoring and several ultrasound-based predictors of fluid responsiveness have been studied. The main objective of this study was to assess the accuracy of these predictors in children.

Methods: PubMed, Embase, Scopus, ClinicalTrials.

Acute kidney injury in critically ill children: predictive value of renal arterial Doppler assessment.

Background: Renal resistive index (RRI) and renal pulsatility index (RPI) are Doppler-based variables proposed to assess renal perfusion at the bedside in critically ill patients. This study aimed to assess the accuracy of such variables to predict acute kidney injury (AKI) in mechanically ventilated children.

Methods: Consecutive children aged <14 years underwent kidney Doppler ultrasound examination within 24 h of invasive mechanical ventilation.

A Pediatric Intensive Care Checklist for Interprofessional Rounds: The R-PICniC Study.

Background: The use of checklists in the pediatric intensive care unit can help improve the quality of care and patient safety.

Objectives: To build and validate a checklist for use in interprofessional rounds in a pediatric intensive care unit.

Methods: This methodological study was conducted in a 20-bed pediatric intensive care unit serving children up to 14 years old.

Carotid doppler ultrasonography as a method to predict fluid responsiveness in mechanically ventilated children.

Aims: The aim of this study was to investigate whether respiratory variations in carotid and aortic blood flows measured by Doppler ultrasonography could accurately predict fluid responsiveness in critically ill children.

Methods: This was a prospective single-center study including mechanically ventilated children who underwent fluid replacement at the discretion of the attending physician. Response to fluid load was defined by a stroke volume increase of more than 15%.

Carotid Doppler Ultrasonography for Hemodynamic Assessment in Critically Ill Children.

An accurate assessment of cardiovascular performance is essential to predict and evaluate hemodynamic response to interventions. The objective of this prospective study was to assess whether point-of-care ultrasonography of the common carotid artery (CCA) can estimate the stroke volume (SV) and cardiac index (Ci) of critically ill children. Participants underwent Doppler ultrasonography of the left CCA and transthoracic echocardiography (TTE).

Sarcopenia in critically ill children: A bedside assessment using point-of-care ultrasound and anthropometry.

Background & Aims: Due to the lack of validated methods of muscle assessment, sarcopenia is not well described in critically ill children. The main objectives of this study were to assess muscle wasting using point-of-care ultrasound (POCUS) and anthropometry, as well as its association with nutrition delivery in PICU.

Methods: This was a single-center, prospective cohort study, including consecutive children admitted to the PICU.

Hypophosphatemia in critically ill pediatric patients receiving enteral and oral nutrition.

Background: Hypophosphatemia(HP) is related to several comorbidities in pediatric intensive care units (PICUs). This study aimed to evaluate the incidence of HP in severely ill pediatric patients receiving oral and/or enteral nutrition. The secondary objectives were to investigate the association between HP and the inflammatory state, PICU length of stay, severity, mortality, nutrition status, and protein, energy, calcium, vitamin D, and phosphate intake.

Extubation in the pediatric intensive care unit: predictive methods. An integrative literature review.

For extubation in pediatric patients, the evaluation of readiness is strongly recommended. However, a device or practice that is superior to clinical judgment has not yet been accurately determined. Thus, it is important to conduct a review on the techniques of choice in clinical practice to predict extubation failure in pediatric patients.

High-frequency oscillatory ventilation in children: A systematic review and meta-analysis.

Background: High-frequency oscillatory ventilation (HFOV) is an alternative mechanical ventilation mode proposed to reduce ventilator-induced lung injuries and improve clinical outcomes. The aim of this study was to determine the effects of HFOV compared to conventional mechanical ventilation (CMV) when used in children with hypoxemic respiratory failure.

Methods: The literature search was conducted to identify all studies published before December 2020.

Hemodynamic effects of increased intra-abdominal pressure in critically ill children.

Objective: To evaluate the influence of intra-abdominal pressure on the cardiac index (CI) at different intra-abdominal hypertension grades achieved when performing an abdominal compression maneuver (ACM). Evaluating the effectiveness of the ACM in distending the left internal jugular vein (LIJV).

Methods: Prospective observational study conducted in the PICU of a quaternary care teaching hospital.

Clinical manifestations of children with COVID-19: A systematic review.

Background: The coronavirus disease 2019 (COVID-19) outbreak is an unprecedented global public health challenge, leading to thousands of deaths every day worldwide. Despite the epidemiological importance, clinical patterns of children with COVID-19 remain unclear. The aim of this study was to describe the clinical, laboratorial, and radiological characteristics of children with COVID-19.

Protein intake deficiency in critically ill children with respiratory insufficiency: A call to action?

Background & Aims: Adequate energy-protein intake is associated with improved clinical outcomes in critically ill children. The aim of this study was to evaluate the time of enteral nutrition (EN) onset and the energy-protein intake in critically ill pediatric patients admitted with respiratory insufficiency.

Methods: A single-center prospective cohort study, including children and adolescents, aged from 1 month to 14 years.

Inferior Vena Cava Ultrasound in Children: Comparing Two Common Assessment Methods.

Objectives: Inferior vena cava ultrasound has been used as a predictor of fluid responsiveness in children. Two ultrasonographic modes can be used to measure the respiratory variation of inferior vena cava diameter: M-mode and B-mode. Inconsistencies in measurements between the modes can result in inaccuracies in commonly used indices that assess fluid responsiveness.

Evaluating viscoelastic properties and membrane electrical charges of red blood cells with optical tweezers and cationic quantum dots - applications to β-thalassemia intermedia hemoglobinopathy.

Biomechanical and electrical properties are important to the performance and survival of red blood cells (RBCs) in the microcirculation. This study proposed and explored methodologies based on optical tweezers and cationic quantum dots (QDs) as biophotonic tools to characterize, in a complementary way, viscoelastic properties and membrane electrical charges of RBCs. The methodologies were applied to normal (HbA) and β-thalassemia intermedia (Hbβ) RBCs.