Publications by authors named "Tom B Rice"

Objectives: Extubation failure (EF) in PICU patients is reintubation within 48, 72, or 96 hours of planned extubation (EF48, EF72, and EF96, respectively). Standardized sedation protocols, extubation readiness testing, and noninvasive respiratory support are used to improve efficient liberation from mechanical ventilation (MV). We therefore aimed to review EF rates, time to failure, and the use of noninvasive respiratory support after extubation, 2017-2021.

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Objectives: To define the prevalence of neurologic diagnoses and evaluate the utilization of critical care and neurocritical care (NCC) resources among children admitted to the PICU.

Design: Retrospective cohort analysis.

Setting: Data submitted to the Virtual Pediatric Systems (VPS) database.

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Objectives: There are limited reports of the impact of the coronavirus disease 2019 pandemic focused on U.S. and Canadian PICUs.

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This is an executive summary of the 2019 update of the 2004 guidelines and levels of care for PICU. Since previous guidelines, there has been a tremendous transformation of Pediatric Critical Care Medicine with advancements in pediatric cardiovascular medicine, transplant, neurology, trauma, and oncology as well as improvements of care in general PICUs. This has led to the evolution of resources and training in the provision of care through the PICU.

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Objectives: To update the American Academy of Pediatrics and Society of Critical Care Medicine's 2004 Guidelines and levels of care for PICU.

Design: A task force was appointed by the American College of Critical Care Medicine to follow a standardized and systematic review of the literature using an evidence-based approach. The 2004 Admission, Discharge and Triage Guidelines served as the starting point, and searches in Medline (Ovid), Embase (Ovid), and PubMed resulted in 329 articles published from 2004 to 2016.

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Objectives: To create a novel tool to predict favorable neurologic outcomes during ICU stay among children with critical illness.

Design: Logistic regression models using adaptive lasso methodology were used to identify independent factors associated with favorable neurologic outcomes. A mixed effects logistic regression model was used to create the final prediction model including all predictors selected from the lasso model.

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Background: Efforts to improve pediatric trauma outcomes need detailed data, optimally collected at lowest cost, to assess processes of care. We developed a novel database by merging 2 national data systems for 5 pediatric trauma centers to provide benchmarking metrics for mortality and non-mortality outcomes and to assess care provided throughout the care continuum.

Study Design: Trauma registry and Virtual Pediatric Systems, LLC (VPS) from 5 pediatric trauma centers were merged for children younger than 18 years discharged in 2013 from a pediatric ICU after traumatic injury.

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Objectives: Little is known about the relationship between freestanding children's hospitals and outcomes in children with critical illness. The purpose of this study was to evaluate the association of freestanding children's hospitals with outcomes in children with critical illness.

Design: Propensity score matching was performed to adjust for potential confounding variables between patients cared for in freestanding or nonfreestanding children's hospitals.

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Rationale: The around-the-clock presence of an in-house attending critical care physician (24/7 coverage) is purported to be associated with improved outcomes among high-risk children with critical illness.

Objectives: To evaluate the association of 24/7 in-house coverage with outcomes in children with critical illness.

Methods: Patients younger than 18 years of age in the Virtual Pediatric Systems Database (2009-2014) were included.

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Background: Multi center data regarding cardiac arrest in children undergoing heart operations of varying complexity are limited.

Methods: Children <18 years undergoing heart surgery (with or without cardiopulmonary bypass) in the Virtual Pediatric Systems (VPS, LLC) Database (2009-2014) were included. Multivariable mixed logistic regression models were adjusted for patient's characteristics, surgical risk category (STS-EACTS Categories 1, 2, and 3 classified as "low" complexity and Categories 4 and 5 classified as "high" complexity), and hospital characteristics.

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Objective: To determine the prevalence of and risk factors associated with the need for mechanical ventilation in children following cardiac surgery and the need for subsequent reintubation after the initial extubation attempt.

Methods: Patients younger than 18 years who underwent cardiac operations for congenital heart disease at one of the participating pediatric intensive care units (ICUs) in the Virtual PICU Systems (VPS), LLC, database were included (2009-2014). Multivariable logistic regression models were fitted to identify factors likely associated with mechanical ventilation and reintubation.

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Purpose: Evaluate national variation in structure and care processes for critically injured children.

Methods: Institutions with pediatric intensive care units (PICUs) that treat trauma patients were identified through the Virtual Pediatric Systems (n=72). Prospective survey data were obtained from PICU and Trauma Directors (n=69, 96% response).

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Aim: To evaluate the association of house staff training with mortality in children with critical illness.

Methods: Patients <18 years of age in the Virtual PICU Systems (VPS, LLC) Database (2009-2013) were included. The study population was divided in two study groups: hospitals with residency programme only and hospitals with both residency and fellowship programme.

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Objective: Comparison of clinical outcomes is imperative in the evaluation of healthcare quality. Risk adjustment for children undergoing cardiac surgery poses unique challenges, due to its distinct nature. We developed a risk-adjustment tool specifically focused on critical care mortality for the pediatric cardiac surgical population: the Pediatric Index of Cardiac Surgical Intensive care Mortality score.

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Background: This study was designed to evaluate the odds of mechanical ventilation and duration of mechanical ventilation after pediatric cardiac surgery across centers of varying center volume using the Virtual PICU Systems database.

Hypothesis: Children receiving cardiac surgery at high-volume centers will be associated with lower odds of mechanical ventilation and shorter duration of mechanical ventilation, compared with low-volume centers.

Methods: Patients age <18 years undergoing operations (with or without cardiopulmonary bypass) for congenital heart disease at one of the participating intensive care units in the Virtual PICU Systems database were included (2009-2013).

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Objective: To describe epidemiology and outcomes associated with cardiac arrest among critically ill children across hospitals of varying center volumes.

Methods: Patients <18 years of age in the Virtual PICU Systems (VPS, LLC) Database (2009-2013) were included. Patients with both cardiac and non-cardiac diagnoses were included.

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Background: Little is known about the relation between center volume and outcomes in children requiring intensive care unit (ICU) admission for acute asthma.

Objective: To evaluate the association of center volume with the odds of receiving positive pressure ventilation and length of ICU stay.

Methods: Patients 2 to 18 years of age with the primary diagnosis of asthma were included (2009-2012).

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Objective: To empirically derive the optimal measure of pharmacologic cardiovascular support in infants undergoing cardiac surgery with bypass and to assess the association between this score and clinical outcomes in a multi-institutional cohort.

Design: Prospective, multi-institutional cohort study.

Setting: Cardiac ICUs at four academic children's hospitals participating in the Pediatric Cardiac Critical Care Consortium during the study period.

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Importance: Outcomes associated with use of high-frequency oscillatory ventilation (HFOV) in children with acute respiratory failure have not been established.

Objective: To compare the outcomes of HFOV with those of conventional mechanical ventilation (CMV) in children with acute respiratory failure.

Design, Setting, And Participants: We performed a retrospective, observational study using deidentified data obtained from all consecutive patients receiving mechanical ventilation aged 1 month to 18 years in the Virtual PICU System database from January 1, 2009, through December 31, 2011.

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Background: The Risk-Adjusted Classification for Congenital Heart Surgery (RACHS-1) method and Aristotle Basic Complexity (ABC) scores correlate with mortality. However, low mortality rates in congenital heart disease (CHD) make use of mortality as the primary outcome measure insufficient. Demonstrating correlation between risk-adjustment tools and the Pediatric Logistic Organ Dysfunction (PELOD) score might allow for risk-adjusted comparison of an outcome measure other than mortality.

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Objective: Describe central line-associated bloodstream infection (CLA-BSI) epidemiology in pediatric intensive care units (PICUs).

Design: Descriptive study (29 PICUs); cohort study (18 PICUs).

Setting: PICUs in a national improvement collaborative.

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Objectives: To evaluate the long-term impact of pediatric central line care practices in reducing PICU central line-associated bloodstream infection (CLA-BSI) rates and to evaluate the added impact of chlorhexidine scrub and chlorhexidine-impregnated sponges.

Methods: A 3-year, multi-institutional, interrupted time-series design (October 2006 to September 2009), with historical control data, was used. A nested, 18-month, nonrandomized, factorial design was used to evaluate 2 additional interventions.

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Objective: Despite the magnitude of the problem of catheter-associated bloodstream infections (CA-BSIs) in children, relatively little research has been performed to identify effective strategies to reduce these complications. In this study, we aimed to develop and evaluate effective catheter-care practices to reduce pediatric CA-BSIs.

Study Design And Methods: Our study was a multi-institutional, interrupted time-series design with historical control data and was conducted in 29 PICUs across the United States.

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We report a case of a patient who received a bilateral lung transplant for end-stage lung disease secondary to Gauchers type-1 disease with no evidence of recurrence of the disease in the transplanted lung.

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