Noninvasive Ventilation or CPAP in the Initial Treatment Phase of Small Infants With Respiratory Failure.

Background: Respiratory failure in infants is a common reason for admission to the pediatric ICU (PICU). Although high-flow nasal cannula (HFNC) is the preferred first-line treatment at our institution, some infants require CPAP or noninvasive ventilation (NIV). Here we report our experience using CPAP/NIV in infants < 10 kg.

Noninvasive Ventilation or CPAP for Postextubation Support in Small Infants.

Background: Infants with a high risk of extubation failure are often treated with noninvasive ventilation (NIV) or CPAP, but data on the role of these support modalities following extubation are sparse. This report describes our experience using NIV or CPAP to support infants following extubation in our pediatric ICUs (PICUs).

Methods: We performed a retrospective study of children < 10 kg receiving postextubation NIV or CPAP in our PICUs.

Use of Intravenous Anakinra for Management of Pediatric Cytokine Storm Syndromes at an Academic Medical Center.

Off-label intravenous (IV) route of anakinra is increasingly recognized to enable higher and faster maximal plasma concentrations than subcutaneous route for treatment of cytokine storm syndromes. To describe off-label indications of IV anakinra, corresponding dosing and safety profiles, particularly during the coronavirus disease 19 (COVID-19) pandemic. A retrospective, single-cohort study was conducted at an academic medical center to evaluate use of IV anakinra in hospitalized pediatric patients (age ≤21 years).

Evaluation of Dosing Regimens of Vancomycin and Aminoglycosides in Pediatric Patients on Continuous Renal Replacement Therapy.

Objective: To determine the optimal empiric dosing regimen to achieve therapeutic serum concentrations of vancomycin and aminoglycosides in pediatric patients who are receiving continuous renal replacement therapy (CRRT).

Methods: This retrospective study investigated pediatric patients (<18 years old) who received at least one dose of an aminoglycoside and/or vancomycin while on CRRT and who had at least one serum concentration assessed during the study period. Rates of culture clearance and discontinuation of renal replacement therapy, pharmacokinetic variables (i.

The use of transcranial direct current stimulation (tDCS) to reduce impulsivity and aggression in adults with mild intellectual developmental disabilities: the tDCS-RIADD randomised controlled trial protocol.

Background: Challenging behaviours, in particular aggressive behaviours, are prevalent among people with intellectual developmental disabilities. Predictors of challenging behaviours are numerous, including past history of aggression, poor coping skills and impulsivity. Factors like motor or rapid-response impulsivity (RRI) have neurobiological underpinnings that may be amenable to change via neuromodulation using non-invasive brain stimulation techniques like transcranial direct current stimulation (tDCS).

The Effect of Rapid Initiation Versus Delayed Initiation of Antibiotics in Pediatric Patients With Sepsis.

Objective: The purpose of this study was to determine if administration of antibiotics within 1 hour of meeting sepsis criteria improved patient outcomes versus antibiotics administered greater than 1 hour after meeting sepsis criteria in pediatric patients. The Surviving Sepsis Campaign's international guidelines recommend appropriate antimicrobial therapy be administered within 1 hour of recognition of severe sepsis or septic shock. Data regarding outcomes in pediatric patients with sepsis regarding antibiotic timing are currently limited.

Evaluation of QTc Interval Effects of Antipsychotic Medications for Intensive Care Unit Delirium in Pediatric Patients.

Objective: Intensive care unit delirium is an increasingly recognized problem in pediatric patients. Controversy exists regarding the safety and efficacy of antipsychotic medications for this indication. The objective of this study was to determine the incidence of and risk factors for QTc interval prolongation in pediatric patients treated with antipsychotics for ICU delirium.

Evaluation of Heparin Anti-Factor Xa Levels Following Antithrombin Supplementation in Pediatric Patients Supported With Extracorporeal Membrane Oxygenation.

Objective: Thrombotic events are potential complications in patients receiving extracorporeal membrane oxygenation (ECMO) necessitating the use of systemic anticoagulation with heparin. Heparin works by potentiating the effects of antithrombin (AT), which may be deficient in critically ill patients and can be replaced. The clinical benefits and risks of AT replacement in children on ECMO remain incompletely understood.

Impact of Clinical, Unit-Specific Guidelines on Dornase Alfa Use in Critically Ill Pediatric Patients Without Cystic Fibrosis.

The purpose of this study was to evaluate the impact of the implementation of pharmacist-guided, unit-specific dornase alfa utilization guidelines for patients without cystic fibrosis in an academic medical institution. The study reviewed the prescribing patterns in the institution's pediatric intensive care unit (PICU) and pediatric cardiac intensive care unit (PCICU) before and after the implementation of these guidelines. The primary objective of this study was to determine the effects of the guidelines on the number of dornase alfa doses prescribed in critically ill pediatric patients without cystic fibrosis.

A Respiratory Therapist-Driven Asthma Pathway Reduced Hospital Length of Stay in the Pediatric Intensive Care Unit.

Background: Asthma is a common reason for admissions to the pediatric intensive care unit (PICU). Since June 2014, our institution has used a pediatric asthma clinical pathway for all patients, including those in PICU. The pathway promotes respiratory therapist-driven bronchodilator weaning based on the Modified Pulmonary Index Score (MPIS).

Evaluation of Calcium Homeostasis and Dietary Supplementation for Pediatric and Neonatal Patients Receiving Extracorporeal Membrane Oxygenation Support.

Objectives: Although the use of extracorporeal membrane oxygenation (ECMO) significantly improves survival in patients with persistent respiratory or cardiovascular failure, it also induces physiologic stress and disrupts homeostatic mechanisms. Patients undergoing ECMO support at our institution have required widely variable quantities of calcium supplementation for maintenance of normal calcium levels. Our primary objective was to assess the frequency of calcium abnormalities in pediatric and neonatal ECMO patients.

Effects of Methadone on Corrected Q-T Interval Prolongation in Critically Ill Children.

Objectives: This study aimed to determine the association between methadone use and corrected Q-T interval (QTc) prolongation in critically ill children.

Methods: A retrospective cohort study of critically ill children receiving methadone at a tertiary care pediatric hospital was conducted. Patients younger than 19 years who had been admitted to the intensive care unit between January 1, 2009, and June 21, 2013, who had received methadone while inpatients, and who had had electrocardiograms (ECGs) performed within 30 days before and after methadone initiation were included.

Association Between Deep Sedation from Continuous Intravenous Sedatives and Extubation Failures in Mechanically Ventilated Patients in the Pediatric Intensive Care Unit.

Objective: The primary objective of this study was to determine whether an association exists between deep sedation from continuous infusion sedatives and extubation failures in mechanically ventilated children. Secondary outcomes evaluated risk factors associated with deep sedation.

Methods: This was a retrospective cohort study conducted between January 1, 2009, and October 31, 2012, in the pediatric intensive care unit (PICU) at Duke Children's Hospital.

Pharmacokinetics and Dosing of Anti-infective Drugs in Patients on Extracorporeal Membrane Oxygenation: A Review of the Current Literature.

Purpose: Extracorporeal membrane oxygenation (ECMO) is a cardiopulmonary bypass device that is used to temporarily support the most critically ill of patients with respiratory and/or cardiac failure. Infection and its sequelae may be an indication for ECMO or infections may be acquired while on ECMO and are associated with a mortality >50%. Effective therapy requires optimal dosing.

Comparison of a Pharmacist-Performed and Physician or Advanced Practice Provider-Performed Medication History in Pediatric Patients.

In the adult population, a high rate of discrepancies exists between provider-performed and pharmacist-performed medication histories. Limited data exist regarding pharmacist-performed medication histories in hospitalized pediatric patients. Identify the incidence and severity of discrepancies in medication histories performed by practitioners compared with pharmacists in the pediatric population.

Acute intoxication caused by a synthetic cannabinoid in two adolescents.

Illicit drug use continues to be a common problem among pediatric patients. Daily marijuana use among high school seniors is currently at a 30-year high. Marijuana use in adults has rarely been associated with cardiovascular adverse effects, including hypertension, tachycardia, arrhythmia, and myocardial infarction.