PCCM Audio Summary - December 2024
The December 2024 issue of Pediatric Critical Care Medicine features two articles about the determination of death by neurologic criteria, one focusing on meropenem pharmacokinetic factors in sepsis and one focusing on the use of peripheral perfusion index in Ugandan children. The clinical investigations cover beta-lactam antibiotic dosing and use during extracorporeal membrane oxygenation; physical, cognitive, emotional, and social health outcomes in children within six months after critical illness; outcomes in pediatric burn patients by timing of referral; and caregiver perspectives on the use of continuity physicians during prolonged hospitalizations. Additionally, find a commentary on the ethics of resource allocation for extracorporeal life support in pediatric patients.
PCCM Audio Summary - November 2024
The November issue of Pediatric Critical Care Medicine (PCCM) starts with a foreword about the World Federation of Pediatric Intensive Care Societies (WFPICCS) which met in June 2024. WFPICCS has a separate supplement to this issue of PCCM that is not recorded but worth reading. The feature articles this month highlight point-of-care ultrasound in the pediatric intensive care unit (PICU), a comprehensive fever algorithm in patients with new fever or instability, validation of an updated acute kidney injury prediction model in pediatric septic shock, and measurement of proteins and fibrin thickness on extracorporeal membrane oxygenation (ECMO) circuits. Clinical investigations include evaluating outcomes in pediatric hematology and oncology patients on ECMO as well as severe pneumonia in PICU admissions. The online special article discusses the possibility of cohorting trauma and postoperative patients for fluid management strategies, and an online cardiac intensive care article evaluates outcomes of patients with and without airway anomalies undergoing surgery for congenital heart disease. Finally, there is an interesting small study in the online research letter that looks at using ethanol lock therapy in smaller peripherally inserted central catheters.
PCCM Audio Summary – October 2024
The October 2024 issue of Pediatric Critical Care Medicine (PCCM) features diverse articles, including delirium screening in critically ill children, the evolution of PCCM physician clinical and academic profiles by gender, intensity of medical interventions at the end of life, and analysis of ethnicity’s role in measuring oxygen saturations. Clinical investigations examined a simulation-based trial and clinician outcomes using an aerosol box to reduce healthcare worker contamination during procedures, the optimal chest compression point during pediatric CPR, pancreatic stone protein as a sepsis biomarker, association of new morbidities and pediatric intensive care unit readmission, and extracorporeal CPR use among children with heart disease. Brief reports focused on perspectives of parents with critically ill children. The PCCM narrative this month is one we can all relate to when experiencing the death of a patient.
PCCM Audio Summary - September 2024
The September 2024 issue of Pediatric Critical Care Medicine (PCCM) features articles on the use of a noninvasive surrogate measurement of physiologic dead space, parental decision regret in the pediatric intensive care unit (PICU), social determinants of health and health-related quality of life after pediatric septic shock, and health-related quality of life after pediatric acute respiratory distress syndrome (PARDS). Clinical investigations cover inequitable resource utilization for common pediatric PICU diagnoses in patients of color, delirium screening post-transplant, the use of driving pressure and its association with duration of mechanical ventilation and mortality, and the adjunctive use of transcutaneous carbon dioxide monitoring for ventilation in critically ill children. The PCCM trials highlight the absence of legal guardians as a barrier to enrolling PICU patients in research studies and outline the Protocol for the Prone and Oscillation Pediatric Clinical Trial (PROSpect). Lastly, the PCCM narrative this month is a raw account of life after cardiac arrest in a loved one.
PCCM Audio Summary - August 2024
The August issue of Pediatric Critical Care Medicine (PCCM) features articles on how management strategies that change after echocardiography improve outcomes in critically ill children, rapid whole genome-sequencing to facilitate timely genetic diagnosis and clinical prognostication, and a secondary analysis of the ADAPT trial to compare levetiracetam and phenytoin in patients with status epilepticus and traumatic brain injury. The clinical investigations examine chest compression depth targets, clinical outcomes in children with a single ventricle after tracheostomy, changes in inhaled nitric oxide use across intensive care units after implementing a standard approach, and outcomes of severe acute kidney injury in children with acute liver failure. The PCCM trial is a randomized controlled trial comparing high-flow nasal cannula to nasal prong bubble continuous positive airway pressure in children with moderate to severe bronchiolitis, and the neurocritical care article compares four definitions of acute brain dysfunction in pediatric sepsis and septic shock.
PCCM Audio Summary – July 2024
The July 2024 issue of Pediatric Critical Care Medicine (PCCM) features an article on the association of Pao2 and mortality in neonatal extracorporeal membrane oxygenation (ECMO), use of a biomarker-based risk stratification tool in pediatric acute respiratory distress syndrome, and bacterial codetection and outcomes for infants intubated for respiratory infections. This month's clinical investigation assesses skeletal muscle mass measurements in pediatric patients and associated factors in PICU patients, and the PCCM trial highlights the protocol used for the PRESSURE randomized controlled trial to evaluate a permissive blood pressure target versus usual care in critically ill children. Finally, the online cardiac intensive care articles investigate outcomes of children with ventricular assist devices (VADs) who were mechanically ventilated and bivalirudin monitoring in patients on mechanical circulatory support including VADS and ECMO. Be sure to check out the supplemental issue supporting the Pediatric ECMO Anticoagulation Collaborative (PEACE) Consensus Conference!
PCCM Audio Summary – June 2024
The June 2024 issue of Pediatric Critical Care Medicine (PCCM) has a strong focus on healthcare resource utilization and peri-PICU hospitalization. Feature articles include post-acute care facilities for pediatric patients; strengths and areas of improvement for interfacility referral communication for PICU patient transfers; sepsis biomarkers in pediatric patients with hypoxemia, encephalopathy, and shock; and post-pediatric acute respiratory distress syndrome healthcare burden and resource utilization. This month's PCCM trial shares the results of an early rehabilitation implementation program. Clinical investigations explore post-discharge health-related quality of life, utility of AI language models for generating differential diagnoses, and outcomes of pediatric oncology and hematopoietic stem cell transplant patients who undergo tracheostomy. The cardiac intensive care articles highlight cost analysis and efficacy of nitroprusside versus nicardipine, association of socioeconomic factors and length of stay after surgery for congenital heart disease, and efficacy of prophylactic peritoneal dialysis catheter placement prior to cardiac surgery. Listen for more details!
PCCM Audio Summary – May 2024
The May 2024 issue of Pediatric Critical Care Medicine (PCCM) features articles on predicting minute ventilation needs, spiritual care training for pediatric critical care fellows, and the use of nudging for decision-making in conferences with family members. A wide variety of clinical investigations explore organ donation, epidemiology and clinical characteristics of pediatric sepsis in China, use of the Pediatric Sequential Organ Failure Assessment score, chest compression interruption in pediatric extracorporeal cardiopulmonary resuscitation, use of rotational thromboelastometry and clot waveform analysis as point-of-care-tests for disseminated intravascular coagulation diagnosis, safety and efficacy of ethanol locks for central venous catheter salvage and central line bloodstream infection prophylaxis, and tools to measure physical function in the pediatric intensive care unit (PICU). The cardiac intensive care article explores cardiac surgery-associated acute kidney injury in neonates undergoing stage 1 palliation/Norwood procedure. The issue ends with two important PCCM perspectives: one describing the tactic of supported privacy for families dealing with a patient’s end of life in the PICU and one investigating the definition of clinical full-time equivalent in U.S. PICUs.
PCCM Audio Summary - April 2024
The April 2024 issue features articles investigating immunocompromised-associated pediatric acute respiratory distress syndrome, use of formal ethics consultation in patients undergoing extracorporeal membrane oxygenation (ECMO), measuring hemodynamics and end-tidal carbon dioxide monitoring in extracorporeal cardiopulmonary resuscitation, and insights into the Child Opportunity Index and pediatric intensive care outcomes. Clinical investigations evaluate airway management in children with trisomy 21, iron deficiency in children with anemia who survive critical illness, use of point-of-care ultrasound during mechanical ventilation in patients with dengue shock syndrome, and pediatric sepsis phenotypes and outcomes. This issue also includes a brief report exploring functional status and ECMO candidacy, a special article evaluating machine learning applications in pediatric critical care research, and an online Pediatric Critical Care (PCCM) perspective on study designs for future sedation research. The neurocritical care article offers insights into differences between neurosurgeons and intensivists in decision-making for platelet and plasma transfusion with intracranial monitor placement.
PCCM Audio Summary - March 2024
The March 2024 issue features articles on the use of prognostication models for critically ill children in locations with limited resources, the use of noninvasive neurally adjusted ventilatory assist (NIV-NAVA) in infants with bronchiolitis, and the development and validation of a model to predict endotracheal intubation in pediatric intensive care unit patients. Clinical investigation articles explore the use of ultrasound preextubation in patients intubated with cuffed endotracheal tubes; a comparative analysis of the severity of illness scores of organ dysfunction in children with blood culture-proven sepsis; and cognitive, functional, and quality of life outcomes in patients six months after being hospitalized for bronchiolitis. Neurocritical care articles explore neurologic and functional outcomes after traumatic brain injury and extracorporeal membrane oxygenation, as well as death by neurologic criteria and withdrawal of life-sustaining therapies after out-of-hospital cardiac arrest. The cardiac intensive care article analyzes the association of chylothorax with fluid overload after cardiac surgery in neonates with congenital heart disease.
PCCM Audio Summary - February 2024
The February 2024 issue highlights three late-breaker articles on various subjects—effects of early rehabilitation in critically ill children, early use of adrenaline infusions in septic shock, and the use of stress ulcer prophylaxis versus placebo in critically ill children with heart disease. Feature articles explore family challenges of PICU patients as well as topics in tracheal intubation. The Pediatric Critical Care Medicine trial and brief report investigate the levels and use of vitamin C and thiamin in children with suspected sepsis. Online clinical investigations cover topics including hospital failure to rescue in postoperative mortality, suicide and self-harm in adolescents during the COVID-19 pandemic, and the association of hospital-acquired venous thromboembolism with mechanical ventilation. The issue concludes with a study on dying and death in a PICU.
PCCM Audio Summary - January 2024
The January 2024 Pediatric Critical Care Medicine (PCCM) issue covers a wide variety of pediatric intensive care unit (PICU) topics to ring in the new year.
This month’s issue features an article examining outcomes after in-hospital cardiac arrest from the ICU-RESUScitation dataset, a second article analyzing the use of the prostacyclin analogue epoprostenol as an anticoagulant in continuous renal replacement therapy in children with liver disease, and a third reviewing tools for predicting fluid responsiveness in pediatric shock. There are many clinical investigations in this issue covering topics such as variability in asthma treatment, perfusion index variations in septic shock, delays in vital signs appearing in the electronic health record, comparing viral DNA detection by reverse transcription polymerase chain reaction in upper respiratory tract infections with metagenomic RNA sequencing in lower respiratory tract infections, a review of pediatric death after withdrawal of life-sustaining measures, and a survey of PICU clinician perspectives about respiratory cultures in ventilator-associated infections. A systematic review and meta-analysis discusses dexmedetomidine withdrawal in children—an important topic with increasing dexmedetomidine use. Additionally, there is an online laboratory investigation and a few online brief reports.
PCCM Audio Summary - December 2023
The December 2023 Pediatric Critical Care Medicine issue is a robust one with audio summaries encompassing a wide variety of articles from many different disciplines. Feature articles examine neonates with congenital diaphragmatic hernia on extracorporeal membrane oxygenation (ECMO), viral respiratory illness severity and management in the PICU, nutrition support for critically ill patients, and patient and family stressors and experiences in the PICU. There are neurocritical care and cardiac intensive care articles, as well as many articles highlighting clinical investigations. This month's review article highlights vascular reconstruction after ECMO, and the brief report examines parental perceptions and functional status in PICU survivors, both of which are engaging reads.
PCCM Audio Summary - November 2023
The November 2023 issue of PCCM is focused entirely on cardiac critical care topics. The feature article describes prevalence and risk factors of children exposed to toxic levels of cardiovascular medications, while clinical investigations cover a breadth of topics from using a psychosocial care model, extracorporeal cardiopulmonary resuscitation (ECPR) and extracorporeal membrane oxygenation (ECMO) in heart disease, minimizing blood draws, and more. A couple of articles highlight airway management and complications in patients with heart disease. Special articles and a clinical physiology review make this issue quite an interesting read.
PCCM Audio Summary - October 2023
The October 2023 audio summary features articles examining pediatric sepsis phenotypes, implementation of an abbreviated neuropsychological evaluation for patients with acquired brain injury, and use of therapeutic plasma exchange and continuous renal replacement therapy in children with dengue-associated acute liver failure and shock syndrome. Clinical investigations evaluated measured body weight and fluid balance as well as association of fluid balance with mortality and health-related quality of life, disorders of consciousness in pediatric severe sepsis and organ failure, measuring energy requirements in traumatic brain injury, parent experience in interhospital transfer of children to pediatric intensive care units (PICUs), visitation and parental policies related to PICU admission, and trends in oncology admissions to PICUs. This issue also included a special article with consensus statements regarding continuity strategies for long-stay PICU patients.
PCCM Audio Summary - September 2023
The September 2023 issue features articles on pediatric acute respiratory failure, including support modalities and analysis of cytokine measures in children. Other respiratory articles included in this month’s issue examine the role of plateau and driving pressures in pediatric acute respiratory distress syndrome, pre-extubation cuffed tube leaks and association with post-extubation laryngeal edema, and hyperoxia exposure and mortality. Other clinical investigations include examining the lactate/albumin ratio in critically ill children, hyperferritinemia in severe dengue infection, rewarming children after drowning-associated out-of-hospital cardiac arrest, and using clinical instability as a sign of severity of illness, among others.
PCCM Audio Summary - August 2023
The August 2023 issue features articles examining physician experience when families refuse determination of death by neurologic criteria and another examining the outcomes after implementation of an ICU Liberation Bundle (A-F). Clinical investigations compared outcomes associated with centrifugal versus roller pumps for neonatal venovenous extracorporeal membrane oxygenation (ECMO) with somewhat unexpected results, assessed the inspiratory efforts in sedated children, implemented an algorithm to work up new fever or instability, and explored the utility of repeat tracheal aspirate cultures in the pediatric intensive care unit (PICU). The PCCM trial assessed the use of bundled consent for PICU patients, and the remainder of articles covered a variety of topics, from the relationship of admission PaO2 and mortality, long-term functional outcomes for neonates with congenital diaphragmatic hernia, enteral nutrition on ECMO, the use of shock in in-hospital cardiac arrest, and the use of inhaled anesthetics versus ECMO for status asthmaticus.
PCCM Audio Summary - July 2023
The July 2023 issue of Pediatric Critical Care Medicine (PCCM) features articles on clinical variables in extracorporeal membrane oxygenation (ECMO) that may affect neurologic outcomes, unplanned extubations in cardiac intensive care units, and the role of biomarkers in sepsis risk stratification in low- to middle-income countries. The clinical investigations focus on pulmonary physiology, especially pediatric acute respiratory distress syndrome (PARDS) and adverse events related to intubation in patients who have received hematopoietic cell transplants. The PCCM trial this month highlights a promising novel hemodialysis device for infants, and the clinical investigations cover the effect of mechanical power on mortality in patients with PARDS, clinician-assigned functional outcome scores in critically ill children, and the use of empirical acyclovir in children with acute encephalitis. The cardiac intensive care articles are both interesting quality improvement initiatives, one focusing on implementation of a sedation-weaning protocol and the other focusing on limiting blood draws for patients. Lastly, a meta-analysis assesses the use of aortic peak flow velocity in predicting fluid responsiveness in mechanically ventilated patients.
PCCM Audio Summary - June 2023
The June 2023 issue of Pediatric Critical Care Medicine features articles on implementing primary care physicians for long-stay pediatric intensive care unit (PICU) patients, diaphragm tonic activity in PICU patients, and an analysis of pulse oximetry and arterial saturation differences by race in pediatric COVID-19 patients. Clinical investigations cover analgesia and sedation at terminal extubation, demographics associated with the first Malawian PICU, implementing a multidisciplinary PICU follow-up clinic, and analyzing anticoagulation-free periods for pediatric patients on extracorporeal membrane oxygenation. The online articles examine sepsis definitions in children worldwide, high-frequency oscillatory ventilation in critically ill children, improving efficiency and productivity in multidisciplinary surgical rounds in the pediatric cardiac ICU, and evidence for escalation of antimicrobial regimens in febrile oncology and hematopoietic stem cell transplant patients in the PICU.
PCCM Audio Summary - May 2023
The May 2023 issue features a study examining characteristics and outcomes in pediatric patients with COVID-19 or multisystem inflammatory syndrome who received extracorporeal membrane oxygenation in U.S. intensive care units. The feature review article is a meta-analysis identifying factors contributing to the common problem of delirium in critically ill children. This PCCM issue is diverse, with studies exploring how to improve daily patient goal setting, long-term quality of life in patients with congenital heart disease, the impact of patient acuity levels on team rounding, prehospital tranexamic acid administration in pediatric trauma patients, the association of prehospital physician presence during out-of-hospital cardiac arrest with neurologic outcomes, and more.
PCCM Audio Summary - April 2023
This month’s issue features four diverse articles. One explores the interpretation of Von Willebrand factor multimers, concentration, and function in patients on extracorporeal membrane oxygenation (ECMO); another investigates the prevalence of mental health and emotional disorders among pediatric intensive care unit (PICU) staff during the COVID-19 pandemic. There is an article assessing neurocognitive, psychosocial, and quality-of-life outcomes in pediatric patients with multisystem inflammatory syndrome in children who were admitted to the PICU, and another reviewing social determinants of health in children with sepsis. Clinical investigations explore the epidemiology of unplanned extubations, a machine model to track clinical deterioration in hospitalized patients, and multiple organ dysfunction syndrome in children with acute myeloid leukemia. Trials and brief reports investigate obtaining assent for PICU research studies, the Cardiohelp ECMO system, and continuous venovenous hemofiltration in neonates with fluid overload.
PCCM Audio Summary - March 2023
This month's issue features diverse articles, including:
- An investigation of the association between corticosteroids and PERSEVERE-II risk stratification with mortality in pediatric septic shock
- An exploration of the relationship between postoperative complications and children’s quality of life
- A comparison of invasive venous oximetry with near-infrared spectroscopy in pediatric cardiac patients
Other articles explore the use of sustained low-efficiency dialysis in a resource-limited setting, adolescent drug ingestions requiring an intensive care unit (ICU) stay, oxidation-reduction responses in children randomized to a conservative versus liberal oxygen target, delirium screening in infants in the cardiovascular ICU, and level of dysfunction in organs used for donation versus those not used for donation.
PCCM Audio Summary - February 2023
This month’s issue debuts two late-breaker articles—one that describes the use of restrictive transfusion practices in hemodynamically stable critically ill children and one that describes long-term pediatric critical care-associated parental traumatic stress. The feature article describes a multicenter collaborative assessing mechanical ventilation practices with liver transplantation in children. Other articles evaluate the use of a protocol, modalities of support, and the amount of oxygen used in bronchiolitis, which are especially pertinent this time of year. This month’s issue also releases the executive summary of the updated Pediatric Acute Lung Injury Consensus Conference (PALICC-2) international guidelines for diagnosis and management of pediatric acute respiratory distress syndrome. Online review articles evaluate the use of diaries as aids in pediatric and neonatal ICUs and establish a definition for pediatric chronic illness, while the neurocritical care article measures outcomes in children after severe brain injury.
PCCM Audio Summary - January 2023
This month’s issue features articles evaluating adverse events in the pediatric ICU (PICU) over a 10-year period, in-hospital cardiac arrests in adults admitted to PICUs, and disease severity trends of SARS-CoV-2 in U.S. PICUs. Two articles discuss prevalence and readmission rates of discharge directly home from the PICU. Other articles focus on goals of care and end of life, including different types of communication and prognostic statements, identification of medical complexity, and end-of-life issues in patients with ventricular assist devices. Additional clinical investigations and brief reports explore in situ simulation of a new critical care unit, pharmacokinetic modeling of midazolam and pentobarbital use in refractory status epilepticus, and the use of steroids in the general PICU population. Online review articles explore antimicrobial stewardship programs and strategies to reduce iatrogenic blood loss in critically ill patients.
PCCM Audio Summary - December 2022
This month’s issue features articles on a variety of sepsis and shock topics as well as challenges with mechanical ventilation in pediatric patients. The neurocritical intensive care articles evaluate phenotypes in acute brainstem dysfunction and the use of a pediatric neurocritical care team for patients with status epilepticus. Several online clinical investigations and brief reports explore mitigation of nephrotoxic pain medications, application of new acute kidney injury criteria, use of esmolol after tetralogy of Fallot repair, risk of infection development with proton pump inhibitor use, outcomes of acute lymphoblastic leukemia and cytokine release syndrome after chimeric antigen receptor T cell therapy, and an article discussing bereaved caregiver perspectives on end-of-life care in pediatric patients with ventricular assist devices.
PCCM Audio Summary - November 2022
This month’s issue features articles on evaluating the use of calcium during cardiopulmonary resuscitation in children with heart disease, assessing moral distress in the pediatric ICU, examining the use of extracorporeal membrane oxygenation in children with neurologic disorders or neurofunctional disability, and creating core outcome measurement sets for pediatric critical care patients. Additional articles describe clinical investigations about cardiopulmonary resuscitation quality and outcomes during the COVID-19 pandemic and centralizing pediatric critical care in Australia and New Zealand. The neurocritical care article examines the utility of high-dose midazolam in pediatric refractory status epilepticus, and there are a couple of articles evaluating the use of antifibrinolytics in pediatric trauma and cardiac surgery with cardiopulmonary bypass. We wrap up with this month's narrative, which focuses on stress and burnout in pediatric critical care.
PCCM Audio Summary - October 2022
This month’s issue features articles on delirium in the pediatric ICU and its impact on pediatric ICU readmission within one year, the use of prophylactic enoxaparin against catheter-associated thrombosis in postoperative cardiac patients, and outcomes associated with sodium bicarbonate use during pediatric in-hospital cardiac arrest. Other articles in this month’s issue investigate children with cardiac disease; one focuses on outcomes with early peritoneal dialysis cardiac surgery, another evaluates a treatment algorithm to mitigate bleeding in children with acquired von Willebrand syndrome type 2A, and another assesses a method to predict use of critical resources after cardiac catheterization. There are several other interesting articles on topics such as respiratory failure, functional status outcomes, optimal epinephrine dose during cardiac arrest, and anticoagulation with ventricular assist devices.
PCCM Audio Summary - September 2022
This month’s issue features articles on utilization of neurocritical resources in critically ill children, examination of early administration of corticosteroids in septic shock and association with clinically meaningful outcomes, and evaluation of increased monocyte distribution width in children with systemic inflammatory response syndrome and sepsis. There are also interesting articles on transport medicine, tracheostomy placement in children with pulmonary hypertension, prevention of clots in patients with modified Blalock-Taussig shunts, parental experience in the pediatric ICU, and semiautomated regional citrate anticoagulation in chronic kidney replacement therapy. Finally, there is a compelling narrative on the complex decision of extracorporeal membrane oxygen candidacy in critically ill children and the need for a systematic approach.
PCCM Audio Summary - August 2022
This month’s issue features articles on assessing physical, emotional/behavioral, and neurocognitive developmental outcomes in children after pediatric ICU admission, neurologic dysfunction relative to timing of recognition of pediatric sepsis, and using social determinants of health to identify neighborhoods where children are at risk for acute respiratory failure requiring mechanical ventilation. Additionally, there are interesting articles assessing peripheral vasoactive infusions in children with shock, an article investigating pathogen type and outcomes of septic shock, and a comparison of multisystem inflammatory syndrome in children with original/alpha versus delta variants of COVID-19.
PCCM Audio Summary - July 2022
This month’s Pediatric Critical Care Medicine features articles on assessing the epidemiology of pediatric intensive care unit admissions over a five-year period, the prevalence of cardiac dysfunction in Malawian children with severe febrile illness, and outcomes with conservative fluid management strategies in septic shock in African children. Additionally, there are a few articles on acute kidney injury, perioperative intensive care for patients with congenital heart disease, and acute respiratory distress syndrome.
