Pediatr Crit Care Me
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Pediatr Crit Care Me · Jan 2024
A Survey of PICU Clinician Practices and Perceptions regarding Respiratory Cultures in the Evaluation of Ventilator-Associated Infections in the BrighT STAR Collaborative.
To characterize respiratory culture practices for mechanically ventilated patients, and to identify drivers of culture use and potential barriers to changing practices across PICUs. ⋯ Respiratory culture collection and ordering practices were inconsistent, revealing opportunities for diagnostic stewardship. CDS would be generally well received; however, anticipated conceptual and psychologic barriers to change must be considered.
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Pediatr Crit Care Me · Jan 2024
Observational StudyComparison of 16 Pediatric Acute Respiratory Distress Syndrome-Associated Plasma Biomarkers With Changing Lung Injury Severity.
Pediatric acute respiratory distress syndrome (PARDS) is a source of substantial morbidity and mortality in the PICU, and different plasma biomarkers have identified different PARDS and ARDS subgroups. We have a poor understanding of how these biomarkers change over time and with changing lung injuries. We sought to determine how biomarker levels change over PARDS course, whether they are correlated, and whether they are different in critically ill non-PARDS patients. ⋯ sICAM1 had the strongest positive correlation with worsening lung injury across all study time points suggesting that it is perhaps the most biologically relevant of the 16 analytes. There was no correlation between biomarker concentration on day 1 and day 1 PARDS severity; however, changes in most biomarkers over time positively correlated with changing lung injury. Finally, in day 1 samples, 7 of the 16 biomarkers were not significantly different between PARDS and critically ill non-PARDS subjects. These data highlight the difficulty of using plasma biomarkers to identify organ-specific pathology in critically ill patients.
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Pediatr Crit Care Me · Jan 2024
Epoprostenol (Prostacyclin Analog) as a Sole Anticoagulant in Continuous Renal Replacement Therapy for Critically Ill Children With Liver Disease: Single-Center Retrospective Study, 2010-2019.
Despite deranged coagulation, children with liver disease undergoing continuous renal replacement therapy (CRRT) are prone to circuit clotting. Commonly used anticoagulants (i.e., heparin and citrate) can have side effects. The aim of this study was to describe our experience of using epoprostenol (a synthetic prostacyclin analog) as a sole anticoagulant during CRRT in children with liver disease. ⋯ Epoprostenol, or prostacyclin, as the sole anticoagulant for children with liver disease receiving CRRT in PICU, results in a good circuit life, and complications such as bleeding and hypotension are similar to reports using other anticoagulants, despite concerns about coagulopathy in this cohort.
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Pediatr Crit Care Me · Jan 2024
Delay Between Actual Occurrence of Patient Vital Sign and the Nominal Appearance in the Electronic Health Record: Single-Center, Retrospective Study of PICU Data, 2014-2018.
Patient vital sign data charted in the electronic health record (EHR) are used for time-sensitive decisions, yet little is known about when these data become nominally available compared with when the vital sign was actually measured. The objective of this study was to determine the magnitude of any delay between when a vital sign was actually measured in a patient and when it nominally appears in the EHR. ⋯ This retrospective study shows a lag between vital sign occurrence and its appearance in the EHR, as well as a frequent practice of batch charting. The magnitude of the delay-median ~40 minutes-suggests that vital signs available in the EHR for clinical review and incorporation into clinical alerts may be outdated by the time they are available.