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O'Hara JE, Graham RJ. Pediatric pulmonology year in review-Pediatric pulmonary critical care. Pediatr Pulmonol 2024. [PMID: 38888167 DOI: 10.1002/ppul.27116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/20/2024]
Abstract
Pediatric pulmonary critical care literature has continued to grow in recent years. Our aim in this review is to narrowly focus on publications providing clinically-relevant advances in pediatric pulmonary critical care in 2023.
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Affiliation(s)
- Jill E O'Hara
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Robert J Graham
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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Brisca G, Strati MF, Buratti S, Mariani M, Ferretti M, Pirlo D, Meleca V, Piccotti E, Castagnola E, Moscatelli A. The increase of bronchiolitis severity in the 2022-2023 season in an Italian tertiary children's hospital: An isolated phenomenon or a warning sign? Pediatr Pulmonol 2024; 59:1236-1245. [PMID: 38289096 DOI: 10.1002/ppul.26891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/04/2024] [Accepted: 01/16/2024] [Indexed: 04/30/2024]
Abstract
AIM Recent literature has shown epidemiological changes in bronchiolitis with an increased incidence in the post-SARS-CoV-2 pandemic period but reports regarding disease severity are conflicting. We aimed to describe the epidemiology, disease severity, and microbiology of bronchiolitis during the 2022-2023 cold season compared to the previous 5 years. METHODS This single-center retrospective observational study at IRCCS Gaslini, Italy, included all children aged 0-2 years hospitalized for bronchiolitis from 1 September 2017 to 31 August 2023. Findings from the 2022-2023 season were compared to the previous 5 years. RESULTS We observed a statistically significant increase in the 2022-2023 season in the absolute number of bronchiolitis admissions. Children who required mechanical ventilation (MV) dramatically increased from a total of seven patients in the previous five seasons to 17 in the 2022-2023 season alone (p = .001). All other severity parameters significantly increased: the need for respiratory support (p = .002), the median length of stay (5 days vs. 4 days, p = .001), and the median duration of respiratory support (4 days vs. 3 days, p = .016). CONCLUSIONS We report a substantial increase in the severity of bronchiolitis in the season 2022-2023 with a remarkable number of previously healthy infants requiring MV. Further studies are needed to confirm whether our findings are an isolated phenomenon or part of a true global trend. Health systems need to be prepared and protective preventive measures should be implemented for all newborns.
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Affiliation(s)
- Giacomo Brisca
- Pediatric and Neonatal Intensive Care Unit, Intermediate Care Unit Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marina Francesca Strati
- Department of Neuroscience-Rehabilitation-Ophthalmology-Genetics-Maternal and Child Health, DINOGMI, Università degli Studi di Genova, Genoa, Italy
| | - Silvia Buratti
- Pediatric and Neonatal Intensive Care Unit, Intermediate Care Unit Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marcello Mariani
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marta Ferretti
- Paediatric Emergency Room and Emergency Medicine, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Daniela Pirlo
- Pediatric and Neonatal Intensive Care Unit, Intermediate Care Unit Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Vincenzo Meleca
- Department of Neuroscience-Rehabilitation-Ophthalmology-Genetics-Maternal and Child Health, DINOGMI, Università degli Studi di Genova, Genoa, Italy
| | - Emanuela Piccotti
- Paediatric Emergency Room and Emergency Medicine, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elio Castagnola
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Moscatelli
- Pediatric and Neonatal Intensive Care Unit, Intermediate Care Unit Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Tasker RC. Editor's Choice Articles for March. Pediatr Crit Care Med 2024; 25:185-188. [PMID: 38451796 DOI: 10.1097/pcc.0000000000003471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Affiliation(s)
- Robert C Tasker
- orcid.org/0000-0003-3647-8113
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA
- Selwyn College, Cambridge University, Cambridge, United Kingdom
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Morrow BM, Lozano Ray E, McCulloch M, Salie S, Salloo A, Appel IN, Du Plooy E, Cawood S, Moshesh P, Keeling KH, Solomon LJ, Hlophe S, Demopoulos D, Parker N, Khan AB, Naidoo KD, Argent AC. Pediatric Acute Respiratory Distress Syndrome in South African PICUs: A Multisite Point-Prevalence Study. Pediatr Crit Care Med 2023; 24:1063-1071. [PMID: 37523579 DOI: 10.1097/pcc.0000000000003330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
OBJECTIVES To describe the prevalence of pediatric acute respiratory distress syndrome (pARDS) and the characteristics of children with pARDS in South African PICUs. DESIGN Observational multicenter, cross-sectional point-prevalence study. SETTING Eight PICUs in four South African provinces. PATIENTS All children beyond the neonatal period and under 18 years of age admitted to participating PICUs. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Clinical and demographic data were prospectively collected on a single day of each month, from February to July 2022, using a centralized database. Cases with or at risk of pARDS were identified using the 2015 Pediatric Acute Lung Injury Consensus Conference criteria. Prevalence was calculated as the number of children meeting pARDS criteria/the total number of children admitted to PICU at the same time points. Three hundred ten patients were present in the PICU on study days: 166 (53.5%) male, median (interquartile range [IQR]) age 9.8 (3.1-32.9) months, and 195 (62.9%) invasively mechanically ventilated. Seventy-one (22.9%) patients were classified as being "at risk" of pARDS and 95 patients (prevalence 30.6%; 95% CI, 24.7-37.5%) fulfilled pARDS case criteria, with severity classified as mild (58.2%), moderate (25.3%), and severe (17.6%). Median (IQR) admission Pediatric Index of Mortality 3 risk of mortality in patients with and without pARDS was 5.6 (3.4-12.1) % versus 3.9 (1.0-8.2) % ( p = 0.002). Diagnostic categories differed between pARDS and non-pARDS groups ( p = 0.002), with no difference in age, sex, or presence of comorbidities. On multivariable logistic regression, increasing admission risk of mortality (adjusted odds ratio [aOR] 1.02; 95% CI, 1.00-1.04; p = 0.04) and being admitted with a respiratory condition (aOR 2.64; 95% CI, 1.27-5.48; p = 0.01) were independently associated with an increased likelihood of having pARDS. CONCLUSIONS The 30.6% prevalence of pARDS in South Africa is substantially higher than reports from other sociogeographical regions, highlighting the need for further research in this setting.
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Affiliation(s)
- Brenda M Morrow
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Division of Pediatric Intensive Care, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Eleonora Lozano Ray
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Division of Pediatric Intensive Care, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Mignon McCulloch
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Division of Pediatric Intensive Care, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Shamiel Salie
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Division of Pediatric Intensive Care, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Asma Salloo
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Division of Pediatric Intensive Care, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Ilse N Appel
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Division of Pediatric Intensive Care, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Elri Du Plooy
- Department of Pediatrics, Tygerberg Children's Hospital, Stellenbosch University, Cape Town, South Africa
| | - Shannon Cawood
- Pediatric Intensive Care Unit, Nelson Mandela Children's Hospital, Johannesburg, South Africa
| | - Porai Moshesh
- Pediatric Intensive Care Unit, Nelson Mandela Children's Hospital, Johannesburg, South Africa
| | - Kathryn H Keeling
- Pediatric Intensive Care Unit, Nelson Mandela Children's Hospital, Johannesburg, South Africa
| | - Lincoln J Solomon
- Department of Pediatrics and Child Health, University of the Free State, Bloemfontein, South Africa
- Department of Paediatrics, Universitas Academic and Pelonomi Tertiary Hospitals, Bloemfontein, South Africa
| | - Sbekezelo Hlophe
- Department of Paediatrics, Greys Hospital, Pietermaritzburg, South Africa
| | - Despina Demopoulos
- Department of Paediatrics, WITS Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Noor Parker
- Department of Pediatrics, Tygerberg Children's Hospital, Stellenbosch University, Cape Town, South Africa
| | - Ayesha Bibi Khan
- Department of Paediatrics, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
- Division of Critical Care, University of the Witwatersrand, Johannesburg, South Africa
| | - Kuban D Naidoo
- Department of Paediatrics, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
- Division of Critical Care, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew C Argent
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Division of Pediatric Intensive Care, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
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Emeriaud G, Pons-Òdena M, Bhalla AK, Shein SL, Killien EY, Alapont VMI, Rowan C, Baudin F, Lin JC, Grégoire G, Napolitano N, Mayordomo-Colunga J, Diaz F, Cruces P, Medina A, Smith L, Khemani RG. Noninvasive Ventilation for Pediatric Acute Respiratory Distress Syndrome: Experience From the 2016/2017 Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Prospective Cohort Study. Pediatr Crit Care Med 2023; 24:715-726. [PMID: 37255352 PMCID: PMC10524424 DOI: 10.1097/pcc.0000000000003281] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The worldwide practice and impact of noninvasive ventilation (NIV) in pediatric acute respiratory distress syndrome (PARDS) is unknown. We sought to describe NIV use and associated clinical outcomes in PARDS. DESIGN Planned ancillary study to the 2016/2017 prospective Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology study. SETTING One hundred five international PICUs. PATIENTS Patients with newly diagnosed PARDS admitted during 10 study weeks. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Children were categorized by their respiratory support at PARDS diagnosis into NIV or invasive mechanical ventilation (IMV) groups. Of 708 subjects with PARDS, 160 patients (23%) received NIV at PARDS diagnosis (NIV group). NIV failure rate (defined as tracheal intubation or death) was 84 of 160 patients (53%). Higher nonrespiratory pediatric logistic organ dysfunction (PELOD-2) score, Pa o2 /F io2 was less than 100 at PARDS diagnosis, immunosuppression, and male sex were independently associated with NIV failure. NIV failure was 100% among patients with nonrespiratory PELOD-2 score greater than 2, Pa o2 /F io2 less than 100, and immunosuppression all present. Among patients with Pa o2 /F io2 greater than 100, children in the NIV group had shorter total duration of NIV and IMV, than the IMV at initial diagnosis group. We failed to identify associations between NIV use and PICU survival in a multivariable Cox regression analysis (hazard ratio 1.04 [95% CI, 0.61-1.80]) or mortality in a propensity score matched analysis ( p = 0.369). CONCLUSIONS Use of NIV at PARDS diagnosis was associated with shorter exposure to IMV in children with mild to moderate hypoxemia. Even though risk of NIV failure was high in some children, we failed to identify greater hazard of mortality in these patients.
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Affiliation(s)
- Guillaume Emeriaud
- Department of Pediatrics, Pediatric Intensive Care Unit, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Marti Pons-Òdena
- Inmune and Respiratory dysfunction in the child research group. Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
- Pediatric Intensive Care and Intermediate care Department, Sant Joan de Déu University Hospital, Universitat de Barcelona, Esplugues de Llobregat, Spain
| | - Anoopindar K Bhalla
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, USA
| | - Steven L Shein
- Rainbow Babies and Children’s Hospital, Division of Pediatric Critical Care Medicine, Cleveland Ohio USA
| | - Elizabeth Y Killien
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, USA
| | | | - Courtney Rowan
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA
| | - Florent Baudin
- Réanimation Pédiatrique, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France
| | - John C Lin
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, USA
| | - Gabrielle Grégoire
- Applied Clinical Research Unit, CHU Sainte-Justine, Montreal, QC, Canada
| | - Natalie Napolitano
- Respiratory Therapy Department, Children’s Hospital of Philadelphia, USA
| | - Juan Mayordomo-Colunga
- Pediatric Intensive Care Unit. Hospital Universitario Central de Asturias, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Franco Diaz
- Instituto de Ciencias e innovación en medicina (ICIM), Universidad del Desarrollo, Santiago de Chile
- Unidad de Paciente Crítico Pediátrico, Hospital El Carmen de Maipú, Santiago de Chile
| | - Pablo Cruces
- Unidad de Paciente Crítico Pediátrico, Hospital El Carmen de Maipú, Santiago de Chile
- Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
| | - Alberto Medina
- Pediatric Intensive Care Unit. Hospital Universitario Central de Asturias, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain
| | - Lincoln Smith
- Department of Pediatrics, University of Washington, Seattle Children’s Hospital, USA
| | - Robinder G Khemani
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, USA
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Iyer N, Khemani R, Emeriaud G, López-Fernández YM, Korang SK, Steffen KM, Barbaro RP, Bembea MM. Methodology of the Second Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2023; 24:S76-S86. [PMID: 36661437 PMCID: PMC11069413 DOI: 10.1097/pcc.0000000000003160] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This article describes the methodology used for The Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2). The PALLIC-2 sought to develop evidence-based clinical recommendations and when evidence was lacking, expert-based consensus statements and research priorities for the diagnosis and management of pediatric acute respiratory distress syndrome (PARDS). DATA SOURCES Electronic searches were conducted using PubMed, Embase, and Cochrane Library (CENTRAL) databases from 2012 to March 2022. STUDY SELECTION Content was divided into 11 sections related to PARDS, with abstract and full text screening followed by data extraction for studies which met inclusion with no exclusion criteria. DATA EXTRACTION We used a standardized data extraction form to construct evidence tables, grade the evidence, and formulate recommendations or statements using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. DATA SYNTHESIS This consensus conference was comprised of a multidisciplinary group of international experts in pediatric critical care, pulmonology, respiratory care, and implementation science which followed standards set by the Institute of Medicine, using the GRADE system and Research And Development/University of California, Los Angeles appropriateness method, modeled after PALICC 2015. The panel of 52 content and four methodology experts had several web-based meetings over the course of 2 years. We conducted seven systematic reviews and four scoping reviews to cover the 11 topic areas. Dissemination was via primary publication listing all statements and separate supplemental publications for each subtopic that include supporting arguments for each recommendation and statement. CONCLUSIONS A consensus conference of experts from around the world developed recommendations and consensus statements for the definition and management of PARDS and identified evidence gaps which need further research.
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Affiliation(s)
- Narayan Iyer
- Fetal and Neonatal Institute, Division of Neonatology, Children’s Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Robinder Khemani
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles. Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Guillaume Emeriaud
- Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montreal, QC, Canada
| | - Yolanda M. López-Fernández
- Pediatric Intensive Care Unit. Cruces University Hospital, Biocruces-Bizkaia Health Research Institute, Bizkaia, Spain
| | - Steven Kwasi Korang
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles. Keck School of Medicine, University of Southern California, Los Angeles, CA
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Ryan P. Barbaro
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Melania M. Bembea
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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