Timely issues facing Pediatric Critical Care Medicine

Brierley J, Carcillo J, Choong K, et al. 2007 American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock* Crit Care Med. 2009; 37(2):666-688 [abstract]

Newth CJ, Venkataraman S, Willson DF, Meert KL, Harrison R, Dean JM, Pollack M, Zimmerman J, Anand KJ, Carcillo JA, Nicholson CE; Eunice Shriver Kennedy National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. Weaning and extubation readiness in pediatric patients. Pediatr Crit Care Med. 2009 Jan;10(1):1-11. [abstract; full-text (pdf; 730K)]

Boucek MM, Mashburn C, Dunn SM, et al. Pediatric Heart Transplantation after Declaration of Cardiocirculatory Death. New Engl J Med 2008; 359:709-714. [full-text]. This issue includes several relevant and thought-provoking commentaries, including: Truog RD, Miller FG. The Dead Donor Rule and Organ Transplantation. New Engl J Med 2008; 359:674-675. [full-text]

Marik PE, Pastores SM, Annane D, et al; American College of Critical Care Medicine. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med. 2008 Jun;36(6):1937-49. [abstract]

de Oliveira CF, de Oliveira DS, Gottschald AF, Moura JD, Costa GA, Ventura AC, Fernandes JC, Vaz FA, Carcillo JA, Rivers EP, Troster EJ. ACCM/PALS haemodynamic support guidelines for paediatric septic shock: an outcomes comparison with and without monitoring central venous oxygen saturation. Intensive Care Med. 2008 Mar 28; DOI 10.1007/s00134-008-1085-9. [abstract]

Dellinger RP, Levy MM, Carlet JM, et al; for the International Surviving Sepsis Campaign Guidelines Committee. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008 Jan;36(1):296-327 [abstract]

Sharek PJ, Parast LM, Long K, Coombs J, Earnest K, Sullivan J, Frankel LR, Roth SJ. Effect of a Rapid Response Team on Hospital-wide Mortality and Code Rates Outside the ICU in a Children's Hospital. JAMA 2007;298 2267-2274 [abstract]

Lacroix J, Hebert PC, Hutchison, et al. Transfusion Strategies for Patients in Pediatric Intensive Care Units. New Engl J Med 2007; 356:1609-1619. [abstract]

Brilli RJ, Gibson R, Luria JW, Wheeler TA, Shaw J, Linam M, Kheir J, McLain P, Lingsch T, Hall-Haering A, McBride M. Implementation of a medical emergency team in a large pediatric teaching hospital prevents respiratory and cardiopulmonary arrests outside the intensive care unit* Pediatr Crit Care Med. 2007; 8(3):236-246 [abstract][full-text (pdf;1.7M)]

Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Pediatric Critical Care Medicine 2003; 4(3):S1-S75. [full-text]

2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, includes new recommendations for Pediatric Basic Life Support and Pediatric Advanced Life Support

The Robert Wood Johnson Foundation has issued a Special Report on Pediatric Palliative Care. This in response to the Institute of Medicine's 2002 report: When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families

Curtis JR, Cook DJ, Wall RJ, et al. Intensive care unit quality improvement: a "how-to" guide for the interdisciplinary team. Crit Care Med. 2006 Jan;34(1):211-8 [abstract]

1st International Sepsis Forum on Sepsis in Infants and Children. Pediatr Crit Care Med 2005; S1-S164. [table of contents]

Rosenberg DI, Moss MM, AAP Section on Critical Care and Committee on Hospital Care. Guidelines and Levels of Care for Pediatric Intensive Care Units. Pediatrics 2004;114 1114-1125. [abstract]

Han YY, Carcillo JA, Dragotta MA, et al. Early Reversal of Pediatric-Neonatal Septic Shock by Community Physicians Is Associated With Improved Outcome. Pediatrics 2003;112 793-799. [abstract]. With an accompanying editorial: Kirby A, Goldstein B. Improved Outcomes Associated With Early Resuscitation in Septic Shock: Do We Need to Resuscitate the Patient or the Physician? Pediatrics 2003;112 976-977 [full-text]

O'Grady NP, Alexander M, Dellinger EP et al. Guidelines for the Prevention of Intravascular Catheter-Related Infections. Pediatrics 2002;110:e51 [abstract]

Nolan JP, Morley PT, Vanden Hoek TL, et al. ; International Liaison Committee on Resuscitation. Therapeutic hypothermia after cardiac arrest: an advisory statement by the advanced life support task force of the International Liaison Committee on Resuscitation. Circulation. 2003 Jul 8;108(1):118-21 [full-text]

American College of Cardiology Foundation/American Heart Association/American College of Physicians, Task Force on Clinical Competence. ACC/AHA/AAP recommendations for training in pediatric cardiology. Pediatrics. 2005; 116:1574-1596. [full-text] Correspondence in response: Baden HP, Zimmerman JJ, Brilli RJ et al. Intensivist-Led Team Approach to Critical Care of Children With Heart Disease. Pediatrics 2006;117 1854-1856 [link]

Last Updated: 2009-02-05 10:40:15

Important News...

---

Posted upon request by Christopher Gregory MD MPH, of the CDC:

HHS/ASPR-CDC Clinical Information Call on Antiviral Treatment Options in Critically Ill 2009 Influenza H1N1 Patients – Wednesday October 28, 3 pm Eastern Time

Due to widespread reports of severe cases of pandemic influenza A (H1N1), the Centers for Disease Control and Prevention (CDC) and the US Department of Health and Human Services (HHS)/Office of the Assistant Secretary for Preparedness and Response (ASPR) are offering weekly nationwide conference calls on the diagnosis and treatment of pandemic influenza A (H1N1) in critically ill adult and pediatric patients. Calls will consist of brief case presentations by practicing clinicians from various locations in the United States, a 10-15 minute update by HHS/CDC experts on pandemic influenza A (H1N1) epidemiology, diagnosis and treatment; and a 30-35 minute question and answer session where participants will be able to ask questions of HHS/CDC content matter experts or other clinicians. Calls are expected to last approximately 60 minutes. The next call is scheduled for Wednesday, October 28th at 3 pm (Eastern Time). Calls will likely be particularly relevant for intensive care and infectious disease physicians, but all clinicians are welcome to participate. CME credit for participation in the call will be offered through the CDC as described below. Call in number for this call is 888-283-2960 and passcode is 3659803. The call will also be recorded and an mp3 audio file of the call will be available at http://www.emergency.cdc.gov/coca/confcall_archive.asp. More details here... (pdf, 74KB)

---

Urgent appeal from the The International Children's Heart Foundation, which welcomes pediatric intensivists and nurses with significant cardiac experience for 2 week trips to provide direct care and local program development.

The International Children's Heart Foundation is in need of A PAEDIATRIC INTENSIVIST, with Significant Cardiac experience - to assist us in our Programme in

Rawalpindi, Pakistan December 5-19 2009

Accommodation and Flight costs are completely covered.

The International Children's Heart Foundation (ICHF) is a non-profit 501(c)3 charitable organization based in Memphis, TN , USA. We respond to Invitations from developing cardiac centres to assist them in growing and improving their cardiac services for Children. Training takes place in the format of supervised experiential learning, commitment to repeated trips (2-4 per centre, per year over 3-5 years), an emphasis on local empowerment and an ultimate goal of programme independence.

We have been assisting the Armed Forces Institute of Cardiology in developing their pediatric services since 2005, and have visited 4 x per year in the last 4 years. and AFIC is now the biggest pediatric cardiac programme in Pakistan operating on over 500 cases a year. This will be our 4th mission in 2009.

Security in Pakistan:
We are accommodated in very comfortable guest accommodation 2 floors above the PICU. The hospital is inside a secure army compound and the only restriction on us is that we do not go out to the city much - this varies trip by trip depending on the current situation. we were in Pakistan during the recent "troubles" and felt secure and not at risk. We have never canceled a trip for security reasons - and we get our security briefings directly from senior Army personnel. All team members - myself included count the programme in Rawalpindi as one of the friendliest places we go - we are very welcome , very well cared for and feel vary safe when we are there.

Also needed: an intensivist for Tegulcigalpa, Honduras, January 9-23, 2010. Spanish-speaking an advantage but not essential.

Frank Molloy, RN, MSc
ICU Clinical educator and Coordinator
International Children's Heart Foundation
1750 Madison #500
Memphis, TN 38104
USA
1 901 869 4243 (Tel)
1 901 432 4243 (Fax)
frankmolloy@babyheart.org
http://www.babyheart.org


Program Assistant
Leslie Ashford
leslieashford@babyheart.org

A full description of needs and the programme is here.... (pdf; 85K), and an updated schedule of trips is here...

---

---

AAP Section on Critical Care News:

The AAP 2009 National Conference and Exhibition is Saturday, October 17, 2009 - Tuesday, October 20, 2009 in Washington, DC. Deadline for submissions was Friday, April 17, 2009. The preliminary Section on Critical Care program schedule now available online via the SOCC website here.... This includes a special 25-Year SOCC Anniversary program and celebration If you have any questions, please contact Carolyn Mensching at 847-434-4079 or via email at cmensching@aap.org.

The SOCC Summer 2009 newsletter is here... (pdf; 848K)

New from PREP®!: Critical Care Self-Assessment Program

Review for exams and maintain your knowledge of pediatric critical care with the new self-study program from a source you can trust. Brought to you by the American Academy of Pediatrics' Pediatrics Review and Education Program®, PREP® ICU is an online subspecialty self-assessment program designed to help pediatric intensivists succeed in the PICU. Click here for a FREE trial.

A joint resource from the AAP and the AHRQ is available: Pediatric Terrorism and Disaster Preparedness: A Resource for Pediatricians

NIH updates:

The Pediatric Critical Care Scientist Development Program (PCCSDP) has been successfully reissued by the NICHD. Read the RFA here... This program is to foster the development of highly promising young faculty in pediatric critical care into physician scientists. Details of the program can be found at www.pccsdp.org

Be sure to scan the list of fellowships available for those with NIH Training Grant funding for pediatric scientist training...

The Collaborative Pediatric Critical Care Research Network (CPCCRN): A renewal RFA has been issued (U10) for site application here... And the Data Coordinating Center RFA is here...

more NIH updates... including announcements regarding changes to the peer review process...

---

CA-BSI Collaborative - Phase II Announcement

The National Association of Children’s Hospitals and Related Institutions (NACHRI) and a team of PICU clinicians and Improvement Science faculty launched a three-year quality improvement project (Phase I) in October of 2006 that focused on prevention of catheter-associated blood stream infections (CA-BSI) in the 29 pediatric intensive care units (PICU) of 27 children’s institutions. The results of this Phase I collaborative have been remarkable. This Phase I collaborative is now being expanded to additional PICUs that seek to improve the healthcare of children by preventing CA-BSI events. Our initial collaborative progress to date shows:

The number of infections has decreased from a pre-collaborative CA-BSI rate of 5.39 per 1,000 catheter days to a sustained rate of 3.19 per 1,000 catheter days. This reduction represents a statistically significant 41 percent decrease in CA-BSI events. The reduced CA-BSI rate can be extrapolated to:

• Prevention of 177 infections in the 27 institutions
• Cost savings of approximately $6 million
• Estimated 20 deaths prevented

As the Co-Chairs for this project we want to make you aware that we are now enrolling participating sites into the second phase of the project. We hope to enroll an additional 40 - 50 PICUs. In addition, we are happy to answer questions you may have. We are attaching additional information and an enrollment sheet for you.

Richard J. Brilli (rich.brilli@cchmc.org ) and Marlene M. Miller (mmiller@nachri.org)

---

The fourth newsletter of the World Federation of Pediatric Intensive and Critical Care Societies (WFPICSS) is here... (pdf; 136K)

---

PEDIATRIC CRITICAL CARE MEDICINE our specialty's first journal is now online - bimonthly - with full-text Support this acclaimed resource by subscribing today!

Featured full-text article from the November 2009 issue of Pediatric Critical Care Medicine: Bronner MB, Knoester H, Sol JJ, Bos AP, Heymans HS, Grootenhuis MA. An explorative study on quality of life and psychological and cognitive function in pediatric survivors of septic shock. Pediatr Crit Care Med. 2009 Nov;10(6):636-42. [abstract] [full-text;188K]

---

Last Updated: 2009-11-10 09:30:20

New PedsCCM Evidence-based Journal Club Reviews

October TW, Hardart GE.
Successful placement of postpyloric enteral tubes using electromagnetic guidance in critically ill children.
[abstract]
[Review by Cara Connolly MD, Beaumont Hospital, Dublin, Ireland]

Scolnik D, Coates AL, Stephens D, et al.
Controlled Delivery of High vs Low Humidity vs Mist Therapy for Croup in Emergency Departments: A Randomized Controlled Trial.
[abstract]
[Review by Eddie Gordon MD, Baylor College of Medicine, Texas Children's Hospital, Houston TX]

Leteurtre S, Martinot A, Duhamel A, et al.
Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicentre study
[abstract]
[Review by J. Davre McNally MD PhD, Children's Hospital of Eastern Ontario, Ottawa, Canada]

Gueugniaud PV, David JS, Chanzy E, et al.
Vasopressin and Epinephrine vs. Epinephrine Alone in Cardiopulmonary Resuscitation
[abstract]
[Review by Varsha Gharpure MD, Children’s Hospital of Pittsburgh]

Mhanna MJ, Zamel YB, Tichy CM, Super DM.
The "air leak" test around the endotracheal tube, as a predictor of postextubation stridor, is age dependent in children
[abstract]
[Review by Mary G. Gaspers MD, Baylor College of Medicine, Houston TX]

[ View All ]

Important News...continued...

SCCM Pediatric Section News

Nursing/Advanced Practice Nursing Section News: The PedsCCM EB Journal Club now has a Nursing Research section. The new section will highlight the research of Advanced Practice Nurses. APN's are encouraged to submit reviews to this new section.

From the FDA and CDC: Call for cases of Guillain Barre Syndrome (GBS) following administration of Meningococcal Conjugate Vaccine A, C, Y, and W135 (trade name Menactra)... More details...

NACHRI and CHCA PICU Catheter-associated Bloodstream infection initiatives make mainstream press: Landro L. Pediatric ICUs Make Headway Against Infection. Wall Street Journal Online. April 18, 2007. [full-text]

The Pediatric Cardiac Intensive Care Society, PCICS, was formed to provide an optimum forum to promote excellence in pediatric cardiac critical care medicine. We have joined together from diverse backgrounds, organized a professional society, and now launch our inaugural membership campaign. The Society seeks international participation by healthcare professionals dedicated to acquiring knowledge and improving practice for our critically ill patients with congenital and acquired heart disease.

The Virtual PICU, in association with the National Association of Children's Hospitals and Related Institutions, and The National Outcomes Center announce the creation of VPS, LLC, the distributor and coordinating center for VPS (Virtual PICU Performance System), PICU database software. Go to myvps.org to learn more and sign up to participate.

The Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit announces the creation of a VPICU Fellowship Program. Read details and application instructions here... (pdf 150K)

Dr. Greg Hammer at Stanford University is seeking sites interested in participating in a NICHD funded study of the effects of sodium nitroprusside. Read more...

Updated request for participation from Drs. Wong and Shanley at Cincinnati Children's: "... we have a large scale clinical study to conduct microarray analyses in children with septic shock. Specifically, we are proposing to develop a national-level genomic data base (RNA) of children with SIRS and septic shock. The data base will be mined to conduct high throughput microarray analyses to define the genome-level expression profiles in this patient population." More details and contact information is here(pdf file, 52K)...

Last Updated: 2009-03-13 09:42:21

What's new for the month of November on PedsCCM...

• Harikumar G, Egberongbe Y, Nadel S, Wheatley E, Moxham J, Greenough A, Rafferty GF. Tension Time Index as a Predictor of Extubation Outcome in Ventilated Children. Am J Respir Crit Care Med. 2009; 180: 982-988. [abstract] (File Cabinet, EB Journal Club)
• Kesecioglu J, Beale R, Stewart TE, Findlay GP, Rouby JJ, Holzapfel L, Bruins P, Steenken EJ, Jeppesen OK, Lachmann B. Exogenous Natural Surfactant for Treatment of Acute Lung Injury and the Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2009; 180: 989-994. [abstract] (File Cabinet, EB Journal Club)
• Bronner MB, Knoester H, Sol JJ, Bos AP, Heymans HS, Grootenhuis MA. An explorative study on quality of life and psychological and cognitive function in pediatric survivors of septic shock. Pediatr Crit Care Med. 2009 Nov;10(6):636-42. [abstract] [full-text;188K] (File Cabinet)
• Michelson KN, Koogler T, Sullivan C, Ortega Mdel P, Hall E, Frader J. Parental views on withdrawing life-sustaining therapies in critically ill children. Arch Pediatr Adolesc Med. 2009 Nov;163(11):986-92. [abstract] (File Cabinet)
• Ferrer R, Artigas A, Suarez D, Palencia E, Levy MM, Arenzana A, Pérez XL, Sirvent JM; Edusepsis Study Group. Effectiveness of treatments for severe sepsis: a prospective, multicenter, observational study. Am J Respir Crit Care Med. 2009 Nov 1;180(9):861-6. [abstract] (File Cabinet)
• Taccone P, Pesenti A, Latini R, Polli F, Vagginelli F, Mietto C, Caspani L, Raimondi F, Bordone G, Iapichino G, Mancebo J, Guérin C, Ayzac L, Blanch L, Fumagalli R, Tognoni G, Gattinoni L; for the Prone-Supine II Study Group. Prone Positioning in Patients With Moderate and Severe Acute Respiratory Distress Syndrome: A Randomized Controlled Trial. JAMA. 2009 Nov 11;302(18):1977-1984. [abstract] (File Cabinet, EB Journal Club)
• Ventre KM, Collingridge DS, DeCarlo D, Schwid HA. Performance of a consensus scoring algorithm for assessing pediatric advanced life support competency using a computer screen-based simulator. Pediatr Crit Care Med. 2009 Nov;10(6):623-35. [abstract] (File Cabinet)
• RENAL Replacement Therapy Study Investigators, Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Lo S, McArthur C, McGuinness S, Myburgh J, Norton R, Scheinkestel C, Su S. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med. 2009 Oct 22;361(17):1627-38. [abstract] (File Cabinet, EB Journal Club)

Last Updated: 2009-11-20 14:48:52

View More

courses & conferences to note...

SCCM's 39th Critical Care Congress, January 09 - January 13 2010 Miami Beach, FL Website...

Cardiology 2010, February 10 - February 14 2010 Contemporary Resort and Convention Center Walt Disney World, Lake Buena Vista, Florida, USA Website...

The 6th International Pediatric Continuous Renal Replacement Therapy (PCRRT), April 08 - April 10 2010 Rome, Italy Website... Brochure... 

6th World Congress on Pediatric Critical Care, March 13 - March 17 2011 Sydney, Australia Website... Brochure... 

[ view all ]

and also worth noting...

A letter from the heart to physicians, from a mom with a child with special needs. A special message worth reading. [pdf; 56K]

Critical Care Nursing of Infants and Children. 2nd Edition. Curley MAQ, Moloney-Harmon PA, eds. 2001. (this edition is out of print and now freely available)

Program for Maintenance of Certification in Pediatrics update: The Pediatric Critical Care Medicine self-assessment is now available on the ABP Web site

Pediatric Critical Care Medicine Board Review questions, from the Board Review Course by Tony Slonim and Heidi Dalton, D.C. Children's, now available for purchase. From Medtext.

World Federation of Pediatric and Intensive Care Societies (WFPICCS) Pediatric Sepsis Initiative Database is operational. Read more...

Children & Clinical Studies: an NIH-developed website to explain clinical research to children and families - why it is needed, what to expect, how to identify additional reliable resources.

The TRIP database (Turning Research Into Practice) now has a special search page for critical care.

Pediatric Emergency Meds Drip Sheet Generator, D Hanauer

Pediatrics on Hand; the website for pediatric applications and files for your Palm OS PDA. Stockwell D, Bell P. Children's National Medical Center.

PICU Tools - a Palm OS application for pediatric intensive care practitioners. Calculate infusion rates, osmolarity, drug dosages, and complete hemodynamic profiles from pulmonary artery catheter data. Provides arterial blood gas interpretation, lab values and more. Now updated to version 4.0! Freeware, by M. Verive. Details here...

A comprehensive website all about pediatric continuous renal replacement therapy: pcrrt.com. Tim Bunchman, DeVos Children's Hospital, Grand Rapids, MI

Scoring Systems for ICU and Surgical Patients, with PRISM, PIM, PELOD, Pediatric Coma Scale, the Rotterdam score for meningococcal septic shock in children, Neonatal TISS, and now updated with PIM 2 and CRIB 2. By Jean-Yves Marandon, Société Française d'Anesthésie et de Réanimation.

Isabel Clinical Decision Support System: a online pediatric differential diagnosis tool, with contextual links to reference sources. (now requires paid subscription)

Request for Information from the CDC: Acute Encephalopathy Cases in U.S. Children Associated with Influenza Virus Infection. Read more here ...

The AAP announces a new area on their website for Children, Terrorism, and Disaster. Also of note: A joint resource from the AAP and the AHRQ is available: Pediatric Terrorism and Disaster Preparedness: A Resource for Pediatricians

AHRQ Web M & M; peer-reviewed, online medical journal highlighting patient safety lessons drawn from real cases of medical errors

The NIH proposes all NIH-sponsored studies' publications be made publicly available, essentially adopting the call of The Public Library of Science. Read more here.... And add your voice to the public comment page. Read about Open Access here...

WWWeb Epidemiology & Evidence-based Medicine Sources for Veterinarians; an incredibly comprehensive list of clinical epidemiology and EBM links for health care practitioners treating all species!

A new, interactive website full of EBM tips: Evidence Based Practice Tips: Learning Tools for Evidence-based Practice

Want to publish your clinical trial in JAMA, The New England Journal, or other member journals of the International Committee of Medical Journal Editors? Since July 2005, your trial needs be registered in advance. Read DeAngelis CD, Drazen JM, Frizelle FA et al. Clinical Trial Registration: A Statement From the International Committee of Medical Journal Editors. JAMA 8 September 2004 (10.1001/jama.292.11.1363) [full-text]. Go to www.clinicaltrials.gov to register a trial. An update: Laine C, et al. Clinical Trial Registration: Looking Back and Moving Ahead. New Engl J Med 2007; 10.1056/NEJMe078110 [full-text]

Mathews SC, Pronovost PJ. Physician Autonomy and Informed Decision Making: Finding the Balance for Patient Safety and Quality JAMA. 2008;300(24):2913-2915. [extract]

Last Updated: 2008-12-23 14:25:40