Editor’s Choice Articles for October

It’s another month of great Pediatric Critical Care Medicine (PCCM) content to read. My three Editor’s Choice articles are different this month: we have two research articles (^1,2), and their editorial pieces (^3,4); I’m also very pleased to announce and present to readers an exciting new clinical educational format–the PCCM Case Conference Records (⁵). All of these articles follow a theme of pulmonary critical care and will be freely available for the next few months.

DOES IMPLEMENTATION OF AN ANTIBIOTIC GUIDELINE FOR SUSPECTED VENTILATOR-ASSOCIATED INFECTION MAKE A DIFFERENCE?

Karsies T, Tarquinio K, Shein SL, et al: Compliance With an Antibiotic Guideline for Suspected Ventilator-Associated Infection: The VAIN2 Study (¹).

In children younger than 3 years on mechanical ventilation for longer than 48 hours who have had 1) culture of respiratory secretions, and 2) new prescription of antibiotics for suspected ventilator-associated infection, did following a guideline influence outcome and duration of antibiotic treatment? Two years, 22 PICUs in North America, and hundreds of patients involved in the project; this article is definitely worth reading, along with the insights from our editorialist (³).

ENGINEERING DESCRIPTORS OF PEDIATRIC ACUTE RESPIRATORY DISTRESS SYNDROME–WHAT DO WE REALLY NEED TO KNOW?

Diaz F, Gonzalez-Dambrauskas S, Critstiani F, et al: Driving Pressure and Normalized Energy Transmission Calculations in Mechanically Ventilated Children Without Lung Disease and Pediatric Acute Respiratory Distress Syndrome (²).

There are new tools to evaluate energy dissipation to lung tissue during mechanical ventilation. Engineering descriptors such as “mechanical power” are now commonplace in the adult pulmonary critical care literature and as pediatric specialists we too need to see whether such thinking is relevant to mechanical ventilation of children. In this report the authors carry out post hoc physiologic evaluations of pediatric ARDS and pediatric anesthesia cases. Our editorialist gives us the context of this new thinking and its relevance to practice (⁴).

A 10-YEAR-OLD MALE WITH RESPIRATORY FAILURE…AFTER HEMATOPOIETIC STEM CELL TRANSPLANT: HOW DO WE EXPLORE THE DIFFERENTIAL DIAGNOSIS?

Loi MM, Eissa H, Weinman JP, et al: Case 1-2021: A 10-Year-Old Male With Respiratory Failure, Pleural Effusions, and Renal Failure 60 Days After Hematopoietic Stem Cell Transplant (⁵).

My third highlighted article is a new format for PCCM: Case Conference Records. Everyone learns from a multidisciplinary, clinicopathological case conference (CPC) with great illustrations, and credible national or international expert discussants, and new/junior faculty as the lead presenter. The aim is to recreate for our global pediatric critical care practitioners the experience of attending a state-of-the-art CPC. The first one of these invited cases comes from the University of Colorado, with Dr. Michele Loi as the presenting author, and a group of five discussants including Dr. Todd Carpenter (attending-in-charge) and Dr. Steve Abman (expert pulmonology discussant). To qualify for such a submission, the case must have been presented and discussed at a CPC in the originating center and parents and/or family must give consent for the case conference record to be published, including any illustrations. The presenting author should be junior/new faculty and if there are investigations being discussed (e.g., histopathology, radiology, echocardiography, etc.) they will need a subspecialist discussant. Authorship is limited to the contributing discussants. (Please note that this format is about clinical decision making, differential diagnosis, and diagnostic investigations rather than an opportunity for multi-authored literature review or case report.) Again, similar to the PCCM Clinical Science Review (⁶), which has been well-received by readers, the journal is now looking for expert insights into the latest case-learning materials and methods. Please send proposals to the Editor-in-Chief.

“PCCM CONNECTIONS” FOR READERS

This month for regular readers of the Journal you will be able to cross-reference two other items in the October issue with material published earlier in the year. First, take a look at the article by Hoffmann and colleagues (⁷). The authors describe the use of ultrasound assessment of quadriceps femoris muscle thickness in 36 critically ill children, and they present serial observations in relation to nutritional state and fluid balance. Cross-reference this article with the editorial (⁸) as well as the expanding PCCM literature on point of care ultrasound–now nine articles in 2021 (see references 9, 10). Finally, read the article by Geva et al (¹¹) on the electronic health record-integrated checklist for clinical decision support during PICU daily rounds. This article is now the fifth in 2021 on the topic of work-rounds in the PICU: start with looking at the April article on standardized work rounds (¹²).