Welcome to April 2022. Again, lots of content in this issue of Pediatric Critical Care Medicine (PCCM). Yes–everything is worthy of your attention and as usual my highlights are the three Editor’s Choice articles. That said, there is more that I want to tell you about in the PCCM Connections for Readers section, where you can learn from a much-anticipated PCCM Concise Clinical Science Review, a PCCM Narrative, as well as more clinical cardiac critical care research articles.
WHAT IS THE IMPACT OF BLOOD PRODUCT RATIOS AND DEFICITS ON SURVIVAL IN INJURED CHILDREN WITH LIFE-THREATENING BLEEDING?
Spinella PC, Leonard JC, Marshall C, et al; Massive Transfusion In Children (MATIC) Investigators and BloodNet: Transfusion Ratios and Deficits in Injured Children With Life-Threatening Bleeding (1).
In this secondary analysis of the prospective MAssive Transfusion epidemiology and outcomes In Children (MATIC) dataset, the authors analyzed weight-adjusted blood product volumes received during life-threatening bleeding in 191 pediatric patients (1). These are important analyses, but the outcomes at 6- and 24-hours in relation to the deficits and transfused plasma-to-red-blood-cell (RBC) and platelet-to-RBC ratios are something new. Our editorial couldn’t be clearer: “…Make no mistake, this is an advance in how we treat these children…” (2). Read on.
HOW IS INHALED NITRIC OXIDE USED IN CONTEMPORARY INTENSIVE CARE PRACTICE OF CONGENITAL HEART DISEASE?
Yates AR, Berger JT, Reeder RW, et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network: Characterization of Inhaled Nitric Oxide Use for Cardiac Indications in Pediatric Patients (3).
Seven centers in the United States Collaborative Pediatric Critical Care Research Network (CPCCRN) studied their “off-label” use of inhaled nitric oxide (iNO) as part of cardiac intensive care management (3). The network presents data from 407 patients stratified by diagnoses; 80% of which were congenital heart disease. Our editorial writer focuses on the research questions now generated by these CPCCRN observations (4).
WHAT ABOUT USING PERIPHERAL VENOUS ACCESS FOR 3% HYPERTONIC SALINE DOSES AND/OR INFUSION?
Pohl CE, Harvey H, Foley J, et al: Peripheral IV Administration of Hypertonic Saline: Single-Center Retrospective PICU Study (5).
My third highlighted article is a single-center, retrospective study of 526 patients who received 3% hypertonic saline (either as continuous infusion or as bolus dosing) (5). The authors present their experience of prevalence of infusion tissue infiltration and extravasation. The accompanying editorial is useful because it provides a historical and clinical context to treatment with hypertonic saline (6). Please judge these data and make up your own minds about risks versus clinical benefit.
“PCCM CONNECTIONS” FOR READERS
Here are some other recommendations for regular readers of PCCM. First, there is another article in the PCCM Concise Clinical Science series. We started this section in July 2021 with a review about the neurologic manifestations of COVID-19 (7). Now, the second review in this series comes from the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network and the BLOODNET (Pediatric Critical Care Blood Research Network) Immunology section and covers the topic of host immunologic response during COVID-19 related multisystem inflammatory syndrome in children (MIS-C) (8). This review achieved social media status of “Altmetric top 5%” for medical publication outputs even before it was printed–so, much anticipated and a must read.
Second, there is a PCCM Narrative called “Why We Shout” (9). There are now seven essays in our PCCM Narrative series, and they are proving to be highly read items. An Arts & Humanities curriculum is now part of most medical and nursing education programs, and we all benefit from these modern graduates now using their education to reflect on shared experiences in our field. If you are interested and involved in pediatric critical care medical and nursing education, then please look at the material in the collection edited by Schrooten and Markovitz on “Shared struggles: stories from parents and pediatricians caring for children with serious illness” (10).
Last, why not use this month to dig deep into the theme of cardiac intensive care? In this issue, we started with an article about iNO (3) and an accompanying editorial (4); now look at three other areas of study. The latest article from the Pediatric Cardiac Critical Care Consortium (PC4) registry describing potentially modifiable organizational and personnel factors on cardiac arrest prevention and rescue in the cardiac ICU (11). An article (12) and editorial (13) on fluid overload, intravascular volume, and fluid removal in the perioperative pediatric cardiac surgery population. A mixed-methods, single-center PC4-registry dataset of outcomes in 364 patients discharged to home directly from the cardiac ICU (14).
1. Spinella PC, Leonard JC, Marshall C, et al.; for the Massive Transfusion In Children (MATIC) Investigators and BloodNet: Transfusion Ratios and Deficits in Injured Children With Life-Threatening Bleeding. Pediatr Crit Care Med. 2022; 23:235–244
2. Parker RI: The Sum May Be More Important Than the Parts When We Resuscitate. Pediatr Crit Care Med. 2022; 23:323–325
3. Yates AR, Berger JT, Reeder RW, et al.: Characterization of Inhaled Nitric Oxide Use for Cardiac Indications in Pediatric Patients. Pediatr Crit Care Med. 2022; 23:245–254
4. Macrae DJ: Inhaled Nitric Oxide in Pediatric Cardiac Care–The First 30 Years. Pediatr Crit Care Med. 2022; 23:325–327
5. Pohl CE, Harvey H, Foley J, et al.: Peripheral IV Administration of Hypertonic Saline: Single-Center Retrospective PICU Study. Pediatr Crit Care Med. 2022; 23:277–285
6. Herrmann JR, Au AK: Saving Brain and Vein: Administering Hypertonic Saline Through a Peripheral IV Catheter. Pediatr Crit Care Med. 2022; 23:327–329
7. Schober ME, Pavia AT, Bohnsack JF: Neurologic manifestations of COVID-19 in children: Emerging pathophysiologic insights. Pediatr Crit Care Med. 2021; 22:655–661
8. Mazer MB, Bulut Y, Brodsky NN, et al.; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network and BLOODNET Immunology section: Multisystem Inflammatory Syndrome in Children: Host Immunologic Responses. Pediatr Crit Care Med. 2022; 23:315–320
9. Reddy AR: Why We Shout. Pediatr Crit Care Med. 2022; 23:321–322
10. Schrooten AF, Markovitz BP (Eds): Shared Struggles: Stories From Parents and Pediatricians Caring For Children With Serious Illnesses. First Edition, Switzerland: Springer, 2021
11. Lasa JJ, Banerjee M, Zhang W, et al.: Critical Care Unit Organizational and Personnel Factors Impact Cardiac Arrest Prevention and Rescue in the Pediatric Cardiac Population. Pediatr Crit Care Med. 2022; 23:255–267
12. Jacquet-Lagreze M, Acker A, Hentzen J, et al.: Preload Dependence Fails to Predict Hemodynamic Instability During a Fluid Removal Challenge in Children. Pediatr Crit Care Med. 2022; 23:296–305
13. Loomba RS, Flores S, Bronicki RA: When Volume and Pressure Are Not Equal. Pediatr Crit Care Med. 2022; 23:333–334
14. Gal DB, Kwiatkowski DM, Fabersunne CC, Kipps AK: Direct Discharge to Home From the Pediatric Cardiovascular ICU. Pediatr Crit Care Med. 2022; 23:e199–e207