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Editor’s Choice

Editor’s Choice Articles for May

Tasker, Robert C. MBBS, MD, FRCP1–3

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Pediatric Critical Care Medicine: May 2022 - Volume 23 - Issue 5 - p 339-340
doi: 10.1097/PCC.0000000000002966
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Three more Editor’s Choice articles for May 2022. Also, PCCM Connections for Readers which focuses on perioperative intensive care for patients with congenital heart disease (CHD), another PCCM Concise Clinical Science Review, and a PCCM Narrative. All worthy reads.

CAN MACHINE LEARNING MODELS INCORPORATING PHYSIOLOGY, THERAPY, AND CARE INTENSITY TRACK CHANGES IN HOSPITAL MORTALITY RISK DURING INTENSIVE CARE?

Trujillo Rivera EA, Chamberlain JM, Patel AK, et al: Dynamic Mortality Risk Predictions For Children in ICUs: Development and Validation of Machine Learning Models (1).

This electronic health record study used data from over 27,000 admissions (1). The mortality rate was 1.8%, and ICU length of stay was less than 120 hours for three quarters of the admissions. In this work, the authors propose a modeling methodology for monitoring patient improvement and deterioration in real-time. The accompanying editorial gives us a context for such work and provides a helpful summary of characteristics that readers need to focus on when evaluating machine learning based clinical prediction models (2).

PCCM MINI SYMPOSIUM: VITAMIN C AND VITAMIN B1

Mehta NM: Resuscitation With Vitamins C and B1 in Pediatric Sepsis–Hold on to Your “HAT” (3).

Equey L, Agyeman PKA, Veraguth R, et al: Serum Ascorbic Acid and Thiamine Concentrations in Sepsis: Secondary Analysis of the Swiss Pediatric Sepsis Study (4).

Fathi A, Downey C, Gohar AR: Vitamin C Deficiency in Critically Ill Children: Prospective Observational Cohort Study (5).

Akkuzu E, Yavuz S, Ozcan S, et al: Prevalence and Time-Course of Thiamine Deficiency in Critically Ill Children: A Multicenter, Prospective Cohort Study in Turkey(6).

Along came three articles on vitamin C and vitamin B1! And so, we now have our first PCCM Mini Symposium. The idea is to bring together works on a theme: start with an expert editorial (3), and on this occasion data from Switzerland (4), the United States (5), and Turkey (6). In fact, the narrative theme of vitamin C (and B1) in contemporary pediatric critical care was reignited in PCCM in 2021 (7,8). I’m sure more publications will follow from these introductory descriptions.

PCCM TECHNICAL NOTE: REAL-TIME POCUS TO ACHIEVE CENTRAL UMBILICAL VENOUS ACCESS

Kozyak BW, Fraga MV, Juliano CE, et al: Real-Time Ultrasound Guidance for Umbilical Venous Cannulation in Neonates With Congenital Heart Disease (9).

What do you do when conventional “blind” placement of perinatal central umbilical venous access has failed? In this PCCM Technical Note, clinicians from three tertiary care units in the United States caring for infants with CHD describe their experience with a new real-time point of care ultrasound technique, its implementation, training, and practice (9). The illustrations and video are outstanding.

PCCM CONNECTIONS” FOR READERS

Here are three other recommendations for regular readers of PCCM that follow the theme of CHD already highlighted in this issue of PCCM (9). First, another article in the PCCM Concise Clinical Science series on acute kidney injury after cardiac surgery (10). Next, an article about opioid weaning using morphine compared with nonprotocolized methadone after the Norwood procedure (11). (Why not also read the article about weaning dexmedetomidine in non-ICU areas [12]). The third article about CHD covers the topic of airway characteristics in patients with 22q11 deletion undergoing pulmonary artery reconstruction surgery (13).

Finally, round up the May 2022 issue of PCCM reading with a reflection on a PCCM Narrative called “Timing is Everything” (14).

References

1. Trujillo Rivera EA, Chamberlain JM, Patel AK, et al.: Dynamic Mortality Risk Predictions for Children in ICUs: Development and Validation of Machine Learning Models. Pediatr Crit Care Med. 2022; 23:344–352
2. Sanchez-Pinto LN, Bennett TD: Evaluation of Machine Learning Models for Clinical Prediction Problems. Pediatr Crit Care Med. 2022; 23:405–408
3. Mehta NM: Resuscitation With Vitamins C and B1 in Pediatric Sepsis–Hold on to Your “HAT”. Pediatr Crit Care Med. 2022; 23:385–389
4. Equey L, Agyeman PKA, Veraguth R, et al.: Serum Ascorbic Acid and Thiamine Concentrations in Sepsis: Secondary Analysis of the Swiss Pediatric Sepsis Study. Pediatr Crit Care Med. 2022; 23:390–394
5. Fathi A, Downey C, Gohar AR: Vitamin C Time-Course of Thiamine Deficiency in Critically Ill Children: A Multicenter, Prospective Cohort Study. Pediatr Crit Care Med. 2022; 23:395–398
6. Akkuzu E, Yavuz S, Ozcan S, et al.: Prevalence and Time-Course of Thiamine Deficiency in Critically Ill Children: A Multicenter, Prospective Cohort Study in Turkey. Pediatr Crit Care Med. 2022; 23:399–404
7. Yanase F, Raman S, Naorungroj T, et al.: Efficacy and safety of parenteral high-dose vitamin C therapy in pediatric patients: A scoping review. Pediatr Crit Care Med. 2021; 22:561–571
8. Sanchez-Pinto LN, Wald EL: Vitamin C, Quo Vadis? Pediatr Crit Care Med. 2021; 22:588–590
9. Kozyak BW, Fraga MV, Juliano CE, et al.: Real-Time Ultrasound Guidance for Umbilical Venous Cannulation in Neonates With Congenital Heart Disease. Pediatr Crit Care Med. 2022; 23:e257–e266
10. Neurmayr TM, Alge JL, Afonso NS, et al.: Acute Kidney Injury After Pediatric Cardiac Surgery. Pediatr Crit Care Med. 2022; 23:e249–e256
11. Achuff BJ, Lemming K, Causey JC, et al.: Opioid Weaning Protocol Using Morphine Compared With Nonprotocolized Methadone Associated With Decreased Dose and Duration of Opioid After Norwood Procedure. Pediatr Crit Care Med. 2022; 23:361–370
12. Solodiuk JC, Sweet E, Greco C, et al.: Weaning Dexmedeto midine in Non-ICU areas: An Implementation Effort. Pediatr Crit Care Med. 2022; 23:353–360
13. Sganga D, Meister K, Sidell DR, et al.: Airway Characteristics of Patients With 22q11 Deletion Undergoing Pulmonary Artery Reconstruction Surgery: Retrospective Cohort Study. Pediatr Crit Care Med. 2022; 23:371–377
14. Mahoney DP: Timing is Everything. Pediatr Crit Care Med. 2022; 23:383–384
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