Halfway through 2022 already, and here are three more Editor’s Choices articles for the June issue. Also, check the PCCM Connections for Readers with a focus on infection and sepsis, including a PCCM Concise Clinical Science Review on septic shock and another PCCM Narrative. All are great reads from our accomplished authors this month.
WHAT IS THE TIME COURSE OF CHANGE IN MICROBIOME AFTER SEVERE TRAUMATIC BRAIN INJURY?
Rogers MB, Simon D, Firek B, et al: Temporal and Spatial Changes in the Microbiome Following Pediatric Severe Traumatic Brain Injury (1).
This report comes from a five-center prospective study in which 23 children with severe traumatic brain injury, along with 35 controls, underwent serial sampling of oral, rectal, and skin microbiome (1). The investigators provide information on timing of loss of site specificity with depletion of commensal bacteria, and the time course of enrichment with pathogens. This work is unique in our field, and we welcome more on the topic of dysbiosis and the implications for interventions during and after PICU admission.
DO WE STILL HAVE A PROBLEM WITH THE AMOUNT OF BLOOD VOLUME SAMPLED AND DISCARDED DURING PICU ADMISSION?
Francois T, Sauthier M, Charlier J, et al: Impact of Blood Sampling on Anemia in the PICU: A Prospective Cohort Study (2).
In this prospective, single-center, observational study of 423 PICU admissions, the investigators from Canada identified a continuing problem with blood sampling wastage. The responsibility falls on us as practitioners. There is clearly need for improved scrutiny and questioning of blood sampling, but how can we make a difference in the future? For discussion.
IS THERE VALUE IN ADDING BLOOD LACTATE CONCENTRATION TO THE PAEDIATRIC INDEX OF MORTALITY METRIC?
Morris KP, Kapetanstrataki M, Wilkins B, et al: Lactate, Base Excess, and the Paediatric Index of Mortality: Exploratory Study of an International, Multicenter Dataset (3).
The question remains as to whether blood lactate concentration is a useful biomarker of severity of illness. Two problems in prior research are: 1) need to use some other prior probability, or case selection such as sepsis, and 2) sample size required for a validation study. Researchers have now combined a database from 33 PICUs in the United Kingdom and Republic of Ireland and 29 units in Australia and New Zealand and identified over 60,000 cases with both base excess and lactate recorded (3). The article is worth reading because we now have an answer to the presenting biomarker-mortality relationship in the context of other available information used in the Paediatric Index of Mortality metric.
“PCCM CONNECTIONS” FOR READERS
My other main recommendations for regular readers of PCCM is to pick-up the theme of sepsis and shock covered in June 2022. First, consider hemodynamics. We have an article in the PCCM Concise Clinical Science series which uses illustrative cardiac function curves and data to give insight into the cardiovascular system in severe sepsis (4). There is also an article about vasoplegic shock being the dominant hemodynamic profile of multisystem inflammatory syndrome following COVID-19 in children and adolescents (5). Finally, there is an article and editorial on the topic of heart rate variability associated with inflammatory biomarkers regarding hemodynamics (6,7). The other two recommendations in the sepsis theme are: 1) augmented renal clearance of vancomycin in suspected sepsis (8), and 2) health resource use in survivors of pediatric septic shock in the United States (9).
Finally, finish up your June 2022 PCCM reading with a moving account in the PCCM Narrative section called “My view from the other side of the bed” (10).
1. Rogers MB, Simon D, Firek B, et al.: Temporal and spatial changes in the microbiome following pediatric severe traumatic brain injury. Pediatr Crit Care Med 2022; 23:425–434
2. Francois T, Sauthier M, Charlier J, et al.: Impact of blood sampling on anemia in the PICU: A prospective cohort study. Pediatr Crit Care Med 2022; 23:435–443
3. Morris KP, Kapetanstrataki M, Wilkins B, et al.: Lactate, base excess, and the Paediatric Index of Mortality: Exploratory study of an international, multicenter dataset. Pediatr Crit Care Med 2022; 23:e268–e276
4. Bronicki RA, Tume SC, Flores S, et al.: The cardiovascular system in severe sepsis: Insight from a cardiovascular simulator. Pediatr Crit Care Med 2022; 23:464–472
5. Alali A, O’Neil E, Anders M, et al.: Vasoplegic shock represents a dominant hemodynamic profile of multisystem inflammatory syndrome following COVID-19 in children and adolescents. Pediatr Crit Care Med 2022; 23:e295–e299
6. Badke CM, Carroll MS, Weese-Mayer DE, et al.: Association between heart rate variability and inflammatory biomarkers in critically ill children. Pediatr Crit Care Med 2022; 23:e289–e294
7. Alcamo A, Weiss SL: Is heart rate variability the spice of life? Pediatr Crit Care Med 2022; 23:477–478
8. Scully PT, Lam WM, Coronado Munoz AJ, et al.: Augmented renal clearance of vancomycin in suspected sepsis: Single-center retrospective pediatric cohort. Pediatr Crit Care Med 2022; 23:444–452
9. Maddux AB, Zimmermann JJ, Banks RK, et al.; Life After Lapse Sepsis Evaluation (LAPSE) Investigators: Health resource use in survivors of pediatric septic shock in the United States. Pediatr Crit Care Med 2022; 23:e277–e288
10. Nolan J: My view from the opposite side of the bed. Pediatr Crit Care Med 2022; 23:473–474