Editor’s Choice Articles for December

Abstract

For December 2021 I draw your attention to three articles as my Editor’s Choices: long-term mental health disorder diagnoses after mechanical ventilation for severe respiratory disease (1); left heart decompression on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for dilated cardiomyopathy and myocarditis (2); and socioeconomic disadvantage and distance to pediatric critical care services in the United States (3). All three research reports have accompanying articles (4−7), and all items will be openly available for the next few months. WHAT IS THE RELATIONSHIP BETWEEN INVASIVE MECHANICAL VENTILATION FOR SEVERE RESPIRATORY DISEASE AND LONG-TERM “MENTAL DISORDER” DIAGNOSES? Geneslaw AS, Lu Y, Miles CH, et al: Long-Term Increase in Mental Disorder Diagnoses After Invasive Mechanical Ventilation for Severe Childhood Respiratory Disease: A Propensity Matched Observational Cohort Study (1). A propensity matching study to learn so much from: the dataset, Texas Medicaid (1999 to 2012); the outcome measure, long-term mental disorder diagnoses; and the comparisons, 1,351 invasively ventilated children matched to 6,755 general inpatients and 7,780 children in the PICU matched to 38,900 general inpatients. For the answer, please read the authors’ transparent analysis of this complex material and their important observations. We all need to understand these data, research this field, and not allow any distortion of fact. Here, we are first helped by an insightful editorial on causal inference from observational data (4). Second, we have an accompanying article in the “PCCM Notes, Methods, and Statistics” section about learning from an association analysis using propensity scores (5). For many reasons, all three of these items are a benchmark for such work in PCCM. WHAT ABOUT LEFT HEART DECOMPRESSION ON VA-ECMO? Choudhury TA, Ofori-Amanfo G, Choi J, et al: Left Heart Decompression on Veno-Arterial Extracorporeal Membrane Oxygenation in Children With Dilated Cardiomyopathy and Myocarditis: An Extracorporeal Life Support Organization Registry Review (2). This database study used the Extracorporeal Life Support Organization (ELSO) registry (2000 to 2016) to review two cohorts of patients supported with VA-ECMO: 532 with myocarditis and 906 with dilated cardiomyopathy. In all, 274 patients had left heart decompression and the authors present an analysis of associated outcomes. There is no editorial with this article. Instead, I am pleased to announce that the accompanying material is the first item in a new section called “PCCM Concise Clinical Physiology Review”. The purpose of this material is to provide an update on some aspect of clinical physiology that applies to pediatric critical illness. This month, Puri and Adachi not only discuss the new ELSO report in the context of other studies, but also treat us to an update of left heart physiology and simulated left ventricle pressure-volume loops on VA-ECMO and cardiopulmonary bypass (6). WHAT IS THE RELATIONSHIP BETWEEN POVERTY AND DISTANCE TO PEDIATRIC CRITICAL CARE SERVICES ACROSS THE UNITED STATES? Brown LE, Franca UL, McManus ML: Socioeconomic Disadvantage and Distance to Pediatric Critical Care (3). My third highlighted article is an epidemiological study using the 2016 American Community Survey that examines access to 319 PICUs within 170 metropolitan statistical areas across the continental United States. Our editorialists provide helpful discussion of the findings and challenge us with their discourse as they argue that unequal access to pediatric critical care services constitutes injustice (7). “PCCM CONNECTIONS” FOR READERS Perhaps you will consider December 2021 as the time to review what is new on the topic of overall health outcomes following pediatric critical illness, which is certainly pertinent given the discussion above about mechanical ventilation and long-term mental disorder diagnoses (1,4,5). Regular readers of PCCM will be able to cross reference to another article in the December 2021 issue, a scoping review of post-PICU discharge methods and instruments used to measure overall health (8). Also consider our other research articles looking at early- to long-term functional outcome and/or quality-of-life of PICU patients reported in the January (9,10), May (11), and October (12) issues of PCCM. Please use all eight articles as a means of quick topic review on how and what others have used in assessing PICU patient outcomes.