Editor’s Choice Articles for May

Abstract

May 2023–something different for a change: after each of the three Editor’s Choices articles, there is additional material that would normally fall within the educational content found in the section called PCCM Connections for Readers. This month I will use my main highlights as a guide to further read about extracorporeal membrane oxygenation (ECMO), delirium, and organization of PICU rounds. WHAT ABOUT THE NEED FOR ECMO IN CHILDREN WITH COVID-19 OR MULTISYSTEM INFLAMMATORY SYNDROME? Bembea MM, Loftis LL, Thiagarajan RR, et al; Overcoming COVID-19 Investigators: Extracorporeal Oxygenation Characteristics and Outcomes in Children and Adolescents With COVID-19 or Multisystem Inflammatory Syndrome Admitted to U.S. ICUs (1). Sixty-three hospitals in 32 US states collaborated in a registry (during March 2020 through December 2021) and now report their experience of using ECMO in children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related cardiorespiratory failure. The entire cohort included 2,733 patients, of whom 108 were supported with ECMO. In addition to important information about the time course of care, the authors also show data that add to PCCM’s focus on social determinants of health (2,3), with analyses according to race, ethnicity, healthcare insurance status, and social vulnerability index (1). All these themes are discussed in the accompanying editorial (4), and it is also worth rereading PCCM’s approach to SARS-CoV-2-related research (5): we are committed to innovation and new perspectives, and the 2020/2021 US registry satisfies these criteria. “PCCM Connections” for Readers: Please read the systematic review of support with ECMO during SARS-CoV-2-related cardiorespiratory failure (6). The authors have identified 44 studies (18 observational, four case series, and 22 case reports) involving 110 children receiving ECMO in the period up to March 2022. The review is a comprehensive summary of the literature up to PCCM’s latest edition (1), and the accompanying editorial provides a unique assessment of what these data mean in the wider context of the literature in adults (7). WHAT ABOUT FACTORS ASSOCIATED WITH DELIRIUM DURING CRITICAL ILLNESS: REMEDIABLE OR NOT? Ista E, Traube C, de Neef M, et al; Dutch Multidisciplinary Pediatric Delirium Guideline Group: Factors Associated With Delirium in Children: A Systematic Review and Meta-Analysis (8). Clinical research into delirium is a longstanding theme in PCCM. Now, international researchers in this field under the auspices of the Dutch Multidisciplinary Pediatric Delirium Guidelines Group report a systematic review of 1990 to 2022 literature. The authors describe information from 24 studies in which 54 factors were found associated with delirium. In the meta-analysis these findings are reduced to seven factors associated with greater odds of developing delirium during pediatric critical illness (8). In the accompanying editorial our writers propose that it is time to include delirium screening as part of our “vital sign” monitoring (9). “PCCM Connections” for Readers: On a similar theme to delirium prevention, please read the Brief Report describing a single-center, prospective, sleep hygiene quality improvement program in PICU patients eligible for early mobilization (10). There are also interesting details about how the program was organized, which is information that should be read together with the recent practice guideline on prevention and management of delirium (11). WHAT ABOUT ROUNDS AND SETTING AND IMPLEMENTING DAILY GOALS OF CARE? Jones AGR, Friedman S, Vu M, et al: Improving Daily Patient Goal-Setting and Team Communication: The Liber8 Glass Door Project (12). Improved communications between everyone, with a clearly defined plan, is the objective for all PICU patients, families, and the broader healthcare team. My last Editor’s Choice is work carried out in a single-center 12-bedded combined medical and surgical PICU. Here, the authors describe the development and implementation of a low-cost aid, literally writing on a glass door. There is an interesting accompanying editorial, which is both creative and challenging (13). “PCCM Connections” for Readers: We have already discussed an article about organization and goal setting during patient care rounds when considering optimizing sleep hygiene (10). Another article about rounding discussions in this issue examines the impact of unit census and patient acuity on effective discussion (14). Why not enhance your review of the literature on the topic of rounds by looking at similar work in recent issues of PCCM (15–17). Finally, another of this month’s highlights is the narrative essay entitled “Line in the Sand” (18).