Editor's Choice Articles for May.

Abstract

I am very pleased to be presenting a new issue of Pediatric Critical Care Medicine (PCCM). Here are another three Editor’s Choice articles, but with a difference. If there is a theme, it is that these articles with their supporting content and editorial materials, together provide a wealth of new clinically relevant information. The first article is about hyperoxia during cardiopulmonary bypass and its association with greater odds of morbidity and mortality (1). The second article reports a framework for compassionate end-of-life endotracheal extubation at home (2). My third choice describes the feasibility of implementing a new tool for serial neurologic assessment in pediatrics (SNAP) in critically ill patients (3). All three articles (1–3) and related editorial material (4–7) will be freely available for the next two months. GIVEN RECENT INTEREST IN HYPEROXIA DURING CRITICAL ILLNESS, IS HYPEROXIA DURING CARDIOPULMONARY BYPASS SURGERY ASSOCIATED WITH OUTCOME? Beshish AG, Jahadi O, Mello A, et al: Hyperoxia During Cardiopulmonary Bypass is Associated With Mortality in Infants Undergoing Cardiac Surgery (1). This article describes a single center, retrospective study of 469 infants, half of whom had hyperoxia (arterial partial pressure of oxygen above 313 mm Hg) during cardiopulmonary bypass. The authors demonstrate an association between hyperoxia and various outcomes after controlling for covariables. In response to this information–and unique to PCCM this month–we have two items of editorial material to guide us as we read this report. Our editorialist discusses the research findings in the context of other literature, what they mean, and what readers should not do with this new information (4). The other readers’ supporting item is our first Statistical Note in the new section of PCCM Notes, Methods, and Statistics (5). Here, our editorialist uses this single center, retrospective study of hyperoxia as a vehicle to discuss confounding and causality in observational studies, and the criteria we should use to better understand the meaning of such research findings. It is definitely worth the time studying these three articles together. WHAT ARE THE INTRICACIES OF DECISION-MAKING AROUND END-OF-LIFE, COMPASSIONATE, EXTUBATION AT HOME? Woodruff AG, Bingham SB, Jarrah RJ, et al: A Framework for Pediatric Intensivists Providing Compassionate Extubation at Home (2). This article describes the framework in which to prepare, plan, and provide compassionate end-of-life extubation at home. The idea started with the authors’ response to a local need, followed by them developing an evidence-based framework for practice. Now, they share their work, clinical framework, and checklist so that other pediatric intensive care practitioners can adapt and use these materials for similar needs. Figures 1 and 2 in the article are a wonderful resource. Our editorialist provides us with an international perspective and a much-needed introduction to some of the legal, ethical, and cultural aspects of such end-of-life care (6). HOW FEASIBLE IS A STANDARDIZED, MODIFIED NEUROLOGIC EXAMINATION IN THE PICU? Kirschen MP, Smith KA, Snyder M, et al: Serial Neurologic Assessment in Pediatrics (SNAP): A New Tool for Bedside Neurological Assessment of Critically Ill Children (3). The third article describes the new beside SNAP tool, which can be used to summarize the neurology of critically ill patients with artificial airways, pharmacological sedation, or developmental disabilities. Our PCCM authors again give us unique materials: the three SNAP assessment scoring criteria panels are particularly useful (see Figures). The editorial places the SNAP tool feasibility study in the wider context of neurologic scoring systems (7). For example, over recent years we have seen the latest iteration of the Glasgow Coma Scale score (8) and other scores, but all for older pediatric or adult patients. Is SNAP the groundbreaking pediatric critical care standardized neurologic assessment tool that we have been waiting for? My three Editor’s Choice articles are not just good reads, but also have important materials to watch out for. The hyperoxia article (1) has a statistical note (4). The article about an aspect of end-of-life care has usefully illustrated a framework and checklist that can be adapted for local use (2). The article about the SNAP tool has highly practical information panels of age-related criteria (3).