Editor's Choice Articles for September.

Abstract

September 2022 articles in Pediatric Critical Care Medicine (PCCM) are outstanding and worthy of your attention. I have selected three Editor’s Choices articles (1–3) along with their accompanying editorials (4–6) that you can use to start your review of this month’s issue. Then, as I outline in more detail in the section called PCCM Connections for Readers, read these four items: a new format called PCCM Trials (7); another educational Case Conference Record (8) and Concise Clinical Science Review (9); and last, our first PCCM Narrative essay from Spain (10). WHAT IS THE EXTENT OF PEDIATRIC NEUROCRITICAL CARE PRACTICE IN OUR SPECIALTY? DeSanti RL, Balakrishnan B, Rice TB, et al: The Utilization of Critical Care Resources In Pediatric Neurocritical Care Patients (1). My first Editor’s Choice is an analysis of the prevalence of neurologic diagnoses in close to 130,000 patients registered in a large multi-institutional PICU database in the United States (US Virtual Pediatric Systems) in 2016 (1). It is higher than you may think, and the accompanying editorial makes us consider the question “who falls under the pediatric neurocritical care umbrella?” (4). WHAT IS THE ROLE OF EARLY CORTICOSTEROIDS IN SEPTIC SHOCK OUTCOMES? Kamps NN, Banks R, Reeder RW, et al: The Association of Early Corticosteroid Therapy With Clinical and Health-Related Quality of Life Outcomes In Children With Septic Shock (2). My next Editor’s Choice is another important contribution to PCCM from the Life After Pediatric Sepsis Evaluation (LAPSE) investigation, which was a prospective, observational cohort study of 12 PICUs in the US, 2013–2017. The other recent works about health-related quality-of-life (HRQL) outcomes from this dataset have reported associations between acute kidney injury and new morbidity (11), and between acute serum biomarkers and HRQL morbidity (12). Now, the LAPSE investigators use propensity scoring methodology to analyze data from 352 patients in the dataset, 155 (44%) of whom received early corticosteroid therapy. The accompanying editorial provides a thoughtful discussion about what this new analysis means, and the “complexity of factors” to consider in randomized clinical trials (RCTs) of early corticosteroids in septic shock (5). WHAT IS MEANT BY “CANDIDACY” FOR SUPPORT WITH EXTRACORPOREAL MEMBRANE OXYGENATION? Moynihan KM, Jansen M, Siegel BD, et al: Extracorporeal Membrane Oxygenation Candidacy Decisions: An Argument for a Process-Based Longitudinal Approach (3). My third Editor’s Choice is about issues of fairness, justice, and transparency in the dynamic process of decision-making surrounding “candidacy” for life support with extracorporeal membrane oxygenation (ECMO) (3). This PCCM Perspective article should be read and considered along with the authors’ other recent works in the journal (13,14), as well as a position paper about candidacy for ECMO from the Pediatric Acute Lung Injury and Sepsis Investigators subgroup on hematopoietic stem cell transplantation (HSCT) and cancer (15). The editorial also provides an important discussion and a commentary on the challenges in this area of practice. “PCCM Connections” FOR READERS This month I am pleased to announce a new section in the journal called PCCM Trials. As mentioned in the August 2022 issue of PCCM, we will now evaluate articles describing the protocol of any RCT in pediatric critical care. The main reason for including such work is to keep readers and researchers informed of contemporary RCTs. Information must include details of trial registration in a registry that is compliant with the World Health Organization (WHO) International Trials Registry Platform (ICTRP, see https://www.who.int/clinical-trials-registry-platform/the-ictrp-search-portal) such as the U.S. National Library of Medicine ClinicalTrials.gov (see https://www.clinicaltrials.gov) database. Out first report in this category is about a multicenter RCT of conservative versus liberal oxygenation targets in critically ill children (OXY-PICU) (7) in the United Kingdom. The study has already completed recruitment with over 2,000 patients. In the educational material this month we have the second PCCM Case Conference Records. The first case conference published in 2021 (Case 1-2021) was about a 10-year-old male with respiratory failure, pleural effusions, and renal failure 60 days after HSCT (16). Case 2-2022 is a beautifully illustrated and informative case conference about cardiac arrest 3 days after liver transplantation (8). The authors have chosen to make their article open access in memory of their teacher and clinical colleague Dr. Thomas Kulik (see acknowledgements). The other educational item this month is a PCCM Concise Clinical Science Review about the Zonulin pathway as a potential mediator of gastrointestinal dysfunction in critical illness (9). Finally, we have our first PCCM Narrative essay from Spain, which is a moving account of death and loss called “The Unequal Fight” (10).