Pediatric Critical Care Medicine Research Articles

Editor's Choice Articles for July.

1 orcid.org/0000-0003-3647-8113 2 Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 3 Selwyn College, Cambridge University, Cambridge, United Kingdom Editor-in-Chief, Pediatric Critical Care Medicine

Pneumonia in pediatric critical care medicine and the adherence to guidelines.

Different studies in adults reported significant outcome improvement for patients treated with high adherence to guidelines. The present study was initiated to evaluate the impact of adherence to antibiotic prescription guidelines on health outcomes of children on pediatric Intensive Care Unit (PICU) suffering from pneumonia. This retrospective cohort study was conducted on a pediatric Intensive Care Unit at Charité Hospital Berlin. All patients with a length of stay (LOS) >24 hours, age <18 years, antimicrobial therapies, and a radiologically confirmed diagnosis of pneumonia according to the "Centers for Disease Control and Prevention" definitions were included during the study period of 2009 and 2010. Adherence to national guidelines was evaluated daily and two groups were defined: Low adherence group (LAG) with a presence of <70% of days with compliant therapy and high adherence group (HAG) with an adherence of ≥70%. High adherence was observed in 65 patients compared with 61 in low-adherence group. Number of patients needing invasive ventilation did not vary between HAG and LAG (N.=37 vs. N.=41; P=0.235). There was a statistically significant shorter duration of ventilation in HAG patients (P=0.031). Time to clinical recovery from pneumonia tended to be shorter in HAG patients (7.5d vs. 10.9d; P=0.07). There was a significant reduction in LOS in HAG patients (9.3d vs. 13.7d; P=0.016). However, mortality appeared comparable between groups. Similar to previous evidence in adult patients, children with pneumonia seem to benefit from guideline-based antibiotic therapy. Further studies are needed to explore strategies to improve guideline adherence.

Editorial introductions.

Editorial introductions.

Ignorance Isn't Bliss: We Must Close the Machine Learning Knowledge Gap in Pediatric Critical Care.

Pediatric intensivists are bombarded with more patient data than ever before. Integration and interpretation of data from patient monitors and the electronic health record (EHR) can be cognitively expensive in a manner that results in delayed or suboptimal medical decision making and patient harm. Machine learning (ML) can be used to facilitate insights from healthcare data and has been successfully applied to pediatric critical care data with that intent. However, many pediatric critical care medicine (PCCM) trainees and clinicians lack an understanding of foundational ML principles. This presents a major problem for the field. We outline the reasons why in this perspective and provide a roadmap for competency-based ML education for PCCM trainees and other stakeholders.

Myocardial Infarction at Mid-Term Follow-Up in a Teenager With Multisystem Inflammatory Syndrome in Children After COVID-19.

HomeCirculation: Cardiovascular ImagingVol. 15, No. 5Myocardial Infarction at Mid-Term Follow-Up in a Teenager With Multisystem Inflammatory Syndrome in Children After COVID-19 No AccessCase ReportRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsNo AccessCase ReportRequest AccessFull TextMyocardial Infarction at Mid-Term Follow-Up in a Teenager With Multisystem Inflammatory Syndrome in Children After COVID-19 Anthony Merlocco, MD, Ranjit Philip, MD, Gary Beasley, MD, Kaitlin Ryan, MD, Samir Shah, MD, Shyam Sathanandam, MD, Karthik Ramakrishnan, MD and Jason N. Johnson, MD, MHS Anthony MerloccoAnthony Merlocco Correspondence to: Anthony Merlocco, MD, Assistant Professor of Pediatrics and Radiology, Co-Director Cardiac MRI Research, The University of Tennessee Health Science Center, Le Bonheur Children’s Hospital & St. Jude Children’s Research Hospital, 51 North Dunlap Street, Faculty Office Building, 3rd floor, Memphis, TN 38105. Email E-mail Address: [email protected] https://orcid.org/0000-0001-6228-0229 Department of Pediatrics, Division of Pediatric Cardiology (A.M., R.P., G.B., K.R., S. Sathanandam, J.N.J.), The University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, TN. Department of Radiology, Division of Pediatric Radiology (A.M., J.N.J.), The University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, TN. Search for more papers by this author , Ranjit PhilipRanjit Philip https://orcid.org/0000-0003-3748-0215 Department of Pediatrics, Division of Pediatric Cardiology (A.M., R.P., G.B., K.R., S. Sathanandam, J.N.J.), The University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, TN. Search for more papers by this author , Gary BeasleyGary Beasley https://orcid.org/0000-0001-6137-6114 Department of Pediatrics, Division of Pediatric Cardiology (A.M., R.P., G.B., K.R., S. Sathanandam, J.N.J.), The University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, TN. Search for more papers by this author , Kaitlin RyanKaitlin Ryan Department of Pediatrics, Division of Pediatric Cardiology (A.M., R.P., G.B., K.R., S. Sathanandam, J.N.J.), The University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, TN. Search for more papers by this author , Samir ShahSamir Shah Division of Pediatric Critical Care Medicine (S. Shah), The University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, TN. Search for more papers by this author , Shyam SathanandamShyam Sathanandam https://orcid.org/0000-0001-8639-0852 Department of Pediatrics, Division of Pediatric Cardiology (A.M., R.P., G.B., K.R., S. Sathanandam, J.N.J.), The University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, TN. Search for more papers by this author , Karthik RamakrishnanKarthik Ramakrishnan Department of Pediatrics, Division of Pediatric Cardiology (A.M., R.P., G.B., K.R., S. Sathanandam, J.N.J.), The University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, TN. Department of Pediatric Cardiothoracic Surgery (K.R.), The University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, TN. Search for more papers by this author and Jason N. JohnsonJason N. Johnson https://orcid.org/0000-0003-0712-1123 Department of Pediatrics, Division of Pediatric Cardiology (A.M., R.P., G.B., K.R., S. Sathanandam, J.N.J.), The University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, TN. Department of Radiology, Division of Pediatric Radiology (A.M., J.N.J.), The University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, TN. Search for more papers by this author Originally published28 Apr 2022https://doi.org/10.1161/CIRCIMAGING.122.014010Circulation: Cardiovascular Imaging. 2022;15FootnotesSupplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/CIRCIMAGING.122.014010.For Sources of Funding and Disclosures, see page 342.Correspondence to: Anthony Merlocco, MD, Assistant Professor of Pediatrics and Radiology, Co-Director Cardiac MRI Research, The University of Tennessee Health Science Center, Le Bonheur Children’s Hospital & St. Jude Children’s Research Hospital, 51 North Dunlap Street, Faculty Office Building, 3rd floor, Memphis, TN 38105. Email [email protected]edu

Moral Distress in Healthcare Providers Who Take Care of Critical Pediatric Patients throughout Italy-Cultural Adaptation and Validation of the Italian Pediatric Instrument.

Background: Although Moral Distress (MD) is a matter of concern within the Pediatric Intensive Care Unit (PICU), there is no validated Italian instrument for measuring the phenomenon in nurses and physicians who care for pediatric patients in Intensive Care. The authors of the Italian Moral Distress Scale-Revised (Italian MDS-R), validated for the adult setting, in 2017, invited further research to evaluate the generalizability of the scale to clinicians working in other fields. Our study aims to reduce this knowledge gap by developing and validating the pediatric version of the Italian MDS-R. Methods: We evaluated the new instrument for construct validity, then we administered it in a multicenter, web-based survey that involved healthcare providers of three PICUs and three adult ICUs admitting children in northern, central, and southern Italy. Finally, we tested it for internal consistency, confirmatory factorial validity, convergent validity, and differences between groups analysis. Results: The 14-item, three-factor model best fit the data. The scale showed good reliability (a = 0.87). Still, it did not correlate with the Emotional Exhaustion and Depersonalization sub-scales of the Maslach Burnout Inventory (MBI) or with the 2-item Connor-Davidson Resilience Scale (CD-RISC 2) or the Satisfaction with Life Scale (SWLS). A mild correlation was found between the Italian Pediatric MDS-R score and intention to resign from the job. No correlation was found between MD and years of experience. Females, nurses, and clinicians who cared for COVID-19 patients had a higher MD score. Conclusions: The Italian Pediatric MDS-R is a valid and reliable instrument for measuring MD among Italian health workers who care for critically ill children. Further research would be helpful in better investigating its applicability to the heterogeneous scenario of Italian Pediatric Critical Care Medicine.

High variability in cardiac education and experiences during United States paediatric critical care fellowships.

Paediatric cardiac critical care continues to become more sub-specialised, and many institutions have transitioned to dedicated cardiac ICUs. Literature regarding the effects of these changes on paediatric critical care medicine fellowship training is limited. To describe the current landscape of cardiac critical care education during paediatric critical care medicine fellowship in the United States and demonstrate its variability. A review of publicly available information in 2021 was completed. A supplemental REDCap survey focusing on cardiac ICU experiences during paediatric critical care medicine fellowships was e-mailed to all United States Accreditation Council of Graduate Medical Education-accredited paediatric critical care medicine fellowship programme coordinators/directors. Results are reported using inferential statistics. Data from 71 paediatric critical care medicine fellowship programme websites and 41 leadership responses were included. Median fellow complement was 8 (interquartile range: 6, 12). The majority (76%, 31/41) of programmes had a designated cardiac ICU. Median percentage of paediatric critical care medicine attending physicians with cardiac training was 25% (interquartile range: 0%, 69%). Mandatory cardiac ICU time was 16 weeks (interquartile range: 13, 20) with variability in night coverage and number of other learners present. A minority of programmes (29%, 12/41) mandated other cardiac experiences. Median CHD surgical cases per year were 215 (interquartile range: 132, 338). When considering the number of annual cases per fellow, programmes with higher case volume were not always associated with the highest case number per fellow. There is a continued trend toward dedicated cardiac ICUs in the United States, with significant variability in cardiac training during paediatric critical care medicine fellowship. As the trend toward dedicated cardiac ICUs continues and practices become more standardised, so should the education.

The Child With Severe Chronic Illness in the ICU: A Concise Review.

Children with severe chronic illness are a prevalent, impactful, vulnerable group in PICUs, whose needs are insufficiently met by transitory care models and a narrow focus on acute care needs. Thus, we sought to provide a concise synthetic review of published literature relevant to them and a compilation of strategies to address their distinctive needs. English language articles were identified in MEDLINE using a variety of phrases related to children with chronic conditions, prolonged admissions, resource utilization, mortality, morbidity, continuity of care, palliative care, and other critical care topics. Bibliographies were also reviewed. Original articles, review articles, and commentaries were considered. Data from relevant articles were reviewed, summarized, and integrated into a narrative synthetic review. Children with serious chronic conditions are a heterogeneous group who are growing in numbers and complexity, partly due to successes of critical care. Because of their prevalence, prolonged stays, readmissions, and other resource use, they disproportionately impact PICUs. Often more than other patients, critical illness can substantially negatively affect these children and their families, physically and psychosocially. Critical care approaches narrowly focused on acute care and transitory/rotating care models exacerbate these problems and contribute to ineffective communication and information sharing, impaired relationships, subpar and untimely decision-making, patient/family dissatisfaction, and moral distress in providers. Strategies to mitigate these effects and address these patients' distinctive needs include improving continuity and communication, primary and secondary palliative care, and involvement of families. However, there are limited outcome data for most of these strategies and little consensus on which outcomes should be measured. The future of pediatric critical care medicine is intertwined with that of children with serious chronic illness. More concerted efforts are needed to address their distinctive needs and study the effectiveness of strategies to do so.

SARS-CoV-2, Lung Protective Ventilation, Low Middle Income Countries, and Pediatric Intensivists as Cross Disciplinary Knowledge Translation and Implementation Science Specialists

PurposeWe hypothesized that despite the low incidence of severe SARS-CoV-2 infections in children in Guyana, due to their specific skillset in lung protective ventilation, our Pediatric Intensivists were uniquely positioned to address significant training and readiness gaps in our colleagues attending a surging critically ill Adult COVID-19 patient population.Methods & MaterialsIn Guyana, there are few clinicians trained in Critical-Care Medicine (CCM). The high incidence of ventilator dependence in seriously ill SARS-CoV2 patients, combined with a dearth of CCM practitioners competent in complex mechanical ventilation management left Guyana ill prepared to manage these patients. This knowledge deficit was further exacerbated in that many clinicians at our National Infectious Diseases Hospital were co-opted into CCM roles from other specialties with little to no CCM training. We have a very small core of Pediatric Surgical Critical Care Medicine staff that was formally trained in PCCM outside of Guyana. This core was instrumental in establishing a unique and formal Pediatric Critical-Care Medicine Micro-Modular Fellowship (PCCM-MMF) program that allowed the creation of Guyana's only Pediatric ICU. A significant number of that core are also involved in Guyana‘s National COVID Task Force. Given that all graduates of our PCCM-MMF program are extensively trained in Lung Protective Ventilation, it was very appropriate to utilize them to augment Adult critical care capacity. Thirty physicians with primarily adult practices and little to no previous knowledge of ventilator management were enrolled in a multi-modal triphasic mechanical ventilation short course facilitated by PCCM staff.ResultsWe were able to rapidly enable two cohorts of 15 Adult clinicians to competently address critical knowledge deficits and staffing shortfalls. We improved morbidity and mortality amongst our mechanically ventilated adult COVID-19 patients, as well as relieved significant multifactorial caregiver strain.ConclusionOur successful utilization of PCCM staff as Mechanical Ventilation didactic and clinical educators for an Adult patient population carries implications for cross disciplinary Knowledge Translation and Implementation Science in a wide variety of practice milieus. We are actively pursuing research opportunities to further experiment with other skill sets incorporated in our PCCM Micro-Modular Fellowship and welcome potential collaborators.

International Pediatric Emergency Medicine and Critical Care Fellow Education: Utilizing Virtual Resuscitation Simulation in Settings With Differing Resources.

Pediatric Emergency and Critical Care-Kenya (PECC-Kenya) is an international collaboration between the University of Nairobi and the University of Washington (UW) supporting a combined fellowship program in pediatric emergency medicine (PEM) and pediatric critical care medicine (PCCM) in Kenya. Typically, PEM/PCCM faculty from UW travel to Kenya to support in-person simulation, which was cancelled due to COVID-19 travel restrictions. This presented a need for alternative modalities to continue simulation-based education. This technical report describes the use of virtual simulation for pediatric emergency and critical care fellow education on the management of hypovolemic and septic shock, utilizing international guidelines and being based on resource availability.

Updated Guidance on Use and Prioritization of Monoclonal Antibody Therapy for Treatment of COVID-19 in Adolescents.

BackgroundStarting in November 2020, the US Food and Drug Administration (FDA) has issued Emergency Use Authorizations (EUAs) for multiple novel virus-neutralizing monoclonal antibody therapies, including bamlanivimab monotherapy (now revoked), bamlanivimab and etesivimab, casirivimab and imdevimab (REGEN-COV), and sotrovimab, for treatment or postexposure prophylaxis of Coronavirus disease 2019 (COVID-19) in adolescents (≥12 years of age) and adults with certain high-risk conditions. Previous guidance is now updated based on new evidence and clinical experience.MethodsA panel of experts in pediatric infectious diseases, pediatric infectious diseases pharmacotherapy, and pediatric critical care medicine from 18 geographically diverse US institutions was convened. Through a series of teleconferences and web-based surveys, a guidance statement was developed and refined based on a review of the best available evidence and expert opinion.ResultsThe course of COVID-19 in children and adolescents is typically mild, though more severe disease is occasionally observed. Evidence supporting risk stratification is incomplete. Randomized controlled trials have demonstrated the benefit of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-specific monoclonal antibody therapies in adults, but data on safety and efficacy in children or adolescents are limited. Potential harms associated with infusion reactions or anaphylaxis are reportedly low in adults.ConclusionsBased on evidence available as of August 31, 2021, the panel suggests a risk-based approach to administration of SARS-CoV-2 monoclonal antibody therapy. Therapy is suggested for the treatment of mild to moderate COVID-19 in adolescents (≥12 years of age) at the highest risk of progression to hospitalization or severe disease. Therapeutic decision-making about those at moderate risk of severe disease should be individualized. Use as postexposure prophylaxis could be considered for those at the highest risk who have a high-risk exposure but are not yet diagnosed with COVID-19. Clinicians and health systems should ensure safe and timely implementation of these therapeutics that does not exacerbate existing healthcare disparities.

An Antiracism Approach to Conducting, Reporting, and Evaluating Pediatric Critical Care Research.

Reporting race and ethnicity without consideration for the complexity of these variables is unfortunately common in research. This practice exacerbates the systemic racism present in healthcare and research, of which pediatric critical care is not immune. Scientifically, this approach lacks rigor, as people are grouped into socially derived categories that are often not scientifically justified, and the field is denied the opportunity to examine closely the true associations between race/ethnicity and clinical outcomes. In this Special Article for Pediatric Critical Care Medicine, we introduce an antiracism approach to conducting, reporting, and evaluating pediatric critical care research. We propose four recommendations: 1) race and ethnicity are social constructs that should be evaluated as such, with researchers considering the context and relevance of related social determinants of health; 2) race and ethnicity data should be collected with sufficient detail to allow detection of meaningful results and minimize the risk of overgeneralizing findings; 3) as health equity research evolves, the pediatric critical care research field must adapt and proactively strive for inclusivity; and 4) the research community, including investigators, authors, research ethics committees, funding organizations, professional organizations, and journal editorial boards, are all accountable for rigorously conducting and reporting race/ethnicity in research. Taking an antiracism approach to research requires the field to ask the difficult question of why racial/ethnic differences exist to eliminate healthcare disparities and optimize healthcare outcomes for all children.

Point-of-Care Ultrasound in the Pediatric Intensive Care Unit.

Ultrasonography has been widely used in medicine for decades but often by specific users such as cardiologists, obstetricians, and radiologists. In the last several years, the use of this imaging modality has moved to the bedside, with clinicians performing and interpreting focused point of care ultrasonography to aid in immediate assessment and management of their patients. The growth of point of care ultrasonography has been facilitated by advancement in ultrasound-related technology and emerging studies and protocols demonstrating its utility in clinical practice. However, considerable challenges remain before this modality can be adopted across the spectrum of disciplines, primarily as it relates to training, competency, and standardization of usage. This review outlines the history, current state, challenges and the future direction of point of care ultrasonography specifically in the field of pediatric critical care medicine.

Assessing agreement on Canadian pediatric critical care training objectives in Japan.

Japan has no accredited learning objectives for pediatric critical care medicine trainees. This study examined the extent of agreement among a panel of Japanese Pediatric Intensive Care (PICU) directors regarding the necessity of the Canadian learning objectives in pediatric critical care knowledge and technical skills training. Using a two-round Delphi survey, we developed consensus among directors of PICUs in Japan on the Canadian training objectives in pediatric critical care medicine. To assess the agreement, we applied a 4-point Likert scale (1=unnecessary, 2=relatively unnecessary, 3=relatively necessary, 4=necessary). We conducted a web-based survey and an Excel-based survey over four-week periods for the first and second rounds, respectively. Consensus was set at ≥80% agreement; therefore, items rated 3 or 4 by ≥80% participants in either rounds were included in the final list. Of the 36 PICU directors invited, 32 (88.9%) completed all survey rounds. In the first round, 164 items were agreed as necessary, 1 item was deemed unnecessary, and 15 items did not reach agreement and were included in the second round. In the second round, 5 items were agreed as necessary and 10 items did not reach agreement. Finally, 169 (94.9%) of the Canadian learning objectives reached the agreement after the two-round Delphi survey. Sixteen participants commented that non-technical skills, such as communication, collaboration, management, and education, were important additional objectives. High consensus was observed among Japanese pediatric critical care experts concerning the Canadian learning objectives for pediatric critical care knowledge and technical skills training.

Patients Found Willing to Answer Routine Question on Firearm Access

Patients Found Willing to Answer Routine Question on Firearm Access

Core Components of a Pediatric Critical Care Transport Communication Curriculum: A Modified Delphi Approach

ObjectiveInterfacility transport of critically ill infants and children is an essential part of the care of children in the United States. However, there is tremendous variation in how transports are coordinated and performed. Pediatric critical care medicine (PCCM) fellows have differing experiences in their fellowships, and there is no standardized way of training medical command for the transport process. The aim of this study was to use a consensus-building process to establish core components of a PCCM transport curriculum focused on communication. MethodsA national group of experts in transport medicine rated 51 total possible topics for their importance to include in a fellowship curriculum. Three rounds of surveys were completed. ResultsFifty-two of 372 invitees (14%) participated in round 1. Consensus was reached to include 15 items in a PCCM curriculum. Twenty of 52 (38%) experts completed round 2, reaching consensus on 2 additional items. Seventeen of 20 (85%) experts completed round 3. No additional items reached consensus. ConclusionExperts reached consensus on 17 core components to include in a PCCM fellowship transport communication curriculum. This curriculum could likely be adapted to train providers from different disciplines in the transport process.

The Gift of Life: Interprofessional Organ Donation Curriculum in Pediatric Critical Care.

BackgroundThe number of patients awaiting organ transplantation is high, particularly in Pediatrics, in which available organs are scarce. To maximize organ donation opportunities and to provide quality end-of-life care, clinicians from all professions must be familiar with the process. There continues to be important gaps in core competencies regarding organ donation, including donor criteria and eligibility, timing of referral to organ procurement organizations, neurological determination of death, donation after cardiocirculatory death, and donor management. These gaps affect healthcare providers across multiple professions and are significant barriers to donation.ObjectiveWe describe an interprofessional curriculum that is designed to teach Pediatric Critical Care Medicine (PCCM) clinicians about the process of organ donation and supporting the families through that process. The approach of families is the purview of organ procurement organization, and the support of the families through the process remains with PCCM clinicians.MethodsKern’s six-step approach to curriculum development was used to develop, implement, and evaluate an interprofessional curriculum on organ donation in PCCM for physicians, nurses, and respiratory therapists.ResultsProblem formulation and both general and targeted needs assessments were performed through a comprehensive literature review, including review of national guidelines and Royal College of Physicians and Surgeons of Canada training objectives. Learning objectives and educational strategies were then outlined using two educational frameworks. After implementation, the curriculum was evaluated using learner self-assessments with a retrospective pre–post design.ConclusionAfter identifying educational gaps contributing to barriers to organ donation, an interprofessional curriculum was developed to increase competency in multiple aspects of organ donation, including team communication and collaboration, with the ultimate goal of promoting a culture of donation while ensuring it is part of quality end-of-life care.

The Effect of the Coronavirus-2019 Pandemic on Pediatric Critical Care Fellowship Training.

Objective: To assess the impact of the coronavirus-2019 (COVID-19) pandemic on pediatric critical care medicine (PCCM) fellowship training through a cross-sectional survey of both program directors (PDs) and fellows. Design: Cross-sectional internet-based survey. Setting: Accreditation Council for Graduate Medical Education (ACGME)-accredited PCCM fellowship programs in the United States. Subjects: PCCM PDs and fellows. Results: A total of 34 PDs and 92 fellows responded to the national survey (rate of 47% and 17%, respectively). The majority (69%) of respondents agreed that medical education has been negatively impacted by the COVID-19 pandemic. When PDs were surveyed, 91% noted a significant decrease in the patient census since March 2020, with 59% citing a >15% decrease. Further, 65% reported trainees had less procedural experience. All respondents reported that education was at least in part provided through virtual learning platforms, with nearly half having exclusive remote learning without in-person sessions. Fifty percent of PDs and 62% of fellows reported decreased learner engagement during virtual didactics when compared to in-person education. The majority of PDs reported specific decreases in simulation, procedural skills training, and ultrasound training. Few PDs (15%) and fellows (13-16%) reported redeployment to adult patient care, with northeastern programs having the highest rates. In univariate analyses, decreased PDs confidence in trainee procedural skills was associated with reported decreases in number of procedures performed (P = .0006) and number of procedural skills didactic sessions (P = .0245). Change in the unit census was associated with less PDs confidence in fellows' medical knowledge (P = .0004), fellows' management skills (P = .0232), and fellows' procedural skills (P = .0003), with larger decreases in patient census correlating with larger decreases in confidence. Conclusions: The COVID-19 pandemic has significantly impacted the education and clinical training of PCCM fellows. More knowledge on this topic can assist PDs in curriculum changes for the future to address any gaps in learning that have occurred.

PELOD-2 Score Mortality Prediction Ability in Children with Multiple Organ Dysfunction

This study evaluates PELOD-2 score mortality prediction ability in children with multiple organ dysfunction. The descriptive cross-sectional study was carried out on 110 children with Multiple Organ Dysfunction at the Pediatric intensive care unit in Vietnam National Children’s Hospital from 1st January 2015 to 31th June 2016. The study results show that the average PELOD-2 score was high (8.8 ± 3.85 points); the PELOD-2 score of the mortality group was significantly higher than the survivor group with 7.07 ± 2.37 and 10.43 ± 4,28, respectively; mortality rate was directly proportional to PELOD-2 score; the PELOD-2 score could separate the mortality group from the survivor group with the area under the ROC curve of 0.76 and the cut-point PELOD-2 score of 8.5. If children with multiple organ dysfunction had over 10 points of PELOD-2 score, their mortality prediction value was nearly the same as the actual mortality rate. The study concludes that PELOD-2 score was significantly correlated with associated multiple organ dysfunction syndrome and useful in predicting mortality.&#x0D; Keywords: Multiple organ dysfunction, PELOD-2 score.&#x0D; References&#x0D; [1] B. Goldstein, B. Giroir, A. Randolph, International Pediatric Sepsis Consensus Conference: Definitions for Sepsis and Organ Dysfunction in Pediatrics. Pediatric Critical Care Medicine, Vol. 6, 2005, pp. 2-8.[2] J. D. Wilkinson et al., Mortality Associated with Multiple Organ System Failure and Sepsis in Pediatric Intensive Care Unit, The Journal of Pediatrics, Vol. 111, 1987, pp. 324-328[3] J. A. Tantaleán et al., Multiple Organ Dysfunction Syndrome in Children, Pediatric Critical Care Medicine, Vol. 4, 2003, pp. 181-185[4] T. K. Hao, Clinical Characteristics and Prognostic Value of PELOD Score in Pediatric Population With Multi-Organ Dysfunction, 11th Pediatric National Conference, 2014 (in Vietnamese).[5] S. Leteurtre et al., PELOD-2: An Update of the Pediatric Logistic Organ Dysfunction Score, Critical Care Medicine, Vol. 41, 2013, pp. 1761-1773.[6] J. P. Gonçalves et al., Performance of PRISM III and PELOD-2 Scores in A Pediatric Intensive Care Unit, European Journal of Pediatrics, Vol. 174, 2016, pp. 1305-1310.[7] T. K. Hao, Evaluation of PMODS Score in Patients with Multi-organ Dysfunction Syndrome at A Pediatric Intensive Care Unit, Journal of Practical Medicine, Vol. 805, 2012 (in Vietnamese).

Gender Equity and Diversity in Pediatric Critical Care Medicine: We Must Do Better

“Variability is the law of life, and as no two faces are the same, so no two bodies are alike, and no two individuals react alike and behave alike under the abnormal conditions which we know as disease.” (Sir William Osler)