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  • 1
    Online Resource
    Online Resource
    Pediatric Organ Dysfunction Information Update Mandate (PODIUM) Contemporary Organ Dysfunction Criteria: Executive Summary
    American Academy of Pediatrics (AAP) ; 2022
    In:  Pediatrics Vol. 149, No. Supplement_1 ( 2022-01-01), p. S1-S12
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 149, No. Supplement_1 ( 2022-01-01), p. S1-S12
    Abstract: Prior criteria for organ dysfunction in critically ill children were based mainly on expert opinion. We convened the Pediatric Organ Dysfunction Information Update Mandate (PODIUM) expert panel to summarize data characterizing single and multiple organ dysfunction and to derive contemporary criteria for pediatric organ dysfunction. The panel was composed of 88 members representing 47 institutions and 7 countries. We conducted systematic reviews of the literature to derive evidence-based criteria for single organ dysfunction for neurologic, cardiovascular, respiratory, gastrointestinal, acute liver, renal, hematologic, coagulation, endocrine, endothelial, and immune system dysfunction. We searched PubMed and Embase from January 1992 to January 2020. Study identification was accomplished using a combination of medical subject headings terms and keywords related to concepts of pediatric organ dysfunction. Electronic searches were performed by medical librarians. Studies were eligible for inclusion if the authors reported original data collected in critically ill children; evaluated performance characteristics of scoring tools or clinical assessments for organ dysfunction; and assessed a patient-centered, clinically meaningful outcome. Data were abstracted from each included study into an electronic data extraction form. Risk of bias was assessed using the Quality in Prognosis Studies tool. Consensus was achieved for a final set of 43 criteria for pediatric organ dysfunction through iterative voting and discussion. Although the PODIUM criteria for organ dysfunction were limited by available evidence and will require validation, they provide a contemporary foundation for researchers to identify and study single and multiple organ dysfunction in critically ill children.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2021-052888B
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2022
    detail.hit.zdb_id: 1477004-0
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  • 2
    Online Resource
    Online Resource
    Prospective Side by Side Comparison of Outcomes and Complications With a Simple Versus Intensive Anticoagulation Monitoring Strategy in Pediatric Extracorporeal Life Support Patients*
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Pediatric Critical Care Medicine Vol. 18, No. 11 ( 2017-11), p. 1055-1062
    Details
    In: Pediatric Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 18, No. 11 ( 2017-11), p. 1055-1062
    Abstract: A continuous infusion of unfractionated heparin is the most common anticoagulant used for pediatric patients on extracorporeal life support. The objective of this study was to compare extracorporeal life support complications and outcomes between two large-volume pediatric extracorporeal life support centers that use different anticoagulation strategies. Design: Prospective, observational cohort study. Setting: The University of Michigan used simple anticoagulation monitoring, whereas the University of Alberta used an intensive anticoagulation monitoring strategy. Patients: Pediatric patients on extracorporeal life support. Interventions: None. Measurements and Main Results: The primary outcome measure was major bleeding per extracorporeal life support run defined as bleeding that was retroperitoneal, pulmonary, or involved the CNS; bleeding greater than 20 mL/kg over 24 hours; or bleeding that required surgical intervention. Secondary outcomes measured were patient thrombosis per run, circuit thrombosis per run, and survival to hospital discharge per patient. Eighty-eight patients (95 runs) less than 18 years old were enrolled at the two centers over 2 years. The two centers enrolled different extracorporeal life support populations; University of Alberta enrolled more postcardiac surgical patients (74% vs 47%; p = 0.005). The indication for extracorporeal life support support also varied by center ( p = 0.04). The two centers used similar proportions of VA extracorporeal life support ( p = 0.3). Median (interquartile range) unfractionated heparin doses were similar between University of Michigan and University of Alberta, 30 (21–34) U/kg/hr and 26 (22–31) U/kg/hr, p value equals to 0.3, respectively. Median (interquartile range) antifactor Xa was lower in the University of Michigan cohort (0.23 [0.19–0.28] vs 0.41 [0.36–0.46] U/mL; p 〈 0.001). There was no significant difference in major bleeding (15% University of Michigan vs 21% University of Alberta; p = 0.6) or in patient thromboses (18% University of Michigan vs 13% University of Alberta; p = 0.5). There was no significant difference in survival to hospital discharge (University of Michigan 63% vs University of Alberta 73%; p = 0.1). Conclusions: Although this prospective cohort study compared different pediatric extracorporeal life support populations, the results did not identify a significant difference in outcomes between simple and intensive anticoagulation monitoring strategies.
    Type of Medium: Online Resource
    ISSN: 1529-7535
    URL: Article
    DOI: 10.1097/PCC.0000000000001306
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2070997-3
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  • 3
    Online Resource
    Online Resource
    2021 ELSO Adult and Pediatric Anticoagulation Guidelines
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  ASAIO Journal Vol. 68, No. 3 ( 2022-03), p. 303-310
    Details
    In: ASAIO Journal, Ovid Technologies (Wolters Kluwer Health), Vol. 68, No. 3 ( 2022-03), p. 303-310
    Abstract: These guidelines for adult and pediatric anticoagulation for extracorporeal membrane oxygenation are intended for educational use to build the knowledge of physicians and other health professionals in assessing the conditions and managing the treatment of patients undergoing ECLS / ECMO and describe what are believed to be useful and safe practice for extracorporeal life support (ECLS, ECMO) but these are not necessarily consensus recommendations. The aim of clinical guidelines are to help clinicians to make informed decisions about their patients. However, adherence to a guideline does not guarantee a successful outcome. Ultimately, healthcare professionals must make their own treatment decisions about care on a case-by-case basis, after consultation with their patients, using their clinical judgment, knowledge and expertise. These guidelines do not take the place of physicians’ and other health professionals’ judgment in diagnosing and treatment of particular patients. These guidelines are not intended to and should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment must be made by the physician and other health professionals and the patient in light of all the circumstances presented by the individual patient, and the known variability and biological behavior of the clinical condition. These guidelines reflect the data at the time the guidelines were prepared; the results of subsequent studies or other information may cause revisions to the recommendations in these guidelines to be prudent to reflect new data, but ELSO is under no obligation to provide updates. In no event will ELSO be liable for any decision made or action taken in reliance upon the information provided through these guidelines.
    Type of Medium: Online Resource
    ISSN: 1058-2916
    URL: Article
    DOI: 10.1097/MAT.0000000000001652
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2083312-X
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  • 4
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    Online Resource
    Heterotaxy syndrome and intestinal rotation abnormalities: A survey of institutional practice
    Elsevier BV ; 2013
    In:  Journal of Pediatric Surgery Vol. 48, No. 10 ( 2013-10), p. 2078-2083
    Details
    In: Journal of Pediatric Surgery, Elsevier BV, Vol. 48, No. 10 ( 2013-10), p. 2078-2083
    Type of Medium: Online Resource
    ISSN: 0022-3468
    URL: Article
    DOI: 10.1016/j.jpedsurg.2013.03.001
    RVK:
    XA 10000
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2013
    detail.hit.zdb_id: 2039299-0
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  • 5
    Online Resource
    Online Resource
    Pediatric extracorporeal membrane oxygenation (ECMO): a guide for radiologists
    Springer Science and Business Media LLC ; 2018
    In:  Pediatric Radiology Vol. 48, No. 10 ( 2018-9), p. 1488-1502
    Details
    In: Pediatric Radiology, Springer Science and Business Media LLC, Vol. 48, No. 10 ( 2018-9), p. 1488-1502
    Type of Medium: Online Resource
    ISSN: 0301-0449 , 1432-1998
    URL: Article
    DOI: 10.1007/s00247-018-4211-z
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2018
    detail.hit.zdb_id: 1463007-2
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  • 6
    Online Resource
    Online Resource
    Prospective Exploratory Experience With Bivalirudin Anticoagulation in Pediatric Extracorporeal Membrane Oxygenation
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Pediatric Critical Care Medicine Vol. 21, No. 11 ( 2020-11), p. 975-985
    Details
    In: Pediatric Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 21, No. 11 ( 2020-11), p. 975-985
    Abstract: Objective of this study was to determine if bivalirudin resulted in less circuit interventions than unfractionated heparin. A secondary objective was to examine associations between bivalirudin dose and partial thromboplastin time, international normalized ratio, and activated clotting time. Design: Prospective observational. Setting: Medical-surgical and cardiac PICUs. Patients: Neonatal and pediatric extracorporeal membrane oxygenation patients who received bivalirudin anticoagulation. Interventions: None. Measurements and Main Results: Twenty extracorporeal membrane oxygenation runs in 18 patients used bivalirudin; 90% were venoarterial. Median (interquartile range) age was 4.5 months (1.6–35 mo). Thirteen patients (72%) had an underlying cardiac diagnosis. Of the 20 runs using bivalirudin, 16 (80%) were initially started on unfractionated heparin and transitioned to bivalirudin due to ongoing circuit thrombosis despite therapeutic anti-Xa levels ( n = 13), ongoing circuit thrombosis with unfractionated heparin greater than or equal to 40 U/kg/hr ( n = 2), or absence of increase in ACT after bolus of 100 U/kg of unfractionated heparin and escalation of unfractionated heparin infusion ( n = 1). Initial bivalirudin dose ranged from 0.2 to 0.5 mg/kg/hr; no bolus doses were used. Median (range) bivalirudin dose was 0.9 mg/kg/hr (0.15–1.6 mg/kg/hr). Median (interquartile range) time on extracorporeal membrane oxygenation was 226.5 hours (150.5–393.0 hr) including 84 hours (47–335 hr) on bivalirudin. Nonparametric results are as follows: the rate of circuit intervention was significantly lower in patients on bivalirudin than on unfractionated heparin (median [interquartile range]: 0 [0–1] and 1 [1–2], respectively; Wilcoxon p = 0.0126). Bivalirudin dose was correlated to PTT ( r s = 0.4760; p 〈 0.0001), INR ( r s = 0.6833; p 〈 0.0001), and ACT ( r s = 0.6161; p 〈 0.0001). Four patients had a significant bleeding complication on bivalirudin. Survival to hospital discharge was 56%. Conclusions: Bivalirudin appears to be a viable option for systemic anticoagulation in pediatric extracorporeal membrane oxygenation patients who have failed unfractionated heparin, but questions remain namely its optimal monitoring strategy. This pilot study supports the need for larger prospective studies of bivalirudin in pediatric extracorporeal membrane oxygenation, particularly focusing on meaningful monitoring variables.
    Type of Medium: Online Resource
    ISSN: 1529-7535
    URL: Article
    DOI: 10.1097/PCC.0000000000002527
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2070997-3
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  • 7
    Online Resource
    Online Resource
    Heterotaxy Syndrome: Is a Prophylactic Ladd Procedure Necessary in Asymptomatic Patients?
    Springer Science and Business Media LLC ; 2013
    In:  Pediatric Cardiology Vol. 34, No. 1 ( 2013-1), p. 59-63
    Details
    In: Pediatric Cardiology, Springer Science and Business Media LLC, Vol. 34, No. 1 ( 2013-1), p. 59-63
    Type of Medium: Online Resource
    ISSN: 0172-0643 , 1432-1971
    URL: Article
    DOI: 10.1007/s00246-012-0385-6
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2013
    detail.hit.zdb_id: 1463000-X
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  • 8
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    Online Resource
    Cardiovascular Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference
    American Academy of Pediatrics (AAP) ; 2022
    In:  Pediatrics Vol. 149, No. Supplement_1 ( 2022-01-01), p. S39-S47
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 149, No. Supplement_1 ( 2022-01-01), p. S39-S47
    Abstract: Cardiovascular dysfunction is associated with poor outcomes in critically ill children. OBJECTIVE We aim to derive an evidence-informed, consensus-based definition of cardiovascular dysfunction in critically ill children. DATA SOURCES Electronic searches of PubMed and Embase were conducted from January 1992 to January 2020 using medical subject heading terms and text words to define concepts of cardiovascular dysfunction, pediatric critical illness, and outcomes of interest. STUDY SELECTION Studies were included if they evaluated critically ill children with cardiovascular dysfunction and assessment and/or scoring tools to screen for cardiovascular dysfunction and assessed mortality, functional status, organ-specific, or other patient-centered outcomes. Studies of adults, premature infants (≤36 weeks gestational age), animals, reviews and/or commentaries, case series (sample size ≤10), and non–English-language studies were excluded. Studies of children with cyanotic congenital heart disease or cardiovascular dysfunction after cardiopulmonary bypass were excluded. DATA EXTRACTION Data were abstracted from each eligible study into a standard data extraction form, along with risk-of-bias assessment by a task force member. RESULTS Cardiovascular dysfunction was defined by 9 elements, including 4 which indicate severe cardiovascular dysfunction. Cardiopulmonary arrest ( & gt;5 minutes) or mechanical circulatory support independently define severe cardiovascular dysfunction, whereas tachycardia, hypotension, vasoactive-inotropic score, lactate, troponin I, central venous oxygen saturation, and echocardiographic estimation of left ventricular ejection fraction were included in any combination. There was expert agreement ( & gt;80%) on the definition. LIMITATIONS All included studies were observational and many were retrospective. CONCLUSIONS The Pediatric Organ Dysfunction Information Update Mandate panel propose this evidence-informed definition of cardiovascular dysfunction.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2021-052888F
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2022
    detail.hit.zdb_id: 1477004-0
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  • 9
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    Online Resource
    Prophylactic peritoneal dialysis catheter does not decrease time to achieve a negative fluid balance after the Norwood procedure: A randomized controlled trial
    Elsevier BV ; 2015
    In:  The Journal of Thoracic and Cardiovascular Surgery Vol. 149, No. 1 ( 2015-01), p. 222-228
    Details
    In: The Journal of Thoracic and Cardiovascular Surgery, Elsevier BV, Vol. 149, No. 1 ( 2015-01), p. 222-228
    Type of Medium: Online Resource
    ISSN: 0022-5223
    URL: Article
    DOI: 10.1016/j.jtcvs.2014.08.011
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2015
    detail.hit.zdb_id: 2007600-9
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  • 10
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    Survival and Neurocognitive Outcomes After Cardiac Extracorporeal Life Support in Children Less Than 5 Years of Age : A Ten-Year Cohort
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation: Heart Failure Vol. 8, No. 2 ( 2015-03), p. 312-321
    Details
    In: Circulation: Heart Failure, Ovid Technologies (Wolters Kluwer Health), Vol. 8, No. 2 ( 2015-03), p. 312-321
    Abstract: Survival after pediatric cardiac extracorporeal life support (ECLS) is guarded, and neurological morbidity varies widely. Our objective is to report our 10-year experience with cardiac ECLS, including survival and kindergarten entry neurocognitive outcomes; to identify predictors of mortality or adverse neurocognitive outcomes; and to compare 2 eras, before and after 2005. Methods and Results— From 2000 to 2009, 98 children had venoarterial cardiac ECLS. Sixty-four patients (65%) survived to hospital discharge, and 50 (51%) survived ≤5 years of age. Neurocognitive follow-up of survivors was completed at mean (SD) age of 52.9 (8) months using Wechsler Preschool and Primary Scale of Intelligence. Logistic regression analysis found the longer time (hours) for lactate to fall below 2 mmol/L on ECLS (hazard ratio, 1.39; 95% confidence interval, 1.05, 1.84; P =0.022), and the amount of platelets (mL/kg) given in the first 48 hours (hazard ratio, 1.18; 95% confidence interval, 1.06, 1.32; P =0.002) was independently associated with higher in-hospital mortality. Receiving ECLS after the year 2005 was independently associated with lower risk of in-hospital mortality (hazard ratio, 0.36; 95% confidence interval, 0.13, 0.99; P =0.048). Extracorporeal cardiopulmonary resuscitation was not independently associated with mortality or neurocognitive outcomes. Era was not independently associated with neurocognitive outcomes. The full-scale intelligence quotient of survivors without chromosomal abnormalities was 79.7 (16.6) with 25% below 2 SD of the population mean. Conclusions— Mortality has improved over time; time for lactate to fall on ECLS and volume of platelets transfused are independent predictors of mortality. Extracorporeal cardiopulmonary resuscitation and era were not independently associated with neurocognitive outcomes.
    Type of Medium: Online Resource
    ISSN: 1941-3289 , 1941-3297
    URL: Article
    DOI: 10.1161/CIRCHEARTFAILURE.114.001503
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 2428100-1
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