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7. A Core Outcome Set for Pediatric Critical Care.

Author

Fink, Ericka L, Maddux, Aline B, Pinto, Neethi, Sorenson, Samuel, Notterman, Daniel, Dean, J Michael, Carcillo, Joseph A, Berg, Robert A, Zuppa, Athena, Pollack, Murray M, Meert, Kathleen L, Hall, Mark W, Sapru, Anil, McQuillen, Patrick S, Mourani, Peter M, Wessel, David, Amey, Deborah, Argent, Andrew, Brunow de Carvalho, Werther, Butt, Warwick, Choong, Karen, Curley, Martha AQ, Del Pilar Arias Lopez, Maria, Demirkol, Demet, Grosskreuz, Ruth, Houtrow, Amy J, Knoester, Hennie, Lee, Jan Hau, Long, Debbie, Manning, Joseph C, Morrow, Brenda, Sankar, Jhuma, Slomine, Beth S, Smith, McKenna, Olson, Lenora M, and Watson, R Scott

Subjects
Clinical Research, Behavioral and Social Science, Pediatric, Good Health and Well Being, Adult, Aged, Child, Child Health, Critical Care, Critical Illness, Delphi Technique, Female, Humans, Intensive Care Units, Pediatric, Male, Middle Aged, Stakeholder Participation, Treatment Outcome, Young Adult, child, critical care, family, outcome assessment, postintensive care syndrome, Pediatric Outcomes STudies after PICU (POST-PICU) Investigators of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network, Clinical Sciences, Nursing, Public Health and Health Services, Emergency & Critical Care Medicine
Abstract

ObjectivesMore children are surviving critical illness but are at risk of residual or new health conditions. An evidence-informed and stakeholder-recommended core outcome set is lacking for pediatric critical care outcomes. Our objective was to create a multinational, multistakeholder-recommended pediatric critical care core outcome set for inclusion in clinical and research programs.DesignA two-round modified Delphi electronic survey was conducted with 333 invited research, clinical, and family/advocate stakeholders. Stakeholders completing the first round were invited to participate in the second. Outcomes scoring greater than 69% "critical" and less than 15% "not important" advanced to round 2 with write-in outcomes considered. The Steering Committee held a virtual consensus conference to determine the final components.SettingMultinational survey.PatientsStakeholder participants from six continents representing clinicians, researchers, and family/advocates.Measurements and main resultsOverall response rates were 75% and 82% for each round. Participants voted on seven Global Domains and 45 Specific Outcomes in round 1, and six Global Domains and 30 Specific Outcomes in round 2. Using overall (three stakeholder groups combined) results, consensus was defined as outcomes scoring greater than 90% "critical" and less than 15% "not important" and were included in the final PICU core outcome set: four Global Domains (Cognitive, Emotional, Physical, and Overall Health) and four Specific Outcomes (Child Health-Related Quality of Life, Pain, Survival, and Communication). Families (n = 21) suggested additional critically important outcomes that did not meet consensus, which were included in the PICU core outcome set-extended.ConclusionsThe PICU core outcome set and PICU core outcome set-extended are multistakeholder-recommended resources for clinical and research programs that seek to improve outcomes for children with critical illness and their families.

Published
2020

8. Development of a core outcome set for pediatric critical care outcomes research

Author

Fink, Ericka L, Jarvis, Jessica M, Maddux, Aline B, Pinto, Neethi, Galyean, Patrick, Olson, Lenora M, Zickmund, Susan, Ringwood, Melissa, Sorenson, Samuel, Dean, J Michael, Carcillo, Joseph A, Berg, Robert A, Zuppa, Athena, Pollack, Murray M, Meert, Kathleen L, Hall, Mark W, Sapru, Anil, McQuillen, Patrick S, Mourani, Peter M, Watson, R Scott, Investigators, and the Pediatric Acute Lung Injury and Sepsis Investigators Long-term Outcomes Subgroup, and Network, the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research

Subjects
Health Services and Systems, Health Sciences, Clinical Research, Pediatric, Generic health relevance, Adolescent, Child, Child, Preschool, Critical Illness, Delphi Technique, Endpoint Determination, Female, Guidelines as Topic, Humans, Infant, Intensive Care Units, Pediatric, Male, Outcome Assessment, Health Care, Research Design, Stakeholder Participation, Pediatrics, Core outcomes set, Clinical research, Critical illness, Morbidity, Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Long-term Outcomes Subgroup Investigators, and, Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network, Medical and Health Sciences, General Clinical Medicine, Public Health, Biomedical and clinical sciences, Health sciences
Abstract

BackgroundPediatric Intensive Care Unit (PICU) teams provide care for critically ill children with diverse and often complex medical and surgical conditions. Researchers often lack guidance on an approach to select the best outcomes when evaluating this critically ill population. Studies would be enhanced by incorporating multi-stakeholder preferences to better evaluate clinical care. This manuscript outlines the methodology currently being used to develop a PICU Core Outcome Set (COS). This PICU COS utilizes mixed methods, an inclusive stakeholder approach, and a modified Delphi consensus process that will serve as a resource for PICU research programs.MethodsA Scoping Review of the PICU literature evaluating outcomes after pediatric critical illness, a qualitative study interviewing PICU survivors and their parents, and other relevant literature will serve to inform a modified, international Delphi consensus process. The Delphi process will derive a set of minimum domains for evaluation of outcomes of critically ill children and their families. Delphi respondents include researchers, multidisciplinary clinicians, families and former patients, research funding agencies, payors, and advocates. Consensus meetings will refine and finalize the domains of the COS, outline a battery instruments for use in future studies, and prepare for extensive dissemination for broad implementation.DiscussionThe PICU COS will be a guideline resource for investigators to assure that outcomes most important to all stakeholders are considered in PICU clinical research in addition to those deemed most important to individual scientists.Trial registrationCOMET database (http://www.comet-initiative.org/, Record ID 1131, 01/01/18).

Published
2020

11. Sedation Management for Critically Ill Children with Pre-Existing Cognitive Impairment

Author

Best, Kaitlin M, Asaro, Lisa A, Curley, Martha AQ, Investigators, Randomized Evaluation of Sedation Titration for Respiratory Failure Study, Wypij, David, Allen, Geoffrey L, Angus, Derek C, Ascenzi, Judy A, Bateman, Scot T, Borasino, Santiago, Bowens, Cindy Darnell, Bysani, G Kris, Cheifetz, Ira M, Cowl, Allison S, Dodson, Brenda L, Faustino, E Vincent S, Fineman, Lori D, Flori, Heidi R, Franck, Linda S, Gedeit, Rainer G, Grant, Mary Jo C, Harabin, Andrea L, Haskins-Kiefer, Catherine, Hertzog, James H, Hutchins, Larissa, Kirby, Aileen L, Lebet, Ruth M, Matthay, Michael A, McLaughlin, Gwenn E, Natale, JoAnne E, Oren, Phineas P, Polavarapu, Nagendra, Schneider, James B, Schwarz, Adam J, Shanley, Thomas P, Simone, Shari, Singer, Lewis P, Sorce, Lauren R, Truemper, Edward J, Heyden, Michele A Vander, Watson, R Scott, and Wells, Claire R

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Neurosciences, Rare Diseases, Clinical Trials and Supportive Activities, Chronic Pain, Clinical Research, Pediatric, Pain Research, Brain Disorders, Adolescent, Analgesics, Child, Child, Preschool, Cognitive Dysfunction, Critical Care, Critical Illness, Female, Humans, Hypnotics and Sedatives, Infant, Infant, Newborn, Male, Patient Selection, Prospective Studies, Respiration, Artificial, Respiratory Insufficiency, Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) Study Investigators, analgesia, cognitive impairment, critical care, neurodevelopmental disability, pediatric, sedation, Human Movement and Sports Sciences, Paediatrics and Reproductive Medicine, Pediatrics, Paediatrics
Abstract

ObjectiveTo compare current analgesia and sedation management practices between critically ill children with pre-existing cognitive impairment and critically ill neurotypical children, including possible indicators of therapeutic efficacy.Study designThis study used secondary analysis of prospective data from the RESTORE clinical trial, with 2449 children admitted to the pediatric intensive care unit and receiving mechanical ventilation for acute respiratory failure. Subjects with a baseline Pediatric Cerebral Performance Category ≥3 were defined as subjects with cognitive impairment, and differences between groups were explored using regression methods accounting for pediatric intensive care unit as a cluster variable.ResultsThis study identified 412 subjects (17%) with cognitive impairment. Compared with neurotypical subjects, subjects with cognitive impairment were older (median, years, 6.2 vs 1.4; P

Published
2019

14. Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2)

Author

Emeriaud, Guillaume, López-Fernández, Yolanda M., Iyer, Narayan Prabhu, Bembea, Melania M., Agulnik, Asya, Barbaro, Ryan P., Baudin, Florent, Bhalla, Anoopindar, Brunow de Carvalho, Werther, Carroll, Christopher L., Cheifetz, Ira M., Chisti, Mohammod J., Cruces, Pablo, Curley, Martha A. Q., Dahmer, Mary K., Dalton, Heidi J., Erickson, Simon J., Essouri, Sandrine, Fernández, Analía, Flori, Heidi R., Grunwell, Jocelyn R., Jouvet, Philippe, Killien, Elizabeth Y., Kneyber, Martin C. J., Kudchadkar, Sapna R., Korang, Steven Kwasi, Lee, Jan Hau, Macrae, Duncan J., Maddux, Aline, Modesto i Alapont, Vicent, Morrow, Brenda M., Nadkarni, Vinay M., Napolitano, Natalie, Newth, Christopher J. L., Pons-Odena, Martí, Quasney, Michael W., Rajapreyar, Prakadeshwari, Rambaud, Jerome, Randolph, Adrienne G., Rimensberger, Peter, Rowan, Courtney M., Sanchez-Pinto, L. Nelson, Sapru, Anil, Sauthier, Michael, Shein, Steve L., Smith, Lincoln S., Steffen, Katerine, Takeuchi, Muneyuki, Thomas, Neal J., Tse, Sze Man, Valentine, Stacey, Ward, Shan, Watson, R. Scott, Yehya, Nadir, Zimmerman, Jerry J., Khemani, Robinder G., Emeriaud, Guillaume, López-Fernández, Yolanda M., Khemani, Robinder G., Iyer, Narayan Prabhu, Bembea, Melania, Korang, Steven Kwasi, Steffen, Katherine M., Yehya, Nadir, Smith, Lincoln, Thomas, Neal J., Zimmerman, Jerry J., Erickson, Simon J., Shein, Steven L., Grunwell, Jocelyn R., Dahmer, Mary K., Sapru, Anil, Quasney, Michael W., Flori, Heidi R., Fernandez, Analia, Alapont, Vicent Modesto i, Rimensberger, Peter, Cheifetz, Ira, Rowan, Courtney, Randolph, Adrienne G., Kneyber, Martin, Valentine, Stacey, Kudchadkar, Sapna, Ward, Shan, Nadkarni, Vinay, Curley, Martha A.Q., Bhalla, Anoopindar, Baudin, Florent, Takeuchi, Muneyuki, Cruces, Pablo, Carroll, Christopher L., Napolitano, Natalie, Pons-Odena, Marti, Essouri, Sandrine, Rambaud, Jérome, Barbaro, Ryan, Macrae, Duncan, Dalton, Heidi, Killien, Elizabeth, Maddux, Aline, Tse, Sze Man, Watson, Scott, Sanchez-Pinto, L. Nelson, Sauthier, Michaël, Rajapreyar, Prakadeshwari, Jouvet, Philippe, Newth, Christopher, Morrow, Brenda, Agulnik, Asya, de Carvalho, Werther Brunow, Chisti, Mohamod, Lee, Jan Hau, Lobner, Katie, Kysh, Lynn, Pincivy, Alix, and Dodin, Philippe

Published
2023
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17. Susceptibility to childhood sepsis, contemporary management, and future directions

Author

Carter, Michael J, Carrol, Enitan D, Ranjit, Suchitra, Mozun, Rebeca, Kissoon, Niranjan, Watson, R Scott, and Schlapbach, Luregn J

Abstract

Sepsis disproportionally affects children across all health-care settings and is one of the leading causes of morbidity and mortality in neonatal and paediatric age groups. As shown in the first paper in this Series, the age-specific incidence of sepsis is highest during the first years of life, before approaching adult incidence rates during adolescence. In the second paper in this Series, we focus on the unique susceptibility of paediatric patients to sepsis and how the underlying dysregulated host response relates to developmental aspects of children's immune system, genetic, perinatal, and environmental factors, and comorbidities and socioeconomic determinants of health, which often differ between children and adults. State-of-the-art clinical management of paediatric sepsis is organised around three treatment pillars—diagnosis, early resuscitation, and titration of advanced care—and we examine available treatment guidelines and the limitations of their supporting evidence. Serious evidence gaps remain in key areas of paediatric sepsis care, especially surrounding recognition, common interventions, and survivor support, and to this end we offer a research roadmap for the next decade that could accelerate targeted diagnostics and personalised use of immunomodulation. However, improving outcomes for children with sepsis relies fundamentally on systematic quality improvement in both recognition and treatment, which is the theme of the third paper in this Series. Digital health, as shown in the fourth and final paper of this Series, holds promising potential in breaking down the barriers that hinder progress in paediatric sepsis care and, ultimately, global child health.

Published
2024
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18. The burden and contemporary epidemiology of sepsis in children

Author

Watson, R Scott, Carrol, Enitan D, Carter, Michael J, Kissoon, Niranjan, Ranjit, Suchitra, and Schlapbach, Luregn J

Abstract

Sepsis is a dysregulated host response to infection that leads to life-threatening organ dysfunction. Half of the 50 million people affected by sepsis globally every year are neonates and children younger than 19 years. This burden on the paediatric population translates into a disproportionate impact on global child health in terms of years of life lost, morbidity, and lost opportunities for children to reach their developmental potential. This Series on paediatric sepsis presents the current state of diagnosis and treatment of sepsis in children, and maps the challenges in alleviating the burden on children, their families, and society. Drawing on diverse experience and multidisciplinary expertise, we offer a roadmap to improving outcomes for children with sepsis. This first paper of the Series is a narrative review of the burden of paediatric sepsis from low-income to high-income settings. Advances towards improved operationalisation of paediatric sepsis across all age groups have facilitated more standardised assessment of the Global Burden of Disease estimates of the impact of sepsis on child health, and these estimates are expected to gain further precision with the roll out of the new Phoenix criteria for sepsis. Sepsis remains one of the leading causes of childhood morbidity and mortality, with immense direct and indirect societal costs. Although substantial regional differences persist in relation to incidence, microbiological epidemiology, and outcomes, these cannot be explained by differences in income level alone. Recent insights into post-discharge sequelae after paediatric sepsis, ranging from late mortality and persistent neurodevelopmental impairment to reduced health-related quality of life, show how common post-sepsis syndrome is in children. Targeting sepsis as a key contributor to poor health outcomes in children is therefore an essential component of efforts to meet the Sustainable Development Goals.

Published
2024
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19. “I Didnʼt Want My Baby to Pass, But I Didnʼt Want Him Suffering Either”: Comparing Bereaved Parentsʼ Narratives With Nursing End-of-Life Assessments in the Pediatric Intensive Care Unit

Author

Broden, Elizabeth G., Hinds, Pamela S., Werner-Lin, Allison V., Curley, Martha A. Q., Curley, Martha A.Q., Wypij, David, Allen, Geoffrey L., Angus, Derek C., Asaro, Lisa A., Ascenzi, Judy A., Bateman, Scot T., Borasino, Santiago, Bowens, Cindy Darnell, Bysani, G. Kris, Cheifetz, Ira M., Cowl, Allison S., Dodson, Brenda L., Faustino, E. Vincent S., Fineman, Lori D., Flori, Heidi R., Franck, Linda S., Gedeit, Rainer G., Grant, Mary Jo C., Harabin, Andrea L., Haskins-Kiefer, Catherine, Hertzog, James H., Hutchins, Larissa, Kirby, Aileen L., Lebet, Ruth M., Matthay, Michael A., McLaughlin, Gwenn E., Natale, JoAnne E., Oren, Phineas P., Polavarapu, Nagendra, Schneider, James B., Schwarz, Adam J., Shanley, Thomas P., Simone, Shari, Singer, Lewis P., Sorce, Lauren R., Truemper, Edward J., Vander Heyden, Michele A., Watson, R. Scott, and Wells, Claire R.

Published
2022
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23. Criteria for Pediatric Sepsis—A Systematic Review and Meta-Analysis by the Pediatric Sepsis Definition Taskforce

Author

Menon, Kusum, Schlapbach, Luregn J., Akech, Samuel, Argent, Andrew, Biban, Paolo, Carrol, Enitan D., Chiotos, Kathleen, Jobayer Chisti, Mohammod, Evans, Idris V. R., Inwald, David P., Ishimine, Paul, Kissoon, Niranjan, Lodha, Rakesh, Nadel, Simon, Oliveira, Cláudio Flauzino, Peters, Mark, Sadeghirad, Benham, Scott, Halden F., de Souza, Daniela C., Tissieres, Pierre, Watson, R. Scott, Wiens, Matthew O., Wynn, James L., Zimmerman, Jerry J., and Sorce, Lauren R.

Published
2021
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25. Protocolized sedation vs usual care in pediatric patients mechanically ventilated for acute respiratory failure: a randomized clinical trial.

Author

Curley, Martha AQ, Wypij, David, Watson, R Scott, Grant, Mary Jo C, Asaro, Lisa A, Cheifetz, Ira M, Dodson, Brenda L, Franck, Linda S, Gedeit, Rainer G, Angus, Derek C, Matthay, Michael A, and RESTORE Study Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators Network

Subjects
RESTORE Study Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators Network, Humans, Respiratory Insufficiency, Psychomotor Agitation, Pain, Critical Illness, Analgesics, Opioid, Hypnotics and Sedatives, Treatment Outcome, Respiration, Artificial, Nursing Care, Conscious Sedation, Arousal, Child, Child, Preschool, Intensive Care Units, Pediatric, Airway Extubation, Clinical Trials and Supportive Activities, Lung, Acute Respiratory Distress Syndrome, Behavioral and Social Science, Patient Safety, Clinical Research, Rare Diseases, Pediatric, Bioengineering, Assistive Technology, Evaluation of treatments and therapeutic interventions, 6.7 Physical, Respiratory, Medical and Health Sciences, General & Internal Medicine
Abstract

ImportanceProtocolized sedation improves clinical outcomes in critically ill adults, but its effect in children is unknown.ObjectiveTo determine whether critically ill children managed with a nurse-implemented, goal-directed sedation protocol experience fewer days of mechanical ventilation than patients receiving usual care.Design, setting, and participantsCluster randomized trial conducted in 31 US pediatric intensive care units (PICUs). A total of 2449 children (mean age, 4.7 years; range, 2 weeks to 17 years) mechanically ventilated for acute respiratory failure were enrolled in 2009-2013 and followed up until 72 hours after opioids were discontinued, 28 days, or hospital discharge.InterventionIntervention PICUs (17 sites; n = 1225 patients) used a protocol that included targeted sedation, arousal assessments, extubation readiness testing, sedation adjustment every 8 hours, and sedation weaning. Control PICUs (14 sites; n = 1224 patients) managed sedation per usual care.Main outcomes and measuresThe primary outcome was duration of mechanical ventilation. Secondary outcomes included time to recovery from acute respiratory failure, duration of weaning from mechanical ventilation, neurological testing, PICU and hospital lengths of stay, in-hospital mortality, sedation-related adverse events, measures of sedative exposure (wakefulness, pain, and agitation), and occurrence of iatrogenic withdrawal.ResultsDuration of mechanical ventilation was not different between the 2 groups (intervention: median, 6.5 [IQR, 4.1-11.2] days; control: median, 6.5 [IQR, 3.7-12.1] days). Sedation-related adverse events including inadequate pain and sedation management, clinically significant iatrogenic withdrawal, and unplanned endotracheal tube/invasive line removal were not significantly different between the 2 groups. Intervention patients experienced more postextubation stridor (7% vs 4%; P = .03) and fewer stage 2 or worse immobility-related pressure ulcers (

Published
2015

26. Sedation Management for Critically Ill Children with Pre-Existing Cognitive Impairment

Author

Wypij, David, Allen, Geoffrey L., Angus, Derek C., Ascenzi, Judy A., Bateman, Scot T., Borasino, Santiago, Bowens, Cindy Darnell, Bysani, G. Kris, Cheifetz, Ira M., Cowl, Allison S., Dodson, Brenda L., Faustino, E. Vincent S., Fineman, Lori D., Flori, Heidi R., Franck, Linda S., Gedeit, Rainer G., Grant, Mary Jo C., Harabin, Andrea L., Haskins-Kiefer, Catherine, Hertzog, James H., Hutchins, Larissa, Kirby, Aileen L., Lebet, Ruth M., Matthay, Michael A., McLaughlin, Gwenn E., Natale, JoAnne E., Oren, Phineas P., Polavarapu, Nagendra, Schneider, James B., Schwarz, Adam J., Shanley, Thomas P., Simone, Shari, Singer, Lewis P., Sorce, Lauren R., Truemper, Edward J., Vander Heyden, Michele A., Watson, R. Scott, Wells, Claire R., Best, Kaitlin M., Asaro, Lisa A., and Curley, Martha A.Q.

Published
2019
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30. International Consensus Criteria for Pediatric Sepsis and Septic Shock.

Author

Schlapbach, Luregn J., Watson, R. Scott, Sorce, Lauren R., Argent, Andrew C., Menon, Kusum, Hall, Mark W., Akech, Samuel, Albers, David J., Alpern, Elizabeth R., Balamuth, Fran, Bembea, Melania, Biban, Paolo, Carrol, Enitan D., Chiotos, Kathleen, Chisti, Mohammod Jobayer, DeWitt, Peter E., Evans, Idris, Flauzino de Oliveira, Cláudio, Horvat, Christopher M., and Inwald, David

Subjects
*SEPTIC shock, *PEDIATRICIANS, *SEPSIS, *SYSTEMIC inflammatory response syndrome, *HOSPITAL mortality, *CONSENSUS (Social sciences), *CRITICALLY ill, *DELPHI method
Abstract

Key Points: Question: How should children with suspected infection at higher risk of mortality, indicative of sepsis, be identified? Findings: Using an international survey, systematic review, and analysis of more than 3 million pediatric health care encounters, and consensus process, new criteria for sepsis and septic shock in children were developed. Pediatric sepsis in children (<18 years) with suspected infection was identified by at least 2 points in the novel Phoenix Sepsis Score, including dysfunction of the respiratory, cardiovascular, coagulation, and/or neurological systems; and septic shock as sepsis with at least 1 cardiovascular point in the Phoenix Sepsis Score. Meaning: The new criteria for pediatric sepsis and septic shock are globally applicable. Importance: Sepsis is a leading cause of death among children worldwide. Current pediatric-specific criteria for sepsis were published in 2005 based on expert opinion. In 2016, the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) defined sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection, but it excluded children. Objective: To update and evaluate criteria for sepsis and septic shock in children. Evidence Review: The Society of Critical Care Medicine (SCCM) convened a task force of 35 pediatric experts in critical care, emergency medicine, infectious diseases, general pediatrics, nursing, public health, and neonatology from 6 continents. Using evidence from an international survey, systematic review and meta-analysis, and a new organ dysfunction score developed based on more than 3 million electronic health record encounters from 10 sites on 4 continents, a modified Delphi consensus process was employed to develop criteria. Findings: Based on survey data, most pediatric clinicians used sepsis to refer to infection with life-threatening organ dysfunction, which differed from prior pediatric sepsis criteria that used systemic inflammatory response syndrome (SIRS) criteria, which have poor predictive properties, and included the redundant term, severe sepsis. The SCCM task force recommends that sepsis in children be identified by a Phoenix Sepsis Score of at least 2 points in children with suspected infection, which indicates potentially life-threatening dysfunction of the respiratory, cardiovascular, coagulation, and/or neurological systems. Children with a Phoenix Sepsis Score of at least 2 points had in-hospital mortality of 7.1% in higher-resource settings and 28.5% in lower-resource settings, more than 8 times that of children with suspected infection not meeting these criteria. Mortality was higher in children who had organ dysfunction in at least 1 of 4—respiratory, cardiovascular, coagulation, and/or neurological—organ systems that was not the primary site of infection. Septic shock was defined as children with sepsis who had cardiovascular dysfunction, indicated by at least 1 cardiovascular point in the Phoenix Sepsis Score, which included severe hypotension for age, blood lactate exceeding 5 mmol/L, or need for vasoactive medication. Children with septic shock had an in-hospital mortality rate of 10.8% and 33.5% in higher- and lower-resource settings, respectively. Conclusions and Relevance: The Phoenix sepsis criteria for sepsis and septic shock in children were derived and validated by the international SCCM Pediatric Sepsis Definition Task Force using a large international database and survey, systematic review and meta-analysis, and modified Delphi consensus approach. A Phoenix Sepsis Score of at least 2 identified potentially life-threatening organ dysfunction in children younger than 18 years with infection, and its use has the potential to improve clinical care, epidemiological assessment, and research in pediatric sepsis and septic shock around the world. This article revises criteria to identify sepsis in children after an exhaustive process that involved surveying clinicians, reviewing health record databases, conducting a systematic review and meta-analysis, and undergoing a Delphi consensus process. [ABSTRACT FROM AUTHOR]

Published
2024
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31. Clinical decision support tools for paediatric sepsis in resource-poor settings: an international qualitative study

Author

Jimenez-Zambrano, Andrea, primary, Ritger, Carly, additional, Rebull, Margaret, additional, Wiens, Matthew O, additional, Kabajaasi, Olive, additional, Jaramillo-Bustamante, Juan Camilo, additional, Argent, Andrew C, additional, Kissoon, Niranjan, additional, Schlapbach, Luregn J, additional, Sorce, Lauren R, additional, Watson, R Scott, additional, Dorsey Holliman, Brooke, additional, Sanchez-Pinto, Lazaro N, additional, and Bennett, Tellen D, additional

Published
2023
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36. Postdischarge Outcome Domains in Pediatric Critical Care and the Instruments Used to Evaluate Them: A Scoping Review

Author

Maddux, Aline B., Pinto, Neethi, Fink, Ericka L., Hartman, Mary E., Nett, Sholeen, Biagas, Katherine, Killien, Elizabeth Y., Dervan, Leslie A., Christie, LeeAnn M., Luckett, Peter M., Loftis, Laura, Lackey, Mellanye, Ringwood, Melissa, Smith, McKenna, Olson, Lenora, Sorenson, Sam, Meert, Kathleen L., Notterman, Daniel A., Pollack, Murray M., Mourani, Peter M., and Watson, R. Scott

Published
2020
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37. Racial and Ethnic Disparities in Parental Refusal of Consent in a Large, Multisite Pediatric Critical Care Clinical Trial

Author

Curley, Martha A.Q., Wypij, David, Allen, Geoffrey L., Angus, Derek C., Asaro, Lisa A., Ascenzi, Judy A., Bateman, Scot T., Borasino, Santiago, Bowens, Cindy Darnell, Bysani, G. Kris, Cheifetz, Ira M., Cowl, Allison S., Dodson, Brenda L., Faustino, E. Vincent S., Fineman, Lori D., Flori, Heidi R., Franck, Linda S., Gedeit, Rainer G., Grant, Mary Jo C., Harabin, Andrea L., Haskins-Kiefer, Catherine, Hertzog, James H., Hutchins, Larissa, Kirby, Aileen L., Lebet, Ruth M., Matthay, Michael A., McLaughlin, Gwenn E., Natale, Joanne E., Oren, Phineas P., Polavarapu, Nagendra, Schneider, James B., Schwarz, Adam J., Shanley, Thomas P., Simone, Shari, Singer, Lewis P., Sorce, Lauren R., Truemper, Edward J., Vander Heyden, Michele A., Watson, R. Scott, Wells, Claire R., Lebet, Ruth, Joseph, Jill G., Ulysse, Christine, and Ascenzi, Judith

Published
2017
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45. Operationalizing Appropriate Sepsis Definitions in Children Worldwide: Considerations for the Pediatric Sepsis Definition Taskforce

Author

Carrol, Enitan D, Ranjit, Suchitra, Menon, Kusum, Bennett, Tellen D; https://orcid.org/0000-0003-1483-4236, Sanchez-Pinto, L Nelson, Zimmerman, Jerry J, Souza, Daniela C, Sorce, Lauren R, Randolph, Adrienne G, Ishimine, Paul, Flauzino de Oliveira, Claudio, Lodha, Rakesh, Harmon, Lori, Watson, R Scott, Schlapbach, Luregn J; https://orcid.org/0000-0003-2281-2598, Kissoon, Niranjan, Argent, Andrew C; https://orcid.org/0000-0001-9333-2036, Carrol, Enitan D, Ranjit, Suchitra, Menon, Kusum, Bennett, Tellen D; https://orcid.org/0000-0003-1483-4236, Sanchez-Pinto, L Nelson, Zimmerman, Jerry J, Souza, Daniela C, Sorce, Lauren R, Randolph, Adrienne G, Ishimine, Paul, Flauzino de Oliveira, Claudio, Lodha, Rakesh, Harmon, Lori, Watson, R Scott, Schlapbach, Luregn J; https://orcid.org/0000-0003-2281-2598, Kissoon, Niranjan, and Argent, Andrew C; https://orcid.org/0000-0001-9333-2036

Abstract

Sepsis is a leading cause of global mortality in children, yet definitions for pediatric sepsis are outdated and lack global applicability and validity. In adults, the Sepsis-3 Definition Taskforce queried databases from high-income countries to develop and validate the criteria. The merit of this definition has been widely acknowledged; however, important considerations about less-resourced and more diverse settings pose challenges to its use globally. To improve applicability and relevance globally, the Pediatric Sepsis Definition Taskforce sought to develop a conceptual framework and rationale of the critical aspects and context-specific factors that must be considered for the optimal operationalization of future pediatric sepsis definitions. It is important to address challenges in developing a set of pediatric sepsis criteria which capture manifestations of illnesses with vastly different etiologies and underlying mechanisms. Ideal criteria need to be unambiguous, and capable of adapting to the different contexts in which children with suspected infections are present around the globe. Additionally, criteria need to facilitate early recognition and timely escalation of treatment to prevent progression and limit life-threatening organ dysfunction. To address these challenges, locally adaptable solutions are required, which permit individualized care based on available resources and the pretest probability of sepsis. This should facilitate affordable diagnostics which support risk stratification and prediction of likely treatment responses, and solutions for locally relevant outcome measures. For this purpose, global collaborative databases need to be established, using minimum variable datasets from routinely collected data. In summary, a “Think globally, act locally” approach is required.

Published
2023

46. Clinical decision support tools for paediatric sepsis in resource-poor settings: an international qualitative study

Author

Jimenez-Zambrano, Andrea, Ritger, Carly, Rebull, Margaret, Wiens, Matthew O, Kabajaasi, Olive, Jaramillo-Bustamante, Juan Camilo, Argent, Andrew C; https://orcid.org/0000-0001-9333-2036, Kissoon, Niranjan, Schlapbach, Luregn J; https://orcid.org/0000-0003-2281-2598, Sorce, Lauren R, Watson, R Scott, Dorsey Holliman, Brooke, Sanchez-Pinto, Lazaro N, Bennett, Tellen D; https://orcid.org/0000-0003-1483-4236, Jimenez-Zambrano, Andrea, Ritger, Carly, Rebull, Margaret, Wiens, Matthew O, Kabajaasi, Olive, Jaramillo-Bustamante, Juan Camilo, Argent, Andrew C; https://orcid.org/0000-0001-9333-2036, Kissoon, Niranjan, Schlapbach, Luregn J; https://orcid.org/0000-0003-2281-2598, Sorce, Lauren R, Watson, R Scott, Dorsey Holliman, Brooke, Sanchez-Pinto, Lazaro N, and Bennett, Tellen D; https://orcid.org/0000-0003-1483-4236

Abstract

Objective: New paediatric sepsis criteria are being developed by an international task force. However, it remains unknown what type of clinical decision support (CDS) tools will be most useful for dissemination of those criteria in resource-poor settings. We sought to design effective CDS tools by identifying the paediatric sepsis-related decisional needs of multidisciplinary clinicians and health system administrators in resource-poor settings. Design: Semistructured qualitative focus groups and interviews with 35 clinicians (8 nurses, 27 physicians) and 5 administrators at health systems that regularly provide care for children with sepsis, April–May 2022. Setting: Health systems in Africa, Asia and Latin America, where sepsis has a large impact on child health and healthcare resources may be limited.ParticipantsParticipants had a mean age of 45 years, a mean of 15 years of experience, and were 45% female.ResultsEmergent themes were related to the decisional needs of clinicians caring for children with sepsis and to the needs of health system administrators as they make decisions about which CDS tools to implement. Themes included variation across regions and institutions in infectious aetiologies of sepsis and available clinical resources, the need for CDS tools to be flexible and customisable in order for implementation to be successful, and proposed features and format of an ideal paediatric sepsis CDS tool. Conclusion: Findings from this study will directly contribute to the design and implementation of CDS tools to increase the uptake and impact of the new paediatric sepsis criteria in resource-poor settings.

Published
2023

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