BACKGROUND: The stay of a critically ill child in a pediatric intensive care unit (PICU) is a significant experience for the family. Thus far, little is known regarding the impact of this stay on parents and their healthy children for whom no continuous aftercare services are offered. This study aimed to capture the post-stay experience and needs of parents after this traumatic event so that they could return to family and everyday life.
METHODS: This qualitative descriptive study was conducted in collaboration with four pediatric intensive care units in Switzerland. It included parents whose children had fully recovered after a stay and who did not require continuous medical follow-up. All children were hospitalized in the PICU for at least 48 h. Data were collected through narrative pairs (n = 6) and individual interviews (n = 8). Interviews were audio recorded, transcribed, coded inductively according to Saldaña, and analyzed.
RESULTS: The results showed three related phases that influence each other to restore normality in daily life: Trust and inclusion in the treatment process during the stay (1), processing after the stay (2), and returning to everyday life (3).
CONCLUSIONS: Follow-up meetings should be available to all parents whose children have been hospitalized in the PICU. In particular, it should also be available to parents whose children have fully recovered and no longer have any medical disabilities.

OBJECTIVE: To study the application value of transport ventilator in the inter-hospital transport of critically ill children.
METHODS: The critically ill children in Hunan Children\'s Hospital who were transported with or without a transport ventilator were included as the observation group (from January 2019 to January 2020; n=122) and the control group (from January 2018 to January 2019; n=120), respectively. The two groups were compared in terms of general data, the changes in heart rate, respiratory rate, and blood oxygen saturation during transport, the incidence rates of adverse events, and outcomes.
RESULTS: There were no significant differences between the two groups in sex, age, oxygenation index, pediatric critical illness score, course of disease, primary disease, heart rate, respiratory rate, and transcutaneous oxygen saturation before transport (P>0.05). During transport, there were no significant differences between the two groups in the changes in heart rate, respiratory rate, and transcutaneous oxygen saturation (P>0.05). The incidence rates of tracheal catheter detachment, indwelling needle detachment, and sudden cardiac arrest in the observation group were lower than those in the control group during transport, but the difference was not statistically significant (P>0.05). Compared with the control group, the observation group had significantly shorter duration of mechanical ventilation and length of stay in the pediatric intensive care unit and significantly higher transport success rate and cure/improvement rate (P<0.05).
CONCLUSIONS: The application of transport ventilator in the inter-hospital transport can improve the success rate of inter-hospital transport and the prognosis in critically ill children, and therefore, it holds promise for clinical application in the inter-hospital transport of critically ill children.
目的: 探讨转运呼吸机在危重患儿院际转运过程中的应用价值。方法: 选择湖南省儿童医院2018年1月—2019年1月未使用转运呼吸机转运和2019年1月—2020年1月使用转运呼吸机转运的危重患儿分别作为对照组（n=120）和观察组（n=122），对两组病例的一般情况，转运途中心率、呼吸、经皮血氧饱和度变化，不良事件发生情况和转归进行对比分析。结果: 转运前两组患儿性别、年龄、氧合指数（PaO2/FiO2）、小儿危重病例评分、转运前病程、原发疾病、心率、呼吸、经皮血氧饱和度的比较差异均无统计学意义（P>0.05）。转运途中两组患儿心率、呼吸、经皮血氧饱和度的比较差异无统计学意义（P>0.05）；观察组气管导管脱管、留置针脱出、心搏骤停发生率低于对照组，差异无统计学意义（P>0.05）。观察组机械通气时间、儿童重症监护病房住院时间较对照组缩短，转运成功率、治愈及好转率较对照组升高，差异有统计学意义（P<0.05）。结论: 转运呼吸机在危重患儿院际转运中的应用可在一定程度上协助提高院际转运的成功率，改善危重患儿的预后，值得在院际转运中推广。.

Pediatric neurocritical care requires multidisciplinary expertise for the care of critically ill children. Approximately 14-16% of critically ill children in pediatric intensive care suffer from a primary neurological disease, whereby cardiac arrest and severe traumatic brain injury play major roles in Europe. The short-term goal of interventions in the pediatric intensive care unit is to stabilize vital functions, whereas the overarching goal is to achieve survival without neurological damage that enables fulfillment of the individual developmental physiological potential. For this reason, evidence-based methods for brain monitoring during the acute phase and recovery are necessary, which can be performed clinically or with technical devices. This applies to critically ill children with primary neurological diseases and for all children at risk for secondary neurological insults. Patients with diseases of the peripheral nervous system are also treated in pediatric intensive care medicine. In these patients, the primary aim frequently consists of bridging the time until recovery after acute deterioration, for example during an infection. In these patients, monitoring the cerebral function can be especially challenging, because due to the underlying disease the results of the examination cannot be interpreted in the same way as for previously neurologically healthy children. This article summarizes the complexity of pediatric neurocritical care by presenting examples of diagnostic and therapeutic approaches in the context of various neurological diseases that can be routinely encountered in the pediatric intensive care unit and can only be successfully treated by multidisciplinary teams.
UNASSIGNED: Die pädiatrische Neurointensivmedizin erfordert multiprofessionelle Expertise für die Versorgung kritisch kranker Kinder. Zwischen 14 und 16 % aller kritisch kranken Kinder in der pädiatrischen Intensivmedizin leiden an einer primären neurologischen Erkrankung, wobei Kreislaufstillstände und schwere Schädel-Hirn-Traumata in Europa die größte Rolle spielen. Das kurzfristige Ziel intensivmedizinischer Therapie bei Kindern ist die Stabilisierung vitaler Funktionen, das übergeordnete Ziel hingegen ist ein Überleben ohne neurologische Schädigung, das die Ausschöpfung des individuellen entwicklungsphysiologischen Potenzials ermöglicht. Aus diesem Grund sind evidenzbasierte Methoden zur Überwachung des Gehirns während der akuten Krankheit und im Verlauf notwendig, die klinisch und apparativ durchgeführt werden. Dies gilt sowohl für Patienten mit primärer neurologischer Erkrankung als auch für alle Kinder mit einem Risiko für eine sekundäre neurologische Schädigung. Auch Patienten mit Erkrankungen des peripheren Nervensystems werden in der pädiatrischen Intensivmedizin behandelt. Hier gilt es häufig, die Zeit bis zur Rekonvaleszenz einer akuten Verschlechterung, beispielsweise im Rahmen einer Infektion, zu überbrücken. Eine besondere Herausforderung kann die Überwachung der zerebralen Funktion bei diesen Patienten darstellen, da durch die Grunderkrankung Untersuchungsergebnisse nicht wie bei vormals neurologisch gesunden Kindern interpretiert werden können. Diese Komplexität der der pädiatrischen Neurointensivmedizin, die im klinischen Alltag nur im multidisziplinären Team zu bewältigen ist, wird anhand der diagnostischen Möglichkeiten, verschiedener Krankheitsbilder und deren therapeutischen Optionen dargestellt.

暂无摘要。

BACKGROUND: Acute kidney injury (AKI) is known to complicate one-third of cases in pediatric intensive care units (PICU), and almost one-fourth of these are due to nephrotoxic drugs (NTDs). Although stopping NTDs seems the most obvious option, it is not practically applicable. Many NTDs are the only existing option, and their potential benefits outweigh the risk of drug-induced AKI.
OBJECTIVE: To assess the proportion of children receiving NTDs in the PICU and highlight the children who developed AKI.
METHODS: A prospective observational study was conducted in the PICU of the National Institute of Child Health, Karachi. All children admitted to the PICU for at least 72 hours not diagnosed with any acute or chronic kidney disease were included. Serum creatinine (SCr) was done at admission and then after 72 hours. Data was entered and analyzed using IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.
RESULTS: Of 99 children, 53 (53.5%) were male. NTD exposure was positive in 97 (97.9%), and 72 (72.7%) had high exposure (≥3 NTDs). Drug-induced AKI was diagnosed in 46 (46.5%). It was significantly related to high SCr even at admission and high NTDs exposure. The mortality rate in the AKI group was 17% compared to 4% in the non-AKI (p=0.02).
CONCLUSIONS: Almost half of all PICU admissions were infants. Almost all patients were exposed to NTDs, and three-fourth experienced high exposure. AKI developed in 46% of patients and may be predicted by raised creatinine at the time of admission. Children exposed to ≥3 NTDs had a higher chance of drug-induced AKI.

In this article, we presented a teenager, in maintenance chemotherapy for leukemia, who was admitted for digestive symptoms related to a parasitic infection and required nutritional support with parenteral nutrition. After 6 weeks, his condition worsened with refractory shock of presumed septic origin, necessitating extracorporeal membrane oxygenation. Despite hemodynamic stabilization, his lactic acidosis worsened until thiamine supplementation was started. Lactate normalized within 12 hours. Thiamine is an essential coenzyme in aerobic glycolysis, and deficiency leads to lactate accumulation through anaerobic glycolysis. Thiamine deficiency is uncommon in the pediatric population. However, it should be considered in patients at risk of nutritional deficiencies with lactic acidosis of unknown origin.

Critically ill children require optimum feeding in the intensive care units for speedy recovery. Several factors determine their feeding and the feeding method to adopt to address this phenomenon. The aim of this study was to explore and describe the feeding criteria of critically ill children at the neonatal and paediatric intensive care units.
A descriptive qualitative design was used to conduct the study. Six focus group discussions were conducted, and each group had five members. In addition, twelve one-on-one interviews were conducted in two public tertiary teaching hospitals in Ghana and analyzed by content analysis using MAXQDA Plus version 2020 qualitative software. Participants were selected purposively (N = 42).
The decision to feed a critically ill child in the ICU was largely determined by the child\'s medical condition as well as the experts\' knowledge and skills to feed. It emerged from the data that cup feeding, enteral, parenteral, and breastfeeding were the feeding processes employed by the clinicians to feed the critically ill children.
Regular in-service training of clinicians on feeding critically ill children, provision of logistics and specialized personnel in the ICU are recommended to reduce possible infant and child mortality resulting from suboptimal feeding.

OBJECTIVE: Pediatric ICUs (PICU) that have adopted family-centered care models welcome families to the critically ill child\'s bedside to partner with clinicians in decision-making and the provision of care. The aim of this review was to synthesize the evidence on the impact of critical illness and injury on families of children admitted to the PICU to identify research needs in pediatric critical care.
UNASSIGNED: This systematic review included quantitative and qualitative studies that examined the experiences of families of children admitted to a PICU published between 2005 and 2019.
METHODS: 33 articles were selected for inclusion in the final analysis after screening those identified by searches in CINAHL, PubMed, PsycINFO, and reference lists of included publications.
RESULTS: Main parental stressors included the sights and sounds within the PICU, child acuity, changes to family functioning and parenting role, and uncertainty of the child\'s outcome. The most common need of parents was to be well-informed. Psychological, physical, and social impact of hospitalization were experienced by parents from days after admission to years after discharge. Spirituality was identified as a coping mechanism in half of the studies.
CONCLUSIONS: Parents experience negative effects of the ill child\'s admission to the PICU and to PICU exposure.
CONCLUSIONS: Careful consideration of the impact of the PICU admission on family members of critically ill or injured children is needed when implementing family-centered care strategies. Future research on other family members including the healthy sibling needs to be conducted.

Penetrating injuries of the carotid and vertebral arteries are rare, but life-threatening conditions. There are still challenges in the first intervention management and patient treatment. Deciding which methods to apply in the first intervention, whether to perform imaging, and the preferred appropriate treatment for the patient (open surgery or endovascular intervention) plays a main role in the patient\'s survival without neurological deficit. The general management of trauma in penetrating neck injuries and the knowledge of special approaches to carotid artery injury are important for pediatric trauma centers. In this case report, we presented a case of penetrating carotid artery injury in a child who has recovered with no disability after a successful first intervention, surgical repair, and proper postoperative care.

BACKGROUND: Transfusion-Related Acute Lung Injury (TRALI) is a major cause of transfusionrelated morbidity and mortality in the intensive care unit setting. There is a paucity of such data from Pakistan. The purpose of this study is to assess the incidence and outcome of TRALI in critically ill children admitted in a pediatric intensive care unit (PICU) of Pakistan.
METHODS: This is a retrospective cohort study of all critically ill or injured children who developed TRALI or \"possible\" TRALI after blood transfusion based on Canadian Conference Consensus criteria in a closed multidisciplinary-cardiothoracic PICU from January 2012 to June 2016. The demographic, pertinent clinical data, transfusion-related variables and outcome of all cases of TRALI were recorded.
RESULTS: Of total 2975 admissions in the PICU during study period, 35.8% (1066) received 5124 blood components. Eleven cases developed TRALI in our cohort. The incidence of TRALI was 1.03% per patient transfused and 0.19% (19/100,000 per blood product transfused). Median age was 8 (range 1-14) yr., 70 % (n=8) were male. Mean PRISM-III score was 16.3±6.7. Mean time interval for onset of TRALI was 2.73±1.67 hr. The postoperative cardiac surgical and hematology-oncology patients were most common categories (63.6%). Plasma and platelets were the most commomly identified trigger of TRALI. The case-specific mortality was 63.6% and the overall mortality was 10.7% (p<0.0001).
CONCLUSIONS: The incidence of TRALI in critically ill children is low, but is associated with high mortality. Critically ill children with high PRISM-III score, postoperative cardiac surgical and hematology-oncology patients are often affected by TRALI.