Melatonin Use and Association With Delirium Burden Among Children Admitted to an Intensive Care Unit Within a Large Pediatric Healthcare Organization.

Sleep disruption and delirium are common among children requiring intensive care. Melatonin secretion is altered in critical illness and supplementation may be beneficial. To characterize melatonin use among children admitted to a pediatric intensive care unit (PICU) within a large pediatric healthcare organization and explore associations with delirium screening scores.

Postintubation Sedation Practices Within Multiple Emergency Departments Across a Large Pediatric Health Care Organization.

Objective: Children requiring rapid or standard sequence intubation are at risk of experiencing paralysis without adequate sedation when the duration of neuromuscular blockade exceeds the duration of sedation provided by the induction agent. The objective of this study was to evaluate the rate of appropriately timed postintubation sedation (PIS; defined as the administration of PIS before the clinical effects of the induction agent have dissipated) in patients requiring intubation across multiple emergency department/urgent care sites within a large pediatric health care organization.

Methods: This retrospective cohort study included patients admitted to 1 of 6 affiliated pediatric emergency department or urgent care sites who were intubated with an induction agent and neuromuscular blocker between January 2016 and December 2021.

Decreases in Nephrotoxic Pain Medications Are Not Associated With Increased Opioid Utilization in Critically Ill Children.

Objectives: Quality improvement initiatives to decrease rates of nephrotoxic medication exposure have reduced rates of acute kidney injury (AKI) in noncritically ill children. The objective of our study was to analyze the implementation of a similar program in critically ill children and to measure important balancing measures including opioid and benzodiazepine exposure.

Design: Prospective quality improvement study.

Methylnaltrexone in the Management of Opioid-Associated Urinary Retention in Children.

Objective: To evaluate the association between methylnaltrexone and urine output (UOP) in critically ill children with opioid-associated urinary retention.

Methods: This retrospective study included patients admitted to the pediatric intensive care unit between December 1, 2019, and November 30, 2020, who received methylnaltrexone for opioid-associated oliguria (spontaneous UOP below 1 mL/kg/hr and at least 1 dose of an opioid within the preceding 6 hours).

Results: Twenty-five patients (median age = 5.

Peripheral Vasoactive Administration in Critically Ill Children With Shock: A Single-Center Retrospective Cohort Study.

Objectives: Management of fluid refractory pediatric shock requires prompt administration of vasoactive agents. Although delivery of vasoactive therapy is generally provided via a central venous catheter, their placement can delay drug administration and is associated with complications. We characterize peripheral vasoactive administration in a cohort of critically ill children with shock, evaluate progression to central venous catheter placement, and describe complications associated with extravasation.

Adherence to a Pediatric Continuous Infusion Propofol Policy for Sedation in Mechanically Ventilated Patients: Opportunities for Change and Improvement.

Objective: To evaluate adherence to an institutional continuous infusion propofol policy for sedation in mechanically ventilated patients, investigate the rate of propofol-related infusion syndrome (PRIS), and explore areas of improvement to enhance policy compliance and safety.

Methods: This was a single center, retrospective chart review of patients admitted to a pediatric or cardiac intensive care unit within a large free-standing quaternary care pediatric hospital who received continuous propofol for non-procedural continuous sedation for at least 6 hours between 2014 and 2019. Propofol exposure (dose and duration), laboratory data, and hemodynamic outcomes of patients were evaluated.

Concentrated hypertonic saline in severe pediatric traumatic brain injury.

Objective: Describe outcomes associated with bolus and continuous infusions of hypertonic saline (HTS) in children with severe traumatic brain injury (TBI).

Methods: IRB-approved, single-center, retrospective review of children admitted between January 1, 2012 to August 30, 2018 with a diagnosis of severe TBI who received HTS.

Results: Forty-five children (age 9.

Pediatric empyemas - Has the pendulum swung too far?

Background: The management of childhood empyemas has transformed over the past decade, with current trends favoring chest tube placement and intrapleural fibrinolytic therapy. Although this strategy often avoids the need for video-assisted thoracoscopic surgery (VATS), hospital length of stay can be long.

Methods: To characterize national trends and outcomes associated with empyema management, the Pediatric Health Information System (PHIS) database was queried to identify children (2 months-18 years) treated for an empyema between January 2010 and December 2017.

Nalbuphine Reduces Opioid-Associated Urinary Retention in Pediatric Patients.

Objectives: To evaluate the effect of nalbuphine administration on urine output in critically ill children with opioid-associated urinary retention.

Design: Institutional review board approved, single center, retrospective medical chart review.

Setting: Large medical-surgical PICU within a free-standing, tertiary care children's hospital.

Increased Testing and Health Care Costs for Pediatric Cannabis Exposures.

Objectives: This study aimed to evaluate the process of identifying marijuana exposure in a children's hospital emergency department and compare the cost of diagnostic testing and procedures.

Methods: A retrospective chart review was performed on patients 31 days to 20 years old with a positive marijuana toxicology screen result between November 2009 and December 2014. Primary outcomes included time to provider recognition of marijuana exposure, number of diagnostic tests and procedures performed, and length of hospital stay.

Low-Dose Epinephrine Boluses for Acute Hypotension in the PICU.

Objectives: To describe the use of low-dose bolus epinephrine in critically ill children during an acute hypotensive episode or prearrest condition.

Design: Institutional Review Board approved, single-center, retrospective medical chart review.

Setting: Large medical-surgical PICU within a freestanding, tertiary care children's hospital.

Marijuana Misadventures in Children: Exploration of a Dose-Response Relationship and Summary of Clinical Effects and Outcomes.

Objectives: This study aimed to explore a dose-response relationship of delta-9-tetrahydrocannabinol (THC) in THC-naïve children after unintentional acute exposure and compare clinical outcomes with non-naïve children.

Methods: A retrospective review was performed on children aged 31 days to 20 years who presented to Children's Hospital Colorado for care related to acute THC toxicity. The children were divided into groups based on exposure: group 1 (THC naïve) and group 2 (THC non-naïve).

Evaluation of prolonged epidural chloroprocaine for postoperative analgesia in infants.

Study Objective: To describe the use and adverse effects of chloroprocaine for epidural analgesia in young infants for infusion durations greater than 3.5 hours.

Design: A retrospective cohort review of the electronic medical record over a 14-month period.

Patterns of Off-Label Prescribing in the Pediatric Intensive Care Unit and Prioritizing Future Research.

Objectives: To characterize off-label prescribing among US pediatric intensive care units (PICUs), determine characteristics associated with off-label use, and identify medications in highest need for additional study.

Methods: Medications prescribed for ≥1% PICU patients (age < 18 years) in 2010 were identified from 39 children's hospitals. Use in a patient younger than the Food and Drug Administration (FDA)-approved age for any indication was considered off-label.

Supra-therapeutic tacrolimus concentrations associated with concomitant nicardipine in pediatric liver transplant recipients.

Tacrolimus is prescribed to prevent allograft rejection in pediatric liver transplant recipients; however, its metabolism through the cytochrome P-450 enzyme system presents a multitude of challenges in regard to drug interactions. Here, we describe four children (ages 1.4-8.

Development of recommendations for dosing of commonly prescribed medications in critically ill obese children.

Purpose: The development and use of a decision support tool to help formulate recommendations for dosing of commonly prescribed medications in critically ill obese children are described.

Methods: Medications prescribed in 2010 to critically ill infants and children (younger than 18 years) were identified from the Pediatric Health Information System. The most commonly prescribed and therapeutically monitored medications were extracted.

Nimodipine for the prevention of cerebral vasospasm after subarachnoid hemorrhage in 12 children.

Introduction: Subarachnoid hemorrhage is a rare, but life-threatening neurological emergency. Cerebral vasospasm is a complication of subarachnoid hemorrhage that contributes significantly to morbidity and mortality. Nimodipine has been used in adults to reduce the incidence of cerebral vasospasm after subarachnoid hemorrhage and improve long-term outcomes.

Comparison of 3 body size descriptors in critically ill obese children and adolescents: implications for medication dosing.

Objective: To compare 3 methods of weight determination for medication dose calculations in obese children and to discuss feasibility for use in routine care.

Methods: This was a patient safety and quality improvement study evaluating patients (2-19 years old) admitted to the pediatric intensive care unit during a 13-month period (July 2010-July 2011). Patients identified as obese (≥95th percentile body mass index [BMI] for age), including severely obese (≥99th percentile BMI for age), were included in the weight method comparison portion of this study.

Hyponatremia in children with bronchiolitis admitted to the pediatric intensive care unit is associated with worse outcomes.

Objective: To characterize the relationship between hyponatremia (serum sodium <135 mEq/L) and clinical outcomes in children ages 1 month to 2 years admitted to the pediatric intensive care unit (PICU) with bronchiolitis.

Study Design: Single-center retrospective cohort study comprising children who were admitted to the PICU between January 2009 and April 2011. Serum sodium concentrations, collected within the first 2 hours after admission to the PICU, were recorded and associations with clinical outcomes were calculated.

Continuous hydromorphone for pain and sedation in mechanically ventilated infants and children.

Objective: To describe dosing regimens and efficacy of continuous infusion hydromorphone in mechanically ventilated children.

Design: Retrospective review.

Setting: Tertiary care, pediatric hospital.

Dexmedetomidine in a child with methylphenidate intoxication.

Methylphenidate intoxication, due to accidental ingestion, is a common occurrence in pediatrics. Symptoms of extreme agitation are typically controlled with benzodiazepines or barbiturates. There is, however, a legitimate risk of mechanical ventilation due to respiratory depression with increasing doses of benzodiazepines.

Thrombosis risk factor assessment and implications for prevention in critically ill children.

Objectives: To describe nursing compliance with a computer-based pediatric thrombosis risk assessment tool; to generate an estimate of risk factors present in our population; and to explore relationships between risk factors and confirmed thrombotic events.

Design: Institutional review board-approved prospective, observational cohort study.

Setting: Pediatric intensive care unit within a tertiary care children's hospital.