Citations 2
Caring for Critically Ill Children With the ICU Liberation Bundle (ABCDEF): Results of the Pediatric Collaborative*
Srivastava, Avantika , Jennison, Susan, Simino, Megan, Traube, Chani , LaRose, Kimberly, Kawai, Yu , Neu, Lori, Kudchadkar, Sapna R. , Wieczorek, Beth, Hajnik, Krista, Kordik, Christina, Kumar, Vishakha K. , Aghamohammadi, Sara, Arteaga, Grace M. , Smith, Heidi A. B. , Orman, Andrea, Landman, Becky McGee, Valdivia, Hector , Browne, H Ilayward's, Fang, Timothy, Zimmerman, Jerry J. , Collaborative, for the Society of Critical Care Medicine’s Pediatric ICU Liberation Campaign, Landman, Bennett A , Lin, John C. H. , Malone, Sara M. , Spentzas, Thomas , Collaborative, for the Society of Critical Care Medicine’s Pediatric ICU Liberation Campaign
Pediatric Critical Care Medicine | May 1, 2023 | Volume: 24 | Issue: 8 | Pages: 636-651
OBJECTIVES: Assess clinical outcomes following PICU Liberation ABCDEF Bundle utilization. DESIGN: Prospective, multicenter, cohort study. SETTING: Eight academic PICUs. PATIENTS: Children greater than 2 months with expected PICU stay greater than 2 days and need for mechanical ventilation (MV). INTERVENTIONS: ABCDEF Bundle implementation. MEASUREMENT AND MAIN RESULTS: Over an 11-month period (3-mo baseline, 8-mo implementation), Bundle utilization was measured for 622 patients totaling 5,017 PICU days. Risk of mortality was quantified for 532 patients (4,275 PICU days) for correlation between Bundle utilization and MV duration, PICU length of stay (LOS), delirium incidence, and mortality. Utilization was analyzed as subject-specific (entire PICU stay) and day-specific (single PICU day). Median overall subject-specific utilization increased from 50% during the 3-month baseline to 63.9% during the last four implementation months ( p < 0.001). Subject-specific utilization for elements A and C did not change; utilization improved for B (0–12.5%; p = 0.007), D (22.2–61.1%; p < 0.001), E (17.7–50%; p = 0.003), and F (50–79.2%; p = 0.001). We observed no association between Bundle utilization and MV duration, PICU LOS, or delirium incidence. In contrast, on adjusted analysis, every 10% increase in subject-specific utilization correlated with mortality odds ratio (OR) reduction of 34%, p < 0.001; every 10% increase in day-specific utilization correlated with a mortality OR reduction of 1.4% ( p = 0.006). CONCLUSIONS: ABCDEF Bundle is applicable to children. Although enhanced Bundle utilization correlated with decreased mortality, increased utilization did not correlate with duration of MV, PICU LOS, or delirium incidence. Additional research in the domains of comparative effectiveness, implementation science, and human factors engineering is required to understand this clinical inconsistency and optimize PICU Liberation concept integration into clinical practice.
Association of Early Steroid Administration With Outcomes of Children Hospitalized for COVID-19 Without Multisystem Inflammatory Syndrome in Children
Nadiger, Meghana , McGarvey, Jeremy , Harthan, Aaron A. , Lombardo, Mónica, Perkins, Nicholas , Sayed, Imran A., Bhalala, Utpal , Raju, Umamaheswara, Miller, Aaron S., Boman, Karen , Arteaga, Grace M. , Bansal, Vikas , Tekin, Aysun , Kumar, Vishakha K. , Group, Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator, Kovačević, Tanja , Markić, Joško , Ardalic, Tatjana Capitovic , Polić, Branka , Ivić, Ivo, Carev, Dominko , Glavinić, Robert, Vadgaonkar, Girish, Ediga, Rekha, Basety, Shilpa, Dammareddy, Shwetha, Kasumalla, Phani Sreeharsha, Manduva, Janaki, Kolakani, Naresh, Sripathi, Shreeja , Chaitanya, Sheetal, Papani, Sridhar, Kamuram, Mahesh, Mohan, Surapaneni Krishna, Jyothisree, Ekambaram, Petrolwala, Mukur, Ladva, Bharat, Kodate, Akira, Suzuki, Reina , Moriki, Koyo, Hassan-Hanga, Fatimah , Gezawa, Abubakar Shehu, Kabara, Halima M. S., Amole, Taiwo Gboluwaga , Kabir, Halima , Haliru, Dalha Gwarzo, Ibrahim, Abdullahi S., Asghar, Muhammad Sohaib , Syed, Mashaal , Naqvi, Syed Anosh Ali, Yasmin, Farah , Ahmed, Iftekhar , Ishaque, Sidra , Saleem, Ali Faisal , Alarifi, Mohammed I, Macarambon, Jara Mia, Bukhari, Ahmad Abdullah, Albahrani, Hussain A., Aldossary, Kaltham M., Malki, Walid, Kouzoukas, Brenna, Jacobs, Nekaiya, Ganbote, Tejashree, Valentine, Beryl, Sreerama, Pavan, Havalad, Vinod, Barry, Suzanne, Woll, Christopher , Wu, Gregory F. , Carrole, Erin, Burke, Kathryn , Irby, Katherine , Sanders, Ronald C., Hefley, Glenda, Christie, Amy B. , Adiga, Rajani, Campbell, Beth Salvagio , Wilson, Cathleen, Rivers, Patrick , Brinks, Jonathan, Mongoh, Mokenge Ndiva, Gilson, Boris, Danesh, Valerie , Dubrocq, Gueorgui , Davis, Amber, Hammers, Marissa J, McGahey, Ill M, Farris, Amanda C., Priest, Elisa L. , Korsmo, Robyn, Fares, Lorie, Skiles, Kathy, Shor, Susan M, Burns, Kenya, Dowell, Corrie A., Gonzales, Gabriela “ Hope”, Flores, Melody, Newman, Lindsay, Wilk, Debora A., Ettlinger, Jason, Bomar, Jaccallene, Darji, Himani, Arroliga, Alejandro C. , Khandhar, Paras B., Kring, Elizabeth, Anderson, Edwin L., Nagy, Rosemary, Inja, Ravali R., Nawathe, Pooja , Tsing, Jennifer, Carr, Karen, Chaudhary, Anila , Guglielmino, Kathleen, Strom, Larisa, Chiotos, Kathleen, Lee, Giyoung , Burnett, Ryan H., Sydney, Guy I. , Traynor, Danielle M., Ahmed, Farzin, Deonarine, Christopher, Jones, Ashley, Shaikh, Mohammad-Ali , Preston, David A. , Chin, Jeanette, Milligan, Patrick S., Koglin, Joy M., Gibson, Regina, Johnson, Lana, Preston, Felicia, Scott, Crimson, Nungester, Bethany, Menter, Sarah, Wasilewski, A., Kaul, Viren , Austin, Praise, Rogner, Jaimie, Russo, Anthony J. , Ontai, Sidney , Contreras, Brian, Obinwanko, Uzoma, Amamasi, Nneka, Sharafi, Amir, Kaufman, Margit, Lobel, G, Gandhi, Nisha, AbdelAty, Amr M. , Shaji, Elizabeth, Lim, Kiana, Marte, Juan M., Sosa, Dani Ashley, Roth, Prerana , Litwin, Alain H. , Pariyadath, Anand, Moschella, Phillip , Llano, Trayson, Salas, Alan, Daube, Ariel , Korn, Michelle, Rajagopalan, Logi, Santos, Laura Jurema dos , Crandall, Christine , Stojanovski, Sasko, Michienzi, Kelly, Amer, Marwa , Dahhan, Talal, Kseibi, Eiad, Butt, Abid, Khurshid, Syed Moazzum, Rabee, Muath, Abujazar, Mohammed, Alghunaim, Razan, Abualkhair, Maal, AlFirm, Abeer Turki, Oulds, Franscene, Nandavar, Akshay, Wen, Andy , DaCar, Allie, Reilkoff, Ronald A., Eichen, Sarah, Goertzen, Lexie, Rajala, Scott, Feussom, Ghislaine, Domecq, Juan Pablo , Sharma, Mayank , Qamar, Shahraz , Morales, Diana J. Valencia , Khan, Syed Anjum , Jain, Nitesh , Wang, Christine, Kotekal, Dhatri, Sendi, Prithvi , Aulakh, Bhagat , Bandy, Jennifer A., Kreps, Lisa M., Bollinger, Dawn R., Nadiger, Meghana, Schauf, Victoria, Rich, Deana, Anderson, Harry L., Rajkumar, Dixy, Abunayla, Ali, Heiter, Jerrilyn, Zaren, Howard A. , Smith, Stephanie J., Lewis, Grant C., Seames, Lauren, Farlow, Cheryl, Miller, Judy, Broadstreet, Gloria, Terrill, Cindy, Montgomery, Brock, Reyes, Sydney A, Reyes, Summer M, Plattner, Alex, Martinez, Anthony , Allison, Micheal, Mittal, Aniket, Ruíz, Rafael Azuar , Skaanland, Aleta, Amzuta, Ioana, Shah, Amish , Modi, Ritu, Al-Khalisy, Hassan, Masuta, Pardeep , Schafer, Melissa , Wratney, Angela, Jones, Tracy L., Ayers, Shonda C., Harrell, Amy B., Brown, Brent R., Malone, Kassidy, Sinko, Lauren A, Hrarrell, Amy B, Settle, Lisa, Sears, Taylor J., Kuehne, Joshua, Garcia, Melinda, Beebe, Morgan, Herrera, Heather , Belden, Katherine A. , Baram, Michael , Weber, Devin , DePaola, Rosalie, Xia, Yuwei , Carter, Hudson, Tolley, A. E., Ferranti, Mary, House, Scott, Aldana, Isabella, Stulce, Casey , Chong, Grace , Ghavam, Ahmeneh , Baslanti, Tezcan Ozrazgat, Omalay, George, Hashemighouchani, Haleh , Cupka, Julie S , Hubbard, Janice, Nazir, Usman, Rampon, Garrett , Riggle, Jake, Dismang, Nathan, Sullivan, Janice, Morris, Sarah, Nason, Jennifer, Rahman, Rania Abdul, Mulrow, Mary, Gál, Tamás, Mahashabde, Manasi, Vagonis, Alexandra , Uber, Rebecca, Mahmud, Haseeb , Leightle, Stefan, Zhang, Zoe, Vissichelli, Nicole C. , O'Meara, A M Iqbal, Rocawich, Katie, Harris, Lynnette , Cusson, Bruce, Reeves, Brandon, Fanelli, Jessica, Disher, Nataya, Samant, Anusha, DeGroot, Chritian, Youshock, Evan, Ligon, R. Miller, McCartney, Katherine, Garcia, Julio, Iloabachie, Chidi, Flores, Kelsey, VanEenenaam, David P., Sands, Lauren , Sweatt, Nia, Fowler, Jacob , Fram, Madeline, Howard, Easton, Johnson, Kathleen N. , Udoh, Imoh, Nosow, Lillian, Howard, Lucy Winesett, Pham, Quan Duc Minh, Irfanullah, Aman, Ong, Tiffany, Enwezor, Chukwunyelu Henry, Dabagian, Hannah, Bansal, Vikas , Asghar, Muhammad S , Tekin, Aysun , Tripathi, Sandeep , Lombardo, Monica, Gharpure, Varsha , Chiotos, Kathleen , Bjornstad, Erica C. , Dapul, Heda , Montgomery, Vicki , Deo, Neha , Gajic, Ognjen , Kashyap, Rahul , Walkey, Allan J. , Group, Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator, Itagaki, Yuki , Galadanci, Hadiza , Kabara, Halima Salisu, Syed, Mashaal, Almazyad, Mohammed , Asfina, Kazi Nur , Cooper, Paul R. , Burke, Kathryn, Mohammed, Mustafa, Ashley, Dennis W. , Mosier, Jarrod , Lutrick, Karen , Dubrocq, Gueorgui , Nagy, Rosemary, Inja, Ravali R., Pedraza, Isabel , Carr, Karen, Gist, Katja M. , Chiotos, Kathleen, Blatz, Allison M. , Cheruku, Sreekanth , Preston, David, Gupta, Sandeep , Abdelaty, Amr, Rennert, Lior , Ramírez, Michelle , Verma, Sourabh , Stojanovski, Sasko D., Johnson, Kristin, Bawazeer, Mohammed Abdullah , Gupta, Manoj , Heneghan, Julia A. , Tang, Ben, Lal, Amos , O’Horo, John C. , Singh, Romil , Koritala, Thoyaja , Tarabichi, Yasir , Perzynski, Adam T. , Wang, Christine, Totapally, Balagangadhar , Nadiger, Meghana, Wall, Chris, Menon, Shina , McGuire, John K. , Anderson, Harry L., Miller, Judy, Lin, John C. H. , Montgomery, Brock, Ruiz, Rafael, Ross, Robert, Gupta, Neha , Brown, Brent , Tolley, Aaron, Tofil, Nancy M. , Mayampurath, Anoop , Bihorac, Azra , Ruppert, Matthew M. , McGonagill, Patrick W. , Galet, Colette , Wang, David , Allan, Lauren , Badheka, Aditya V. , Chegondi, Madhuradhar , Sullivan, Janice, Nason, Jennifer, Akhter, Murtaza , Kashiouris, Markos , Gal, Tamas, Karam, Oliver , Carvalho, Heloisa De, Khanna, Ashish K. , Garcia, Julio, Robinson, Samuel, Enwezor, Chukwunyelu Henry , Mendoza, Rafael
JAMA Pediatrics | October 3, 2022 | Volume: 176 | Issue: 12 | Pages: 1208
10.1001/jamapediatrics.2022.3611
ImportanceThere is limited evidence for therapeutic options for pediatric COVID-19 outside of multisystem inflammatory syndrome in children (MIS-C).ObjectiveTo determine whether the use of steroids within 2 days of admission for non–MIS-C COVID-19 in children is associated with hospital length of stay (LOS). The secondary objective was to determine their association with intensive care unit (ICU) LOS, inflammation, and fever defervescence.Design, Setting, and ParticipantsThis cohort study analyzed data retrospectively for children (&lt;18 years) who required hospitalization for non–MIS-C COVID-19. Data from March 2020 through September 2021 were provided by 58 hospitals in 7 countries who participate in the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 registry.ExposureAdministration of steroids within 2 days of admission.Main Outcomes and MeasuresLength of stay in the hospital and ICU. Adjustment for confounders was done by mixed linear regression and propensity score matching.ResultsA total of 1163 patients met inclusion criteria and had a median (IQR) age of 7 years (0.9-14.3). Almost half of all patients (601/1163, 51.7%) were male, 33.8% (392/1163) were non-Hispanic White, and 27.9% (324/1163) were Hispanic. Of the study population, 184 patients (15.8%) received steroids within 2 days of admission, and 979 (84.2%) did not receive steroids within the first 2 days. Among 1163 patients, 658 (56.5%) required respiratory support during hospitalization. Overall, patients in the steroids group were older and had greater severity of illness, and a larger proportion required respiratory and vasoactive support. On multivariable linear regression, after controlling for treatment with remdesivir within 2 days, country, race and ethnicity, obesity and comorbidity, number of abnormal inflammatory mediators, age, bacterial or viral coinfection, and disease severity according to ICU admission within first 2 days or World Health Organization ordinal scale of 4 or higher on admission, with a random intercept for the site, early steroid treatment was not significantly associated with hospital LOS (exponentiated coefficient, 0.94; 95% CI, 0.81-1.09; P = .42). Separate analyses for patients with an LOS of 2 days or longer (n = 729), those receiving respiratory support at admission (n = 286), and propensity score–matched patients also showed no significant association between steroids and LOS. Early steroid treatment was not associated with ICU LOS, fever defervescence by day 3, or normalization of inflammatory mediators.Conclusions and RelevanceSteroid treatment within 2 days of hospital admission in a heterogeneous cohort of pediatric patients hospitalized for COVID-19 without MIS-C did not have a statistically significant association with hospital LOS.