Acute and Critical Care

Review Article

Nursing
Implementation of a partnership involving parents in the care of critically ill children: an integrative review: Tuti Seniwati, Nani Nurhaeni, Dessie Wanda; Acute Crit Care. 2025;40(4):521-537. Published online November 24, 2025; DOI: https://doi.org/10.4266/acc.001896

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Abstract PDF: The admission of a child to an intensive care unit, such as pediatric or neonatal intensive care units, serves as a significant stressor for parents. This condition is exacerbated when the child undergoes treatment in isolation from their parents. One strategy to address this challenge involves positioning parents at the bedside during the child’s care. This study aimed to identify and synthesize qualitative and quantitative research evidence on partnerships involving parents in the care of critically ill children. This research employed an integrative review method, and it was registered with the International Prospective Register of Systematic Reviews as a research-implementation protocol (ID no. CRD42023414924t). Six databases were searched for relevant literature, including ScienceDirect, Scopus, ProQuest, Sage Journals, PubMed, and Google Scholar. The evaluation of article quality used the 2018 version of the Mixed Methods Appraisal Tool, while content analysis was employed for data analysis. The results indicated that 18 articles fulfilled the inclusion requirements, out of the 5,435 articles found during the search phase. The analysis resulted in the discovery of three primary themes: partnership components, partnership outcomes and factors influencing partnerships. These three themes collectively constitute the conceptual model of partnerships in treating children with critical illness. It can be concluded that the active participation of parents in a child's critical care will yield positive outcomes for both the child and the parents. Existing empirical data underscore the significance of comprehending the factors influencing this specific situation.

Original Articles

Pediatrics
Low vitamin C concentrations and prognosis in critically ill children: Min Jung Kim, Yoon Hee Kim, Soo Yeon Kim, Jong Deok Kim, Mireu Park, Hamin Kim, Myung Hyun Sohn, Kyung Won Kim; Acute Crit Care. 2025;40(3):482-490. Published online August 29, 2025; DOI: https://doi.org/10.4266/acc.000975

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Background
The administration of high-dose vitamins has been focused on in critically ill patients as adjunctive therapy for life-threatening conditions. We evaluated the association between serum vitamin C concentrations and patient prognosis. Methods: We retrospectively reviewed and collected clinical and biochemical data, including thiamine and vitamin C levels, of patients admitted to the pediatric intensive care unit (PICU). Results: In total, 177 patients were admitted to the PICU during the study period, and 63 children were enrolled in this study. The most common reason for PICU admission was sepsis (33.3%). The median thiamine and vitamin C levels were 3.6 µg/dl (interquartile range [IQR], 2.9–4.5 µg/dl) and 2.84 µg/ml (IQR, 1.61–4.55 µg/ml), respectively. Thiamine deficiency was observed in 10 patients (15.9%), and 17 (27.0%) had vitamin C deficiency. There were no differences in the vitamin levels according to the reason for PICU admission. Vitamin C levels were affected by nutritional status. The length of stay in the PICU and duration of mechanical ventilation were longer in patients with vitamin C deficiency than in those without (P=0.035 and P=0.010, respectively). The serum delta neutrophil index and C-reactive protein and lactate levels increased in the vitamin C-deficient group (P=0.028 and P=0.039, respectively). There was a significant difference in Pediatric Index of Mortality 3 scores according to vitamin C levels but not in mortality directly. Conclusions: Vitamin C deficiency was associated with elevated inflammatory marker levels, increased mechanical ventilation durations, and PICU admission. Our results support the potential benefits of vitamin C administration in critically ill children.

Citations

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Clinical Characteristics and Outcomes of Pediatric Vitamin C Deficiency
Thanaporn Trangkanont, Maneerat Puwanant, Thirachit Chotsampancharoen
Nutrients.2025; 17(23): 3755. CrossRef

Pediatrics
Acute severe hepatitis in children following extrahepatic infection in South Korea: etiology, clinical course, and outcomes: Sanghoon Lee, Young Ok Kim, Seo-Hee Kim; Acute Crit Care. 2025;40(1):122-127. Published online February 28, 2025; DOI: https://doi.org/10.4266/acc.000600

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Abstract PDF

Background
Acute hepatitis can occur in association with systemic diseases outside the liver. Acute severe hepatitis with markedly elevated transaminase levels following extrahepatic infection has been reported in children. However, research on this condition remains limited. This study aimed to investigate its etiology, clinical course, and outcomes.
Methods
We retrospectively reviewed data from 2013 to 2020 for children under 12 years old with elevated liver enzymes following systemic infection. Acute severe hepatitis was defined as serum transaminase levels exceeding 1,000 IU/L in the absence of underlying liver disease. We analyzed hepatitis-associated pathogens, liver enzyme trends, and factors influencing recovery.
Results
A total of 39 patients were included in this study. The most common age group was 7–12 months (54.8%), and 53.8% were male. Respiratory infections were the most common (61.5%), followed by gastrointestinal infections (23.1%), meningitis (10.3%), and urinary tract infections (5.1%). The median peak alanine transaminase (ALT) level was 1,515.8±424.2 IU/L, with a median time to peak ALT of 4.2±2.3 days from symptom onset. ALT levels normalized within 21 days in 71.8% of patients and within 28 days in 94.9%. Younger age was associated with delayed ALT normalization, whereas hepatoprotective agent use was associated with faster normalization.
Conclusions
Acute severe hepatitis can develop following respiratory and other systemic infections. Younger children were more susceptible and had a more prolonged disease course.

Citations

Citations to this article as recorded by

Differentiating leptospirosis from Rickettsial diseases and Q fever: A syndrome-based study in Southern Taiwan
Shih-Hao Lo, Chung-Hao Huang, Tun-Chieh Chen, Chun-Yu Lin, Po-Liang Lu, Ko Chang
Tropical Doctor.2026;[Epub] CrossRef

Trauma
Predictive value of initial lactate levels for mortality and morbidity in critically ill pediatric trauma patients: a retrospective study from a Turkish pediatric intensive care unit: Abdulrahman Özel, Esra Nur İlbeği, Servet Yüce; Acute Crit Care. 2025;40(1):87-94. Published online February 18, 2025; DOI: https://doi.org/10.4266/acc.003528

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Abstract PDF

Background
This study investigated the relationship between initial lactate levels and both mortality and morbidity in critically ill pediatric trauma patients requiring intensive care.
Methods
This retrospective study at tertiary center’s pediatric intensive care unit from January 2020 to June 2024 aimed to characterize trauma patients and assess admission lactate levels' prognostic value.
Results
A total of 190 critically ill pediatric trauma patients were included in the study. The mortality rate was 7.9%, with most deaths occurring within the first 48 hours of admission. Initial lactate levels ≥6.9 mmol/L demonstrated moderate predictive power (area under the curve [AUC], 0.878) for mortality. Pediatric Risk of Mortality III (PRISM III) score showed good predictive ability (AUC, 0.922), while Pediatric Trauma Scores exhibited variable predictive performance (AUC, 0.863). Higher initial lactate levels were significantly associated with severe brain injury, the need for intubation, and an increased incidence of thoracic or abdominal injuries.
Conclusions
Initial lactate levels and PRISM III score are effective predictors of mortality in critically ill pediatric trauma patients. Lactate levels ≥5 mmol/L upon admission should prompt close monitoring and consideration of aggressive management strategies.

Citations

Citations to this article as recorded by

Beyond survival: Early markers of poor outcome in pediatric trauma
Kubra Boydag Guvenc, Ebru Guney Sahin, Idris Abdullah Yılmaz, Refik Ozturk, Ceyhan Sahin, Fatih Varol, Cansu Durak
The American Journal of Emergency Medicine.2026; 101: 103. CrossRef
PIM2, lactate, and trauma score to predict mortality in critically ill pediatric trauma patients
Luciana G. Barcellos, Fernanda M. Rubin, Ana Paula P. da Silva, Júlia L. Vieira, Luciane G. da Cunha, Lucinara V. Enéas Machado, Geniara da S. Conrado, Cristian T. Tonial
Jornal de Pediatria.2026; 102(2): 101509. CrossRef
Prognostic value of lactate-to-albumin ratio and inflammatory indices in pediatric traumatic brain injury: A comparative study with PRISM III
Özlem Bostan Gayret, Abdulrahman Özel, Servet Yüce, Harun Çatak, Selen Mandel Işikli, Meltem Erol
Medicine.2026; 105(8): e47689. CrossRef
Pediatric Trauma Score (PTS) combined with blood lactate measurement provides clinical treatment guidance and prognosis prediction for children with compound injuries: a prospective study
Wenbin Gao, Xianpu Song, Yuman Xing, Lili Liang, Yanhua Feng
European Journal of Pediatrics.2026;[Epub] CrossRef
Development and validation of a clinical nomogram for predicting 30-day in-hospital mortality in children with moderate-to-severe traumatic brain injury
Yi Zhong, Yuchen Liu, Mingyang Huang, Rongting Zhang, Ruxuan Zhou, Yongjun Xiang, Yuan Bin, Tianquan Yang, Yong Han, Min Chen, Hangzhou Wang
Frontiers in Pediatrics.2026;[Epub] CrossRef
Incidence, severity and outcomes of hypoxemia in paediatric emergencies seen at a tertiary hospital in Southern Nigeria
Moses T. Abiodun, Gabriel Oziegbe, Imuwahen A. Mbarie, Wilson O. Osarogiagbon, Collins E. Etin-Osa, Rosena O. Oluwafemi, Godwin E. Okungbowa, Ovonomo Ewhe, Rahmon Olusola, Benjamin Nandom, Adesuwa Kpongo-Ogieva, Jane Aghama, Cyril Oputa
International Journal of Contemporary Pediatrics.2025; 12(8): 1289. CrossRef
Prognostic value of the lactate dehydrogenase-to-albumin ratio for predicting mortality in critically ill pediatric patients: a retrospective cohort study
Ming Liu, Yunpeng Gou, Ping Yang
Frontiers in Pediatrics.2025;[Epub] CrossRef

Pediatrics
Hyper- and hypomagnesemia as an initial predictor of outcomes in septic pediatric patients in Egypt: Aya Osama Mohamed; Acute Crit Care. 2025;40(1):105-112. Published online February 4, 2025; DOI: https://doi.org/10.4266/acc.000480

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Abstract PDF: Background
Critically ill septic children are susceptible to electrolyte abnormalities, including magnesium disturbance, which can easily be neglected. This study examined the potential correlation between serum magnesium levels upon admission to the pediatric intensive care unit (PICU) and the outcomes of critically ill septic patients.
Methods
This prospective study, conducted from May 2023 to November 2023, included 76 children with sepsis who underwent clinical and lab assessments that included initial magnesium levels. The outcome of sepsis was documented. Predictors of mortality were identified through multivariate logistic regression models, with discrimination and calibration assessed using the area under the curve (AUC).
Results
The median magnesium level upon PICU admission was 2.0 mg/dl (range 1.1–4.9), and it was slightly higher in non-survivors than survivors (2.1 mg/dl; interquartile range [IQR], 1.9–2.5 vs. 2.0; IQR, 1.8–2.6, respectively), Hypermagnesemia was observed to have a negative effect on critically ill septic patients. It was also found that hypermagnesemia was associated with low C-reactive protein levels (P=0.043). With a cutoff of 5.5, the pediatric Sequential Organ Failure Assessment score strongly predicted mortality (AUC=0.717, P<0.001), with a sensitivity of 64.3% and specificity of 68.8%.
Conclusions
As an initial predictor of mortality, the serum magnesium level cannot be used alone; however, hypermagnesemia has a negative impact on critically ill septic patients. Thus, healthcare professionals should be cautious with magnesium administration.

Pediatrics
Post–intensive-care morbidity among pediatric patients in Thailand: prevalence, risk factors, and the importance of the post–intensive-care clinic: Chanapai Chaiyakulsil; Acute Crit Care. 2024;39(4):600-610. Published online November 18, 2024; DOI: https://doi.org/10.4266/acc.2024.01011

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Abstract PDF Supplementary Material: Background
Long-term survival data for critically ill children discharged to post-intensive care clinics are scarce, especially in Asia. The main objective of this study was to assess the prevalence of post–intensive-care morbidity among pediatric intensive care unit (PICU) survivors at 1 month and 1 year after hospital discharge and to identify the associated risk factors.
Methods
We conducted a retrospective chart review of all children aged 1 month to 15 years who were admitted to the PICU for >48 hours from July 2019 to July 2022 and visited a post–intensive-care clinic 1 month and 1 year after hospital discharge. Post-intensive care morbidity was defined using the Pediatric Cerebral Performance Category (PCPC). Descriptive statistics, univariate, and multivariate analyses were conducted.
Results
A total of 111 children visited the clinic at 1 month, and 100 of these children visited the clinic at 1 year. Only 39 of 111 children (35.2%) had normal PCPC assessments at 1 month, while 54 of 100 (54.0%) were normal at 1 year. Baseline developmental delays were significantly associated with any degree of disability and at least moderate disability at both time points. Mechanical ventilation for >7 days was associated with at least moderate disability at both time points, while PICU stay >7 days was significantly associated with moderate disability at 1 month and any degree of disability at 1 year.
Conclusions
A substantial percentage of PICU survivors had persistent disabilities even 1 year after critical illness. A structured multidisciplinary post–intensive-care follow-up plan is warranted to provide optimal care for such children.

Epidemiology
Prevalence of extracorporeal blood purification techniques in critically ill patients before and during the COVID-19 pandemic in Egypt: Aya Osama Mohammed, Hanaa I. Rady; Acute Crit Care. 2024;39(1):70-77. Published online February 1, 2024; DOI: https://doi.org/10.4266/acc.2023.00654

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Abstract PDF: Background
Extracorporeal blood-purification techniques are frequently needed in the pediatric intensive care unit (PICU), yet data on their clinical application are lacking. This study aims to review the indications, rate of application, clinical characteristics, complications, and outcomes of patients undergoing extracorporeal blood purification (i.e., by continuous renal replacement therapy [CRRT] or therapeutic plasma exchange [TPE]) in our PICU, including before the coronavirus disease 2019 (COVID-19) pandemic in 2019 and during the pandemic from 2020 to 2022.
Methods
This study included children admitted for extracorporeal blood-purification therapy in the PICU. The indications for TPE were analyzed and compared to the American Society for Apheresis categories.
Results
In 82 children, 380 TPE sessions and 37 CRRT sessions were carried out children, with 65 patients (79%) receiving TPE, 17 (20.7%) receiving CRRT, and four (4.8%) receiving both therapies. The most common indications for TPE were neurological diseases (39/82, 47.5%), followed by hematological diseases (18/82, 21.9%). CRRT was mainly performed for patients suffering from acute kidney injury. Patients with neurological diseases received the greatest number of TPE sessions (295, 77.6%). Also, the year 2022 contained the greatest number of patients receiving extracorporeal blood-purification therapy (either CRRT or TPE).
Conclusions
The use of extracorporeal blood-purification techniques increased from 2019 through 2022 due to mainly autoimmune dysregulation among affected patients. TPE can be safely used in an experienced PICU. No serious adverse events were observed in the patients that received TPE, and overall survival over the 4 years was 86.5%.

Epidemiology
Implementation and effectiveness of a delirium care protocol in Thai critically ill children: Chanapai Chaiyakulsil, Thananya Thadahirunchot; Acute Crit Care. 2023;38(4):488-497. Published online November 28, 2023; DOI: https://doi.org/10.4266/acc.2023.00045

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Abstract PDF

Background
Delirium in critically ill children can result in long-term morbidity. Our main objectives were to evaluate the effectiveness of a new protocol on the reduction, prevalence, and duration of delirium and to identify associated risk factors.
Methods
The effectiveness of the protocol was evaluated by a chart review in all critically ill children aged 1 month to 15 years during the study period. A Cornell Assessment of Pediatric Delirium score ≥9 was considered positive for delirium. Data on delirium prevalence and duration from the pre-implementation and post-implementation phases were compared. Univariate and multivariate analyses were used to identify the risk factors of delirium.
Results
A total of 120 children was analyzed (58 children in the pre-implementation group and 62 children in the post-implementation group). Fifty children (41.7%) screened positive for delirium. Age less than 2 years, delayed development, use of mechanical ventilation, and pediatric intensive care unit (PICU) stay >7 days were significantly associated with delirium. The proportion of children screened positive was not significantly different after the implementation (before, 39.7% vs. after, 43.5%; P=0.713). Subgroup analyses revealed a significant reduction in the duration of delirium in children with admission diagnosis of cardiovascular problems and after cardiothoracic surgery.
Conclusions
The newly implemented protocol was able to reduce the duration of delirium in children with admission diagnosis of cardiovascular problems and after cardiothoracic surgery. More studies should be conducted to reduce delirium to prevent long-term morbidity after PICU discharge.

Citations

Citations to this article as recorded by

Risk Factors for Delirium in Pediatric Intensive Care Units: A Systematic Review and Meta-Analysis
Zhiwen Zhang, Peng Zhou
Pediatric Neurology.2026; 180: 146. CrossRef
Pediatric Delirium in Pediatric Intensive Care Setting: A Review of Recognition and Prevalence
Patricia Savrimuthu, Putri Yubbu
Malaysian Journal of Paediatrics and Child Health.2025; 31(1): 33. CrossRef
Non-pharmacological interventions for delirium in critically ill children: a scoping review
Max Zilezinski, Natascha-Elisabeth Denninger, Antje Tannen, Jan Kottner
BMJ Open.2025; 15(9): e094529. CrossRef
The growing significance of delirium in children
Roberta Esteves Vieira de Castro, Yu Kawai, Alexandria Barry, Dickey Catherine Fuchs, Elizabeth Engstrom, Kristina A. Betters, Heidi A. B. Smith
Critical Care Science.2025;[Epub] CrossRef

Pediatric
Impact of the COVID-19 pandemic on diabetic ketoacidosis management in the pediatric intensive care unit: Fevzi Kahveci, Buse Önen Ocak, Emrah Gün, Anar Gurbanov, Hacer Uçmak, Ayşen Durak Aslan, Ayşegül Ceran, Hasan Özen, Burak Balaban, Edin Botan, Zeynep Şıklar, Merih Berberoğlu, Tanıl Kendirli; Acute Crit Care. 2023;38(3):371-379. Published online August 31, 2023; DOI: https://doi.org/10.4266/acc.2023.00038

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Abstract PDF

Background
Diabetic ketoacidosis (DKA) is a common endocrine emergency in pediatric patients. Early presentation to health facilities, diagnosis, and good management in the pediatric intensive care unit (PICU) are crucial for better outcomes in children with DKA.
Methods
This was a single-center, retrospective cohort study conducted between February 2015 and January 2022. Patients with DKA were divided into two groups according to pandemic status and diabetes diagnosis.
Results
The study enrolled 59 patients, and their mean age was 11±5 years. Forty (68%) had newly diagnosed type 1 diabetes mellitus (T1DM), and 61% received follow-up in the pre-pandemic period. Blood glucose, blood ketone, potassium, phosphorus, and creatinine levels were significantly higher in the new-onset T1DM group compared with the previously diagnosed group (P=0.01, P=0.02, P<0.001, P=0.01, and P=0.08, respectively). In patients with newly diagnosed T1DM, length of PICU stays were longer than in those with previously diagnosed T1DM (28.5±8.9 vs. 17.3±6.7 hours, P<0.001). The pandemic group was compared with pre-pandemic group, there was a statistically significant difference in laboratory parameters of pH, HCO3, and lactate and also Pediatric Risk of Mortality (PRISM) III score. All patients survived, and there were no neurologic sequelae.
Conclusions
Patients admitted during the pandemic period were admitted with more severe DKA and had higher PRISM III scores. During the pandemic period, there was an increase in the incidence of DKA in the participating center compared to that before the pandemic.

Citations

Citations to this article as recorded by

Covid 19 and diabetes in children: advances and strategies
Zhaoyuan Wu, Jinling Wang, Rahim Ullah, Minghao Chen, Ke Huang, Guanping Dong, Junfen Fu
Diabetology & Metabolic Syndrome.2024;[Epub] CrossRef
Impact of the COVID-19 Pandemic on Diabetic Ketoacidosis Patients Treated in a Pediatric Intensive Care Unit: A Single-Center Cross-Sectional Study
Eva Perak, Dina Mrcela, Josko Markic
Medicina.2024; 60(11): 1775. CrossRef

Epidemiology
Characteristics and timing of mortality in children dying in pediatric intensive care: a 5-year experience: Edin Botan, Emrah Gün, Emine Kübra Şden, Cansu Yöndem, Anar Gurbanov, Burak Balaban, Fevzi Kahveci, Hasan Özen, Hacer Uçmak, Ali Genco Gençay, Tanil Kendirli; Acute Crit Care. 2022;37(4):644-653. Published online November 11, 2022; DOI: https://doi.org/10.4266/acc.2022.00395

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Abstract PDF

Background
Pediatric intensive care units (PICUs), where children with critical illnesses are treated, require considerable manpower and technological infrastructure in order to keep children alive and free from sequelae.
Methods
In this retrospective comparative cohort study, hospital records of patients aged 1 month to 18 years who died in the study PICU between January 2015 and December 2019 were reviewed.
Results
A total of 2,781 critically ill children were admitted to the PICU. The mean±standard deviation age of 254 nonsurvivors was 64.34±69.48 months. The mean PICU length of stay was 17 days (range, 1–205 days), with 40 children dying early (<1 day of PICU admission). The majority of nonsurvivors (83.9%) had comorbid illnesses. Children with early mortality were more likely to have neurological findings (62.5%), hypotension (82.5%), oliguria (47.5%), acidosis (92.5%), coagulopathy (30.0%), and cardiac arrest (45.0%) and less likely to have terminal illnesses (52.5%) and chronic illnesses (75.6%). Children who died early had a higher mean age (81.8 months) and Pediatric Risk of Mortality (PRISM) III score (37). In children who died early, the first three signs during ICU admission were hypoglycemia in 68.5%, neurological symptoms in 43.5%, and acidosis in 78.3%. Sixty-seven patients needed continuous renal replacement therapy, 51 required extracorporeal membrane oxygenation support, and 10 underwent extracorporeal cardiopulmonary resuscitation.
Conclusions
We found that rates of neurological findings, hypotension, oliguria, acidosis, coagulation disorder, and cardiac arrest and PRISM III scores were higher in children who died early compared to those who died later.

Citations

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Being broken: A qualitative study exploring unexpected death in the Paediatric Intensive Care Unit and the family experience of care
Arielle Jolly, Ashleigh E. Butler, Simon Erickson, Kristen Gibbons, Kylie Davies, Nick Williams, Yetunde Odutolu, Jacqueline Reid, Kelly Higgins, Linda Thomas, Fenella J. Gill
Australian Critical Care.2026; 39(1): 101515. CrossRef
The Application of Scoring Systems in Pediatric Intensive Care Unit for Onco-Hematological Patients Who Have Not Undergone Stem Cell Transplantation: A Cross-Sectional Study
Shereen Abdelmonem Mohamed Mohamed, Hanaa Ibrahim Abdel Fattah Rady, Eman Hany Ahmed Elsebaie, Rana Saber Bastawy Mahmoud
Indian Journal of Medical and Paediatric Oncology.2026;[Epub] CrossRef
Predictors of Mortality Among Pediatric Patients Admitted to Intensive Care Units in Eastern Amhara, Ethiopia: A Prospective Multi-Center Cohort Study
Abel Temeche Kassaw, Eliyas Addisu Taye, Desalegn Addis Mussie, Getachew Yitayew Tarekegn, Samuel Berihun Dagnew, Tigabu Eskeziya Zerihun
Sage Open Pediatrics.2026;[Epub] CrossRef
Mortality in children and adolescents with autoimmune inflammatory rheumatic diseases admitted to the pediatric intensive care unit
Tinnapat Buranapattama, Suwannee Phumeetham, Nuntawan Piyaphanee, Maynart Sukharomana, Sirirat Charuvanij
Pediatric Rheumatology.2025;[Epub] CrossRef
Mortality Pattern and Risk Factors in Pediatric ICU: A Retrospective Study at Mukalla Maternal and Childhood Hospital in Yemen (2021–2024)
Haifa Ali BinDahman
Journal of Epidemiology and Global Health.2025;[Epub] CrossRef
Parents’ and nurses’ experiences of end-of-life care in intensive care for children: A systematic review
Melissa J. Bloomer, Ashleigh E. Butler, Laura A. Brooks, Alysia Coventry, Stephen McKeever, Kristen Ranse, Jessie Rowe, Shontelle Thomas, Rebecca Thornton
Australian Critical Care.2025; 38(6): 101455. CrossRef
Characteristics and Outcomes of Patients Admitted to a Tertiary Pediatric Intensive Care Unit in Western Black Sea Region of Turkey
Hamdi Metin, Akın Seçkin, Eylem Sevinç
Experimental and Applied Medical Science.2024; 5(4): 193. CrossRef
Association between phosphate and 30-day in-hospital mortality in paediatric ICU: a retrospective cohort study
Yiyi Ding, Yaqin Lei, Yufang Zhu, Hongwei Zhang, Yunbin Xiao
BMJ Paediatrics Open.2024; 8(1): e003171. CrossRef
Descriptive and Clinical Characteristics of Nonsurvivors in a Tertiary Pediatric Intensive Care Unit in Turkey: 6 Years of Experience
Zeynep Karakaya, Merve Boyraz, Seyma Koksal Atis, Servet Yuce, Muhterem Duyu
Journal of Pediatric Intensive Care.2023;[Epub] CrossRef
Association between mortality and critical events within 48 hours of transfer to the pediatric intensive care unit
Huan Liang, Kyle A. Carey, Priti Jani, Emily R. Gilbert, Majid Afshar, L. Nelson Sanchez-Pinto, Matthew M. Churpek, Anoop Mayampurath
Frontiers in Pediatrics.2023;[Epub] CrossRef

Epidemiology
Incidence and associated factors of pediatric post-intensive care syndrome using the VSCAREMD model: Paweethida Tippayawong, Chanapai Chaiyakulsil; Acute Crit Care. 2022;37(4):627-635. Published online October 19, 2022; DOI: https://doi.org/10.4266/acc.2022.00234

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Abstract PDF

Background
The VSCAREMD model is used for evaluating vaccination, sleep, and parental care burden, which includes daily activity and social interaction, rehabilitation requirements, hearing, mood, and development. It has been proposed to detect post-intensive care syndrome (PICS) in children. This study aimed to outline the incidence of PICS in children using the VSCAREMD model and to describe the associated factors.
Methods
All children ages 1 month to 15 years and admitted to the intensive care unit for at least 48 hours were evaluated using the VSCAREMD model within 1 week of intensive care discharge. Abnormal findings were assorted into four domains: physical, cognitive, mental, and social. Descriptive statistics were performed using chi-square, univariate, and multivariate analyses.
Results
A total of 78 of 95 children (82.1%) had at least one abnormal domain. Physical, cognitive, mental, and social morbidity were found in 64.2%, 26.3%, 13.7%, and 38.9% of the children, respectively. Prolonged intensive care unit stay greater than 7 days was associated with dysfunction in physical (adjusted odds ratio [aOR], 3.80; 95% confidence interval [CI], 1.31–11.00), cognitive (aOR, 10.11; 95% CI, 3.01–33.89), and social domains (aOR, 5.01; 95% CI, 2.01–12.73). Underlying medical conditions were associated with cognitive (aOR, 13.63; 95% CI, 2.64– 70.26) and social morbidity (aOR, 2.81; 95% CI, 1.06–7.47).
Conclusions
The incidence of PICS using the VSCAREMD model was substantially high and associated with prolonged intensive care. This model could help evaluate PICS in children.

Citations

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Post-traumatic stress disorder in children after discharge from the pediatric intensive care unit: a scoping review
Maoting Tang, Ping Lei Chui, Mei Chan Chong, Xianliang Liu
European Child & Adolescent Psychiatry.2025; 34(2): 483. CrossRef
Post intensive care syndrome in paediatrics PICS-p: symptoms, severity and prevalence
Patrycja Krystyna Mazurek, Anna Aftyka
Pielegniarstwo XXI wieku / Nursing in the 21st Century.2025; 24(1): 83. CrossRef
Prevalence of Post-intensive care syndrome among intensive care unit-survivors and its association with intensive care unit length of stay: Systematic review and meta-analysis
Temesgen Ayenew, Menberu Gete, Mihretie Gedfew, Addisu Getie, Abebe Dilie Afenigus, Afework Edmealem, Haile Amha, Girma Alem, Bekele Getenet Tiruneh, Mengistu Abebe Messelu, Ramya Iyadurai
PLOS One.2025; 20(5): e0323311. CrossRef
Pain, Analgesia, Sedation, and the Developing Brain
Callie Marshall, Christopher McPherson
Pediatric Clinics of North America.2025; 72(5): 877. CrossRef
Post–intensive-care morbidity among pediatric patients in Thailand: prevalence, risk factors, and the importance of the post–intensive-care clinic
Chanapai Chaiyakulsil
Acute and Critical Care.2024; 39(4): 600. CrossRef

Epidemiology
Clinical implications of discrepancies in predicting pediatric mortality between Pediatric Index of Mortality 3 and Pediatric Logistic Organ Dysfunction-2: Eui Jun Lee, Bongjin Lee, You Sun Kim, Yu Hyeon Choi, Young Ho Kwak, June Dong Park; Acute Crit Care. 2022;37(3):454-461. Published online July 29, 2022; DOI: https://doi.org/10.4266/acc.2021.01480

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Abstract PDF

Background
Pediatric Index of Mortality 3 (PIM 3) and Pediatric Logistic Organ Dysfunction-2 (PELOD-2) are validated tools for predicting mortality in children. Research suggests that these tools may have different predictive performance depending on patient group characteristics. Therefore, we designed this study to identify the factors that make the mortality rates predicted by the tools different.
Methods
This retrospective study included patients (<18 years) who were admitted to a pediatric intensive care unit from July 2017 to May 2019. After defining the predicted mortality of PIM 3 minus the predicted mortality rate of PELOD-2 as “difference in mortality prediction,” the clinical characteristics significantly related to this were analyzed using multivariable regression analysis. Predictive performance was analyzed through the Hosmer-Lemeshow test and area under the receiver operating characteristic curve (AUROC).
Results
In total, 945 patients (median [interquartile range] age, 3.0 [0.0–8.0] years; girls, 44.7%) were analyzed. The Hosmer-Lemeshow test revealed AUROCs of 0.889 (χ2=10.187, P=0.313) and 0.731 (χ2=6.220, P=0.183) of PIM 3 and PELOD-2, respectively. Multivariable linear regression analysis revealed that oxygen saturation, partial pressure of CO2, base excess, platelet counts, and blood urea nitrogen levels were significant factors. Patient condition-related factors such as cardiac bypass surgery, seizures, cardiomyopathy or myocarditis, necrotizing enterocolitis, cardiac arrest, leukemia or lymphoma after the first induction, bone marrow transplantation, and liver failure were significantly related (P<0.001).
Conclusions
Both tools predicted observed mortality well; however, caution is needed in interpretation as they may show different prediction results in relation to specific clinical characteristics.

Citations

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Evaluation of cases hospitalised in paediatric intensive care and the factors affecting mortality due to acute myocarditis
Ulkem Kocoglu Barlas, Nihal Akcay, Mehmet Emin Menentoglu, Esra Sevketoglu, Demet Kangel, Ibrahim Cansaran Tanidir, Erkut Ozturk, Busra Ates, Leyla Telhan, Murat Kangin, Hazal Ceren Tugrul, Seher Erdogan, Emrullah Ayguler, Demet Demirkol, Eda Dilara Bay,
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Pediatric
Effects of the presence of a pediatric intensivist on treatment in the pediatric intensive care unit: Jung Eun Kwon, Da Eun Roh, Yeo Hyang Kim; Acute Crit Care. 2020;35(2):87-92. Published online May 12, 2020; DOI: https://doi.org/10.4266/acc.2019.00752

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Abstract PDF

Background
There are few studies on the effect of intensivist staffing in pediatric intensive care units (PICUs) in Korea. We aimed to evaluate the effect of pediatric intensivist staffing on treatment outcomes in a Korean hospital PICU.
Methods
We analyzed two time periods according to pediatric intensivist staffing: period 1, between November 2015 to January 2017 (no intensivist staffing, n=97) and period 2, between February 2017 to February 2018 (intensivists staffing, n=135).
Results
Median age at admission was 5.4 years (range, 0.7–10.3 years) in period 1 and 3.6 years (0.2–5.1 years) in period 2 (P=0.013). The bed occupancy rate decreased in period 2 (75%; 73%–88%) compared to period 1 (89%; 81%–94%; P=0.015). However, the monthly bed turnover rate increased in period 2 (2.2%; 1.9%–2.7%) compared to period 1 (1.5%, 1.1%– 1.7%; P=0.005). In both periods, patients with chronic neurologic illness were the most common. Patients with cardiovascular problems were more prevalent in period 2 than period 1 (P=0.008). Daytime admission occurred more frequently in period 2 than period 1 (63% vs. 39%, P<0.001). The length of PICU stay, parameters related with mechanical ventilation and tracheostomy, and pediatric Sequential Organ Failure Assessment score were not different between periods. Sudden cardiopulmonary resuscitations occurred in two cases during period 1, but no case occurred during period 2.
Conclusions
Pediatric intensivist staffing in the PICU may affect efficient ICU operations.

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Impact of medical crisis on the critical care system in South Korea
Ye Rim Chang, Jae Hwa Cho, Joongbum Cho, Tae Sun Ha, Bo Gun Kho, Eunhye Kim, Im-kyung Kim, Dong Hyun Lee, Suk-Kyung Hong
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The impact of pediatric intensivists on the management of pediatric diabetic ketoacidosis in pediatric intensive care units
Ah Young Choi, Esther Park
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Impact of staffing model conversion from a mandatory critical care consultation model to a closed unit model in the medical intensive care unit
Sung Jun Ko, Jaeyoung Cho, Sun Mi Choi, Young Sik Park, Chang-Hoon Lee, Chul-Gyu Yoo, Jinwoo Lee, Sang-Min Lee, Robert Jeenchen Chen
PLOS ONE.2021; 16(10): e0259092. CrossRef
Intensivists in the pediatric intensive care unit: conductors for better operational efficiency
June Dong Park
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Case Report

Neurology/Pulmonary
Extensive and Progressive Cerebral Infarction after Mycoplasma pneumoniae Infection: Yu Hyeon Choi, Hyung Joo Jeong, Bongjin Lee, Hong Yul An, Eui Jun Lee, June Dong Park; Korean J Crit Care Med. 2017;32(2):211-217. Published online December 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00283

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Acute cerebral infarctions are rare in children; however they can occur as a complication of a Mycoplasma pneumoniae (MP) infection due to direct invasion, vasculitis, or a hypercoagulable state. We report on the case of a 5-year-old boy who had an extensive stroke in multiple cerebrovascular territories 10 days after the diagnosis of MP infection. Based on the suspicion that the cerebral infarction was associated with a macrolide-resistant MP infection, the patient was treated with levofloxacin, methyl-prednisolone, intravenous immunoglobulin, and enoxaparin. Despite this medical management, cerebral vascular narrowing progressed and a decompressive craniectomy became necessary for the patient’s survival. According to laboratory tests, brain magnetic resonance imaging, and clinical manifestations, the cerebral infarction in this case appeared to be due to the combined effects of hypercoagulability and cytokine-induced vascular inflammation.

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Min-Su Oh
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Quan Luo, Na Lu, Xia Wan, Fang Zheng, Xingxing Feng, Yan Bai
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Was the occurrence of mycoplasma pneumoniae pneumonia combined with cerebral watershed infarction a coincidence?: A CARE compliant case series and literature review
Yuan-Yuan Wang, Jun-Ling Cui, Feng Mo, Ge-Fei Li
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Anthoula C. Tsolaki, Galaktion Konstantinidis, Stavroula Koukou, Fotini Michali, Despina Georgiadou, Thomas Tegos, Nikolaos D. Michalis
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Original Article

Hematology/Pediatric
Delta Neutrophil Index as a Prognostic Marker in the Pediatric Intensive Care Unit: In Suk Sol, Hyun Bin Park, Min Jung Kim, Seo Hee Yoon, Yoon Hee Kim, Kyung Won Kim, Myung Hyun Sohn, Kyu-Earn Kim; Korean J Crit Care Med. 2016;31(4):351-358. Published online November 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00171

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Abstract PDF

Background
The delta neutrophil index (DNI) is a useful marker for diagnosing and predicting the prognosis of sepsis. The purpose of this study was to investigate the usefulness of DNI as a prognostic marker in patients within the pediatric intensive care unit (PICU), as well as its association with other prognostic factors.
Methods
A total of 516 children admitted to Severance Children’s Hospital PICU from December 2009 to February 2015 were analyzed. DNI was measured on the day of PICU admission. Mortality was defined as death within 28 days following PICU admission.
Results
The median value of DNI was 1.2% (interquartile range [IQR] 0-4.3%) in the survivor group and 9.5% (IQR 2.3-20.8%) in the non-survivor group, and the difference was statistically significant (p < 0.001). DNI was significantly positively correlated with ICU scores such as Pediatric Index of Mortality 3 and Pediatric Risk of Mortality III, as well as with C-reactive protein and lactate levels. The area under the receiver operating characteristic curve of DNI for mortality was 0.748 (95% CI: 0.687-0.808) and the cut-off value was 4.95%.
Conclusions
The initial DNI level can be considered a useful indicator for predicting prognosis in PICU patients.

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Metin Yigit, Aslinur Ozkaya‐Parlakay, Naci Yilmaz, Ozhan Akyol, Belgin Gulhan, Saliha Kanik Yuksek, Basak Yalcin Burhan, Enes K Kilic, Cuneyt Karagol
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Scientific Reports.2020;[Epub] CrossRef

Case Report

Pyriform Sinus Perforation in a Child after Falling with a Spoon Handle in the Mouth: Joongbum Cho, Mi Ran Park, Jihyun Kim, Han Sin Jeong, Kangmo Ahn; Korean J Crit Care Med. 2013;28(3):214-217.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.214

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Abstract PDF: Pyriform sinus perforation is uncommon in children and most cases are secondary to iatrogenic causes such as endotracheal intubations. Due to this rarity, the management of these injuries is controversial. We report a case of pyriform sinus perforation in a 14-month-old boy who fell down with a spoon handle in the mouth and was successfully treated by transoral laryngomicrosurgery. Two hours after falling down, the patient had breathing difficulties and started vomiting. A chest X-ray showed subcutaneous emphysema and pneumomediastium. Esophagogram revealed leakage of contrast media at the hypopharynx. Although air leakage was reduced the next day, his fever became frequent even with conservative management of antibiotics. On the 4th hospital day, closure of pyriform sinus perforation was done by transoral laryngomicrosurgery. The patient became apyrexial by the 2nd post-operative day. On the 21th hospital day, the child was able to consume food orally without problems and was allowed to go home.

Original Articles

Usefulness of Thrombocytopenia and Changes in Platelet Counts as Prognostic Markers in Pediatric Intensive Care Units: Yoon Hee Kim, Hyun Bin Park, Min Jung Kim, Hwan Soo Kim, Hee Seon Lee, Yoon Ki Han, Kyung Won Kim, Myung Hyun Sohn, Kyu Earn Kim; Korean J Crit Care Med. 2013;28(2):93-100.; DOI: https://doi.org/10.4266/kjccm.2013.28.2.93

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Abstract PDF: BACKGROUND
Thrombocytopenia has been shown to be a useful predictor of mortality in adult intensive care units (ICUs). The aim of this study is to assess whether the level of platelet count at ICU admission and the changes in platelet counts can predict mortality in the pediatric ICU (PICU).
METHODS
Platelet counts were checked daily for at least 4 days in a total of 303 children who were admitted to the ICU. We compared the initial platelet counts and changes in platelet counts between survivors and non-survivors. A multivariable logistic regression model, a receiver operating characteristic curve and a linear mixed model were used.
RESULTS
The initial platelet count was significantly lower in non-survivors when compared to survivors. Multivariate analysis demonstrated that platelet count <120 x 10(9)/L (Odds ratio, 4.913; 95% confidence interval 2.451-9.851; p < 0.0001) was an independent predictor of mortality. In the case of children with thrombocytopenia (<120 x 10(9)/L) at admission to the ICU, the platelet counts increased serially in survivors, whereas non-survivors maintained their decreased platelet counts. In the case of children without thrombocytopenia, the platelet counts decreased most on day 3 in non-survivors.
CONCLUSIONS
At admission to the ICU, thrombocytopenia defined as a platelet count <120 x 10(9)/L can be a useful predictor of mortality in children. In children who had initial thrombocytopenia, the serial increase of platelet counts can be related to increased survival, whereas in children who did not have initial thrombocytopenia, more than a 10% decrease of platelet counts on day 3 can be related to mortality.

Low Blood Selenium Concentrations in Critically Ill Children with Systemic Inflammatory Response Syndrome and Respiratory Dysfunction: Young A Kim, Eun Ju Ha, Won Kyoung Jhang, Seong Jong Park; Korean J Crit Care Med. 2013;28(2):86-92.; DOI: https://doi.org/10.4266/kjccm.2013.28.2.86

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Abstract PDF: BACKGROUND
Selenium is an essential trace-element with antioxidant and immunological function. We studied the relationship between blood selenium concentrations, systemic inflammatory response syndrome (SIRS) and organ dysfunctions in critically ill children.
METHODS
This was a retrospective, observational study of the blood selenium concentrations of critically ill children at the time of a pediatric intensive care unit admission.
RESULTS
A total of 62 patients with a median age of 18 (5-180) months were included in this study. The mean of blood selenium concentration (microg/dl) was 8.49 +/- 2.42. The platelet count (r = -0.378) and PaCO2 (r = -0.403) showed negative correlations with blood selenium concentration, while PaO2/FiO2 (r = 0.359) and PaO2 (r = 0.355) showed positive correlations (p < 0.05, for all variables). Blood selenium concentrations were significantly lower in patients with SIRS than in those patients without SIRS (8.08 +/- 2.42 vs. 9.45 +/- 2.02, p = 0.011). Patients with severe sepsis and septic shock had showed significantly lower blood selenium concentrations than those without SIRS (7.03 +/- 2.73 vs. 9.45 +/- 2.02, p = 0.042). Patients with PaO2/FiO2 < or = 300 had lower blood selenium concentrations than those with PaO2/FiO2 > 300 (7.90 +/- 2.43 vs. 9.54 +/- 2.17, p = 0.018). Blood selenium concentrations were significantly lower in patient with PaO2/FiO2 < or = 200 than in those with PaO2/FiO2 > 300 (7.64 +/- 2.76 vs. 9.54 +/- 2.17, p = 0.018).
CONCLUSIONS
Patients with systemic inflammatory response syndrome or respiratory dysfunction showed significantly low blood selenium concentrations.

Case Report

Spontaneous Pneumomediastinum and Subcutaneous Emphysema in Children Infected with H1N1 Virus: A Case Report: Bo Geum Choi, Hye Jung Yun, Yeo Hyang Kim, Myung Chul Hyun; Korean J Crit Care Med. 2010;25(3):155-158.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.155

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Abstract PDF: Spontaneous pneumomediastinum (SPM) is a rare condition in children which is triggered by respiratory infection and inflammation, although it occurs most commonly in asthmatics. It is caused by alveolar rupture and dissection of air into the mediastinum and hilum, and the prognosis is usually benign. We report two cases of SPM and subcutaneous emphysema complicating pneumonia in children with severe H1N1 infection. The patients were admitted to the intensive care unit and treated with oxygen, inhalation of a bronchodilator, intravenous systemic corticosteroid (methyprednisolone, 2 mg/kg/day for 5 days) and antibiotics, together with antiviral therapy. On day 4 after admission, there was no further evidence of SPM. SPM associated with severe H1N1 infection in children resolves with aggressive supportive care, without progression to pneumothorax. We should remain aware of this air leak complication in children with severe respiratory infection.

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