A5060436181- Respiratory Support and Mechanisms
- Sepsis Diagnosis and Treatment
- Neonatal Respiratory Health Research
- Cardiac Arrest and Resuscitation
- Mechanical Circulatory Support Devices
- Intensive Care Unit Cognitive Disorders
- Respiratory viral infections research
- Congenital Heart Disease Studies
- Pneumonia and Respiratory Infections
- Childhood Cancer Survivors' Quality of Life
- Family and Patient Care in Intensive Care Units
- Hemodynamic Monitoring and Therapy
- Infant Development and Preterm Care
- Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Cardiac, Anesthesia and Surgical Outcomes
- Blood Coagulation and Thrombosis Mechanisms
- Transplantation: Methods and Outcomes
- Chronic Obstructive Pulmonary Disease (COPD) Research
- Diabetes Management and Research
- Renal function and acid-base balance
- Pulmonary Hypertension Research and Treatments
- Disaster Response and Management
- Influenza Virus Research Studies
- Tracheal and airway disorders
- Traumatic Brain Injury and Neurovascular Disturbances
University of California, Los Angeles
2016-2025
Mattel Children's Hospital
2016-2025
Ronald Reagan UCLA Medical Center
2016-2023
UCLA Medical Center
2016-2023
University of Southern California
2018-2023
Children's Hospital of Los Angeles
2017-2023
UCLA Health
2018-2022
ORCID
2021
University of California System
2013-2020
Queen's University
2020
We sought to update our 2015 work in the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) guidelines for diagnosis and management of pediatric acute respiratory distress syndrome (PARDS), considering new evidence topic areas that were not previously addressed.International consensus conference series involving 52 multidisciplinary international content experts PARDS four methodology from 15 countries, using methodology, implementation science.Not applicable.Patients with or...
In the Fluid and Catheter Treatment Trial (NCT00281268), adults with acute lung injury randomized to a conservative vs. liberal fluid management protocol had increased days alive free of mechanical ventilator support (ventilator-free days). Recruiting sufficient children into pediatric trial is challenging. A Bayesian statistical approach relies on adult for priori effect estimate, requiring fewer patients. Preparing mirroring Trial, we aimed to: 1) identify an inverse association between...
On the basis of laboratory cardiopulmonary resuscitation (CPR) investigations and limited adult data demonstrating that survival depends on attaining adequate arterial diastolic blood pressure (DBP) during CPR, American Heart Association recommends using to guide pediatric CPR. However, evidence-based targets CPR remain an important knowledge gap for guidelines.
Objectives: The prevalence of septic acute kidney injury and impact on functional status PICU survivors are unknown. We used data from an international prospective severe sepsis study to elucidate outcomes children suffering injury. Design: Secondary analysis patients in the Sepsis PRevalence, OUtcomes, Therapies point study: was defined day using Kidney Disease Improving Global Outcomes definitions. Patients with no or stage 1 (“no/mild injury”) were compared those 2 3 (“severe injury”)....
Despite improved diagnostics, pulmonary pathogens in immunocompromised children frequently evade detection, leading to significant mortality. Therefore, we aimed develop a highly sensitive metagenomic next-generation sequencing (mNGS) assay capable of evaluating the microbiome and identifying diverse lungs children.We collected 41 lower respiratory specimens from 34 undergoing evaluation for disease at 3 children's hospitals 2014-2016. Samples underwent mechanical homogenization, parallel...
Objectives: In-hospital pediatric sepsis mortality has decreased substantially, but long-term and morbidity among children initially surviving sepsis, is unknown. Accordingly, the Life After Pediatric Sepsis Evaluation investigation was conducted to describe trajectory of health-related quality life for encountering community-acquired septic shock. Design: Prospective, cohort-outcome study, 2013–2017. Setting: Twelve academic PICUs in United States. Patients: Critically ill children, 1 month...
The unique characteristics of pulmonary circulation and alveolar-epithelial capillary-endothelial barrier allow for maintenance the air-filled, fluid-free status alveoli essential facilitating gas exchange, maintaining alveolar stability, defending lung against inhaled pathogens. hallmark pathophysiology in acute respiratory distress syndrome is loss capillary permeability presence protein-rich edema fluid alveoli. This alteration accumulation accompanies damage to epithelium vascular...
A companion article reports the trajectory of long-term mortality and significant health-related quality life disability among children encountering septic shock. In this article, investigators examine critical illness factors associated with these adverse outcomes.Prospective, cohort-outcome study, conducted 2013-2017.Twelve United States academic PICUs.Critically ill children, 1 month to 18 years, community-acquired shock requiring vasoactive-inotropic support.Illness severity, organ...
To describe the trajectory of respiratory failure in COVID-19 and explore factors associated with risk invasive mechanical ventilation (IMV).A retrospective, observational cohort study 112 inpatient adults diagnosed between March 12 April 16, 2020. Data were manually extracted from electronic medical records. Multivariable Univariable regression used to evaluate association baseline characteristics, initial serum markers outcome IMV.Our had median age 61 (IQR 45-74) was 66% male. In-hospital...
Approximately 40% of children who experience an in-hospital cardiac arrest survive to hospital discharge. Achieving threshold intra-arrest diastolic blood pressure (BP) targets during cardiopulmonary resuscitation (CPR) and systolic BP after the return circulation may be associated with improved outcomes.To evaluate effectiveness a bundled intervention comprising physiologically focused CPR training at point care structured clinical event debriefings.A parallel, hybrid stepped-wedge, cluster...
Lower respiratory tract infections (LRTI) are a leading cause of critical illness and mortality in mechanically ventilated children; however, the pathogenic microbes frequently remain unknown. We combined traditional diagnostics with metagenomic next generation sequencing (mNGS) to evaluate LRTI critically ill children.We conducted prospective, multicentre cohort study children aged 31 days 17 years failure requiring mechanical ventilation (>72 h) USA. By combining bacterial culture upper...
Angiopoietin-2 (Ang-2) is a key mediator of pulmonary vascular permeability. This study tested the association between plasma Ang-2 and mortality in pediatric acute respiratory distress syndrome (ARDS), with stratification for prior hematopoietic cellular transplantation (HCT), given severe, yet poorly understood, ARDS phenotype this subgroup. We enrolled 259 children <18 years age ARDS; 25 had HCT. Plasma Ang-2, von Willebrand Factor antigen (vWF), endothelial growth factor (VEGF) were...
Over 2,500 children undergo hematopoietic stem cell transplantation in the United States each year, and up to 35% require PICU support for life-threatening complications. mortality has dropped from 85% 44%, but interpretation is confounded by significant cohort heterogeneity. Reports conflict regarding outcomes patients with different underlying indications, burden of infectious complications these not been evaluated. We aim describe infections, critical care interventions, pediatric...
Objectives: More children are surviving critical illness but at risk of residual or new health conditions. An evidence-informed and stakeholder-recommended core outcome set is lacking for pediatric care outcomes. Our objective was to create a multinational, multistakeholder-recommended inclusion in clinical research programs. Design: A two-round modified Delphi electronic survey conducted with 333 invited research, clinical, family/advocate stakeholders. Stakeholders completing the first...
Interferon-induced transmembrane protein 3 (IFITM3) restricts endocytic fusion of influenza virus. IFITM3 rs12252_C, a putative alternate splice site, has been associated with severity in adults. not evaluated pediatric influenza. The Pediatric Influenza (PICFLU) study enrolled children suspected infection across 38 intensive care units during November 2008 to April 2016. was sequenced patients and parents were genotyped for specific variants family-based association testing. rs12252 54...
Abstract Background Epinephrine is provided during cardiopulmonary resuscitation (CPR) to increase systemic vascular resistance and generate higher diastolic blood pressure (DBP) improve coronary perfusion attain return of spontaneous circulation (ROSC). The DBP response epinephrine pediatric CPR its association with outcomes have not been well described. Thus, the objective this study was measure between change in after administration ROSC. Methods This a prospective multicenter children...
Deposition of fibrin in the alveolar space is a hallmark acute lung injury (ALI). Plasminogen activator inhibitor-1 (PAI-1) an antifibrinolytic agent that activated during inflammation. Increased plasma and pulmonary edema fluid levels PAI-1 are associated with increased mortality adults ALI. This relationship has not been examined children. The objective this study was to test whether worse clinical outcomes pediatric patients ALI.We measured on first day ALI among 94 enrolled two separate...
Objectives: To determine the impact of patient-specific and disease-related characteristics on severity illness outcome in pediatric patients with acute respiratory distress syndrome intent guiding current medical practice identifying important areas for future research. Design: Electronic searches PubMed, EMBASE, Web Science, Cochrane, Scopus were conducted. References reviewed relevance features included following section. Settings: Not applicable. Subjects: PICU evidence lung injury,...
Objectives: Pediatric acute respiratory distress syndrome is heterogeneous, with a paucity of risk stratification tools to assist trial design. We aimed develop and validate mortality prediction models for patients pediatric syndrome. Design: Leveraging additional data collection from preplanned ancillary study (Version 1) the multinational Acute Respiratory Distress Incidence Epidemiology study, we identified predictors mortality. Separate were built entire Version 1 cohort, cohort...