A5081947887- Cardiac Arrest and Resuscitation
- Family and Patient Care in Intensive Care Units
- Respiratory Support and Mechanisms
- Sepsis Diagnosis and Treatment
- Palliative Care and End-of-Life Issues
- Childhood Cancer Survivors' Quality of Life
- Mechanical Circulatory Support Devices
- Neonatal Respiratory Health Research
- Grief, Bereavement, and Mental Health
- Infant Development and Preterm Care
- Emergency and Acute Care Studies
- Intensive Care Unit Cognitive Disorders
- Clinical Nutrition and Gastroenterology
- Airway Management and Intubation Techniques
- Trauma and Emergency Care Studies
- Respiratory viral infections research
- Ethics and Legal Issues in Pediatric Healthcare
- Renal function and acid-base balance
- Traumatic Brain Injury and Neurovascular Disturbances
- Cardiac, Anesthesia and Surgical Outcomes
- Thermal Regulation in Medicine
- Electrolyte and hormonal disorders
- Child Nutrition and Feeding Issues
- Traumatic Brain Injury Research
- Family and Disability Support Research
Children's Hospital of Michigan
2016-2025
Central Michigan University
2020-2025
Michigan United
2021-2024
Children's Hospital Colorado
2018-2023
University of Colorado Denver
2018-2023
University of California, San Francisco
2023
Wayne State University
2013-2022
University of Toronto
2021
University Health Network
2021
Sinai Health System
2021
The optimal hemoglobin threshold for erythrocyte transfusions in critically ill children is unknown. We hypothesized that a restrictive transfusion strategy of using packed red cells were leukocyte-reduced before storage would be as safe liberal strategy, judged by the outcome multiple-organ dysfunction.
Therapeutic hypothermia is recommended for comatose adults after witnessed out-of-hospital cardiac arrest, but data about this intervention in children are limited.We conducted trial of two targeted temperature interventions at 38 children's hospitals involving who remained unconscious arrest. Within 6 hours the return circulation, patients were older than 2 days and younger 18 years age randomly assigned to therapeutic (target temperature, 33.0°C) or normothermia 36.8°C). The primary...
The goal was to create a functional status outcome measure for large studies that is well defined, quantitative, rapid, reliable, minimally dependent on subjective assessments, and applicable hospitalized pediatric patients across wide range of ages inpatient environments.Functional Status Scale (FSS) domains functioning included mental status, sensory functioning, communication, motor feeding, respiratory categorized from normal (score = 1) very severe dysfunction 5). Adaptive Behavior...
Extracorporeal membrane oxygenation (ECMO) is used for respiratory and cardiac failure in children but complicated by bleeding thrombosis.(1) To measure the incidence of (blood loss requiring transfusion or intracranial hemorrhage) thrombosis during ECMO support; (2) to identify factors associated with these complications; (3) determine impact complications on patient outcome.This was a prospective, observational cohort study pediatric, cardiac, neonatal intensive care units eight hospitals,...
Objective: To investigate significant new morbidities associated with pediatric critical care. Design: Randomly selected, prospective cohort. Setting: PICU patients from eight medical and cardiac PICUs. Patients: This was a randomly cohort of Measurements Main Results: The main outcomes measures were hospital discharge functional status measured by Functional Status Scale scores morbidity defined as an increase in the more than or equal to 3. Of 5,017 patients, there 242 (4.8%), 99 deaths...
Targeted temperature management is recommended for comatose adults and children after out-of-hospital cardiac arrest; however, data on in-hospital arrest are limited.In a trial conducted at 37 children's hospitals, we compared two interventions in who had arrest. Within 6 hours the return of circulation, older than 48 younger 18 years age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or normothermia 36.8°C). The primary efficacy outcome, survival 12 months...
Severity of illness measures have long been used in pediatric critical care. The Pediatric Risk Mortality is a physiologically based score to quantify physiologic status, and when combined with other independent variables, it can compute expected mortality risk morbidity risk. Although the ranges for variables not changed, recent data collection improvements made adapt new practice patterns, minimize bias, reduce potential sources error. These include changing outcome hospital survival/death...
To determine the incidence of cardiopulmonary resuscitation in PICUs and subsequent outcomes.Multicenter prospective observational study children younger than 18 years old randomly selected intensively followed from PICU admission to hospital discharge Collaborative Pediatric Critical Care Research Network December 2011 April 2013.Among 10,078 enrolled, 139 (1.4%) received for more or equal 1 minute and/or defibrillation. Of these children, 78% attained return circulation, 45% survived...
Objective: Changes in technology and increased reports of successful extracorporeal life support use patient populations, such as influenza, cardiac arrest, adults, are leading to expansion support. Major limitations remain bleeding thrombosis. These complications the most frequent causes death morbidity. As a pilot project provide baseline data for detailed evaluation thrombosis current era, patients were analyzed from eight centers Eunice Kennedy Shriver National Institute Child Health...
Assessments of care including quality assessments adjusted for physiological status should include the development new morbidities as well mortalities. We hypothesized that morbidity, like mortality, is associated with dysfunction and could be predicted simultaneously mortality.Prospective cohort study from December 4, 2011, to April 7, 2013.General cardiac/cardiovascular PICUs at seven sites.Randomly selected PICU patients their first admission.None.Among 10,078 admissions, unadjusted...
Objectives: 1) To describe clinical characteristics, hospital courses, and outcomes of a cohort children cared for within the Pediatric Emergency Care Applied Research Network who experienced in-hospital cardiac arrest with sustained return circulation between July 1, 2003 December 31, 2004, 2) to identify factors associated mortality in this population. These data are required prepare randomized trial therapeutic hypothermia on neurobehavioral after arrest. Design: Retrospective study....
Objective: Communicating bad news about a child's illness is difficult task commonly faced by intensive care physicians. Greater understanding of parents' scope experiences with during their hospitalization will help physicians communicate more effectively. Our objective to describe perceptions conversations regarding terminal and death in the pediatric unit (PICU). Design: A secondary analysis qualitative interview study. Setting: Six children's hospitals National Institute Child Health...
Objective: Death is common in pediatric intensive care units. A child’s death can shatter parents’ personal identities, disrupt their relationships, and challenge worldviews. Spirituality a human characteristic that engenders transcendence; seeks meaning, purpose, connection to others; helps construct coherent worldview. Greater attention spiritual needs may help parents cope with loss. Our objective gain deeper understanding of during bereavement. Design: Prospective, qualitative study....
Objectives: To describe a large multicenter cohort of pediatric cardiac arrest (CA) with return circulation (ROC) from either the in-hospital (IH) or out-of-hospital (OH) setting and to determine whether significant differences related pre-event, event, early postarrest event characteristics, outcomes exist that would be critical in planning clinical trial therapeutic hypothermia (TH). Design: Retrospective study. Setting: Fifteen Pediatric Emergency Care Applied Research Network sites....
To describe a large cohort of children with out-of-hospital cardiac arrest return circulation and to identify factors in the early postarrest period associated survival. These objectives were for planning an interventional trial therapeutic hypothermia after pediatric arrest.
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.
Abstract The pediatric intensive care unit (PICU) is a high-tech setting aimed at restoring health to critically ill children. When childhood death occurs in the PICU, it constitutes special context for parent bereavement. purpose of this interdisciplinary qualitative research was gain deeper understanding parents' needs around time their child's PICU. Through interviews and focus groups with bereaved parents hospital chaplains, categories emerged. Deeper will allow professionals better...
The aim of this study was to evaluate the relative frequency pediatric in-hospital cardiopulmonary resuscitation events occurring in ICUs compared general wards. We hypothesized that proportion provided versus wards has increased over past decade, and shift is associated with improved outcomes.Prospective observational study.Total 315 hospitals American Heart Association's Get With Guidelines-Resuscitation database.Total 5,870 between January 1, 2000 September 14, 2010. Cardiopulmonary were...
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...
Pertussis persists in the United States despite high immunization rates. This report characterizes presentation and acute course of critical pertussis by quantifying demographic data, laboratory findings, clinical complications, care therapies among children requiring admission to PICU.Prospective cohort study.Eight PICUs comprising Eunice Kennedy Shriver National Institute for Child Health Human Development Collaborative Pediatric Critical Care Research Network 17 additional across...