Critical Care Commons^™

Leveraging Administrative Health Data To Capture Rare Adverse Drug Reactions: Identifying Pediatric Patients With Trimethoprim-Sulfamethoxazole Acute Respiratory Distress Syndrome., Keith Feldman, Jenna Miller, Katherine Doane, Laura Loftis, James W. Antoon, Kevin J. Downes, Jennifer Goldman

Manuscripts, Articles, Book Chapters and Other Papers

Rare adverse drug reactions (ADRs) are underrecognized and underreported in the electronic medical record (EMR). These events often require clinical review, making systematic identification challenging. The study aim was to develop an approach to prioritize identification and validation of a rare ADR to trimethoprim-sulfamethoxazole causing acute respiratory distress syndrome (TMP-SMX ARDS) across medical institutions. We developed a clinical phenotype based on 2 local TMP-SMX ARDS cases mapped to standardized elements of a national comparative healthcare database (PHIS). We validated identification of TMP-SMX ARDS at scale across medical institutions. A set of scoring criteria was created to prioritize cases and generate …

State And Regional Variation In Access To Pediatric Extracorporeal Membrane Oxygenation., Allan M. Joseph, Andrew J. Lautz, Carlie N. Myers, Ranjit S. Chima, Juan P. Gurria, Shafee Salloum, Wendy Hasson, Matthew P. Malone, Jenna Miller, Reanna Smith, Maya L. Dewan

Manuscripts, Articles, Book Chapters and Other Papers

Extracorporeal membrane oxygenation (ECMO) is only available in specialized medical centers. We conducted a geospatial analysis and found state- and region-level variation in the supply of ECMO centers, and the number of children who had access to ECMO. These findings may help target areas for the development of new ECMO programs.

Clinical And Non-Clinical Factors Associated With Early Discharge In Pediatric Non-Trauma Patients Transported By Rotor Wing, Jordon Mitzelfelt, Lisa Pruitt, Amy Papa, Ashley K. Sherman, David Juang, Sarah Brunner, Asdis Finnsdottir Wagner, Jennifer Flint

Posters

Objective: Helicopter emergency medical services (HEMS) are crucial for transporting critically ill children to definitive care, however, rising costs and relative risks of this type of transportation necessitate careful evaluation of potential over-utilization. Current literature primarily focuses on pediatric trauma patients, leaving a significant gap in data regarding non-trauma pediatric HEMS transports and the influence of non-clinical factors such as referral hospital distance, resources, and capabilities on transport decisions. This study aims to address these gaps by examining non-trauma pediatric HEMS patients and identifying associated clinical and non-clinical factors related to early hospital discharge (< 24 hours). Methods: This retrospective, single-center study includes pediatric patients with medical and non-trauma surgical diagnoses transported by HEMS between April 1, 2021 and March 31, 2024. Clinical data were extracted from transport team records and the hospital’s electronic health records. Analyses were performed to identify factors associated with discharge within 24 hours of admission. To identify predictors of early discharge, we analyzed clinical factors including chief complaint, pre-transport vascular access, transport crew interventions (medication administration and procedures), respiratory assistance, and Pediatric Age-Adjusted Shock Index (SIPA) scores. Additionally, we examined the impact of the initial admit unit, and medical support required within the first 24 hours of hospitalization. Non-clinical predictors included the referring hospital’s status (critical access and/or rural designation) and the time of transport. Results: A total of 568 patients were transported by HEMS, of whom 88 (15%) were discharged within 24 hours. Patients in the early discharge group were more likely to present with neurologic chief complaints (40%), whereas those remaining hospitalized beyond 24 hours more frequently presented with respiratory complaints (40%). Normal SIPA scores both prior to and at the conclusion of transport were significantly associated with early discharge (p=0.012 and p=0.011, respectively). Furthermore, patients requiring no medications or respiratory assistance during transport, or no respiratory support within the first 24 hours of admission, were significantly more likely to be discharged early (p< 0.001). Notably, all patients with central access prior to transport remained admitted for more than 24 hours (p=0.004). Regarding non-clinical factors, patients transported from designated rural hospitals were more likely to experience early discharge (p< 0.001). Conclusion: These results characterize the pediatric non-trauma HEMS population and identify key predictors of early hospital discharge. This data is essential for developing standardized dispatch criteria to mitigate over-utilization and ensure high-acuity transport is reserved for the most appropriate patients.

Eeg Features And Rotterdam Head Ct Score Predict Early Favorable Outcome In Pediatric Severe Tbi, Xuexin Lu

Presentations

INTRODUCTION Accurate prognostication after pediatric severe TBI (sTBI) remains challenging. We examined the utility of continuous EEG (cEEG) and Rotterdam head CT score in predicting short-term favorable outcome. METHODS 7-yr (01/2018-12/2024) retrospective study of children aged 1.5-18 yrs admitted to our PICU with sTBI and receiving cEEG monitoring per institutional protocol. Early favorable outcome was defined as Pediatric Cerebral Performance Category scale 1-3 at PICU discharge. cEEG features (background, sleep architecture, reactivity, and seizure) during the 1st 12-hrs of monitoring and initial Rotterdam head CT scores were recorded. Demographics, GCS score, pupillary reactivity, injury severity score (ISS), clinical seizure, cardiac …

Geographic Access To Pediatric Ecmo And Ecpr: A Geospatial Study Of Transport Networks And Disparities., Allan M. Joseph, Andrew J. Lautz, Carlie N. Myers, Ranjit S. Chima, Juan P. Gurria, Shafee Salloum, Wendy Hasson, Matthew P. Malone, Jenna Miller, Maya L. Dewan

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND AND AIM: Extracorporeal membrane oxygenation (ECMO) can help children survive severe cardiac and/or respiratory failure, but it is only provided in specialized centers. There are disparities in access by ground transport to ECMO services, but it is unknown to what extent interfacility transfer systems can expand access. Additionally, the number of children who live in proximity to centers that perform extracorporeal cardiopulmonary resuscitation (ECPR) to be potential candidates in case of out-of-hospital cardiac arrest (OHCA) is unknown. We conducted a geospatial analysis to answer these questions.

METHODS: We conducted a geospatial analysis of the Extracorporeal Life Support Organization (ELSO) …

Adult Out Of Hospital Cardiac Arrest Criteria For Extracorporeal Cardiopulmonary Resuscitation Activation May Not Be The Same For Pediatric Out Of Hospital Cardiac Arrest, Lindsay Fick, Sherouk A. Abdelmoity, Jennifer Flint, Ashley Sherman, Jenna Miller

Presentations

Pediatric out-of-hospital cardiac arrest (OHCA) remains a high-mortality event, with survival to discharge consistently below 10%. Although extracorporeal cardiopulmonary resuscitation (E-CPR) improves outcomes for in-hospital cardiac arrest, its application in the pre-hospital environment is not well defined for pediatrics. Identifying which pediatric patients might benefit from OHCA ECPR activation is essential for developing feasible pre hospital pediatric E-CPR systems. Preliminary analysis of applying  criteria for adult OHCA ECPR activation can provide a crucial next step in establishing feasibility and applicability for the pediatric patient population.

Methods

A single center retrospective review was conducted of pediatric OHCA cases presenting from 2018–2025. …

Blood Product Transfusion And Coagulopathy In Children With Traumatic Brain Injury: A Narrative Review., Robert Marcel T. Huibonhoa, Niranjan Vijayakumar, Daniel Kelly, Oliver Karam, Madhuradhar Chegondi

Manuscripts, Articles, Book Chapters and Other Papers

Traumatic brain injury (TBI) is a leading cause of critical illness and mortality in children. Transfusion of blood products, a common intervention in the management of pediatric TBI, has important implications for related principles, including trauma-induced coagulopathy, cerebral perfusion, and cerebral oxygen delivery. Knowledge gaps persist due to the limited availability of pediatric-specific data regarding blood product transfusion in TBI. In particular, there is a lack of prospective studies defining appropriate specific laboratory thresholds and transfusion targets, as well as insufficient evidence to guide the weighing of potential benefits against transfusion-related risks in this population. Although blood product transfusion in …

Perioperative Nutrition In Pediatric Patients With Congenital Heart Disease And Heart Failure., Jaime Silva-Gburek, Kelsey May, Bailey Walvoord, Catalina Lozano, Jorge A. Coss-Bu

Manuscripts, Articles, Book Chapters and Other Papers

Optimal nutritional therapy is important for infants and children with perioperative congenital heart disease and heart failure. Medical providers face physiological and metabolic challenges when administering enteral and parenteral nutrition to these patients. Complications related to enteral nutrition can increase morbidity and mortality, although outcomes are improved in those cases in which caloric and nutrient administration can be achieved. Consensus regarding feeding strategies and timing of nutritive care is lacking. This narrative review aims to summarize, analyze and discuss the most recent literature on nutritional therapy in perioperative congenital heart disease, heart failure and pediatric patients requiring mechanical circulatory support …

Ultra-Low-Field Portable Magnetic Resonance Imaging Feasibility And Safety In Pediatric And Neonatal Extracorporeal Membrane Oxygenation: A Single-Center Year-Long Experience., Jessica S. Wallisch, Asdis Finnsdottir Wagner, John M. Daniel Iv, Allison Taber, Maura Sien, Sarah Foster, Nathan S. Artz, Timothy Zinkus, Hung-Wen Yeh, Jose A. Pineda, Patrick M. Kochanek, Sherwin S. Chan

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Despite improving outcomes, extracorporeal membrane oxygenation (ECMO) remains associated with high rates of acute brain injury, impacting survival and outcomes. Clinical imaging modalities, including computed tomography and standard-field magnetic resonance imaging (≥1.5 Tesla), have either limited early detection of ischemic-type injuries or are incompatible with ECMO, causing diagnostic delays. A Food and Drug Administration-cleared ultra-low-field portable magnetic resonance imaging (pMRI; 0.064 Tesla) has shown promise in acute brain injury detection and use with MRI-unsafe equipment, but pediatric ECMO data are limited.

METHODS: This institutional review board-approved, single-center study was conducted at a quaternary children's hospital. Neonatal and pediatric patients …

Discontinuous Or Attenuated Background, Absent Sleep Architecture, Absent Reactivity, And Presence Of Subclinical Seizures On Continuous Electroencephalography Are Associated With Unfavorable Short-Term Outcome Following Pediatric Severe Traumatic Brain Injury​, Xuexin Lu, Ara Hall, Yong Y. Han, Madeline Burdick, Avner Moeded, Isabella Boedefeld, Christian Kaufman, Jessica S. Wallisch

Presentations

BACKGROUND/PURPOSE: Accurate prognostication following pediatric severe traumatic brain injury (sTBI) remains challenging. Adult neuroprognostication guidelines recommend the use of prediction models that have not yet been validated in pediatric patients. We hypothesized certain continuous electroencephalography (cEEG) characteristics would be associated with unfavorable short-term outcome. METHODS: This was an IRB-approved, 7-year retrospective cohort study of children aged 1.5-18 years admitted to our PICU from 01/2018-12/2024 with sTBI and receiving cEEG monitoring per institutional standard management protocol. cEEG patterns (background, sleep architecture, reactivity, and electrographic seizure) during the first 12-hours of monitoring were analyzed for association with unfavorable short-term outcome at PICU …

Successful Va Ecmo On An Adolescent Pre-B Cell Acute Lymphoblastic Leukemia Patient With Necrotizing Fasciitis From Clostridium Septicum, Jenna Miller, Johanna I. Orrick, Cara Holton, David Juang

Manuscripts, Articles, Book Chapters and Other Papers

Extracorporeal membrane oxygenation (ECMO) has historically been avoided in oncological patients due to perceived risks. However, recent literature suggests improved survival rates for pediatric oncology patients. Additionally, necrotizing fasciitis from Clostridium septicum is associated with high morbidity and mortality, especially in patients with preexisting malignancies. Few studies have explored the outcomes of ECMO in patients with both necrotizing fasciitis and hematologic malignancies. We present a case of a 16-year-old male with pre-B cell acute lymphoblastic leukemia (ALL) and Clostridium septicum necrotizing fasciitis successfully supported with veno-arterial (VA) ECMO. The patient underwent induction chemotherapy for ALL but developed severe septic shock …

Exploring Anticoagulation Trends As Early Infection Markers In Pediatric Ecmo And Crrt Patients, Samantha Davidson, Jay Rilinger, Jenna Miller, Caroline Holton, Joshua Herigon, Brian Lee

Research Days

This retrospective cohort study at a tertiary pediatric hospital included ICU patients who developed infections after 72 hours on extracorporeal support from 2017-2023. We assessed whether the number of anticoagulation dose changes are linked to acquired infections.

Ecmo Without Compressions Versus Ecpr For Lcos Following Cardiac Surgery, Amjad Halloum, Apurva Panchal, Sarah Tabbutt, Martina Steurer, Mousumi Banerjee, John Charpie, Javi Lasa, Amy Mccammond, Katie Moynihan, Nancy Ghanayem, Tia Raymond

Research Days

A retrospective study looking into ECMO vs eCPR outcomes in the CICU. By refining the approach to postoperative ECMO initiation, this study aims to contribute valuable insights that could improve survival and reduce complications in pediatric cardiac surgery patients.

Respiratory Failure In Pediatric Hematology And Oncology Patients On Extracorporeal Membrane Oxygenation: A Comparative Analysis, Michelle Brown Do, Jenna Miller, Asdis Finnsdottir Wagner, Erin Hall, Maya Dewan Md, Christopher Dandoy Md, Kalee Grassia Md, Bin Zhang Phd

Research Days

This project was a retrospective comparative analysis between two tertiary care pediatric institutions. The primary objective entailed examining survival outcomes in the oncologic and hematopoetic stem cell transplant patient populations with respiratory failure in the presence and absence of ECMO support.

Reducing Vancomycin In A Cicu, Karoline Krzywda, Lauren Johnson, Allison Taber

Posters

Introduction: In the cardiac intensive care unit (CICU) empiric vancomycin is frequently prescribed. This practice occurs without wide knowledge of the true rates of methicillin resistant staph aureus (MRSA) and methicillin resistant staph epidermidis (MRSE) infections. Given the potential for harmful side effects of vancomycin as well as concern for growing antibiotic resistance we sought to better characterize local unit prescribing practices and MRSA/MRSE infection rates to guide our quality improvement project with an aim of reducing vancomycin use in our CICU. Methods: This project is taking place at Children’s Mercy Kansas City CICU, a 24 bed unit with an …

Comparative Analysis Of Oxygenators And Anticoagulation Strategies In Neonatal And Pediatric Ecmo Patients, Debra E. Newton, Johanna I. Orrick

Presentations

Background: Due to supply chain challenges, our institution transitioned from Pediatric Quadrox oxygenators to Nautilus oxygenators for neonatal and pediatric extracorporeal membrane oxygenation (ECMO) patients. During this transition, variations in anticoagulation results were observed with bivalirudin, the first-line anticoagulant, in patients weighing less than 8 kg. This study aimed to evaluate heparin as an alternative anticoagulant in this patient population utilizing Nautilus oxygenators. Methods: A retrospective analysis was conducted on 29 neonatal and pediatric ECMO patients (weight range: 2.3–6.1 kg). Patients were divided into three groups based on oxygenator and anticoagulant type: · Group 1: Quadrox with bivalirudin (n=11) · …

The Role Of The Apheresis Tandem Safety Timeout In Ecmo And Apheresis Therapy, Johanna I. Orrick, Debra E. Newton, Kari L. Davidson, Karen Murray

Posters

The Apheresis Tandem Safety Timeout was implemented in 2017 at Children’s Mercy Hospital (CMH) to ensure safe, coordinated care when performing therapeutic plasma exchange (TPE) alongside Extracorporeal Membrane Oxygenation (ECMO). The first tandem procedure at CMH was performed in 2013, introducing a valuable tool for treating the sickest patients in the region. However, when patients are placed on two extracorporeal circuits simultaneously, the risk of complications increases significantly. These include electrolyte imbalances, anticoagulation challenges, hemodynamic instability, and the potential for either circuit to be compromised. The ECMO and Apheresis team recognized that even minor miscommunication could lead to life-threatening complications …

Development Of Mobility Scales For Infants And Children On Ecmo, Johanna I. Orrick, Debra E. Newton, Caroline Holton

Posters

Extracorporeal Membrane Oxygenation (ECMO) is a life-saving intervention commonly used in pediatric and neonatal intensive care; however, it presents unique challenges for maintaining patient mobility. Early mobility contributes to better long-term outcomes. Existing mobility scales by the Extracorporeal Life Support Organization (ELSO) are limited to patients aged 8 years and older, leaving a gap for younger populations. This study aimed to develop and validate mobility scales specifically for infants (< 2 years) and children aged 2-8 years undergoing ECMO therapy. Through a collaborative effort involving pediatric ECMO specialists, physicians, and critical care nurses, we adapted ELSO’s mobility criteria to be developmentally appropriate for these younger age groups. For infants, mobility benchmarks include passive and active limb movements, head control, and supported sitting. The criteria for children aged 2-8 is expanded to include sitting, supported standing, and age-appropriate gross motor activities. This scale provides graded levels of mobility that accommodate ECMO-specific safety considerations, allowing practitioners to chart interventions according to each child’s developmental and physiological capacity. The resulting scales are being pilot-tested at our large ECMO center, with data showing preliminary effectiveness at capturing the degree of mobility achieved during ECMO runs. This mobility scale fills a critical need by providing structured charting guidelines for mobilizing infants and young children on ECMO, promoting functional recovery and potential improvements in long-term developmental outcomes. Further studies are recommended to establish consistency across institutions and confirm the scale's impact on mobility outcomes in pediatric ECMO patients.

Ultralow-Field Mri Feasibility In Pediatric Ecmo Patients, Jessica S. Wallisch, Asdis Finnsdottir Wagner, Maura Sien, John M. Daniel Iv, Allison Taber, Nathan S. Artz, Sherwin S. Chan

Presentations

INTRODUCTION Extracorporeal membrane oxygenation (ECMO) is used to treat refractory cardiopulmonary failure. Survival has significantly improved, yet high rates of acute brain injury (ABI) in this population results in significant morbidity and mortality. Currently available imaging modalities [ultrasound (US), computed tomography (CT)] have low detection of early hypoxic-ischemic and cerebrovascular-type injuries, which delays the diagnosis of ABI while on ECMO. CT sensitivity increases only when it is too late to effectively intervene. High-field (>=1.5 Tesla) magnetic resonance imaging (MRI) is the gold standard to diagnose pediatric ischemic brain injury but is not compatible with ECMO. An ultralow-field (0.064 T) …

Ecmo In Pediatric Oncologic And Hsct Patients: A Descriptive And Comparative Analysis, Michelle Brown

Presentations

Introduction: Pediatric oncologic and hematopoietic stem cell transplant (HSCT) recipients are vulnerable to development of respiratory failure due to chemotherapy, radiation, surgery, and immunosuppression. Yet, providing extracorporeal membrane oxygenation (ECMO) support in these patient populations remains controversial with heterogenous utilization across pediatric institutions. The aim of this study is to characterize and compare outcomes in pediatric oncologic and HSCT patients with respiratory failure in the presence and absence of ECMO support. Methods: This study was a retrospective matched comparative analysis between two tertiary care pediatric institutions. Patients less than 18 years old with an underlying oncologic diagnosis and/or HSCT with …

Delirium On Admission To The Cicu, Spencer Wittmeyer, Jaime Silva-Gburek, Kelly S. Tieves

Research Days

Background: Delirium is increasingly recognized in the pediatric cardiac intensive care unit (CICU) with an incidence up to 67% and is associated with worse outcomes including increased mortality, prolonged hospitalization, and increased rates of intubation and mechanical circulatory support. The Cornell Assessment for Pediatric Delirium (CAPD) is the only validated tool for the diagnosis of delirium in the pediatric population. The CAPD may be limited in children with developmental disabilities as it does not account for baseline ability in scoring. Prior work has identified low specificity for the CAPD in children with developmental disabilities and those requiring mechanical ventilation. This …

Characterizing New Invasive Infections In Children’S Mercy Extracorporeal Membrane Oxygenation And And Continuous Renal Replacement Therapy Patients, Samantha M. Davidson, Jay F. Rilinger, Jenna O. Miller, Caroline Holten, Josh Herigon

Research Days

This abstract characterizes the patients at Children's Mercy who developed a new serious bacterial infection while on extracorporeal support.

Improving Nutritional Delivery To Pediatric Patients While Using Continuous Renal Replacement Therapy, Jennifer Ruiz-Boada, Sarah Brunner, Tara Benton, Vimal Chadha

Research Days

This quality improvement guide aims to enhance early nutritional delivery to pediatric patients with renal failure who require renal replacement therapy.ng renal replacement therapy.

Recurrent Diffuse Alveolar Hemorrhage And Extracorporeal Membrane Oxygenation Utilization In A Hematopoietic Stem Cell Transplant Patient With Hunter's Syndrome., Nasreen Noor, Gene Peir, Asdis Finnsdottir Wagner, Jay Rilinger, Jenna Miller

Manuscripts, Articles, Book Chapters and Other Papers

We describe the natural history of a three-month-old patient with Hunter Syndrome with hematopoietic stem cell transplant (HSCT) who developed recurrent diffuse alveolar hemorrhage (DAH) requiring extracorporeal membrane oxygenation (ECMO). The patient underwent HSCT with several complications, including veno-occlusive disease and DAH. He was managed with ECMO. Unfortunately, despite initial success he developed recurrent DAH and ultimately died. This is a novel report of this severe adverse event requiring ECMO following the use of HSCT in this rare patient population. We share the clinical strategies employed to address the complications associated with HSCT and the progression of his disease over …

Successful Hepatectomy, Anhepatic State, And Liver Transplant On Ecmo, Jenna Miller, Kari L. Davidson, Bhargava Mullapudi, Richard J. Hendrickson, Ryan T. Fischer, Lisa Conley, Wes Ware, Michelle Mckain, Tara Benton

Presentations

We discuss the case of a 13-month-old previously healthy male who presented with acute liver failure (ALF) of unknown etiology. He progressed to fulminant cardiopulmonary failure requiring mechanical ventilation and high dose inotropes with persistent lactate >20. He was cannulated to VA ECMO and tandem continuous renal replacement therapy (CRRT) with single pass albumin dialysis (SPAD) and plasma exchange (PLEX) therapies. He required high dose inotropes on ECMO and had persistently elevated lactate despite maximal medical therapy. Limited imaging studies suggested cirrhotic liver and possible intestinal pneumatosis. Due to evidence of fulminant ALF and potential for a reversible process, he …

Improving Nutritional Delivery To Pediatric Patients On Continuous Renal Replacement Therapy, Jennifer Ruiz-Boada, Sarah Brunner, Tara Benton, Vimal Chadha

Presentations

INTRODUCTION: Continuous renal replacement therapy (CRRT) is used in critically ill children with acute renal failure. CRRT can lead to malnutrition by removing essential proteins and micronutrients. Malnutrition is associated with worse outcomes, including increased length of stay and mortality. CRRT guidelines suggest the importance of early nutrition and ensuring high protein intake. After evaluating our CRRT patients, we found sub-optimal adherence to the guidelines. This Quality Improvement project aimed to increase the percentage of patients achieving 75% of their goal protein and caloric intake by day 5 of CRRT initiation by 15% by August 2023. METHODS: A multidisciplinary group …

Ecmo Clinical Practice Committee: Empowering The Frontline Staff, Michelle Mckain, Shayna Evans, Johanna I. Orrick, Kari L. Davidson

Posters

Background: Extracorporeal Membrane Oxygenation (ECMO) is a complex artificial life support for patients with severe respiratory and cardiac failure. Children’s Mercy was an early ECMO pioneer, establishing a program in 1987. Despite CM’s successful history, wide variations existed between regional management of ECMO (Schwartz et al., 2022). Studies show that patient outcomes, resources, staff satisfaction, and financial metrics improve with implementation of an interprofessional shared governance team (Olender et al., 2019; Schwartz et al., 2022). In 2016, the ECMO Clinical Practice Committee (ECP) was created, tasked with addressing projects aimed at ECMO process improvements. Methods: ECP members include Registered Nurses …

Delirium On Admission To The Cicu, Spencer Wittmeyer, Jaime Silva-Gburek, Kelly S. Tieves

Posters

Background: Delirium is increasingly recognized in the pediatric cardiac intensive care unit (CICU) with an incidence up to 67% and is associated with worse outcomes including increased mortality, prolonged hospitalization, and increased rates of intubation and mechanical circulatory support. The Cornell Assessment for Pediatric Delirium (CAPD) is the only validated tool for the diagnosis of delirium in the pediatric population. The CAPD may be limited in children with developmental disabilities as it does not account for baseline ability in scoring. Prior work has identified low specificity for the CAPD in children with developmental disabilities and those requiring mechanical ventilation. This …

Prognostic And Predictive Value Of Endothelial Dysfunction Biomarkers In Sepsis-Associated Acute Kidney Injury: Risk-Stratified Analysis From A Prospective Observational Cohort Of Pediatric Septic Shock., Mihir R. Atreya, Natalie Z. Cvijanovich, Julie C. Fitzgerald, Scott L. Weiss, Michael T. Bigham, Parag N. Jain, Adam J. Schwarz, Riad Lutfi, Jeffrey Nowak, Geoffrey L. Allen, Neal J. Thomas, Jocelyn R. Grunwell, Torrey Baines, Michael Quasney, Bereketeab Haileselassie, Matthew N. Alder, Stuart L. Goldstein, Natalja L. Stanski

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Sepsis-associated acute kidney injury (SA-AKI) is associated with high morbidity, with no current therapies available beyond continuous renal replacement therapy (CRRT). Systemic inflammation and endothelial dysfunction are key drivers of SA-AKI. We sought to measure differences between endothelial dysfunction markers among children with and without SA-AKI, test whether this association varied across inflammatory biomarker-based risk strata, and develop prediction models to identify those at highest risk of SA-AKI.

METHODS: Secondary analyses of prospective observational cohort of pediatric septic shock. Primary outcome of interest was the presence of ≥ Stage II KDIGO SA-AKI on day 3 based on serum creatinine …

Detrimental Effects Of Pcsk9 Loss-Of-Function In The Pediatric Host Response To Sepsis Are Mediated Through Independent Influence On Angiopoietin-1., Mihir R. Atreya, Natalie Z. Cvijanovich, Julie C. Fitzgerald, Scott L. Weiss, Michael T. Bigham, Parag N. Jain, Adam J. Schwarz, Riad Lutfi, Jeffrey Nowak, Geoffrey L. Allen, Neal J. Thomas, Jocelyn R. Grunwell, Torrey Baines, Michael Quasney, Bereketeab Haileselassie, Matthew N. Alder, Patrick Lahni, Scarlett Ripberger, Adesuwa Ekunwe, Kyle R. Campbell, Keith R. Walley, Stephen W. Standage

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Sepsis is associated with significant mortality. Yet, there are no efficacious therapies beyond antibiotics. PCSK9 loss-of-function (LOF) and inhibition, through enhanced low-density lipoprotein receptor (LDLR) mediated endotoxin clearance, holds promise as a potential therapeutic approach among adults. In contrast, we have previously demonstrated higher mortality in the juvenile host. Given the potential pleiotropic effects of PCSK9 on the endothelium, beyond canonical effects on serum lipoproteins, both of which may influence sepsis outcomes, we sought to test the influence of PCSK9 LOF genotype on endothelial dysfunction.

METHODS: Secondary analyses of a prospective observational cohort of pediatric septic shock. Genetic variants …