Speaker: Robert C.Tasker, MA, MBBS, MD, FRCP, FRCPCH
Robert C.Tasker, MA, MBBS, MD, FRCP, FRCPCH: Welcome, September 2023 and another great issue of Pediatric Critical Care Medicine. I'm Robert Tasker, your Editor-in-Chief and my Editor's Choices this month are about pediatric acute respiratory distress syndrome. It's been a hot topic this year. Sixteen papers so far and I thought I would focus on three more from this month. The first highlight is by Emeriaud and colleagues on noninvasive ventilation used in the PARDIE data set from 2016/2017. Out of those 708 patients, there are 160 who underwent noninvasive ventilation. Just to give you a bit of context, we had the PALICC-1 in 2015 where this was much debated, PALICC-2 in 2023 where there was still an ongoing debate, a systematic review and meta-analysis published earlier this year in PCCM and a concise physiology review on the topic. Do read the paper. There's an accompanying editorial which calls this analysis a game changer. My second article to do with PARDS is by Ardila and colleagues. They have looked at biomarker trajectory for nonpulmonary organ dysfunction in patients with ARDS. For this work, they use the BALI and the RESTORE data sets from 2009 to 2013, 350 patients with PARDS. They've looked at the trajectory of developing organ dysfunction along with inflammatory biomarkers. Very interesting stuff. I think for me, it brings to in context this inflammation shock parts continuum and I hope that there can be some connection with the dynamic modeling that we're hearing about in other pieces of work. The third article is by Cruces et al. This is about lung resistance in PARDS and this is a detailed study in 16 patients looking at plateau pressure and driving pressure in patients undergoing volume and pressure controlled ventilation and separating out frictional and viscoelastic components of lung resistance. For me, I think it's useful to have some detailed physiology with the epidemiology. Then in the PCCM Connections for readers, I focused on biomarker reviews. The first is about severity of illness and looking at the Lactate-Albumin ratio as a component variable rather than the individual sorry, a compound variable rather than the individual components and their relationship to outcomes. The second type of biomarker is a severity of oxygen exposure and looking at that relationship with outcomes in over 3,000 mechanically ventilated patients. For me, I think this speaks to the much anticipated Oxy-PICU study that we know is completed and we want to see the results of that. So, rather than just hearing about associations, let's see what difference actual oxygen targeting makes. Lastly, severity of ferritin level in Dengue, sepsis and outcomes. Again, an interesting study that ties back to work that we published last year in PCCM to do with ferritin and outcomes. Collectively, a very interesting month to read. Do enjoy and there's gonna be more on PARDS later this year. I think it's the topic of the year. Thank you very much for your attention. See you next month.
